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Access Code Inside
Gould’s Pathophysiology for the
Health Professions

SEVENTH EDITION

Karin C. VanMeter, PhD

Lecturer
Austrian Biotech University of Applied Sciences, Tulln, Austria
University of Applied Sciences Upper Austria, Hagenberg, Austria
Lecturer (retired)
Iowa State University
College of Veterinary Medicine
Department of Biomedical Sciences
Ames, Iowa

Robert J. Hubert, BS
Laboratory Coordinator (retired)
Iowa State University
Department of Animal Sciences
Ames, Iowa
Copyright
Elsevier
3251 Riverport Lane
St. Louis, Missouri 63043

GOULD'S PATHOPHYSIOLOGY FOR THE

HEALTHPROFESSIONS, SEVENTH EDITION EISBN: 978-0-
323-79288-2

Copyright © 2023 by Elsevier Inc. All Rights Reserved.

Previous editions copyrighted 2018, 2014, 2011, 2006, 2002, 1997.

No part of this publication may be reproduced or transmi ed in

any form or by any means, electronic or mechanical, including
photocopying, recording, or any information storage and retrieval
system, without permission in writing from the publisher. Details
on how to seek permission, further information about the
Publisher's permissions policies and our arrangements with
organizations such as the Copyright Clearance Center and the
Copyright Licensing Agency, can be found at our website:
www.elsevier.com/permissions.

This book and the individual contributions contained in it are

protected under copyright by the Publisher (other than as may be
noted herein).

Notices

Practitioners and researchers must always rely on their own

experience and knowledge in evaluating and using any information,
methods, compounds or experiments described herein. Because of
rapid advances in the medical sciences, in particular, independent
verification of diagnoses and drug dosages should be made. To the
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Printed in the United States of America

Last digit is the print number: 9 8 7 6 5 4 3 2 1

Reviewers
Amit K. Mitra, MD, PhD
Associate Professor
School of Nursing
Franciscan Missionaries of Our Lady University
Baton Rouge, Louisiana
Thomas F. Moore, EdD, MMSc, PA-C
Dean, College of Medical Science
Assistant Professor of Physician Assistant Studies
College of Medical Science
Alderson Broaddus University
Philippi, West Virginia
Kaneez R. Odgers, DNP, RN, APN, FNP-BC
Assistant Professor of Nursing
Department of Nursing
Ramapo College of New Jersey
Mahwah, New Jersey
Preface
This textbook provides an introduction to pathophysiology for
students in a variety of academic programs for the health
professions at colleges and universities. Major disorders are
described, as well as selected additional diseases, with the intention
of providing information on a broad spectrum of diseases, with one
or more distinguishing features for each. It is anticipated that
additional information and resources pertinent to the individual’s
professional needs may be added to classroom presentations and
assignments. We trust that students will enjoy studying these
topics and proceed with enthusiasm to more detailed studies
within their individual specialties.

Organization
The textbook is organized into five major sections, followed by the
appendices.

Section I—Basic Concepts of Disease

Processes
• An introduction to pathophysiology, including medical
terminology and basic cellular changes, is provided.
• Topics such as fluid, electrolyte, and acid–base imbalances,
basic pharmacology, and pain are covered.
• The core information for each topic is complemented by the
inclusion of a specific disease/condition as an immediate
clinical application at the end of each chapter.
Section II—Defense/Protective Mechanisms
• Topics such as inflammation and healing, infection, and
immunity are covered.
• Specific areas included are a review of body defenses,
healing involved in specific trauma such as burns, basic
microbiology, review of the immune system components,
and mechanisms.

Section III—Pathophysiology of Body

Systems
• Selection of specific disorders is based on incidence and
occurrence, as well as on the need to present a variety of
pathophysiological processes and etiologies to the student.
• For major disorders, information is provided on
pathophysiology, etiology, clinical manifestations,
significant diagnostic tests, common treatment modalities,
and potential complications.
• Other selected diseases are presented in less detail, but
significant, unique features are highlighted.

Section IV—Factors Contributing to

Pathophysiology
• Normal physiological changes related to cancer,
adolescence, pregnancy, and aging, with their relevance and
effect on disease processes and the treatment of the affected
individual, are described.
• Specific disorders associated with cancer and the
developmental stages are discussed.
Section V—Environmental Factors and
Pathophysiology
• Factors such as immobility, stress, substance abuse, and
environmental hazards are the major components in this
section.
• Effects of the various environmental factors on the various
body systems and potential complications beyond physical
pathologies are discussed.
• New research and data are included, as these are areas of
increasing concern with regard to pathophysiology and
patient health.

Appendices—Additional Information
• Ready References include lists of anatomic terms,
abbreviations and acronyms, a selection of diagnostic tests,
an example of a medical history, a disease index, and a drug
index.
• A glossary and a list of additional resources complete this
resource.

Format and Features

The basic format as well as the straightforward, concise approach
remain unchanged from the previous editions. Some material has
been reorganized to improve the flow of information and facilitate
comprehension. Many features related to the presentation of
information in this textbook continue as before.

• Generic learning objectives are included in each chapter.

Instructors may modify or add applicable objectives for a
specific professional program.
• Cross-references are included, facilitating access to
information.
• In the discussion of a particular disorder, the
pathophysiology is presented first, because this “sets the
stage,” describing the basic change(s) in the body. Once the
student understands the essence of the problem, he or she
can easily identify the role of predisposing factors or causes
and relate the resulting signs and symptoms or
complications. Diagnostic tests and treatment also follow
directly from the pathophysiology.
• Changes at the cellular level are included when significant.
• Brief reviews of normal anatomy and physiology are
presented at the beginning of each chapter to remind
students of the structures and functions that are frequently
affected by pathological processes. A review of basic
microbiology is incorporated into the chapter on infections.
Additional review material, such as the pH scale or the
location of body cavities, may be found in the Appendices.
• Numerous illustrations, including flow charts, schematic
diagrams, and photographs, clarify and reinforce textual
information, as well as offering an alternative visual
learning mode, particularly when complex processes are
involved. Illustrations are fully labeled, including
anatomical structures and pathologic changes. Different
colors may be used in a figure to distinguish between the
various stages or factors in a process.
• Tables summarize information or offer comparisons, which
are helpful to the student in selecting the more significant
information and for review purposes.
• Brief reference to diagnostic tests and treatment measures
promotes understanding of the changes occurring during a
disease.
• Questions are found in boxes throughout the text to
stimulate application and review of new concepts. “Apply
Your Knowledge” questions are based on review of normal
physiology and its application, “Think About” questions
follow each small section of information, and “Study”
questions are located at the end of each chapter. Questions
 q p
may relate to simple, factual information, potential
applications, or the integration of several concepts. These
questions are helpful in alerting a student to points initially
overlooked and are useful for student self-evaluation before
proceeding to the next section. These features may also
serve as a tool for review and test preparation. Brief answers
are provided on the Evolve website.
• Brief, adaptable case studies with questions are incorporated
at the end of many chapters and are intended to provide a
basis for discussion in a tutorial, an assignment, or an
alternative learning mode. It is expected that specific
clinical applications may be added by instructors for each
professional group.
• Chapter summaries precede the review questions in each
chapter.

What’s New?
• Information on specific diseases has been updated
throughout.
• The specific disorders for each body system have been
expanded to reflect current trends and research.
• A broader emphasis on all allied health professions has
been incorporated.
• Sections and chapters have been reorganized to present the
student with a building block approach: basic science and
how it relates to human biology, the body’s various
mechanisms that respond to the disorders/diseases, the
general overview of body systems and their specific
disorders, other biological factors outside of the physiology
of each system that contribute to instances of
disorders/disease, and finally those environmental factors
not directly a ributed to a biological function or condition
that may contribute to pathophysiology throughout a
number of body systems.
 • Figures have been updated with new photographs and
illustrations to help in the recognition and identification of
the various concepts and specific disorders.
• Tables have been updated with new information that has
been made available since the previous edition.
• New boxes have been added:
• Technology––presents information on newly developed
tools/technologies being used to address the challenges
in the specific chapter subject, with emphasis on
artificial intelligence.
• The Bigger Picture––in a body system chapter, a
representative disorder/disease originating in that
system is selected, and its effects in other body systems
are listed, showing the interactions between different
systems.
• Additional resources have been expanded and updated.
• Study questions and Think About questions have been
reviewed and updated to cover new material in the chapter.
The Apply Your Knowledge questions have replaced the
Challenge questions in the previous editions.
• The Study Guide associated with this text has been updated
to reflect the most recent information regarding various
disorders.

Guidelines for Users

Certain guidelines were developed to facilitate the use of this
textbook by students with diverse backgrounds studying in various
health science programs. As well as ongoing general changes, some
professional groups have developed unique practice models and
language. In some disciplines, rapid changes in terminology have
occurred, creating difficulty for some students. For example, current
terms such as chemical dependency or cognitive impairment have many
synonyms, and some of these are included to enable students to
relate to a more familiar phrase. To avoid confusion, the common,
traditional terminology has been retained in this text.
• The recipient of care or service is referred to as a patient.
• When a disease entity refers to a group of related disorders,
discussion focuses on either a typical representative of the
group or on the general characteristics of the group.
• Key terms are listed at the beginning of the chapter. They are
presented in bold print and defined when initially used in
the chapter. Key terms are not indicated as such in
subsequent chapters but may be found in the glossary at
the back of the book.
• Italics are used to emphasize significant words.
• It is assumed that students have studied anatomy and
physiology prior to commencing a pathophysiology course.
• The concise, readable style includes sufficient scientific and
medical terminology to help the student acquire a
professional vocabulary and appropriate communication
skills. An effort has been made to avoid overwhelming the
student with a highly technical approach or impeding the
learning process for a student with li le scientific
background.
• The presence of numeric values within textual information
often confuses students and detracts from the basic
concepts being presented; therefore, specific numbers are
included only when they promote understanding of a
principle.
• Suggested diagnostic tests and treatments are not
individualized or necessarily complete, but are presented
generally to assist the student’s application of the
pathophysiology. They are also intended to provide
students with an awareness of the impact of certain
diseases on a client and of possible modifications in the
individualized care required. Diagnostic tests increase
student cognizance of the extent of data collection and
sifting that may be necessary before making a diagnosis, as
well as the importance of monitoring the course of a disease
or the response to treatment.
 • A brief introduction to pharmacology is included in Section
I, and specific drugs are referred to during the discussion of
certain disorders. Drugs are identified by generic name,
followed by a trade name. Examples provided in the
appropriate chapter are not recommendations but are
suggested only as frequently used representatives of a drug
classification. A drug index with references to the
applicable chapter is located in the appendices.
• Information regarding adverse effects of drugs or other
treatment is included when there may be potential
problems, such as high risk for infection or special
precautions required of members of the health care team.
• Every effort has been made to present current information
and concepts simply but accurately. This content provides
the practitioner in a health profession with the prerequisite
knowledge to recognize and understand a client’s problems
and the limitations and implications of certain treatment
measures; to reduce exacerbating factors; to participate in
preventive programs; and to be an effective member of a
health care team. The student will develop a knowledge
base from which to seek additional information. Individual
instructors may emphasize certain aspects or topics, as is
most appropriate for students in a specialty area.

Resources
In the textbook:

• Selected additional resources are listed in the appendices in

Ready Reference 9.
• Reference tables are located inside the front book cover. These
comprise common normal values for blood, cerebrospinal
fluid, and urine; a pH scale for body fluids; a list of blood
clo ing factors; and diagnostic tests.
• The chapter introducing pharmacology and therapeutics is
limited in content but, combined with the brief references
 to treatments with individual disorders, is intended to
complement the pathophysiology. This chapter also
introduces a few traditional and nontraditional therapeutic
modalities to facilitate the student’s understanding of
various therapies and of the impact of diverse treatments
on the patient and on care by all members of the health care
team. Also included are brief descriptions of a few selected
forms of therapy, for example, physiotherapy, in hopes of
clarifying the roles of different members of a health care
team.
• The appendices at the back of the textbook are intended to
promote effective use of study time. They include:
• A brief review of anatomical terms describing body
cavities and planes, with accompanying illustrations, as
well as basic body movements.
• Selected numerical conversions for temperature,
weights, and volumes.
• Lists of anatomical terms and combining forms, common
abbreviations, and acronyms; because of the broad scope
of pathophysiology, a medical dictionary is a useful
adjunct for any student in the health-related
professions.
• A brief description with illustrations of common
diagnostic tests such as ultrasound and magnetic
resonance imaging.
• An example of a medical history, which can be modified
to fit the needs of a particular professional group.
• A disease index, with a brief description and references
to the relevant chapter.
• A drug index identifying the principal action and
references to the appropriate chapters.
• A list of additional resources; websites consist primarily
of health care groups or professional organizations that
will provide accurate information and are likely to
persist. Additional specific journals and websites are
available for individual professions.
 p
• A glossary, including significant terms used to describe
diseases, as well as key words.
• Accompanying this textbook and developed for it, the
ancillaries available include:
• A study guide for students, which provides learning
activities such as complex test questions, matching
exercises, crossword puzzles, diagrams to label, and
other assignments.
• The interactive Evolve web site, which includes self-
evaluation tools and can be found at
h p://evolve.elsevier.com/Hubert/Goulds/.

We appreciate the time and effort of reviewers and users of this

text, of sales representatives, and of the editors, who have
forwarded comments regarding the first four editions. We have
a empted to respond to these suggestions while recognizing that
comments come from a variety of perspectives, and there is a need
to respect the primary focus of this textbook, space constraints, and
student concerns.
We hope that teachers and students will enjoy using this
textbook, and that it will stimulate interest in the acquisition of
additional knowledge in this dynamic field.
Robert Hubert
Karin VanMeter
Acknowledgements
The authors thank the editorial and production team at Elsevier for
their continuous support and assistance throughout the process for
a new and improved edition of this great book. We also would like
to thank the reviewers for their valuable input.
My special thanks as always go to my friend and coauthor Rob
Hubert. We are a great team and together have achieved many
improvements for this edition. This time I would like to add a
special thanks to my brother Dr. Hermann Sikora for his valuable
input on Digitalization, Artificial Intelligence, and Machine
Learning – an important addition (Technology) for this edition of
the book.
I will dedicate this book to my mother Theresia “Susi” Sikora, a
great mother who I took care of the last five years but passed away
as we were finishing the last items for the book. Without her I
would not have achieved what I did – “Danke Mu i”. To the same
subject I would like to thank my children for their acceptance that
they had a mom living between two continents and seeing me very
li le.
Karin C. VanMeter

I would first like to thank my co-author and friend Karin VanMeter.

We have completed numerous publishing projects together and it
is her dedication to education and professionalism that has
contributed to our success as a writing team. I thank the faculty and
staff in the microbiology program at Iowa State University for all
their encouragement and support. As with all the challenges I have
tackled in my life, I give my love and thanks to my family-my late
parents John and Ann, and my sister Donna for their loving
support. Finally, I lift my thanks to Jesus Christ, my Lord and
Savior who makes all things possible.
Robert J. Hubert
Table of Contents

Cover Image

Title Page

Copyright

Reviewers

Preface

Acknowledgments

Table of Contents

Section I Pathophysiology: Background and Overview

Chapter 1 Introduction to Pathophysiology

Chapter Outline

Learning Objectives
 What Is Pathophysiology and Why Study It?

Introduction to Cellular Changes

Chapter Summary

Study Questions

Chapter 2 Fluid, Electrolyte, and Acid-Base Imbalances

Chapter Outline

Learning Objectives

Fluid Imbalance

Electrolyte Imbalances

Acid-Base Imbalance

Treatment of Imbalances

Chapter Summary

Study Questions

Chapter 3 Introduction to Basic Pharmacology and Other Common

Therapies

Chapter Outline

Learning Objectives

Pharmacology

Traditional Forms of Therapy

 Complementary or Alternative Therapies

Chapter Summary

Study Questions

Chapter 4 Pain

Chapter Outline

Learning Objectives

Etiology and Sources of Pain

Structures and Pain Pathways

Physiology of Pain and Pain Control

Characteristics of Pain

Basic Classifications of Pain

Pain Control

Chapter Summary

Study Questions

Section II Defense/Protective Mechanisms

Chapter 5 Inflammation and Healing

Chapter Outline

Learning Objectives
 Review of Body Defenses

Review of Normal Capillary Exchange

Physiology of Inflammation

Acute Inflammation

Chronic Inflammation

Treatment of Inflammation

Healing

Example of Inflammation and Healing

Chapter Summary

Study Questions

Inflammation

Healing

Burns

Chapter 6 Infection

Chapter Outline

Learning Objectives

Review of Microbiology

Principles of Infection

Physiology of Infection
 Chapter Summary

Study Questions

Chapter 7 Immunity

Chapter Outline

Learning Objectives

Review of the Immune System

Tissue and Organ Transplant Rejection

Hypersensitivity Reactions

Autoimmune Disorders

Immunodeficiency

Chapter Summary

Study Questions

Section III Pathophysiology of Body Systems

Chapter 8 Skin Disorders

Chapter Outline

Learning Objectives

Review of the Skin

Resident Microbial Flora

 Skin Lesions

Skin Inflammatory Disorders

Skin Infections

Skin Tumors

Chapter Summary

Study Questions

Chapter 9 Musculoskeletal System Disorders

Chapter Outline

Learning Objectives

Review of the Musculoskeletal System

Trauma

Bone Disorders

Disorders of Muscle, Tendons, and Ligaments

Joint Disorders

Chapter Summary

Study Questions

Chapter 10 Blood and Circulatory System Disorders

Chapter Outline

Learning Objectives
 Review of the Circulatory System and Blood

Blood Dyscrasias

Neoplastic Blood Disorders

Vascular Disorders

Venous Disorders

Chapter Summary

Study Questions

Chapter 11 Lymphatic System Disorders

Chapter Outline

Learning Objectives

Review of the Lymphatic System

Lymphatic Disorders

Chapter Summary

Study Questions

Chapter 12 Cardiovascular System Disorders

Chapter Outline

Learning Objectives

Review of the Cardiovascular System

Heart Disorders
 Vascular Disorders

Shock

Chapter Summary

Study Questions

Chapter 13 Respiratory System Disorders

Chapter Outline

Learning Objectives

Review of Structures of the Respiratory System

General Manifestations of Respiratory Disease

Common Treatment Measures for Respiratory Disorders

Infectious Diseases

Obstructive Lung Diseases

Chronic Obstructive Pulmonary Disease

Restrictive Lung Disorders

Vascular Disorders

Expansion Disorders

Chapter Summary

Study Questions

Chapter 14 Nervous System Disorders

 Chapter Outline

Learning Objectives

Review of Nervous System Anatomy and Physiology

Functional Areas

General Effects of Neurologic Dysfunction

Acute Neurologic Problems

Congenital Neurologic Disorders

Seizure Disorders

Chronic Degenerative Disorders

Dementia

Mental Disorders

Spinal Cord Disorder

Chapter Summary

Study Questions

Chapter 15 Disorders of the Eyes, Ears, and Other Sensory Organs

Chapter Outline

Learning Objectives

Sensory Receptors

The Eye
 The Ear

Chapter Summary

Study Questions

Chapter 16 Endocrine System Disorders

Learning Objectives

Key Terms

Review of the Endocrine System

Endocrine Disorders

Insulin and Diabetes Mellitus

Parathyroid Hormone and Calcium

Pituitary Hormones

Thyroid Disorders

Adrenal Glands

Multiple Endocrine Neoplasia Type I

Chapter Summary

Study Questions

Chapter 17 Digestive System Disorders

Learning Objectives

Key Terms
 Review of the Digestive System

Common Manifestations of Digestive System Disorders

Basic Diagnostic Tests

Common Therapies and Prevention

Upper Gastrointestinal Tract Disorders

Disorders of the Liver and Pancreas

Lower Gastrointestinal Tract Disorders

Chapter Summary

Study Questions

Chapter 18 Urinary System Disorders

Learning Objectives

Key Terms

Review of the Urinary System

Structures and Anatomy

Incontinence and Retention

Diagnostic Tests

Diuretic Drugs

Dialysis

Disorders of the Urinary System

 Urinary Tract Obstructions

Vascular Disorders

Congenital Disorders

Renal Failure

Chapter Summary

Study Questions

Chapter 19 Reproductive System Disorders

Learning Objectives

Key Terms

Disorders of the Male Reproductive System

Disorders of the Female Reproductive System

Infertility

Sexually Transmitted Diseases

Chapter Summary

Study Questions

Section IV Factors Contributing to Pathophysiology

Chapter 20 Neoplasms and Cancer

Learning Objectives
 Key Terms

Review of Normal Cells

Benign and Malignant Tumors

Malignant Tumors: Cancer

Examples of Malignant Tumors

Chapter Summary

Study Questions

Chapter 21 Congenital and Genetic Disorders

Learning Objectives

Key Terms

Review of Genetic Control

Congenital Anomalies

Genetic Disorders

Developmental Disorders

Diagnostic Tools

Genetic Technology

Down Syndrome

Chapter Summary

Study Questions
Chapter 22 Complications of Pregnancy

Learning Objectives

Key Terms

Embryonic and Fetal Development

Physiologic Changes During Pregnancy

Potential Complications of Pregnancy

Chapter Summary

Study Questions

Chapter 23 Complications of Adolescence

Learning Objectives

Key Terms

Review of Changes During Adolescence

Obesity and Metabolic Syndrome

Musculoskeletal Abnormalities

Eating Disorders

Skin Disorders

Infection

Disorders Affecting Sexual Development

Chapter Summary
 Study Questions

Chapter 24 Complications of Aging

Learning Objectives

Key Terms

The Aging Process

Physiological Changes With Aging

Other Factors

Multiple Disorders

Chapter Summary

Study Questions

Section V Environmental Factors and Pathophysiology

Chapter 25 Immobility and Associated Problems

Learning Objectives

Key Terms

Factors Involving Immobility

Musculoskeletal System Effects

Cutaneous Effects

Cardiovascular System Effects

 Respiratory System Effects

Digestive System Effects

Urinary System Effects

Neurologic/Psychological Effects

Effects of Immobility on Children

Chapter Summary

Study Questions

Chapter 26 Stress and Associated Problems

Learning Objectives

Key Terms

Review of the Stress Response

Technostress

Stress and Disease

Chapter Summary

Study Questions

Chapter 27 Substance Abuse and Associated Problems

Learning Objectives

Key Terms

Overview
 Opioid Overdose Crisis

Terminology

Predisposing Factors

Environmental/Behavioral Risk Factors

Indications/Recognition of Abuse

Potential Complications of Substance Abuse

Chapter Summary

Study Questions

Chapter 28 Environmental Hazards and Associated Problems

Learning Objectives

Key Terms

Chemicals

Physical Agents

Biologic Agents

Chapter Summary

Study Questions

Appendices

Ready Reference 1

Ready Reference 2
 Ready Reference 3

Ready Reference 4

Ready Reference 5

Ready Reference 6

Ready Reference 7

Ready Reference 8

Ready Reference 9

Textbooks

Glossary

Index
S E CT I ON I

Pathophysiology: Background
and Overview
C H AP T E R 1

Introduction to Pathophysiology

Key Terms
anaerobic
apoptosis
autopsy
biopsy
endogenous
exogenous
gangrene
homeostasis
hypoxia
iatrogenic
idiopathic
inflammation
ischemia
lysis
lysosomal
microorganisms
microscopic
morphologic
necrosis
probability
pyroptosis
Chapter Outline
What is Pathophysiology and Why Study It?
Understanding Health and Disease
Concept and Scope of Pathophysiology
Beginning the Process: A Medical History
New Developments and Trends
Basic Terminology of Pathophysiology
The Disease Process
Etiology-Causes of Disease
Characteristics of Disease
Disease Prognosis
Introduction to Cellular Changes
Terms Used for Common Cellular Adaptations
Cell Damage and Necrosis
Case Studies
Chapter Summary
Study Questions

Learning Objectives
After studying this chapter, the student is expected to:

1. Explain the role of pathophysiology in the diagnosis and

treatment of disease.
2. Use the terminology appropriate for pathophysiology.
3. Explain the importance of a patient’s medical history.
4. Describe common cellular adaptations and possible reasons
for the occurrence of each.
5. Identify precancerous cellular changes.
6. List the common causes of cell damage.
7. Describe the common types of cell necrosis and possible
outcomes.
What Is Pathophysiology and Why Study It?
Pathophysiology involves the study of functional or physiologic
changes in the body that result from disease processes. This subject
builds on knowledge of the normal structure and function of the
human body. Disease development and the associated changes to
normal anatomy or physiology may be obvious or may be hidden
with its quiet beginning at the cellular level. As such,
pathophysiology includes some aspects of pathology, the laboratory
study of cell and tissue changes associated with disease.

Understanding Health and Disease

Disease may be defined as a deviation from the normal structure or
function of any part, organ, or system (or combination of these), or
from a state of wellness. Disease is a definite pathological process
with characteristic sets of signs and symptoms. The World Health
Organization (WHO) includes physical, mental, and social well-
being in its definition of health.
A state of health is difficult to define because the genetic
differences among individuals, as well as the many variations in life
experiences and environmental influences, create a variable base.
The context in which health is measured is also a consideration. A
person who is blind can be in good general health. Injury or
surgery may create a temporary impairment in a specific area, but
the person’s overall health status is not altered.
Homeostasis is the maintenance of a relatively stable internal
environment regardless of external changes. Disease develops
when significant changes occur in the body, leading to a state in
which homeostasis cannot be maintained without intervention.
Under normal conditions homeostasis is maintained within the
body with regard to factors such as blood pressure, body
temperature, and fluid balance. As frequent minor changes occur in
the body, the compensation mechanisms respond, and homeostasis
is quickly restored. Usually the individual is not aware of these
changes or the compensations taking place.
Steps to Health (Box 1.1) are recommended to prevent disease.

Box 1.1
S e v e n S t e p s t o H e a lt h

1. Be a nonsmoker and avoid secondhand smoke.

2. Eat 5 to 10 servings of vegetables and fruit a day. Choose
high-fiber, lower-fat foods. If you drink alcohol, limit your
intake to one to two drinks a day.
3. Be physically active on a regular basis. This will also help
you to maintain a healthy body weight.
4. Protect yourself and your family from the sun.
5. Follow cancer screening guidelines.
6. Visit your doctor or dentist if you notice any change in your
normal state of health.
7. Follow health and safety instructions at home and at work
when using, storing, and disposing of hazardous materials.

When one is defining “normal” limits for health indicators such

as blood pressure, pulse, or laboratory data, the values used usually
represent an average or a range. These values represent what is
expected in a typical individual but are not absolutes. Among
normal healthy individuals, the actual values may be adjusted for
factors such as age, gender, genetics, environment, and activity
level. Well-trained athletes often have a slower pulse or heart rate
than the average person. Blood pressure usually increases slightly
with age, even in healthy individuals. Also, small daily fluctuations
in blood pressure occur as the body responds to minor changes in
activity, body position, and even emotions. Therefore it is
impossible to state a single normal value for blood pressure or
pulse rate. It is also important to remember that any one indicator
or lab value must be considered within the total assessment for the
individual client.
Likewise, a discussion of a specific disease in a text presents a
general description of the typical characteristics of that disease, but
some differences in the clinical picture can be expected to occur in a
specific individual, based on similar variables.

Concept and Scope of Pathophysiology

Pathophysiology requires the use of knowledge of basic anatomy
and physiology and is based on a loss of or a change in normal
structure and function. Many disorders affecting a particular
system or organ (e.g., the liver) display a set of common signs and
symptoms directly related to that organ’s normal structure and
function. The interruption of the normal functioning of one organ
(or tissue) will affect other organ systems as well. For example,
when the liver is damaged, many clo ing factors cannot be
produced; therefore, excessive bleeding results. Jaundice, a yellow
color in the skin, is another sign of liver disease, resulting from the
liver’s inability to excrete bilirubin. Also, basic pathophysiologic
concepts related to the causative factors of a disease, such as the
processes of inflammation or infection, are common to many
diseases. Inflammation in the liver causes swelling of the tissue and
stretching of the liver capsule, resulting in pain, as does
inflammation of the kidneys. This cause-and-effect relationship,
defined by signs and symptoms, facilitates the study of a specific
disease.
To provide a comprehensive overview of disease processes, this
text focuses on major diseases. Other disorders are included when
appropriate to provide exposure to a broad range of diseases. The
principles illustrated by these diseases can then be applied to other
conditions encountered in practice. In addition, a general approach
is used to describe diseases in which there may be several subtypes.
For example, only one type of glomerulonephritis, a kidney disease,
is described in the text—acute poststreptococcal
glomerulonephritis, which represents the many forms of
glomerulonephritis.
Prevention of disease has become a primary focus in health care.
The known causes of and factors predisposing to specific diseases
are being used in the development of more effective preventive
programs, and it is important to continue efforts to detect
additional significant factors and gather data to further decrease
the incidence of certain diseases. The Centers for Disease Control
and Prevention (CDC) in the United States have a significant role in
collection of data about all types of disease and provide evidence-
based recommendations for prevention. Prevention includes
activities such as maintaining routine vaccination programs and
encouraging participation in screening programs such as blood
pressure clinics and vision screening (Box 1.2). As more community
health programs develop, and with the increase in information
available on the Internet, health care workers are becoming more
involved in responding to questions from many sources and have
an opportunity to promote appropriate preventive measures in
their communities. A sound knowledge of pathophysiology is the
basis for preventive teaching in your profession.

Box 1.2
P rim a ry , S e co n d a ry , a n d Te rt ia ry P re v e n t io n
Primary Prevention
The goal is to protect healthy people from developing a disease
or experiencing an injury in the first place. For example:

• Education about good nutrition, the importance of regular

exercise, and the dangers of tobacco, alcohol, and other drugs
• Education and legislation about proper seat belt and helmet
use
• Regular exams and screening tests to monitor risk factors for
illness
 • Immunization against infectious disease
• Controlling potential hazards at home and in the workplace

Secondary Prevention
These interventions happen after an illness or serious risk factors
have already been diagnosed. The goal is to halt or slow the
progress of disease (if possible) in its earliest stages; in the case of
injury, goals include limiting long-term disability and preventing
reinjury. For example:

• Telling people to take daily, low-dose aspirin to prevent a first

or second heart a ack or stroke
• Recommending regular exams and screening tests in people
with known risk factors for illness
• Providing suitably modified work for injured workers

Tertiary Prevention
This phase focuses on helping people manage complicated, long-
term health problems such as diabetes, heart disease, cancer, and
chronic musculoskeletal pain. The goals include preventing
further physical deterioration and maximizing quality of life. For
example:

• Cardiac or stroke rehabilitation programs

• Chronic pain management programs
• Patient support groups

From h p://www.iwh.on.ca/wrmb/primary-secondary-and-tertiary-
prevention.

While studying pathophysiology, the student becomes aware of

the complexity of many diseases, the difficulties encountered in
diagnosis and treatment, and the possible implications arising from
a list of signs and symptoms or a prognosis. Sophisticated and
expensive diagnostic tests are now available. The availability of
these tests, however, also depends on the geographic location of
individuals, including their access to large, well-equipped medical
facilities. More limited resources may restrict the number of
diagnostic tests available to an individual, or a long waiting period
may be necessary before testing and treatment are available. When
students understand the pathophysiology they can also be er
understand factors such as the disease manifestations, potential
complications, and finally develop appropriate treatments. A solid
knowledge base enables health care professionals to meet these
increased demands with appropriate information.
Individuals working in health care have found that many new
scientific developments have raised ethical, legal, and social issues.
For example, the explosion in genetic information and related
technologies has raised many ethical concerns (see Chapter 21). In
relatively new areas of research such as genetics and artificial
intelligence (including machine learning), discussion and
resolution of the legal and ethical issues lag far behind the
scientific advances. Health research is most often funded by
commercial sources (up to 80%, according to some studies), and
new breakthrough therapies are often announced before the start
of any clinical trials. This causes increased hope and immediate
demand for such treatments often as much as a decade before they
become available. Understanding the research process and the time
required for clinical trials of new therapies is crucial for answering
questions about new therapies.
The research process in the health sciences is a lengthy three-
stage process that aims to demonstrate both the safety and the
effectiveness of a new therapy:

• The first stage in this process is often referred to as “basic

science,” in which researchers work to identify a technology
that will limit or prevent the disease process. This stage is
carried out in the laboratory and often requires the use of
animals or cell cultures.
Discovering Diverse Content Through
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Title: Spacemen are born

Author: Bolling Branham

Release date: February 12, 2021 [eBook #64530]

Language: English

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*** START OF THE PROJECT GUTENBERG EBOOK SPACEMEN ARE

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 SPACEMEN ARE BORN

By BOLLING BRANHAM

Everyone knows that spacemen are born—not

made. But grav-bound Trase Barnes, No. 1 v.p.
of Air-Lines, Inc., bet his arrogant soul that
he could shoot Saturn's rings—and live.

[Transcriber's Note: This etext was produced from

Planet Stories May 1952.
Extensive research did not uncover any evidence that
the U.S. copyright on this publication was renewed.]
 O, Jewel of the Eastern Sky,
O, Mother of many things,
Bring home your sons to safety,
From the Stars to Saturn's rings....

Curse it, I am too old to go to space, and why can't I be content

with that?
Must I hear the spacemen's songs and the stories they tell, so that
the breath of romance aches each day in my bones? For here on
Earth's cool moon I am as close to the sky as I need be, and the sky
is close enough to me.
But those spacemen who go to Saturn—ah, they have viewed a
scene that exists nowhere else in all our universe, and I think they
delight in singing the Saturn "Home Song" in my ears and telling me
of the wonders of Saturn's skies.
For have you ever been to Saturn? No, you needn't go away, for in a
moment I'm going to tell the story of Trase Barnes. But in order to
understand him you've got to know about Saturn.
For, you see, you're coasting when you come in, riding with idling
jets, cutting in under the edge of the outside ring, into the darkness
away from the sun. On the fourth day you go between the big ring
and the crape, and then, when you look above you—you see one
magnificent reason why men go to space.
There's Saturn.
The God of Time, he is, and you're looking out over the flatness of
the rings at the yellow bulk of a planet, filling your sky ahead.
Yellow, streaked with purple streamers, fading away at the edges
into the blackness that is eternal space. Yes, fortunes have been
made and lost on trips to Saturn, but no one loses the memory of
how it looks when you shoot the rings.
Now about Trase Barnes....
Trase was born here on the Moon, right in the dispatcher's station,
with the pull of artificial gravity helping to push the blood around for
the first time in his little squalling body.
You know what gravity does for you? Of course, it's the reason that
today spacemen are a special breed. Back when every country was
racing to get the first rocket on the moon no one thought much
about gravity except how to nullify it.
But when the first men got out in space on the way to the moon,
they couldn't think much of gravity except how to get back to it.
They didn't get back, nor did the men on the next trip, nor the next
sixteen brave crews that darted off into the night sky with the
howling fire coming out below them. It was number 19 before they
found the trouble, for aboard it was the first crew member with
spacemen's ear—and don't we know now that spacemen are born?
Maybe you know they're born and not made, and maybe you don't
know why. I'll tell you then, cause my story isn't right without it.

Back when I was a kid in Tennessee, I used to raise a thousand

chickens every spring and never lost but a few. But there was one
chicken one year that I'll remember for the rest of my days. He
never was able to walk. From the time he was hatched he kept
falling on his face, or his behind, and rolling over and over, with the
other chickens walking on him. So one day I asked the Doc what
was wrong.
"No equilibrium," said the Doc, and now you know what that means!
Right inside his ear the canals were messed up, the canals where
the liquid rolls around, and this chicken didn't know which way was
up. Seems like he didn't have any liquid in there. No liquid at all.
Well, that's what makes a spaceman. A man with a normal ear, why
he knows which way is up or down, because the gravity pulls that
liquid around in there, and it rolls over those sensory hairs which
contact the brain with the latest information. But when the first
spacemen got out into space, there wasn't any gravity to pull the
liquid, and it charged around in there whichever way it felt like—up,
down, sideways, whichever way they moved their heads, and the
walls, sky, and world just whirled around. They all got sick; couldn't
see, couldn't eat, couldn't move. Most of the first rockets just passed
right on by the moon and went out into space, and those that didn't
just piled into it head on, with half-dead men lying at the controls.
But in number 19 there was a man who'd always had trouble with
his sense of balance, a man who fell easily and hit hard when he
went down. That man saved his crew. For when they got out in
space they got sick, like the other eighteen crews, but the other
man, he just heaved a sigh of relief, just looked out at the sky and
the stars and the great big universe of space, and his whole insides
cried, "This is for me!"
Yes sir, he was a spaceman-born—the first spaceman—and he
brought that ship back by himself to tell the world that spacemen
are born.
It was a funny thing too. For so many of the born spacemen are
weaklings, kids who never feel sure of themselves, who never can
play hard games because they're always falling down. Other kids
always made fun of them, but now these men came into their own.
They weren't at home on the earth, the moon, Mars, or any planet—
their home was the deep purple nothingness of space.
And they built our space colonies and have always run our space-
lanes.
But Trase Barnes wasn't one of them.
Like I say, Trase's father was a spaceman, a long thin giant of a man
who loved the sky and lived in it. Trase's mother was like his father,
a space-woman born, and they lived out there at No-Grav City, hung
there fifty thousand miles away from the moon, where spacemen
live without the heavy bonds of gravity.
But Mrs. Barnes came into the Moon-Station hospital to have her
baby, and naturally she hoped for a son—a spaceman-born. But
Trase was just as sound and healthy as an Iowa pig in October, and
he knew from the beginning which way was up and down. But how
he hated it!
When Trase's pa came back from a long haul out to Pluto—he'd been
gone a year and a half—and found out that Trase would never be a
spaceman, he broke into tears. Only time he ever cried.
Well, they lived with him and they raised him, here in the gravity of
the moon. His pa had to make a living, hitching space hulks back
and forth in the dark of the sky, but his ma was as kind as ever; she
just gritted her teeth and stayed in the gravity with him till he got
out of Moon-Station prep-school. They finally had another child, a
girl, who was a space-woman born. Now she's a woman pilot on a
Mercury to Venus run.

Oh, how Trase hated himself, and the world, and most of all the
gravity that bound his feet to the ground. His first wanderings were
out there to the space-port, where the spacemen in their gray
uniforms strolled easily about and swaggered before his eyes. There
were the mysterious vessels, crouched in their launching racks, their
skins shiny with the flow-sheen imparted to them by tremendous
speeds out in nothing. There were the gatherings of spacemen to
talk about the black, black side of Mercury, the pale corona of the
sun seen from Neptune, the thousands of square miles of flat green
moss on Venus, but mostly they talked of the purple and yellow
rings of Saturn, and the deep-breath feeling of space.
So Trase would go back to his school books and try to understand
arithmetic and geography, and his body would always be on time,
his physical being would say "present"—but his mind, ah, his mind
wandered a golden pathway among the glittering worlds of the sky.
His little fingers were deft and quick, and by the time he was ten he
had made a dozen space-models. There was a model of old number
19, crude, rough, and laughable, with its huge stepped rockets that
were dropped away to the rear on the way to the moon. There
beside his schoolbooks was the Adventurer II, first ship to go inside
Mercury's orbit and come back to tell the tale. His walls were lined
with pictures of such men as Rak Bartel, the laughing spaceman who
rescued the Wofford expedition from the wilds of Titan, and over
there was Colombo Dante, the pale little Indian half-breed who held
ten speed records around the solar system that are still unbeaten
today.
But under his pillow was the picture of Mortan Barnes, his father,
whose huge, thin face gave the appearance of looking wistfully at
the stars. Yet, it couldn't have been more wistful than the eyes of
Trase.
So Trase went on with his growing up, and they told him to study
medicine, so he gobbled up his chemistry, his biology, and
anthropology, but he studied space-math at night. By the time he
got out of prep-school he could work some astro-nav problems in his
head and knew the names, tonnages, and horsepower of the seven
hundred models of space vessels without so much as cracking a
book.
He read a story about a stowaway one day, and then he read it
again. It made his mind start to working and he began to say to
himself, "Maybe they're wrong about my ears. Maybe I would be a
good spaceman. If a man's got a mind to be a spaceman, looks like
he ought to be able to make himself do it, doesn't it?"
The space-station doctor spoke sympathetically. "No, Trase, there's
very little that can be done. An operation, maybe—but the only
doctor I know capable of performing such an operation is on Earth,
and it would cost thousands of dollars. No, Trase, be happy, can't
you? Most spacemen are not really happy. I think they really envy us
gravity-bound people, for they can't ever know a real home. Can't
you see the wistfulness in their faces and the haunted look deep
back in their eyes?"
Yes, Trase could see all that, but to him it was because they saw
things that no other man could see.
Trase didn't believe the doctor. He had to try it, so he smuggled
himself into an air-lock one day, grabbed an air-suit, and wandered
out on the ground of the moon.
Now the moon's got a little gravity, you know, but when Trase got
out of the artificial gravity of the Moon-Station, he began to run into
trouble. It was all right as long as he stood still, because the little
gravity of the moon would pull at the liquid in his ears. But if he
moved suddenly, why it would shake all around in there, and the
moon and the stars and the bright big Earth over there would whirl
in a blaze of light. Then Trase would wake up lying on his face with
his suit messed up from being sick.
So Trase figured out a method of training himself. "I'll show 'em," he
would groan through clenched teeth while the sky wheeled around
his head. "By the Great Big Bear I'll show 'em that a spaceman can
be made!"

His private method of training was to move in exaggerated slow

motion. To walk out on the rough ground of the moon and lift one
foot so-o-o slowly and carefully, with his eyes fixed on one tall, spiky
peak of the Appenines, and with the crust of Mare Imbrium staying
in place. He got where he could cover a mile or two in an earth-time
afternoon, never taking his eyes off the fix on the mountain peak,
never moving his head to catch a glimpse of the fiery trails of the
space vessels roaring off into the purple-blue sky.
And the magic catch-phrase would come like a chant from between
his twisted lips, "Spacemen are made ... spacemen are made!"
He really made a little headway. He got where he could move a little
faster and could occasionally take a quick glance upward at the
crystalline patchwork of the sky.
And what was that beautiful point of light out there?
Trase knew it was Saturn, and his eyes would be fixed upon it as a
final mount of redemption, as the supreme goal of a well lived
lifetime. He wheedled his way into the Moon-Station Astrodome and
hungrily gulped in the sight of the ringed planet canted there in the
scope view-finder. It was there! The rings were there, the huge
planet was there, but the scope only showed you enough to make it
just out of your reach; tantalizing, torturing—a pearl to melt through
your fingers when you reached for it.
"Hi'ya Saturn!" he would cry. "God of Time that you are, you've
waited a long time for me but I'll be there!"
Trase began going to the dispatcher's station, getting the schedules
of arrivals and departures and destinations, and figuring the orbits.
Then he could tell the exact time the space vessels were due to
shoot the rings at Saturn, or burst through the 1,100 mile space
between the crape ring and the middle one. Then he would be
sitting there at the scope, imagining that he could see a ship—a so-
small fleck of blackness skimming across the yellow of the watery
hulk of Saturn. That was the way he saw the blow-up of the
Andromeda, carrying a load of fissionable materials, when she burst
in a flash of white-hot energy in a collision with some hunks of jet in
the middle ring.
After he saw that, Trase walked home with something dead inside of
him, with his head quiet, his shoulders drooping, his heart sobbing
out the Saturn "Home Song" as he had heard his father sing it so
often. For his father had been master of the Andromeda.
Trase was the one who had to tell his mother, and she took it, dry-
eyed, for the first few minutes. But then she could stand it no longer,
and she flung herself at her tall son, lean and muscular, and sobbed,
"I'm glad you can't be a spaceman. I'm glad, I'm glad. It's a dirty
life, and your reward is a flashing death in a fire-pit."
Trase held her while she sobbed out her grief. He had to keep
swallowing down the lump in his own throat, but he could somehow
keep seeing that white-hot burst of flame framed before the God of
Time, and could imagine that his father's spirit was freed in the
space he had loved, out there where he could live on forever, gazing
on that magnificent scene.
After that, there wasn't any more studying medicine for Trase. He
had to go to work. Because of his aptness with figures he got a job
in the dispatcher's office as assistant calculator. It paid well, but
somehow it didn't mean so much any more, for Trase seemed to be
living in an emptiness greater than that of space. He clocked in and
clocked out each shift, and his error index was smaller than that of
any other clerk in the office. The other clerks used to look at him
and grunt, "There goes Trase Barnes—never a mistake. He's just as
infallible as the machine."
So he went up. Assistant calculator to calculator, to assistant
dispatcher to dispatcher. In seven years he was chief dispatcher and
in three more he ran the Moon-Station space-port. Twenty-nine
years old, vice-president of Air-Lanes, Inc., owned a block of
Marsopolis, Inc., stock, and had never been off the moon.
In later years, it kind of quit bothering him, except sometimes when
some of his pilots came in to make a report and they'd seen a
flashing meteor on Io, or had screamed through the blue, thin,
upper atmosphere of Jupiter—and they simply could not hide their
feelings in the language of official reports. At times like that, Trase
would sometimes slip on the air-suit, go through his old routine out
there on the forgotten dust of Mare Imbrium, and mutter his phrase
about "Spacemen are made!"
But it was just a ritual, just an escape, just a way of breathing an
occasional bit of life into an empty dream, and Trase knew it. Where
was that feeling of yesterday, that lift in his breast, that catch in his
throat, that wild calling from out there among the white stars that
made his legs tremble, his heart hammer, and his spirit cry out, "I'll
be there"?
Where, indeed, had the ghosts gone, those ghosts that fought so
bitterly the mound-bound vision of himself, sitting at his desk and
never leaving the moon?

Trase had just come in from one of those visits one afternoon when
Irinia Custer walked into his office unannounced, and caught him
there in an unlighted office, staring out at the constellations low on
the horizon.
Now, Irinia was almost a legend. Her reaction time was the fastest
of any pilot employed by Air-Lanes Inc. Her hardness and cynicism in
the face of danger, death, and the accepted ideals of life made top
story-telling material wherever spacemen gathered. She wouldn't
have needed to be beautiful, but on top of it all she was; for her
sensuous figure and black hair, with equally coal-black eyes, made
her wild beauty as legendary as her deeds. Yet Trase Barnes was
known to be twice as cold-blooded as she, an automaton who sent
pilots into danger with nothing but money in mind.
So Irinia eased quietly into Trase's office that afternoon, and there
the tough man sat, with his back to the door, staring out the huge
lucite port into the jewelled splendor of the clear night sky—seeing
the constellations that to Trase were as familiar as the walls of his
office.
Irinia stood quietly behind him for a moment, then she spoke. "So
the v.p. likes the stars," she breathed slowly, but her voice was not
scornful. "The big, moon-bound executive, with ice-water in his
veins, has got a spark of romance."
Trase turned to her slowly, a part of his mind still out there among
the stars where strange kings and queens fought for galactic
empires.
Irinia looked at him, at the expression on Trase's face, and then
suddenly she could read the whole story written there in plain
characters. Right there in his eyes she could see the soul of a
spaceman penned up in a moon-bound cage.
And suddenly Irinia Custer felt sorry for the hardness that was in her
spirit, sorry for her bitter, cynical attitude, sorry for the dirty,
laughing nicknames she had fashioned among space-crews for vice-
president Trase Barnes.
They looked at each other for a long time. Then Trase got out the
thick words slowly. "Well, I'm stuck, Irinia," he smiled. "You know
the way I feel—the secret's out, and I know you'll tell it."
Irinia started to talk, but something was lodged in her throat and her
mouth felt dry, strangely dry. She walked over to Trase and her
trembling hand reached out and touched the features of his face,
and the fierceness of what she felt inside her made her whole body
shake.
"Yes, I know, Trase," she breathed. "I know." Then suddenly she put
her head on his shoulder and cried.
Well, that's the way it goes, you know. The two toughest people in
spacing ran together, and it was like joining two ribbons of molten
steel. It was a love such as the Moon-Station had seldom seen, and
the talk ran through the space-lines like it had never gone before. It
had been bound to happen to Trase, yet all the worlds wept for the
two of them. Because everyone knew that nothing was worse than
for a spaceman or woman to be mated with a ground-bounder.
At first their happiness was untouchably supreme, and Trase walked
about in a kind of warm haze, deliciously aware of things he had
never before noticed—the pleasant coughing sound of a Moon-Dog
barking, the tinny clatter of dishes that rang out from the
Spacemen's Mess; all small things which never before had meaning,
but which now made him seem like part of the world.
Yet, it caught up with them, for they both knew that Irinia couldn't
give up space and Trase couldn't go to space. Or could he?
It got Trase to thinking. Hadn't there been something about a doctor,
or an operation ... maybe now he had the money to pay. He went
back to see the space doctor who told him that, and found that he
was dead. He asked other doctors and they told him that it was a
bunch of foolishness, that they had never known of a successful
operation of that type, that the only thing to remember was the
phrase, "Spacemen are born—not made."
Trase got kind of tired of hearing it, but no doctor would risk his
reputation on the operation.
So that was that.

Trase and Irinia talked it over; that is, as much as they could with
their throats kind of choked up, and they decided the only thing they
could do was to forget each other. Irinia could never be happy living
in gravity. So she went off to space again, and Trase just sat back at
his great carved oaken desk, looked out his lucite port, and
pondered.
Oh, that Trase was a thinker, and his thinking got faster and faster
as the days went by, and sometimes again he began to be seen on
an earth-time afternoon down on the flight line, watching the ships
come in and out. It was a place he hadn't frequented in years.
By the time Irinia got back on her trip from Deimos, his face was
hard—hard as the thought that was in his mind. He called Irinia to
come to his office. She didn't want to, because they had vowed
never to speak again, but somehow, from the tone of the note, she
had to come.
"O.K., veepee," she cracked, a frozen, bitter, mask of a smile on her
lips, "What've I done now?"
Trase said, "I'm going to space."
Irinia's face went white for a minute, but she knew her Trase—and
she knew argument was no good.
"Where?" she whispered.
"Saturn," Trase replied.
"Oh, no!" cried Irinia. "Not Saturn! It's the worst of them all."
"I know it is," Trase said. "That's the reason I want to go."
"You'll never come back alive," whispered Irinia. "If the sickness
doesn't get you, the rings will."
"Maybeso, Irinia. But I need your help. I've got plans and I need
you. If I make this trip, maybe I can make others. Maybe ... maybe I
can prove that spacemen can be made. But if I can't make it without
sickness, I promise you I'll never bother you or ask anything of you
again."
"But what are your plans, Trase?"
"Drugs, first, Irinia. Progressive slackening off, and attempted self-
induced hypnotism. Small artificial gravity unity, enough to create
about a tenth of earth gravity. I think I can do it, Irinia."
"But it's all been tried before, Trase, and it's never worked! You
know that—it's deeply psychological as well as physical. You can't do
it simply by wanting it!"
Trase looked long and hard at her. His smile was almost ghastly. "Life
is worth nothing to me unless I try it, Irinia," he said quietly.
So that did it. Trase cashed in his stock in Air-Lanes, bought a ship
and they went to work on it. He couldn't get a first-rate crew
because the news got around about what they were trying to do,
and no self-respecting spaceman would have anything to do with it.
But there were drifters to be had.
They blew off in the middle of the two-week moon night, the
polyglot crew grazing the space-station dome, and setting off ten
degrees off course, with Trase strapped in his bunk and drugged into
unconsciousness, and Irinia cursing the crew in pure venom they
had never heard before.
And that, essentially, was the way the trip went. Irinia never
weakened and by the time they were two months out she had the
crew almost to a state of discipline.
Of course, drugs had been tried before—they were the method used
to transport non-space-born passengers between the Earth and the
moon. Irinia fed Trase intravenously. At the end of the two months
she turned on the puny artificial gravity system and let him come
awake.
His first words were, "Where's Saturn?"
"O, Trase, we haven't even got well started yet," Irinia cried.

Trase came awake. He tried to sit up in his bunk, and fell out lightly
on the floor with his whole insides heaving. Irinia dosed him up
again and toyed with the idea of turning back. But Trase was in good
health, so she decided to go on. At the end of the third month, Trase
found that he could lie flat on his back in his bunk with eyes
blindfolded, and with no movement at all. This way he could stay
awake at stated intervals, as long as there was no change in course
or velocity.
Oh, the beauty of open space! Though he couldn't get out of his
bunk to see it, Trase knew that they were way out in the middle of
nowhere, and Irinia would come around to tell him about it.
The time passed, and then Saturn began gradually to fill the screen
of the ship's vision-plate, and Irinia began to worry. For to shoot the
rings required plenty of deft acceleration and deceleration, and Irinia
knew that Trase couldn't stand the maneuvering.
"How about just a look at Saturn from a distance, Trase?" Irinia
would ask.
"We've got to shoot the rings," he would reply grimly.
So Irinia knew he wouldn't be satisfied with anything less, and she
went busily about the procedure of lining up the polyglot crew for
the ring-shooting.
At fifty million miles from Saturn she fired two small braking blasts,
and Trase cried out from his bunk and was sick again. She ran back
to him and said, "Oh, Trase, let me drug you till we get there."
His white suffering face showed clenched teeth. He grabbed her arm
and said, "I'll make it, Irinia, I'll make it. Just let me know when the
view gets good."
So she let him alone and went about the business of braking. She
heard no more groans from Trase. But when she went back to see
him, there he would be with his hands gripped until the knuckles
showed white, with the bedclothes gripped between his teeth. "I'll
make it, Irinia," he would gasp. Then sometimes she would hear him
cry, "I'll be there, God of Time, I'll be there!"
Space-sickness and nausea.... Those it doesn't kill generally try to kill
themselves.
Well, from fifty million miles it's a four-day trip to shoot the rings and
get started away again, and there was Trase with the universe
spinning around his ears, suffering as much as anyone can suffer.
They went in under the darkness of the huge outside ring, for the
rings were canted at that time almost their total 28 degrees to the
ecliptic.
And then out of the misery and the eons of suffering Trase suddenly
heard a voice, "Trase! Trase! Come to the Astrodome, we're shooting
the rings! Trase, we're shooting the rings!"
Trase prayed. His hands reached out for the bunk straps and he felt
Irinia helping him. He had long ago lost everything on his stomach
but the world whirled in a wild clanging clatter of craziness and he
had to be guided along the passageway.
"I can't make it!" he cried at once, and Irinia had to drag him back
to his feet, and then he said, "Yes, I can—I'll be there."
Well, that was the way Trase made it. His clothes reeking with his
sickness, his body wasted away from inaction, his eyes dimmed and
glazed over from suffering, his face a mask of thin ferocity from his
determination. But he made it.
There's Saturn, Trase.
He looked out over the burning brilliant flatness of the crape ring to
the huge yellow hulk of the God of Time towering over him. The
light and majesty of what he saw swam to his brain out of the fogs
of bitterness that had shrouded his soul and he saw it—one
magnificent reason why men go to space.
Personal Saturn, unreachable Saturn ... yellow, streaked with purple
streamers, fading away at the edges into the blackness that is
eternal space. From there at the edge of the crape ring it is as
though you were standing on a plain of golden dust, staring up into
the face of destiny. The features of the face are plain, formed out of
the whirling evanescent colors of the gases whipped around on the
surface by cyclonic winds. You can see rainbows and pots of gold
fashioned and then whipped away to change to greater things. The
breath of eternal mystery blows on the spirit, and spacemen say you
can see anything you desire.
The ship lurched this way and that as the jets kept it on its course,
and Trase suddenly realized that the sickness had dropped away
from him like a fetter. The ship headed back towards Titan for a
refueling stop, but Trase sat there and stared at Saturn until the
Astrodome got around to the front and the jet trails obscured the
view at the rear. He was not sick while he looked at Saturn.
His clear-headedness lasted about half-an-hour. Then Trase got sick
again. He was sick for a day and a half, until the ship began to come
in on Titan.
But the drifter crew had hid out some Mercurian liquor and got
drunk before landing. They failed to cut the jets. Irinia cursed until
the spaceship bulkheads turned red hot, but she fell and knocked
herself out running down from the pilot's compartment to the
engine-room. And so there was the ship headed wide-open into
Titan with the crew drunk, Irinia unconscious, and Trase dead-sick in
his bunk.
Well, you'll know now that Trase saved the day. He began to think of
Saturn as he had seen it. He staggered down to the engine-room,
cut the jets, then ran up to the pilot's room where the rough surface
of Titan stared him in the face. And he wasn't sick while he thought
of Saturn.
The ship cracked up but nobody was killed. They hadn't been able to
get any insurance with an unlicensed crew, so that left Trase flat-
broke. He wasn't a veepee anymore since he had no stock in Air-
Lanes, and Irinia got fired for taking the extended leave.
So things were kind of tough for a while, but.... Where are they
now? Oh, you know, you've heard all about it. They found a backer,
and now they're out on Pluto with a space-drive job, getting ready to
set out for Centauri. And Trase has never been sick again.
What does it prove?
Well, see those words written right there over the entrance to the
spacemen's mess? Those are the words Trase used when they pulled
him out of the wreck on Titan. I'll read them for you. "I've seen
Saturn! And to you who have seen it, I don't need to say whether
spacemen can be made. To others, to millions of youngsters who
want to be spacemen, I'll say now that spacemen are born. But to
each of them I'll say this—If you want to be a spaceman, you don't
need a spaceman's ear, all you need is a spaceman's soul."
So the spacemen took that and added another verse to the Saturn
"Home Song," and it's the one that really makes me hurt because I
can't go to space again. Sometimes late at night I hear them singing
it from far out on the field when a crew is coming in off a run, and
that's when I know you can't stop them. You can't stop the born
spacemen until they reach the stars. The verse goes like this:

Oh, Saturn, the God of Time,

May your majesty never fade.
For your beauty is final proof,
Spacemen are born not made.
 *** END OF THE PROJECT GUTENBERG EBOOK SPACEMEN ARE
BORN ***

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