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Printed in the United States of America

Print Number: 01 Print Year: 2022
To my husband, Larry Butler, who is now with the Lord, and my
son Jeremy Neighbors, his wife Misty, and my grandson Kieran. I love
you all very much. Marianne
To my husband, Jim, the quiet, solid, love of my life for over

48 years, and to the other man in my life, my brother Bob Tannehill,
who has always loved and supported me, “his younger, little sister.” Ruth
Contents
List of Tables xii Hyperplasias and Neoplasms 15

Preface xiii Hyperplasias 15
Neoplasms 15
Reviewers xxi
Nutritional Imbalance 16
Malnutrition 16
Unit I Obesity 18
CONCEPTS OF HUMAN DISEASE 1 Vitamin or Mineral Excess or Deficiency 18
Impaired Immunity 18
Allergy 18
CHAPTER 1 Autoimmunity 18
Immunodeficiency 19
Introduction to Human Diseases 3
Aging 19
Disease, Disorder, and Syndrome 4 Death 20
Disease 4
Cellular Injury 20
Disorder 4
Cellular Adaptation 20
Syndrome 4
Atrophy 20
Pathology 4 Hypertrophy 21
Pathogenesis 4 Hyperplasia 21
Etiology 5 Dysplasia 21
Metaplasia 21
Predisposing Factors 6
Neoplasia 22
Age 6
Cell and Tissue Death 22
Sex 7
Organism Death 23
Environment 7
Summary 23
Lifestyle 7
Heredity 7 Review Questions 23
Diagnosis 7 Case Studies 24
Prognosis 8
Acute Disease 8 CHAPTER 3
Chronic Disease 8
Complication 9
Neoplasms 25
Mortality Rate 9 Terminology Related to Neoplasms and Tumors 26
Survival Rate 9 Classification of Neoplasms 26
Treatment 9 Appearance and Growth Pattern 26
Medical Ethics 10 Benign Neoplasm 26
Summary 11 Malignant Neoplasm 26
Tissue of Origin 27
Review Questions 11
Epithelial Tissue (Skin or Gland) 27
Case Studies 12 Connective Tissue (Bone, Muscle, or Fat) 27
Lymphatic or Blood-Forming Tissue 27
CHAPTER 2 Other Tissues 27
Growth of Benign and Malignant Neoplasms 27
Mechanisms of Disease 13 Benign Neoplasm Growth 28
Causes of Disease 14 Malignant Neoplasm Growth 28
Heredity 14 Hyperplasias and Neoplasms 29
Trauma 14 Hyperplasias 30
Inflammation and Infection 15 Neoplasms 30
v
vi Contents
Development of Malignant Neoplasms (Cancer) 30 Fibrinous Exudate 47

Invasion by and Metastasis of Cancer 31 Purulent Exudate 48
Inflammatory Lesions 48
Lymphatic System Metastasis 31
Abscesses 48
Bloodstream Metastasis 31
Ulcer 48
Cavity Metastasis 32
Cellulitis 49
Grading and Staging of Cancer 32
Tissue Repair and Healing 49
Grading 32
Tissue Repair 49
Staging 32
Regeneration 49
Causes of Cancer 32
Fibrous Connective Tissue Repair (Scar Formation) 49
Chemical Carcinogens 32 Tissue Healing 50
Hormones 33 Primary Union (First Intention) 50
Radiation 33 Secondary Union (Secondary Intention) 50
Viruses 34 Delayed Wound Healing 51
Genetic Predisposition 34 Complications of Wound Healing 51
Personal Risk Behaviors 34 Infection 52
Smoking and Tobacco Product Use 34
Frequency and Types of Infection 52
Diet 34
Bacteria 53
Alcohol Use 35
Viruses 54
Sexual Behavior 35
Fungi 55
Cancer Prevention 35
Rickettsiae 55
Frequency of Cancer 37 Protozoa 56
Diagnosis of Cancer 38 Helminths 57
Signs and Symptoms of Cancer 38 Testing for Infection 57
Pain 38 Summary 59
Obstruction 38 Review Questions 59
Hemorrhage 39 Case Studies 60
Anemia 39
Fractures 39 Unit II
Infection 39
Cachexia 39
COMMON DISEASES AND
Cancer Treatment 39 DISORDERS OF BODY SYSTEMS 61
Surgery 40
Chemotherapy 40 CHAPTER 5
Radiation 40
Hormone Therapy 41 Immune System Diseases and Disorders 63
Summary 41 Anatomy and Physiology 64
Review Questions 41 Common Signs and Symptoms 65
Case Studies 42 Diagnostic Tests 65
Common Diseases of the Immune System 66
CHAPTER 4 Hypersensitivity Disorders 67
Autoimmune Disorders 72
Inflammation and Infection 43
Isoimmune Disorders 78
Defense Mechanisms 44 Immune Deficiency Disorders 81
Physical or Surface Barriers (Nonspecific) 44 Trauma 83
Inflammation (Nonspecific) 44 Rare Diseases 83
Immune Response (Specific) 44
Severe Combined Immunodeficiency Disease (Scid) 83
Inflammation 45
Effects of Aging on the Immune System 85
The Inflammatory Process 45
Summary 85
Chronic Inflammation 46
Inflammatory Exudates 47 Review Questions 85
Serous Exudate 47 Case Studies 86
Contents vii
CHAPTER 6 Von Willebrand’s Disease 133

Lymphosarcoma 133
Musculoskeletal System Diseases Effects of Aging on the System 134
and Disorders 87 Summary 134
Anatomy and Physiology 88 Review Questions 134
Common Signs and Symptoms 90 Case Studies 136
Diagnostic Tests 90
Common Diseases of the Musculoskeletal System 91 CHAPTER 8
Diseases of the Bone 91
Other Diseases of the Bone 94 Cardiovascular System Diseases
Diseases of the Joints 96 and Disorders 137
Arthritis 96
Anatomy and Physiology 138
Joint Deformities 100
Diseases of the Muscles and Connective Tissue 101 Common Signs and Symptoms 140
Neoplasms 102 Diagnostic Tests 142
Trauma 103 Common Diseases of the Cardiovascular System 144
Fracture 103 Diseases of the Arteries 144
Types of Fractures 103 Diseases of the Heart 153
Treatment of Fractures 105 Coronary Heart Disease 154
Complications of Fractures 105 Diseases of the Veins 160
Strains and Sprains 106 Thrombophlebitis 160
Rare Diseases 115 Trauma 162
de Quervain’s Disease 115 Hemorrhage 162
Tuberculosis of the Bone 115 Shock 163
Paget’s Disease 116 Rare Diseases 163
Myasthenia Gravis 116
Malignant Hypertension 163
Effects of Aging on the System 116 Cor Pulmonale 163
Summary 116 Raynaud’s Disease 164
Review Questions 117 Buerger’s Disease 164
Case Studies 118 Polyarteritis Nodosa 164
Effects of Aging on the System 164
Summary 164
CHAPTER 7
Review Questions 165
Blood and Blood-Forming Organs Case Studies 168
Diseases and Disorders 119
Anatomy and Physiology 120 CHAPTER 9
Common Signs and Symptoms 121
Respiratory System Diseases
Diagnostic Tests 122
and Disorders 169
Common Diseases of the Blood
and Blood-Forming Organs 123 Anatomy and Physiology 170
Disorders of Red Blood Cells 123 Common Signs and Symptoms 171
Polycythemias 128 Diagnostic Tests 173
Disorders of White Blood Cells 129 Common Diseases of the Respiratory System 173
Mononucleosis 129
Diseases of the Upper Respiratory Tract 174
Lymphomas 130
Hay Fever (Allergic Rhinitis) 176
Disorders of Platelets 132
Diseases of the Bronchi and Lungs 178
Trauma 133 Diseases of the Pleura and Chest 189
Rare Diseases 133 Diseases of the Cardiovascular and Respiratory
Thalassemia 133 Systems 192
viii Contents
Trauma 193 Gluten-Induced Enteropathy 234

Pneumothorax and Hemothorax 193 Intestinal Polyps 234
Suffocation 193 Effects of Aging on the System 234
Rare Diseases 195 Summary 235
Pneumoconioses 195 Review Questions 235
Fungal Diseases 195 Case Studies 237
Legionnaires’ Disease 195
CHAPTER 12
Summary 196
Review Questions 196 Liver, Gallbladder, and Pancreatic
Case Studies 197 Diseases and Disorders 239
CHAPTER 10 Common Signs and Symptoms 241
Lymphatic System Diseases
Common Diseases of the Accessory
and Disorders 199 Organs of Digestion 241
Anatomy and Physiology 200 Liver Diseases 241
Common Signs and Symptoms 201 Other Diseases of the Liver 244
Diagnostic Tests 201 Gallbladder Diseases 250
Pancreatic Diseases 252
Common Diseases of the Lymphatic System 201
Rare Diseases 253
Lymphoma 204
Primary Biliary Cirrhosis 253
Mononucleosis 204
Gilbert’s Syndrome 253
Rare Diseases 204 Hemochromatosis 253
Kawasaki Disease 204 Effects of Aging on the System 253
Summary 253
Summary 204
Case Studies 255
Case Studies 205
CHAPTER 13
CHAPTER 11
Urinary System Diseases and Disorders 257
Digestive System Diseases Anatomy and Physiology 258
and Disorders 207 Common Signs and Symptoms 258
Anatomy and Physiology 208 Diagnostic Tests 259
Common Signs and Symptoms 209 Common Diseases of the Urinary System 260
Diagnostic Tests 210 Urethritis 264
Common Diseases of the Digestive System 213 Cystitis 264
Pyelitis 264
Diseases of the Mouth 213
Pyelonephritis 264
Diseases of the Throat and Esophagus 215
Diseases of the Kidney 265
Diseases of the Stomach 219
Diseases of the Bladder 272
Diseases of the Small Intestine 222
Diseases of the Colon 225
Trauma 275
Diseases of the Rectum 233 Straddle Injuries 275
Trauma 234 Rare Diseases 276
Trauma to the Mouth 234 Goodpasture Syndrome 276
Trauma to the Stomach and Intestines 234 Interstitial Cystitis 276
Rare Diseases 234 Effects of Aging on the System 276
Achalasia 234 Summary 277
Contents ix
Review Questions 277 Effects of Aging on the System 332

Case Studies 278 Summary 332
CHAPTER 14 Case Studies 334
Endocrine System Diseases
CHAPTER 16
and Disorders 279
Anatomy and Physiology 280 Eye and Ear Diseases and Disorders 335
Common Signs and Symptoms 282 Anatomy and Physiology 336
Diagnostic Tests 283 Eye 336
Common Diseases of the Endocrine System 284 Ear 337
Pituitary Gland Diseases 284
Thyroid Gland Diseases 286 Diagnostic Tests 338
Parathyroid Gland Diseases 289 Diagnostic Tests of the Eye 338
Adrenal Gland Diseases 290 Diagnostic Tests of the Ear 339
Hyperadrenalism 290 Common Diseases of the Eye 340
Other Diseases of the Adrenal Glands 292 Inflammation and Infection 344
Pancreatic Islets of Langerhans Diseases 292 Common Diseases of the Ear 350
Reproductive Gland Diseases 298
Infection 350
Trauma 299
Serous 350
Rare Diseases 299 Suppurative 350
Effects of Aging on the System 299 Deafness 354
Summary 299 Trauma 357
Review Questions 300 Rare Diseases 359
Case Studies 302 Retinoblastoma 359
Meniere’s Disease 359
Otitis Interna 359
CHAPTER 15 Effects of Aging on the System 359
Nervous System Diseases Summary 360
and Disorders 303 Review Questions 361
Case Studies 362
The Central Nervous System 304
The Peripheral Nervous System 305 CHAPTER 17
Reproductive System Diseases
and Disorders 363
Common Diseases of the
Nervous System 309 Anatomy and Physiology 364
Infectious Diseases 309 Female Anatomy and Physiology 364
Vascular Disorders 312 Male Anatomy and Physiology 365
Functional Disorders 315 Common Signs And Symptoms 366
Dementias 320 Diagnostic Tests 366
Sleep Disorders 324 Common Diseases of The
Tumors 325 Reproductive System 369
Trauma 326 Female Reproductive System Diseases 369
Rare Diseases 330 Other Female Reproductive
Amyotrophic Lateral Sclerosis 330 System Diseases and Disorders 374
Guillain-Barre Syndrome 330 Diseases of the Breast 381
Huntington’s Disease 330 Disorders of Pregnancy 384
Multiple Sclerosis 332 Male Reproductive System Diseases 387
x Contents
Sexually Transmitted Diseases 392

Unit III
Acquired Immunodeficiency Syndrome 392
Hepatitis 393 GENETIC AND DEVELOPMENTAL,
Sexual Dysfunction 398 CHILDHOOD, AND MENTAL
Trauma 401
HEALTH DISEASES AND
Rape 401
Rare Diseases 402 DISORDERS 445
Vaginal Cancer 402
Puerperal Sepsis 402 CHAPTER 19
Hydatidiform Mole 402
Effects of Aging on The System 402 Genetic and Developmental
Summary 403 Diseases and Disorders 447
Review Questions 403 Anatomy and Physiology 448
Case Studies 404 Common Signs and Symptoms 452
CHAPTER 18 Common Genetic and Developmental
Integumentary System Diseases Disorders 453
Musculoskeletal 453
and Disorders 405 Neurologic 455
Anatomy and Physiology 406 Cardiovascular 459
Common Signs and Symptoms 407 Blood 462
Sickle Cell Anemia 462
Hemophilia 462
Common Diseases of the Integumentary System 409 Digestive 462
Infectious Diseases 409 Urinary 465
Viral Diseases 409 Reproductive 467
Bacterial Diseases 412 Cryptorchidism 467
Fungal Diseases 416 Other Developmental Disorders 467
Parasitic Diseases 419 Multisystem Diseases and Disorders 468
Metabolic Diseases 421 Trauma 470
Hypersensitivity or Immune Diseases 423 Failure to Thrive 470
Scleroderma 425 Fetal Alcohol Syndrome 470
Idiopathic Diseases 425 Congenital Rubella Syndrome 470
Benign Tumors 427
Rare Diseases 470
Premalignant and Malignant Tumors 429
Anencephaly 470
Abnormal Pigmented Lesions 432
Achondroplasia 471
Diseases of the Nails 432
Tay-Sachs Disease 471
Diseases of the Hair 433
Trauma 434 Summary 471
Mechanical Skin Injury 434 Review Questions 471
Thermal Skin Injury 435 Case Studies 473
Electrical Injury 438
Radiation Injury 438
Pressure Injury 438 CHAPTER 20
Insect and Spider Bites and Stings 439
Childhood Diseases and Disorders 475
Rare Diseases 442
Elephantiasis 442 Infectious Diseases 476
Effects of Aging on The System 442 Viral Diseases 476
Bacterial Diseases 482
Summary 442
Fungal Diseases 484
Review Questions 443 Parasitic Diseases 485
Case Studies 444 Pediculosis 486
Contents xi
Respiratory Diseases 487 Narcotics 511

Digestive Diseases 490 Inhalants 512
Anabolic Steroids 512
Fluid Imbalances 490
Organic Mental Disorders 512
Food Allergies 490
Psychosis 514
Eating Disorders 490
Mood or Affective Disorders 516
Cardiovascular Diseases 491
Dissociative Disorders 518
Musculoskeletal Diseases 491 Anxiety Disorders 519
Blood Diseases 492 Somatoform Disorders 520
Neurologic Diseases 493 Personality Disorders 521
Gender Dysphoria 522
Eye and Ear Diseases 494
Sleep Disorders 523
Strabismus 494 Trauma 524
Trauma 494
Grief 524
Child Abuse 494 Suicide 524
Suicide 495 Rare Diseases 524
Drug Abuse 495
Poisoning 495 Mental Health Disorders in the Older Adult 524
Summary 498 Summary 525
Review Questions 498 Review Questions 525
Case Studies 500 Case Studies 527
CHAPTER 21 Appendix A:
References 529
Mental Health Diseases and Disorders 501
Common Signs and Symptoms 502 Appendix B:
Diagnostic Tests 502 Common Laboratory Values 537
Common Mental Health Diseases and Disorders 502
Developmental Mental Health Disorders 502 Appendix C:
Substance-Related Mental Disorders 506 Metric Conversion Tables 539
Methamphetamine Abuse 509
Caffeine and Nicotine Abuse 509
Sedatives or Depressants Abuse 510 Glossary 541
Amphetamine Abuse 510
Hallucinogen Abuse 510 Index 557
List of Tables
CHAPTER 1 CHAPTER 6
1-1 Types of Pathologists 4 6-1 Classification of Joints by Movement 89
1-2 Examples of Acute and Chronic Diseases/ 6-2 Risk Factors for Osteoporosis 95
Disorders 5 6-3 Risk Factors for Osteoarthritis 97
1-3 Examples of Common Diagnostic Tests and
Procedures 8 CHAPTER 7
7-1 RBC Blood Donor and Recipient Chart 121
CHAPTER 2
7-2 Blood Cell Abnormalities and Associated
2-1 Classification of Hereditary Disease with Symptoms 122
Examples 14
7-3 CBC Normal Values 123
2-2 Examples of Neoplasms or Tumors 16
CHAPTER 13
CHAPTER 3
13-1 Urinalysis Values 259
3-1 Neoplasm vs. Nonneoplasm 26
3-2 Origins and Names for Benign and CHAPTER 14
Malignant Neoplasms 28
14-1 The Endocrine Glands: Their Hormones
3-3 Comparison of Benign and Malignant and Hormone Functions 281
Neoplasms 29
14-2 Emergency Treatment of Diabetic Coma or
3-4 Comparison of Carcinomas and Sarcomas 32 Insulin Shock 296
3-5 Lifetime Risk of Being Diagnosed with
Cancer—Both Sexes, All Races 37 CHAPTER 15
3-6 Lifetime Risk of Dying from Cancer—Both 15-1 The Cranial Nerves 306
Sexes, All Races 37
CHAPTER 21
CHAPTER 4 21-1 Genetic and Acquired Causes of Intellectual
4-1 Some of the Leading Causes of Death Disability 503
in the World Due to Infections 53 21-2 Physical Causes of Dementia and Delirium 514
4-2 Some Common Infections Caused by 21-3 Phobias 520
Microorganisms in Humans 53
21-4 Dr. Elisabeth Kubler-Ross’s Five Stages
of Grief/Death and Dying 524
CHAPTER 5
5-1 Types and Functions of Leukocytes 64
5-2 Types of Immunity 65
xii
Preface
llied health professionals are required to be and physiology before introducing the most common
A knowledgeable about the common diseases and

disorders health care providers see and treat. As
the medical field continues to grow and change and new
diseases related to each system and specialty area.
Common diseases and disorders for each body system
are presented consistently through a description of the
diseases emerge, the need for these careers will continue disease or disorder, the etiology, symptoms, diagnosis,
to expand. This book includes the most current research treatment, and prevention.
and reflects the latest practices from actual practice. Simulated real-world activities provide learn
ers with hands-on experience applying key concepts
learned in the chapters into practice.
Conceptual Approach
Several dilemmas immediately emerge when one
Many pathophysiology books have been written considers writing a textbook for such a large and diverse
to address the informational needs of the medical audience as the health care field. Questions arise as to
community, but learners in allied health professional how much content to include, what to exclude, how
programs require an essential pathophysiology detailed the content should be, and how to organize the
text geared specifically for these programs. Human content in the most understandable manner. Another
Diseases, Sixth Edition is designed and specifically common concern is the question of the appropriate
written for learners in health care programs pursuing reading level.
careers as allied health professionals, including but not In an attempt to resolve these dilemmas, it was
limited to medical assistants, medical coders, surgical decided to organize the book in such a way that blocks
technologists, respiratory therapist assistants, physical of material or even entire chapters could be omitted or
therapist assistants, radiologic technologists, medical covered in detail, depending on the format of the course
transcriptionists, emergency medical technicians, and needs of the learner. At the same time, informa
nursing assistants. The book is intended to meet the tion on each disease is written in such a way that it can
needs of learners enrolled in an allied health career stand alone or be viewed as all inclusive. This concept
program as well as serve as a valuable resource for health allows the instructor, learner, or individual to select and
care professionals on the job. It is also ideal as a resource study only those specific diseases or individual disease
on basic diseases by anyone within the medical arena of interest. Not all health conditions are covered in the
or individuals interested in human diseases. Current text, so the conditions chosen to be included are those
information for this book was based on the authors’ own that are most common, along with the new and emerg
experiences and research sought from current literature, ing diseases. A few rare conditions are also included. Of
books, Internet resources, and physician consultations. the conditions chosen for the text, only general infor
Students will understand this text best if a basic mation is covered. The text is designed to be a basic
medical terminology or anatomy and physiology overview of common diseases and disorders, not an
course has been completed before this course of study. in-depth study. Thus, the diseases presented are not
However, this book is designed to make difficult patho described on a cellular physiological level, which would
physiology concepts easier to understand by using a be too complex for the intended audience. The intention
consistent organization, and including pronunciations, also was to keep the reading level of the text at an easy-
boxed features, and full-color illustrations and photos to-read basic level to promote understanding. We did
of diseases and disorders. Organized into three units, not want to write beneath the level of the learner but, at
the book begins with basic concepts of human diseases, the same time, felt that a difficult reading level would
introduces common diseases and disorders of the only increase the complexity of the material and thus
body systems, followed by genetic and developmental, fail to promote understanding of the subject matter.
childhood, and mental health diseases and disorders. The boxed features within the chapters either add
Chapters progress through a basic review of anatomy interesting information about staying healthy, present
xiii
xiv Preface
new research on the chapter topics, or present infor Appendices and Glossary
mation about alternative treatments. The pharmacology
Appendix A presents common laboratory values.
boxed features list some of the possible medications for
Appendix B includes metric conversion tables. The
diseases or disorders in the chapter. These drugs are
glossary includes key terms and their definitions.
listed with generic names only since there are many
trade names for the same generic medication. It is
not intended to be an exhaustive list of possible med New to This Edition
ications, but just to give the reader some information
Changes to the sixth edition include:
about common medications that might be prescribed
for certain diseases or disorders reviewed in the chapter.
The “Consider This” feature presents interesting facts to Changes in All Chapters
engage learners in the material. Cengage is committed to providing quality and inclusive
learning materials. As we adapt our learning materials to
Organization of The Text the continually evolving areas of inclusion and diversity,
the below strategies were adopted for this edition.
Human Diseases, Sixth Edition, consists of 21 chapters,
two appendices, glossary, index, and bibliography. To ■ Use age and gender-appropriate terms with the fol
gain the most benefit from your use of this text, take lowing exceptions:
advantage of the review questions and case studies that ■ Use the terms male and female when discussing
are included at the end of each chapter. anatomical structures and physiology based on
biological sex assignment to ensure alignment of
Unit I Chapters terminology learners see in other scientific courses.
Chapters 1 through 4 lay the foundation for some basic ■ Use the terms male(s) and female(s) when refer
disease concepts, including mechanisms of disease, ring to different age groups based on biological
neoplasms, inflammation, and infection. sex assignment rather than using terms based on
various age groups (for example, a disease affects
female adolescents, women, and older adult).
Unit II and Unit III Chapters
■ Use terms that appear in ICD-10 coding as diagnosis
Unit II includes chapters 5-18 which are organized
codes to ensure consistency of the medical language
by body systems and begin with a basic anatomy and
learners are exposed to in the text and will see in
physiology review of each system before discussing
actual practice.
that system’s common diseases and disorders. Included
with this discussion, where appropriate, are common ■ In an effort to keep the text as current as possible, the
signs and symptoms, diagnostic tests, trauma, and rare Glimpse of the Future boxes were eliminated because
diseases. In addition, a unique section toward the end this content quickly becomes outdated.
of each chapter discusses the effects of aging on each
system to help learners understand the natural aging
Chapter-Specific Changes
process of the human body.
Unit III includes chapters 19 through 21 on spe Chapter 1
cialty areas covering genetics, childhood diseases, and
■ Added the term healthcare-associated infection
mental health disorders.
(HAI)
Each disease in Units II and III is broken down
(where applicable) into the following sections: ■ Added material to clarify the difference between an
Description, Etiology, Symptoms, Diagnosis, Treatment, epidemic and a pandemic
and Prevention. Although this may appear to be very
Chapter 2
title-heavy when there is only a sentence or two in each
section, this breakdown will assist the learner to clearly ■ Updated the list of deaths caused by trauma
identify these components of each disease. It also main
■ Updated the BMI scale
tains consistency throughout the textbook.
Preface xv
■ Updated Consumer Responsibility in Disease Pre ■ Added a new Healthy Highlight: Increasing Iron in
vention Healthy Highlight to include COVID-19. the Diet
■ Added material on comorbidity ■ Updated the treatment section for aplastic anemia
■ Updated the treatment section for Hodgkin’s lym
Chapter 3
phoma, Non-Hodgkin’s lymphoma, and multiple
■ Updated cancer statistics myeloma
■ Updated personal risk behaviors for cancer ■ Added a new Complementary and Alternative Ther
apy: Hematologic Disorders Treated with Stem Cell
■ Updated material on smoking and tobacco product
Transplants
use
■ Updated cancer prevention with the latest recom Chapter 8
mendations from the American Cancer Society
■ Updated the Pharmacology Highlight
■ Updated the section on diagnosis of cancer
■ Added a new Complementary and Alternative Ther
apy: Quercetin for Cardiovascular Disease
apy: Kombucha Beverage for Some Forms of Cancer
■ Updated the Healthy Highlight: Prevent High Blood
Chapter 4 Pressure
■ Updated the treatment section for coronary artery
■ Added a new Healthy Highlight: Emerging Infectious
disease
Diseases: How to Stay Healthy
Chapter 5
apy: Low Fat Diets: Are They Necessary?
■ Updated the section on common signs and ■ Added a new Complementary and Alternative Ther
symptoms apy: Salidroside Use in Heart Disease
■ Added a new Healthy Highlight: The Importance of
Chapter 9
Sleep to the Immune System
■ Updated the Pharmacology Highlight with the bio ■ Updated the Healthy Highlight: Why Do I Sneeze?
logics category ■ Updated the Diagnostic Tests section
■ Added a new Healthy Highlight: There’s a Difference ■ Updated the Pharmacology Highlight with the anti
Between Food Allergy and Food Intolerance cholinergics and mucolytics categories, added exam
■ Added a new Complementary and Alternative Ther ples of decongestants, and information on drugs used
apy: How to Boost the Immune System to treat COVID-19
■ Updated the section on Acquired Immunodeficiency ■ Added a new Complementary and Alternative Ther
Syndrome (AIDS) apy: Echinacea for Colds and Influenza Prevention
Chapter 6
apy: Nutritional Supplements as a Treatment for
■ Added information on arthroscopy. COVID-19?
■ Added a new Complementary and Alternative Ther ■ Added a Healthy Highlight: Coronavirus 2019
apy: Stem Cell Therapy for Knee Osteoarthritis (COVID-19)
■ Added a new Complementary and Alternative Ther ■ Updated the pulmonary tuberculosis section
apy: Honey for Bone Health? ■ Updated the Healthy Highlight: The Harmful Effects
of Smoking
Chapter 7
■ Added a Healthy Highlight: Are Electronic Cigarettes
■ Updated the Pharmacology Highlight with the anti Safe?
coagulants and plasminogen activators category ■ Updated the Healthy Highlight: Abdominal Thrust
xvi Preface
Chapter 10 ■ Updated the renal calculi section

■ Updated the renal failure section
■ Updated the Pharmacology Highlight with the
immunotherapy category and added examples of ■ Added a new Complementary and Alternative Ther
medications apy: Herbal Medicine for Incontinence
■ Added a new Complementary and Alternative Ther ■ Updated the urinary incontinence section
apy: Acupuncture for Lymphedema Treatment
Chapter 14
Chapter 11 ■ Updated the Diagnostic Tests section
■ Updated the Diagnostic Tests section ■ Updated the Pharmacology Highlight with the
alpha-glucosidase inhibitors, thioglitazones, hor
■ Updated the Pharmacology Highlight with the pro
mone agonists, hormone antagonists, and anti
motility agent category and updated the examples of
cancer agents categories, and updated the examples
medications
of medications
■ Updated the Healthy Highlight: What Does the
Tongue Tell You?
apy: Berberine for Hyperglycemia
■ Updated the Healthy Highlight: What You Need to
apy: Essential Oils for Relief of Nausea and Vomiting
Know About Type 2 Diabetes and Taking Dietary
■ Updated the Healthy Highlight: How to Tell Heart Supplements
burn from a Heart Attack
■ Added a new Complementary and Alternative Ther apy: Luteolin to Maintain Blood Glucose Levels
apy: Curcumin
■ Added a new Complementary and Alternative Ther apy: Acupuncture for Diabetic Neuropathy
apy: Natural Therapies for Irritable Bowel Syndrome
Chapter 15
■ Updated the Healthy Highlight: Screening Tests for
Colon Cancer ■ Updated the Diagnostic Tests section
■ Updated the Pharmacology Highlight with the dopa
Chapter 12
mine agonists category and added and updated the
■ Updated the Diagnostic Tests section examples of medications
■ Updated the Pharmacology Highlight with the alco ■ Updated the treatment section for shingles
hol abuse treatment, kinase inhibitor, and immune ■ Updated the diagnosis section and added a new
system booster categories, and updated the examples image for cerebrovascular accident
of medications ■ Added a new Complementary and Alternative Ther
■ Updated the Complementary and Alternative Ther apy: Using Acupuncture for Dysphagia
apy: Dietary Supplements for Hepatitis C ■ Added a new Complementary and Alternative Ther
■ Added a new Complementary and Alternative Ther apy: Meditation for Dementia
apy: Liver Cancer Treatment ■ Updated the Healthy Highlight: Hand Tremors
■ Updated the Healthy Highlight: Brain Foods (New
Chapter 13
title: The MIND Diet for Brain Health)
■ Updated the Diagnostic Tests section ■ Added a new Complementary and Alternative Ther
■ Updated the Pharmacology Highlight with the apy: Aromatherapy for Better Sleep
immunotherapy category and updated the examples
Chapter 16
of medications
■ Added a new Complementary and Alternative ■ Updated the Diagnostic Tests of the Eye section
Therapy: New Ways to Treat Lower Urinary Tract ■ Updated the example medications in the Pharmacol
Problems ogy Highlight for eye disorders
Preface xvii
■ Updated the Diagnostic Tests of the Ear section Chapter 18

■ Updated the example medications in the Pharmacol
■ Updated the Healthy Highlight: Collagen for Healthy
ogy Highlight for ear disorders Skin
■ Added a new Healthy Highlight: UV Light Exposure
■ Updated the Diagnostic Tests section
and Your Eyes
■ Updated the Pharmacology Highlight with the anti
■ Updated the Healthy Highlight: What is a
virals, enzyme inhibitors, and immunosuppressants
Blepharospasm? categories, and updated the examples of medications
apy: Nutrition for Eye Health apy: Therapies for Skin Conditions
■ Updated the Healthy Highlight: Foods to Help Dry
■ Updated the Complementary and Alternative Ther
Eyes apy: Chamomile for Skin Conditions
■ Added a new Healthy Highlight: Some Drugs Can
Cause Ear Problems apy: Therapy for Scars
■ Updated the Healthy Highlight: Preserving and
Improving Your Hearing apy: The Lone Star Tick and Red Meat Food Allergies
■ Added a new Healthy Highlight: Natural Treatments
for Ear Problems Chapter 19
Chapter 17 ■ Added a new Healthy Highlight: Gene Mutations

apy: Using Meditation to Improve Health
■ Updated the Pharmacology Highlight for Female
Reproductive Disorders with the Fertility drugs cat
egory and updated the examples of medications ■ Updated the examples of medications in the Pharma
cology Highlight
■ Updated the Pharmacology Highlight for Male
Reproductive Disorders with the Phosphodiesterase ■ Updated the Microcephaly section
inhibitors category and example medications ■ Updated the Huntington’s Disease section
■ Added a new Complementary and Alternative Ther ■ Added a new Healthy Highlight: Genetic Testing
apy: The Chaste Tree Berry Benefits ■ Added a new Complementary and Alternative Ther
■ Updated the section on breast cancer apy: Herbs for Treatment of Phenylketonuria (PKU)
■ Added a new Complementary and Alternative Ther ■ Updated the Autism Spectrum Disorder section
apy: Art and Music Therapy to Improve Quality of
Life for Breast Cancer Patients Chapter 20
■ Updated the Complementary and Alternative Ther ■ Updated the Acquired Immunodeficiency Syndrome
apy: Supplements for Men’s Health section
■ Added a new Complementary and Alternative Ther ■ Updated statistics in the Diphtheria section
apy: Apitherapy for Benign Prostatic Hyperplasia
■ Updated the Healthy Highlight: Epinephrine for
(BPH)
Allergic Reactions
■ Updated the statistics in the genital herpes section
■ Updated the Healthy Highlight: Preventing Sexually apy: Managing Food Allergies
Transmitted Infections: Practice Safe Sex
■ Updated the Healthy Highlight: Some Facts about apy: Herbs for Children
Human Papillomavirus (HPV)
■ Updated statistics in the Suicide section
apy: Alternative Ways to Boost Testosterone Levels
xviii Preface
■ Updated the Healthy Highlight: Immunization ■ The Cognero® Test Bank includes 60 questions per
Schedule for Children chapter, including multiple-choice and scenario mul
tiple-choice questions and feedback; true/false ques
Chapter 21 tions were deleted.

Added a new Healthy Highlight: Staying Positive to
■
Mindtap
Improve Life
■ Updated the examples of medications in the Pharma MindTap is a fully online, interactive learning
cology Highlight experience built upon authoritative Cengage Learning
content. By combining readings, multimedia, activities,
■ Updated the Intellectual Disability section
and assessments into a singular learning path, MindTap
■ Added a new Healthy Highlight: The National elevates learning by providing real-world application
Helpline for Mental Health and/or Substance Use to better engage students. Instructors customize the
Disorders learning path by selecting Cengage Learning resources
■ Updated the Caffeine and Nicotine Abuse section and adding their own content via apps that integrate
into the MindTap framework seamlessly with many
■ Added a new Healthy Highlight: Naloxone for
learning management systems.
Overdoses
■ To learn more, visit www.cengage.com/training
■ Added a new Healthy Highlight: Preventing Opioid /mindtap.
Overdoses
apy: Aromatherapy for Mood Elevation About the Authors
apy: Exercise for Relief from Depression Dr. Marianne Neighbors has been in nursing practice
and nursing education for more than 40 years. She
■ Added a section on Gender Dysphoria received her bachelor’s degree in nursing at Mankato
State, a master’s degree in health education at the
University of Arkansas, a master’s degree in nursing
Instructor and Student Resources at the University of Oklahoma, and a doctoral degree
in education with a focus on health science at the
Additional instructor and student resources for University of Arkansas. Dr. Neighbors has taught in
this product are available online. Instructor assets associate degree nursing education for 18 years, focusing
include an Instructor’s Manual, Educator’s Guide, on medical/surgical nursing, and in baccalaureate
PowerPoint® slides, Solution and Answer Guide, and a nursing education for 23 years, focusing on health
test bank powered by Cognero®. Student assets include promotion and community health. She also taught
PowerPoint® slides. Sign up or sign in at www.cengage advanced health promotion and nurse educator classes
.com to search for and access this product and its online at the master’s level. She has coauthored many research
resources. articles; four medical/surgical nursing texts, along with
two medical/surgical handbooks; a health assessment
■ The Instructor’s Manual includes a sample course
handbook; and a home health handbook, in addition to
syllabus and outline as a guide for setting up a course.
the six editions of Human Diseases. Dr. Neighbors has
Additional materials for each chapter include detailed
content outlines, learning objectives, expanded chap also written chapters for other nursing authors’ books.
She is currently an Emeritus professor in the Eleanor
ter summaries, discussion topics and learning activi
Mann School of Nursing at the University of Arkansas,
ties, and discussion questions.
Fayetteville, Arkansas.
■ The Solution and Answer Guide includes answers to Ruth Tannehill-Jones worked as a registered
the text chapter review questions and case studies. nurse for more than 30 years. She began her nursing
The PowerPoint® slides include chapter objectives, education at the University of Arkansas, Fayetteville,
content and activity slides, and a self-assessment. with completion of an associate degree in nursing.
Preface xix
Ms. Tannehill-Jones was not a newcomer to this cam

pus; some years previously, she had completed a bach
Acknowledgments
elor’s degree in home economics. On receiving her A special thanks goes out to all our colleagues, friends,
RN license, she worked at St. Mary-Rogers Memorial and family members who have supported us throughout
Hospital in Rogers, Arkansas, in the capacities of staff this project.
nurse, head nurse, and nursing supervisor. Her other
nursing experience includes assisting orthopedic sur
geons while employed by Ozark Orthopedic and Sports Feedback From The User(S)
Medicine Clinic located in the Northwest Arkansas The authors would like to hear from instructors, learners,
area. Ms. Tannehill-Jones gained experience in edu or anyone using the textbook about its strengths and/
cation by working as an instructor of surgical technol or suggestions for revisions. They are truly interested in
ogy while serving as the Divisional Chair of Nursing making the textbook user-friendly and comprehensive
and Allied Health Programs at Northwest Technical but not too detailed or too in-depth for the reader. The
Institute in Springdale, Arkansas. She obtained her authors want to know how the text is being used and
bachelor’s degree in nursing from Missouri Southern what features are most helpful. Please feel free to forward
State College in Joplin and her master’s degree in health comments to the authors through Cengage Learning or
service administration at Southwest Baptist University directly by e-mail to Dr. Neighbors at neighbo@uark
in Bolivar, Missouri. She worked for St. Mary’s— .edu and Ms. Tannehill-Jones at rjonesnwark@hotmail
Mercy Health System for more than 20 years in a vari .com.
ety of nursing positions, with her last position being
Vice President of Patient Care Services, Chief Nurse Marianne Neighbors, EdD, RN
Executive. Ms. Tannehill-Jones retired from Regency Ruth Tannehill-Jones, MS, RN
Hospital of Northwest Arkansas in 2011.
Reviewers
We would like to thank all of the reviewers who have Nanette Mosser, RMA (AMT), BA
been an invaluable resource in guiding this book as it Program Director: Medical Assisting program,
has evolved. Their insights, comments, suggestions, MedQuest College
and attention to detail were extremely important in
Gloria Madison, MS, RHIA, CHDA, CHTS-IM
developing this textbook.
Program Director, Faculty: Health Information
Manuel F. Sanchez, M.D. Technology, Moraine Park Technical College
Faculty: St. Paul’s School of Nursing, Nursing and
Jennifer Pierce, CPC, CPC-I
Medical Assisting programs
Adjunct Professor: San Joaquin Valley College
Angela Campbell, MSHI, RHIA
HIT Instructor: San Juan College
Trena M. Soucy, MS
Biology Professor: Northern Maine Community College
Gladdi Tomlinson, RN, MSN
Professor of Nursing: Harrisburg Area Community
College
xxi
Unit
Concepts of
Human Disease
Introduction to
Human Diseases
Key Terms
Acute (p. 5) Exacerbation (p. 8) Palliative (p. 10) Predisposing factors (p. 6)
Auscultation (p. 8) Fatal (p. 9) Palpation (p. 8) Prevalent (p. 7)
Chronic (p. 5) Holistic medicine (p. 9) Pandemic (p. 8) Preventive (p. 9)
Complication (p. 9) Homeostasis (p. 4) Pathogenesis (p. 4) Prognosis (p. 8)
Diagnosis (p. 7) Iatrogenic (p. 5) Pathogens (p. 4) Remission (p. 8)
Disease (p. 4) Idiopathic (p. 5) Pathologic (p. 4) Signs (p. 8)
Disorder (p. 4) Lethal (p. 9) Pathologist (p. 4) Symptoms (p. 8)
Epidemic (p. 8) Mortality rate (p. 9) Pathology (p. 4) Syndrome (p. 4)
Etiology (p. 5) Nosocomial (p. 5) Percussion (p. 8)
Learning Objectives
Upon completion of the chapter, the learner should be able to:
1. Define basic terminology used in the study 4. Identify the predisposing factors to human diseases.
of human diseases. 5. Explain the difference between the diagnosis and
2. Discuss the pathogenesis of a disease. the prognosis of a disease.
3. Describe the standard precaution guidelines 6. Describe some common tests used to diagnose
for disease prevention. disease states.
Overview
he study of human diseases is important for understanding a variety of other topics in the health care
T field. Diseases that affect humans can range from mild to severe and can be acute (short term) or chronic
(long term). Some diseases affect only one part of the body or a particular body system, whereas others affect
several parts of the body or body systems at the same time. Many factors influence the body’s ability to stay
healthy or predispose the body to a disease process. Some of these factors are controllable, but some are
strictly related to heredity. Diseases can be diagnosed by professional health care providers using a variety of
techniques and tests. ■
3
4 Chapter 1
TABLE 1-1 Types of Pathologists

Disease, Disorder,
and Syndrome Pathologist Role or Subject
In the study of human disease, several terms may be Experimental Research

similar and often used interchangeably but might not Academic Teaching
have identical definitions. Anatomic Clinical examinations
Autopsy Postmortem
Surgical Biopsies
Disease Clinical Laboratory examinations
Hematology Blood
Disease may be defined in several ways. It may be called
Immunology Antigen/antibodies
a change in structure or function that is considered to
Microbiology Microorganisms
be abnormal within the body, or it may be defined as
any change from normal. It usually refers to a condi
tion in which symptoms occur and a pathologic state is
present, such as in pneumonia or leukemia. Both defi pathologist (pah-THOL-oh-jist) is one who studies dis
nitions have one underlying concept: the alteration of ease. Using this strict definition of the word, even a stu
homeostasis (ho-mee-oh-STAY-sis). dent studying diseases might be considered a pathologist.
Homeostasis is the state of sameness or normalcy There are many types of pathologists because there
the body strives to maintain. The body is remarkable are numerous ways to study disease. One of the more
in its ability to maintain homeostasis, but when this commonly known pathologists is the surgical pathol
homeostasis is no longer maintained, the body is dis ogist, who inspects surgical tissue or biopsies for evi
eased or “not at ease.” dence of disease. The medical examiner or coroner can
be a pathologist who studies human tissue to determine
the cause of death and provide evidence of criminal
Disorder
involvement in a death. Other types of pathologists are
Disorder is defined as a derangement or abnormal outlined in Table 1-1.
ity of function. The term disorder can also refer to a The prefix patho- can be used in a variety of ways to
pathologic condition of the body or mind but more describe disease processes or the disease itself. Microor
commonly is used to refer to a problem such as a ganisms or agents that cause disease are called pathogens
vitamin deficiency (nutritional disorder). It is also (PATH-oh-jens). These include some types of bacteria,
used to refer to structural problems such as a mal viruses, fungi, protozoans, and helminths (worms). All
formation of a joint (bone disorder) or a condition pathogens have the ability to cause a disease or disor
in which the term disease does not seem to apply, der. Fractures that are caused by a disease process that
such as dysphagia (swallowing disorder). Because weakens the bone, such as osteoporosis, would be called
disease and disorder are so closely related, they are pathologic (path-oh-LODGE-ick) fractures.
often used synonymously.
Pathogenesis
Syndrome
The pathogenesis (PATH-oh-JEN-ah-sis; patho = dis
Syndrome (SIN-drome) refers to a group of symptoms,
ease, genesis = arising) is a description of how a partic
which might be caused by a specific disease but might
ular disease progresses. Many of us are familiar with the
also be caused by several interrelated problems. Exam
pathogenesis of the common cold.
ples include Tourette’s syndrome, Down syndrome, A cold begins with an inoculation of the cold virus.
and acquired immunodeficiency syndrome (AIDS),
This can occur following a simple handshake with some
which are discussed later in the text.
one who has a cold. Afterward, the target person might
rub their eyes or nose, allowing entry of the virus into
Pathology the body. After the inoculation period comes the incu
bation time. During this period, the virus multiplies, and
Pathology (pah-THOL-oh-jee) can be broadly defined as the target person begins to have symptoms such as a
the study of disease (patho = disease, ology = study). A runny nose and itchy eyes. The pathogenesis of the cold
TABLE 1-2 Examples of Acute and Chronic

Diseases/Disorders Etiology
Acute Chronic
The etiology (EE-tee-OL-oh-jee) of a disease means
the study of cause. The term etiology is commonly
Upper respiratory infections Arthritis used to mean simply “the cause.” One might say that
Lacerations Hypertension the cause is unknown or “of unknown etiology.” The
Middle ear infections Diabetes mellitus cause or etiology of pneumonia can be a virus or a
Gastroenteritis Low back pain bacterium. The etiology of athlete’s foot is a fungus
Pneumonia Heart disease named tinea pedis.
Fractures Asthma Another term used to mean “the cause is
unknown” is idiopathic (ID-ee-oh-PATH-ick). If an
individual is diagnosed as having idiopathic gastric
then moves into full-blown illness, usually followed by pain, it means the cause of the pain in the stomach
recovery and return to the previous state of health. is unknown.
The pathogenesis of a disease can be explained in Other terms related to cause of disease are
terms of time. An acute (a-CUTE) disease is short term iatrogenic (EYE-at-roh-JEN-ick) and nosocomial
and usually has a sudden onset. If the disease lasts for (NOS-oh-KOH-me-al). Iatrogenic (iatro = medicine,
an extended period or the healing process is progressing physician, genic = arising from) means that the prob
slowly, it is classified as a chronic (KRON-ick) condition. lem arose from a prescribed treatment. An example of
See Table 1-2 for examples of acute and chronic diseases !. an iatrogenic problem is the development of anemia
Healthy Highlight
How Should You eeping your hands clean through improved hand hygiene is one of the most
Wash Your Hands K important steps we can take to avoid getting sick and spreading germs to others.
Many diseases and conditions are spread by not washing hands with soap and clean
water.
To wash your hands,
■ wet your hands with clean, running water (warm or cold), turn off the tap, and apply
soap.
■ lather your hands by rubbing them together with the soap. Be sure to lather the backs
of your hands, between your fingers, and under your nails.
■ scrub your hands for at least 20 seconds. Need a timer? Hum the “Happy Birthday”
song from beginning to end twice.
■ rinse your hands well under clean, running water.
■ dry your hands using a clean towel or air-dry them.
It is important to wash
■ before eating or preparing food.
■ before touching your face.
■ after using the restroom.
■ after blowing your nose, coughing, or sneezing.
■ after handling a face mask.
■ after changing a diaper.
■ after caring for someone who is ill.
■ after touching animals.
Source: Centers for Disease Control and Prevention (2020).
6 Chapter 1
Healthy Highlight
Standard sing standard precautions is recommended by the Centers for Disease Control and
Precautions U Prevention for the care of all patients or when administering first aid to anyone.
These standards also include respiratory hygiene and cough etiquette, safe injection
techniques, and wearing masks for spinal insertions.
■ Handwashing Wash your hands after touching blood, body fluids, or both, even if
gloves are worn; use an antimicrobial soap.
■ Respiratory etiquette Cover your mouth, nose, or both with a tissue when coughing
and dispose of used tissue immediately. Wear a mask if possible. Maintain distance
from others, ideally greater than 3 feet. Wash hands after contact with secretions.
■ Gloves Wear gloves when touching blood, body fluids, and contaminated items;
change gloves after patient contact or contact with contaminated items; wash your
hands before and after.
■ Eyewear, mask, and face shield Wear protection for your eyes, mouth, and face when
performing procedures in which a risk of splashing or spraying of blood or body
secretions exists. This includes inserting catheters or injecting material into spinal or
epidural spaces. A mask should also be worn if the caregiver has a respiratory infection
but cannot avoid direct patient contact.
■ Gown Wear a waterproof gown to protect the clothing from splashing or spraying
blood or body fluids.
■ Equipment Wear gloves when handling equipment contaminated with blood or
body fluids; clean equipment appropriately after use; discard disposable equipment
in proper containers.
■ Environment control Follow proper procedures for cleaning and disinfecting the
patient’s environment after completion of a procedure.
■ Linen Use the proper procedure for disposing of linen contaminated with blood or
body fluids.
■ Blood-borne pathogens Do not recap needles; dispose of used needles and other
sharp instruments in proper containers; use a mouthpiece for resuscitation; keep a
mouthpiece available in areas where there is a likelihood of need.
in a patient undergoing chemotherapy treatments for factors are not the cause of the disease, and people with
cancer. predisposing factors do not always develop the dis
Nosocomial is a closely related term; it implies that ease. These factors include age, sex, environment, life
the disease was acquired from a hospital environment. style, and heredity. Some risk factors, such as lifestyle
A more comprehensive descriptor of a disease acquired behaviors, are controllable, whereas others such as age
in the hospital or in any health care facility is health are not.
care-associated infection (HAI). An example of a nos
ocomial or HAI would be a postoperative patient devel
oping an incisional staphylococcal infection. The best Age
way to prevent these infections is through the practice From the beginning of life until death, our risk of
of good handwashing. A good handwashing technique disease follows our age. Newborns are at risk of
is described in the Healthy Highlight box. disease because their immune systems are not fully
developed. On the other hand, older persons are
Predisposing Factors at risk because their immune systems are degen
erating or wearing out. Girls in their early teens
Predisposing factors, also known as risk factors, make and women over the age of 30 are at high risk for
a person more susceptible to disease. Predisposing a difficult or problem pregnancy. The older we
become, the higher the risk for diseases such as

cancer, heart disease, stroke, senile dementia, and
Alzheimer’s disease. Consider This...
About 90% of diseases are partially caused
Sex or affected by stress.
Some diseases are more prevalent (occurring more
often) in one gender or the other. Men are more at risk
for diseases such as lung cancer, gout, and parkinson Heredity
ism. Other disorders or diseases, including osteoporo
sis, rheumatoid arthritis, and breast cancer, occur more Although one cannot change genetic makeup, being
often in women. aware of hereditary risk factors might encourage the
individual to change lifestyle behaviors to reduce the
risk of disease. For example, coronary heart disease has
Environment been shown to have a high familial tendency. Persons
Air and water pollution can lead to respiratory and with this family inheritance are compounding their
gastrointestinal disease. Poor sanitation, excessive chances if they smoke, have poor nutritional intake,
noise, and stress are also environmental risk factors. and do not exercise routinely.
Occupational diseases such as lung disease are high Breast cancer and cervical cancer also have famil
among miners and persons working in areas with ial tendencies. Women with family members who have
increased amounts of dust or other particles in the been diagnosed with breast cancer or cervical cancer
air. are at a higher risk of developing these diseases. These
Farmers are considered to be at higher risk for dis women should be screened routinely for evidence of
eases because of their increased exposure to dust, pes cancer and should complete monthly breast self-exams.
ticides, and other pollutants. Farmers are also at higher With this knowledge about hereditary factors, individu
risk for trauma injuries due to safety problems around als can choose to decrease their overall risk by improv
farm machinery. People living in remote, rural areas ing their lifestyle health behaviors.
do not have health care availability comparable to that
enjoyed by people living in urban areas. This increases Diagnosis
their risk for chronic illnesses.
Diagnosis (die-ag-NO-sis) is the identification or
naming of a disease or condition. When an individual
Lifestyle
seeks medical attention, it is the duty of the physician
Lifestyle factors fall into a category over which the indi to determine a diagnosis of the problem. A diagnosis is
vidual has some control. Choosing to improve health made after a methodical study by the physician, using
behaviors in these areas could lead to a reduction in risk data collected from a medical history, physical exam
and thus a possibility of avoiding the occurrence of the ination, and diagnostic tests (Figure 1-1).
disease. Such factors include smoking, drinking alcohol,
poor nutrition (excessive fat, salt, and sugar and not
enough fruits, vegetables, fiber), a lack of exercise, and
stress.
Practicing health behaviors to prevent contami
nation, and thus disease, is also an important lifestyle
behavior. The Centers for Disease Control and Pre
vention recommends the use of standard precautions
when caring for any individual when there is a chance
of being contaminated with blood or body fluids (see
the Healthy Highlight box “Standard Precautions”).
This is an important measure to prevent transmission
of any disease that can be passed between humans in
blood or body fluids, such as hepatitis, Escherichia coli
infections, and AIDS. Figure 1-1 Physician checking a patient.
8 Chapter 1
A medical history is a systems review that might If an unusually large number of people in a region
include such information as previous illnesses, fam are diagnosed with the same disease around the same
ily illness, predisposing factors, medication allergies, time, the disease is called an epidemic. During the
current illnesses, and current symptoms (SIMP-tums; late fall, winter, and early spring, influenza (flu) often
what patients report as their problem or problems). reaches epidemic numbers in various regions. If an epi
Examples of symptoms might include stomach pain, demic affects an exceptionally large area, even as far
headache, and nausea. as worldwide, it is called a pandemic. Pandemics are
The physician proceeds with a head-to-toe phys rare. The most recent being Coronavirus Disease 2019
ical examination of the patient, looking for signs of (COVID-19).
the disease. Signs differ from symptoms in that signs
are observable or measurable. Signs are what the
physician sees or measures. Examples of signs could Prognosis
include vomiting, elevated blood pressure, and ele Prognosis (prawg-KNOW-sis) is the predicted or
vated temperature. expected outcome of the disease. For example, the prog
In some cases, a patient’s concern might be con nosis of the common cold would be that the individual
sidered as both a symptom and a sign. Some references should feel better in 7 to 10 days.
call this an objective or observable symptom, whereas
others state that it is also a sign. An example would be
a patient complaining of a runny nose. The runny nose Acute Disease
is the patient’s symptom, and because it is observable The duration of the disease can be described as acute in
to the physician, it is also a sign. nature. An acute disease is one that usually has a sud
During the physical examination, the physician den onset and lasts a short amount of time (days or
might use other skills such as auscultation (aws- weeks). Most acute diseases are related to the respira
kul-TAY-shun; using a stethoscope to listen to body tory system. Again, the common cold would be a good
cavities), palpation (pal-PAY-shun; feeling lightly example.
or pressing firmly on internal organs or structures),
and percussion (per-KUSH-un; tapping over vari
Chronic Disease
ous body areas to produce a vibrating sound). All the
results are compared to a normal standard to identify If the disease persists for a long time, it is considered
problems. chronic. Chronic diseases might begin insidiously
Diagnostic tests and procedures to assist in deter (slowly and without symptoms) and last for the individ
mining a diagnosis are numerous. The routine or most ual’s entire life. As one ages, the occurrence of chronic
common include urinalysis, complete blood count, disease increases. One of the most common chronic
chest X-ray, and electrocardiography (EKG or ECG). diseases is hypertension, or high blood pressure.
See Table 1-3 for examples of common diagnostic tests Chronic diseases often go through periods of
and procedures. remission and exacerbation (eg-ZAS-er-BAY-shun).
TABLE 1-3 Examples of Common Diagnostic Tests and Procedures
Test Description
Complete blood count (CBC) An examination of blood for cell counts and abnormalities
Urinalysis (UA) An examination of urine for abnormalities
Chest X-ray (CXR) X-ray examination of the chest cavity
Electrocardiography (ECG or EKG) A procedure for recording the electrical activity of the heart
Blood glucose A test of the blood to determine its glucose or sugar levels
Computerized axial tomography (CT or CAT) A special X-ray examination showing detailed images of body
structures and organs
Serum electrolytes An examination of blood serum to determine the levels of the common
electrolytes (sodium, potassium, chloride, and carbon dioxide)
Remission refers to a time when symptoms are dimin to the individual with expected outcomes or progno
ished or temporarily resolved. Exacerbation refers to a ses. The individual’s entire being should be taken into
time when symptoms flare up or become worse. Leu consideration. The concept of considering the whole
kemia is a disease that progresses through periods of person rather than just the physical being is called
remission and exacerbation. Both acute and chronic holistic medicine.
diseases can range from mild to life-threatening. From a holistic viewpoint, there is an interac
tion among the spiritual, cognitive, social, physical,
and emotional being. These areas do not work inde
Complication
pendently but have a dynamic interaction (Figure 1-2).
The prognosis might be altered or changed at times if Treatment interventions might include (a) medi
the individual develops a complication. A complication cations, (b) surgery, (c) exercise, (d) nutritional mod
is the onset of a second disease or disorder in an indi ifications, (e) physical therapy, and (f) education.
vidual who is already affected with a disease. An indi Individuals and family members should be educated
vidual with a fractured arm might have a prognosis of and involved in the treatment plan. Failing to involve
the arm healing in 6 to 8 weeks. If the individual suffers the individual and family can decrease compliance and
the complication of bone infection, the prognosis might lead to the plan failing.
change drastically. After the treatment plan is implemented, the
physician will follow up with the individual to deter
Mortality Rate mine the plan’s effectiveness. The individual and
physician should work together to modify the plan
Mortality is defined as the quality of being mortal, that if it is found to be ineffective. Implementation of the
is, destined to die. Diseases commonly leading to the plan usually requires an entire health care team. The
death of an individual have a high mortality rate. The team can include nurses, a physical therapist, a social
mortality rate of a disease (also called death rate) is worker, clergy, and other health care professionals
related to the number of people who die with the dis as needed.
ease in a certain amount of time. Other terms the med The best treatment option is a preventive plan. In
ical community uses to refer to a deadly disease include preventive treatment, care is given to prevent disease.
fatal and lethal. Examples of preventive care are breast mammograms
Consider This...
The ashes of the average cremated human
weigh approximately 9 pounds.
Physiological
Survival Rate
A physician’s prognosis can also consider the survival Spiritual Psychological
rate. The survival rate is the percentage of people with
Individual
a particular disease who live for a set time. For example,
the 2-year survival rate of individuals with lung cancer
would be the percentage of people alive 2 years after
diagnosis. Intellectual Sociocultural
Treatment
After the diagnosis is established, the physician will
work with the individual to explain or outline a plan
of care. The physician might offer treatment options Figure 1-2 Holistic medicine.
10 Chapter 1
to screen for breast cancer, blood pressure screening When challenges concerning medical ethics arise
for hypertension, routine dental care to prevent dental in a health care facility, an ethics committee might be
caries, and a fecal occult blood test to screen for colon called on to make a decision. This committee might
cancer. involve one or more persons at each of these levels:
Other treatment plans might include palliative physician, nurse, ethicist, social worker, case manager,
(PAL-ee-ay-tiv) treatment. Palliative treatment is chaplain, legal representative, and administrator, or
aimed at preventing pain and discomfort but does director.
not seek to cure the disease. Treatment for end-term Groups or committees involved in decision-making
cancer and other serious chronic conditions can be might need to consider previous works of philosophy,
palliative. history, law, and religion to assist them in reaching a
Decisions concerning treatment plans can be very conclusion. Participation in ethical decision-making
difficult for the patient, the patient’s family, and the requires members to follow some basic rules, which
health care team. This is especially true when those can include
decisions involve palliative treatment and end-of-life
issues. During these times, professionals often seek ■ keeping the discussion focused and civil.
assistance in decision-making by using their knowledge ■ listening with an open mind to all opinions.
of medical ethics. ■ entertaining diverse ideas.
■ weighing out the pros and cons of each idea.
Medical Ethics ■ considering the impact of the decision on all per
Webster’s Dictionary defines ethics as “the study of sons involved.
standards of conduct and moral judgment.” More
Every individual at some time or another will
simply put, ethics deals with the “rightness and wrong
encounter or be called on to make a decision that is bio-
ness” or “goodness and badness” of human actions.
ethical in nature. Examples of these can include one’s
Ethics covers many areas of conduct and judgment in
willingness to
our society.
Bioethics is a branch of ethics concerned with ■ use a surrogate mother or father to have a bio
what is right or wrong in bio (life) decisions. Because logical child.
bioethics is a study of life ethics, it covers or becomes
■ control the sex of children through chromosome
entwined with medical ethics. Medical ethics includes
selection.
the values and decisions in medical practice, including
relationships to patients, patients’ families, peer physi ■ use fetal stem cells to grow new organs and tissues.
cians, and society. ■ use prescription stimulants in children.
Part of the ethical challenge in this age of rapidly
■ legalize abortion.
advancing technologies is actually determining what is
right or wrong, good or bad. New scientific discover ■ use mood-altering drugs for older persons.
ies are challenging familiar or usual human behaviors, ■ clone humans.
leading to reconsideration of actions, thoughts, and ■ treat disease by replacing damaged or abnormal
emotions. Ethical dilemmas, once rare, are now com genes with normal genes.
mon and often happen so quickly that society is unable
■ use animal organs or tissues (xenotransplants) in
to understand completely the impact these decisions
humans.
will have on the future.
Bioethical decisions are often very difficult ■ support euthanasia.
because they touch the core of humanity in dealing ■ allow physician-assisted suicide.
with issues of birth, death, sickness, health, and dig
nity. This generation and generations to come will Each of the preceding issues can be overwhelm
be faced with ethical decisions formerly unknown to ing. Even so, yet another concern must be addressed,
humans. Many of these decisions will have a great involving the economics of these choices.
impact on medical ethics and will actually shape the Consider, for example, the economics of
future of humankind. human cloning. How will research, technology, and
intervention be funded? If costs are funded by individ

uals, only wealthy individuals would be able to afford
clones. Is that fair or right? If costs are funded by the Consider This...
government, what criteria will be used for selection?
Will selection be based on intelligence, physical ability, A study in the Netherlands determined
or artistic skills? Who decides? that smokers and obese persons benefit
Medical ethics includes some very complicated a socialized health care system due to
life issues. Bioethical decision-making, or determin earlier deaths. Health care costs for a
ing the rightness or wrongness of such issues, will lifetime for a healthy person will average
continue to be a challenge for society well into the $417,000, whereas the obese person will
future. cost $371,000 and the smoker will cost
$326,000.
Summary
he study of human diseases is important to any health care or allied health professional. Disease can affect any body
T system or organ and can range from mild to severe, depending on many factors. Several risk factors for disease can
be controlled to some extent by one’s lifestyle. Other diseases might not be preventable or controlled but need medical
intervention for treatment or cure. Diagnosing and treating a disease are usually accomplished by a team of health care
professionals led by the physician. Ethical decision-making has become a challenge in health care today, and as tech
nology continues to grow and develop, medical ethics will become more challenging than ever.
Review Questions
Short Answer
1. Identify why it is important to study human diseases.
2. Describe the types of pathologists and their roles in the study of disease.
3. List the five predisposing factors for disease and one disease related to each factor.
Matching
4. Match the terms in the left column with the correct definition in the right column.
_____ Pathogenesis a. The cause of a disease
_____ Etiology b. Interventions to cure or control a disease
_____ Diagnosis c. The development of a disease
_____ Prognosis d. The identification or naming of a disease
_____ Treatment e. The predicted or expected outcome of a disease

12 Chapter 1
Fill in the Blank

5. A common test used in determining a disease diagnosis that involves recording the electrical activity of the heart
is a/an ________ .
Case Studies
■ Stan Cotton was accidentally tripped by another player while running down the field at a soccer game you
were coaching. He is able to walk to the sideline with assistance but has obvious bleeding on his legs and one
arm. You grab the first-aid box and go to his side. What do you do next? What equipment might you use to give
aid to Stan? What standard precautions should apply to this case?
■ Jane Swenson has been suffering from a cold for about a week and has missed 3 days of work. She decides
to return to work at the local community center for older adults. She is still coughing at intervals and has a runny
nose but has improved since last week. Should she still use some precautions to prevent spreading her illness?
If so, what should she do?
2
Mechanisms of
Disease
Key Terms
AIDS (p. 19) Cancer (p. 16) Infarct (p. 22) Neoplasms (p. 15)
Allergen (p. 18) Comorbidity (p. 23) Infection (p. 15) Oncology (p. 15)
Allergy (p. 18) Congenital (p. 14) Inflammation (p. 15) Organ rejection (p. 19)
Anoxia (p. 20) Degenerative (p. 19) Ischemia (p. 22) Parenteral (p. 17)
Antibodies (p. 18) Dysplasia (p. 20) Malignant (p. 16) Total parenteral
Antigens (p. 18) Encapsulated (p. 16) Metaplasia (p. 20) nutrition (TPN)
Atrophy (p. 20) Enteral (p. 17) Metastasize (p. 16) (p. 17)
Autoimmunity (p. 18) Gangrene (p. 22) Metastatic (p. 16) Trauma (p. 14)
Bariatrics (p. 18) Hyperplasias (p. 15) Morbidity (p. 23) Triage (p. 15)
Benign (p. 16) Hypertrophy (p. 20) Motor vehicle accidents Tumors (p. 15)
Body mass index Hypoxia (p. 20) (MVAs) (p. 14)
(BMI) (p. 18) Immunodeficiency Necrosis (p. 22)
Cachexia (p. 17) (p. 19) Neoplasia (p. 20)
Learning Objectives
Upon completion of the chapter, the learner should be able to:
1. Identify important terminology related to the 5. Compare the various types of impaired immunity.
mechanisms of human disease. 6. Identify the basic changes in the body occurring
2. Describe the causes of disease. in the aging process.
3. Identify disorders in each category of the causes 7. Describe the process of cell and tissue injury,
of disease. adaptation, and death.
4. Describe behaviors important to a healthy lifestyle.
Overview
he human body is a complex machine that normally runs in an efficient, balanced manner, but when
T changes occur in the body due to lifestyle behaviors, abnormal growths, nutritional problems, bacterial
invasion, or any other factor that upsets the balance, the result might be a disease process. Human disease
13
14 Chapter 2
can be very minor or life-threatening. Diseases are caused by a variety of factors; some are controllable, and
some are not. Even normal changes, such as aging, can put the individual at higher risk for developing dis
ease. Many changes or alterations in cell and tissue structure can occur. Some of these changes are reversible,
but some might cause cellular, tissue, organ, or system death. ■
Chromosomal and genetic abnormalities might or

Causes of Disease might not be compatible with life. Some abnormalities
To gain a better understanding of the different causes might be present but cause no effect on the individual,
of diseases, it is usually helpful to classify or divide whereas others might lead to the death and sponta
them into smaller groups. This classification can be neous abortion of the unborn child.
approached in several different yet logical ways. One More information related to hereditary diseases
commonly used approach is to divide the causes of dis can be found in Chapter 19, “Genetic and Develop
ease into the following six categories: mental, Childhood, and Mental Health Diseases and
Disorders.”
1. Heredity
2. Trauma
Trauma
3. Inflammation and infection
Traumatic diseases are caused by a physical injury
4. Hyperplasias and neoplasms from an external force. Trauma is the leading cause
5. Nutritional imbalance of death in children and young adults. The type of
trauma (TRAW-mah) or traumatic disease most
6. Impaired immunity
commonly affecting individuals varies with age, race,
and residence. For example, accidents, especially
Heredity falls, are a common cause of traumatic disorders
in older adults, whereas motor vehicle accidents
Hereditary diseases are caused by an abnormality in the
(MVAs) are the most frequent cause of injury and
individual’s genetic or chromosomal makeup. These dis
death in young adults.
eases might or might not be apparent at birth. Hereditary
The National Safety Council lists deaths caused
diseases present at birth, even if not apparent, are called
by trauma, in order of prevalence (or occurrence), as
congenital (kon-JEN-ih-tahl) disorders. However, not
follows:
all congenital disorders are inherited. Some other causes
of congenital disorders include disease during pregnancy ■ Poisoning
(e.g., fetal alcohol syndrome) or difficulty with delivery
■ Falls
(e.g., cerebral palsy), to name only a couple.
Hereditary diseases are classified in three basic ways: ■ MVA
(1) a single-gene abnormality, (2) an abnormality of sev ■ Choking
eral genes (polygenic), or (3) an abnormality of a chro ■ Drowning
mosome (either entire absence of a chromosome or the
presence of an additional chromosome). See Table 2-1 Emergency management of trauma is often neces
for the classification of hereditary diseases and examples. sary to prevent the complications of shock, hemorrhage,
TABLE 2-1 Classification of Hereditary Disease with Examples
Single Gene Polygenic Chromosomal
Cystic fibrosis Gout Klinefelter’s syndrome

Phenylketonuria Hypertension Turner’s syndrome
Sickle cell anemia Congenital heart anomalies Down syndrome
Mechanisms of Disease 15
and infection. On arrival at an emergency department,

patients are assessed according to signs and symptoms,
age, and medical history. Needs are then prioritized,
and care is given in order of severity of injury. This pri
oritizing of care is called triage (tree-AZH) and incor
porates an ABC prioritizing method, with A for airway,
B for breathing, and C for cardiac function. After these
areas are assessed, other areas of trauma such as bleed
ing and fractures are addressed. An example of triage,
in general, would be giving priority care to a patient
who is not breathing before assisting a patient who has
a bleeding leg wound.
Types of trauma commonly occurring in each body
system are discussed in the specific system chapters.
Inflammation and Infection Figure 2-1 Inflammation of a finger.

Inflammation (in-flah-MAY-shun) is a protective
immune response that is triggered by any type of injury
or irritant. Even the slightest trauma can initiate the Hyperplasias and Neoplasms
inflammatory response. Signs of inflammation are red
Hyperplasias (high-per-PLAY-zee-ahs; hyper 5 exces
ness, heat, swelling, pain, and loss of motion. An exam
sive, plasia 5 growth) and neoplasms (NEE-oh-pla-
ple of inflammation is sunburn. The tissue is red, warm
zms; neo 5 new, plasm 5 growth) are similar because,
to the touch, swollen, painful, and uncomfortable when
in both, an increase in cell number leads to an increase
moving. Although this area is inflamed, it is usually not
in tissue size.
infected.
Infection (in-FEK-shun) refers to the invasion of
microorganisms into tissue that causes cell or tissue Hyperplasias
injury. Inflammation and infection are often used syn Hyperplasias differ from neoplasms in terms of cause
onymously even though they are quite different. A tis and growth limits. Hyperplasias are overgrowths in
sue can be inflamed but not infected, as in sunburn, but response to some type of stimulus. An example of a
usually, infected tissue will also be inflamed. hyperplasia would be enlargement of the thyroid gland
For tissue to be infected or for an infection to occur, (goiter) in response to a hormone deficiency.
there has to be an invasion of microorganisms. Usually,
inflammation and infection go hand in hand. For exam Neoplasms
ple, when the skin is cut, the tissue around the cut will Neoplasms (new growths) are commonly called
undergo a mild inflammation. As skin bacteria invade tumors. The Latin word tumor means “swelling” and
the cut tissue, the area becomes infected and usually originally was used in the description of the swelling
becomes even more inflamed due to the irritation to the related to inflammation. The Greek term for swelling
tissue caused by the bacteria (Figure 2-1). is onkos, which has been used to construct the word
Diseases that are related to inflammation are iden oncology (ong-KOL-oh-jee; onco 5 tumor, logy 5
tified with the suffix -itis. Examples include appendicitis study of, or the study of cancer). Although all tumors
(inflammation of the appendix), gastritis (inflammation are not neoplasms, as described in more detail in
of the stomach), colitis (inflammation of the colon), Chapter 3, “Neoplasms,” the words are often used
and encephalitis (inflammation of the brain). In many synonymously.
cases, the inflammation will progress to an infection Diseases with tumor involvement usually end with
due to the presence of bacteria in the region. For exam the suffix -oma. Examples include lipoma, carcinoma,
ple, appendicitis can be caused by an obstruction of melanoma, and sarcoma (Table 2-2). An exception to
the appendix. Because the bacteria Escherichia coli (E. this is the word hematoma, which is a clot of blood in
coli) are commonly found in the colon, the appendix an area. A hematoma on the head due to a blunt blow
becomes infected. would be an example.
16 Chapter 2
TABLE 2-2 Examples of Neoplasms or Tumors
Neoplasm/Tumor Description
Adenoma Usually benign tumor arising from glandular epithelial tissue

Carcinoma Malignant tumor of epithelial tissue
Fibroma Benign encapsulated tumor of connective tissue
Glioma Malignant tumor of neurologic cells
Lipoma Benign fatty tumor
Melanoma Malignant tumor of the skin
Sarcoma Malignant tumor arising from connective tissue such as muscle or bone
Neoplasms or tumors (-omas) may be classified as

benign (beh-NINE) or malignant (mah-LIG-nant).
Generally, benign tumors have limited growth, are
encapsulated (enclosed in a capsule) and thus easily
removed, and are not deadly. Malignant tumors are
just the opposite. These tumors grow uncontrollably;
have fingerlike projections into surrounding tissue,
making removal very difficult; and are usually deadly.
Malignant means deadly or progressing to death.
With these definitions, it is understandable why the
terms tumor, malignancy, and cancer bring fear to an
individual. Some -omas, or tumor diseases, are com
monly called cancer. Cancer is defined as any malig
nant tumor.
The fingerlike or crab-like projections that char
acterize malignant tumors give cancer its name, from
the Greek karkinos, meaning “crab.” This character
istic makes surgical removal of cancer quite difficult
(Figure 2-2). Another characteristic of malignant
neoplasms is that they metastasize (meh-TAS-tah-
sighz), or spread. Metastatic (MET-ah-STAT-ic)
cancers spread from a site of origin to a secondary
Figure 2-2 Crab-like appearance of cancer in a kidney.
site in the body. For example, lung cancer com
monly metastasizes to the bone. Chapter 3 discusses
more detailed information about hyperplasias and
neoplasms.
Consider This...
Nutritional Imbalance Lack of water is the number one trigger of
Good nutrition is important in maintaining good health daytime fatigue.
and reducing the chance of disease. Nutritional disor
ders can cause problems with physical growth, mental
and intellectual changes, and even death in extreme
cases. Most nutritional diseases are related to overcon Malnutrition
sumption or under-consumption of nutrients. Specific Malnutrition can be due to inadequate nutrient intake
problems are malnutrition, obesity, and excessive or or to intake of an adequate amount with poor nutritive
deficient vitamins, minerals, or both. value. Diseases that cause a problem with the absorption of
Persons who are unable to eat enough to maintain

their body weight can receive nutritional supplements in
a liquid drink. Another way to supplement or provide
for total nutritional intake is not through the alimentary
canal or digestive system but through a parenteral (pah-
REN-ter-al; to administer by injection) route. Parenteral
routes can include subcutaneous (sub 5 under, cutane
ous 5 skin), intramuscular (intra 5 within, muscular 5
muscle), or intravenous (intra 5 within, venous 5 vein)
administration. The intravenous route is the most com
monly used parenteral route. Providing the total nutri
tion needed by giving nutritive liquid through a venous
(vein) route is called total parenteral nutrition (TPN).
Nutrition can also be provided through an enteral
(small intestine) route. A nasogastric (naso 5 nose, gas
tric 5 stomach) tube or a tube running through the nose
and into the stomach can be used for feedings if the sup
plement is planned short term. For longer-term enteral
Figure 2-3 Cachexia. feeding, a gastrostomy (gastro 5 stomach, ostomy 5 open
ing; opening into the stomach) procedure is performed
nutrients can also lead to malnutrition. Children and older to place a tube through the abdominal and stomach wall
persons are the age groups most affected by malnutrition. (Figure 2-4A). Enteral feeding, commonly called “tube
Persons suffering with cancer often experience prob feeding,” is accomplished by this method (Figure 2-4B).
lems with malnutrition and develop cachexia. Cachexia
(ca-KECK-see-ah) is a term that describes any individual
who has an ill, thin, wasted appearance (Figure 2-3).
(B)
(C)
Figure 2-4 Gastrostomy. (A) Feeding. (B) Insertion site. (C) internal location.
18 Chapter 2
Obesity consume large amounts of vitamins for an extended

Although many individuals in the United States have time.
a nutritional deficiency, the most common problem Nutritional guidelines for a healthy lifestyle are dif
is obesity, which is primarily due to overconsump ficult to determine because they must cover a variety of
tion of nutrients and lack of exercise. According to ages and nutritional needs. Children, teens, and preg
the American Heart Association, obesity is a national nant women have very specific nutritional needs. See
health concern, with nearly one in three (31.7%) U.S. the Healthy Highlight box “General Guidelines for a
children ages 2 to 19 being obese and more than one Healthy Lifestyle” for more information.
third (33.7%) of adults being obese. Obesity shortens
the life span of the individual by increasing the chance Impaired Immunity
for arteriosclerosis, leading to cardiovascular diseases.
The immune system of the body is a specialized group
It also affects the individual’s risk for developing bone
of cells, tissues, and organs designed to defend the
or joint problems due to the increased pressure on the
body against pathogenic attacks. The body’s first line
skeletal system.
of defense against pathogens is its normal structure and
Obesity is simply defined as too much body fat.
function, including intact skin, mucous membranes,
It is medically determined when an individual has a
tears, and secretions. The immune system protects the
body mass index (BMI) of greater than 29.9. BMI is
body in two additional ways, through
obtained by dividing the individual’s weight in pounds
by the square of their height, multiplied by 703. For 1. the inflammatory response, in which leukocytes
example, a person weighing 250 pounds who is 5 feet play a vital part in killing foreign invaders.
6 inches tall (66 inches) has a BMI of 40.3. This is cal
2. the specific antigen-antibody reaction, in which
culated as 250 divided by (66 3 66) 3 703. This person
the body responds to antigens (AN-tih-jens) by
is considered extremely obese.
producing antibodies. Antigens are substances
A simple BMI scale uses these figures to determine
that cause the body some type of harm, thus
levels of obesity:
setting off this specific reaction. Antibodies,
BMI also called immune bodies, are proteins that
,18.5 underweight the body produces to react to the antigen and
18.5-,25 normal render it harmless.
25-,30 overweight Impaired immunity occurs when some part of this
30-,40 obese system malfunctions. Following are some common
.40 or higher extremely obese ways the system malfunctions.
Bariatrics (bear-ee-AT-tricks) is a branch of med
icine that deals with the prevention and treatment of Allergy
obesity. First-line treatment for obesity often includes The immune response is too intense or hypersensitive to
diet, exercise, anti-obesity medication, and behavior an environmental substance. The allergen (environmen
modification. These treatments in the severely obese tal substance that causes a reaction) in an allergy might
population often have poor long-term success. In these be such things as house dust, grass, pets, perfumes, or
cases, bariatric or weight loss surgery may be recom insect bites, to name a few. These allergens do not usu
mended. Gastric banding and gastric bypass are two of ally cause this type of reaction in most persons but do
the most common types of surgery. cause an allergic reaction in persons sensitive to them.
Obesity is one of the most preventable causes of
death. Worldwide, it is viewed as one of the most seri Autoimmunity
ous public health problems of the twenty-first century. The immune response attacks itself. In autoimmunity
(auto 5 self), the body’s lymphocytes (white blood cells
Vitamin or Mineral Excess that produce antibodies) cannot identify the body’s own
or Deficiency self-antigens, which are harmless. In response, the lym
Vitamin and mineral excesses and deficiencies are usu phocytes form antibodies that then attack the body’s
ally related to diet, metabolic disorders, and some medi own cells. Examples of autoimmune diseases include
cations. Hypervitaminosis can occur in individuals who rheumatoid arthritis and rheumatic fever.
Healthy Highlight
General Guidelines eneral guidelines for a healthy lifestyle include the
for a Healthy G■
following tips:
Maintain proper body weight.
Lifestyle ■ Eat a variety of foods.
■ Avoid excessive fat, salt, and sugar.
■ Eat adequate amounts of fiber.
■ Consume alcohol in moderation, no more than two drinks per day for men and one
for women.
■ Get enough rest and sleep, at least seven or more hours per day.
■ Always eat breakfast.
■ Maintain a moderate exercise schedule.
Immunodeficiency understood but is progressive and irreversible. Diseases

related to aging are often called degenerative diseases.
The immune response is unable to defend the body
Tissue degeneration is a change in functional activity
due to a decrease or absence of leukocytes, primarily
to a lower or lesser level. Examples of degenerative dis
lymphocytes. Persons with immunodeficiency are
eases are degenerative joint disease and degenerative
usually asymptomatic (without symptoms) except for
disk disease.
recurrent infections. It is these recurrent infections
The mechanisms of aging are complex and thought
that often lead to death. An example of an immuno
to include such factors as heredity, lifestyle, stress, diet,
deficiency disease is acquired immunodeficiency syn
and environment. One might slow the process of aging
drome (AIDS). Immunodeficiency also can be caused
to some degree by living a healthy lifestyle and con
by medications, chemotherapy, or radiation. Organ
trolling stress and environmental factors.
recipients are intentionally immunosuppressed or
Hereditary factors can include an increased life
immunodeficient to save their transplanted organ.
span related to an inherited ability to resist disease. Just
Without immunosuppressant medications, the body’s
as families have a history of disease patterns, they also
immune system would recognize the organ as for
appear to have a pattern of longevity. Thus, individuals
eign and attack it, leading to organ death. This pro
who have relatives who live to be in their nineties might
cess is called organ rejection. Cancer patients often
themselves live to that age. Individuals with a family
undergo chemotherapy and radiation treatments that
history of members who have died of heart disease in
can cause immunodeficiency. Some medications also
their early years might also suffer from the same prob
affect the system by depressing its ability to function
lem. Although hereditary patterns cannot be controlled,
properly. Chapter 5, “Immune System Diseases and
longevity can be increased and disease decreased by
Disorders,” discusses the immune system and related
controlling lifestyle behaviors that increase the risk of
diseases in more detail.
chronic disease.
The body replaces and repairs itself throughout its
Aging lifetime, but with aging, this process slows. As early as
age 40, there are changes in skin, endocrine function,
There is no definite age in years when an individual vision, and muscle strength. Other changes in the aging
becomes aged. However, some statisticians consider process might include bone loss leading to osteoporo
the retirement age of 65 as aged. An individual’s body sis, decreased melanin pigment production leading
actually begins to age at physical maturity, around to graying of the hair, decreased immunity leading to
age 18, in a complicated process that is not completely an increase in infections and possible development of
20 Chapter 2
Healthy Highlight
Consumer oday’s consumer should be more health conscious than in the past. Individuals
Responsibility in T are now expected to take charge of their health care needs and be more informed
about health choices. However, this may not be the case with many people. It is recom
Disease Prevention mended that the consumer become more knowledgeable about diseases, medications,
and prevention. Unfortunately, many diseases are on the rise in the United States due
to a variety of causes. The public needs to be informed about these and to be active
in prevention. Diseases on the rise include pertussis, Shigella (especially in day-care
centers), salmonellosis, E. coli, meningococcal infection, tuberculosis, influenza, and
streptococcal infections, as well as new viral diseases, such as COVID-19. Epidemics
have been common in the past, but most people are not as familiar with pandemics. In
these circumstances, the public needs to be kept informed about lifestyle changes that
might be needed. Health care providers should help their patients find the most accu
rate information about these diseases and help them incorporate prevention strategies
into their lifestyles.
cancer, a loss of brain and nerve cells that might lead The ability of the cell to survive depends on several fac
to senile dementia, and a decrease in intestinal motility tors, including the amount of time the cell suffers and the
leading to constipation and possible diverticulosis. type of cell injury that occurred. If the cause of the injury is
short term, the cell has a greater chance of survival.
The type of cell also plays a part in its ability to
recuperate. The heart, brain, and nerve cells are eas
Consider This... ily injured and often suffer death. This is particularly
important because these cells do not replace them
After age 30, the brain loses 50,000 neu selves. Even short-term injury might readily lead to
rons per day, causing a brain shrinkage death in these cells. Other cells are not as easily dam
of approximately one-fourth of a percent aged. Connective and epithelial cells often recuperate
(0.25%) each year. and even readily replace themselves by mitosis (cell
division).
Cellular Adaptation
Death
Cells that are exposed to adverse conditions often go
Humans are mortal, so eventually, everyone will die. through a process of adaptation. When the condi
Even though we are unable to understand the aging tion is changed, these cells might be able to change
process fully, cellular, tissue, and organ deaths can be back to their normal structure and function. How
reviewed in an effort to understand the death of the ever, some adaptations are permanent, so even if the
organism as a whole. condition improves, the cells are not able to return to
normal. Types of adaptation include atrophy (AT-tro-
fee), hypertrophy (high-PER-tro-fee), hyperplasia,
Cellular Injury dysplasia (dis-PLAY-zee-ah), metaplasia (met-ah-
Cellular injury and death can be due to some type of PLAY-zee-ah), and neoplasia (nee-oh-PLAY-zee-ah).
trauma, hypoxia (high-POCK-see-ah; not enough
oxygen), anoxia (ah-NOCK-see-ah; no oxygen), drug Atrophy
or bacterial toxins, or viruses. Cells can undergo near Atrophy (a 5 without, trophy 5 growth) is a decrease
death experiences and actually recuperate in what is in cell size, which leads to a decrease in the size of the
considered reversible cell injury. tissue and organ (Figure 2-5). Atrophy is often due to
Hyperplasia
Atrophy
Figure 2-5 Normal cell versus atrophied cell.

Figure 2-7 Normal tissue versus hyperplasia.
the aging process itself or to disease. An example of does not change with exercise; only the size of each
atrophy related to aging would be the smaller size of cell changes. To adapt to an increased workload, mus
the muscles and bones of older people. As the female cle cells increase in size. Increased workload on the
ages, the breasts and female reproductive organs atro skeletal muscles causes cellular hypertrophy and an
phy, especially after menopause. Examples of disease increase in muscle size. Heart muscle hypertrophy
or pathologic atrophy are usually related to decreased is usually seen in the left ventricle of the heart (left
use of the organ, especially muscles. Spinal cord inju ventricular hypertrophy) when the left ventricle must
ries lead to an inability to move muscles. Without use, work harder to pump blood through diseased valves
muscle cells decrease in size, and the muscles atrophy. and arteries. To adapt to this need, the cells increase
in size and the left side of the heart enlarges.
Hypertrophy
Hypertrophy (hyper 5 excessive, trophy 5 growth) is Hyperplasia
an increase in the size of the cell leading to an increase Hyperplasia (hyper 5 increased, plasia 5 growth) is
in tissue and organ size (Figure 2-6). Skeletal muscle an increase in cell number that is commonly due to
and heart muscle cells do not increase in number by hormonal stimulation (Figure 2-7). Hyperplasia is dis
mitosis. Literally, what an individual has at birth is cussed in more detail in Chapter 3.
what the individual has throughout life. This helps
explain why some athletes bulk up with exercise while
Dysplasia
others do not. The inherited number of muscle cells
Dysplasia (dys 5 bad or difficult, plasia 5 growth) usu
ally follows hyperplasia. It is an alteration in size, shape,
Normal and organization of cells (Figure 2-8). Dysplastic cells
might change back to the normal cell structure if the
irritant or stimulus is removed, but usually, these cells
progress to neoplasia.
Basement membrane Metaplasia

Hypertrophy Metaplasia (meta 5 changed, plasia 5 growth) is a cel
lular adaptation in which the cell changes to another
type of cell (Figure 2-9). An example is the colum
nar epithelial cells of the respiratory tree, which often
change to stratified squamous epithelial cells when
exposed to the irritants of cigarette smoking. This pro
tective adaptation might be reversible if the individual
Figure 2-6 Normal cell versus hypertrophied cell. quits smoking.
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Julius Cæsar and a pagan Rome there stood the Town Hall, with the
Cross Keys, and the City Motto: Post Tenebras Lux.[115]
The only Campus Martius that Robyn had ever known had been
the fields outside Geneva, where every Sunday after the evening
devotions the young townsmen were allowed to exercise their arms,
practising diligently with the gun and the long and cross bows, for
prizes of pewter plates and dishes. Robert Boyle had brought his
bows and arrows back with him to London. He must have practised
with the rest, as John Evelyn did two years later, on that peaceful
Champs de Mars, and played with the rest on its “noble Pall Mall.”
He had known the gardens of rare tulips and other choice flowers
outside the earthen fortifications, and he must have seen Geneva
also in its sterner moods. For that same “Mars’ Field” was the place
of public execution; and in Geneva there was then no hospitality of
extradition-law. Capital crime in other countries was capital crime
there. Fugitives from other countries were put to death in the
sunshine of that spacious field; and for the Genevans, by Genevan
law, adultery was death.[116]
But Geneva and its Mars’ Field lay behind him. And in front?
Robert Boyle must have heard something of what had been
happening at home. Accounts had reached him from time to time of
the “dreadful confusion of affairs” in England, Ireland and Scotland.
During those last two years in Geneva he must have heard all kinds
of rumours of the struggle that was going on between the Parliament
and the Crown, between the Prelates and the Presbyterians. His
friends in Geneva must have talked of the Solemn League and
Covenant, and the Great Assembly of Divines that was meeting in
Westminster; and of Archbishop Laud, then still alive, still in prison,
his trial still deferred.
But it takes seeing to realise civil war. When Robyn arrived in
England it was to find a kingdom in arms against itself, a nation
divided into two great opposing armies; husbands and wives taking
different sides, fathers and sons in opposite camps, brother against
brother. The king’s headquarters were at Oxford; Prince Rupert with
his Royalist army was in Lancashire. York was defended by the
Marquis of Newcastle against the combined Parliamentarian forces
under Manchester, Fairfax and Cromwell. Robert Boyle had arrived
in England almost on the eve of the battle of Marston Moor.
And what to do? There was only one thing at this moment that the
great Earl’s Benjamin could think of doing. He was no soldier, this
dreamy youth, with his books and his bows and arrows; but force of
heredity—a kind of force of inertia—would have carried him into the
Royalist camp. His brothers were all soldiers; though it is doubtful if
he knew, when he came home, where they were and what they were
doing. The very politics of the various members of this scattered
family, the “sides” they were taking in the quick march of political
events, must have been a puzzle to him. And so it was Robert
Boyle’s intention to join the army, where he told himself he would
find, besides his brothers, “the excellent King himself, divers eminent
divines, and many worthy persons of several ranks.” But he knew
also that “the generality of those he would have been obliged to
converse with were very debauched, and apt, as well as inclinable,
to make others so.”
If Robert Boyle had joined the King’s army! It is difficult to think of
him in “armor of prooff,” and quite impossible to picture him as a
laughing Cavalier. He disliked “customary swearing”; he drank water;
he did not smoke; he dearly loved to point a moral; and he never
adorned a tale. It is certain no officers’ mess would have endured
him for ten minutes, in the rôle either of sceptical chymist or of
Christian virtuoso. And what would have become of the Invisible
College, and the Royal Society?
But, fortunately for them, for him, and for posterity, it was to be
ordered otherwise. It happened that his sister Katherine, now, since
the death of her father-in-law,[117] Lady Ranelagh, was in the
summer of 1644 actually living in London, and “it was by an
accident” that Robyn found her out; an accident to which he used
afterwards to ascribe “a good part of his future happiness.”
In later years, when Robert Boyle was giving Bishop Burnet some
of the facts of his life for an intended biography, he did not mention
what the “accident” was. Perhaps, so soon after the Restoration, he
had still reason to be discreet in the use of names; for Lady
Ranelagh, in the summer of 1644, was very much among the
Parliamentarians.
In the light of after events, one or two possibilities suggest
themselves, if it be forgivable in anything concerning an
experimental chemist to indulge in speculation. Marcombes must
surely have furnished Robyn with letters to persons in London who
would be of practical help to the boy on his arrival. Who were they?
Mr. Perkins the tailor had proved perfidious, and was out of the
question. There were Peter Naylor, the lawyer-cousin in New Inn,
and Cousin Croone of the Nag’s Head, and Philip Burlamachy, once
Lord Mayor, with whom the old Earl had done so much business,
and who was also a relation of the Diodati family, Dr. John Diodati’s
wife being a Burlamachy. But it could scarcely be called an accident
if in a business call on any of these Robyn had obtained his sister’s
address. It must have been some chance meeting with, or news of,
her in some unexpected quarter.
Other men there were to whom the boy may well have carried
letters from Marcombes or his Genevan friends. There was Dr.
Theodore Diodati, the London physician—brother of Dr. John in
Geneva,—who knew a great many people in London; and there was
Samuel Hartlib, the naturalised German, the merchant-philanthropist
who knew everybody and whom everybody knew. And there was
Milton himself, a friend of the Diodati family in Geneva, and a friend
also of Dr. Theodore Diodati and Mr. Hartlib. Dr. Theodore Diodati
lived in the parish of St. Bartholomew the Less, not far from Milton’s
house in Aldersgate Street, and Hartlib was living in Duke’s Place,
Aldgate. He was a man with many hobbies and interests, and a large
correspondence. He conducted, in fact, “a general news agency,”
and must have been as well known in Geneva as in London from his
connexion with Durie and the great project of a union of all the
Protestant Churches of Europe, and for his friendship with
Comenius, and his active part in the scheme which the English
Parliament was then itself taking up of a reform, on Baconian lines,
of the English Universities and Public Schools. It is certain that
Hartlib was one of Robert Boyle’s earliest friends in London; that
Hartlib and Milton were intimate, and that Milton had first addressed
his Tract on Education to Hartlib. And it is difficult to believe that
Milton was unknown—by name at least—to Robert Boyle. For Milton
had been in Geneva in the summer of 1639, just before Frank and
Robyn went there. Milton’s great friend Charles Diodati was the son
of Dr. Theodore in London and the nephew of Dr. John of Geneva;
and when Milton passed through Geneva on his way home from his
Italian tour Dr. John had been very hospitable to him. Milton had
been an honoured guest at the Villa Diodati, and it is supposed that
he heard there the news of Charles Diodati’s death. Even if Robyn
had not met Milton at Sir Henry Wotton’s table when Milton dined at
Eton, he may well have heard in Geneva all about Charles Diodati
and John Milton, and the Epitaphium Damonis—the Latin poem that
Milton wrote on his return home, in memory of his dead friend. And it
is probable he knew of Comus, acted by the Bridgewater family, and
of Lycidas also, and Milton’s friendship for Edward King, the brilliant
young Irishman, whose relatives in Ireland must have been well
known to the Boyle family. Robyn may well have read the
Epitaphium Damonis in the Villa Diodati; and in the house of the
Italian teacher and refugee, Count Cerdogni, he may have looked
through the famous autograph album in which Milton had written the
words (of which Robyn would certainly have approved)—
“If Vertue feeble were,

Heaven itself would stoop to her.”
It is not so certain that Milton’s prose would have pleased the boy;—
the church-politics, the anti-episcopal pamphlets, and the divorce
tract that had recently been the topic of conversation in London.
There is no trace of a personal friendship between Milton and Robert
Boyle. Their paths constantly crossed, but they were to walk apart.
Boyle deplored religious controversy, and did not sympathise with
the sects and sectaries. And yet it is here that the possibility of the
“accident” comes in. For Lady Ranelagh was a very progressive
Puritan, whose interests were already bound up with the
Parliamentarian Party and its reforms. She must have known Milton
well personally or by reputation at this time, and she can have had
no bad opinion of him or his prose-writings, or she would not have
sent, as she did, her own nephew, young Lord Barrymore, to be one
of Milton’s pupils. Barrymore, only four years younger than Robert
Boyle, was one of Milton’s resident pupils when, in September 1645,
Milton removed from Aldersgate Street into a larger house in
Barbican with the purpose of being able to board a larger number of
boys. Lady Ranelagh was later on to send her own boy, Dick Jones,
to be taught by Milton; her friendship for Milton was to endure
through many troublous years; in his own words she stood “in place
of all kith and kin”[118] to him in his blindness and solitude; and her
good offices seem not to have stopped even there. May it have been
through this Diodati-Milton-Hartlib connexion that Robert Boyle and
his sister Ranelagh were brought together?
But London was not so large a place in 1644. Cousin Croone was
presumably still at the Nag’s Head in Cheapside, and people met in
Cheapside in those days. Had not Dr. John Diodati himself, on his
one visit to London in 1627, run up against the very man he most
wanted to meet—Mr. Bedell, afterwards the Bishop—in Cheapside?
Whatever the “accident” was, Lady Ranelagh received her young
brother with open arms. Her address in that summer of 1644 still
remains uncertain, though not long afterwards she seems to have
been living in the house in the Old Mall which was to be her home to
the end of her life.[119] It may have been in Pall Mall that Robyn
came knocking at his sister’s door. Lord Ranelagh—he had taken his
seat in the House of Peers in February 1644—was probably in
Ireland, for there is no mention of him as one of the family circle at
this time; and the husband and wife, as the years went on, had lived
more and more apart. Lord Ranelagh, who had run through his own
and his wife’s money, lived in Ireland, and Lady Ranelagh in London.
She was in the receipt, for some reason unexplained, of a pension
from Government of £4 a week, and was otherwise helped by the
members of her own family.
For nearly five months, Robert Boyle lived with his sister and her
young children,[120] and a strongly Parliamentarian sister-in-law—
wife of a member of the House of Commons.[121] And Mary, “my
Lady Molkin,” as Robyn calls her, now Charles Rich’s wife, and
daughter-in-law of the great Earl of Warwick, was not far off, whether
at Warwick House in Holborn, or at “delicious Leeze” in Essex. Mary
had had her troubles, since her romantic marriage three years
before. She had lost her first baby, a little girl, when it was “one year
and a quarter old,”[122] and her second child, a boy, had been born
just at the dark time of the old Earl’s death. Charles Rich had kept
back the bad news till his young wife was “up again.”[123]
In his sister’s house, Robert Boyle found himself in the very thick
of the Parliamentarian interests. She was still a young woman—only
thirty—and a very clever woman, highly educated for her time, and
popular by reason of her “universal affability.” In her house, Robyn
came to know, as real friends, “some of the great men of that Party,
which was then growing, and soon after victorious.”[124] Her house
was, in fact, even then, a rendezvous of the Parliamentarian Party.
And what a vehemently interesting time it was, in London! Both
Houses were sitting: the Westminster Assembly was busy with the
new Directory of Worship and the new frame of Church Government.
In September, Essex was beaten by the King’s forces in Cornwall;
and Manchester and Cromwell were back in London from the north.
During the last weeks of Robert Boyle’s sojourn under his sister’s
roof, the talk must have been all of, if not with, Manchester and
Cromwell, and of Cromwell’s “Toleration Order” and the abolition of
the use of the Prayer Book. In October the King was moving back to
Oxford, and there was fought the second battle of Newbury. And now
the thoughts of the Parliament men were veering round from Church
Government to Army Reform; and towards the end of that year, the
talk was of Cromwell’s “Self-denying Ordinance” and the great
changes it would carry with it; and of the new modelling of the Army
—the “new noddle” as the scoffers called it. And all the time Hartlib,
in Aldgate, was immersed in his social and educational schemes;
and Milton, in Aldersgate Street, was teaching his boys and writing
his second divorce tract and his Areopagitica; and all the time Laud
was lying in the Tower, his trial dragging wearily on. What did Robert
Boyle think of it all after the profound peace of Geneva?
Whatever was in his thoughts at this time—and it is very certain
Robert Boyle had no intention of giving up the Book of Common
Prayer, or any book he might wish to keep—there was no more talk
of joining the King’s Army; and when at last, towards the end of the
year, the state of the roads south-west of London permitted it, it was
under a Parliamentarian escort that the young Squire found his way
into Dorsetshire, to take possession of his own Manor of Stalbridge.
Through his sister’s influence with her Parliamentarian friends,
Robyn had got “early protection for his English and Irish estates.”
Even with this protection, there were difficulties in front of him.
There must have been a sadness about his solitary return to the
Manor, empty except for the child-memories of five years before. The
fair chimney-pieces and carved balustrades, the beautiful rose-
coloured furniture “hastened home” for those great house-parties of
1639—must have talked to him of a chapter of his life wiped out for
ever. What things had happened there! There was the arrival of
Mary’s suitor, and Mary’s high averseness and contradiction, and the
young man’s discomfiture and departure to the Bath: Mary was the
same imperious little woman now, as then; she now had a “high
averseness” to Charles Rich’s “engaging in the wars.” Here poor
Lettice had drooped and complained, and George Goring, with his
wounded leg, had limped up and down stairs. Then there was the
“private discourse” in the Stalbridge parlour, that had settled poor
Frank’s fate: Betty had refused to live with the old Earl after Mary’s
marriage, and had gone her own way; she was now, nominally with
the Staffords, at The Hague, the gay little courtier that she was, a
Killigrew all over!... There were the paths where Mr. Dowch had
discoursed Latin Syntax, and where Robyn had first come to know
the cheerful and choleric Marcombes, as they talked in “familiar
French” about all the European cities they were going to see.
Through these gates Frank and Robyn had come “home” after the
years at Eton—the “blew-perpetuana” curtains following duly.
Through these gates, he and Frank and Marcombes had passed, on
that memorable journey to London, where Frank was to “make his
addresses” to Betty in the Savoy. All round him lay the fields where
he had dreamed, and the orchards of which he had been so proud to
possess the keys. And it was all his own, now—all empty and
neglected: “my own ruined cottage in the country”:[125] a depressing
place for a boy of eighteen to return alone to. One of the first events
of the new year, 1645, the news of which could have reached
Stalbridge was the execution of Laud on Tower Hill.
Nobody could have been very glad to see Robert Boyle come
back again; least of all Tom Murray, whom the old Earl had left in
charge, and who proved himself to have been, during his reign there,
as untrustworthy as Mr. Perkins the London tailor. “The roguery of
Tom Murray” was one of the first difficulties that faced the young
squire.
Two other pieces of business, however, could have admitted of no
delay. Marcombes was to be repaid; and partly to that end,
apparently, in August 1645, as soon as Robert Boyle could put his
hands on some of his own money, he set out from Stalbridge, “the
necessities of my affairs,” as he explained in a letter to his brother
Broghill, “calling me away (according to the leave the Parliament has
given me) into France.”[126] By August 1645, the New Model had
done extraordinary things. In the spring, Cromwell and Waller had
been in the west of England. Naseby had been fought in June, and
the King’s private correspondence taken and published. In July,
George Goring had been badly beaten in the west; Bath had
surrendered on July 30. Was Robert Boyle still at Stalbridge on
August 15, when Sherborne Castle was stormed and battered—
Sherborne Castle, where the old Earl and his sons had killed that
buck and dined the very day that Lady Ranelagh’s baby had been
born? Probably not. It was probably wise that he should absent
himself, “according to the leave the Parliament had given him.” At
any rate, he was well away from English shores again when on
September 10 there came “the splendid success of the storming of
Bristol.”[127]
It is not known if Robert Boyle went so far as Geneva, or whether
he actually saw his old governour again; but in any case his visit was
a brief one. His business was done, and he was back in London
before the end of that year, staying with Lady Ranelagh, and able to
attend to the other business that remained to be done—if indeed it
had not been done before he left Stalbridge in August.
There were, it will be remembered, certain deeds in a sealed box
left by the old Earl in the hands of Mr. Peter Naylor of New Inn. But
they were duplicates. The originals had been left with Lord Howard
of Escrick, the father of “My Robyn’s yonge Mrs.” and the uncle of
Broghill’s wife, Lady Pegg. They embodied the old Earl’s last effort in
family match-making; a fitting match for the youngest son of the
great Earl of Cork, which would further unite the families of Cecil,
Howard, and Boyle; already intermarried, as Broghill’s wife was a
niece of Lord Edward Howard, Lady Salisbury his sister, and Lady
Dungarvan’s mother a Cecil. The old Earl had done his very best for
his Benjamin. And it is a mistake to suppose it probable that the
children had never met. They may very well have made shy
advances to one another during those weeks in the autumn of 1639
when Frank and Robyn were in London, just before Frank’s wedding.
The House of the Savoy and Salisbury House were very near each
other; the families were often together; and little Ann Howard—her
mother dead—was often with Lady Salisbury. The two children may
even have made a pretty and much-admired pair at Frank’s wedding
in Whitehall, and hence may have come the old Earl’s confident “My
Robyn’s yonge Mrs.” But there it had ended: the children, if they met
then, had never seen each other since; and in five years they had
both grown up. It was in 1642 that the old Earl commissioned Lady
Pegg to carry to her little cousin the ring “besett rownd with
diamonds”; but now it was 1645, and many things had happened.
The vast Irish estates had been devastated in the Rebellion.
Dorsetshire had been scourged by civil war; and Robyn had come
back penniless and foreign-looking from Geneva, and was returning
to his “ruined cottage in the country” to examine and administer his
disordered affairs as best he could.
A boy of eighteen, Robert Boyle had come back heart-whole.
Evelyn has left it on record that there were very few fair ladies in
Geneva, when he and Captain Wray[128] and the poet Waller
stopped there on their homeward journey, in 1646. “This towne,”
wrote Evelyn, “is not much celebrated for beautifull women, for even
at this distance from the Alps the gentlewomen have something full
throats; but our Captain Wray ... fell so mightily in love with one of
Mons. Saladine’s[129] daughters that with much persuasion he could
not be persuaded to think on his journey into France.” Robert Boyle
had not fallen in love with any of M. Saladine’s daughters; and his
views on the subject of marriage would scarcely have been
understood by Captain Wray. “Marriage,” wrote Robert Boyle from
Stalbridge when he was scarcely twenty, “is not a bare present, but a
legal exchange of hearts;—and the same contract that gives you
right to another’s, ties you to look upon your own as another’s
goods, and too surely made over to remain any longer in your gift.”
Curiously enough, “my Robyn’s yonge Mrs.” had already come, by
an even shorter process of reasoning, to the same conclusion.
The Lady Ann Howard was a particular girl-friend of Anne
Murray[130]—a daughter of that Murray who had been Provost of
Eton before Sir Henry Wotton. Lady Ann Howard often stayed with
the widowed Mrs. Murray and her daughter in their house in St.
Martin’s Lane; and during the summer months of 1644 the two girls
were constantly together at the house of Anne Murray’s elder sister,
Lady Newton, at Charlton in Kent. It was a house surrounded by a
garden with quiet walks in it. Lord Howard of Escrick’s eldest son,
brother of “My Robyn’s yonge Mrs.,” was often there, for he was in
love with Anne Murray; and Mr. Charles Howard—a young cousin of
the Howards—was often there too, for he was in love with his cousin,
Lady Ann. Anne Murray has left a pretty description of the love-
making that went on in that garden. They called it amour in those
days, and they were all ridiculously young. Lord Howard of Escrick,
the father, was a Parliamentarian, and at this time very busy as one
of the ten Lords who were lay members of the Westminster
Assembly; but he was not too busy to come and fetch away his son
and daughter when he heard what was going on. The four young
people had been very happy in that garden. Anne Murray has
described how once Charles Howard took his fair cousin by the
hand, and “led her into another walke, and left him and I together.”
“Him” was Lord Howard of Escrick’s son and heir, who straightway
proposed to “I.” But Anne Murray was not allowed to say “yes”; her
mother shut her up, and she was fed on bread and water. With the
Lady Ann and Charles Howard it was quite different. The boy-cousin
can have had no reason to conceal his feelings, unless indeed it
were the prior claim of the absent Robyn. Charles Howard’s brilliant
career may be read in any Peerage. He was a soldier and a man of
parts at sixteen. He was to serve Cromwell and to become one of
Cromwell’s Lords, and to be created Earl of Carlisle at the coronation
of Charles II. He was the “finest gentleman”; and he won his cousin
Ann, who was “My Robyn’s yonge Mrs.”
Robert Boyle also seems to have acted his part as became “a very
parfit gentle knight” and the old Earl’s Benjamin. There can be little
doubt that a passage in an undated letter from Lady Ranelagh to her
brother belongs to this period, and ends, for him, the episode. “You
are now,” she says, “very near the hour wherein your mistress is, by
giving herself to another, to set you at liberty from all the
appearances you have put on of being a lover; which, though they
cost you some pains and use of art, were easier, because they were
but appearances.”[131]
The Howard cousins, Mr. Charles Howard and the Lady Ann, must
have been married very shortly after, if not before, Robert Boyle
returned from his flying visit to France at the end of 1645. The box of
deeds left with Lord Howard of Escrick must have come back into
Robyn’s hands. The little lady was to pass out of his life almost
before she can be said to have entered it. Twenty years afterwards
the Lady Ann was still a young woman, though she was the mother
of grown-up children, when Mr. Pepys made the entry in his diary: “I
to church: and in our pew there sat a great lady, whom I afterwards
understood to be my Lady Carlisle, a very fine woman indeed in
person.”
CHAPTER IX
THE DEARE SQUIRE
“... When a Navigator suddenly spies an unknown Vessel afar off, before he has
hail’d her, he can scarcely, if at all, conclude what he shall learn by her, and he
may from a Ship that he finds perhaps on some remoter coast of Africa, or the
Indies, meet with Informations concerning his own Country and affairs; And thus
sometimes a little Flower may point us to the Sun, and by casting our eyes down
to our feet, we may in the water see those Stars that shine in the Firmament or
highest visible Heaven.”—Robert Boyle: Occasional Reflections on Several
Subjects.
It was in March 1646 that Robert Boyle once more set out from
London to ride into Dorsetshire. The Manor of Stalbridge was to be
his home for the next five or six years.
What fate had overtaken the Earl’s choice dun mare that waited at
Lismore for Robyn’s home-coming? The old order had changed; and
it was on a borrowed courser, “none of the freest of his legs,” that
Robert Boyle made the journey. Lord Broghill was with him, and they
had the company of a States-Messenger, who was travelling the
same way. The account of their long ride, by Farnham and
Winchester and over Salisbury Plain is a little romance in itself.[132]
The war was drawing to an end. The King was again at Oxford:—it
was not long before his escape, in disguise, to the Scots at
Newcastle. The new-modelled Army had very nearly completed its
work of conquest in the south-west. The Cavaliers were out between
Egham and Farnham, but the travellers dodged them.[133] Farnham
was deserted—“all the townsmen having gone to oppose the King’s
Army.” Robert Boyle almost lost himself in meditation, “invited by the
coolness of the evening and the freshness of the garden,” in which
he walked up and down waiting for his supper. The travellers
supped, and retired quietly to bed; and it was not till the dead of night
that they were roused by a thundering at the chamber door. Robyn
slept in his clothes and stockings: “my usual night-posture when I
travel.” He produced his bilboa from under his pillow, and a pistol
from one of his holsters; his bows and arrows were not far off. But it
turned out to be only the town-constable with a group of musketeers,
in search of somebody else. “Away went my gentleman,” wrote
Robyn gaily to his sister, “in prosecution of his search; and I even
took my bows and arrows and went to sleep.”
They dined next day at Winchester, and lay that night at Salisbury;
and there Robyn overtook his trunks, which had been sent on in front
of him. In the middle of Salisbury Plain they were surrounded by a
party of horse, who would have searched them for “Malignant
Letters” such as “use to be about the King’s Picture in a Yellow-
Boy.”[134] But the States-Messenger carried them safely through,
and they rode on, past weary troops of foot, “poor pressed
countrymen,” goaded on by the party of horse. “Amongst them,”
wrote Robert Boyle, “I saw one poor rogue, lacqueyed by his wife,
and carrying a child upon his shoulders.” Even then, as now, “new
models” leave much to be desired.
In spite of his bilboa and pistols, Robert Boyle hated the sight of
war. “Good God!” he wrote, “that reasonable creatures, that call
themselves Christians too, should delight in such an unnatural thing
as war, where cruelty at least becomes necessity....”
He reached Stalbridge in safety; but the weather had broken, and
was wretchedly cold. “We all suspect the almanac-maker of a
mistake in setting down March instead of January.” The bad weather
kept him indoors, and was “so drooping that it dulls me to all kinds of
useful study.” Even his country neighbours were prevented from
making their usual “visitations.” Robert Boyle was depressed:
Stalbridge was not so lively as London. “My stay here,” he says,
“God willing, shall not be long.”
There were still troops in the neighbourhood, and the plague had
“begun to revive again”; there had been cases at Bristol, and at
Yeovil, only six miles off. Dorsetshire was suffering from “fits of the
Committee”;[135] and at the Manor itself there were many calls on the
Squire’s slender purse. This had for the time been replenished by
one of his brothers; and he was going to cut down some of his wood,
to repay the loan. He was arranging to make “my brother’s sixty
trees bear him some golden fruit”; but this was to be done by
instalments—one third at May Day next. And meantime he was
trying to settle down to his “standish and books”; but even writing did
not come easily. “My Ethics,” he wrote to his sister (of a little treatise
he had begun, one of his first literary attempts), “go very slowly
on.”[136]
And the days must have passed slowly too. “I am grown so perfect
a villager, and live so removed,” runs a letter to Lady Ranelagh, “not
only from the roads, but from the very by-paths of intelligence, that to
entertain you with our country discourse, would have extremely
puzzled me, since your children have not the rickets nor the
measles.”[137] He was feeling the difficulties of his position, in being
one of a family so important to both political parties. “I have been
forced to observe a very great caution and exact evenness in my
carriage, since I saw you last,” he wrote to Marcombes in Geneva; “it
being absolutely necessary for the preservation of a person whom
the unfortunate situation of his fortune made obnoxious to the
injuries of both parties and the protection of neither.” And his money
matters were still in disorder, as indeed were everybody else’s. Out
of his Irish estates he had not received “the worth of a farthing.”
The roguery of Tom Murray at Stalbridge, however, had had one
good result: it had obliged Robyn to make “further discoveries into
æconomical knowledge” than he would otherwise have done. He
had turned Tom Murray away, “to let him know that I could do my
business very well without him”; and then, towards the end of 1646,
Tom Murray was to be taken back: “Having attained to a knowledge
of my own small fortune beyond the possibility of being cheated, I
am likely to make use of him again, to show my father’s servants that
I wish no hurt to the man, but to the knave.”
In October 1646, Robert Boyle was back on a visit to London,
perhaps to see the great Essex buried “in kingly state.” On that day,
the solemn pageant just over, he sat down to write a letter—a
wonderful letter for a boy not yet twenty—to Marcombes in Geneva.
He wrote of the long procession of four hundred officers, “not one so
low as a captain,” the House of Peers, the House of Commons, the
City-Fathers, and the Assembly of Divines, that had followed Essex
to the grave. But to Robert Boyle the “pageants of sorrow” had
“eaten up the reality”; the “care of the blaze” had “diverted men from
mourning.”[138]
His letter to his old governour gives a vivid picture of the political
conditions of the time. In England there was “not one Malignant
garrison untaken”; in Wales “but two or three rocky places held out
for the King.” The Scots were about to deliver up their garrisons and
return into their own country, the Parliament having agreed to
compound with them for all their arrears. A sum of £300,000 had
been agreed upon, but “the first payment is yet in debate.” The King
was still at Newcastle, “both discontenting and discontented”; and
the Scots would be obliged to make up their minds how to “dispose
of his person,” which the Houses had “voted to remain in the
disposition of both Houses of Parliament.” People were flattering
themselves with hopes of a speedy settlement of things, but Robert
Boyle was not so hopeful. He has, he says, “always looked upon Sin
as the chief incendiary of this war”; and yet, “by careful experience,”
he has observed that the war has “only multiplied and heightened
those sins to which it owes its being.” And his simile is characteristic:
“As water and ice,” he adds, “which by a reciprocal generation beget
one another.”
In Ireland the state of things was no more hopeful than nearer
home. The news of Lord Ormonde’s peace must have reached
Geneva; but Robert Boyle explains carefully to Marcombes the
respective attitudes of the three parties;—the Protestant English
proper; the “mere natives,” who hoped by rebellion “to exchange the
Throne of England for St. Peter’s Chair,” or “to shake off the English
yoke for that of some Catholic foreign prince”; and, thirdly, the
Catholic Lords of the English Pale—“so we call the counties about
Dublin”—who are “by manners and inclination Irish, though English
by descent.”
In Inchiquin’s absence from Munster, Broghill, Governor of
Youghal, had been left in full command.[139] Robyn is very proud of
Broghill, not only as a gallant soldier, but as “none of the least wits of
the time.” Broghill had come to England to appeal for troops and
supplies for Munster;[140] but Parliament was so slow in granting
them that “the physic will not get thither before the patient be dead.”
And then Robert Boyle gives Marcombes a piece of his mind
about the sects and sectaries:—
“The Presbyterian Government is at last settled (though I can
scarce think it will prove long lived) after the great opposition of
many, and to their no less dislike.” But many people had begun to
think it was high time to “put a restraint upon the spreading
impostures of the sectaries,” who had made London their general
rendezvous. The City “entertains at present no less than 200 several
opinions in point of religion.” Some have been “digged out of the
graves,” where they had been long condemned to lie buried; others
have been “newly fashioned in the forge of their own brains”; most
are but “new editions of old errors.”
“If the truth be anywhere to be found,” wrote the young
philosopher, “it is here sought so many several ways that one or
other must needs light upon it.” But he speaks with respect of that
kind of tolerance that tries to see even in impostures “glimpses and
manifestations of obscure or formerly concealed truths,” and that
would not “aggravate very venial errors into dangerous and
damnable heresies.”
“The Parliament is now upon an ordinance for the punishment of
many of these supposed errors; but since their belief of their contrary
truths is confessedly a work of divine revelation, why a man should
be hanged because it has not yet pleased God to give him his Spirit,
I confess I am yet to understand....”
After this the letter goes off into domestic and personal matters.
Robert Boyle had been in company with the Archbishop of
Armagh[141]—“our Irish St. Austin” [142]—and had been telling him of
Marcombes’s French translation of a sermon of the Archbishop’s,
“The Mystery of the Incarnation.” “He seemed very willing that you
should publish it, upon the assurance I gave him of the fidelity of its
translation.” Lady Ranelagh and Broghill were anxious to find
Marcombes some more pupils; but all the great families of England
were at present “standing at a gaze.” Whether peace or war be the
outcome of events, “it is probable that a good many of them will
make visits to foreign climates.”[143]
Robyn himself had seen a variety of fortune since he and his
governour had parted: “plenty and want, danger and safety, sickness
and health, trouble and ease.” He had actually once been a prisoner
in London, “on some groundless suspicion,” but had quickly got off
with advantage. At Stalbridge he was pursuing his studies by fits and
starts. “Divers little essays, both in prose and verse, I have taken the
pains to scribble upon several subjects”; and as soon as he can “lick
them into some less imperfect shape” he will send some of the “least
bad” to Marcombes in Geneva. He tells Marcombes about his study
of ethics, and his desire to “call them down from the brain into the
breast, and from the school to the house”; and he mentions his little
treatise that goes on so slowly.
“The other humane studies I apply myself to are natural
philosophy, the mechanics, and husbandry, according to the
principles of our new philosophical college, that values no knowledge
but as it hath a tendency to use.” And he begs Marcombes to inquire
for him into the “ways of husbandry” practised about Geneva; “and
when you intend for England, to bring along with you what good
receipts or good books of any of those subjects you can procure,
which will make you extremely welcome to our invisible college.”
The “Invisible College,” the embryo of the Royal Society of
London, was then already in existence. Since some time in 1645, a
little club composed of a few “worthy persons inquisitive into natural
philosophy” had been holding its weekly meetings; sometimes in the
lodging of the physician, Dr. Jonathan Goddard, in Wood Street,
Cheapside; sometimes at a “convenient place” in Cheapside itself,—
in fact, the Bull’s Head Tavern; and sometimes in Gresham College,
near by. Its originator was Theodore Haak, who, like Hartlib, was a
naturalised German; and among its first members were Dr. John
Wallis, clerk to the Westminster Assembly; Dr. Wilkins, afterwards
Warden of Wadham College, Oxford, and brother-in-law of Oliver
Cromwell; Foster, the professor of astronomy at Gresham College;
the young William Petty; Dr. Goddard himself; and one or two other
“doctors in physic” more or less well known in London. They had
their telescopes and microscopes and their attendant apothecaries,
etc.; and, “precluding theology and state-affairs,” they wandered at
will among the sciences,—the physics and chemics, and mechanics
and magnetics,—“as then cultivated at home and abroad.” Hartlib
was from the very first connected with this club: “The Invisible
College of his imagination seems to have been that enlarged future
association of all earnest spirits for the prosecution of real and fruitful
knowledge of which this club might be the symbol and promise.”[144]
His early letters to Robert Boyle at Stalbridge are full of the
subjects under discussion. And there is no doubt that it was to a
great extent the fascination of these weekly meetings in Wood
Street, and the company he met there, that drew Robert Boyle so
often to London and kept him in London as long as he could manage
to stay there.
“I have been every day these two months,” he wrote to his friend
Francis Tallents, in February 1647,[145] “upon visiting my own ruined
cottage in the country; but it is such a labyrinth, this London, that all
my diligence could never yet find a way out on’t ... the best on’t is,
that the corner-stones of the invisible, or as they term themselves,
the philosophical college, do now and then honour me with their
company ... men of so capacious and searching spirits, that school-
philosophy is but the lowest region of their knowledge; and yet,
though ambitious to lead the way to any generous design, of so
humble and tractable a genius, as they disdain not to be directed to
the meanest, so he can but plead reason for his opinion; persons
that endeavour to put narrow-mindedness out of countenance by the
practice of so extensive a charity that it reaches unto everything
called man, and nothing less than a universal goodwill can content it.
And indeed they are so apprehensive of the want of good
employment, that they take the whole body of mankind for their
care.”
And he concludes his panegyric with the recital of their chiefest
fault, “which is very incident to almost all good things; and that is,
that there is not enough of them.”
The London outside this pleasant coterie was not so congenial to
Robert Boyle. Above all, the sects and sectaries were his
abomination. They were coming over from Amsterdam like so many
bills of exchange; they were like “diurnals,” eagerly read, and then in
a day or two torn up as not worth keeping. They were “mushrooms of
last night’s coming up.” “If any man have lost his religion,” he wrote,
“let him repair to London, and I’ll warrant him he shall find it: I had
almost said too, and if any man has a religion, let him but come
hither now, and he shall go near to lose it.... For my part, I shall
always pray God to give us the unity of the Spirit in the bond of
peace....”[146]
One immediate outcome of these club meetings in Wood Street
was a little scheme, evidently aided and abetted by Lady Ranelagh,
which filled all Robyn’s thoughts on his return to Stalbridge in the
spring of 1647. He was going to set up a laboratory of his own, in the
empty manor-house. It was a scheme not easy to carry out in those
days; and his first efforts were to result in dire failure. “That great
earthen furnace,” he wrote to Lady Ranelagh, “whose conveying
hither has taken up so much of my care, and concerning which I
made bold very lately to trouble you, since I last did so, has been
brought to my hands crumbled into as many pieces as we into sects;
and all the fine experiments and castles in the air I had built upon its
safe arrival have felt the fate of its foundation. Well, I see I am not
designed to the finding out the philosopher’s stone, I have been so
unlucky in my first attempts at chemistry. My limbecks, recipients,
and other glasses have escaped indeed the misfortune of their
incendiary, but are now, through the miscarriage of that grand
implement of Vulcan, as useless to me as good parts to salvation
without the fire of zeal. Seriously, Madam, after all the pains I have
taken, and the precautions I have used, to prevent this furnace the
disasters of its predecessors, to have it transported a thousand miles
by land that I may after all this receive it broken, is a defeat that
nothing could recompense, but that rare lesson it teaches me, how
brittle that happiness is that we build upon earth.”[147]
These words breathe the first hint of a melancholy in Robert
Boyle’s life, the causes of which—though he did his best to conceal
and conquer them—are not far to seek.
As early as 1646, when he was not yet twenty, there comes into
his letters the note of physical suffering. Like many scholars and
thinkers, Robert Boyle was very sensitive about physical pain, and
the chances of infection and disease. As a boy at Eton, it will be
remembered, the “potion” held more than ordinary terrors for the
spiritay Robyn. Perhaps he had heard about little Hodge, who had
died at Deptford, after so dutifully swallowing the powder of unicorns’
horns. But even if not, he must have seen the same thing happening
all about him; he must have known well enough that medical
treatment in his day was steeped in the optimism of blackest
ignorance. The plasters and powders and potions and purges with
which the Faculty “wrought” so boldly on every disease, and the
weird and melodramatic endings which were their usual results, had
given Robyn “a perfect aversion to all physick.” He believed that, in
most cases, it “did but exasperate the disease.” Had not he seen “life
itself almost disgorged together with a potion”? It was his own
childish experiences that inclined this experimentalist, all his life, to
“apprehend more from the physician than the disease,” and set him
to apply himself to the study of physic “that he might have the less
need of them that profess it.” And so, though he was to count among
his friends of the Philosophical College and elsewhere the most
learned and eminent physicians of his time, and as he grew older
came to trusting very humbly and gratefully to the skill of more than
one of them, Robert Boyle’s tendency, all through life, was to simplify
medical treatment, and as far as possible to doctor himself with the
aid of an intelligent and obedient “apothecary.”
If he had known that he was to live till he was sixty-five, and that
the five-and-forty years that lay before him were to be years of more
or less invalidism and suffering! But the long future was veiled; at
twenty, the months in front of him were all-important. And he must
have known as early as 1646 that his attacks of pain and “ague fits”

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To my husband, Jim, the quiet, solid, love of my life for over

List of Tables xii Hyperplasias and Neoplasms 15

Development of Malignant Neoplasms (Cancer) 30 Fibrinous Exudate 47

CHAPTER 6 Von Willebrand’s Disease 133

Trauma 193 Gluten-Induced Enteropathy 234

Review Questions 277 Effects of Aging on the System 332

Sexually Transmitted Diseases 392

Respiratory Diseases 487 Narcotics 511

A knowledgeable about the common diseases and

Chapter 10 ■ Updated the renal calculi section

■ Updated the Diagnostic Tests of the Ear section Chapter 18

Chapter 17 ■ Added a new Healthy Highlight: Gene Mutations

■ Updated the Diagnostic Tests section

Ms. Tannehill-Jones was not a newcomer to this cam­

TABLE 1-1 Types of Pathologists

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

TABLE 1-2 Examples of Acute and Chronic

become, the higher the risk for diseases such as

TABLE 1-3 Examples of Common Diagnostic Tests and Procedures

intervention be funded? If costs are funded by individ­

_____ Etiology b. Interventions to cure or control a disease

_____ Diagnosis c. The development of a disease

_____ Prognosis d. The identification or naming of a disease

_____ Treatment e. The predicted or expected outcome of a disease

Fill in the Blank

Chromosomal and genetic abnormalities might or

TABLE 2-1 Classification of Hereditary Disease with Examples

Single Gene Polygenic Chromosomal

Cystic fibrosis Gout Klinefelter’s syndrome

and infection. On arrival at an emergency department,

Inflammation and Infection Figure 2-1 Inflammation of a finger.

TABLE 2-2 Examples of Neoplasms or Tumors

Adenoma Usually benign tumor arising from glandular epithelial tissue

Neoplasms or tumors (-omas) may be classified as

Persons who are unable to eat enough to maintain

Obesity consume large amounts of vitamins for an extended

General Guidelines eneral guidelines for a healthy lifestyle include the

Immunodeficiency understood but is progressive and irreversible. Diseases

Figure 2-5 Normal cell versus atrophied cell.

Basement membrane Metaplasia

“If Vertue feeble were,

Ms. Tannehill-Jones was not a newcomer to this cam

intervention be funded? If costs are funded by individ