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Copyright 2019 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-200-202
U M A N
H E S
D I S E A S
Fifth
Edition
s , E d D , RN
N e i g h bor
ne , RN
Marian l-Jon e s , M S
n n e h i l
Ruth Ta
Australia ● Brazil ● Singapore ● United Kingdom ● United States
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Printed in the United States of America

Print Number: 01 Print Year: 2017
To my husband, Larry Butler, who is now with the Lord, and my
son Jeremy Neighbors, his wife Misty, and my grandson Kieran. I love you
all very much. Marianne
To my husband, Jim, the quiet, solid, love of my life for over 40 years,
and to the other man in my life, my brother Bob Tannehill, who has always
loved and supported me, “his younger, little sister.” Ruth
Contents
List of Tables xiii Trauma 14

Preface xv Inflammation and Infection 15
Hyperplasias and Neoplasms 15
Reviewers xix
Hyperplasias 15
Neoplasms 15
Unit I
Nutritional Imbalance 16
CONCEPTS OF HUMAN DISEASE 1 Malnutrition 16
Obesity 17
CHAPTER 1 Vitamin or Mineral Excess or Deficiency 18
Impaired Immunity 18
Introduction to Human Diseases 3 Allergy 19
Disease, Disorder, and Syndrome 4 Autoimmunity 19
Disease 4 Immunodeficiency 19
Disorder 4 Aging 19
Syndrome 4 Death 20
Pathology 4 Cellular Injury 20
Pathogenesis 4 Cellular Adaptation 20
Etiology 5 Atrophy 20
Hypertrophy 21
Predisposing Factors 5 Hyperplasia 21
Age 6 Dysplasia 21
Sex 6 Metaplasia 21
Environment 6 Neoplasia 21
Lifestyle 7
Cell and Tissue Death 22
Heredity 7
Organism Death 22
Diagnosis 7
Summary 23
Prognosis 8
Review Questions 23
Acute Disease 8
Chronic Disease 8 Case Studies 24
Complication 8 Bibliography 24
Mortality Rate 8
Survival Rate 9 CHAPTER 3
Treatment 9 Neoplasms 27
Medical Ethics 9
Terminology Related to Neoplasms and
Summary 10 Tumors 28
Review Questions 11 Classification of Neoplasms 28
Case Studies 11 Appearance and Growth Pattern 28
Bibliography 12 Benign Neoplasm 28
Malignant Neoplasm 28
CHAPTER 2 Tissue of Origin 28
Mechanisms of Disease 13 Epithelial Tissue (Skin or Gland) 28
Connective Tissue (Bone, Muscle, or Fat) 29
Causes of Disease 14 Lymphatic or Blood-Forming Tissue 29
Heredity 14 Other Tissues 29
vi CONTENTS
Growth of Benign and Malignant Neoplasms 29 Physical or Surface Barriers (Nonspecific) 48

Benign Neoplasm Growth 30 Inflammation (Nonspecific) 48
Malignant Neoplasm Growth 30 Immune Response (Specific) 48
Hyperplasias and Neoplasms 31 Inflammation 49
Hyperplasias 31 The Inflammatory Process 49
Neoplasms 31 Chronic Inflammation 50
Inflammatory Exudates 51
Development of Malignant Neoplasms (Cancer) 32 Serous Exudate 51
Invasion by and Metastasis of Cancer 32 Fibrinous Exudate 51
Lymphatic System Metastasis 33 Purulent Exudate 51
Bloodstream Metastasis 33 Inflammatory Lesions 52
Cavity Metastasis 33 Abscesses 52
Grading and Staging of Cancer 33 Ulcer 52
Grading 33 Cellulitis 53
Staging 34 Tissue Repair and Healing 53
Causes of Cancer 34 Tissue Repair 53
Chemical Carcinogens 34 Regeneration 53
Hormones 35 Fibrous Connective Tissue Repair (Scar
Radiation 35 Formation) 53
Viruses 35 Tissue Healing 53
Genetic Predisposition 35 Primary Union (First Intention) 53
Personal Risk Behaviors 36 Secondary Union (Secondary Intention) 54
Smoking and Tobacco Product Use 36
Delayed Wound Healing 54
Diet 36
Complications of Wound Healing 55
Alcohol Use 36
Sexual Behavior 36 Infection 56
Cancer Prevention 37 Frequency and Types of Infection 56
Bacteria 57
Frequency of Cancer 38 Viruses 58
Diagnosis of Cancer 39 Fungi 59
Signs and Symptoms of Cancer 40 Rickettsiae 60
Pain 41 Protozoa 60
Obstruction 41 Helminths 60
Hemorrhage 41 Testing for Infection 61
Anemia 41 Summary 63
Fractures 41
Infection 41 Review Questions 63
Cachexia 42 Case Studies 64
Cancer Treatment 42 Bibliography 64
Surgery 42
Chemotherapy 42 Unit II
Radiation 42 COMMON DISEASES AND
Hormone Therapy 43
DISORDERS OF BODY SYSTEMS 67
Summary 43
Review Questions 43 CHAPTER 5
Case Studies 44
Bibliography 45 Immune System Diseases and
Disorders 69
CHAPTER 4
Anatomy and Physiology 70
Inflammation and Infection 47 Common Signs and Symptoms 71
Defense Mechanisms 48 Diagnostic Tests 71
CONTENTS vii
Common Diseases of the Immune System 72 Effects of Aging on the System 120
Hypersensitivity Disorders 73 Summary 121
Autoimmune Disorders 77 Review Questions 121
Isoimmune Disorders 84
Immune Deficiency Disorders 86 Case Studies 122
Bibliography 123
Trauma 89
Rare Diseases 89
Severe Combined Immunodeficiency Disease CHAPTER 7
(SCID) 89 Blood and Blood-Forming Organs
Effects of Aging on the Immune System 90 Diseases and Disorders 125
Summary 90
Review Questions 91
Common Signs and Symptoms 127
Case Studies 92
Diagnostic Tests 128
Bibliography 92
Common Diseases of the Blood and Blood-
Forming Organs 129
CHAPTER 6 Disorders of Red Blood Cells 130
Musculoskeletal System Diseases Disorders of White Blood Cells 135
Disorders of Platelets 138
and Disorders 95
Trauma 139
Rare Diseases 139
Thalassemia 139
Diagnostic Tests 98 Von Willebrand’s Disease 139
Common Diseases of the Musculoskeletal Lymphosarcoma 139
System 99 Effects of Aging on the System 139
Diseases of the Bone 99 Summary 140
Diseases of the Joints 104
Diseases of the Muscles and Connective Tissue 108 Review Questions 140
Neoplasms 109 Case Studies 142
Trauma 109 Bibliography 143
Fracture 110
Types of Fractures 110 CHAPTER 8
Treatment of Fractures 110
Complications of Fractures 112 Cardiovascular System Diseases and
Strains and Sprains 113 Disorders 145
Dislocations and Subluxations 114 Anatomy and Physiology 146
Low Back Pain (LBP) 114
Herniated Nucleus Pulposus (HNP) 114 Common Signs and Symptoms 148
Bursitis 116 Diagnostic Tests 150
Tendonitis 117 Common Diseases of the Cardiovascular System 152
Carpal Tunnel Syndrome 117 Diseases of the Arteries 152
Plantar Fasciitis 118 Diseases of the Heart 161
Torn Rotator Cuff 118 Diseases of the Veins 168
Torn Meniscus 118
Cruciate Ligament Tears 119 Trauma 170
Shin Splints 119 Hemorrhage 170
Shock 171
Rare Diseases 120
de Quervain’s Disease 120 Rare Diseases 172
Tuberculosis of the Bone 120 Malignant Hypertension 172
Paget’s Disease 120 Cor Pulmonale 172
Myasthenia Gravis 120 Raynaud’s Disease 172
viii CONTENTS
Buerger’s Disease 172 Rare Diseases 214

Polyarteritis Nodosa 172 Kawasaki Disease 214
Effects of Aging on the System 172 Effects of Aging on the System 214
Summary 173 Summary 215
Review Questions 173 Review Questions 215
Case Studies 176 Case Studies 215
Bibliography 176 Bibliography 216
CHAPTER 9 CHAPTER 11
Respiratory System Diseases and Digestive System Diseases and
Disorders 179 Disorders 217
Anatomy and Physiology 180 Anatomy and Physiology 218
Common Signs and Symptoms 181 Common Signs and Symptoms 219
Diagnostic Tests 183 Diagnostic Tests 220
Common Diseases of the Respiratory System 183 Common Diseases of the Digestive System 223
Diseases of the Upper Respiratory Tract 184 Diseases of the Mouth 223
Diseases of the Bronchi and Lungs 187 Diseases of the Throat and Esophagus 225
Diseases of the Pleura and Chest 197 Diseases of the Stomach 228
Diseases of the Cardiovascular and Respiratory Diseases of the Small Intestine 230
Systems 200 Diseases of the Colon 234
Trauma 202 Diseases of the Rectum 242
Pneumothorax and Hemothorax 202 Trauma 243
Suffocation 202 Trauma to the Mouth 243
Rare Diseases 202 Trauma to the Stomach and Intestines 243
Pneumoconioses 202 Rare Diseases 243
Fungal Diseases 203 Achalasia 243
Legionnaires’ Disease 204 Gluten-Induced Enteropathy 243
Effects of Aging on the System 204 Intestinal Polyps 243
Summary 204 Effects of Aging on the System 244
Review Questions 204 Summary 244
Case Studies 205 Review Questions 244
Bibliography 206 Case Studies 245
Bibliography 246
CHAPTER 10
CHAPTER 12
Lymphatic System Diseases and
Disorders 209 Liver, Gallbladder, and Pancreatic
Anatomy and Physiology 210 Diseases and Disorders 249
Common Signs and Symptoms 211 Anatomy and Physiology 250
Diagnostic Tests 211 Common Signs and Symptoms 251
Common Diseases of the Lymphatic System 211 Diagnostic Tests 251
Lymphadenitis 211 Common Diseases of the Accessory Organs
Lymphangitis 212 of Digestion 251
Lymphedema 212 Liver Diseases 251
Lymphoma 214 Gallbladder Diseases 259
Mononucleosis 214 Pancreatic Diseases 261
CONTENTS ix
Rare Diseases 263 Trauma 313

Primary Biliary Cirrhosis 263 Rare Diseases 313
Gilbert’s Syndrome 263 Effects of Aging on the System 313
Hemochromatosis 263
Summary 313
Effects of Aging on the System 263
Review Questions 314
Summary 264
Case Studies 315
Bibliography 316
Case Studies 266
Bibliography 266 CHAPTER 15
CHAPTER 13 Nervous System Diseases and
Urinary System Diseases and Disorders 319
Disorders 269 Anatomy and Physiology 320
The Central Nervous System 320
The Peripheral Nervous System 322
Common Diseases of the Urinary System 272
Common Diseases of the Nervous System 324
Urinary Tract Infection (UTI) 274
Infectious Diseases 325
Diseases of the Kidney 277
Vascular Disorders 328
Diseases of the Bladder 284
Functional Disorders 330
Trauma 287 Dementias 335
Straddle Injuries 287 Sleep Disorders 338
Neurogenic Bladder 287 Tumors 340
Rare Diseases 288 Trauma 340
Goodpasture Syndrome 288 Concussions and Contusions 340
Interstitial Cystitis 288 Skull Fractures 341
Effects of Aging on the System 288 Epidural and Subdural Hematomas 342
Spinal Cord Injury: Quadriplegia and Paraplegia 343
Summary 289
Review Questions 289 Rare Diseases 344
Amyotrophic Lateral Sclerosis 344
Case Studies 290
Guillain–Barré Syndrome 346
Bibliography 291 Huntington’s Disease 346
Multiple Sclerosis 346
CHAPTER 14 Effects of Aging on the System 346
Endocrine System Diseases and Summary 347
Disorders 293 Review Questions 347
Anatomy and Physiology 294 Case Studies 348
Common Signs and Symptoms 297 Bibliography 349
Common Diseases of the Endocrine System 298 CHAPTER 16
Pituitary Gland Diseases 298 Eye and Ear Diseases and
Thyroid Gland Diseases 300
Parathyroid Gland Diseases 303
Disorders 351
Adrenal Gland Diseases 304 Anatomy and Physiology 352
Pancreatic Islets of Langerhans Diseases 306 Eye 352
Reproductive Gland Diseases 312 Ear 353
x CONTENTS
Common Signs and Symptoms 354 Sexually Transmitted Diseases 409

Diagnostic Tests 355 Sexual Dysfunction 415
Diagnostic Tests of the Eye 355 Trauma 418
Diagnostic Tests of the Ear 356 Rape 418
Common Diseases of the Eye 356 Rare Diseases 418
Refractive Errors 357 Vaginal Cancer 418
Inflammation and Infection 359 Puerperal Sepsis 418
Cataract 361 Hydatidiform Mole 419
Glaucoma 362
Nystagmus 363 Effects of Aging on the System 419
Strabismus 363 Summary 419
Macular Degeneration 364 Review Questions 420
Diabetic Retinopathy 364
Color Blindness or Color Vision Deficiency 365 Case Studies 421
Bibliography 421
Common Diseases of the Ear 365
Infection 365
Deafness 369 CHAPTER 18
Motion Sickness 372
Integumentary System Diseases
Trauma 373
and Disorders 425
Corneal Abrasion 373
Retinal Detachment 373 Anatomy and Physiology 426
Ruptured Tympanic Membrane 373 Common Signs and Symptoms 427
Rare Diseases 374 Diagnostic Tests 427
Retinoblastoma 374 Common Diseases of the Integumentary
Ménière’s Disease 374 System 429
Otitis Interna 374
Infectious Diseases 430
Effects of Aging on the System 374 Metabolic Diseases 441
Summary 376 Hypersensitivity or Immune Diseases 443
Idiopathic Diseases 445
Benign Tumors 446
Case Studies 377 Premalignant and Malignant Tumors 449
Bibliography 378 Abnormal Pigmented Lesions 451
Diseases of the Nails 452
Diseases of the Hair 453
CHAPTER 17 Trauma 454
Mechanical Skin Injury 454
Reproductive System Diseases and Thermal Skin Injury 455
Disorders 381 Electrical Injury 458
Anatomy and Physiology 382 Radiation Injury 458
Pressure Injury 458
Female Anatomy and Physiology 382
Insect and Spider Bites and Stings 459
Male Anatomy and Physiology 383
Rare Diseases 461
Elephantiasis 461
Effects of Aging on the System 462
Common Diseases of the Reproductive System 387 Summary 462
Female Reproductive System Diseases 387
Diseases of the Breast 399
Disorders of Pregnancy 401 Case Studies 464
Male Reproductive System Diseases 405 Bibliography 464
CONTENTS xi
Croup 509
Unit III Adenoid Hyperplasia 510
GENETIC AND DEVELOPMENTAL, Asthma 510
CHILDHOOD, AND MENTAL Pneumonia 511
HEALTH DISEASES AND Digestive Diseases 511

Fluid Imbalances 511
DISORDERS 467 Food Allergies 512
Eating Disorders 512
CHAPTER 19 Cardiovascular Diseases 513
Genetic and Developmental Diseases Musculoskeletal Diseases 513
and Disorders 469 Legg–Calvé–Perthes Disease 513
Ewing’s Sarcoma 513
Blood Diseases 514
Leukemia 514
Neurologic Diseases 514
Common Genetic and Developmental Disorders 475
Reye’s Syndrome 514
Musculoskeletal 475
Neurologic 477 Eye and Ear Diseases 515
Cardiovascular 481 Strabismus 515
Blood 483 Deafness 515
Digestive 484 Trauma 516
Urinary 487 Child Abuse 516
Reproductive 488 Suicide 516
Other Developmental Disorders 489 Drug Abuse 517
Multisystem Diseases and Disorders 490 Poisoning 517
Trauma 491 Summary 520
Failure to Thrive 491 Review Questions 520
Fetal Alcohol Syndrome 491
Congenital Rubella Syndrome 491 Case Studies 521
Rare Diseases 492 Bibliography 522
Anencephaly 492
Achondroplasia 492 CHAPTER 21
Tay–Sachs Disease 492
Summary 492
Mental Health Diseases and Disorders 525
Review Questions 492 Common Signs and Symptoms 526
Case Studies 494 Diagnostic Tests 526
Bibliography 495 Common Mental Health Diseases and
Disorders 526
CHAPTER 20 Developmental Mental Health Disorders 526
Substance-Related Mental Disorders 530
Childhood Diseases and Disorders 497 Organic Mental Disorders 537
Infectious Diseases 498 Psychosis 539
Mood or Affective Disorders 540
Viral Diseases 498
Dissociative Disorders 543
Bacterial Diseases 503
Anxiety Disorders 543
Fungal Diseases 505
Somatoform Disorders 545
Parasitic Diseases 506
Personality Disorders 546
Respiratory Diseases 509 Gender Identity Disorder 547
Sudden Unexpected Infant Death (SUID) and Sexual Disorders 547
Sudden Infant Death Syndrome (SIDS) 509 Sleep Disorders 548
xii CONTENTS
Trauma 549 APPENDIX A:

Grief 549 Common Laboratory Values 555
Suicide 549
Rare Diseases 550 APPENDIX B:
Mental Health Disorders in the Older Adult 550 Metric Conversion Tables 557
Summary 550
GLOSSARY 559
Case Studies 552 INDEX 575
Bibliography 552
List of Tables
CHAPTER 1 CHAPTER 6
1–1 Types of Pathologists 4 6–1 Classification of Joints by Movement 97
1–2 xamples of Acute and Chronic Diseases/
E 6–2 Risk Factors for Osteoporosis 103
Disorders 5 6–3 Risk Factors for Osteoarthritis 105
1–3 Examples of Common Diagnostic Tests and
Procedures 8 CHAPTER 7
7–1 RBC Blood Donor and Recipient Chart 127
CHAPTER 2
7–2 lood Cell Abnormalities and Associated
B
2–1 Classification of Hereditary Disease with Symptoms 128
Examples 14
7–3 CBC Normal Values 128
2–2 Examples of Neoplasms or Tumors 16
CHAPTER 13
CHAPTER 3
13–1 Urinalysis Values 271
3–1 Neoplasm vs. Nonneoplasm 28
3–2 Origins and Names for Benign and CHAPTER 14
Malignant Neoplasms 29 14–1 The Endocrine Glands: Their Hormones
3–3 Comparison of Benign and Malignant and Hormone Functions 295
Neoplasms 31 14–2 Emergency Treatment of Diabetic Coma
3–4 Comparison of Carcinomas and Sarcomas 33 or Insulin Shock 310
3–5 L ifetime Risk of Being Diagnosed with
Cancer—Both Sexes, All Races 39 CHAPTER 15
3–6 L ifetime Risk of Dying from Cancer—Both 15–1 The Cranial Nerves 322
Sexes, All Races 39
CHAPTER 21
CHAPTER 4 21–1 Genetic and Acquired Causes of
4–1 ome of the Leading Causes of Death
S Intellectual Disability 527
in the World Due to Infections 56 21–2 Physical Causes of Dementia and Delirium 537
4–2 Some Common Infections Caused by 21–3 Phobias 544
Microorganisms in Humans 57
21–4 Dr. Elisabeth Kübler-Ross’s Five Stages
of Grief/Death and Dying 549
CHAPTER 5
5–1 Types and Functions of Leukocytes 70
5–2 Types of Immunity 71
xiii
Preface
A
s the medical field has undergone an explosion and needs of the student. At the same time, informa-
in new techniques and therapies, there has been tion on each disease is written in such a way that it can
a matching explosion in the need for techni- stand alone or be viewed as all inclusive. This concept
cians, patient care providers, and general health care allows the instructor, student, or individual to select
professionals to support this growth. These new and and study only those specific diseases or individual
developing careers, which include nurses, medical assis- disease of interest. Not all health conditions are cov-
tants, nursing assistants, surgical technologists, respi- ered in the text, so the conditions chosen to be included
ratory therapy assistants, physical therapy assistants, are those that are most common, along with the new
radiographic technologists, medical transcriptionists, and emerging diseases. A few rare conditions are also
medical office assistants, and emergency medical tech- included. Of the conditions chosen for the text, only
nicians, to name only a few, assist and support physi- general information is covered. The text is designed to
cians in a variety of health care settings. be a basic overview of common diseases and disorders,
not an in-depth study. Thus, the diseases presented are
APPROACH not described on a cellular physiological level, which
would be too complex for the intended audience. The
Many pathophysiology books have been written to intention also was to keep the reading level of the text
address the informational needs of the medical commu- at an easy-to-read basic level to promote understanding.
nity, but few basic disease textbooks exist for the benefit We did not want to write beneath the level of the stu-
of the health care professional, especially those in allied dent but, at the same time, felt that a difficult reading
health care disciplines. This book has been designed level would only increase the complexity of the material
and written specifically for this group. It is intended to and thus fail to promote understanding of the subject
meet the needs of the student in the classroom as well as matter.
serve as a valuable resource for health care profession- The boxed features within the chapters either add
als on the job. In addition, this text may be used as a interesting information about staying healthy, present
resource on basic diseases by anyone within the medical new research on the chapter topics, or present infor-
arena or lay community. Current information for this mation about alternative treatments. The pharmacol-
book was based on the authors’ own experiences and ogy boxed features list some of the possible medications
research sought from current literature, books, Internet for disorders in the chapter. These drugs are listed with
resources, and physician consultations. Students will generic names only since there are many trade names
understand this text best if a basic medical terminology for the same generic medication. It is not intended to
or anatomy and physiology course has been completed be an exhaustive list of possible medications, but just to
before this course of study. give the reader some information about common med-
Several dilemmas immediately emerge when one ications that might be prescribed for certain disorders
considers writing a textbook for such a large and diverse reviewed in the chapter. The “Consider This” feature
audience as the health care field. Questions arise as to presents interesting facts.
how much content to include, what to exclude, how
detailed the content should be, and how to organize the ORGANIZATION OF THE TEXT
content in the most understandable manner. Another
common concern is the question of the appropriate Human Diseases, Fifth Edition, consists of 21 chapters
reading level. organized into three units. Unit I (Chapters 1 through
In an attempt to resolve these dilemmas, it was 4) lays the foundation for some basic disease concepts,
decided to organize the book in such a way that blocks including mechanisms of disease, neoplasms, inflam-
of material or even entire chapters could be omitted or mation, and infection. Unit II (C hapters 5 t hrough
covered in detail, depending on the format of the class 18) is organized by body systems, and opens with a
xv
xvi PREFACE
basic Anatomy and Physiology review of each system ■■ Bibliographies have been updated to include the
before discussing that system’s Common Diseases most up-to-date references to information used in
and Disorders. Included with this discussion, where each chapter.
appropriate, are Common Signs and Symptoms,
Diagnostic Tests, Trauma, and Rare Diseases. In addi-
tion, a unique section toward the end of each chap-
LEARNING RESOURCES
ter discusses the Effects of Aging on each system to WORKBOOK
help learners understand the natural aging process of
the human body. Unit III (Chapters 19 through 21) ISBN 978-1-3373-9680-6
includes specialty areas covering genetics, childhood The workbook offers additional practice with exer-
diseases, and mental health disorders. Each disease cises corresponding to each chapter in the book, includ-
in Units II and III is broken down (where applica- ing multiple choice, fill-in-the-blank, true/false, short
ble) into the following sections: Description, Etiology, answer, and matching questions.
Symptoms, Diagnosis, Treatment, and Prevention.
Although this may appear to be very title-heavy when ONLINE RESOURCES
there is only a sentence or two in each section, this
breakdown will assist the reader to clearly identify A student companion website is available to accom-
these components of each disease. It also maintains pany the text that includes slide presentations created in
consistency throughout the textbook. Microsoft PowerPoint, and anatomy, physiology, and
pathophysiology animations.
To access the student companion website:
1. Go to http://www.CengageBrain.com.
CHANGES TO THE FITTH 2. Register as a new user or log in as an existing user if
EDITION you already have an account with Cengage Learning
or CengageBrain.com.
Changes to the fifth edition include:
3. Select Go to MY Account.
■■ Some new “Glimpse of the Future” boxes, which
4. Open the product from the My Account page.
detail cutting-edge information or treatments, have
been added to the existing content.
■■ “Complementary and Alternative Therapy” boxes, MINDTAP
which discuss herbal and other nontraditional treat-
MindTap is a fully online, interactive learning experi-
ments, have been updated with new content.
ence built upon authoritative Cengage Learning con-
■■ Some new “Consider This” comments have been tent. By combining readings, multimedia, activities,
added to enlighten and entertain the reader. and assessments into a singular learning path, MindTap
■■ Several new “Healthy Highlight” boxes have been elevates learning by providing real-world application to
added. better engage students. Instructors customize the learn-
■■ More illustrations have been replaced with color ing path by selecting Cengage Learning resources and
photographs to enhance understanding of the dis- adding their own content via apps that integrate into
eases and disorders presented in the text. the MindTap framework seamlessly with many learning
management systems.
■■ Disease statistics have been updated to reflect the To learn more, visit www.cengage.com/mindtap
latest statistics available.
New diagnostic tests have been added.
INSTRUCTOR RESOURCES
■■
■■ Non-Alcoholic Fatty Liver Disease (NAFLD) is

added in chapter 12. Comprehensive instructor tools are designed to assist
■■ Respiratory Syncytial Virus (RSV) is added in you in teaching the content.
chapter 20. ■■ The Instructor’s Manual includes a s ample course
■■ Fifth Disease is added in Chapter 20. syllabus and outline as a guide for setting up a course.
PREFACE xvii
Additional materials for each chapter include detailed nurse, head nurse, and nursing supervisor. Her other
content outlines, learning objectives, expanded chap- nursing experience includes assisting orthopedic sur-
ter summaries, discussion topics, learning activities, geons while employed by Ozark Orthopedic and Sports
answers to the text review questions, answers to the Medicine Clinic located in t he Northwest Arkansas
workbook activities, and chapter tests with answer area. Ms. Tannehill-Jones gained experience in e du-
keys. cation by working as an instructor of surgical technol-
■■ The Cognero Testbank contains 1,000 questions. You ogy while serving as the Divisional Chair of Nursing
can use these questions to create your own tests. and Allied Health Programs at Northwest Technical
Institute in S pringdale, Arkansas. She obtained her
bachelor’s degree in nursing from Missouri Southern
ABOUT THE AUTHORS State College in Joplin and her master’s degree in health
service administration at Southwest Baptist University
Dr. Marianne Neighbors has been in n ursing in Bolivar, Missouri. She worked for St. Mary’s—
practice and nursing education for more than 40 years. Mercy Health System for more than 20 years in a vari-
She received her bachelor’s degree in nursing at ety of nursing positions, with her last position being
Mankato State, a master’s degree in health education Vice President of Patient Care Services, Chief Nurse
at the University of Arkansas, a m aster’s degree in Executive. Ms. Tannehill-Jones retired from Regency
nursing at the University of Oklahoma, and a doctoral Hospital of Northwest Arkansas in 2011.
degree in education with a focus on health science at
the University of Arkansas. Dr. Neighbors has taught in
associate degree nursing education for 18 years, focus- ACKNOWLEDGMENTS
ing on medical/surgical nursing, and in baccalaureate
nursing education for 23 years, focusing on health A special thanks goes out to all our colleagues, friends,
promotion and community health. She also taught and family members who have supported us throughout
advanced health promotion and nurse educator classes this project.
at the master’s level. She has coauthored many research
articles; four medical/surgical nursing texts, along with FEEDBACK FROM THE USER(S)
two medical/surgical handbooks; a health assessment The authors would like to hear from instructors, learn-
handbook; and a home health handbook. Dr. Neighbors ers, or anyone using the textbook about its strengths
has also written chapters for other nursing authors’ and/or suggestions for revisions. They are truly inter-
books. She is currently an Emeritus professor in t he ested in making the textbook user-friendly and com-
Eleanor Mann School of Nursing at the University of prehensive but not too detailed or too in-depth for the
Arkansas, Fayetteville, Arkansas. reader. The authors want to know how the text is being
Ruth Tannehill-Jones worked as a r egistered used and what features are most helpful. Please feel free
nurse for more than 30 years. She began her nursing to forward comments to the authors through Cengage
education at the University of Arkansas, Fayetteville, Learning or directly by e-mail to Dr. Neighbors at
with completion of an associate degree in n ursing. [email protected] and Ms. Tannehill-Jones at rjonesn-
Ms. Tannehill-Jones was not a newcomer to this cam- [email protected].
pus; some years previously, she had completed a bach-
elor’s degree in home economics. On receiving her Marianne Neighbors, EdD, RN
RN license, she worked at St. Mary-Rogers Memorial Ruth Tannehill-Jones, MS, RN
Hospital in Rogers, Arkansas, in the capacities of staff
Reviewers
We would like to thank all of the reviewers who have Francesca Langlow, MSHCM
been an invaluable resource in guiding this book as it Professor, Allied Health Division
has evolved. Their insights, comments, suggestions, and
Kelli Lewis, MSHI, RHIA
attention to detail were extremely important in devel-
Online Adjunct Professor
oping this textbook.
Dawn Muntean, RPh, BS Pharmacy, BA Biology
Amy Branch, RHIA
Lead Medical Instructor
Health Information Technology Program Director
Dr. Tawny Nix, DBA, MBA, BSB, AAS, RMA (AMT)
Cyndi Cavines, CRT, CMA (AAMA), AHI
Program Director for Medical Assisting/Medical
Director, Senior Instructor
Coding
Deborah J. Cipale, MSN, RN
Online Adjunct Professor
xix
Unit I
CONCEPTS OF
HUMAN DISEASE
1
Introduction to
Human Diseases
KEY TERMS
Acute (p. 5) Fatal (p. 8) Palpation (p. 8) Prevalent (p. 6)
Auscultation (p. 7) Holistic medicine (p. 9) Pathogenesis (p. 4) Preventive (p. 9)
Chronic (p. 5) Homeostasis (p. 4) Pathogens (p. 4) Prognosis (p. 8)
Complication (p. 8) Iatrogenic (p. 5) Pathologic (p. 4) Remission (p. 8)
Diagnosis (p. 7) Idiopathic (p. 5) Pathologist (p. 4) Signs (p. 7)
Disease (p. 4) Lethal (p. 8) Pathology (p. 4) Symptoms (p. 7)
Disorder (p. 4) Mortality rate (p. 8) Percussion p. 8) Syndrome (p. 4)
Etiology (p. 5) Nosocomial (p. 5) Predisposing
Exacerbation (p. 8) Palliative (p. 9) factors (p. 5)
LEARNING OBJECTIVES
Upon completion of the chapter, the learner should be able to:
1. Define basic terminology used in the study of 4. Identify the predisposing factors to human
human diseases. diseases.
2. Discuss the pathogenesis of disease. 5. Explain the difference between diagnosis and
3. Describe the standard precaution guidelines for prognosis of a disease.
disease prevention. 6. Describe some common tests used to diagnose
disease states.
OVERVIEW
T he study of human diseases is important for understanding a variety of other topics in the health care field.
Diseases that affect humans can range from mild to severe and can be acute (short term) or chronic (long term).
Some diseases affect only one part of the body or a particular body system, whereas others affect several parts of the
body or body systems at the same time. Many factors influence the body’s ability to stay healthy or predispose the
body to a disease process. Some of these factors are controllable, but some are strictly related to heredity. Diseases can
be diagnosed by professional health care providers using a variety of techniques and tests. ■
4 CHAPTER 1
TABLE 1–1 Types of Pathologists

DISEASE, DISORDER,
AND SYNDROME Pathologist Role or Subject
In the study of human disease, several terms may be Experimental Research

similar and often used interchangeably but might not Academic Teaching
have identical definitions. Anatomic Clinical examinations
Autopsy Postmortem
© Cengage®. All Rights Reserved.

Surgical Biopsies
DISEASE Clinical Laboratory examinations
Disease may be defined in several ways. It maybe called Hematology Blood
a change in structure or function that is considered to Immunology Antigen/antibodies
be abnormal within the body, or it may be defined as Microbiology Microorganisms
any change from normal. It usually refers to a condition
in which symptoms occur and a pathologic state is pres-
ent, such as in pneumonia or leukemia. Both of these
definitions have one underlying concept: the alteration a student studying diseases might be considered a
of homeostasis (ho-mee-oh-STAY-sis). pathologist.
Homeostasis is the state of sameness or normalcy There are many types of pathologists because there
the body strives to maintain. The body is remarkable are numerous ways to study disease. One of the more
in its ability to maintain homeostasis, but when this commonly known pathologists is the surgical pathol -
homeostasis is no longer maintained, the body is dis- ogist, who inspects surgical tissue or biopsies for evi -
eased or “not at ease.” dence of disease. The medical examiner or coroner can
be a pathologist who studies human tissue to determine
the cause of death and provide evidence of criminal
DISORDER involvement in a death. Other types of pathologists are
Disorder is defined as a derangement or abnormality outlined in Table 1–1.
of function. The term disorder can also refer to a patho- The prefix patho- can be used in a variety of ways
logic condition of the body or mind but more com - to describe disease processes or the disease itself.
monly is used to refer to a problem such as a vitamin Microorganisms or agents that cause disease are called
deficiency (nutritional disorder). It is also used to refer pathogens (PATH-oh-jens). These include some types
to structural problems such as a malformation of a joint of bacteria, viruses, fungi, protozoans, and helminths
(bone disorder) or a condition in which the termdisease (worms). All pathogens have the ability to cause a dis -
does not seem to apply, such as dysphagia (swallowing ease or disorder. Fractures that are caused by a disease
disorder). Because disease and disorder are so closely process that weakens the bone, such as osteoporosis,
related, they are often used synonymously. would be called pathologic (path-oh-LODGE-ick)
fractures.
SYNDROME
Syndrome (SIN-drome) refers to a group of symptoms, PATHOGENESIS
which might be caused by a specific disease but might The pathogenesis (PATH-oh-JEN-ah-sis; patho = dis-
also be caused by several interrelated problems. Exam- ease, genesis = arising) is a description of how a particu-
ples include Tourette’s syndrome, Down syndrome, lar disease progresses. Many of us are familiar with the
and acquired immunodeficiency syndrome (AIDS), pathogenesis of the common cold.
which are discussed later in the text. A cold begins with an inoculation of the cold virus.
This can occur following a simple handshake with
PATHOLOGY someone who has a cold. Afterward, the target person
might rub his or her eyes or nose, allowing entry of the
Pathology (pah-THOL-oh-jee) can be broadly defined virus into the body. After the inoculation period comes
as the study of disease (patho = disease, ology = study). incubation time. During this period, the virus multi -
A pathologist (pah-THOL-oh-jist) is one who studies plies, and the target person begins to have symptoms
disease. Using this strict definition of the word, even such as a runny nose and itchy eyes. The pathogenesis
INTRODUCTION TO HUMAN DISEASES 5
TABLE 1–2 Examples of Acute and Chronic The etiology of athlete’s foot is a fungus named tinea
Diseases/Disorders pedis.
Another term used to mean “the cause is unknown”
Acute Chronic
is idiopathic (ID-ee-oh-PATH-ick). If an individual is
Upper respiratory infections Arthritis diagnosed as having idiop athic gastric pain, it means

Lacerations Hypertension the cause of the pain in the stomach is unknown.
Middle ear infections Diabetes mellitus Other terms related to cause of disease areiatrogenic
Gastroenteritis Low back pain (EYE-at-roh-JEN-ick) and nosocomial (NOS-oh-KOH-
Pneumonia Heart disease me-al). Iatrogenic (iatro = medicine, physician, genic =
Fractures Asthma arising from) means that the problem arose from a pre-
scribed treatment. An example of an iatrogenic problem
is the development of anemia in a patient undergoing
of the cold then moves into full-blown illness, usually chemotherapy treatments for cancer.
followed by recovery and return to the previous state Nosocomial is a closely related term; it implies that
of health. the disease was acquired from a hospital environment.
The pathogenesis of a disease can be explained in An example would be a postoperative patient develop-
terms of time. An acute (a-CUTE) disease is short term ing an incisional staphylococcal infection. The best way
and usually has a sudden onset. If the disease lasts for an to prevent nosocomial infections is through the practice
extended period of time or the healing process is pro- of good hand washing. A good hand-washing technique
gressing slowly, it is classified as achronic (KRON-ick) is described in the Healthy Highlight box below.
condition. See Table 1–2 for examples of acute and
chronic diseases.
PREDISPOSING FACTORS
ETIOLOGY Predisposing factors, also known as risk factors, make
a person more susceptible to disease. Predisposing fac-
The etiology (EE-tee-OL-oh-jee) of a disease means tors are not the cause of the disease, and people with
the study of cause. The term etiology is commonly used predisposing factors do not always develop the disease.
to mean simply “the cause.” One might say that the These factors include age, sex, environment, lifestyle,
cause is unknown or “of unknown etiology.” The cause and heredity. Some risk factors, such as lifestyle behav-
or etiology of pneumonia can be a virus or a bacterium. iors, are controllable, whereas others such as age are not.
HEALTHY HIGHLIGHT
How Should You
Wash Your Hands
K eeping your hands clean through improved hand hygiene is one of the most
important steps we can take to avoid getting sick and spreading germs to others.
Many diseases and conditions are spread by not washing hands with soap and clean
water.
To wash your hands:
■■ Wet your hands with clean, running water (warm or cold), turn off the tap, and apply
soap.
■■ Lather your hands by rubbing them together with the soap. Be sure to lather the backs
of your hands, between your fingers, and under your nails.
■■ Scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday”
song from beginning to end twice.
■■ Rinse your hands well under clean, running water.
■■ Dry your hands using a clean towel or air dry them.
Source: Centers for Disease Control and Prevention (CDC) 2016
6 CHAPTER 1
HEALTHY HIGHLIGHT
Standard
Precautions
U sing standard precautions is recommended by the Centers for Disease Control and
Prevention for the care of all patients or when administering first aid to anyone.
These standards also include respiratory hygiene and cough etiquette, safe injection
techniques, and wearing masks for spinal insertions.
■■ Hand washing Wash hands after touching blood, body fluids, or both, even if gloves
are worn; use an antimicrobial soap.
■■ Respiratory etiquette Cover mouth, nose, or both with a tissue when coughing and
dispose of used tissue immediately. Wear mask if possible. Maintain distance from
others, ideally greater than 3 feet. Wash hands after contact with secretions.
■■ Gloves Wear gloves when touching blood, body fluids, and contaminated items;
change gloves after patient contact or contact with contaminated items; wash hands
before and after.
■■ Eye wear, mask, and face shield Wear protection for the eyes, mouth, and face when
performing procedures when a risk of splashing or spraying of blood or body secre-
tions exists. This includes insertion of catheters or injection of material into spinal or
epidural spaces. A mask should also be worn if the caregiver has a respiratory infection
but cannot avoid direct patient contact.
■■ Gown Wear a waterproof gown to protect the clothing from splashing or spraying
blood or body fluids.
■■ Equipment Wear gloves when handling equipment contaminated with blood or
body fluids; clean equipment appropriately after use; discard disposable equipment
in proper containers.
■■ Environment control Follow proper procedures for cleaning and disinfecting the
patient’s environment after completion of a procedure.
■■ Linen Use proper procedure for disposing of linen contaminated with blood or body
fluids.
■■ Blood-borne pathogens Do not recap needles; dispose of used needles and other
sharp instruments in proper containers; use a mouthpiece for resuscitation; keep a
mouthpiece available in areas where there is likelihood of need.
AGE Parkinsonism. Other disorders or diseases, including

osteoporosis, rheumatoid arthritis, and breast cancer,
From the beginning of life until death, our risk of dis -
occur more often in women.
ease follows our age. Newborns are at risk of disease
because their immune systems are not fully developed. ENVIRONMENT
On the other hand, older persons are at risk because their
immune systems are degenerating or wearing out. Girls Air and water pollution can lead to respiratory and
in their early teens and women over the age of 30 are at gastrointestinal disease. Poor sanitation, excessive
high risk for a difficult or problem pregnancy. The older noise, and stress are also environmental risk factors.
we become, the higher the risk for diseases such as cancer, Occupational diseases such as lung disease are high
heart disease, stroke, senile dementia, and Alzheimer’s. among miners and persons working in areas where
there are increased amounts of dust or other particles
in the air.
SEX Farmers are considered to be at higher risk for dis-
Some diseases are more prevalent (occurring more eases because of their increased exposure to dust, pes -
often) in one gender or the other. Men are more ticides, and other pollutants. Farmers are also at higher
at risk for diseases such as lung cancer, gout, and risk for trauma injuries due to safety problems around
farm machinery. People living in remote, rural areas With this knowledge about hereditary factors, individu-
do not have health care availability comparable to that als can choose to decrease their overall risk by improv-
enjoyed by people living in urban areas. This increases ing their lifestyle health behaviors.
their risk for chronic illnesses.
DIAGNOSIS
LIFESTYLE Diagnosis (die-ag-NO-sis) is the identification or
Lifestyle factors fall into a category over which the indi- naming of a disease or condition. When an individual
vidual has some control. Choosing to improve health seeks medical attention, it is the duty of the physician
behaviors in these areas could lead to a reduction in risk to determine a diagnosis of the problem. A diagnosis is
and thus a possibility of avoiding the occurrence of the made after a methodical study by the physician, using
disease. Such factors include smoking, drinking alcohol, data collected from a medical history, physical exam -
poor nutrition (excessive fat, salt, and sugar and not ination, and diagnostic tests (Figure 1–1).
enough fruits, vegetables, and fiber), lack of exercise, A medical history is a systems review that might
and stress. include such information as previous illnesses, fam -
Practicing health behaviors to prevent contami - ily illness, predisposing factors, medication allergies,
nation, and thus disease, is also an important lifestyle current illnesses, and current symptoms (SIMP-tums,
behavior. The Centers for Disease Control and Pre - what patients report as their problem or problems).
vention recommends the use of standard precautions Examples of symptoms might include stomach pain,
when caring for any individual when there is a chance headache, and nausea.
of being contaminated with blood or body fluids (see The physician proceeds with a head-to-toe physi-
the Healthy Highlight box “Standard Precautions”). cal examination of the patient, looking for signs of the
This is an important measure to prevent transmission disease. Signs differ from symptoms in that signs are
of any disease that can be passed between humans in observable or measurable. Signs are what the physician
blood or body fluids, such as hepatitis, Escherichia coli sees or measures. Examples of signs could include vom-
infections, and AIDS. iting, elevated blood pressure, and elevated temperature.
In some cases, a patient’s concern might be con-
sidered as both a symptom and a sign. Some references
call this an objective or observable symptom, whereas
Consider This... others state that it is also a sign. An example would be
a patient complaining of a runny nose. The runny nose
About 90% of diseases are partially caused is the patient’s symptom and, because it is observable
or affected by stress. to the physician, it is also a sign.
During the physical examination, the physician
might use other skills such as auscultation (aws-kul-
TAY-shun, using a stethoscope to listen to body
HEREDITY
Although one cannot change genetic makeup, being
aware of hereditary risk factors might encourage the
individual to change lifestyle behaviors to reduce the
risk of disease. For example, coronary heart disease has
been shown to have a high familial tendency. Persons
with this family inheritance are compounding their
chances if they smoke, have poor nutritional intake,
and do not exercise routinely.

Breast cancer and cervical cancer also have famil -
ial tendencies. Women with family members who have
been diagnosed with breast cancer or cervical cancer
are at a higher risk for developing these diseases. These
women should be screened routinely for evidence of
cancer and should complete monthly breast self-exams. FIGURE 1–1 Physician checking a patient.
8 CHAPTER 1
TABLE 1–3 Examples of Common Diagnostic Tests and Procedures
Test Description
Complete blood count (CBC) An examination of blood for cell counts and abnormalities
Urinalysis (UA) An examination of urine for abnormalities
Chest X-ray (CXR) X-ray examination of the chest cavity
Electrocardiography (ECG or EKG) A procedure for recording the electrical activity of the heart
Blood glucose A test of the blood to determine its glucose or sugar levels
Computerized axial tomography (CT or CAT) A special X-ray examination showing detailed images of body
structures and organs
Serum electrolytes An examination of blood serum to determine the levels of the common
electrolytes (sodium, potassium, chloride, and carbon dioxide)
cavities), palpation (pal-PAY-shun, feeling lightly or Chronic diseases often go through periods of
pressing firmly on internal organs or structures), and remission and exacerbation (eg-ZAS-er-BAY-shun).
percussion (per-KUSH-un; tapping over various body Remission refers to a time when symptoms are dimin-
areas to produce a vibrating sound). All the results are ished or temporarily resolved. Exacerbation refers to a
compared to a normal standard to identify problems. time when symptoms flare up or become worse. Leu -
Diagnostic tests and procedures to assist in deter - kemia is a disease that progresses through periods of
mining a diagnosis are numerous. The routine or most remission and exacerbation. Both acute and chronic
common include urinalysis, complete blood count diseases can range from mild to life threatening.
(CBC), chest X-ray (CXR), and electrocardiography
(EKG or ECG). See Table 1–3 for examples of common COMPLICATION
diagnostic tests and procedures.
The prognosis might be altered or changed at times if
the individual develops a complication. A complication
PROGNOSIS is the onset of a second disease or disorder in an indi -
vidual who is already affected with a disease. An indi -
Prognosis (prawg-KNOW-sis) is the predicted or
vidual with a fractured arm might have a prognosis of
expected outcome of the disease. For example, the prog-
the arm healing in 6 to 8 weeks. If the individual suffers
nosis of the common cold would be that the individual
the complication of bone infection, the prognosis might
should feel better in 7 to 10 days.
change drastically.
ACUTE DISEASE
MORTALITY RATE
The duration of the disease can be described as acute
Mortality is defined as the quality of being mortal, that
in nature. An acute disease is one that usually has a
is, destined to die. Diseases commonly leading to the
sudden onset and lasts a short amount of time (days or
death of an individual have a high mortality rate. The
weeks). Most acute diseases are related to the respira-
mortality rate of a disease (also called death rate) is
tory system. Again, the common cold would be a good
related to the number of people who die with the dis -
example.
ease in a certain amount of time. Other terms the med-
ical community uses to refer to a deadly disease include
CHRONIC DISEASE fatal and lethal.
If the disease persists for a long time, it is considered to
be chronic. Chronic diseases might begin insidiously
(slowly and without symptoms) and last for the entire Consider This...
life of the individual. As one ages, the occurrence
of chronic disease increases. One of the most com - The ashes of the average cremated human
mon chronic diseases is hypertension, or high blood weigh approximately 9 pounds.
pressure.
SURVIVAL RATE After the treatment plan is implemented, the phy-

sician will follow up with the individual to determine
A physician’s prognosis can also consider survival rate.
effectiveness. The individual and physician should
Survival rate is the percentage of people with a par-
work together to modify the plan if it is found to be
ticular disease who live for a set period of time. For
ineffective. Implementation of the plan usually requires
example, the two-year survival rate of individuals with
an entire health care team. The team can include nurses,
lung cancer would be the percentage of people alive
a physical therapist, a social worker, clergy, and other
2 years after diagnosis.
health care professionals as needed.
The best treatment option is a preventive plan. In
TREATMENT preventive treatment, care is given to prevent disease.
Examples of preventive care are breast mammograms
After the diagnosis is established, the physician will work to screen for breast cancer, blood pressure screening for
with the individual to explain or outline a plan of care. hypertension, routine dental care to prevent dental caries,
The physician might offer treatment options to the indi- and a fecal occult blood test to screen for colon cancer.
vidual with expected outcomes or prognoses. The indi- Other treatment plans might include palliative
vidual’s entire being should be taken into consideration. (PAL-ee-ay-tiv) treatment. Palliative treatment is aimed
The concept of consider ing the whole person rather at preventing pain and discomfort but does not seek to
than just the physical being is called holistic medicine. cure the disease. Treatment for end-term cancer and
From a holistic viewpoint, there is interaction other serious chronic conditions can be palliative.
between the spiritual, cognitive, social, physical, Decisions concerning treatment plans can be very
and emotional being. These areas do not work inde- difficult for the patient, the patient’s family, and the
pendently, but have a dynamic interaction (Figure 1–2). health care team. This is especially true when those
Treatment interventions might include (1) medi - decisions involve palliative treatment and end-of-life
cations, (2) surgery, (3) exercise, (4) nutritional mod - issues. During these times, profe ssionals often seek
ifications, (5) physical therapy, and (6) education. assistance in decision making by using their knowledge
Individuals and family members should be educated of medical ethics.
and involved in the treatment plan. Failure to involve
the individual and family can decrease compliance and
lead to failure of the plan.
MEDICAL ETHICS
Webster’s Dictionary defines ethics as “the study of stan-
dards of conduct and moral judgment.” More simply
put, ethics deals with the “rightness and wrongness” or
“goodness and badness” of human actions. Ethics covers
many areas of conduct and judgment in our society.
Bioethics is a branch of ethics concerned with
what is right or wrong in bio (life) decisions. Because
bioethics is a study of life ethics, it covers or becomes
entwined with medical ethics. Medical ethics includes
the values and decisions in medical practice, including
relationships to patients, patients’ families, peer physi-
cians, and society.
Part of the ethical challenge in this age of rapidly
advancing technologies is actually determining what
is right, wrong, good, or bad. New scientific discover -

ies are challenging familiar or usual human behaviors,
leading to reconsideration of actions, thoughts, and
emotions. Ethical dilemmas, once rare, are now com -
mon and often happen so quickly that society is unable
to understand completely the impact these decisions
FIGURE 1–2 Holistic medicine. will have on the future.
10 CHAPTER 1
Bioethical decisions are often very difficult because ■■ Legalize abortion.

they touch the core of humanity in dealing with issues ■■ Use mood-altering drugs for older persons.
of birth, death, sickness, health, and dignity. This gen -
eration and generations to come will be faced with eth- ■■ Clone humans.
ical decisions formerly unknown to man. Many of these ■■ Treat disease by replacing damaged or abnormal
decisions will have great impact on medical ethics and genes with normal genes.
will actually shape the future of mankind. ■■ Use animal organs or tissues (xenotransplants) in
When challenges concerning medical ethics arise humans.
in a health care facility, an ethics committee might be
■■ Support euthanasia.
called on to make a decision. This committee might
involve one or more persons at each of these levels: ■■ Allow physician-assisted suicide.
physician, nurse, ethicist, social worker, case manager,
Each of the preceding issues can be overwhelm -
chaplain, legal representative, and administrator, or
ing. Even so, yet another concern must be addressed,
director.
involving the economics of these choices.
Groups or committees involved in decision making
Consider, for example, the economics of human
might need to consider previous works of philosophy,
cloning. How will research, technology, and interven -
history, law, and religion to assist them in reaching a
tion be funded? If costs are funded by individuals, only
conclusion. Participation in ethical decision making
wealthy individuals would be able to afford clones. Is
requires members to follow some basic rules, which
that fair or right? If costs are funded by the government,
can include:
what criteria will be used for selection? Will selection be
■■ Keeping the discussion focused and civil. based on intelligence, physical ability, or artistic skills?
Who decides?
■■ Listening with an open mind to all opinions.
Medical ethics includes some very complicated life
■■ Entertaining diverse ideas. issues. Bioethical decision making, or determining the
■■ Weighing out the pros and cons of each idea. rightness or wrongness of such issues, will continue to
■■ Considering the impact of the decision on all per- be a challenge for society well into the future.
sons involved.
Every individual at some time or another will
encounter or be called on to make a decision that is bio- Consider This...
ethical in nature. Examples of these can include one’s
willingness to: A study in the Netherlands determined
that smokers and obese persons benefit
■■ Use a surrogate mother or father to have a biolog- a socialized health care system due to
ical child. earlier deaths. Health care costs for a
■■ Control the sex of children through chromosome lifetime for a healthy person will average
selection. $417,000, whereas the obese person will
cost $371,000 and the smoker will cost
■■ Use fetal stem cells to grow new organs and tissues. $326,000.
■■ Use prescription stimulants in children.
SUMMARY
T h e study of human diseases is important to any

health care or allied health professional. Disease
can affect any body system or organ and can range
intervention for treatment or cure. Diagnosis and
treatment of a di sease are usually accomplished by
a team of health care professionals led by the physi-
from mild to severe, depending on many factors. cian. Ethical decision making has become a challenge
Several risk factors for disease can be controlled to in health care today, and as technology continues to
some extent by one’s lifestyle. Other diseases might grow and develop, medical ethics will become more
not be preventable or controlled but need medical challenging than ever.
REVIEW QUESTIONS
Short Answer
1. Identify why it is important to study human diseases.
2. Describe the types of pathologists and their roles in the study of disease.
3. List the five predisposing factors for disease and one disease related to each factor.
Matching
4. Match the terms in the left column with the correct definition in the right column.
Pathogenesis a. The cause of a disease
Etiology b. Interventions to cure or control a disease
c. The development of a disease
Diagnosis
d. The identification or naming of a disease
Prognosis e. The predicted or expected outcome of a disease
Treatment
CASE STUDIES
■ Stan Cotton was accidentally tripped by another player while running down the field at a soccer game you
were coaching. He is able to walk to the sideline with assistance but has obvious bleeding on his legs and one
arm. You grab the first-aid box and go to his side. What do you do next? What equipment might you use to give
aid to Stan? What standard precautions should apply to this case?
■ Jane Swenson has been suffering from a cold for about a week and has missed three days of work. She
decides to return to work at the local senior citizen center. She is still coughing at intervals and has a runny nose
but has improved since last week. Should she still use some precautions to prevent spreading her illness? If so,
what should she do?
Study Tools
Workbook Practice Online Resources
Complete Chapter 1 PowerPoint® presentations
12 CHAPTER 1
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Dale, A., Hartley, P., Drysdale, H., Goldacre, B., Heneghan, Healthcare, 46(11), H006.
C., & COMPare project. (2016). Effectiveness of an Solomon, E. P. (2016). Introduction to human anatomy and
internet-delivered handwashing intervention. The Lancet, physiology. St. Louis, MO: Elsevier Saunders.
387(10016), 337. Treise, D., Weigold, M. F., Birnbrauer, K., & Schain, D. (2016).
Evans, H., Chao, M. G., L eone, C. M., Finney, M., & Fraser, The best of intentions: Patients’ intentions to request
A. (2016). Content analysis of web-based norovirus edu- health care workers cleanse hands before examinations.
cation materials targeting consumers who handle food: Health Communication, 31(4), 425–433.
2
Mechanisms
of Disease
KEY TERMS
AIDS (p. 19) Cancer (p. 16) Infection (p. 15) Oncology (p. 15)
Allergen (p. 19) Congenital (p. 14) Inflammation (p. 15) Organ rejection (p. 19)
Allergy (p. 19) Degenerative (p. 19) Ischemia (p. 22) Parenteral (p. 17)
Anoxia (p. 20) Dysplasia (p. 20) Malignant (p. 16) Total Parenteral
Antibodies (p. 19) Encapsulated (p. 16) Metaplasia (p. 20) Nutrition (TPN)
Antigens (p. 19) Enteral (p. 17) Metastasize (p. 16) (p. 17)
Atrophy (p. 20) Gangrene (p. 22) Metastatic (p. 16) Trauma (p. 14)
Autoimmunity (p. 19) Hyperplasias (p. 15) Morbidity (p. 23) Triage (p. 15)
Bariatrics (p. 18) Hypertrophy (p. 20) Motor Vehicle Accidents Tumors (p. 15)
Benign (p. 16) Hypoxia (p. 20) (MVAs) (p. 14)
Body mass index (BMI) Immunodeficiency Necrosis (p. 22)
(p. 18) (p. 19) Neoplasia (p. 20)
Cachexia (p. 17) Infarct (p. 22) Neoplasms (p. 15)
LEARNING OBJECTIVES
Upon completion of the chapter, the learner should be able to:
1. Identify important terminology related to the 5. Compare the various types of impaired immunity.
mechanisms of human disease. 6. Identify the basic changes in the body occurring
2. Describe the causes of disease. in the aging process.
3. Identify disorders in each category of the causes of 7. Describe the process of cell and tissue injury,
disease. adaptation, and death.
4. Describe behaviors important to a healthy
lifestyle.
OVERVIEW
T he human body is a complex machine that normally runs in an efficient, balanced manner, but when changes occur
in the body due to lifestyle behaviors, abnormal growths, nutritional problems, bacterial invasion, or any other fac-
tor that upsets the balance, the result might be a disease process. Human disease can be very minor or life threatening.
13
14 CHAPTER 2
Diseases are caused by a variety of factors; some are controllable and some are not. Even normal changes such as aging
can put the individual at higher risk for developing disease. Many changes or alterations in cell and tissue structure
can occur. Some of these changes are reversible, but some might cause cellular, tissue, organ, or system death. ■
Chromosomal and genetic abnormalities might or

CAUSES OF DISEASE might not be compatible with life. Some abnormalities
To gain a better understanding of the different causes might be present but cause no effect on the individual,
of diseases, it is usually helpful to classify or divide whereas others might lead to the death and sponta-
them into smaller groups. This classification can be neous abortion of the unborn child.
approached in several different yet logical ways. One More information related to hereditary diseases can
commonly used approach is to divide the causes of dis- be found in Chapter 19, “Genetic and Developmental,
ease into the following six categories: Childhood, and Mental Health Diseases and Disorders.”
1. Heredity TRAUMA
2. Trauma Traumatic diseases are caused by a physical injury
3. Inflammation and infection from an external force. Trauma is the leading cause
4. Hyperplasias and neoplasms of death in children and young adults. The type of
trauma (TRAW-mah) or traumatic disease most com-
5. Nutritional imbalance monly affecting individuals varies with age, race, and
6. Impaired immunity residence. For example, accidents, especially falls, are a
common cause of traumatic disorders in older adults,
whereas gunshot wounds are the most common cause
HEREDITY of traumatic disease and even death in young adult
black males living in urban areas. However, motor vehi-
Hereditary diseases are caused by an abnormality in the
cle accidents (MVAs) are the most frequent cause of
individual’s genetic or chromosomal makeup. These dis-
serious injury overall.
eases might or might not be apparent at birth. Hereditary
The Centers for Disease Control and Prevention
diseases that are present at birth, even if not apparent, are
(CDC) lists deaths caused by trauma, in order of prev-
called congenital (kon-JEN-ih-tahl) disorders. How-
alence (or occurrence), as follows:
ever, not all congenital disorders are inherited. Some
other causes of congenital disorders include disease ■■ MVAs
during pregnancy (fetal alcohol syndrome) or difficulty
■■ Poison
with delivery (cerebral palsy), to name only a couple.
Hereditary diseases are classified in three basic ways, ■■ Firearms
as (1) a single gene abnormality, (2) an abnormality of ■■ Falls
several genes (polygenic), or (3) an abnormality of a chro- ■■ Suicide
mosome (either entire absence of a chromosome or the
presence of an additional chromosome). See Table 2–1 ■■ Suffocation
for the classification of hereditary diseases and examples. ■■ Homicide
TABLE 2–1 Classification of Hereditary Disease with Examples
Single Gene Polygenic Chromosomal
Cystic fibrosis Gout Klinefelter’s syndrome

Phenylketonuria Hypertension Turner’s syndrome
Sickle cell anemia Congenital heart anomalies Down syndrome
MECHANISMS OF DISEASE 15
Emergency management of trauma is often neces -

sary to prevent the complications of shock, hemorrhage,
and infection. On arrival at an emergency department,
patients are assessed according to signs and symptoms,
age, and medical history. Needs are then prioritized, and
care is given in order of severity of injury. This prioritiz-
ing of care is called triage (tree-AZH) and incorporates
an ABC prioritizing method, with A for airway, B for
breathing, and C for cardiac function. After these areas
are assessed, other areas of trauma such as bleeding and
fractures are addressed. An example of triage, in gen-
eral, would be giving priority care to a patient who is not
breathing before assisting a patient who has a bleeding
leg wound.
Types of trauma commonly occurring in each body
system are discussed in the specific system chapters.
FIGURE 2–1 Inflammation of a finger.
INFLAMMATION AND INFECTION

Inflammation (in-flah-MAY-shun) is a protective obstruction of the appendix. Because the bacteria Esch-
immune response that is triggered by any type of injury erichia coli (E. coli) are commonly found in the colon,
or irritant. Even the slightest trauma can initiate the the appendix becomes infected.
inflammatory response. Signs of inflammation are red-
ness, heat, swelling, pain, and loss of motion. An exam-
ple of inflammation is sunburn. The tissue is red, warm HYPERPLASIAS AND NEOPLASMS
to the touch, swollen, painful, and uncomfortable when Hyperplasias (high-per-PLAY-zee-ahs; hyper = exces-
moving. Although this area is inflamed, it is usually not sive, plasia = growth) and neoplasms (NEE-oh-plazms;
infected. neo = new, plasm = growth) are similar because, in both,
Infection (in-FEK-shun) refers to the invasion of an increase in cell number leads to an increase in tissue
microorganisms into tissue that cause s cell or t issue size.
injury. Inflammation and infection are often used
synonymously even though they are quite different. Hyperplasias
A tissue can be inflamed but not infected, as in sun - Hyperplasias differ from neoplasms in terms of cause
burn, but usually, tissue that is infected will also be and growth limits. Hyperplasias are an overgrowth in
inflamed. response to some type of stimulus. An example of a
For tissue to be infected or for infection to occur, hyperplasia would be enlargement of the thyroid gland
there has to be an invasion of microorganisms. Usually, (goiter) in response to a hormone deficiency.
inflammation and infection go hand in hand. For exam-
ple, when the skin is cut, the tissue around the cut will Neoplasms
undergo a mild inflammation. As skin bacteria invade Neoplasms (new growths) are commonly called
the cut tissue, the area becomes infected and usually tumors. The Latin word tumor means “swelling” and
becomes even more inflamed due to the irritation to the originally was used in the description of the swelling
tissue caused by the bacteria (Figure 2–1). related to inflammation. The Greek term for swelling
Diseases that are related to inflammation are is onkos, which has been used to construct the word
identified with the suffix “-itis.” Examples include oncology (ong-KOL-oh-jee; onco = tumor, logy = study
appendicitis (inflammation of the appendix), gastritis of, or the study of cancer). Although all tumors are not
(inflammation of the stomach), colitis (inflammation neoplasms, as described in more detail in Chapter 3,
of the colon), and encephalitis (inflammation of the “Neoplasms,” the words are often used synonymously.
brain). In many cases, the inflammation will progress Diseases with tumor involvement usually end with
to an infection due to the presence of bacteria in the the suffix “-oma.” Examples include lipoma, carcinoma,
region. For example, appendicitis can be caused by an melanoma, and sarcoma (Table 2–2). An exception to
16 CHAPTER 2
TABLE 2–2 Examples of Neoplasms or Tumors
Neoplasm/Tumor Description
Adenoma Usually benign tumor arising from glandular epithelial tissue

Carcinoma Malignant tumor of epithelial tissue
Fibroma Benign encapsulated tumor of connective tissue
Glioma Malignant tumor of neurologic cells
Lipoma Benign fatty tumor
Melanoma Malignant tumor of the skin
Sarcoma Malignant tumor arising from connective tissue such as muscle or bone
this is the word hematoma, which is a clot of blood in

an area. A hematoma on the head due to a blunt blow
would be an example.
Neoplasms or tumors (-omas) may be classified as
benign (beh-NINE) or malignant (mah-LIG-nant).
Generally speaking, benign tumors have a limited
growth, are encapsulated (enclosed in a capsule)
and thus easily removed, and are not deadly. Malig -
nant tumors are just the opposite. These tumors grow
uncontrollably; have finger-like projections into sur -
rounding tissue, making removal very difficult; and are
usually deadly. Malignant means deadly or progressing
to death. With these definitions, it is understandable
why the terms tumor, malignancy, and cancer bring
fear to an individual. Some -omas, or tumor diseases,
are commonly called cancer. Cancer is defined as any
malignant tumor.
Courtesy of Mark L. Kuss

The finger-like or crab-like projections that char -
acterize malignant tumors give cancer its name, from
the Greek karkinos, meaning “crab.” This character -
istic makes surgical removal of cancer quite difficult
(Figure 2–2). Another characteristic of malignant neo-
FIGURE 2–2 Crab-like appearance of cancer in a kidney.
plasms is that they metastasize (meh-TAS-tah-sighz),
or spread. Metastatic (MET-ah-STAT-ic) cancers
spread from a site of origin to a secondary site in the
body. For example, lung cancer commonly metastasizes
to the bone. Chapter 3 discusses more detailed informa-
tion about hyperplasias and neoplasms.
Consider This...
Lack of water is the number 1 trigger of
NUTRITIONAL IMBALANCE daytime fatigue.
Good nutrition is important in maintaining good health
and reducing the chance of disease. Nutritional disor -
ders can cause problems with physical growth, mental
and intellectual retardation, and even death in extreme Malnutrition
cases. Most nutritional diseases are related to overcon- Malnutrition can be due to inadequate nutrient intake
sumption or underconsumption of nutrients. Specific or to intake of an adequate amount with poor nutritive
problems are malnutrition, obesity, and excessive or value. Diseases that cause a problem with absorption of
deficient vitamins, minerals, or both. nutrients can also lead to malnutrition. Children and
in a liquid drink. Another way to supplement or pro -

vide for total nutritional intake is not through the
alimentary canal or digestive system but through a
parenteral (pah-REN-ter-al; to administer by injec-
tion) route. Parenteral routes can include subcutaneous
(sub = under, cutaneous = skin), intramuscular ( intra
= within, muscular = muscle), or intravenous ( intra =
within, venous = vein) administration. The intravenous
route is the most commonly used parenteral route.
Providing the total nutrition needed by giving nutri -
tive liquid through a venous (vein) route is called total
parenteral nutrition (TPN).
Nutrition can also be provided through an enteral

(small intestine) route. A nasogastric (naso = nose, gas-
tric = stomach) tube or a tube running through the nose
and into the stomach can be used for feedings if the sup-
plement is planned short term. For longer-term enteral
feeding, a gastrostomy (gastro = st omach, ostomy =
FIGURE 2–3 Cachexia. opening; opening into the stomach) procedure is per-
formed to place a tube through the abdominal and
stomach wall. Enteral feeding, commonly called “tube
older persons are the age groups most affected by mal- feeding,” is accomplished by this method (Figure 2–4).
nutrition. Persons suffering with cancer often experi -
ence problems with malnutrition and develop cachexia. Obesity
Cachexia (ca-KECK-see-ah) is a term that describes Although many individuals in the United States have
any individual who has an ill, thin, wasted appearance a nutritional deficiency, the most common problem
(Figure 2–3). is obesity, which is primarily due to overconsump -
Persons who are unable to eat enough to maintain tion of nutrients and lack of exercise. According to
their body weight can receive nutritional supplements the American Heart Association, obesity is a national
(A) (B)
FIGURE 2–4 Gastrostomy. (A) Feeding. (B) Insertion site.
18 CHAPTER 2
health concern with nearly one in three (31.7%) U.S. recommended. Gastric banding and gastric bypass are
children ages 2 to 19 being obese and over one-third two of the most common types of surgery.
(33.7%) of adults being obese. Obesity shortens the Obesity is one of the most preventable causes of
life span of the individual by increasing the chance for death. Worldwide, it is viewed as one of the most seri-
arteriosclerosis, leading to cardiovascular diseases. It ous public health problems of the twenty-first century.
also affects the individual’s risk for developing bone
or joint problems due to the increased pressure on the Vitamin or Mineral Excess or Deficiency
skeletal system. Vitamin and mineral excesses and deficiencies are usu-
Obesity is simply defined as too much body fat. ally related to diet, metabolic disorders, and some medi-
It is medically determined when an individual has a cations. Hypervitaminosis can occur in individuals who
body mass index (BMI) of greater than 29.9. BMI is consume large amounts of vitamins for an extended
obtained by dividing the individual’s weight in pounds period of time.
by the square of his or her height, multiplied by 703. Nutritional guidelines for a healthy lifestyle are dif-
For example, a person weighing 250 pounds who is ficult to determine because they must cover a variety of
5 feet 6 inches tall (66 inches) has a BMI of 40.3. This ages and nutritional needs. Children, teens, and preg -
is calculated as 250 divided by (66 3 66) 3 703. This nant women have very specific nutritional needs. See
person is considered extremely obese. the Healthy Highlight box “General Guidelines for a
A simple BMI scale uses these figures to determine Healthy Lifestyle” for more information.
levels of obesity:
BMI IMPAIRED IMMUNITY
<18.5: underweight
The immune system of the body is a specialized
18.5–24.9: normal
group of cells, tissues, and organs that are designed
25–29: overweight
to defend the body against pathogenic attacks. The
30–35: obese
body’s first line of defense against pathogens is its
36–40: moderately obese
normal structure and function, including an intact
>40: extremely obese
skin; mucous membranes; tears; and secretions. The
Bariatrics (bear-ee-AT-tricks) is a branch of med- immune system protects the body in two additional
icine that deals with the prevention and treatment of ways, through:
obesity. First-line treatment for obesity often includes
diet, exercise, antiobesity medication, and behavior 1. The inflammatory response, in which leukocytes
modification. These treatments in the severely obese play a vital part in killing foreign invaders.
population often have poor long-term success. In 2. The specific antigen–antibody reaction, in which
these cases, bariatric or weight loss surg ery may be the body responds to antigens (AN-tih-jens) by
HEALTHY HIGHLIGHT
General Guidelines
for a Healthy
G
■■
eneral guidelines for a healthy lifestyle include the following tips:
Maintain proper body weight.

Lifestyle ■■ Eat a variety of foods.
■■ Avoid excessive fat, salt, and sugar.
■■ Eat adequate amounts of fiber.
■■ Consume alcohol in moderation, no more than two drinks per day for men and one
for women.
■■ Get enough rest and sleep, at least 7 or more hours per day.
■■ Always eat breakfast.
■■ Maintain a moderate exercise schedule.
producing antibodies. Antigens are substances

that cause the body some type of harm, thus setting
AGING
off this specific reaction. Antibodies, also called There is no definite age in years when an individual
immune bodies, are proteins that the body pro- becomes aged. However, some statisticians consider
duces to react to the antigen and render it harmless. the retirement age of 65 as aged. An individual’s body
actually begins to age at physical maturity, around age
Impaired immunity occurs when some part of this
18, in a complicated process that is not completely
system malfunctions. Following are some common
understood but is progressive and irreversible. Diseases
ways the system malfunctions.
related to aging are often called degenerative diseases.
Allergy Tissue degeneration is a change in functional activity
to a lower or lesser level. Examples of degenerative dis-
The immune response is too intense or hypersensitive
eases are degenerative joint disease and degenerative
to an environmental substance. The allergen (environ-
disk disease.
mental substance that causes a reaction) in an allergy
The mechanisms of aging are complex and thought
might be such things as house dust, grass, pets, per-
to include such factors as heredity, lifestyle, stress, diet,
fumes, or insect bites, to name a few. These allergens do
and environment. One might slow the process of aging
not usually cause this type of reaction in most persons
to some degree by living a healthy lifestyle and con -
but do cause an allergic reaction in persons sensitive
trolling stress and environmental factors.
to them.
Hereditary factors can include increased life span
Autoimmunity related to an inherited ability to resist disease. Just as
families have a history of disease patterns, they also
The immune response attacks itself. In autoimmunity
appear to have a pattern of longevity. Thus, individuals
(auto = self), the body’s lymphocytes (a white blood cell
who have relatives who live to be in their nineties might
that produces antibodies) cannot identify the body’s
themselves live to that age. Individuals with a family
own self-antigens, which are harmless. In response,
history of members who have died of heart disease in
the lymphocytes form antibodies that then attack the
their early years might also suffer from the same prob-
body’s own cells. Examples of autoimmune diseases
lem. Although hereditary patterns cannot be controlled,
include rheumatoid arthritis and rheumatic fever.
longevity can be increased and disease decreased by
controlling lifestyle behaviors that increase risk of
Immunodeficiency chronic disease.
The immune response is unable to defend the body The body replaces and repairs itself throughout its
due to a decrease or absence of leukoc ytes, primar- lifetime, but with aging, this process slows. As early as
ily lymphocytes. Persons with immunodeficiency are age 40, there are changes in skin, endocrine function,
usually asymptomatic (without symptoms) except for vision, and muscle strength. Other changes in the aging
recurrent infections. It is these recurrent infections process might include bone loss leading to osteoporo-
that often lead to death. An example of an immuno - sis, decreased melanin pigment production leading to
deficiency disease is acquired immunodeficiency syn- graying of the hair, decreased immunity leading to an
drome (AIDS). Immunodeficiency also can be caused increase in infections and possible development of can-
by medications, chemotherapy, or radiation. Organ cer, loss of brain and nerve cells that might lead to senile
recipients are intentionally immunosuppressed or dementia, and decrease in intestinal motility leading to
immunodeficient to save their transplanted organ. constipation and possible diverticulosis.
Without immunosuppressant medications, the body’s
immune system would recognize the organ as foreign
and attack it, leading to organ death. This process is
called organ rejection. Cancer patients often undergo Consider This...
chemotherapy and radiation treatments that can cause
immunodeficiency. Some medications also affect the After age 30, the brain loses 50,000 neu-
system by depressing its ability to function properly. rons per day, causing a brain shrinkage
Chapter 5, “Immune System Diseases and Disorders,” of approximately one-fourth of a percent
discusses the immune system and related diseases in (0.25%) each year.
more detail.
20 CHAPTER 2
HEALTHY HIGHLIGHT
Consumer
Responsibility in
T oday’s consumer should be more health-conscious than in the past. Individuals are
now expected to take charge of their health care needs and to be more informed
about health choices. However, this may not be the case with many people. It is recom-
Disease Prevention mended that the consumer become more knowledgeable about diseases, medications,
and prevention. Unfortunately, many diseases are on the rise in the United States due
to a variety of causes. The public needs to be informed about these and to be active
in prevention. Diseases on the rise include Pertussis, Shigella (especially in day care
centers), Salmonellosis, E. Coli, Meningococcal infection, Tuberculosis, Influenza, and
Streptococcal infections. Health care providers need to help their patients find the most
accurate information about these diseases and help them incorporate prevention strate-
gies into their lifestyles.
back to their normal structure and function. How -

DEATH ever, some adaptations are permanent, so even if the
Humans are mortal, so eventually, everyone will die. condition improves, the cells are not able to return to
Even though we are unable to understand the aging normal. Types of adaptation include atrophy (AT-tro-
process fully, cellular, tissue, and organ deaths can be fee), hypertrophy (high-PER-tro-fee), hyperplasia,
reviewed in an effort to understand the death of the dysplasia (dis-PLAY-zee-ah), metaplasia (met-ah-
organism as a whole. PLAY-zee-ah), and neoplasia (nee-oh-PLAY-zee-ah).
Atrophy
CELLULAR INJURY Atrophy (a = without, trophy = growth) is a decrease in
Cellular injury and death can be due to some type of cell size, which leads to a decrease in the size of the tis-
trauma, hypoxia (high-POCK-see-ah; not enough sue and organ (Figure 2–5). Atrophy is often due to the
oxygen), anoxia (ah-NOCK-see-ah; no oxygen), drug aging process itself or to disease. An example of atrophy
or bacterial toxins, or viruses. Cells can undergo near- related to aging would be the smaller size of the mus -
death experiences and actually recuperate in what is cles and bones of older people. As the female ages, the
considered to be reversible cell injury. breasts and female reproductive organs atrophy, espe -
The ability of the cell to survive depends on several cially after menopause. Examples of disease or patho -
factors, including the amount of time the cell suffers logic atrophy are usually related to decreased use of the
and the type of cell injury that occurred. If the cause of organ, especially muscles. Spinal cord injuries lead to
the injury is short term, the cell has a greater chance of
survival.
The type of cell also plays a part in its ability to
recuperate. The heart, brain, and nerve cells are eas -
ily injured and often suffer death. This is particularly
important because these cells do not replace themselves.
Even short-term injury might readily lead to death in
these cells. Other cells are not as easily damaged. Con-
nective and epithelial cells often recuperate and even
readily replace themselves by mitosis (cell division).
CELLULAR ADAPTATION
Cells that are exposed to adverse conditions often go
through a process of adaptation. When the condi-
tion is changed, these cells might be able to change FIGURE 2–5 Normal cell versus atrophied cell.
FIGURE 2–6 Normal cell versus hypertrophied cell.

FIGURE 2–7 Normal tissue versus hyperplasia.
an inability to move muscles. Without use, muscle cells irritant or stimulus is removed, but usually, these cells
decrease in size and the muscle atrophies. progress to neoplasia.
Hypertrophy Metaplasia
Hypertrophy (hyper = excessive, trophy = growth) is an Metaplasia (meta = changed, plasia = growth) is a cellu-
increase in the size of the cell leading to an increase in lar adaptation in which the cell changes to another type
tissue and organ size (Figure 2–6). Skeletal muscle and of cell (Figure 2–9). An example is the columnar epithe-
heart muscle cells do not increase in number by mito- lial cells of the respiratory tree, which often change to
sis. Literally, what an individual has at birth is what the stratified squamous epithelial cells when exposed to the
individual has throughout life. This helps explain why irritants of cigarette smoking. This protective adapta -
some athletes bulk up with exercise while others do not. tion might be reversible if the individual quits smoking.
The inherited number of muscle cells does not change
with exercise; only the size of each cell changes. To Neoplasia
adapt to an increased workload, muscle cells increase Neoplasia (neo = new, plasia = growth) is the develop-
in size. Increased workload on the ske letal muscles ment of a new type of cell with an uncontrolled growth
causes cellular hypertrophy and an increase in muscle pattern (Figure 2–10). Neoplasia is discussed in more
size. Heart muscle hypertrophy is usually seen in the detail in Chapter 3.
left ventricle of the heart (left ventricular hypertro-
phy) when the left ventricle must work harder to pump
blood through diseased valves and arteries. To adapt to
this need, the cells increase in size and the left side of
the heart enlarges.
Hyperplasia
Hyperplasia (hyper = increased, plasia = growth) is an
increase in cell number that is commonly due to hor -
monal stimulation (Figure 2–7). Hyperplasia is dis -
cussed in more detail in Chapter 3.
Dysplasia
Dysplasia (dys = bad or difficult, plasia = growth) usu-
ally follows hyperplasia. It is an alteration in size, shape,
and organization of cells (Figure 2–8). Dysplastic cells
might change back to the normal cell structure if the FIGURE 2–8 Normal tissue versus dysplasia.
22 CHAPTER 2
called an infarct (IN-farkt). Infarcts are commonly due

to obstruction of arteries. The most common infarct
affects tissues of the heart, leading to a myocardial
infarction, or heart attack.
Cells that are injured and not able to recover even-
tually die. The cause of cell death can be determined by
a pathologist because the gross (visible with the eye)
and microscopic appearance of the tissue differs with
the type of death. There are several types of necrosis,
primarily named by the microscopic appearance of the
dead cells.
The most common type of necrosis is called coag-
ulation necrosis and is due to cellular anoxia. Coagula-
tion necrosis is the type of cell death experienced with
myocardial infarction.
A common alteration in necrosis occurs when
FIGURE 2–9 Normal tissue versus metaplasia. saprophytic (dead tissue–loving) bacteria become
involved in the necrotic tissue. With this occurrence,
the necrotic tissue is now described as gangrenous or
CELL AND TISSUE DEATH having gangrene (GANG-green). The type of gangrene
Cell death, as previously mentioned, can be caused can be wet, dry, or gas, depending on the appearance of
by trauma, hypoxia, anoxia, drug or bacterial toxins, the necrotic tissue.
or viruses. The most common causes of cell death are Wet gangrene usually occurs when the necrosis has
hypoxia and anoxia. been caused by the sudden stoppage of blood flow, as in
Cell hypoxia caused by decreased blood flow is the trauma of burning, freezing, or embolism.
called ischemia (iss-KEE-me-ah; isch = hold back, Dry gangrene occurs when blood flow has been
emia = blood). A cell without oxygen cannot produce slowed for a long period of time before necrosis
needed energy and eventually dies. occurred, as in the case of arteriosclerosis and advanced
Cellular death, called necrosis (neh-CROW-sis), diabetes. In dry gangrene, the tissue is black, shriveled,
can involve a group of cells and, thus, tissue. When or mummified. This type of gangrene occurs on the
referring to dead cells or tissue, one would describe extremities only, primarily on the feet and toes.
the area as necrotic. When necrosis occurs due to Gas gangrene occurs with dirty, infected wounds.
ischemia, the area of dead cells (ischemic necrosis) is The tissue becomes infected with anaerobic (growing
without oxygen) bacte ria that produ ce a toxic gas.
This is an acute, painful, and often fatal type of
gangrene.
ORGANISM DEATH
Human death can be related to any of the aforemen -
tioned causes of disease. The aging process leads to
death due to a change in the normal structure of the
individual’s organs or a decrease in the ability to fight
disease. Diseases that would not be lethal in our younger
years, such as respiratory infections, can be the cause of
death in an older individual.
According to CDC, the most common cause of
death in the United States is heart disease, followed by
cancer and strokes (cerebrovascular accident). Although
heart disease is the leading cause of death, stroke is the
FIGURE 2–10 Normal tissue versus neoplasia. leading cause of serious, long-term disability in the
United States. (See Chapter 8, “Cardiovascular System of brain death. The criteria for determining brain death
Diseases and Disorders,” for more information.) include:
Many times, the human organism—like the cell—
does not die but becomes disabled. Disability is called ■■ Lack of response to stimuli.
morbidity (state of being diseased). Often, morbidity is ■■ Loss of all reflexes.
so extreme that the individual’s quality of life is severely ■■ Absence of respirations or breathing effort.
limited. This is often seen in cases of severe brain injury
or even in some congenital disorders. ■■ Lack of brain activity as shown by an electroen-
Prior to death, major organs such as the heart, cephalogram (EEG).
lungs, and brain stop functioning. When the brain This issue of defining death and when an individ -
ceases to function, the individual is considered brain ual is actually dead is still controversial in the medical
dead. Although death is difficult to define and difficult profession.
to determine in some cases, one guideline used is that
SUMMARY
H uman diseases are caused by heredity; trauma;

inflammation, infection, or both; hyperplasias, neo-
plasms, or both; nutritional imbalances; impaired immu-
be contributing factors to disease development, as can
the aging process. Eventually, all organisms die, and the
process of death can occur at the cellular, tissue, or whole
nity; or some or all of these. Lifestyle behaviors can also organism level.
REVIEW QUESTIONS
Matching
1. Match the cause of diseases in the left column with the example of a disease for that category in the right column.
Heredity a. Pneumonia
Trauma b. Motor vehicle accident
c. Cancer
Inflammation/infection
d. Obesity
Hyperplasias/neoplasms e. Allergies
Nutritional imbalance f. Cystic fibrosis
Impaired immunity
True or False
2. T F In autoimmunity, the body’s immune system attacks itself.
3. T F Some medications used to prevent or cure some diseases can cause immunodeficiency.
4. T F Diseases related to the aging process are called regenerative disorders.
5. T F All congenital disorders are easily recognized at birth.
6. T F Heart and brain cells are easily injured by hypoxia.
7. T F Heredity does not affect the aging process.
8. T F Cellular death occurs only in the event of hypoxia (lack of oxygen).
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[Inhoud]
[1]
[Inhoud]
☞ Elke aflevering bevat een volledig verhaal. ☜

UITGAVE VAN DEN ROMAN-, BOEK- EN KUNSTHANDEL—SINGEL 236,—
AMSTERDAM.
[Inhoud]
DE SCHIJNDOODEN.
HOOFDSTUK I.
Een Adellijke Bandiet.
Sedert eenige dagen lag er in het groote ziekenhuis in de Sloane Street

te Londen op de algemeene mannenzaal een man, die niet weinig de
belangstelling trok van het verplegend personeel.
Hij kon tusschen de vijfendertig en de veertig jaar zijn, en zijn bleek

gelaat vertoonde de sporen van vroegere schoonheid, die echter voor
een groot deel waren uitgewischt door een losbandig leven.
Hij had groote, donkere oogen, een rechten, aristocratischen neus en

een klein, sierlijk kneveltje, waarvan de punten opwaarts gekruld waren,
en dat hem aanstonds als een vreemdeling verried.
Wie hij was, kon niemand in het gasthuis zeggen.
Eens waren er een paar bezoekers gekomen, die hem als Brown
hadden aangesproken—maar het was naderhand gebleken, dat de man
dezen naam zeker niet kon dragen.
Hoe hij dan wel heette? Dat kwam men niet te weten.
Hij was, door messteken zwaar gewond, des nachts door een paar
mannen naar het gasthuis gebracht, die verklaarden, dat zij den keurig
gekleeden vreemdeling aldus op het trottoir hadden zien liggen,
kermend en om hulp roepend.
Zij hadden geen verdere inlichtingen kunnen geven en waren aanstonds

weder verdwenen, nadat de vreemdeling aan de veilige hoede van den
geneesheer-directeur was overgebracht, die hem dadelijk naar de
algemeene mannenzaal had laten brengen, waar nog een aantal
bedden onbezet waren.
Men had zijn kleeren onderzocht, die van fijn laken waren vervaardigd,
maar daarin niets gevonden dan een beurs, die eenige ponden sterling
bevatte, een groot zakmes, zooals electriciens ze wel bij zich dragen en
waaraan zich tevens een schroevendraaier, een boor en een kleine vijl
bevinden, een zakdoek, gemerkt met de initialen B/S., waarboven een
kroontje, een zilveren sigarettenkoker en nog eenige andere
voorwerpen, die echter weinig licht konden verspreiden aangaande de
ware identiteit van den gewonde.
Reeds den volgenden dag, nadat hij was binnengebracht, [2]had zich
een zeer schoone jonge vrouw aangemeld die gesmeekt had bij den
gewonde te worden toegelaten, maar die evenmin zijn naam had
genoemd.
En daarna waren er na een kort tijdsverloop eenige dingen met den

zwaargewonde voorgevallen, die er niet weinig toe bijdroegen, hem in
een waas van geheimzinnigheid te hullen.
Den dag vóór dat ons verhaal een aanvang neemt, waren er laat op den
avond twee mannen verschenen, die den zoogenaamden Brown
wegens een zeer ernstige zaak verlangden te spreken.
Weliswaar was het reglementaire bezoekuur reeds lang verstreken,

maar daar men niet wist of de gewonde in het leven zou blijven en de
zaak werkelijk van groot gewicht scheen te zijn, zoo gaf men den laten
bezoekers verlof, aan de sponde van den gewonden vreemdeling te
treden.
Tijdens het gesprek riep Brown de hoofdverpleegster bij zich en

verzocht haar dringend, aanstonds naar het hotel „Het vergulde Hert” te
telefoneeren en daar na te vragen of een zekere miss Bispham daar
nog aanwezig was.
De gewonde scheen in een toestand van groote opwinding te verkeeren

en, zoo verklaarde de hoofdverpleegster later, scheen in koortsachtig
ongeduld op antwoord te wachten.
Zij sprak echter niet met de vrouw, naar wie de gewonde vroeg, maar
trof aan het andere einde van de lijn een detective, die haar dringend
verzocht de twee late bezoekers aan de praat te houden totdat hij
gekomen zou zijn om hen te arresteeren, daar zij stellig iets kwaads in
den zin hadden.
Dit was slechts ten halve gelukt, want de twee bezoekers hadden,
ondanks alle pogingen om hen met een zoet lijntje op de ziekenzaal te
houden, reeds in de lift plaats genomen en hadden de vestibule reeds
bereikt toen de politiebeambte met een helper aankwam en de twee
mannen in verzekerde bewaring stelde.
Men had den vreemdeling aanstonds ondervraagd, maar deze scheen

zeer onrustig en het was duidelijk, dat hij ontwijkend antwoordde.
Hij gaf voor, niet juist te weten, wat de beide bezoekers van hem wilden,
maar dat zij gepoogd hadden, hem geld af te zetten, en verzocht zóó
dringend hem met rust te laten, dat men aan dit verzoek gevolg gaf.
Hij had nog een kort gesprek onder vier oogen met den detective en
vervolgens, blijkbaar een weinig gerust gesteld, was hij ingeslapen.
Maar de grootste verrassing zou de directeur van het ziekenhuis pas

den volgenden morgen ervaren, want toen hij eens bij Scotland Yard
informeerde, om te weten wat die twee geheimzinnige bezoekers, die in
zijn inrichting gearresteerd waren, eigenlijk gewild hadden, moest hij
vernemen, dat men op het hoofdbureau van politie volstrekt niets wist
van die arrestatie! Het ziekenhuis lag in een wijk, waar nog eenige
andere groote politiebureaux zich bevonden, en zoo werden ook deze
opgebeld, maar zonder eenig resultaat—men wist daar niets van een
arrestatie, en men had in het geheel geen detectives gezonden!
Daarop stelde de directeur natuurlijk de vraag of het geen particuliere

detectives geweest konden zijn.
Het antwoord luidde bevestigend.

Maar dan moest toch nog de vraag beantwoord worden, waarom die
beide detectives hunne gevangenen niet aanstonds hadden afgeleverd.
De directeur kreeg toezegging, dat er onderzoek zou worden gedaan

naar deze geheimzinnige zaak en daarmee moest hij zich voorloopig
tevreden stellen.
Wel trachtte hij den gewonden vreemdeling nog een en ander te

ontlokken, maar deze bleef norsch zwijgen, en verklaarde, dat hij zich
niet wilde uitlaten over zuiver particuliere aangelegenheden, die
niemand iets aangingen.
De gewonde had een vrij rustigen nacht doorgebracht, maar zoodra het
daglicht door de hooge vensters naar binnen kwam schijnen, dat wil
zeggen, omstreeks acht uur in den morgen van een triestigen
Novemberdag, begon hij zich heen en weder te werpen, ofschoon de
hoofdverpleegster hem dringend had vermaand stil te liggen.
Blijkbaar werd hij verteerd door een onrust, die machtiger was dan zijn
wil.
Hij keek telkens op de groote hangklok boven de groote deur en had

reeds een paar malen gevraagd of er geen boodschappen voor hem
waren gekomen.
Om half negen werd de hooge deur van de ziekenzaal opnieuw

geopend en trad er een jonge verpleegster binnen, die even rondkeek
en toen snel op de hoofdverpleegster, [3]die aan het einde van de zaal
een lastigen zieke tot kalmte bracht, toeliep.
De gewonde had het jonge meisje met de oogen gevolgd en zag nu,
hoe de beide vrouwen eenige woorden met elkander wisselden en
daarbij den blik op hem gevestigd hielden.
Zijn hart begon met wilde slagen te bonzen—blijkbaar was dit korte
gesprek voor hem van de grootste beteekenis.
De hoofdverpleegster kwam nu met snelle schreden langs het breede
gangpad aanloopen, trad op zijn bed toe, en zeide op vriendelijken toon:
—Er is zooeven een telefonische boodschap voor u gekomen, mijnheer

Brown. Men verzoekt ons, u mede te deelen, dat uw vriendin geheel
buiten gevaar is en dat er goed voor haar gezorgd wordt! Zij zal u nog
hedenmorgen komen bezoeken, vergezeld door haar vader!
Er had zich een lichte blos over het bleeke gelaat van den gewonde
uitgestrekt, terwijl hij de hand van de hoofdverpleegster krampachtig
omvat hield.
Hij zeide op heeschen toon:
—Ik dank u voor uw mededeeling, zuster, zij zal meer bijdragen tot mijn
herstel dan al uw drankjes en pillen!
Hij liet zich met een zucht achterover in de kussens vallen en sloot de
oogen. Maar als de hoofdverpleegster wat nauwkeuriger had
toegeluisterd, had zij hem kunnen hooren mompelen:
—Haar vader? Wat heeft dat te beteekenen? Zou dat misschien.…..?
Hij scheen in nadenken te verzinken en sluimerde zachtjes weder in.
Hij werd pas vele uren later weder wakker, een uur ongeveer vóór de
familieleden bij de zieken zouden worden toegelaten.
Maar juist toen hij wakker was geworden, trad de hoofdverpleegster

opnieuw naar hem toe en zeide:
—Gij zult hier niet langer blijven liggen, mijnheer Brown. Zoodra het met
het oog op uw toestand mogelijk is—dat wil zeggen over een paar
dagen—zult gij naar het paviljoen vervoerd worden en daar een kamer
voor u alleen krijgen. Uw vriendin heeft zooeven getelefoneerd, dat zij
twee weken verplegingskosten vooruit zal betalen. Dat zal u wel
bevallen, want gij zult het daar vrij wat prettiger krijgen.
—Ik wist wel, dat zij zoo iets doen zou! riep Brown uit, terwijl er een
glimlach om zijn bloedelooze lippen speelde.
Nu lag hij weder alleen en voortdurend dwaalden zijn blikken af naar de

groote klok.
Nog een kwartier—en het uur voor het reglementaire bezoek was
aangebroken.
Maar juist ging de deur open, twee dragers droegen op een baar een
nieuwen bewoner van de groote zaal binnen, die honderd twintig
bedden telde, waarvan er honderd tien bezet waren.
Zij droegen de baar tot vóór een dezer bedden, waarbij de

hoofdverpleegster hun den weg wees en tilden den zieke van de baar
op het bed.
Daarop verwijderden zij zich weder met de draagbaar, en voor zoover zij
zich bewegen konden, richtten alle zieken hun blikken nieuwsgierig in
de richting van het zooeven bezette bed.
De man, die daar lag en die thans door een van de verpleegsters
zorgvuldig werd toegedekt, had een zeer bleek gelaat en lag met
wijdgeopende oogen naar de zoldering te staren.
Maar nu ging de deur opnieuw open en enkele bezoekers traden

binnen.
Onder de eersten, die de ziekenzaal betraden, was een rijzige, jonge,

schoone vrouw met een bleek gelaat en chic gekleed.
Naast haar liep een grijsaard met bijna spierwit haar, dat op den schedel
reeds begon te dunnen, en in krullen op zijn schouders neerviel.
Een lange, witte, baard gaf hem een eerwaardig voorkomen.

Hij scheen een weinig gebrekkig te zijn en leunde op een zwaren
wandelstok.
De jonge vrouw zag nauwelijks den geheimzinnigen Brown of zij

bekommerde zich niet meer om den ouden man, snelde op het bed toe
en liet er zich vóór op de knieën vallen, terwijl zij haar hoofd aan de
borst van den gewonde vlijde.
Deze streelde zachtjes heur haar en fluisterde:
—Ik heb je dus weer, mijn lieveling! Je weet niet, wat ik geleden heb!
Raffles heeft je dus weten te bevrijden? [4]
De jonge vrouw knikte, terwijl zij op haar beurt het haar van den
gewonde zachtjes met haar lange witte vingers streelde.
—Alles is hem dus gelukt? vroeg Brown fluisterend. Waar is hij nu?
Zonder te antwoorden, wenkte de vrouw in de richting van de deur, waar

de grijsaard kwam aanstrompelen.
—Is hij dat? Is dat John Raffles? vroeg de gewonde fluisterend, terwijl
hij den grijsaard met groote oogen aanstaarde. Maar dat lijkt mij
onmogelijk toe.
—Ook ik meende eerst mijn oogen niet te kunnen vertrouwen, Raoul,

antwoordde de jonge vrouw fluisterend. Bij de vermommingskunst van
dien man valt die van alle leden onzer bende volkomen in het niet!
De vrouw had zeer zachtjes gesproken en zij kon er nu zeker van zijn,
dat niemand zou kunnen hooren wat zij zeide, daar twee bedden ter
rechter zijde en één links van den gewonde onbezet waren.
De grijsaard was intusschen naderbij getreden en nam naast het bed

van den gewonde plaats.
Hij boog zich over dezen heen en zeide zachtjes:

—Ik zie met genoegen, Beaupré, dat je toestand reeds vooruitgaande
is! Ik heb Marthe Debussy hier heen willen vergezellen, omdat ik
volstrekt niet zeker ben van haar veiligheid!
De gewonde had de hand van Raffles gegrepen—want hij was

inderdaad de gentleman-inbreker, de Groote Onbekende—en drukte
haar krachtig, terwijl hij zeide:
—Wij zijn vijanden geweest, John Raffles—en niemand kan zeggen,

hoe wij in de toekomst tegenover elkander zullen komen te staan! Gij zijt
een verklaard tegenstander van ons Genootschap, waartoe ook ik
behoor, markies Beaupré de la Sardogne! Maar toch—nu zou ik
onmogelijk van betere gevoelens jegens u vervuld kunnen zijn! Gij hebt
haar—hier vestigden zich zijn oogen op de bleeke vrouw aan de andere
zijde van het bed—uit de klauwen van mijn felsten vijand, Dr. Fox,
gered. Ik ben er zeker van, dat dit met levensgevaar gepaard ging, want
de chef van het Genootschap van den Gouden Sleutel is er de man niet
naar, om iemand, die zich in zijn macht bevindt, en die de doodstraf te
wachten staat, niet goed te laten bewaken!
—Ik beken, dat het niet bepaald een pleziertochtje was, hernam Raffles
glimlachend, maar het geluk was aan onze zijde!
—Wilt ge mij niet zeggen, hoe alles gegaan is? vroeg Raoul Beaupré,
dien wij nu hebben leeren kennen als een lid van een Parijsche
dievenbende, die naar Londen was gekomen, om zich op te werpen als
chef van het Genootschap van den Gouden Sleutel.
—Het is in een paar woorden verteld, antwoordde Raffles, ik ben hier

als detective de schurken komen arresteeren, die u namens Fox het
voorstel waren komen doen om de geheimen van uw bende te
verraden, en tevens een eed te zweren, dat gij nooit meer een poging
zoudt doen om naar het leiderschap van het Genootschap te streven, in
ruil waarvoor zij u het leven van uw minnares beloofden, die zich aan
verraad had schuldig gemaakt, en zich in handen van Dr. Fox bevond. Ik
heb hen bewusteloos gemaakt met een geheim middel, waarvan ik
alleen de samenstelling ken, en een vriend van mij en ik zelf hebben
hun plaats ingenomen, nadat wij hun uiterlijk zoo goed mogelijk hebben
nagebootst. De rest had niet veel meer te beteekenen—wij waren het
wachtwoord te weten gekomen op een wijze, welke ik u liever niet zal
mededeelen, en zoo viel het ons niet moeilijk, met nog een derden
helper, die over buitengewone spierkracht beschikt, het dievenhol
binnen te treden, waar uw vriendin gevangen werd gehouden. Wij
schoten een paar bewakers overhoop—en onze makker brak de deur
van de cel open, alsof het ’t deksel van een sigarenkistje was! Verdere
bijzonderheden zal madame u later wel mededeelen!
Beaupré had verbaasd toegeluisterd, en hij vroeg zich nu af, over welke
geheimzinnige macht deze man beschikte, dat hij kon slagen in een
onderneming, waarbij ieder andere zou hebben gefaald.
Even heerschte er stilte en toen zeide Beaupré:
—Ik bewonder u! Het is waar, dat wij elkander bestreden hebben en het
later nog wel zullen doen, maar wat gij gedaan hebt, grenst aan het
wonderbaarlijke! Maar zooeven zeidet gij, dat Marthe zich nog steeds in
gevaar bevindt! Waarom denkt gij dat?
—Zij wordt gevolgd! antwoordde Raffles eenvoudig. Fox heeft zijn

spionnen in de buurt van het ziekenhuis opgesteld: ik heb een paar
verdachte individuen hier zien rondzwerven. [5]
Er vertoonde zich een trek van grooten schrik en ongerustheid op het

gelaat van den gewonde, en hij greep krampachtig de hand van zijn
minnares.
—Ik voorzag zoo iets en daarom heb ik Marthe ook vergezeld!

vervolgde Raffles. Ik verzeker u, dat zij geen gevaar loopt zoo lang mijn
vrienden en ik toe zien! Zoodra gij als hersteld ontslagen bent, zult gij
natuurlijk dadelijk onze taak overnemen.
[Inhoud]
HOOFDSTUK II.
Een nieuwe patiënt.
Beaupré had de vuisten gebald, en heesch kwam het nu over zijn

lippen:
—Laat Fox zich voor mij in acht nemen, zoodra ik van mijn ziekbed kan
opstaan! Hij heeft mij in dezen toestand gebracht! In een stikdonker
gemaakt vertrek hebben wij elkander met messen bestreden, maar de
verraderlijke schurk had het vloerkleed gegrepen en dit om zijn linker
arm en bovenlijf gewikkeld, waardoor hij veel beter beschermd was dan
ik.
—Op die wijze hebt gij dus om de macht geduelleerd? vroeg Raffles.
—Ja—het was de wil der vergadering! antwoordde Beaupré.
Zij zwegen, daar de hoofdverpleegster op vriendelijk vermanenden toon

zeide:
—Nog enkele minuten, miss, dan zal ik u moeten verzoeken om heen te

gaan, want onze patiënt mag zich volstrekt niet te zeer inspannen!
—Wij beloven het u, zuster, zeide Marthe Debussy. Is er reeds gezorgd

voor een afzonderlijk vertrek voor mijnheer?
—Het wordt morgen in orde gemaakt—hij mag niet vóór over een paar
dagen vervoerd worden. De patiënt is zeer zwak, en iedere druppel
bloedverlies meer, zou hem den dood kunnen brengen.
Zij keek Beaupré even peinzend aan en vervolgde toen:
—Hoe staat het toch met den naam van onzen patiënt? Wij willen
natuurlijk volstrekt niet doordringen in uw particuliere aangelegenheden,
maar wij moeten toch een naam opgeven.
Marthe Debussy wisselde een snellen blik met haar minnaar en
antwoordde toen:
—Vult maar in: Pierre Dubois! Mijn vriend is genaturaliseerd

Franschman.
De hoofdverpleegster had den naam genoteerd en vervolgde nu:
—Weet gij wel, dat er hier vreemde dingen zijn voorgevallen? Scotland
Yard weet in het geheel niets af van de arrestatie, die hier gisternacht
heeft plaats gehad. Gij zult toch wel van de zaak weten?
Het was een vrij lastige vraag!
Raffles moest natuurlijk verondersteld worden, volkomen onkundig te

zijn—en slechts Marthe Debussy, wier naam de verpleegster trouwens
niet kende, kon gevoegelijk een weinig op de hoogte zijn van het geval,
daar de hoofdverpleegster namens haar minnaar naar haar had moeten
informeeren.
Zij achtte het echter het verstandigste, na Raffles snel met den blik
geraadpleegd te hebben, om zich van alles onkundig te houden, en
zeide daarom:
—Heeft hier een arrestatie plaats gehad?
—Ja, miss, van twee mannen, die den patiënt hier waren komen
bezoeken, naar de detective zeide, om geld af te zetten. Er waren twee
particuliere detectives hier, maar Scotland Yard verklaarde, van de
geheele zaak volstrekt niets af te weten.
Nu was Marthe door Raffles op de hoogte gesteld van de wijze, waarop

hij de twee handlangers van Dr. Fox onschadelijk had weten te maken,
en zij moest [6]dus comedie spelen, toen zij zoogenaamd verrast uitriep:
—Maar hoe is dat mogelijk?

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Human Diseases Marianne Neighbors

Strange Neighbors Ashlyn Chase

Diseases of the Human Body, 6th edition 6th Edition,

Handbook Of Clinical Neurology: Human Prion Diseases

With Neighbors Like This Tracy Goodwin

Autophagy: Cancer, Other Pathologies, Inflammation,

No Neighbors’ Lands in Postwar Europe: Vanishing Others

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List of Tables xiii Trauma 14

Growth of Benign and Malignant Neoplasms 29 Physical or Surface Barriers (Nonspecific) 48

Buerger’s Disease 172 Rare Diseases 214

Rare Diseases 263 Trauma 313

Common Signs and Symptoms 354 Sexually Transmitted Diseases 409

HEALTH DISEASES AND Digestive Diseases 511

Trauma 549 APPENDIX A:

■■ Non-Alcoholic Fatty Liver Disease (NAFLD) is

TABLE 1–1 Types of Pathologists

In the study of human disease, several terms may be Experimental Research

© Cengage®. All Rights Reserved.

© Cengage®. All Rights Reserved.

AGE Parkinsonism. Other disorders or diseases, including

and do not exercise routinely.

TABLE 1–3 Examples of Common Diagnostic Tests and Procedures

SURVIVAL RATE After the treatment plan is implemented, the phy-

is right, wrong, good, or bad. New scientific discover -

Bioethical decisions are often very difficult because ■■ Legalize abortion.

T h e study of human diseases is important to any

Chromosomal and genetic abnormalities might or

TABLE 2–1 Classification of Hereditary Disease with Examples

Single Gene Polygenic Chromosomal

Cystic fibrosis Gout Klinefelter’s syndrome

Emergency management of trauma is often neces -

INFLAMMATION AND INFECTION

TABLE 2–2 Examples of Neoplasms or Tumors

Adenoma Usually benign tumor arising from glandular epithelial tissue

this is the word hematoma, which is a clot of blood in

Courtesy of Mark L. Kuss

in a liquid drink. Another way to supplement or pro -

Courtesy of Mark L. Kuss

Courtesy of Mark L. Kuss

FIGURE 2–4 Gastrostomy. (A) Feeding. (B) Insertion site.

Maintain proper body weight.

producing antibodies. Antigens are substances

back to their normal structure and function. How -

FIGURE 2–6 Normal cell versus hypertrophied cell.

called an infarct (IN-farkt). Infarcts are commonly due