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 Contents vii

Germline Mutations and Pancreatic Cancer . . . . . . . 268 Protective Reproductive Factors and Ovarian
Somatic Mutations in Pancreatic Cancer . . . . . . . . . . 269 Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Epigenetics of Pancreatic Cancer. . . . . . . . . . . . . . . . . . 269 Oral Contraceptives and Ovarian Cancer. . . . . . . . . . 306
Obesity, Diabetes Mellitus Type 2, Screening for Ovarian Cancer. . . . . . . . . . . . . . . . . . . . . 306
and Pancreatic Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . 269
Islet Cell Tumors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270 Chapter 23 Epidemiology of Cancer of
Prevention of Pancreatic Cancer . . . . . . . . . . . . . . . . . . 270 the Corpus Uteri: Endometrial
Cancer, Uterine Sarcoma,
Chapter 20 Epidemiology of Primary and Choriocarcinoma . . . . . . . . . . 309
Liver Cancer: Hepatocellular Global Impact of Cancer of the Corpus Uteri . . . . . . 309
Carcinoma and Malignant Tumors of the Corpus Uteri . . . . . . . . . . . . 311
Cholangiocarcinoma. . . . . . . . . . . 273 Endometrial Cancer Versus Cervical Cancer:
Cellular Origins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Liver Function and Anatomy. . . . . . . . . . . . . . . . . . . . . . 273
Trends in Endometrial Cancer. . . . . . . . . . . . . . . . . . . . . 312
Hepatocellular Carcinoma
and Cholangiocarcinoma. . . . . . . . . . . . . . . . . . . . . . . 274 Endometrial Cancer: Postmenopausal
Age of Onset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313
Hepatocellular Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . 274
Subtypes of Endometrial Cancer. . . . . . . . . . . . . . . . . . 313
Cholangiocarcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281
Models of Endometrial Carcinogenesis. . . . . . . . . . . . 313
Chapter 21 Epidemiology of Risk Factors for Endometrial Cancer. . . . . . . . . . . . . . . 315
Breast Cancer. . . . . . . . . . . . . . . . . 287 Summary: Epidemiology of Endometrial
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
Anatomy and Function of the Epidemiology of Choriocarcinoma. . . . . . . . . . . . . . . . 322
Mammary Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287
Global Burden of Breast Cancer. . . . . . . . . . . . . . . . . . . 287 Chapter 24 Epidemiology of Cervical
Breast Cancer Detection, Staging, Cancer. . . . . . . . . . . . . . . . . . . . . . . 327
and Survival. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Pathology of Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . 289 Global Burden of Cervical Cancer . . . . . . . . . . . . . . . . . 327
Mechanisms of Breast Carcinogenesis. . . . . . . . . . . . . 290 Early Detection of Cervical Dysplasia. . . . . . . . . . . . . . 327
Risk Factors for Breast Cancer . . . . . . . . . . . . . . . . . . . . . 290 Pathogenesis of Cervical Cancer . . . . . . . . . . . . . . . . . . 329
Body Mass and Postmenopausal Breast Risk Factors for Cervical Cancer . . . . . . . . . . . . . . . . . . . 329
Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292 Prevention of Cervical Cancer. . . . . . . . . . . . . . . . . . . . . 332
Mammographic Breast Density and
Postmenopausal Breast Cancer Risk. . . . . . . . . . . . . 294 Chapter 25 Epidemiology of Vaginal,
Male Breast Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295 Vulvar, and Anal Cancer . . . . . . . . 335
Prevention of Breast Cancer. . . . . . . . . . . . . . . . . . . . . . . 295 Global Burden of Vaginal, Vulvar, and
Summary of Breast Cancer Epidemiology. . . . . . . . . 296 Anal Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Human Papillomavirus in Vaginal, Vulvar,
Chapter 22 Epidemiology of Ovarian and Anal Carcinoma. . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Cancer. . . . . . . . . . . . . . . . . . . . . . . 301 Global Pattern of Vaginal, Vulvar, and Anal
Squamous Cell Cancers. . . . . . . . . . . . . . . . . . . . . . . . . 337
Global Epidemiology of Ovarian Cancer. . . . . . . . . . . 301 Human Immunodeficiency Virus in Vaginal,
Ovarian Cancer: The “Silent Killer”. . . . . . . . . . . . . . . . . . 301 Vulvar, and Anal Carcinoma. . . . . . . . . . . . . . . . . . . . . 337
Pathophysiology of the Human Ovary . . . . . . . . . . . . 301 Epidemiology of Vaginal Cancer . . . . . . . . . . . . . . . . . . 338
Pathogenesis of Ovarian Cancer . . . . . . . . . . . . . . . . . . 302 Epidemiology of Vulvar Cancer. . . . . . . . . . . . . . . . . . . 342
Risk Factors for Ovarian Cancer. . . . . . . . . . . . . . . . . . . . 304 Epidemiology of Anal Carcinoma . . . . . . . . . . . . . . . . . 344
viii Contents

Primary Prevention of HPV-Related Vaginal, Molecular Carcinogenesis. . . . . . . . . . . . . . . . . . . . . . . . . 374

Vulvar, and Anal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . 346 Preventive Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374
Screening for Squamous Cell Vaginal, Vulvar,
and Anal Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346 Chapter 29 Epidemiology of
Urinary Bladder Cancer . . . . . . . . 377
Chapter 26 Epidemiology
Anatomy and Function of the Urinary Bladder . . . . 377
of Prostate Cancer. . . . . . . . . . . . . 351
Global Epidemiology of Bladder Cancer. . . . . . . . . . . 377
Global Burden of Prostate Cancer. . . . . . . . . . . . . . . . . 351 Pathogenesis of Urinary Bladder Cancer. . . . . . . . . . . 378
Age-Specific Risk of Prostate Cancer . . . . . . . . . . . . . . 352 Risk Factors for Urinary Bladder Cancer. . . . . . . . . . . . 379
Anatomy and Function of the Prostate Prevention of Bladder Cancer. . . . . . . . . . . . . . . . . . . . . 383
Gland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354
Pathogenesis of Prostate Cancer. . . . . . . . . . . . . . . . . . 354 Chapter 30 Epidemiology of Kidney
Finasteride and Prostate Cancer. . . . . . . . . . . . . . . . . . . 355 Cancer. . . . . . . . . . . . . . . . . . . . . . . 385
Dietary Fat and Prostate Cancer. . . . . . . . . . . . . . . . . . . 355
Anatomy and Function of the Kidneys . . . . . . . . . . . . 385
Genetics of Prostate Cancer. . . . . . . . . . . . . . . . . . . . . . . 356
Global Epidemiology of Kidney Cancer. . . . . . . . . . . . 385
Prostate Cancer and Sexual Activity. . . . . . . . . . . . . . . 357
Global Pattern of Kidney Cancer . . . . . . . . . . . . . . . . . . 387
Supplemental Antioxidants and
Prostate Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 Kidney Cancer Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . 387
Nonsteroidal Anti-inflammatory Drugs Types of Kidney Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . 387
and Prostate Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . 357 Pathologic Subtypes of Renal Cell
Screening for Prostate Cancer. . . . . . . . . . . . . . . . . . . . . 357 Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388
Zinc and Survival of Prostate Cancer . . . . . . . . . . . . . . 358 Risk Factors for Renal Cell Carcinoma. . . . . . . . . . . . . . 389
Risk Factors for Transitional Cell Carcinoma
of the Renal Pelvis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392
Chapter 27 Epidemiology
Prevention of Kidney Cancer. . . . . . . . . . . . . . . . . . . . . . 392
of Testicular Cancer. . . . . . . . . . . . 361
Anatomy of the Testis and Spermatogenesis . . . . . . 361 Chapter 31 Epidemiology of Cancers
Pathology of Testicular Cancer. . . . . . . . . . . . . . . . . . . . 361 of the Thyroid and
Global Epidemiology of Testicular Cancer . . . . . . . . . 363 Parathyroid . . . . . . . . . . . . . . . . . . 395
Cytogenetics and Genetics of Testicular
Germ Cell Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363 Thyroid Gland: Anatomy and Function. . . . . . . . . . . . 395
Risk Factors for Testicular Cancer. . . . . . . . . . . . . . . . . . 365 Benign Adenomas of the Thyroid Gland. . . . . . . . . . . 396
Prevention and Therapy of Testicular Cancer . . . . . . 366 Malignant Tumors of the Thyroid
and Parathyroid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397
Global Burden of Thyroid Cancer. . . . . . . . . . . . . . . . . . 397
Chapter 28 Epidemiology of Carcinoma
Trends in Papillary and Follicular Thyroid
of the External Male Genitalia: Carcinoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399
Penis and Scrotum . . . . . . . . . . . . 369 Risk Factors for Thyroid Cancer. . . . . . . . . . . . . . . . . . . . 400
Global Epidemiology of Penile Cancer . . . . . . . . . . . . 369 Iodine and Thyroid Function. . . . . . . . . . . . . . . . . . . . . . 405
Penile Cancer in the United States . . . . . . . . . . . . . . . . 370 Goitrogenic Dietary Factors and
Age-Specific Incidence of Penile Cancer . . . . . . . . . . 371 Thyroid Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408
Pathology and Histology. . . . . . . . . . . . . . . . . . . . . . . . . . 371 Medullary Thyroid Cancer. . . . . . . . . . . . . . . . . . . . . . . . . 408
Risk Factors for Carcinoma of the Penis. . . . . . . . . . . . 371 Prevention and Therapy of Thyroid Cancer . . . . . . . . 409
Cancer of the Scrotum. . . . . . . . . . . . . . . . . . . . . . . . . . . . 374 Epidemiology of Parathyroid Cancer. . . . . . . . . . . . . . 409
 Contents ix

Chapter 32 Epidemiology of Adrenal Vitamin D and Skin Cancer. . . . . . . . . . . . . . . . . . . . . . . . 446

Cancer. . . . . . . . . . . . . . . . . . . . . . . 415 Epidemiology of Merkel Cell Carcinoma. . . . . . . . . . . 446
Environmental Prevention of Skin Cancer . . . . . . . . . 447
Anatomy and Function of the Adrenal Glands. . . . . 415
Behavioral Prevention of Skin Cancer. . . . . . . . . . . . . 447
Detection of Adrenal Tumors . . . . . . . . . . . . . . . . . . . . . 415
Adrenal Cortical Carcinoma. . . . . . . . . . . . . . . . . . . . . . . 416
Chapter 35 Epidemiology of Classic Sarcoma
Risk Factors for Adrenal Cortical Carcinomas . . . . . . 416
and Kaposi Sarcoma. . . . . . . . . . . 453
Tumors of the Adrenal Medulla: Neuroblastoma
and Pheochromocytoma. . . . . . . . . . . . . . . . . . . . . . . 418 Classification of Sarcoma . . . . . . . . . . . . . . . . . . . . . . . . . 453
Multiple Endocrine Neoplasia and Sipple Global Epidemiology of Sarcoma . . . . . . . . . . . . . . . . . 453
Syndrome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420 Sarcoma in the U.S. Population. . . . . . . . . . . . . . . . . . . . 453
Summary of Adrenal Cancer Epidemiology . . . . . . . 420 Epidemiology of Pediatric Sarcomas . . . . . . . . . . . . . . 455
Epidemiology of Adult Sarcomas . . . . . . . . . . . . . . . . . 459
Chapter 33 Epidemiology of Malignant Cyclooxygenase-2 in Sarcomas . . . . . . . . . . . . . . . . . . . 468
Melanoma . . . . . . . . . . . . . . . . . . . 423 Prevention and Control of Kaposi Sarcoma. . . . . . . . 468
Global Epidemiology of Malignant Melanoma . . . . 423 Prevention and Treatment
Pathogenesis of Malignant Melanoma . . . . . . . . . . . . 424 of Other Sarcomas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469
Risk Factors for Malignant Melanoma . . . . . . . . . . . . . 426
Malignant Melanoma and Parkinson’s Disease. . . . . 428 Chapter 36 Epidemiology of Lymphoma:
Prevention of Malignant Melanoma. . . . . . . . . . . . . . . 429 Non-Hodgkin’s Lymphoma,
Hodgkin’s Lymphoma, and
Chapter 34 Epidemiology of Nonmelanoma Multiple Myeloma. . . . . . . . . . . . . 473
Skin Cancer: Basal Cell, Classification of Lymphoma. . . . . . . . . . . . . . . . . . . . . . . 473
Squamous Cell, and Epidemiology of Non-Hodgkin’s Lymphoma. . . . . . 474
Merkel Cell Skin Cancers. . . . . . . . 433 Gender and Ethnic Differences in
Anatomy and Function of the Skin. . . . . . . . . . . . . . . . 433 Non-Hodgkin’s Lymphoma . . . . . . . . . . . . . . . . . . . . . 477
Nonmelanoma Skin Cancer. . . . . . . . . . . . . . . . . . . . . . . 434 Risk Factors for Non-Hodgkin’s Lymphoma. . . . . . . . 477
Global Burden of Nonmelanoma Skin Cancer . . . . . 434 Epidemiology of Hodgkin’s Lymphoma . . . . . . . . . . . 485
Age-Specific Incidence Risk Factors for Hodgkin’s Lymphoma. . . . . . . . . . . . . 486
of Nonmelanoma Skin Cancer. . . . . . . . . . . . . . . . . . 435 Epidemiology of Multiple Myeloma. . . . . . . . . . . . . . . 487
Global Incidence and Mortality of Waldenström’s Macroglobulinemia . . . . . . . . . . . . . . . 489
Nonmelanoma Skin Cancer. . . . . . . . . . . . . . . . . . . . . 435 Models of Pathogenesis of Lymphoma. . . . . . . . . . . . 489
Longitudinal Trends in Basal Cell and Prevention of AIDS-Related Lymphoma. . . . . . . . . . . 489
Squamous Cell Carcinomas of the Skin. . . . . . . . . . 436
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490
Solar Radiation and Nonmelanoma Skin Cancer . . . . 438
Risk Factors for Basal Cell Carcinoma of the Skin. . . . 439
Chapter 37 Epidemiology of Leukemia . . . . . 497
Risk Factors for Squamous
Cell Carcinoma of the Skin. . . . . . . . . . . . . . . . . . . . . . 440 Classification of Leukemia . . . . . . . . . . . . . . . . . . . . . . . . 497
Genetics of Nonmelanoma Skin Cancer. . . . . . . . . . . 443 Hematopoiesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498
Immunosuppression and Skin Cancer. . . . . . . . . . . . . 445 Pathogenesis of Leukemia. . . . . . . . . . . . . . . . . . . . . . . . 498
Inflammogenesis of Skin Cancer. . . . . . . . . . . . . . . . . . 445 Global Epidemiology of Leukemia . . . . . . . . . . . . . . . . 499
Risk of Multiple Basal Cell or Squamous Cell Incidence and Mortality of Leukemia Subtypes. . . 501
Carcinomas of the Skin . . . . . . . . . . . . . . . . . . . . . . . . . 446 Trends in Leukemia Incidence and Survival. . . . . . . . 501
x Contents

Pediatric Leukemia: Trends in Incidence and Pneumonia and COPD. . . . . . . . . . . . . . . . . . . . . . . . . . . . 549

Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502 HIV and COPD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
Adult Leukemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507 Lung Cancer and COPD. . . . . . . . . . . . . . . . . . . . . . . . . . . 550
Prevention and Control of Leukemia. . . . . . . . . . . . . . 513 Case Fatality of COPD Exacerbation. . . . . . . . . . . . . . . 550
Prevention of COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550
Chapter 38 Epidemiology of Brain Tumors:
Smoking Cessation in COPD Patients. . . . . . . . . . . . . . 551
Glioma, Meningioma,
Control of Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . . 552
Acoustic Neuroma,
Global Alliance Against Chronic Respiratory
and Pituitary Tumors . . . . . . . . . . 517 Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 552
Global Epidemiology of Brain Tumors. . . . . . . . . . . . . 517
Brain Tumors in the United States. . . . . . . . . . . . . . . . . 518 Chapter 40 Epidemiology of Asthma . . . . . . . 555
Classification of Brain Tumors. . . . . . . . . . . . . . . . . . . . . 519 Clinical Diagnosis of Asthma. . . . . . . . . . . . . . . . . . . . . . 555
U.S. Study of Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . 526 Global Burden of Asthma. . . . . . . . . . . . . . . . . . . . . . . . . 556
Genetic Anomalies and Brain Tumors . . . . . . . . . . . . . 526 Global Studies of Asthma in Children and Adults. . . . 556
Oligodendroglioma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528 Asthma in Children. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 556
Risk Factors for Meningiomas. . . . . . . . . . . . . . . . . . . . . 528 Asthma in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 557
Pituitary Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530 Global Initiative for Asthma. . . . . . . . . . . . . . . . . . . . . . . 557
Primary Lymphoma of the Brain . . . . . . . . . . . . . . . . . . 530 The Hygiene Hypothesis of Asthma. . . . . . . . . . . . . . . 559
Brain Tumors in Children. . . . . . . . . . . . . . . . . . . . . . . . . . 531 Risk Factors of Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . 560
Therapeutic Approaches to Glioma and Other Atopy and Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 560
Brain Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 531
Respiratory Viruses and Asthma. . . . . . . . . . . . . . . . . . . 562
Environmental Tobacco Smoke and Asthma . . . . . . 562
SECTION III Epidemiology of Chronic Atopy, Environmental Tobacco Smoke, and
Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
Respiratory, Metabolic, Food Allergy and Asthma. . . . . . . . . . . . . . . . . . . . . . . . . 563
and Musculoskeletal Asthma and Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 563
Diseases 537 Asthma and Household Cleaning Products . . . . . . . 564
Drug-Induced Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . 564
Chapter 39 Epidemiology of Chronic Vaccination and Childhood Asthma. . . . . . . . . . . . . . . 565
Obstructive Pulmonary Genetics of Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 565
Disease. . . . . . . . . . . . . . . . . . . . . . 539 Preventing Asthma Progression: Avoidance
of Environmental Tobacco Smoke. . . . . . . . . . . . . . . 566
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 539
Risk Factors for Fatal Asthma Attack. . . . . . . . . . . . . . . 566
Anatomy and Function of the Lungs. . . . . . . . . . . . . . 539
Therapy for the Asthmatic Patient. . . . . . . . . . . . . . . . . 566
Diagnosis of COPD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 540
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 567
Age Distribution of COPD. . . . . . . . . . . . . . . . . . . . . . . . . 540
Global Burden of COPD. . . . . . . . . . . . . . . . . . . . . . . . . . . 541
Chapter 41 Epidemiology of Diabetes
Trends in Mortality Rates of COPD:
United States and Western Europe. . . . . . . . . . . . . . 542
Mellitus . . . . . . . . . . . . . . . . . . . . . 571
Pathogenesis of COPD. . . . . . . . . . . . . . . . . . . . . . . . . . . . 542 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571
Underdiagnosis of COPD . . . . . . . . . . . . . . . . . . . . . . . . . 549 Historical Summary of Diabetes Mellitus . . . . . . . . . . 571
Population Attributable Fraction: Role of Insulin in Diabetes . . . . . . . . . . . . . . . . . . . . . . . . 572
Smoking and COPD . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549 Diagnosis of Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 573
 Contents xi

Types of Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 574 Prevalence of Adult Obesity in the

Global Pandemic of Diabetes Mellitus. . . . . . . . . . . . . 574 United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 615
Global Prevalence of Diabetes . . . . . . . . . . . . . . . . . . . . 575 Distribution of Obesity by Age, Gender,
and Ethnicity in the United States. . . . . . . . . . . . . . . 615
Distribution of Diabetes by Gender and Age . . . . . . 576
Health Consequences of Obesity . . . . . . . . . . . . . . . . . 616
Global Deaths Attributable to Diabetes . . . . . . . . . . . 576
Obesity and Total Mortality . . . . . . . . . . . . . . . . . . . . . . . 616
Disability-Adjusted Life Years for Diabetes. . . . . . . . . 578
Obesity and Type 2 Diabetes. . . . . . . . . . . . . . . . . . . . . . 617
Burden of Diabetes in the United States. . . . . . . . . . . 578
Obesity and Cardiovascular Disease. . . . . . . . . . . . . . . 618
Mortality from Diabetes in the United States. . . . . . 579
Obesity and Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 619
Population-Based Models of Diabetes. . . . . . . . . . . . . 580
Obesity and GERD. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 621
The Health Impact of Diabetes. . . . . . . . . . . . . . . . . . . . 581
Obesity and Obstructive Sleep Apnea. . . . . . . . . . . . . 622
Diabetic Ketoacidosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 582
Obesity and Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . 623
Microvascular Complications of Diabetes . . . . . . . . . 582
Obesity and Quality of Life. . . . . . . . . . . . . . . . . . . . . . . . 623
Macrovascular Complications of Diabetes. . . . . . . . . 582
Mechanisms of Pathogenesis
Epidemiology of Type 1 Diabetes . . . . . . . . . . . . . . . . . 583
in Obesity-Related Diseases. . . . . . . . . . . . . . . . . . . . . 624
Risk Factors for Type 1 Diabetes. . . . . . . . . . . . . . . . . . . 585
Obesity and Atherogenesis . . . . . . . . . . . . . . . . . . . . . . . 625
Birth Weight and Type 1 Diabetes. . . . . . . . . . . . . . . . . 587
Obesity and Insulin Resistance. . . . . . . . . . . . . . . . . . . . 626
Accelerator Hypothesis of Type 1 Diabetes. . . . . . . . 588
Overview of Adipocyte Regulatory Processes . . . . . 626
Treatment for Type 1 Diabetes . . . . . . . . . . . . . . . . . . . . 588
Fat Storage (Lipogenesis) . . . . . . . . . . . . . . . . . . . . . . . . . 627
Prediabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588
Fat Breakdown (Lipolysis). . . . . . . . . . . . . . . . . . . . . . . . . 627
Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 589
Secretion of Adipokines by Adipocytes . . . . . . . . . . . 627
Risk Factors for Type 2 Diabetes. . . . . . . . . . . . . . . . . . . 589
Fat Cell Size, Number, and Turnover in
The Metabolic Syndrome (Syndrome X). . . . . . . . . . . 596 Humans. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 628
Gestational Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598 Brown Adipose Tissue . . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
Type 2 Diabetes in Children and Risk Factors of Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . 629
Adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598
Genetics of Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 630
Double Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 598
Environmental Factors Contributing
Economic Impact of Diabetes. . . . . . . . . . . . . . . . . . . . . 599 to Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 630
Prevention of Diabetes Mellitus. . . . . . . . . . . . . . . . . . . 599 Childhood Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 631
Screening for Gestational Diabetes. . . . . . . . . . . . . . . . 600 The Burden of Childhood Obesity. . . . . . . . . . . . . . . . . 632
Tertiary Prevention of Microvascular/ Risk Factors in Early Life and the
Macrovascular Complications of Diabetes. . . . . . . 600 Development of Later Obesity. . . . . . . . . . . . . . . . . . 633
Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 600 Prevention of Obesity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 634
Therapy of Obesity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 635
Chapter 42 Epidemiology of Obesity . . . . . . . 609 Liposuction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 609 Bariatric Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 636
Classification of Overweight and Summary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 637
Obesity in Adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610
Limitations of the BMI . . . . . . . . . . . . . . . . . . . . . . . . . . . . 610 Chapter 43 The Epidemiology of Thyroid
Global Burden of Adult Obesity. . . . . . . . . . . . . . . . . . . 612 Disease: Hyperthyroidism
Global Prevalence of Adult Obesity . . . . . . . . . . . . . . . 612 and Hypothyroidism . . . . . . . . . . . . 647
Gender Differences in Obesity . . . . . . . . . . . . . . . . . . . . 614 Thyroid Gland: Anatomy and Function. . . . . . . . . . . . 647
Urban Versus Rural Differences in Obesity . . . . . . . . 614 Diseases of the Thyroid Gland. . . . . . . . . . . . . . . . . . . . . 648
xii Contents

Prevalence and Incidence of Hyperthyroidism Obesity and Chronic Kidney Disease. . . . . . . . . . . . . . 671
and Hypothyroidism. . . . . . . . . . . . . . . . . . . . . . . . . . . . 648 Smoking and Chronic Kidney Disease. . . . . . . . . . . . . 672
Rare Medical Emergencies of Thyroid Alcohol Abuse, Gout and Kidney Disease . . . . . . . . . 673
Dysfunction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 649
Chronic Kidney Disease in Children and
Mortality Rates of Hyperthyroidism Adolescents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 673
and Hypothyroidism. . . . . . . . . . . . . . . . . . . . . . . . . . . . 649
Prevention of Chronic Kidney Disease. . . . . . . . . . . . . 674
Hyperthyroidism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 650
Tertiary Prevention of Chronic Kidney Disease. . . . . 674
Graves’ Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 651
Dialysis and Renal Transplantation for
The Human Leukocyte Antigen Locus and End-Stage Renal Disease. . . . . . . . . . . . . . . . . . . . . . . . 674
Autoimmune Thyroiditis. . . . . . . . . . . . . . . . . . . . . . . . 652
Hemodialysis for End-Stage Renal Disease . . . . . . . . 675
Hashimoto’s Thyroiditis . . . . . . . . . . . . . . . . . . . . . . . . . . . 653
Renal Transplant for End-Stage Renal Disease . . . . . 675
Iatrogenic Hyperthyroidism. . . . . . . . . . . . . . . . . . . . . . . 654
Peritoneal Dialysis for End-Stage Renal
Exogenous Hyperthyroidism. . . . . . . . . . . . . . . . . . . . . . 654 Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 675
Hypothyroidism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 654
Cretinism. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 655 Chapter 45 Epidemiology of Cirrhosis
Goitrogenic Dietary Factors and of the Liver. . . . . . . . . . . . . . . . . . . 681
Thyroid Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 656
Global Burden of Cirrhosis of the Liver . . . . . . . . . . . . 681
Global Impact of Iodine Deficiency . . . . . . . . . . . . . . . 656
Liver Function and Anatomy. . . . . . . . . . . . . . . . . . . . . . 682
Hypothyroidism in ­Iodine-Replete Nations. . . . . . . . 657
Cirrhosis of the Liver: Pathology, Clinical
Iodine Deficiency in Pregnancy. . . . . . . . . . . . . . . . . . . 657
Symptoms, and Diagnosis . . . . . . . . . . . . . . . . . . . . . . 684
Prevention of Thyroid Dysfunction. . . . . . . . . . . . . . . . 657
Pathogenesis of Cirrhosis of the Liver . . . . . . . . . . . . . 684
Prevention of Viral Hepatitis. . . . . . . . . . . . . . . . . . . . . . . 699
Chapter 44 Epidemiology of Chronic
Conclusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 700
Kidney Disease . . . . . . . . . . . . . . . 661
Anatomy and Function of the Kidneys . . . . . . . . . . . . 661
Chapter 46 Epidemiology of Osteoporosis. . . . 707
Glomerular Filtration Rate. . . . . . . . . . . . . . . . . . . . . . . . . 661
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
Diagnosis of Chronic Kidney Disease. . . . . . . . . . . . . . 662
Discovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 707
Epidemiologic Transition
of Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . . . . 663 Pathogenesis of Osteoporosis. . . . . . . . . . . . . . . . . . . . . 707
Global Burden of Chronic Kidney Disease . . . . . . . . . 663 Diagnosis of Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . 708
Cardiovascular Deaths and Chronic Kidney Bone Mineral Density and Osteoporosis. . . . . . . . . . . 708
Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664 Incidence and Prevalence of Hip Fracture. . . . . . . . . 708
Global Pattern of Chronic Kidney Disease: Survival and Mortality: Hip Fractures. . . . . . . . . . . . . . 709
Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664 Global Burden of Osteoporosis. . . . . . . . . . . . . . . . . . . . 710
Chronic Kidney Disease in Developing Risk Factors for Osteoporosis. . . . . . . . . . . . . . . . . . . . . . 711
Countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 664 Primary Prevention of Osteoporosis. . . . . . . . . . . . . . . 721
Chronic Kidney Disease in Developed
Countries. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 666
Causation of Chronic Kidney Disease. . . . . . . . . . . . . . 667
Chapter 47 Epidemiology of Arthritis . . . . . . 727
Diabetic Nephropathy. . . . . . . . . . . . . . . . . . . . . . . . . . . . 667 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727
Hypertensive Nephropathy. . . . . . . . . . . . . . . . . . . . . . . 668 Synovial Joints. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 727
Chronic Glomerulonephritis . . . . . . . . . . . . . . . . . . . . . . 669 Pathogenesis of Arthritis. . . . . . . . . . . . . . . . . . . . . . . . . . 728
Blood Lipids, Cholesterol, Osteoarthritis (Degenerative Joint Disease) . . . . . . . 728
and Chronic Kidney Disease . . . . . . . . . . . . . . . . . . . . 670 Diagnosis of Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . 729
 Contents xiii

Age-Specific Incidence and Prevalence Pathology of Parkinson’s Disease. . . . . . . . . . . . . . . . . . 777

of Osteoarthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 729 Incidence and Prevalence
Disability in Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . . 730 of Parkinson’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . 777
Trends in Osteoarthritis Prevalence. . . . . . . . . . . . . . . 730 Global Incidence of Parkinson’s Disease. . . . . . . . . . . 779
Prevention of Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . 733 Global Age-Specific Prevalence of
Rheumatoid Arthritis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 734 Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780
Disability in Rheumatoid Arthritis . . . . . . . . . . . . . . . . . 734 Survival, Dementia, and Mortality in
Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 780
Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 738
Parkinson’s Disease: Trends in
Ankylosing Spondylitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . 744
Global Mortality and Prevalence . . . . . . . . . . . . . . . . 781
Juvenile Idiopathic Arthritis. . . . . . . . . . . . . . . . . . . . . . . 745
Disability-Adjusted Life Years:
Suppurative (Septic) Arthritis . . . . . . . . . . . . . . . . . . . . . 747 Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 781
Causes of the Rising Global Burden
of Parkinson’s Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . 783
SECTION IV Epidemiology of
Risk Factors for Parkinson’s Disease. . . . . . . . . . . . . . . . 783
Neurological Diseases 751 Tertiary Prevention in Parkinson’s Disease . . . . . . . . . 787

Chapter 48 Epidemiology of Alzheimer’s Chapter 50 Epidemiology of Multiple

Disease. . . . . . . . . . . . . . . . . . . . . . 753 Sclerosis . . . . . . . . . . . . . . . . . . . . . 791
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 753 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 791
Diagnosis and Progression of Alzheimer’s Discovery of Multiple Sclerosis. . . . . . . . . . . . . . . . . . . . 791
Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 753
Diagnosis of Multiple Sclerosis. . . . . . . . . . . . . . . . . . . . 792
Age-Specific Incidence of Alzheimer’s Disease . . . . 754
Course of Multiple Sclerosis. . . . . . . . . . . . . . . . . . . . . . . 792
Global Incidence of Alzheimer’s Disease . . . . . . . . . . 755
Global Burden of Multiple Sclerosis . . . . . . . . . . . . . . . 792
Global Prevalence of Alzheimer’s Disease . . . . . . . . . 755
Global Prevalence and Incidence of Multiple
Alzheimer’s Disease: Survival and Case Sclerosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 793
Fatality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 755
Age-Specific Incidence of Multiple Sclerosis. . . . . . . 794
Alzheimer’s Disease: Global Mortality . . . . . . . . . . . . . 756
Case Fatality and Life Expectancy . . . . . . . . . . . . . . . . . 794
Alzheimer’s Disease: Disability-Adjusted
Life Years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 758 Suicide in Multiple Sclerosis. . . . . . . . . . . . . . . . . . . . . . . 795
Burden of Alzheimer’s Disease Global Mortality: Multiple Sclerosis. . . . . . . . . . . . . . . . 795
in the United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 758 Autoimmunity and Multiple Sclerosis. . . . . . . . . . . . . 796
Pathology of Alzheimer’s Disease . . . . . . . . . . . . . . . . . 759 Pathogenic Mechanisms in Multiple Sclerosis. . . . . 796
Risk Factors of Alzheimer’s Disease. . . . . . . . . . . . . . . . 760 Prevention and Therapy of Multiple Sclerosis. . . . . . 801
Genetics of Alzheimer’s Disease. . . . . . . . . . . . . . . . . . . 766
Vascular Dementia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 Chapter 51 Epidemiology of Epilepsy. . . . . . . 805
Lewy Body Dementia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 767 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 805
Mixed Forms of Dementia . . . . . . . . . . . . . . . . . . . . . . . . 768 Diagnosis of Epilepsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 805
Prevention of Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . 769 Types of Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 805
Types of Epilepsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 807
Chapter 49 Epidemiology of Epilepsy Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 808
Parkinson’s Disease. . . . . . . . . . . . 775 Febrile (Fever) Seizures and Epilepsy . . . . . . . . . . . . . . 811
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 775 Isolated Seizures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 813
History of Parkinson’s Disease. . . . . . . . . . . . . . . . . . . . . 775 Circumstantial (Situation-Related) Seizures. . . . . . . . 813
xiv Contents

Status Epilepticus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 813 Historical Record of Tuberculosis. . . . . . . . . . . . . . . . . . 865

Global Burden of Epilepsy. . . . . . . . . . . . . . . . . . . . . . . . . 814 Global Burden of Tuberculosis in the
Global Prevalence of Epilepsy. . . . . . . . . . . . . . . . . . . . . 815 21st Century. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 866
Disability-Adjusted Life Years (DALY) Tuberculosis: Incidence, Prevalence, and
Lost from Epilepsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 815 Mortality, 2007 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867
Epilepsy Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 816 Tuberculosis: Incidence, Prevalence, and
Mortality, 2017 Update . . . . . . . . . . . . . . . . . . . . . . . . . 868
Suicide and Epilepsy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 818
Disability-Adjusted Life Years: Tuberculosis . . . . . . . . 869
Epilepsy Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 819
Tuberculosis in the United States . . . . . . . . . . . . . . . . . 870
Epilepsy: Treatment and Prognosis. . . . . . . . . . . . . . . . 822
Transmission of Tuberculosis. . . . . . . . . . . . . . . . . . . . . . 870
Chapter 52 Epidemiology of Pathogenesis of Tuberculosis . . . . . . . . . . . . . . . . . . . . . 871
Risk Factors for Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . 871
Schizophrenia . . . . . . . . . . . . . . . . 827
Multidrug-Resistant Tuberculosis and
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 827 Extensively Drug-Resistant Tuberculosis . . . . . . . . 875
Global Burden of Schizophrenia. . . . . . . . . . . . . . . . . . . 827 Antibiotic Resistance in Mycobacterium
Global Incidence of Schizophrenia. . . . . . . . . . . . . . . . 828 tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 875
Global Prevalence of Schizophrenia. . . . . . . . . . . . . . . 828 Prevention of Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . 875
Prevalence of Schizophrenia in
the United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 828
Chapter 55 Epidemiology of Malaria . . . . . . . 879
Excess Mortality from Schizophrenia. . . . . . . . . . . . . . 829
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879
Course of Schizophrenia. . . . . . . . . . . . . . . . . . . . . . . . . . 829
History of Malaria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 879
Suicide in Schizophrenia. . . . . . . . . . . . . . . . . . . . . . . . . . 831
Life Cycle of Plasmodia . . . . . . . . . . . . . . . . . . . . . . . . . . . 880
Models of Pathogenesis: Schizophrenia. . . . . . . . . . . 832
Pathogenesis of Malaria. . . . . . . . . . . . . . . . . . . . . . . . . . . 880
Risk Factors of Schizophrenia . . . . . . . . . . . . . . . . . . . . . 833
Global Burden of Malaria. . . . . . . . . . . . . . . . . . . . . . . . . . 881
Prenatal Dietary Deficiency and Schizophrenia. . . . 836
Malaria: Incidence and Mortality,
Primary Prevention of Schizophrenia. . . . . . . . . . . . . . 839
2013–2016 Update. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 882
Tertiary Prevention in Schizophrenia. . . . . . . . . . . . . . 839
Global Incidence of Plasmodium falciparum:
Controversial Findings. . . . . . . . . . . . . . . . . . . . . . . . . . 883
Chapter 53 Epidemiology of Suicide. . . . . . . . 845 Genetic Resistance to Malaria. . . . . . . . . . . . . . . . . . . . . 885
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 845 Control of Malaria. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 886
Global Burden of Suicide. . . . . . . . . . . . . . . . . . . . . . . . . . 845
Gender and Suicide. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 846 Chapter 56 Epidemiology of HIV/AIDS . . . . . . 889
Age Distribution of Suicide . . . . . . . . . . . . . . . . . . . . . . . 847
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 889
Time Trends in Suicide Rates. . . . . . . . . . . . . . . . . . . . . . 848
History of HIV/AIDS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 889
Risk Factors for Suicide. . . . . . . . . . . . . . . . . . . . . . . . . . . . 849
Human Immunodeficiency Virus Life Cycle. . . . . . . . 890
Global Burden of HIV/AIDS. . . . . . . . . . . . . . . . . . . . . . . . 890
SECTION V Epidemiology of HIV/AIDS in Africa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 892
HIV/AIDS in the United States. . . . . . . . . . . . . . . . . . . . . 893
Chronic Infectious Origin of HIV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 894
Diseases 863 Coinfections Involving HIV. . . . . . . . . . . . . . . . . . . . . . . . 895
Prevention and Control of HIV/AIDS. . . . . . . . . . . . . . . 898
Chapter 54 Epidemiology of Tuberculosis. . . . 865
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 865 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 901
© Andrew Brookes/Getty Images
Preface
T
his second edition of Epidemiology of Chronic
Disease: Global Perspectives is written for all
students and teachers of the health sciences,
particularly those in epidemiology, public health, and
medicine. Its main purpose is to present current and
comprehensive information on epidemiology, etiol-
ogy, pathogenesis, risk factors, and preventive fac-
tors of common chronic diseases. In writing the new
edition of this book, I have made liberal use of the
internet and drawn upon worldwide information to
address the global landscape of chronic diseases.
This new edition has 56 chapters that are orga-
nized into five distinct sections beginning with an
introductory chapter on the “epidemiologic transition”
whereby chronic diseases have replaced acute infec-
tious conditions concurrent with improved health
care and increasing longevity in many populations of
the world. Subsequent sections cover cardiovascular
and cerebrovascular diseases (coronary heart disease,
myocardial infarction, sudden cardiac death, stroke,
congestive heart failure, peripheral artery disease
and aortic aneurysms, venous thromboembolism
and pulmonary embolism, and hypertension), major
forms of cancer (lung cancer, laryngeal cancer, head
and neck cancer, esophageal cancer, stomach cancer,
colon cancer, pancreatic cancer, liver cancer, breast
cancer, ovarian cancer, vulvar and vaginal cancer,
cervical cancer, prostate cancer, testicular cancer and
other male genital cancers, bladder cancer, kidney
cancer, sarcoma, malignant melanoma, lymphoma,
leukemia, and brain tumors), diseases of the respi-
ratory tract (chronic obstructive pulmonary disease
and asthma), metabolic and digestive diseases (diabe-
tes mellitus, obesity, thyroid disease, kidney disease,
and liver disease), musculoskeletal diseases (osteo-
porosis and arthritis), neurodegenerative diseases
(Alzheimer’s disease, Parkinson’s disease, schizophre-
nia, epilepsy, multiple sclerosis, and suicide), and
finally three major infectious diseases (tuberculosis,
malaria, and HIV disease) that often manifest as
chronic conditions.
I have added new chapters on sudden cardiac
death, congestive heart failure, peripheral artery
disease and aortic aneurysms, and venous thrombo-
embolism and pulmonary embolism. Important new
findings are discussed, such as the association of post-
traumatic stress disorder with suicide and the emerg-
ing crisis of antibiotic resistance in tuberculosis and
other chronic infections. Epidemiologic findings and
references have been updated throughout this book.
Each chapter follows a similar format, with sub-
sections describing diagnostic criteria, historical per-
spectives, the global burden of disease, population
differences and time trends in incidence, prevalence,
disability and mortality, mechanisms of pathogenesis,
risk factors, preventive factors, and opportunities for
disease prevention and control. Key epidemiologic
studies and findings are presented in chronological
order with supporting evidence and references selected
to guide readers for further study. It is assumed that
students and readers are building on a knowledge
base of basic epidemiology and human biology. The
text blends the traditional elements of epidemiology
with human anatomy, physiology, and molecular biol-
ogy. The text is accompanied by an online instructor’s
manual with recommended questions and answers
drawn from each of the chapters.
It is my hope that the text will provide a forum for
examining current hypotheses regarding chronic dis-
ease epidemiology. Subsections of each chapter focus
on controversial topics in the epidemiology of each
disease. This format facilitates active student discus-
sion of molecular mechanisms of disease pathogene-
sis and the relevant epidemiologic issues pertaining to
the prevention and control of chronic diseases.
In essence, the new edition of this book, like the
first, is an amalgamation of a long-standing continuum
of the exchange of ideas and information with many
colleagues in the fields of medicine, public health,
epidemiology, biostatistics, genetics, pathology, and
molecular biology. This new edition will continue to
reflect my own experiences in medicine, epidemiol-
ogy, and public health, and I am deeply indebted to
mentors, colleagues, and particularly students who
have contributed to my education, research, and
teaching over the past four decades.
xv
xvi Preface
▸▸ What Is New and Improved?
Epidemiology of Chronic Disease: Global Perspectives,
Second Edition presents the current epidemiology and
global burden of each of the 56 major diseases. This new
edition contains the most recent information available
on the epidemiology of major cardiovascular diseases;
cancers; respiratory, metabolic, and musculoskeletal
conditions; and neurodegenerative diseases complete
with updated figures, tables, and global maps. The
section on cardiovascular and cerebrovascular dis-
ease includes four new chapters on the epidemiology
of congestive heart failure, peripheral artery disease
and aortic dissection, venous thromboembolism and
pulmonary embolism, and sudden cardiac death. The
new epidemiology of cancer section contains widely
updated materials to provide in-depth information on
cancers that affect 28 regions of the body.
■■ New Chapters. The new edition includes 13 new
chapters to include more information on Epide-
miology of Sudden Cardiac Death (Chapter 5),
Epidemiology of Heart Failure (Chapter 7),
Epidemiology of Aortic Aneurysm and Dissec-
tion (Chapter 8), and Epidemiology of Venous
Thromboembolism and Pulmonary Embolism
(Chapter 9). There are also nine new chapters on
cancer epidemiology including Epidemiology of
Laryngeal Cancer (Chapter 14), Epidemiology
of Cancers of the Lip, Oral Cavity, and ­Pharynx
(Chapter 15), Epidemiology of Cancer of the
Corpus Uteri (Chapter 23), Epidemiology of
Vaginal, Vulvar, and Anal Cancer (Chapter 25),
Epidemiology of Testicular Cancer (Chapter 27),
Epidemiology of Carcinoma of the External Male
Genitalia (Chapter 28), Epidemiology of Cancers
of the Thyroid and Parathyroid (Chapter 31),
Epidemiology of Adrenal Cancer (Chapter 32),
and Epidemiology of Nonmelanoma Skin Can-
cer (Chapter 34).
■■ Global Burden of Disease. This new edition
incorporates the most recent data from the World
Health Organization, the Institute of Health Met-
rics and Evaluation, the International Agency for
Cancer Research, and other international organi-
zations to characterize important global patterns
and trends in the epidemiology of each disease.
Updated world maps and figures are used to dis-
play global patterns and trends in disease preva-
lence, incidence, mortality, and disability-adjusted
life years.
■■ U.S. Burden of Disease. Each chapter includes a
section on the burden of disease in the U.S. pop-
ulation based on current data from the National
Institutes of Health, the American Heart Asso-
ciation, the American Cancer Society, and other
national organizations.
■■ Risk Factors. Published studies from the recent
literature are discussed regarding new findings on
risk factors and preventive factors that impact the
pathogenesis of disease.
■■ Pathogenesis. Current mechanisms of pathogen-
esis of each disease are discussed and depicted in
each chapter.
■■ Disease Prevention and Control. The most recent
and effective programs of disease prevention and
control are presented in each chapter.
■■ Instructor Resources. Instructors using the text will
have online access to updated lecture slides, outlines,
and test banks with answers for each chapter.
Randall E. Harris, MD, PhD
Professor, Colleges of Public Health and Medicine
Director, Center of Molecular Epidemiology &
Environmental Health
Division of Epidemiology & Departments of
Pathology & Emergency Medicine
The Ohio State University Wexner Medical Center
Columbus, Ohio
© Andrew Brookes/Getty Images
Contributors
Susanne K. Scott, PhD, MPH
Belgium, Wisconsin
Zachary M. Harris, MD, Fellow
Pulmonary, Critical Care and Sleep Medicine
Department of Internal Medicine
Yale School of Medicine
Yale University
New Haven, Connecticut
xvii
 SECTION I
Epidemiologic
Transition and
Epidemiology of
Cardiovascular
Diseases
CHAPTER 1 Global Epidemiology of Chronic Diseases:
The Epidemiologic Transition. . . . . . . . . . . . . . . . . . . . 3
CHAPTER 2 Global Epidemiology of Cardiovascular Disease. . . . 27
CHAPTER 3 Epidemiology of Ischemic (Coronary)
Heart Disease. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
CHAPTER 4 Epidemiology of Myocardial Infarction. . . . . . . . . . . 57
CHAPTER 5 Epidemiology of Sudden Cardiac Death . . . . . . . . . . 75
CHAPTER 6 Epidemiology of Stroke (Cerebral Infarction). . . . . . 85
CHAPTER 7 Epidemiology of Heart Failure . . . . . . . . . . . . . . . . 105
© Andrew Brookes/Getty Images

1
2 Section I Epidemiologic Transition and Epidemiology of Cardiovascular Diseases

CHAPTER 8 Epidemiology of Aortic Aneurysm and Dissection . . . ������������������������������������������������������119

CHAPTER 9 Epidemiology of Venous Thromboembolism and Pulmonary Embolism������������������������129
CHAPTER 10 Epidemiology of Hypertension ��������������������������������������������������������������������������������������������137
© Andrew Brookes/Getty Images
CHAPTER 1
Global Epidemiology of Chronic
Diseases: The Epidemiologic
Transition
▸▸ Global Pandemic of Chronic
Diseases
A
silent pandemic of chronic diseases is gradually
enveloping the world population, spreading to
all corners of the globe. This distinct spectrum
of human afflictions is systemically replacing infectious
and parasitic diseases as the leading cause of morbidity
and mortality worldwide, thereby producing one of the
greatest public health challenges of all time. Accord-
ing to global cause-specific mortality data reported
by the Institute of Health Metrics and Evaluation non-
communicable (chronic) disorders such as coronary
heart disease, stroke, cancer, chronic obstructive pul-
monary disease (COPD), diabetes mellitus type 2, neu-
rodegenerative disease, and renal failure accounted for
39.5 million of the 54.7 million deaths (72%) for which
a cause was identified during 2016 (Ritchie & Roser,
2018). This compares with 10.6 million deaths (19%)
due to communicable (infectious) diseases, maternal,
neonatal, and nutritional diseases, and 4.6 million
deaths (8%) from injury including homicide, suicide,
conflict, and terrorism. As shown in FIGURE 1.1, trends
in the annual number of deaths in these three cate-
gories during 1990–2016 reflect a steady increase in
annual deaths from noncommunicable diseases con-
current with a steady decline in annual deaths from
communicable, maternal, neonatal, and nutritional
diseases, whereas the annual number of deaths from
injury has remained stable (Ritchie & Roser, 2018;
WHO, 2009a, 2017c).
The following excerpts from the 2008 WHO global
report entitled Preventing Chronic Diseases: A Vital
Investment capture the essence of the global pandemic
of chronic diseases (Reprinted from WHO, 2008a).
“Chronic diseases are the leading causes of death
and disability worldwide. Disease rates from these
conditions are accelerating globally, advancing
across every region and pervading all socioeconomic
classes. The World Health Report 2002 “Reducing
Risks, Promoting Healthy Life” indicates that the
mortality, morbidity and disability attributed to the
major chronic diseases currently account for almost
60% of all deaths and 43% of the global burden
of disease. By 2020 their contribution is expected
to rise to 73% of all deaths and 60% of the global
burden of disease. Moreover, 79% of the deaths
attributed to these diseases occur in the develop-
ing countries. Four of the most prominent chronic
diseases, cardiovascular diseases (CVD), cancer,
chronic obstructive pulmonary disease (COPD),
and type 2 diabetes, are linked by common and pre-
ventable biological risk factors, notably high blood
pressure, high blood cholesterol and overweight, and
3
4 Chapter 1 Global Epidemiology of Chronic Diseases: The Epidemiologic Transition

45
39.5
40
35.8
34
35 32

Millions of Deaths
30
30 27
25
20
15.4 15.1 14.8 14.1
15 12.7
10.6
10
4.2 4.5 4.6 4.7 4.8 4.6
5
0
1990 1995 2000 2005 2010 2016
Year

Non-communicable disease Communicable, maternal, neonatal, nutritional disease Injury

FIGURE 1.1 Global Trends in Deaths from Noncommunicable and Communicable Diseases and Injuries, 1990–2016.
Data from WHO. (2009a). World health statistics, 2009. Geneva, Switzerland: WHO; WHO. (2017). World health statistics, 2017. Geneva, Switzerland: WHO; Ritchie, H., & Roser, M. (2018). “Causes of Death”. Published online at OurWorldInData.org. Retrieved from https://
ourworldindata.org/causes-of-death [Online Resource]

by related major behavioral risk factors: unhealthy estimated that the world population consisted of
diet, physical inactivity, and tobacco use. Action to 7.55 billion living human beings (World Population
prevent these major chronic diseases should focus Prospects, 2017). In that year, approximately 60 million
on controlling these and other key risk factors in a people died and 140 million new babies were born, a
well-integrated manner.” net gain of 80 million people. Based upon projections
of death rates and birth rates, the world population is
The global pandemic of chronic diseases has expected to increase to nearly 9 billion people by the
emerged in concert with the changing demography year 2040 (FIGURE 1.2).
of the world population. Overall, the world birth rate
exceeds the death rate, and the number of living indi-
viduals on the planet continues to increase. At the same ▸▸ Aging of the World Population
time, more and more people are living to older ages
thereby creating the phenomenon of “global aging.” The world population is not only increasing in num-
Aging populations are particularly evident in the indus- ber, but it is also growing older. Two demographic
trialized and developed nations of the world, such as parameters are driving these phenomena: longevity
Japan, Italy, and Germany, where the proportion of is increasing and the fertility rate is decreasing. Stud-
elderly people (over 65 years of age) has increased from ies at the World Health Organization (WHO, 2009a)
approximately 10% to 20% in the past half century and the Stanford Center of Longevity (Hayutin, 2007)
(Hayutin, 2007). In large developing nations such as clearly show that people around the world are living
China and India, the proportion of elderly people is also longer and women are having fewer children.
expected to increase from current levels of about 5% to
nearly 10% in the next few decades. In smaller under-
developed nations where less than 5% of the people
▸▸ Increasing Longevity
currently live beyond 65 years of age, population aging (Life Expectancy)
is also progressing, but at a slower pace. As a general
consequence of the aging world population, long-term The average life expectancy (also called longevity)
mechanisms of pathogenesis are more likely to cause for members of the world population born during
disease late in life, thus resulting in vastly increased 2010–2015 is 71 years (68 years for men and 73
rates of chronic diseases, particularly among the elderly. years for women) (CIA, 2017). In the past half cen-
tury, life expectancy has increased dramatically
throughout the world, particularly in populations
▸▸ Increase in World Population of developing nations. Since 1950, life expectancy in
highly populated nations such as China and India
As of July 1, 2017, The Department of Economic has increased from approximately 40 years to nearly
and Social Affairs of the United Nations Secretariat 70 years (FIGURE 1.3).
 Increasing Longevity (Life Expectancy) 5

9
8
7

Billions of People
6
5
4
3
2
1
0
1800 1850 1900 1950 1975 2000 2010 2020 2030 2040
Year

FIGURE 1.2 World Population.

Data from the United States Census Bureau. (2018). International Data Base. (estimates for 2020–2040 are based on curvilinear regression).

90
85
80
Life Expectancy (Years)

75
70
65
60
55
50
45
40
35
1950 1960 1970 1980 1990 2000 2010 2020
Calendar Year

Japan USA Europe China

WORLD India Africa

FIGURE 1.3 Longevity Trends in Selected Populations.

Data from United Nations Department of Economic and Social Affairs, Population Division. (2017). United Nations World Population Prospects: 2017 revision. New York, NY: United Nations. National Center for Health Statistics, 2017, USA.

In lesser developed nations, particularly those of Derivation of life expectancy is usually presented as
central Africa where acute infectious and parasitic a “two-step” process. For large populations, life expec-
diseases prevail and greatly reduce the survival of chil- tancy is calculated by first constructing a life table and
dren and young adults, life expectancy is much less, recording the number of deaths and survivors that occur
currently only about 50 years. In highly developed in a given year for successive intervals of the life span.
nations such as Japan, the United States, and European The number of deaths and survivors and correspond-
countries, longevity now approaches or surpasses 80 ing age-specific death rates are usually tabulated for
years and deaths are more likely due to chronic dis- ages 0–1 years, 1–5 years, and successive 5-year age
eases of old age. The Japanese people currently enjoy groups for ages 5 and above. From these data, a second
the greatest longevity, about 82 years. Longevity in life table is then constructed to represent the entire
the United States currently stands at 79 years, only mortality experience from birth to death for a hypo-
slightly higher than the average of the more developed thetical cohort of 100,000 infants born alive and sub-
nations (FIGURE 1.4). ject to the age-specific death rates that prevail in the
Life expectancy is the average number of years population of interest for a particular year. Using the
that a newborn could expect to live if he or she were data from this second life table for 100,000 hypotheti-
to pass through life subject to the age-specific death cal individuals, life expectancy is simply calculated as
rates of the population of interest for the past year. the average years of life for all members since birth
6 Chapter 1 Global Epidemiology of Chronic Diseases: The Epidemiologic Transition
80 +
77.5–80
75–77.5
FIGURE 1.4 Global Longevity, 2011.
Data from CIA World Factbook, 2011 Estimates of Life Expectancy at Birth (Years).
(e.g., life expectancy = total years of life for all mem-
bers of the life table divided by the total number of per-
sons at birth, Life Expectancy = Σ years of life/100,000).
Life expectancy (longevity) at birth is therefore the
mean years of life for individuals based entirely on the
age-specific death rates for the population and year of
interest (Colton, 1974).
▸▸ Gender Differences
in Longevity
Throughout the world, life expectancy (longevity) for
women is 5–10 years greater than for men. With some
exceptions in nations where high maternal death rates
prevail due to lack of prenatal care, women have lower
death rates and better survival at every age. In the
industrialized world, improvements in prenatal care
have reduced maternal mortality during the child-
bearing years thereby widening the gender gap in lon-
gevity during much of the 20th century. For example,
the gender divergence in longevity in the U.S. popula-
tion gradually increased from about 2 years in 1900 to
approximately 8 years in 1970, after which the differ-
ence shrank back to about 6 years, currently 81 years
for women versus 75 years for men (FIGURE 1.5). The
slight shrinkage of the U.S. gender gap during the past
40 years is believed to reflect equalizing smoking rates
among men and women (Pampel, 2002).
The survival differential favoring females actually
begins at conception. Only about 90% of male fetuses
survive to birth compared to nearly 100% of female
72.5–75 65–67.5 50–55 0–40
70–72.5 60–65 45–50
67.5–70 55–60 40–45
fetuses. While precise causative factors for this dispar-
ity remain unclear, the relatively high rates of sponta-
neous abortions, miscarriages, and stillbirths among
male fetuses could be due to hormonal incompatibil-
ities of the male genotype in a milieu of female hor-
mones such as estrogen and progesterone throughout
gestation (Austad, 2006). At the other end of the life
span, approximately 70% of individuals over 90 years
of age are female, and remarkably, about 90% of cente-
narians (individuals over 100 years of age) are female
(Perls, Hutter Silver, & Lauerman, 1999).
While no single factor can satisfactorily explain the
clear survival advantage of women throughout life, cer-
tain environmental and biological differences are worth
pointing out. The longer life span of women compared
to men is undoubtedly related to gender differences in
lifestyle. Despite the fact that men are, on average, bigger,
stronger, faster, and more economically self-­sufficient,
their lifestyle choices and risky health behaviors obvi-
ously confer a clear survival advantage to women. In
general, men have greater exposure to classical risk
factors of disease such as tobacco and alcohol and, as a
consequence, are more likely to die earlier from associ-
ated chronic conditions such as cardiovascular disease,
lung cancer, chronic obstructive pulmonary disease,
and cirrhosis of the liver. Men are also more likely to
die from injuries, whether unintentional (motor vehi-
cle or occupational accidents) or intentional (suicide,
homicide, or war). Reciprocally, women have tradition-
ally been the “sentinels of health” for their families and
communities at large. Due to their instinctive “nurtur-
ing maternal instinct,” women tend to take better care
Another random document with
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The Project Gutenberg eBook of Confessions of
a book-lover
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Title: Confessions of a book-lover

Author: E. Walter Walters

Author of introduction, etc.: Coulson Kernahan

Release date: September 17, 2023 [eBook #71667]

Language: English

Original publication: London: Charles H. Kelly, 1913

Credits: Laura Natal and the Online Distributed Proofreading

Team at https://www.pgdp.net (This file was produced
from images generously made available by The
Internet Archive/American Libraries.)

*** START OF THE PROJECT GUTENBERG EBOOK

CONFESSIONS OF A BOOK-LOVER ***
CONFESSIONS OF A BOOK-LOVER
CONFESSIONS OF A BOOK-
LOVER
BY
E. WALTER WALTERS

With an Introduction by
COULSON KERNAHAN
AUTHOR OF ‘THE FACE BEYOND THE DOOR,’
‘GOD AND THE ANT,’ ETC.

LONDON
CHARLES H. KELLY
25-35 CITY ROAD, AND 26 PATERNOSTER ROW, E.C.
First Edition, 1913
 To
THE MEMORY OF
MY FATHER
 CONTENTS
CHAP. PAGE
INTRODUCTION BY COULSON KERNAHAN 9
I. ‘HUMBLY TO CONFESS’ 17
II. BOOKS AND GARDENS 27
III. BOOKS THAT TEMPT 37
IV. ‘OUTSIDE THEIR BOOKS’ 47
V. BOOKS THAT CAPTIVATE 55
VI. PERSONALITIES IN ‘BOOKLAND’ 63
VII. SECOND-HAND BOOKS 73
VIII. ‘THE CULT OF THE BOOKPLATE’ 81
IX. BEDSIDE BOOKS 91
X. OLD FRIENDS 99
XI. THROUGH ROSE-COLOURED SPECTACLES 107
XII. WITH NATURE 117
XIII. A PILGRIMAGE 127
XIV. FAREWELL 137
 INTRODUCTION
BY COULSON KERNAHAN

I
PART of the present volume appeared in Great Thoughts. Yet here
am I, whose name is associated—if at all—in the memory of readers
with ‘little thoughts,’ and with booklets impudent in the slenderness
of their matter, presumptuously standing forth to bow the public into
the writer’s presence, and essaying to introduce the one to the other.
The necessary explanation shall be brief. I must have been a young
man, and Mr. E. Walter Walters a boy, when he and I last met;
indeed I am not sure that I altogether remember him. But his father,
who bore an honoured name, I well remember.
The Rev. W. D. Walters and my own dear and honoured father were
personal friends; and when the former’s son sent me a manuscript of
a book, with the request that I should write an introduction, how
could I do otherwise than accede, and express myself honoured by
the invitation?
That I share all Mr. Walters’s whole-hearted bookish enthusiasm, I
may not pretend, for, as R. L. Stevenson says, in An Apology for
Idlers, ‘Books are good enough in their own way, but they are a
mighty bloodless substitute for life.’ So long, however, as the reading
of it be not allowed to deprive either man or woman of drinking deep
at the wells of life, there are few greater joys, for young or old, than
are to be found within the covers of a noble book; and to the
enthusiastic book-lover, Mr. Walters’s volume should prove treasure
trove indeed.
He drags (to use a phrase of Stevenson’s) with a wide net, but his
castings are made, for the most part, in the same waters. Of the
literature of the time of Elizabeth, or even of Anne, he tells us little,
and it is not until we come to Goldsmith, Lamb, De Quincey, Leigh
Hunt, and, later, to Jefferies, Thoreau, and Stevenson, that Mr.
Walters may be said to let himself go. What my friend Mr. Le
Gallienne calls The Lilliput of Literary London, he wisely leaves
severely alone.
That Mr. Walters has a pretty sense of humour is clear from the
following passage:
‘Here is a copy of Milton’s Paradise Lost, “hooked” in the deep
waters of a “penny tub.” It is calf-bound, mark you, and in fairish
condition, though much stained with the passing of years. My heart
leaps; it is very old—a first edition possibly! But no, it is anything but
that.... Many of the pages are entirely missing, and others partially
so. Judged by the books that surround me it is dear at a penny ...
Paradise Lost!’
The word-play is not unworthy of Mr. Zangwill; but when Mr. Walters
writes, ‘I have frequently trodden snow-covered ground with my nose
a few inches from an open book,’ I wish him, for the time being,
‘Good afternoon’ and seek other company, preferably that of some
lover of the Emerson who wrote:

See thou bring not to field or stone

The fancies found in books,
Leave authors’ eyes, and fetch your own
To brave the landscape’s looks.

Or, better still:

Canst thou copy in verse one chime

Of the woodbell’s peal and cry?
Write in a book the morning’s prime?
Or match with words that tender sky?
 II
‘I KNOW a pretty little edition of the Religio Medici,’ writes Mr. Le
Gallienne in his Retrospective Reviews, ‘which has been quite
spoiled for me by the astounding remark of its editor upon Browne’s
beautiful description of his life as “a miracle of thirty years”—yet its
actual incidents justify no such description!’
Mr. Walters will not thus spoil for his readers the work of the writers
he loves. He strikes no jarring note. On the contrary, he is capable,
when writing of books, book-making, and book-buying, of an
enthusiasm which I envy as much as I admire.
‘I have confessed,’ he says in his chapter on ‘Second-hand Books,’
‘that I am of the company of book-lovers who delight in dipping into
the “lucky tubs” to be found outside booksellers’ windows. I know of
no pleasanter way of spending a spare half-hour. Give me a few
“loose” coppers, place my feet upon a likely road, and I am content. I
am now, let me say, of the happy company of book-fishermen. And
this, mark you, is fishing in real earnest, this effort to “hook” good
food for the mind, to place in one’s basket a “book that delighteth
and giveth perennial satisfaction.”’
The comparison of a book-seeker to an angler is as happy as it is
original, and the phrase—though phrase-making must not be
confused, as Leslie Stephen points out, with thought-finding—‘a
book-fisherman’ has something of Charles Lamb’s own ‘self-pleasing
quaintness.’
Lamb would, indeed, appear to be Mr. Walters’s favourite author.
That he knows his Elia intimately and can interpret him aright to
others is clear from the chapter on ‘Books and Gardens.’
‘We are told,’ says Mr. Walters, ‘that Lamb was a lover of towns and
crowded streets. Would it not be truer to say that he was a lover of
the conditions in which he chanced to be placed? London claimed
him—for the sanest reasons, no doubt—and, lo! under his pen,
London became a garden.’
This is truly and finely said. Of such acute and illuminative comment,
there is no lack in Mr. Walters’s delightful book, which should
assuredly find a place in the library of book-loving women and men.
 I
‘HUMBLY TO CONFESS’

HOW ruthlessly Webster strips the word ‘confession’ of the tender

associations woven around it by the hand of the gentle essayist! A
confession, he informs us, is the acknowledgement of a crime or
fault, open declaration of guilt, &c. True, a brighter note is struck in
further definitions; but I cannot find in any book at my command a
definition of the word as used, for example, by Thomas De Quincey.
The fact that De Quincey took opium was, I believe, known long
before he wrote his Confessions. He personally avers that his object
was to emblazon the power of opium, not over bodily disease and
pain, but over the grander and more shadowy world of dreams. He
desired

Humbly to confess
A penitential loneliness.

And I take that to mean that he desired to admit us into the

innermost recesses of his heart, to speak to us as one speaks to a
bosom friend.
I plead, therefore, for a wider definition of the word ‘confession’—a
definition that embraces those ‘gentle whisperings’ which pass
between bosom friends, the confidence that springs from the very
roots of the human heart.
An eminent essayist of our own day has been pleading for more
autobiographies of unknown persons. If I read him aright, he wishes
that more persons, however humble, however obscure, would set
forth their thoughts and experiences. He believes that such writings
would make better reading than much that finds its way into print.
There is an idea in some quarters that unless a person enjoys
peculiar gifts of expression, or has achieved distinction in some walk
of life, his thoughts and experiences are of no public interest. But
there are, I am certain, many who would rather have the unadorned
expression of a man’s innermost feelings than the thoughts that flit
so lightly from the mind of the accomplished litterateur. How many
are they—men whose names are emblazoned upon the roll of
honour—who have confessed to a love for conversing with the
ordinary man, ‘the man in the street’! As for your ‘men of letters,’ you
are well aware of their love for conversing with unknown and
frequently humble persons, ‘casual acquaintances.’ And who shall
say to what extent we are indebted to those persons for the thoughts
which, having been selected and refined, sparkle like jewels fresh
from the cutter’s hands?
How numerous are the men who have read widely and thought
deeply, and yet hesitate before expressing an opinion upon the most
trivial matters! Fortunate is the person who can induce such men to
talk freely, to express their views, their secret thoughts, on this, that,
and the other subject—their beloved books, their likes, their dislikes,
their aspirations, their fears, their hopes. Such confessions should
make good reading. By dint of a little gentle persuasion I have
managed to glean ‘copy’ of this description, which I shall hope to set
down in these pages, carefully avoiding meanwhile any mention of
names. The mere thought of publicity would bring a blush to the
cheeks of the good gentlemen I have in mind. I must adopt the plan
of those ‘Knights of the Pen’ of whom mention has been made. But
here the process will be reversed. Here the rich thought of others will
come forth in homely attire.
I would, however, first inquire in what respect the lover of books
differs from the rank-and-file? What are his distinctive
characteristics? Langford has declared that no matter what his rank
or position may be, the lover of books is the richest and happiest of
men. But is that entirely true? I confess that I do not find it so. The
lover of books is, I fancy, grievously prone to hanker after the moon,
or, to put it another way, to build wondrous fairy palaces, which he
would fain inhabit and cannot. I fancy he is apt to suffer from a
‘glorious discontent.’ He is too imaginative, too sensitive, to enjoy the
distinction of being the happiest of men.
Indeed, is it not a fact that we book-lovers stand in danger of falling
out of sympathy with this rough-and-tumble old world? Certainly
many of us resent anything that threatens to come between us and
our idols. (I have friends, book-lovers, who as strongly resent an
intrusion into the sacred nook that holds themselves and a book as
they would resent the invasion of a foreign power.) Thus grows upon
the book-lover an ever-deepening desire for solitude, for the quiet
life. Others may, if they choose, jostle for the gilded things of life. He
is for other prizes, treasures of the mind and spirit. He, for his part,
prefers to saunter through quiet by-ways, knowing full well that
prizes will rest in his path, and that these, which he need but stoop to
gather, will prove abiding treasures.
Yes, certainly the lover of books is rich. Every true lover must in the
nature of the case be that. Listen to Gibbon: ‘My early and invincible
love of reading I would not change for the treasures of India.’ How
many have spoken in like manner! ‘You, O Books,’ cried Aungervyle,
‘are the golden vessels of the temple, the arms of the clerical militia
with which missiles of the most wicked are destroyed; fruitful olives,
vines of Engedi, fig-trees knowing no sterility; burning lamps to be
ever held in hand.’
I have a friend, a book-lover, who confesses that he acquired this
love of his after having passed through the most painful experiences.
Often he stumbled, often he fell, seemingly never to rise again. But,
happily, he has reached safe ground at last. He is now the contented
owner of a rich storehouse of books. But he confesses that he is not
boisterously happy. He doubts not that others laugh more heartily
than he; that many have lighter hearts. But he, be it remembered,
has passed through deep sorrow, has lost friends, home, wealth—all
that men hold most dear. Without his books and all they have taught
him his lot would be that of a wanderer in a wilderness. ‘My books,’
he says, ‘are my inseparable comforters—my friends, companions,
teachers, consolers, creators, amusers.’ But he makes no claim to
being a student, or an authority on books. He does not burn the
proverbial midnight oil. There is nothing of the book-worm about him.
He is simply a book-lover, and being such, enjoys the very best that
books can give.
I confess that I envy the pleasure derived by this friend of mine from
the little ‘crackling’ sound caused by the opening of a new book. It is
the sweetest music in his ears—an overture composed of the most
pleasing notes. And with what relish he enters into the entertainment
that follows! With what zest he reads aloud the choice passages!
The four walls of his library must, I fancy, have peculiar knowledge of
‘the dainties that are bred in books.’ They are his only audience.
When friends are with him, it is they who must do the reading, whilst
he plays the better part.
How many a tale such as this might be told! How full of eccentricities
is the lover of books, aye, and how full, too, of whims and fads and
fancies! Each one is for a particular type of binding. In no two cases
can you find tastes exactly alike. One is for plain cloth, plainly
lettered, another is for calf or russia, another for parchment. And
each one has his own views as regards size. Some cry out for books
that can be handled with ease; others maintain that the size of a
book should suit the nature of its contents. And thus the battle
wages, quite a long and wordy affair, before any question arises as
regards the actual contents of a book. But are not these views
concerning the make-up of a book healthy and desirable? I seem to
remember having read of men held in high repute who had marked
preferences as regards the get-up of a book. Did not Charles Lamb
maintain that to be strong-backed and neat-bound is the
desideratum of a volume? ‘Magnificence comes after. This, when it
can be afforded, is not lavished upon all kinds of books
indiscriminately. I would not dress a set of magazines, for instance,
in full suit. The deshabille or half-binding (with russia backs) is our
costume. A Shakespeare or a Milton (unless the first editions) it were
mere foppery to trick out in gay apparel.’
And what of the ‘inside’ of books? What of their contents? For my
own part, I confess that, when pressed for a list of my favourite
authors, I am at a loss for an answer, or, at least, for a satisfactory
answer. The question is so pointed, the answer resting quietly in my
mind so wide, so shadowy, so needful of explanation. So much
depends upon one’s mood and environment. I require the
opportunity to say why certain books appeal to me in certain moods
and leave me untouched at other times. I desire to show that certain
books, in order to be enjoyed to the full, must be read in certain
seasons and under certain conditions. I wish to hold forth upon, say,
‘Books and Gardens,’ ‘Unknown Books,’ and so forth, and on the
peculiarities of certain authors, giving reasons why I like or dislike
their works. I wish to confess, to bare my heart. And that is too
lengthy a process to cram in a direct answer to a direct question.
Only this much can I confess ‘off-hand’: The books that please me
most are the books that speak to the heart. Such volumes are my
most highly treasured possessions.
 II
BOOKS AND GARDENS

The mind relaxing into needful sport,

Should turn to writers of an abler sort,
Whose wit well-managed, and whose classic style
Give truth a lustre and make wisdom smile.
Cowper.

I have confessed that the books which please me most are the
books that speak to the heart—books that greet one with the ease
and familiarity of a friend. I desire to feel the humanity, the heart of
an author. I desire to know that he is genial, kindly, well-disposed. I
have no inclination for angry, fretful men of letters. I no more desire
to meet such through the medium of a book, than I desire to make
the acquaintance of quarrelsome individuals in the flesh. I, too, ‘find
myself facing as stoutly as I can a hard, combative existence, full of
doubts, difficulties, and disappointments, quite a hard enough life
without dark countenances at my elbow.’ Give me pleasant
company. Give me gentlemen of letters. Still, I have no taste for the
company of the maudlin or weak-kneed. Robert Louis Stevenson
says that ‘we are all for tootling on the sentimental flute in literature;
and not a man amongst us will go to the head of the march to sound
the heady drums!’ Note with what grace he makes the observation! It
is more in the nature of a good-tempered laugh than a growl. How
gracefully he wears the title—a Gentleman of Letters! How
pleasantly he addresses us! Little wonder if, in his presence, our
failings are as open wounds. He has no need to probe. His gentlest
touch is sufficient, more effective by far than the rough treatment of
the irascible author.