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Study Guide For Pathophysiology The Biological Basis Disease in Adults and Ebook PDF Version
Study Guide For Pathophysiology The Biological Basis Disease in Adults and Ebook PDF Version
Pathophysiology
The Biologic Basis for Disease in Adults and Children
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Study Guide for
Pathophysiology
The Biologic Basis for Disease in Adults and Children
Seventh Edition
Kathryn L. McCance
Sue E. Huether
Prepared by:
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted 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, except that, until further notice, instructors requiring their
students to purchase Study Guide for Pathophysiology by Kathryn McCance and Sue Huether, may reproduce the
contents or parts thereof for instructional purposes, provided each copy contains a proper copyright notice as
follows: Copyright © 2013 by Butterworth Heinemann, an imprint of Elsevier Inc.
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information or
methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most
current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be
administered, to verify the recommended dose or formula, the method and duration of administration, and
contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of
their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient,
and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the
material herein.
The study of pathophysiology can be an exciting process. n Complete These Sentences: Filling in the blanks re-
What happens in the tissues to cause the redness and quires more knowledge than simply recognizing words.
swelling of inflammation? What happens in the heart dur- n Draw Your Answers: Explaining a concept or process
ing a heart attack? Why do people who have a specific by drawing it requires mental processing of ideas that
disease display characteristic signs and symptoms? How enables people to remember them for future use.
might the same disease process be different in children, n Order the Steps: Putting the parts of a pathophysio-
adults, and older adults? logic process into their correct sequence facilitates
This study guide is written to accompany the seventh learning to explain them, a higher order skill.
edition of Pathophysiology: The Biologic Basis for Dis- n Explain the Pictures: Directed toward visual learners,
ease in Adults and Children by Kathryn L. McCance and these questions build explaining and integrating skills.
Sue E. Huether. In a logical progression, the textbook n Categorize These: Choosing the category into which
begins with the central concepts of pathophysiology at items belong requires understanding them and assists
the cellular and tissue level, followed by pathophysio- with differentiating between them.
logic processes at the organ and system levels. This study n Describe the Difference: These questions build the
guide follows that logical progression. For example, it skill of comparing and contrasting, an excellent way to
assists with building a working knowledge of what hap- learn about similar items without confusing them.
pens in the tissues during inflammation before addressing n Teach These Patients about Pathophysiology: Unique
questions regarding heart attacks and other pathophysi- to this study guide, these teaching activities provide the
ologies at the organ and system level. opportunity to learn pathophysiology at the level of
The study guide follows the organization of the text- explaining rather than rote recall.
book, with 49 chapters. Each chapter contains a variety n Case Scenarios: Patient examples with questions assist
of activities that develop several cognitive skills, moving with application and integration of knowledge in real-
from the basic skills of learning definitions and acquiring world settings.
knowledge to the higher-level skills of explaining, appli- As a whole, the activities in each study guide chapter
cation, and integration of knowledge. Here are examples build a sequence of cognitive skills that facilitate mastery
of these activities: of pathophysiology at the application level needed for
n Match the Definitions: An understanding of definitions clinical practice.
provides the foundation for higher-level knowledge. Working with Karen Turner and Sandra Clark at Elsevier
n Puzzle Out These Technical Terms: Occasional has been delightful. I appreciate their receptiveness to my
crossword puzzles assist with learning technical terms. ideas and their enthusiasm for this project.
n Choose the Correct Words: Recognizing the correct I dedicate this study guide to my past, present, and
word that belongs in a sentence reinforces basic knowl- future students.
edge acquisition. Linda Felver
REVIEWERS
Instructors Student
Nancy M. Burruss, PhD, RN, CNE Gillian Claire Meyers
Associate Professor BS in Genetics
School of Nursing Nursing Student
Belling College Oregon Health and Science University
Green Bay, Wisconsin Portland, Oregon
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Preface
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Contents
vii
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Contents
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UNIT ONE THE CELL
1 Cellular Biology
Match the cellular functions below with their location in the picture. Hint: Identify the structure first and then consider
its function.
H
G
C
F
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 1 Cellular Biology
���� 5. Synthesizes steroid hormones
10. What is the difference between the nucleolus and the nucleus?
14. Proteins in the nucleus that bind DNA and help regulate its activity are called _______________.
15. Cells such as neutrophils that use hydrogen peroxide as a defensive weapon synthesize it in their _______________.
16. A section of a membrane that is rich in cholesterol and helps organize membrane proteins is called a _______________
_______________.
17. The cells that secrete the extracellular matrix are called _______________.
18. The mechanical force of water pushing against cellular membranes is called _______________ pressure.
19. An _______________ solution has the same osmolality as normal body fluids.
Chapter 1 Cellular Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
20. In a simple epithelium, the epithelial cells are in contact with a _______________ membrane that provides support.
21. _______________ tissue is characterized by only a few cells surrounded by a lot of extracellular matrix.
23. Write the letters here in the correct order of the steps: _______________________________
A. Sodium ions move into the cell.
B. Potassium ions leave the cell.
C. Sodium permeability increases.
D. Resting membrane potential is reestablished.
E. Potassium permeability increases.
Circle the correct word from the choices provided to complete these sentences.
24. The main difference between cells that divide rapidly and those that divide slowly is the amount of time they spend
in the (S, G1) phase of the cell cycle.
25. Cells develop specialized functions through the process of (differentiation, intermediary metabolism).
26. A particle that is dissolved is called a (solvent, solute), and the medium in which it is dissolved is called the (solvent,
solute).
28. During osmosis, (particles, water molecules) move across the plasma membrane.
29. (Autocrine, Paracrine) signals act on nearby cells by (diffusion, active transport) through interstitial fluid.
30. A cell that has an insufficient oxygen supply will not be able to perform the chemistry of (the Krebs cycle,
glycolysis).
31. (Active transport, Facilitated diffusion) can move substances against their concentration gradients.
32. Receptors are (proteins, lipids) that bind specific small molecules.
Test your understanding by defining each term using your own words.
33. Ligand
34. Caveolae
35. Mechanotransduction
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 1 Cellular Biology
36. Amphipathic molecule
37. Endocytosis
For each situation, choose the direction that the items will move. Choose A or B from the figure.
���� 38. If the ECF becomes hypotonic, in which direction will water move?
���� 39. If the concentration of substance X in the ECF is higher than its concentration inside the cell, in which direc-
tion will active transport move substance X?
���� 40. If the glucose concentration in the ECF is higher than its concentration inside the cell, in which direction will
facilitated diffusion move glucose?
���� 41. In which direction does Na1, K1-ATPase move sodium ions?
���� 42. In which direction does Na1, K1-ATPase move potassium ions?
43. A mutation affecting what function would cause a lysosomal storage disease?
44. How does the presence of gap junctions in cardiac muscle facilitate cardiac function?
45. Explain why intracellular receptors do not use second messengers, but many cell surface receptors do.
46. What happens during the interphase portion of the cell cycle? Why are those events important?
Chapter 1 Cellular Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
2 Altered Cellular and Tissue Biology
Match the word on the right with its definition on the left.
���� 2. Unintentional decrease of core body temperature below 35° C B. Free radical
(95° F)
���� 3. A type of cellular housekeeping in which a cell digests some of C. Livor mortis
its own components
���� 4. Area of cell death in which dead cells disintegrate, but the D. Accidental hypothermia
debris is not digested completely by enzymes
���� 5. Area of cell death in which denatured proteins appear firm and E. Rigor mortis
opaque
���� 8. Cell death that involves orderly dismantling of cell components H. Caseous necrosis
and packaging the remainders in vesicles
Write the type of cellular adaptation beside its clinical example. Possible choices: atrophy, hypertrophy, hyperplasia,
metaplasia.
�������������� 9. Lining of uterus thickens after ovulation because of increased amounts of estrogen.
�������������� 10. Man who lifts weights regularly develops larger biceps.
�������������� 12. Columnar epithelium in bronchi of cigarette smoker is replaced by stratified squamous
epithelium.
�������������� 13. Captain of roller derby team has greater thigh diameter on left than right from skating
clockwise.
�������������� 14. Left calf is smaller than right calf when cast is removed from it.
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 2 Altered Cellular and Tissue Biology
CHOOSE THE CORRECT WORDS
Circle the correct word from the choices provided to complete these sentences.
16. Cell death by (necrosis, apoptosis) causes inflammation, but cell death by (necrosis, apoptosis) does not.
18. Release of (potassium, calcium) ions from intracellular stores into the cytoplasm during ischemia damages the cell.
19. Compared with normal aerobic metabolism, cells that use anaerobic metabolism produce (more, less) ATP and
(more, less) lactic acid.
20. The most important way to prevent medication-related poisoning deaths in children is safe (storage, prescribing) of
medications.
21. Reactive oxygen species, such as (superoxide radicals, superoxide dismutase), damage cells by attacking their
(potassium, membranes).
26. What is the difference between dystrophic calcification and metastatic calcification?
27. What is the difference between a penetrating gunshot wound and a perforating gunshot wound?
Chapter 2 Altered Cellular and Tissue Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
ORDER THE STEPS
Beginning with the acute obstruction of a coronary artery, sequence the events that occur during necrosis of a myocardial cell.
28. Write the letters here in the correct order of the steps: _______________________________
A. ATP supply decreases within the cell.
B. Acute obstruction of coronary artery cuts off arterial blood supply to myocardium.
C. Cell runs on anaerobic metabolism because of lack of oxygen.
D. Cell bursts and spills its contents into the interstitial fluid.
E. Active transport of ions across the cell membrane slows.
F. Lysosomal enzymes destroy components of their own cell.
G. Osmosis causes cell swelling, and calcium accumulates in the cell.
H. Organelles, including lysosomes, swell and rupture.
29. Active enzymes that dismantle the cellular components during apoptosis are called _______________.
30. Acute cellular swelling during ischemia is reversible if _______________ is supplied quickly.
31. Active tuberculosis disease is characterized by _______________ necrosis, whereas death of brain cells is character-
ized by _______________ necrosis.
32. During apoptosis, cell contents are contained in vesicles called _______________ _______________, which are
removed by _______________.
33. Liver enzymes metabolize most blood ethanol to _______________, which damages tissues.
34. When excessive reactive oxygen species overwhelm the endogenous antioxidant systems, _______________
_______________ occurs.
36. Melanin is synthesized by epidermal cells called _______________ and accumulates in epidermal cells called
_______________.
Place yourself in these situations and write your responses in the spaces provided.
37. Mr. Turin had severe crushing injuries of both lower extremities when his house collapsed on him during an earth-
quake. Among other abnormal values, his laboratory tests show elevated creatine kinase in his blood. Why is his
blood creatine kinase high?
38. Mrs. Montoya died peacefully in her sleep at home while lying prone. When her relatives discovered her body and
rolled her over, they saw purple discoloration of half of her face and of her abdomen. They are very concerned that
she might have been beaten the night before she died. What factual information do they need to relieve their concern?
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 2 Altered Cellular and Tissue Biology
39. The entire Berg family was in the hospital room when Mrs. Berg died quietly from terminal cancer. As the family
is preparing to leave, Kevin Berg, age 10, says to his mother, “I don’t think grandma is really dead. She’s just sleep-
ing. Dead people are stiff as boards. I saw that on TV. Grandma’s hands are cold, but her arms aren’t stiff.” His
mother looks at the nurse for help. In addition to addressing the emotional issues, what factual information should
be provided?
40. Two of your colleagues are discussing the effects of reactive oxygen species on cells. “Too many ROS cause necro-
sis,” says one. “But I read that too many ROS cause apoptosis,” says the other. What information should be explained
to them to clarify that both are correct?
These are normal cells that are capable of cell division and normally receive basal levels of hormonal stimulation.
Normal
(From Lewis SM, Heitkemper MM, Dirksen SR: Medical-surgical nursing: assessment and management
of clinical problems, ed 6, St Louis, 2004, Mosby.)
41. Draw what these cells would look like after their hormonal stimulation has been reduced substantially for several
weeks.
42. Draw what these cells would look like after receiving excessive hormonal stimulation for several weeks.
Which of the following are characteristic of apoptosis? You may select more than one answer. Choose all that apply.
Chapter 2 Altered Cellular and Tissue Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
TEACH THESE PEOPLE ABOUT PATHOPHYSIOLOGY
44. Kenesha Francis, age 9, broke her arm 6 weeks ago, and the cast will be removed today. Before the cast is removed,
teach her about the expected appearance of her arm in words appropriate to her age.
45. “The doctor said my heart enlarged because my blood pressure is high,” says Mr. Hendricks. “Please explain that!”
46. Mr. Bax has diabetes and will have amputation of toes shown in the photograph.
(From Damjanov I: Pathology for the health professions, ed 4, Philadelphia, 2012, Saunders.)
He says, “Why did my toes get black and hard rather than swollen and mushy like my dad’s toes did before surgery?”
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 2 Altered Cellular and Tissue Biology
PUZZLE OUT THESE TECHNICAL TERMS
Use the clues to complete the puzzle, demonstrating your knowledge of important technical terms.
1 2
7 8
10
11
Across Down
1. Adaptive increase in the number 1. Adaptive increase in cell size
of cells 2. Adaptive decrease in cell size
7. Shrunken nucleus appearing as a 3. Loss of skeletal muscle mass and strength
small dense mass 4. Lack of oxygen to tissues caused by insufficient blood supply
10. Adaptive replacement of one ma- 5. Goes with mortis to denote postmortem reduction of body temperature
ture cell type by another normal 6. Abnormal change in size, shape, and organization of mature tissue cells
cell type 8. Nuclear dissolution and lysis of chromatin
11. Yellow-brown age pigment 9. Partial deprivation of oxygen
10
Chapter 2 Altered Cellular and Tissue Biology Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
The Cellular Environment: Fluids and
3 Electrolytes, Acids and Bases
Circle the correct word from the choices provided to complete these sentences.
1. The osmolality of the intracellular fluid normally is (higher than, the same as, lower than) the extracellular fluid
because water crosses cell membranes (with difficulty, freely) through aquaporins.
3. Thirst prompts fluid intake through action of (baroreceptors, osmoreceptors) located in the (hypothalamus, posterior
pituitary).
5. Renal compensation for an acid-base balance is (fast, slow); pulmonary compensation for an acid-base balance is
(fast, slow).
6. Fluid moves out of capillaries by (osmosis, filtration) and into or out of cells by (osmosis, filtration).
8. The most dangerous effect of hyperkalemia is its action on the (kidneys, heart).
Write the major cause of the edema beside each clinical situation. Possible choices include: increased capillary hydro-
static pressure, decreased plasma oncotic pressure, increased capillary permeability, lymphatic obstruction.
16. Who has a greater percentage of body weight as water: a lean woman or an obese woman?
17. Who has a greater percentage of body weight as water: an infant or an adolescent?
18. Who has a greater percentage of body weight as water if both persons weigh the same: a woman or a man?
11
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases
19. Who has a greater percentage of body weight as water if both persons weigh the same: a 56-year-old man or a
78-year-old man?
20. Where is the potassium ion concentration greater: extracellular fluid or intracellular fluid?
21. Where is the sodium ion concentration greater: extracellular fluid or intracellular fluid?
23. Which is greater: the respiratory rate during metabolic acidosis or the respiratory rate during metabolic alkalosis?
Na+ Na+
H2O H2O Na+
H2 O
Na+ H2O
Na+
Na+ Na+
Na+
Na+
Na+ H2O
H 2O Na+ Na+
24. Compare the sodium concentration in panels A and B. Panel B shows isotonic fluid, so the fluid in A
is ______________, and the fluid in C is ______________.
26. What cerebral clinical manifestations occur when neurons swell as in panel A?
27. Why are the cerebral clinical manifestations of the situation in panel C very similar to those in panel A?
12
Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
CHARACTERIZE THESE HORMONES
Write one letter and one number by each hormone in the left column to indicate the stimuli that increase its secretion
and its physiologic effects when secreted.
Choose the Stimuli that Increase Choose the Physiologic Effects of the
Hormone Secretion of the Hormone Hormone
���� 28. Aldosterone A. High plasma calcium 1. Increases renal sodium and water excretion
���� 29. Parathyroid B. Increased plasma osmolality, 2. Increases renal sodium and water reabsorp-
hormone substantially decreased arterial tion; increases renal excretion of potassium
blood pressure and hydrogen ions
���� 30. Atrial natriuretic
peptide C. Low plasma calcium 3. Increases resorption of bone; stimulates
renal reabsorption of calcium; inhibits
���� 31. Calcitonin D. Increased volume in the cardiac renal reabsorption of phosphate
atria
���� 32. Antidiuretic 4. Increases renal water reabsorption, vaso-
hormone E. Angiotensin II, increased plasma constriction
potassium
5. Inhibits osteoclasts in bone
33. What is the difference between interstitial fluid and extracellular fluid?
34. What is the difference between a volatile acid and a nonvolatile acid?
36. With regard to an acid-base imbalance, what is the difference between correction and compensation?
13
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases
COMPLETE THESE SENTENCES
37. One third of body water is in the _______________ fluid, and two thirds is in the _______________ fluid.
38. A standard 68-kg man has _____ liters of total body water.
40. An _______________ fluid has the same concentration of solute as the plasma.
41. A person who has a lung disease may develop a primary _______________ acid-base imbalance, but a person who
has a kidney disease may develop a primary _______________ acid-base imbalance.
42. When the blood pH is 7.40, the bicarbonate-to-carbonic acid ratio is _______________.
44. Calculating the anion gap may help to distinguish between different causes of metabolic _______________.
45. Overuse of phosphate-containing over-the-counter enemas can cause _______________, which in turn will
_______________ the plasma calcium concentration.
Write one letter and one number by each patient situation in the left column to indicate the imbalance(s) for which that
patient has high risk and the assessment findings for the imbalance(s).
��� 46. Mrs. Singh takes glucocor- A. Isotonic fluid deficit, hypokalemia, 1. Paresthesias of fingers, lighthead-
ticoids for a chronic metabolic alkalosis edness, confusion
disease.
B. Isotonic fluid excess and 2. Slow, shallow respirations; blood
���� 47. Mr. Wiggins has been sob- hypokalemia pH less than 7.35; blood Paco2
bing and breathing deeply increased
and rapidly for an hour C. Hypercalcemia
since his wife died. 3. Dependent edema, weight gain,
D. Respiratory acidosis distended neck veins when upright,
���� 48. Mr. Jenkins is comatose skeletal muscle weakness, consti-
from a heroin overdose. E. Respiratory alkalosis pation, abdominal distention
14
Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
CHOOSE THE DIRECTION
For each situation, choose the direction that the items will move.
Possible answers:
55. Mr. Sheehan has bilateral ankle edema from congestive heart failure. “Are my ankles inflamed?” he asks. “I know
that inflammation causes swelling.”
56. Mrs. Kiley, who is taking care of her husband at home after his hospitalization for a stroke, was told to call the doc-
tor if Mr. Kiley develops dependent edema. She says, “I know what edema looks like, but where is dependent edema
located?”
57. Mr. Janus, who is having his first renal dialysis session, says, “I know that my failed kidneys cannot excrete acids,
but I did not eat any acids, so why did I get metabolic acidosis?”
58. Ms. Winsom, age 16, has diabetic ketoacidosis. “Why is she breathing so fast?” asks her father. “Does she have
pneumonia as well as diabetes ketoacidosis?”
15
Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc. Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases
59. “Tell me the most common fluid, electrolyte, and acid-base imbalances in oliguric renal failure patients,” says a
nurse. “I am being sent to help on the renal unit this morning.”
CASE SCENARIO
Read the case scenario and answer the questions to explore your understanding of fluid, electrolyte, and acid-base
imbalances.
Mrs. Tanaka, age 76, was brought to an urgent care facility because she fell when she stood up
after sitting all afternoon in her apartment, where she lives alone. Although slow to answer questions,
Mrs. Tanaka states she has muscle weakness, muscle cramping, and constipation. She has had
diarrhea for 3 weeks. Physical examination with Mrs. Tanaka supine revealed flat neck veins, HR
102, pulse regular but weak, BP 90/56, respirations 20/min and deep. The on-site clinical laboratory
provided these results: serum sodium 142 mEq/L, potassium 2.8 mEq/L.
60. What fluid imbalance does Mrs. Tanaka have? _______________ What data support that?
61. What imbalance is indicated by her laboratory results? _______________ What other clinical manifestations are
consistent with that imbalance?
62. What additional electrolyte imbalance(s) might Mrs. Tanaka have? Provide supporting data.
63. Mrs. Tanaka may have an acid-base imbalance. Which one? _______________ What aspects of her history and
clinical presentation support that?
64. Mrs. Tanaka was given intravenous isotonic sodium chloride, with appropriate electrolytes in it. What was the
purpose of administering that particular fluid?
16
Chapter 3 The Cellular Environment: Fluids and Electrolytes, Acids and Bases Copyright © 2015, 2010, 2006, 2002, 1998 by Mosby, an imprint of Elsevier Inc.
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DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI
I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.