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 Contents
Preface xv
Part 1 Finding Rhythm 1 Developing and Maintaining
1 Discovering Your Personal
Rhythm for Healthy Living 1 Getting Adequate Sleep 39
What Is Health? 2
Health and Sickness: Defined by Extremes 2
Health: More Than Not Being Sick 2
Health as Wellness: Putting Quality into Years 3
Health Promotion: Helping You Stay Healthy 5
Prevention: The Key to Future Health 6
Sex Differences 7
Improving Your Health 7
Benefits of Achieving Optimal Health 7
Preparing for Behaviour Change 8
S t u d ent H e a lth T o d ay 9
Factors Influencing Behaviour Change 9
Your Beliefs and Attitudes 13
Do Beliefs and Attitudes Influence Behaviours? 13
Your Intentions to Change 14
POINT OF VIEW 15
Significant Others as Change Agents 15
Behaviour Change Techniques 17
Shaping: Developing New Behaviours in Small Steps 17
Visualizing: The Imagined Rehearsal 17
Modelling 18
Controlling the Situation 18
Reinforcement 18
Changing Self-Talk 18
Making Behaviour Change 19
Self-Assessment: Antecedents and Consequences 19
Analyzing the Behaviours You Want to Change 19
Decision Making: Choices for Change 19
ASSESS YOURSELF 21
2 Promoting and Preserving Your
Psychosocial Health 27
Defining Psychosocial Health 28
Intellectual Health: The Thinking You 29
Emotional Health: The Feeling You 30
Social Health: Interactions with Others 31
Spiritual Health: An Inner Quest for Well-Being 31
Factors Influencing
Psychosocial Health 34
External Influences 34
A01_DONA9396_07_SE_FM.indd 7
Internal Influences 35
Resiliency and Developmental Assets 37
Enhancing Psychosocial Health 37
Self-Esteem and Self-Efficacy 37
POINT OF VIEW 38
Forming Realistic Expectations 38
Understanding the Mind–Body Connection 40
Understanding Mood Disorders 41
Depression 42
Seasonal Affective Disorder 44
Anxiety Disorders 44
Schizophrenia 45
Sex Issues in Psychosocial Health 45
Depression and Sex 45
PMS: Physical or Mental Disorder? 46
Suicide: Giving Up On Life 46
Warning Signals of Suicide 46
S t u d ent H e a lth T o d ay 4 7
Taking Action to Prevent Suicide 47
When Mood Disorders and
Substance Use Disorders Mix 48
Seeking Professional Help 48
Types of Mental Health Professionals 49
Choosing a Therapist: Key Factors to Consider 49
What to Expect When You Begin Therapy 50
ASSESS YOURSELF 51
3 Understanding and
Coping with Life’s Stressors 53
What Is Stress? 54
The Mind–Body Connection: Physical Responses 55
Stress and Impaired Immunity 55
S t u d ent H e a lth T o d ay 5 6
The General Adaptation Syndrome 57
Alarm Phase 57
Resistance Phase 59
Exhaustion Phase 59
Sources of Stress 59
Psychosocial Sources of Stress 59
Other Forms of Psychosocial Stress 61
Environmental Stress 61
Self-Imposed Stress 61
Stress and The Post-Secondary Student 63
POINT OF VIEW 64
vii
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 Stress Management 65 Body Composition 100
Dealing with Stress 65 Planning Your Physical
Managing Emotional Responses 68 Fitness Training Program 100
Learning to Laugh and Cry 68 Identifying Your Physical Fitness
Managing Social Interactions 68 Goals and Designing Your Program 100
Making the Most of Support Groups 69 S t u d ent H e a lth T o d ay 1 0 1
Taking Mental Action 69 Fitness-Related Injuries 102
Taking Physical Action 70
Causes of Fitness-Related Injuries 102
Learning Time Management 71
Prevention 102
Using Alternative Stress Management Techniques 72
Common Overuse Injuries 103
ASSESS YOURSELF 73
Exercising in the Heat 104
Exercising in the Cold 105
Focus On Spiritual Health 76
Your Movement Journey 105
ASSESS YOURSELF 84
ASSESS YOURSELF 106
ASSESS YOURSELF 107

Part 2 Choosing Healthy 5 Eating for Optimal Health and

Lifestyles 85
Performance 116

4 Engaging in Physical Activity for Health, Healthy Eating 117

Dietary Patterns Around the Globe 117
Fitness, and Performance 85 In Canada 117
Physical Activity for Health, Eating Well with Canada’s Food Guide 118
Fitness, and Performance 86 The Digestive Process 119
Benefits of Regular Physical Activity 88 Dietary Reference Intake vs.
Improved Cardiorespiratory Endurance 88 Recommended Nutrient Intake 122
Improved Bone Health 89
Improved Weight Management 89 Obtaining Essential Nutrients 122
Improved Quantity and Quality of Life 90 Calorie 122
Improved Mental Health and Water 123
Stress Management 90 Proteins 123
Improving Cardiorespiratory Carbohydrates 124
Endurance 91 Simple Carbohydrates 125
Cardiorespiratory Fitness Programs 91 Complex Carbohydrates: Starches and Glycogen 125
Determining Exercise Frequency 91 Complex Carbohydrates: Fibre 125
Determining Exercise Intensity 91 Fats 126
Determining Exercise Time 93 Vitamins 128
Determining Exercise Type 93 Minerals 131
The Recovery 93 Sex Differences in Nutritional Needs 134

Improving Muscular Strength and Vegetarianism 135

Endurance 93 S t u d ent H e a lth T o d ay 1 3 6
Principles of Strength Development 93 Eating Well as A Student 136
Types of Muscle Contractions 94 Fast Foods: Eating on the Run 137
Methods of Providing Resistance 95 Understanding Nutrition and Health Claims 138
Getting Started 96 Healthy Eating on a Budget 140
Improving Your Flexibility 97 Healthy Eating in Residence 140
Types of Stretching Exercises 97 Food Safety Concerns 141
Yoga, Tai Chi, and Pilates 97 Food-Borne Illness 141
Food Additives 142
POINT OF VIEW 98
Food Allergies 142
Yoga 98 Choosing Organic 143
Tai Chi 99
Locally Grown Foods 143
Pilates 100
Genetically Modified Food Crops 143

viii CONTENTS

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 POINT OF VIEW 144
ASSESS YOURSELF 145 Part 3 Creating Healthy and
Caring Relationships 188

6 Managing Your Weight:

Finding a Healthy Balance 149 7 Committing to Relationships and
Health Risks of Overweight and Obesity 150 Sexual Health 188

Overweight and Obesity 151 Communicating: A Key to

Establishing Relationships 189
POINT OF VIEW 153
Communicating How You Feel 189
Determining the Right Weight for You 154
Improving Communication Skills 189
Assessing Your Body Fat Content 155
Characteristics of Intimate
Managing Your Weight 156 Relationships 191
Keeping Weight Loss in Perspective 156
Forming Intimate Relationships 192
What Is a Calorie? 157
Physical Activity 157 Families: The Ties That Bind 192
Is Dieting Healthy? 158 Today’s Family Unit 192
Improving Your Eating Habits 159 Establishing Friendships 193
Choosing to Eat Well 159 Significant Others, Partners, Couples 194
“Miracle” Diets 160 This Thing Called Love 194
Low-Carbohydrate Diets 160 Gender Issues 196
Trying to Gain Weight 161 Why the Differences? 197
Risk Factors for Obesity 161 Picking Partners: Similarities and
Differences between Genders 197
Heredity and Genetic Factors 162
Endocrine Influences: The Hungry Hormones 162 Barriers to Intimacy 197
Hunger, Appetite, and Satiety 163 Dysfunctional Families 197
Developmental Factors 163 Jealousy in Relationships 198
Metabolic Rates and Weight 163
Psychosocial Factors 164 Committed Relationships 199
Eating Cues 164 Marriage 199
Dietary Myth and Misperception 165 Cohabitation 199
Lifestyle 165 Gay and Lesbian Partnerships 200
Social Bias Against Success in Committed
the Overweight 165 Relationships 200
S t u d ent H e a lth T o d ay 1 6 6 Partnering Scripts 200
Thinking Thin: Body The Importance of Self-Nurturance 200
Image Disorders 166 Elements of Good Relationships 201
Eating Disorders 167 Staying Single 201
Anorexia Nervosa 167 Having Children 202
Bulimia Nervosa 167 Ending a Relationship 202
Binge Eating Disorder 168 The Warning Signs 202
Eating Disorder Not Otherwise Specified 168 Seeking Help: Where to Look 202
Disordered Eating 168 Trial Separations 203
Anorexia Athletica 169 Why Relationships End 203
Who Is at Risk? 169 Deciding to End Your Relationship 203
Treating Eating Disorders 169 Coping with Loneliness 204
Helping Someone with an Eating Disorder 169
Your Sexual Identity 204
Creating A Personalized Plan for
Gender Identity and Roles 205
Achieving Your Healthy Weight 170
ASSESS YOURSELF 172 Reproductive Anatomy and
Physiology 205
Focus On Body Image 177 Female Reproductive Anatomy and Physiology 205
ASSESS YOURSELF 187 Male Reproductive Anatomy and Physiology 209

CONTENTS ix

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 Expressing Your Sexuality 210
Human Sexual Response 210
Sexual Orientation 211
Developing Sexual Relationships 212
Sexual Expression:
What Are Your Options? 212
What Is Right for Me? 214
Variant Sexual Behaviour 214
Difficulties that Can
Hinder Sexual Functioning 214
S t u d ent H e a lth T o d ay 2 1 5
Sexual Desire Disorders 215
Sexual Arousal Disorders 215
Orgasm Disorders 216
Sexual Pain Disorders 216
Drugs and Sex 216
ASSESS YOURSELF 217
8 Considering Your Reproductive
Choices 221
Managing Your Fertility 222
Reversible Contraception 222
POINT OF VIEW 225
S t u d ent H e a lth T o d ay 2 2 8
Oral Contraceptives for Men? 231
Fertility Awareness Methods (FAM) 231
Permanent Contraception 232
Abortion 234
Methods of Abortion 234
Planning a Pregnancy 235
Emotional Health 235
Maternal Health 235
Paternal Health 236
Financial Evaluation 236
Contingency Planning 236
Decision Making about
Unplanned Pregnancy 237
Pregnancy 237
Prenatal Care 237
Alcohol and Drugs 238
A Woman’s Reproductive Years 241
Pregnancy Testing 241
The Process of Pregnancy 242
Prenatal Testing and Screening 243
Childbirth 244
Where to Have Your Baby 244
Labour and Delivery 244
Prenatal Education 245
Drugs in the Delivery Room 245
Breastfeeding and the
Postpartum Period 245
Complications 246
x CONTENTS
A01_DONA9396_07_SE_FM.indd 10
Infertility 248
Causes in Women 248
Causes in Men 248
Treatment 248
Surrogate Motherhood 249
ASSESS YOURSELF 250
Focus On Sexually Transmitted
Infections (STIs) 253
ASSESS YOURSELF 258
Part 4 Limiting Risks from
Potentially Harmful
Habits 260
9 Recognizing Use, Misuse, Abuse,
and Addiction to Drugs and
Behaviours 260
Drug Use, Misuse, and Abuse 261
Individual Response: Set and Setting 261
Defining Addiction 262
The Physiology of Addiction 263
The Addictive Process 263
Signs of Addiction 264
Addictive Behaviours 264
Gambling 264
Shopping and Borrowing 265
Exercise Addiction 266
Technology Addictions 266
Managing an Addiction 266
Drug Dynamics 267
Types of Drugs 268
Routes of Administration of Drugs 269
Drug Interactions 270
POINT OF VIEW 272
Prescription Drugs 272
Types of Prescription Drugs 273
Use of Generic Drugs 274
OVER-THE-COUNTER (OTC) DRUGS 274
Types of OTC Drugs 274
ASSESS YOURSELF 277
10 Using Alcohol and Caffeine Responsibly
and Refraining from Tobacco Use 281
Alcohol: An Overview 282
Alcohol and the Post-Secondary Student 283
Rights versus Responsibilities 285
23/01/17 4:02 PM
 The Production of Alcohol 286 Focus On Improving Your Sleep 330
Physiological and Behavioural
ASSESS YOURSELF 339
Effects of Alcohol 286
Behavioural Effects 286

5 Preventing and Managing

Absorption and Metabolism 287
Immediate Effects 289 Part
Long-Term Effects 289
Fetal Alcohol Spectrum Disorders 291
DISEASE 340
Drinking and Driving 292
Alcoholism 292 12 Reducing Risk for Cardiovascular
How, Why, Whom? 293 Disease and Cancer 340
The Causes of Alcoholism 293
Cardiovascular Diseases 341
Effects of Alcoholism on the Family 294
Costs to Society 294 Understanding Your Cardiovascular
Women and Alcoholism 295 System 341
Types of Cardiovascular Diseases 343
Recovery 295
Atherosclerosis 343
The Family’s Role 295 Coronary Heart Disease 343
Treatment Programs 295 Stroke 345
Relapse 297 S t u d ent H e a lth T o d ay 3 4 6
Smoking 297 Hypertension 346
Tobacco and Its Effects 298 Arrhythmia, Congestive Heart Failure, and
Smoking—A Learned Behaviour 299 Congenital and Rheumatic Heart Disease 347
Smokeless Tobacco 299 Controlling Your Risks for
Environmental Tobacco Smoke 300 Cardiovascular Diseases 348
Quitting 300 Risks You Can Control 348
Breaking the Nicotine Addiction 300 Obesity 350
Breaking the Habit 301 Risks You Cannot Control 351
Benefits of Quitting 301 Women and Cardiovascular Disease 351
Caffeine 302 Risk Factors for Heart Disease in Women 351
S t u d ent H e a lth T o d ay 3 0 3
Recognizing Heart Disease in Women 352
Caffeine Addiction 304 New Weapons Against
The Health Consequences of Heart Disease 352
Long-Term Caffeine Use 305 Techniques of Diagnosing Heart Disease 352
POINT OF VIEW 307 Angioplasty versus Bypass Surgery 353
ASSESS YOURSELF 308 Thrombolysis 353
Cancer Incidence and Mortality 353
11 Understanding Illicit Drugs 312 What Is Cancer? 355
What Causes Cancer? 356
Illicit Drugs 313 Risks for Cancer 357
Cocaine 314 POINT OF VIEW 359
Amphetamines 316
Marijuana (Cannibis) 317 Types of Cancer 360
Opiates 319 Lung Cancer 360
POINT OF VIEW 320 Breast Cancer 361
S t u d ent H e a lth T o d ay 3 2 1 Colorectal Cancers 363
Prostate Cancer 363
Psychedelics 322
Skin Cancer 363
Deliriants 324
Testicular Cancer 364
Designer Drugs 324
Ovarian Cancer 365
Steroids 325
Uterine Cancer 365
Solutions to the Problem 326 Leukemia 366
Harm Reduction 326 Oral Cancer 366
ASSESS YOURSELF 327

CONTENTS xi

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 Facing Cancer 366 Sex-Related Disorders 401
Detecting Cancer 366 Fibrocystic Breast Disease 401
New Hope in Cancer Treatments 366 Premenstrual Syndrome (PMS) 401
Life after Cancer 367 Endometriosis 402
ASSESS YOURSELF 368
Digestion-Related Disorders 402
Diabetes 402
13 Controlling Risk for Infectious and Colitis and Irritable Bowel Syndrome (IBS) 403
Diverticulosis 403
Noninfectious Conditions 371 Peptic Ulcers 403
Infectious Disease Risk Factors 372 Gallbladder Disease 404
Risk Factors You Cannot Control 373 Musculoskeletal Diseases 404
Risk Factors You Can Control 373 Arthritis 404
The Pathogens: Fibromyalgia 405
Routes of Invasion 373 Systemic Lupus Erythematosus (SLE) 405
Bacteria 374 Low Back Pain (LBP) 405
Viruses 376 Other Maladies 406
Your Body’s Defences: Chronic Fatigue Syndrome (CFS) 406
Keeping You Well 379 Job-Related Disorders 407
Physical and Chemical Defences 379 ASSESS YOURSELF 408
The Immune System: Your Body Fights Back 379 Focus On Diabetes 411
Fever 380
ASSESS YOURSELF 417
Pain 380
Vaccines: Bolstering Your Immunity 380
Sexually Transmitted Infections 382
POINT OF VIEW 383
Part 6 Facing Life’s Challenges 419
Possible Causes: Why Me? 384
Modes of Transmission 385
Chlamydia 385
14 Choosing Healthy Living for the
Pelvic Inflammatory Disease (PID) 386 Environment 419
Gonorrhea 387 Overpopulation 421
Syphilis 387
Air Pollution 422
Pubic Lice 389
Venereal Warts 389 Sources of Air Pollution 422
Smog 423
S t u d ent H e a lth T o d ay 3 9 0
Acid Rain 423
Candidiasis (Moniliasis) 391
Indoor Air Pollution 424
Trichomoniasis 391
Ozone Layer Depletion 426
General Urinary Tract Infections 391
Global Warming 427
Herpes 392
POINT OF VIEW 428
Acquired Immune Deficiency Reducing Air Pollution 428
Syndrome (AIDS) 393
Water Pollution 429
How HIV Is Transmitted 394
Reducing Your Risks for HIV 395 Water Contamination 429
Symptoms of the Disease 396 Chemical Contaminants 430
Testing for HIV Antibodies 396 Noise Pollution 432
Preventing HIV Infection 396 Land Pollution 432
Noninfectious Diseases 397 Solid Waste 432
Respiratory Disorders 397 Hazardous Waste 432
Allergy-Induced Problems 397 Radiation 432
Hay Fever 398
S t u d ent H e a lth T o d ay 4 3 3
Asthma 398
Ionizing Radiation 433
Emphysema 399
Nonionizing Radiation 434
Chronic Bronchitis 399
Nuclear Power Plants 434
Neurological Disorders 399
Food Quality 434
Headaches 399
ASSESS YOURSELF 436
Seizure Disorders 400

xii CONTENTS

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 15 Preventing Violence, Quality Assurance 476
Detecting Fraud and Abuse in the System 476
Abuse, and Injury 439 POINT OF VIEW 477
Violence in Canada 440 Health Service Organizations: A New
Homicide 441 Model of Health Care 477
Suicide 442
ASSESS YOURSELF 478
Youth Violence 444
The Violence of Hate 444
Violence against Women 445
Domestic Violence 446
17 Preparing for Aging,
Violence against Children 447 Dying, and Death 481
S t u d ent H e a lth T o d ay 4 4 9 Redefining Aging 482
Violence against Men 449 What is Normal Aging? 482
Violence against Older Adults 449
Who are The Elderly? 483
Sexual Victimization 450 Theories on Aging 483
Sexual Assault 450 Biological Theories 483
Psychosocial Theories 483
Preventing Personal Assaults 452
Self-Defence against Sexual Assault 452 Changes in The Body and Mind 484
Preventing Assaults in Your Home 454 Physical Changes 484
Preventing Assaults When Mental Changes 488
You Are Away from Home 455
Health Challenges of Older
Violence and Health 455 Canadians 490
Injury Prevention 456 Alcohol Use and Abuse 490
Who Are the Victims of Unintentional Injury? 456 Prescription Drug Use: Unique
POINT OF VIEW 457 Problems for Older Canadians 490
ASSESS YOURSELF 458 Over-the-Counter Remedies 490
Physical Activity 490
S t u d ent H e a lth T o d ay 4 9 1
16 Becoming a Wise Consumer Dietary Concerns 491
of Health Services 461 Gender Issues: Caring
for Older Canadians 491
Making Informed
Health-Care Choices 463 Understanding Death and Dying 492
Evaluating Online Medical Resources 463 Defining Death 492
Financing Health Care 463 Denying Death 493
Accepting Responsibility The Process of Dying 494
for Your Health Care 463
Coping Emotionally with Death 494
Why Some False Claims
Social Death 495
May Seem True 464
Near-Death Experiences 495
Self-Care 464 Coping with Loss 495
When to Seek Help 465 What Is “Normal” Grief? 496
Being Proactive in Your Health Care 465 Coping with Grief 497
S t u d ent H e a lth T o d ay 4 6 6 Worden’s Model of Grieving Tasks 497
When an Infant or a Child Dies 497
Assessing Health Professionals 468
Quasi-Death Experiences 497
Choices of Medical Care 468
Life-And-Death Decision Making 498
Traditional (Allopathic) Medicine 468
Allied Professionals 469 Palliative Care 498
Complementary and POINT OF VIEW 499
Alternative Medicine 469 ASSESS YOURSELF 501

Types of Medical Practices 475 Focus On Financial Health 504

Hospitals and Clinics 475
Promises and Problems of Notes 508
Canada’s Health-Care System 476
Index 531
Access 476

CONTENTS xiii

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 P r e fa c e

A Letter to Our Readers

Dear Readers,
We are pleased to present you with the seventh Canadian edition of Health: The Basics. Please know that we
revised this textbook with you in mind—you, the postsecondary student.
Some of the health challenges you face today are different than when we entered university years ago. However,
some are the same—managing stress, eating well, being physically active, protecting yourself from sexually trans-
mitted infections, using the health-care system wisely, to name a few similarities.
Although we likely now know more about what it takes to live healthily, we also seem to face more challenges
in doing so. We know we should be physically active, and we are well aware of the importance of eating a balanced
diet—focusing on vegetables and fruits—each day, and yet many of us cannot manage to do either. Some of us
choose to drive short distances when walking or cycling would be a healthier—and the more environmentally
friendly—option. Many believe that we must work out to benefit from physical activity. Food choices can be
perplexing, especially given the abundance and availability of fast and convenient foods; media and advertising
messages convince us that such foods will save us time.
Many of us also have an “all-or-nothing” way of thinking. In other words, we may not recognize that each
lifestyle choice—whether physical or mental—is important and contributes to our overall health and wellness.
Further, our health results from a culmination of many factors and influences with each playing its own role.
Sometimes we think of and manage only the components related to our physical health, neglecting our social,
emotional, intellectual, and spiritual dimensions.
You may be studying Human Kinetics or Kinesiology, Physical Education, Nursing, Health Sciences, Business,
or General Arts or Science. Regardless of your program of study, we invite you to engage with this textbook, your
classmates, and your professor. Please read and think about how each opening scenario, introductory section, and
detailed presentation of various Canadian statistics is relevant to you. How does each topic apply to you? Do you
invest time thinking about a particular topic? Why or why not?
We challenge you to question the choices you make and the attitudes you have toward your health and wellness.
Are they the best for you, for right now? How can you make better decisions? When will you make better choices?
We also encourage you to question contemporary thinking about many health issues; for example, binge drinking.
Why is it socially acceptable and expected to drink heavily in your college and university years? You might also
query the societal and media pressures regarding body image. Why do we expect men and women to look a certain
way? Why do we judge people based upon how they look? Question contemporary thinking about many issues,
not just those we bring up here.
We encourage you to read and to reflect deeply. Learning can only happen with reflection. Further, we urge you
to ask questions that will help you to better understand yourself, questions that will help you to better understand
health and wellness, questions that will encourage you to choose more wisely now while you are a student and later
when you are not.
Finally, we suggest you approach this textbook with a sense of optimism and hopefulness, as well as an oppor-
tunity to be selfish. Reading this textbook, participating in class, and completing your assignments provide you
with the chance to think about yourself and what is best for you and your health. As you read through this book,
you will understand why we suggest you have a sense of optimism and hopefulness—that is a choice we all make.
Wishing you all the best and success in your studies!

Sunshine and smiles,

Angie and Amanda

xv

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 In developing Health: The Basics, we listened to the comments and concerns of Canadian personal health educators
and learned that we share the following goals for a personal health textbook:
• To prepare students to lead healthy lives, now and in the future, by providing knowledge, tools, and strategies
to make responsible and appropriate decisions regarding their health.
• To include “high-interest” topics not always included in health texts, such as multicultural and sex-specific
perspectives on health.
• To include current Canadian research, material, and statistics.
• To recognize that students learn in many ways and require strong pedagogical elements to help them synthesize
information and build healthy attitudes and behaviours.
• To include practical, real-life applications to encourage students to think critically about their health and to
apply the material to their own lives.
• To encourage self-awareness, integrity, respect, self-responsibility, and gratitude in the reader.

Inside the Book

• Decision making through critical thinking is the cornerstone of every chapter, beginning with the intro-
duction of the DECIDE model for decision making, Prochaska and DiClemente’s Stages of Change
model, and various behaviour change techniques in Chapter 1.
• Personal reflection, a hallmark feature woven throughout, includes Consider This . . . scenarios and reflective
questions, Student Health and Point of View boxed features, and Taking Charge sections with the opportunity
to Assess Yourself at the end of each chapter.
• An overriding philosophy of self-responsibility, including a better understanding and self-awareness behind
the reasons why we do what we do (or do not do) in regards to our health and wellness, appears throughout
each section of this book.
• Each part of the textbook concludes with Focus On, a three- to five-page feature that provides additional
information on an engaging topic relevant to university and college students and their health.
• Coverage of sex issues in health is integrated throughout the text. Topics include sex bias in mental health
treatment; women and heart disease; and how sex and gender roles can affect stress, stress management, and a
person’s ultimate health status.
• Updated references in APA format help the reader connect more easily to the research and to the thinking that
leads to making better choices regarding his or her health.
• Each chapter applies a pedagogical framework that stresses building health skills consistently. Students can
personalize each chapter through the Student Health and Point of View textboxes within each chapter, as well as
through the Assess Yourself and Taking Charge boxes at the end of each chapter.

New to the Seventh Canadian Edition

Building on a strong foundation, the seventh Canadian edition of Health: The Basics continues to reflect and ex-
emplify self-awareness, integrity, respect, self-responsibility, and gratitude. Key changes to each chapter include the
following:
Chapter 1 features a new figure illustrating the Socio Ecological Model. Updated figures illustrating the leading
causes of death in Canada have also been incorporated.
We have incorporated updated information about volunteer rates, mental illness, and depression in Canada into
Chapter 2. Also included is updated information on LGBT Youth and Suicide prevention. A new section dis-
cusses what happens when mood disorder and substance use disorders mix.
Chapter 3 includes updated and clarified material on the general adaptation syndrome (GAS). In addition,
information and statistics on technostress have been updated.
The introduction to Chapter 4 has been heavily revised and reframed and now incorporates material on physi-
cal literacy. There is an updated and revised section on physical activity for health, and a new discussion talks about
doctors prescribing physical activity for treating and preventing disease. The section on identifying your physical
fitness goals and designing your physical fitness program has been revised, and a new exercise called the “your
movement journey” (physical activity and physical literacy in your life so far) has been incorporated.

xvi P R E FA C E

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 New to Chapter 5 is the First Nations, Inuit, and Métis Food Guide, including a new table with estimated daily
calorie needs. This chapter also includes a completely revised section on carbohydrates, and a new section on
choosing organic or locally grown foods, and the slow food movement.
Chapter 6 includes updated statistics and discussion of overweight and obesity in Canada
Chapter 7 includes updates to the discussion and terminology related to gender and sex, including an updated
gender differences diagram. Selected activities have been updated to incorporate social orientation, and a new fig-
ure on gender-specific communication patterns has been added. This chapter also includes an updated and revised
discussion of sexual orientation.
Chapter 8 incorporates updated statistics and information on paternal health and sperm damage.
Chapter 9 includes updated material on gambling addiction.
In Chapter 10 information on alcohol use and Low Risk Drinking Guidelines have been updated. Material
on alcohol sales by province has also been updated. New figures have been added that illustrate reported heavy
drinking by age, the physiological and behavioural effects of increased blood alcohol concentration, and compare a
healthy liver to a cirrhotic liver. A new figure and example of the use of the decision support framework have been
incorporated. Information on smoking rates in Canada has been updated, and a new Student Health Today box
dealing with the dangers of e-cigarettes and a new application activity has been added.
Chapter 11 includes updates to material on use of illicit drugs in Canada and self-reported use of marijuana.
Clarified and updated material on heart disease and heart function have been added to Chapter 12. Updated
information on cancer incidence and mortality, including updated information on the incidences of specific types
of cancer has been incorporated, and a new figure on the geographic distribution of new cancer cases across
Canada has been added. We have also added new figures on the percent distribution of estimated new cancer cases,
by sex, and the process of metastasis.
New to Chapter 13 is a figure illustrating the epidemiological triad of disease. A number of updates have been
made to the chapter including updated information on worldwide rates of tuberculosis, instances of hepatitis C in
Canada, and instances of death from measles worldwide. Updated information on the instances of chlamydia in
Canada and the rate of gonorrhoea in Canada has also been included, along with updated information regarding
HIV/AIDS.
Updated and revised material on overpopulation and fertility is presented in Chapter 14, along with a new
figure illustrating global fertility rates by region.
Chapter 15, features new figures illustrating homicide rates by province and female homicide rates by Indigenous
group. Updated information on youth violence, domestic violence, violence against children, and violence against
older adults are also include, along with an updated figure illustrating suicide rates by sex and age group. Lastly, a
new figure illustrating incidents of elder abuse has been added.
New to Chapter 16 is the introduction to section on self-care. Material on the number of physicians and nurses
in Canada has been updated, and a new section has been added on complementary and alternative medicine.
Chapter 17 has been revised to include an updated discussion of the proportion of Canadians who are 65 years
of age or older. Moreover, a new figure illustrates the normal effects of aging on the body.

P R E FA C E xvii

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 Hallmark Pedagogical Features
In addition to the features noted above, Health: The Basics continues to employ the following pedagogical features.
• Learning Objectives: Each chapter begins with learning outcomes that provide a learning path of the
important topics covered within the chapter.
• Consider This . . . Chapter-Opening Sce-
narios: These practical, real-life scenarios intro- Pa r t 2 C h o o s i n g h e a lt h y l i f e s t y l e s

duce concepts covered in the chapter and can be

a springboard to stimulating discussions. End-of-
Chapter Application Exercises provide further dis- ChaPter 4
cussion of the topic. engaging in
PhysiCaL aCtivity

Galyna Andrushko/Getty Images

for heaLth, fitness,
and PerformanCe
Consider this . . . Learning outComes

While in high school, Laura participated in many physical activities, • Discuss physical activity and
including organized sports such as volleyball, soccer, swimming, and exercise for health, physical
track. Among the many lifestyle changes she encountered during her fitness, and performance.
first year of post-secondary studies was the need to spend time alone
• Define the components of a
in sedentary scenarios such as reading, writing, and studying. Laura
health-related physical fitness
had seen some of her friends struggle to include any physical activity
program and describe the exercise
or exercise in their student lives. Despite the academic demands of her
frequency, intensity, time, and type
first semester at school, Laura was determined to make time for exer-
to build and/or maintain fitness in
cise and worked out daily, alternating physical activities focused on car-
each component.
diorespiratory endurance and muscular strength and endurance each
day. She studied for long solitary hours and got high grades, though she • Identify and discuss the
averaged less than six hours of sleep a night. By the end of each week, recommendations for physical
Laura usually felt lonely and tired and was not sure she could continue activity promoted in Canada’s
this routine. Physical Activity Guide for
Healthy Active Living.

I
s Laura overdoing it? What potential problems can you foresee if she • Discuss common barriers to
continues her first-semester schedule? What changes should Laura students’ physical activity
make in her lifestyle to feel less lonely and tired? participation and methods to
overcome them.
• Describe common physical
fitness-related injuries as well
as methods to reduce your risk
of these injuries.

85

M04_DONA9396_07_SE_C04.indd 85 29/12/16 5:05 PM

• Point of View boxes: Each chapter features point of view

a Point of View box that offers perspectives on a
controversial health issue and provokes students to
consider where they stand.
Obesity: is it a Disability?
there is no question that obesity can lead to health
problems and difficulty performing activities of daily liv-
ing. a person who is 50 to 100 kilograms overweight
can have difficulty walking, running, getting out of a
chair, and doing simple daily tasks. But does that mean
that his or her level of obesity constitutes a disability?
although obesity was recently classified as a disease in
the United states, it is generally not considered a dis-
ability under the federal americans with Disabilities act
(aDa), which defines disability as “a physical or mental
impairment that substantially limits one or more of the
major life activities of [an] individ-
ual.” to be covered by the aDa,
a person who is obese must be
at least 45 kilograms overweight
or have a body mass index (BMi)
of over 40, as well as an underlying disorder that caused
the obesity. these strict criteria mean that the aDa cur-
rently receives few complaints. however, some people
believe obesity should be considered a disability that
legally entitles individuals to health benefits and other
accommodations. other people believe that labelling
obesity as a disability would add to its stigma and create
more problems than it would solve.
in 2007, the supreme Court of Canada ruled that dis-
ability is no longer predicated on no responsibility for the
disability or an inability to change the circumstances of that
disability. thus under this ruling
those considered to be obese
(BMi of 30 or more) are consid-
ered to have a disability (obesity
network of Canada, 2009).

ARguments FAvOuRing DisAbility ARguments OPPOsing DisAbility

stAtus FOR PeOPle wHO ARe Obese stAtus FOR PeOPle wHO ARe Obese
) Labelling obesity as a disability ) Doctors are worried that defining
provides individuals who are obese with obesity as a disability would make them
better medical insurance (more of an vulnerable to lawsuits from patients who
issue in the United States). are obese and do not want their weight
) A disability label would protect the discussed. The threat of such lawsuits
rights of individuals who are obese against would prevent doctors from discussing
discrimination based on their weight. obesity with their patients and recom-
mending specific actions (again, more of
) Obesity can involve physical disability: an issue in the United States).
A person who is obese can have many
related medical conditions including arthri- ) Rather than labelling obesity as
tis, elevated blood pressure, type 2 diabe- a disability and adding to its stigma,
tes, diabetic-related vascular diseases, and issues of unfair insurance or job
a weakened cardiovascular system. All of practices could be handled with
these conditions can lead to the need for antidiscrimination laws.
walkers, wheelchairs, and other mobility ) Not all people who are obese are
devices, as well as special health accom- disabled by their weight, so labelling them
modations at home or in the workplace. as such would be discriminatory.

Dennis MacDonald/PhotoEdit

Where Do You Stand? ○ how would you determine whether an individual

is disabled because of his or her weight?
○ in your opinion, what positive results could come
○ are there legitimate situations where a person
from classifying individuals who are obese as disabled?
who is obese should be labelled as disabled?
○ What negative consequences do you foresee
○ Do you think labelling obesity as a disability would
from classifying individuals who are obese as
alter the way our society behaves toward and perceives
disabled?
individuals who are obese? if so, in what way?

Chapter 6 M a n a g i n g Y o u r W e i g h t: F i n d i n g a h e a lt h Y B a l a n c e 153

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xviii P R E FA C E

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 • Student Health Today boxes: A Student Health
Student Peter O’Toole/Shutterstock

Today box stimulates critical and personal thinking

Health
• Loss of a relationship
• Access to firearms and other

through the presentation of a student-related issue

lethal means

TodAY Protective factors to reduce

relevant to the chapter’s topic. lGbTQ Youth
and Suicide
Prevention
According to U.S. research among
lesbian, gay, bisexual, transgender,
and queer (LGBTQ) people, up to
40 percent of youth in grades 9 to
12 have considered suicide, com-
pared with just over 10 percent of
their heterosexual peers. Moreover,
a study of 350 LGBTQ youth in
Canada, the United States, and
New Zealand found that over 4 out
of 10 had considered suicide, and 1
in 3 had attempted suicide.
LGBTQ youth who come from
highly rejecting families are more
than eight times as likely to have
attempted suicide as LGBTQ peers
who reported no or low levels of
family rejection. Furthermore, those
that have experienced bullying in
school and verbal or physical abuse
by classmates are at greater risk for
suicide. Other risk factors for sui-
• Assess Yourself: Every chapter and Focus On
cide attempts include:
suicide attempts include:
• Support through ongoing
medical and mental health
relationships
• Coping, problem-solving,
and conflict-resolution skills
• Restricted access to highly
lethal means of suicide
LGBTQ youth can experience unique
• Strong connections to family
challenges that may lead to depression
• Family and parental acceptance or attempting suicide.
of sexual orientation and/or
gender identity
• School safety, support,
connectedness and peer LGBTQ organizations, and encour-
groups such as gay–straight age consideration of how suicide
alliances, LGBTQ groups, and prevention can be advanced within
so on the context of each organization’s
mission and activities.
• Community support
• Positive role models and Sources: Based on Rainbow Health Ontario, (2013).
RHO Fact Sheet: LGBTQ Youth Suicide. Retrieved on
self-esteem
October 11, 2016 from http://www.rainbowhealthontario
• Cultural and religious beliefs that .ca/resources/rho-fact-sheet-lgbt-youth-suicide/;
discourage suicide and support Haas et al., “Suicide and Suicide Risk in Lesbian, Gay,
Bisexual, and Transgender Populations: Review and
self-preservation
Recommendations,” Journal of Homosexuality, 58, no.
1 (2011), 10–51; The Trevor Project. Suicidal
Furthermore, there is growing
Signs and Facts. www.thetrevorproject.org/suicide
awareness for the need to address
-resources/suicidal-signs, (2010); M. Posner and L.
LGBTQ suicide risk and possible Potter. “Suicide Risk and Prevention for Lesbian, Gay,

assess
Bisexual, and Transgender Youth,” Suicide Prevention
interventions for reducing risk in
• A lack of social support Resource Center, www.hhd.org/resources/publications/

feature ends by encouraging the reader to “take • A sense of isolation

national and provincial suicide pre- suicide-risk-and-prevention-lesbian-gay-bisexual

YOURSELF
vention strategies and plans. Provide -and-transgender-youth, 2008.
• Stigma associated with seeking educational and resource materials Go to MyHealthLab to complete this

charge” of his or her health. These textboxes help on LGBTQ suicide and suicide risk to questionnaire with automatic scoring

­include Assess Yourself questionnaires, a personal taKiNg Charge: Creating Better relationships
after reading this chapter, it should be apparent that relationships involve complex interactions between

self-assessment tool. individuals. to create strong and effective relationships, you must carefully assess the values you put on
• moodfriendships,
swings, emotional
irritability
significant outbursts,
or aggression
others, andhigh
otherlevel
formsofof interpersonal
conditions,interactions.
situations, Healthy
and substances thatinvolve
relationships may pre-
developing intimacy in several dimensions. it may be cipitate attempts,
helpful for including
you to take alcohol,
a personal drugs,of loneliness,
inventory your
• feelings of hopelessness
relationships. (Canadian
to determine Mental they
how healthy Health isolation,
are, consider and accessbelow:
the questions to guns. If someone you know
Association, n.d.) threatens or displays warnings signs of suicide, take
• What relationships are most important to you right now?
the following actions:
• How have these relationships affected your relationships with others? Are you giving enough time to your other
relationships?
• Monitor the warning signals. Ensure that
Taking• Action to Prevent
Have you thought about howSuicide
good your relationships are there
from anis emotional
someoneperspective?
around theA psychological
person as much as
perspective? A physical perspective? A spiritual perspective? Which of these factors is the most important to
Suicide is often seen as the only way out of an intol-
you? Why?
possible, 24/7 ideally.
erable situation. People who commit suicide are
• What would an ideal set of relationships look like for you?• Find a safe
How many close place to talk
interactions wouldwith
you the
want person.
to make
often in suchtimepain
for?they
Whatcannot seethe
would be any other
nature andway out.of these relationships?
extent Allow as much time as necessary. Talking about
Crisis counsellors and help lines
• Are you comfortable can help
with yourself temporar-
sexually? suicide
Are you satisfied will current
with your most likely decrease
choice(s) theexpression?
of sexual chances that
ily, but the onlydo
• What way
youtoexpect
prevent
in a suicide is to
committed alleviate What would
relationship? someone
you bewill act on
willing his or in
to accept herterms
suicidal feelings.and/
of attitudes
or behaviours from your committed partner? What do you expect of yourself?
• What do you think are the three most important attributes of a friend? Do you display these attributes with your
friends? C h a p t e r 2 P R O M O T I N G A N D P R E S E R V I N G Y O U R P S Y C H O S O C I A L H E A LT H 47
• How are you limited or bound by gender-role stereotypes?
• Have you considered your values or beliefs about what is most important to you in a prospective lifelong partner?
Are you asking for the same attributes that you would be able to give to a partner?
• Do you make a habit of putting yourself in the other person’s shoes when discussing how your actions may have
M02_DONA9396_07_SE_C02.indd 47 made that person feel or how that person may be feeling in general? 29/12/16 5:00 PM

• Do you take time to listen to your friends? Your parents? Your acquaintances? Your professors? Do you find
yourself thinking about your own problems, thoughts, or issues when someone is trying to tell you about his or
her problems?
• Do you reach out to friends who are having problems in their relationships?
• Are you supportive of couples having problems in their relationship without being judgmental or taking sides?
• Do you try to work through your problems with others, or do you run from, avoid, or get angry rather than try to
talk through your difficulties?
• Are you supportive of counselling services and other campus and community services that offer help for people
who have troubled relationships?
• Do you listen carefully to what your legislators propose in the way of family and individual policies and programs
that may unfairly harm others?

Is It Love or Infatuation?
in the early stages, love and infatuation can be very person better and come to appreciate him or her
similar. they both produce a characteristic rush more. With infatuation or a crush, you realize that

on
of excitement as well as a strong desire to have
more of the loved one’s time, energy, and physical
contact. the primary difference is that, with love,
the feelings grow deeper as you get to know the
Ms. or Mr. right was not all you had thought. taking
the following test may help you determine whether it
is the real thing or an infatuation. respond honestly
yes or no to the following statements.

focus (continued )

Diabetes
Chapter 7 C o m m i t t i n g t o R e l at i o n s h i p s a n d s e x u a l h e a lt h 217

M07_DONA9396_07_SE_C07.indd 217 29/12/16 5:33 PM

• Running Glossary of Key Terms: Key terms

Like many college and university students, as well as
most Canadian adults, Nora is overweight. She used
are boldfaced in the text and defined in the mar-
to think it was no big deal—after all, there are lots of
students like her and some are fatter! Nora planned
to eat better and be more physically active as soon as
gins on the page where they first appear.
she graduated and started to live “a normal life.” But
last week, her mom called and told Nora that she just
found out that she has type 2 diabetes. Her mother’s
• Discussion Questions: These questions encour-
voice sounded shaky as she told Nora about her own
mother’s death from kidney failure—a complication of
diabetes—at age 52, a few months before Nora was
age critical thinking about important concepts pre-
born. When Nora got off the phone, she searched
online for information about diabetes. What she dis-
covered made her feel scared, too; her Aboriginal eth-
sented from a variety of angles.
nicity, family history, high stress level and lack of sleep,
excessive weight, and sedentary lifestyle all increased
her own risk for diabetes.
• Focus On: After the last chapter of each part,
The next morning, Nora stopped off at the cam-
pus health centre and made an appointment for diabe-
tes screening. She was instructed to fast the night before
these three- to five-page features present in-depth
and was scheduled for an appointment first thing in
the morning. At her visit, the nurse practitioner took
a blood sample. A few days later, she called with the
information relevant to the topic(s) of the section,
news: Nora has prediabetes, and needs to make changes
to reduce her risk for developing type 2 diabetes like
her mom.
Ashley Cooper pics/Alamy
including spiritual health, body image, STIs, sleep,
diseases, each with its own mechanisms. Diabetes is
a serious, widespread, and costly chronic disease and
if left untreated results in numerous health problems, diabetes, and financial health.
including blindness, amputation, and kidney dysfunc-
diaBetes: inCidenCe tion, and ultimately, death.
Over the past 20 years, the number of Canadians
and mortalitY 12 years and older diagnosed with diabetes has more
than doubled. Current estimates (2012, the latest data
Diabetes mellitus is a disease characterized by a available) indicate that 6.5 percent of the Canadian
persistently high level of sugar—technically glucose— population has diabetes (Statistics Canada, 2013). At all
in the blood. Another characteristic sign is the pro- ages except for 20 to 34 years, males are more likely to
duction of an unusually high volume of glucose-laden be diagnosed with diabetes than females. Further, diag-
urine, a fact reflected in its name—diabetes is derived noses increase with age, with
from a Greek word meaning “to flow through,” and 8.6 percent of people between Diabetes mellitus a group of dis-
mellitus is the Latin word for “sweet.” The high blood the ages of 45 and 64 years and eases characterized by elevated
blood glucose levels.
glucose levels—or hyperglycemia—seen in diabetes 18.1 percent of all individuals
can lead to a variety of serious health problems and over the age of 65 years having Hyperglycemia elevated blood glu-
cose level.
even premature death. Diabetes is actually a group of a positive diagnosis.

Chapter 13 Controlling risk for infeCtious and noninfeCtious Conditions 411

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P R E FA C E xix

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 INSTRUCTOR SUPPLEMENTS
Designed to facilitate lecture preparation and learning, a comprehensive set of ancillary material accompanies
Health: The Basics, Seventh Canadian Edition. These instructor supplements are available for download from a
password-protected section of Pearson Canada’s online catalogue (http://www.pearsoncanada.ca/highered).
­
­Navigate to your book’s catalogue page to view a list of those supplements that are available. Speak to your local
Pearson sales representative for details and access.

Instructor’s Manual
This comprehensive manual, filled with material to enhance the course, includes chapter outlines; discussion ques-
tions; student activities including individual, community, and diverse population/nontraditional categories; and
additional references for further information.

Computerized Test Bank

Pearson’s computerized test banks allow instructors to filter and select questions to create quizzes, tests, or home-
work. Instructors can revise questions or add their own, and can choose print or online options. These questions
are also available in Microsoft Word format.

PowerPoint Slides
Every chapter features a Microsoft PowerPoint® slide deck that highlights, illuminates, and builds on key concepts
for lecture or online delivery. Educators can tailor each deck to their specifications.

Image Libraries
Image libraries help with the creation of vibrant lecture presentations. Most figures, tables, charts, photos, and Assess
Yourself features from the text are provided in electronic format, organized by chapter for convenience. These images
can be imported easily into Microsoft PowerPoint®.

Learning Solutions Managers

Pearson’s Learning Solutions Managers work with faculty and campus course designers to ensure that Pearson
technology products, assessment tools, and online course materials are tailored to meet your specific needs. This
highly qualified team is dedicated to helping schools take full advantage of a wide range of educational resources,
by assisting in the integration of a variety of instructional materials and media formats. Your local Pearson Canada
sales representative can provide you with more details on this service program.

MasteringHealth
MasteringHealth (www.masteringhealthandnutrition.com or www.pearsonmastering.com) is an online home-
work, tutorial, and assessment product designed to improve student performance. MasteringHealth coaches stu-
dents through the toughest health topics. A variety of Coaching Activities guide students through key health
concepts with interactive mini-lessons, complete with hints and wrong-answer feedback. Reading Quizzes ensure
students have completed the assigned reading before class. ABC News videos stimulate classroom discussions and
include multiple-choice questions with feedback for students. Assignable Behaviour Change Video Quiz and
Which Path Would You Take? activities ensure students complete and reflect on behaviour change and health
choices. NutriTools in the nutrition chapter allow students to combine and experiment with different food options
and learn firsthand how to build healthier meals. MP3 Tutor Sessions relate to chapter content and come with
multiple-choice questions that provide wrong-answer feedback. Learning Catalytics provides open-ended questions
students can answer in real time. MasteringHealth also includes the Behavior Change Log Book.

Pearson eText
The Pearson eText gives students access to their textbook anytime, anywhere. In addition to note taking, high-
lighting, and bookmarking, the Pearson eText offers interactive and sharing features. Instructors can share their
comments or highlights, and students can add their own, creating a tight community of learners within the class.

xx P R E FA C E

A01_DONA9396_07_SE_FM.indd 20 17/03/17 12:59 PM

 Student Supplements
The Study Area of MasteringHealth
The Study Area of MasteringHealth™ is organized by learning areas. Read It houses the Pearson eText as
well as the Chapter Objectives and up-to-date health news. See It includes ABC News videos and the Behaviour
Change videos. Hear It contains MP3 Tutor Session files and audio-based case studies. Do It contains the choose-
your-own-adventure-style Interactive Behaviour Change Activities—Which Path Would You Take?, interactive
NutriTools activities, critical-thinking Points of View questions, and Web links. Review It contains Practice Quiz-
zes for each chapter, Flashcards, and Glossary. Live It will help jump-start students’ behaviour change projects with
interactive Assess Yourself Worksheets and resources to plan change.

Acknowledgments
We thank the following people at Pearson Canada for their part in the seventh Canadian edition of Health: The
Basics: executive acquisitions editor Cathleen Sullivan; marketing manager Jordanna Caplan Luth; developmental
editor Toni Chahley; program manager Kamilah Reid-Burrell; production manager Andrea Falkenberg; senior
designer Anthony Leung; copy editor Ruth Chernia; and proofreader Cat Haggert. We gratefully acknowledge the
contribution of our technical reviewer Kerry-Anne Hogan of the University of Ottawa and Queen’s University.
We also thank the following reviewers whose helpful feedback helped shape this new edition:
Brant Bradley, St. Lawrence College David Harper, University of the Fraser Valley
Frank Christinck, Algonquin College Ken Kustiak, MacEwan University
Michelle Cundari, Canadore College Robin Laking, Georgian College
Tara Dinyer, Mohawk College Emilio Landolfi, University of the Fraser Valley
Shaun Ferguson, Confederation College Katherine McLeod, University of Regina
Pam Fitch, Algonquin College Robin Milhausen University of Guelph
Paula Fletcher, Wilfrid Laurier University Chris Perkins, Lambton College

And our thanks to the reviewers whose feedback helped shape the fifth and sixth Canadian editions:
Brenda Bruner, Queen’s University
Penny Deck, Simon Fraser University
Cathy Deyo, College of New Caledonia
Joe Ellis, Sir Sanford Fleming College
Celine Homsy, John Abbott College
Gareth R. Jones, University of British Columbia
Jennifer Kuk, York University
Emilio Landolfi, University of the Fraser Valley
Patty McCrodan, Camosun College
Linda McDevitt, Algonquin College
Mary McKenna, University of New Brunswick
Chris Perkins, Lambton College
Michelle Meuller, University of Alberta
Rick Muldoon, St. Clair College
Tien Nguyen, University of Ottawa
Noel Quinn, Sheridan College
Mandana Salijegheh, Simon Fraser University
Deanna Schick, Trinity Western University
Tammy Whitaker-Campbell, Brock University
Sanni Yaya, University of Ottawa

P R E FA C E xxi

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A01_LO5943_03_SE_FM.indd iv 04/12/15 4:22 PM

 Part  1 FINDING RHYTHM

CHAPTER 1
DISCOVERING YOUR
PERSONAL RHYTHM
FOR HEALTHY LIVING
Micromonkey/Fotolia

C onsider T his . . . L earning O utcomes

Jonah is a 22-year-old, fourth-year university student who engages in • Identify and define the seven
very little physical activity, eats a lot of fast food, and is 20 kilograms dimensions of health and
overweight. A sensitive, caring young man, he has many close friends and wellness.
volunteers at various agencies that help people in need. He enjoys
• Discuss the goals and objectives
nature and the inner peace he derives from sitting on the beach listen-
of the Pan-Canadian Healthy
ing to the rolling surf or a quiet night by a campfire in the wilderness.
Living Strategy.
He is a strong advocate for social justice and the preservation of the
environment. • List the lifestyle behaviours
related to living longer.
Camesha is a 19-year-old, first-year university student who lives off
campus. She tries to eat well most of the time, thinks she is fat, and • Compare and contrast
walks two to four kilometres per day. She is shy and has not made many behaviour-change techniques
friends since coming to university. During a typical day, she goes to that identify not only when,
class, studies, watches TV or a movie, texts with her high-school friends but how and why to change.
and family, and spends time on Facebook. She likes cycling and usually • Describe the role of decision
rides each weekend on her own. making in making behaviour
changes.

D
o you know people similar to either Jonah or Camesha? Who do
you think is healthier? Why? What factors might contribute to
their current attitudes and behaviours regarding their health?
What actions might you suggest to help them achieve a more balanced
“healthstyle” or one that is more in rhythm with what they are doing?

M01_DONA9396_07_SE_C01.indd 1 29/12/16 4:57 PM

 I f you and your close friends listed the most important
things in your lives, you might be surprised by what
the others have to say. Some would likely include
family, love, financial security, significant ­others, and
happiness. Others might list health. Raised on a steady
stream of clichés and slogans—“If you have your health,
you have everything,” “Be all that you can be,” “Use it
or lose it,” “Just do it!”—most of us readily acknowledge
that good health is desirable. However, many of us strug-
gle to define health, let alone good health. What does
it mean to be healthy? How do you ‘get’ healthy? How
can you maintain and enhance the positive attitudes
and behaviours you already have toward your health
and wellness? How can you change your not-so-good,
health-detracting attitudes and behaviours?
This text provides you with health information
consistent with making positive lifestyle decisions that
support who you are and what you want to be. You can
learn how to change your attitudes and behaviours to
not only reduce your risk for many physical and mental
health issues, but equally, or even more importantly, to
positively influence how you feel right now. For the
risk factors beyond your control, you can learn to react,
adapt, and make optimal use of the resources available
to you to create the best situation for you. Further, by
making informed, rational decisions, you will be able
to improve the quality—and quantity—of your life.
WHAT IS HEALTH?
Although we use the term health widely, few people
understand the broad scope of the word. For some,
health simply means the antithesis of sickness or to
be without disease. To others, it means being in good
physical shape or having the ability to resist disease and
illnesses. Still others include in the terms wellness or
well-being a wide array of factors that lead to positive
health status. Why all the definitions? Partly because
of the different perceptions of an increasingly enlight-
ened view of health that has evolved over time. As our
understanding of illness has improved, so has our ability
to understand the many nuances of health.
people, survivors were considered healthy and congratu-
lated themselves on their good fortune. In the late 1800s
and early 1900s, researchers discovered that the victims
of these epidemics were not simply people who were
unhealthy but rather victims of microorganisms found in
contaminated water, air, and human waste. Public health
officials moved swiftly to sanitize the environment, and,
as a result, many people began to think of health as good
hygiene. Practices such as sanitary disposal of wastes, hand
washing, and other behaviours that promoted hygiene
then became the harbingers of good health.
Health: More Than Not Being Sick
Once scientists learned about the microorganisms that
caused infectious diseases, dramatic changes occurred
in the sickness profile of the Canadian population.
In the early 1900s, the leading causes of death were
infectious diseases such as tuberculosis, pneumonia,
and influenza, and the average life expectancy at birth
was only 58.8 years for men and 60.6 years for women
(Statistics Canada, 1997). Improved sanitation brought
about remarkable changes in life expectancy, and the
development of vaccines and antibiotics added years to
the average life span. According to mortality (death
rate) statistics, people live longer now than at any other
time in our history. Further, morbidity (illness) rates
indicate that people are also sick less often from the
common infectious diseases that devastated previous
generations. Today, because most childhood diseases are
curable and multiple public health efforts are aimed at
reducing the spread of infectious diseases, many people
are living well into their 70s, 80s, and even 90s. The aver-
age Canadian child born between 2007 and 2009 (the
latest data available) has a life expectancy of 81.1 years—
78.8 years for men and 83.3 years for women (Statistics
Canada, 2012). There are approximately 5825 persons in
Canada over the age of 100 (Statistics Canada, 2011).
Also, the gender gap is slowly decreasing as men’s life

Health and Sickness:

Defined by Extremes
Before the late 1800s, people viewed health simply as the
absence of diseases. A person was healthy if he or she was
Imtmphoto/Fotolia

not suffering from a life-threatening infectious disease.

Mortality Death rate.
Morbidity Illness rate.
When deadly epidemics such
as bubonic plague, pneumonic
plague, influenza, tuberculosis,
and cholera killed millions of Good health refers to more than living long; it also means living well.

2 pa r t I FINDING RHYTHM

M01_DONA9396_07_SE_C01.indd 2 29/12/16 4:57 PM

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 PLATE XLV
FIG. 1

Lacrymal Fistula on the Right Side; Ectasia of the

Lacrymal Sac on the Left; Bilateral Epicanthus.
(Haab.)
FIG. 2
 Dacrocystitis. (Haab.)

THE CONJUNCTIVAL SAC.

The mucous membrane lining the conjunctival sac is perhaps the
most exposed to irritation and even infection of all mucous surfaces. It
is not strange then that conjunctivitis is the most common of all eye
affections. Whether irritated by constant exposure to dust and dirt, or
raw and cold winds, or by the heat of a blast furnace, by the dazzling
brilliancy of electric lights, or contact with bacteria, it displays a
surprising degree of accommodation and resistance. It has peculiar
susceptibilities, particularly to the germs of gonorrhea and diphtheria.
To these it is peculiarly sensitive, and under their influence it may
quickly succumb. The harm done in either of these conditions is by no
means limited to the conjunctiva, but may extend in such a way as to
eventually cause loss of vision.
Nowhere else may the phenomenon of hyperemia be so easily
studied as by watching the ocular conjunctiva for a few moments after
the occurrence of irritation. The rapidity with which the vessels dilate
and become visible, the occurrence of the consequent redness and
swelling, and the reflex phenomena attending it become appreciable
within a short time. In the chronic conditions the tissues become
thickened and less mobile. A chronic conjunctivitis is the constant
condition in certain laborers whose eyes are exposed in their
occupation.
A peculiar granulomatous condition of the conjunctiva, especially
the palpebral, is that known as trachoma, which appears to be due to
a specific form of infection that leads to exudation, organization and
thickening, intensified in punctate areas, and giving the surface the
appearance of an ordinary granulation. This condition has assumed
such importance as to be sufficient for the exclusion of aliens and
immigrants.
The milder conditions of acute or subacute conjunctivitis subside
under cold applications and mild antiseptic and astringent eye-washes
or collyria. These should be frequently instilled, beneath the lid
whenever this area is involved as a complication of injuries to the
head or face. In acute cases of the infectious type, such as the
gonorrheal or diphtheritic, atropine should be used locally, so that the
iris may be drawn out of harm’s way and the pupil left free should
resolution and recovery ensue. Individuals suffering from either
gonorrhea or diphtheria should be cautioned and protected from
possibility of conjunctival infection. The eyes of the newborn are not
infrequently infected during the process of parturition. The parturient
canal of women suspected of having an infectious lesion of this kind
should be cleansed before the passage of the fetal head, and in all
suspicious cases instant and constant attention should be given to the
eyes of the newborn infant.

THE LACRYMAL TRACT.

The lacrymal gland, though situated in the anterior and upper part of
the orbit, and beneath the upper lid, where it is ordinarily well
protected, is nevertheless liable to both acute infections and chronic
irritations. When acutely inflamed it usually goes on to abscess
formation. We have then acute dacryo-adenitis, which will produce the
ordinary symptoms of phlegmon, with the added ocular features of
vascularity and chemosis of the conjunctiva and more or less edema
and immobility of the upper lid. Displacement of the eyeball may be
produced by great inflammatory swelling. These abscesses tend to
discharge either through the skin near the external angle or
sometimes through the conjunctiva. While in the former case a scar
results, it nevertheless is a preferable point either for spontaneous
opening or for incision. If the case be seen in time it will be advisable
to make this incision early and so limit destruction. (See Plate XLV,
Fig. 1.)
The lacrymal gland suffers occasionally in instances of
constitutional syphilis, undergoing chronic and obstinate enlargement.
It may also be the site of tumors either non-malignant, usually
adenoma, or cancerous, most instances of the latter being
expressions of extension.
The tear passages proper are composed of the canaliculi, the
lacrymal sac, and the duct. These are altered, occasionally, in their
relations, or absent, as the result of congenital defects. The passages
proper frequently become obstructed, as the result of any chronic
irritation which produces thickening of the conjunctiva, and in many
laborers and others who are exposed to dust, dirt, or cold winds there
will be a more or less constant stillicidium or overflow of tears. In some
of these cases it is sufficient to slit up one or both canaliculi with a fine
probe-pointed bistoury.

DACRYOCYSTITIS.
The lacrymal sac proper is frequently the site of both acute and
chronic disease, known as dacryocystitis, which is the result of
infection spreading from the conjunctival sac, rarely from the nose, or
the exaggeration of conjunctival thickenings, like those mentioned
above. The first symptoms are overflow of tears, accompanied by
swelling or enlargement in the region of the sac. By pressure upon this
a mixture of water, mucus, and sometimes pus may be expressed. As
the disease goes on the fluid becomes purulent. If the sac, by
pressure, can be emptied into the nose the nasal duct may be
regarded as patulous and the treatment is simplified. If not there is
stricture, usually at the upper end of the duct, which requires division
and dilatation. The more chronic forms of trouble in this region are
frequently intensified into acute phlegmonous lesions which, if
neglected, will lead to spontaneous perforation and the formation of a
lacrymal fistula at a point below the inner angle of the eye. (See Plate
XLV, Fig. 2.)
Treatment.—The treatment should consist of exposure of the sac
by incision of the canaliculi and its irrigation by means of
a syringe and antiseptic fluid. Unless this fluid passes easily into the
nose the stricture should be divided and Bowman’s probes passed,
the principle of treatment being the same as that in treating urethral
stricture. This part of the treatment should be referred to an oculist.
In acute dacryocystitis with suppuration the sac along the natural
passages should be opened. When a diagnosis of an acute lesion of
this kind is made nothing but the most radical treatment is advisable.

THE LIDS.
 Congenital deformities of mild degree are not infrequent about the
eyelids.

EPICANTHIS.
Epicanthis is a term implying folds of redundant skin extending from
the internal end of each eyebrow to the inner canthus and over the
lacrymal sac. It varies much in degree, is a more or less hereditary
feature in certain families, and is not infrequently associated with other
defects. The palpebral fissure varies in length in different individuals,
giving a longer or shorter window through which the eye proper shall
appear. Sometimes the fissure is much too short and requires division
or extension, which is easily made by incision at the outer angle.

COLOBOMA.
Coloboma is a term applied to various lesions of the eyelid, the iris,
and the choroid, implying a defect in structure, which, in the eyelid,
leaves a V-shaped deficiency, corresponding to harelip, whose edges
may be brought together by a simple operation.

STYE; HORDEOLUM.
The eyelids are subject to certain painful or disfiguring lesions,
which frequently come under the notice of the general surgeon. Of
these the most common is stye, or hordeolum. This is a phlegmon of
one of the minute glands along the margin of the lid, which has
become infected and violently reacted. It forms a miniature furuncle,
often associated with conjunctivitis, and giving a disproportionate
reaction. So soon as the presence of pus can be detected a puncture
should be made and the contained drop of pus exvacuated.
Threatening suppuration may sometimes be aborted by local use of 1
or 2 per cent. mercurial (yellow) oxide ointment.

CHALAZION.
A somewhat similar but non-inflammatory cystic distention of one of
the Meibomian glands, which pursues a slow and painless course, is
called chalazion. It presents rather beneath the mucous surface, but is
often visible through the skin. Its contents are mucoid or dermoid.
When it attains troublesome dimensions it should be exposed through
a small incision, usually external, and thoroughly extirpated.

XANTHELASMA.
Small, elevated areas of dirty-yellow color are met with in the skin
about the eyelids, more often near the inner angle. Such a lesion is
called xanthelasma, the lesion being a fatty metamorphosis of a
portion of the skin structure. While harmless, it is amenable to excision
for cosmetic effect.
Any of the ordinary tumors which affect similar tissues elsewhere
may be seen about the eyelids. The more common are the vascular
tumors, especially small nevi. Epithelioma occasionally commences
along the palpebral margin, but is more often an extension from
neighboring tissues.

BLEPHARITIS.
The margins of the lids are frequently involved in a mildly infectious
inflammatory condition called blepharitis, in which nearly all the
structures participate; when the borders alone are involved it is
referred to as blepharitis marginalis. The condition is largely due to
dirt, and to irritation in which the Meibomian ducts seem to share. It is
accompanied by chronic conjunctivitis. The condition is seen more
often in the ill-nourished, the rickety, and the tuberculous. The best
local treatment consists in the use of an ointment of yellow oxide or
yellow sulphate of mercury. The former may be used in 2 per cent.
strength, and the latter not stronger than 1 per cent. This should be
applied along the lid margins at night, and thoroughly rubbed in. A
commencing phlegmon and stye may be aborted by one of these
preparations.

TRICHIASIS.
Another very annoying complication, and usually the sequel of the
condition already mentioned, is trichiasis, or turning inward of the
eyelashes. Chronic irritation and cicatricial contraction on the inner
aspect of the eyelids, or a chronic blepharospasm, which may be the
result of corneal infections, serve to draw the lids inward, especially
with the margins of the hair follicles, so that the eye-winkers grow
toward the ocular surfaces, which they constantly irritate. The result is
a vicious circle, each morbid condition intensifying the other. In time
there is produced a condition of entropion, which is to be remedied
only by operation. It is not sufficient to treat trichiasis by epilation, as
the hairs will grow again and continuously cause trouble. The cause
should be removed and the effect treated.

ENTROPION.
By this term is meant a condition of inversion of the margin of one or
both lids, by which the external surface is brought into actual contact
with the surface of the eyeball. It is a chronic condition brought about
through the action of several contributing causes. Any condition of the
cornea or deeper portion of the eye which leads to photophobia and
spasmodic closure of the eyelids will produce in time hypertrophy of
the orbicularis, with corresponding strengthening of the muscle and
exaggeration of its activity. Chronic blepharospasm will thus in time
lead to a mild degree of entropion, while any affection of the inner
palpebral surfaces which leads to cicatricial contraction will still more
intensify it. So soon as trichiasis or irritation by the eyelashes is added
to what has gone before, every feature is exaggerated and the cornea
is made to lie practically in contact with the skin surface of the eyelid.
A further consequence is corneal disease, often with ulceration and
opacity, with even worse structural changes.
The condition is really a serious one and is to be treated not alone
by operation upon the lid, but care should be given to all the
contributing features. So far as the lid condition alone is concerned, I
have found the operation suggested by Hotz the most satisfactory of
any, at least in average cases. An incision is made from one end of
the lid to the other, along the distal border of the tarsal cartilage, and
down to it. Through this a bundle of those orbicularis fibers which run
parallel with the incision is dissected away. In extreme cases the tarsal
cartilage, which is incurved as the result of the old condition, may be
either incised or a strip excised from its structure. Sutures are then
inserted which include not only the borders of the skin incision, but the
exposed border of the tarsus and the tarsoörbital fascia. By applying
the central suture first, and then one on either side, it will usually be
found that as the sutures are tightened the edge of the lid is drawn
outward and the desired effect obtained.
The large number of operative methods which have been suggested
for the cure of entropion bespeak the variety of causes which may
produce it and the many devices to which different ingenious
ophthalmic surgeons have resorted.
Fig. 390
ECTROPION.
This condition is the
reverse of entropion,
and implies eversion of
the margin, or of a
considerable portion of
a lid, with consequent
exposure of its
conjunctival surface,
which undergoes
changes in
consequence of which
it becomes thickened,
contracted, and
irritated. Ectropion may
possibly be produced
by violent orbicular
Arlt’s operation for ectropion. (Arlt.)
spasm, especially in
children, the lids being
so tightly shut as to be everted. Ordinarily it is the result of external
lesions which produce cicatricial contraction, like burns, or of chronic
ulcerative lesions along the palpebral border, such as are met with in
tuberculous and syphilitic disease. The lower lid is much more
frequently involved than the upper.
For the relief of ectropion plastic operations are practised, usually
on the lower lid. The milder cases require a V-shaped incision, its
apex downward, with free dissection of the integument up or near to
the margin of the lid, by which it is released from the scar tissue which
has bound it down. Fig. 390 illustrates the general principle of such an
operation. The lower portion of the V-shaped defect is then brought
together with sutures, the triangular flap being fastened in a position
much higher than that in which it originally rested.
All of these operations upon the eyelids are included under the term
blepharoplasty, of which the above is the most simple. When
necessary new flaps may be raised from the temporal region, from the
forehead or from the cheek, as may be required, and turned into
place, their pedicles being so planned as to carry a sufficient blood
supply for nourishment of the same. If this supply be properly provided
these operations are practically always successful. It is necessary only
to make the transplanted flap at least one-third larger than appears to
be necessary, judging from mere size of the defect, for experience
shows the necessity of allowing at least one-third for primary and
cicatricial shrinkage. A heteroplastic operation is occasionally
performed for this purpose, by which the flap of skin is detached from
an entirely different part of the body, or from the body of another
individual. Skin thus transplanted should be prepared by removal of all
of the fat upon its raw surfaces, skin alone being desired and not other
tissue. Figs. 391, 392, 393 and 394 illustrate blepharoplastic
operations of various types, which may be modified or made more
extensive. These are but a few of the various plastic devices, and are
intended to serve merely as suggestions or examples rather than
methods to which one is limited.
 Fig. 391

Richet’s operation for ectropion. (Arlt.)

Fig. 392

Fricke’s method of blepharoplasty. (Arlt.)

 Fig. 393 Fig. 394

Dieffenbach’s method of blepharoplasty. Arlt’s method when a portion of the eyelid

(Arlt.) is to be sacrificed. (Arlt.)

INJURIES OF THE EYEBALL AND ADNEXA IN GENERAL.

This topic has already been considered. It seems advisable,
however, to summarize some of the results of such injuries in order to
call attention to their dangers and methods of treatment. Burns of the
orbital regions, for instance, are liable to cause not only opacity of the
cornea following ulceration, but adhesions between the conjunctival
surfaces and the palpebral margins. The term symblepharon is
applied to those lesions where the lids are more or less fixed upon the
globe and their motility partly or completely impaired. When the edges
alone of the lids have grown together the condition is known as
ankyloblepharon. Both of these conditions are the result of adhesion
of granulating surfaces and of cicatricial contraction, and should be
avoided.
By a concussion of the orbital region, and especially of the eyeball,
all sorts of injuries may be inflicted, from those involving the cornea to
deep lesions which leave little or no superficial evidences, but cause
partial or complete blindness. Detachment of the retina, for instance,
is one of the possibilities of such conditions. Intra-ocular hemorrhages
or dislocation of the lens, with traumatic cataract, may also occur.
The sclerotic may be ruptured with or without the presence of a
foreign body, in which case the contents of the eye may have partially
or completely escaped. An eye which has collapsed from these
causes offers an almost hopeless field for the general or special
surgeon, and little can be done, save possibly for cosmetic purposes.
There is danger of sympathetic ophthalmia, and it may be a question
whether evisceration, i. e., completion of the evacuation, may not be
the wiser course.
Perforating wounds, even when inflicted by minute bodies, have
dangers of their own, including the possibilities of infection. The
interior mechanism of the eye is so easily disturbed, and its
transparent media so easily clouded, by the results of accident or
hemorrhage, that even apparently trivial injuries may be followed by
disturbances of vision.
Treatment.—The general principles of treatment of all such injuries
should include, first, the removal of every detectable
foreign body, followed by the application of cold, and the use of
antiseptic eye-washes, which, however, must not be used too strong
lest they irritate. Saturated boric-acid solution is perhaps as strong as
anything which is permitted, while even this may occasionally require
dilution. In addition to this the use of atropine solution is always
indicated. It has the double effect of soothing and allaying pain and of
dilating the iris into a narrow ring. With such measures as these it may
be possible to save vision; at all events it will limit reaction and prevent
harm.

DISTURBANCES OF INNERVATION.
The nerves which supply the eye and its adnexa may undergo
injury, either within the orbit or within the cranium, or in their course
from one to the other. The paralyses may be caused by syphilis, by
intracranial tumors, or by injury. A careful study of the areas and
nerves involved will sometimes lend considerable help in diagnosis,
both in traumatic and pathological cases. Thus diplopia, or double
vision, may be caused by paralysis of the external rectus on one side,
by which its antagonistic internal rectus is permitted to swerve the eye
too much to the inner side and away from the normal axis of vision
required for single sight. When there is complete paralysis of the third
nerve there may be drooping of the eyelid, called ptosis, with impaired
motion of the eye, upward, inward, or downward. The eye will roll
outward because the external rectus is supplied by the sixth nerve.
There will also be dilatation of the pupil, with loss of accommodation.
When the upper lid is raised there is also double vision. This third-
nerve paralysis, however, is not always complete, and diplopia may
result only when the eye is directed in a certain way. When the sixth
nerve is paralyzed the eye is rolled inward, and again there is diplopia.
When the fourth nerve is paralyzed the eye is but slightly displaced
upward and inward. When the sympathetic nerve is involved there will
be protrusion of the globe with dilatation of the pupil. This will be
accompanied by flushing of the face.

MUSCULAR AND ACCOMMODATIVE DEFECTS.

Detection of errors of accommodation is practically a specialty
within a specialty, while the various forms of strabismus, or deviation
of the eyes from their normal axes, depend largely upon regulation of
accommodative errors.

REGION OF THE EXTERNAL AND MIDDLE EAR.

The region of the ear is subject to congenital malformations,
deviations, and defects, which include anomalous shapes of the
auricle, malpositions of the organ, defects in the cartilaginous
structure with resulting deformity, and congenital excesses or
redundancies by which there are made to appear supernumerary
auricles or portions thereof. These latter have been described by
Sutton and treated in his work on Comparative Pathology. They bear
relation as well to the branchial clefts, and are of great interest from a
phylogenetic point of view. Some of these defects result from absolute
arrest or excess of development, others from injury during intra-uterine
life; some are accentuated by lack of care during the early months of
infancy. The most common deformity of the ear is that by which it is
made unduly prominent and deflected outward or forward, the
cartilage being thick and abnormally curved. Such overlapping or
overprominent ears can be made to assume their proper position on
the side of the head by the excision of an elliptical piece, either of skin
or of skin and cartilage, at the point of junction of the ear and the
scalp. The amount to be removed should be proportionate to the
desired effect. The parts may be brought together by sutures, and the
auricle should then be bound upon the head.
Fig. 395 illustrates a common form of defect, inherently of the
cartilage and of the overlying skin. This is but one illustration of many,
two cases being rarely found exactly alike. Not infrequently these
arrests of development include the structures of the middle ear as
well. The auditory meatus may be entirely covered and concealed, or
may be absent, having failed to develop.
 Fig. 395

Developmental defect of external ear. (Broome.)

Supernumerary auricles are usually found as small tags of skin and

cartilage in front of or below the ear. They are easily removed and
leave no disfiguring scar.
The external ear is also exposed to injury, which it frequently
receives in the way of contusions and lacerations. It is occasionally
detached. The ordinary wounds of these parts require only the
conventional treatment, while it may be possible, by replacement and
approximation of a completely detached portion, to see it re-adhere.
This happened to the writer after his horse had completely bitten a
piece out of the ear of his groom. Here, as with detached finger-tips,
cleanliness is necessary, and the parts must be kept warm and
protected after dressing. The cartilage of the ear is covered by a
perichondrium which corresponds to the periosteum. Beneath it, or
beneath the skin alone, blood may be extravasated as the result of
contusions. When such collections fail to promptly resorb they should
be incised and the contained blood released. Such lesions are
referred to as traumatic othematomas.
A peculiar lesion of this general character occurs occasionally in the
insane. If due to injury the latter is but trifling. It makes a conspicuous
tumor, involving usually the lower end of the auricle, and is known as
the othematoma of the insane. It is scarcely amenable to surgery, nor
does it often need it, but it constitutes a disfigurement which is not
only easily apparent, but diagnostic as to the cerebral or mental
condition.
The ear is the site of many neoplasms, both innocent and
malignant. Small papillomas are common, while fibrous tumors are
likely to develop, especially about the fibrocartilaginous lower end of
the auricle, where the ear has been pierced for ear-rings. Keloid
tumors, of still more conspicuously fibrous nature, are common about
the ear, especially among negroes. All innocent tumors may be
excised, through incisions which should be so planned as to leave a
minimum of disfigurement. (See Fig. 397.)
Of the malignant tumors epithelioma is perhaps the most frequent. It
pursues a course here similar to that which characterizes it elsewhere,
save that the dense structures of the cartilaginous ear yield but slowly
to its encroachment. The form known as “rodent ulcer” is slower here
than elsewhere. Fig. 396 illustrates a case under the writer’s care,
showing complete destruction of the external ear by a growth of this
kind, which had attained a degree and extent that did not permit of
successful treatment, and which eventually proved fatal. When
growths of this character have not progressed too far they should be
radically removed, the question of cosmetic effect being secondary to
that of their eradication. By a well-planned plastic operation much can
be done to atone for disfigurement resulting from radical operation.

Fig. 396 Fig. 397

Complete destruction of auricle by rodent Congenital lymphangioma of ear. (Lexer.)

ulcer. (Buffalo Clinic.)

FOREIGN BODIES IN THE EAR.

All sorts and descriptions of foreign bodies may enter the ear.
Young children have a tendency to introduce all kinds of bodies into
the ear, as into the nose, and sometimes intrude them to such a
distance that their removal is made difficult. Living insects make their
way into the meatus auditorius and even deposit their larvæ, which
may subsequently go through their developmental phases and fill the
passage-way with young insects. Among the inanimate materials
which children introduce are small buttons, pebbles, beans, peas,
beads, etc. Such a foreign body may not be at once discovered, and
some of those which easily undergo decomposition, like fresh
vegetable substances, may not be detected until they have set up
trouble by decomposition. Therefore it may be hours or days before its
presence is recognized. Sometimes it may be easily seen, again it
may be concealed. When the auricle is drawn upward and backward
the external meatus is somewhat straightened, and bodies within it are
more easily made visible, especially by reflected light. Therefore the
head mirror is usually required for their detection and removal. The
substance may be one which is easily seized and withdrawn, after
certain turning or shifting motions have been attempted, or it may be
impacted so as to offer considerable difficulties. It should never be
pushed farther in, for injury might thus be done to the membrana
tympani, and the effort should be to remove it with the least possible
damage to the lining of the canal. So essential is it to have the head
kept perfectly still during these maneuvers that it will be advisable,
with young children, to administer an anesthetic. Instances
occasionally occur which necessitate incision and liberation of the
auricle, with its deflection forward, and the consequent more complete
exposure of the auditory canal. Forceps of various fashions may be
used, or occasionally a blunt hook may be made with a probe, which
may be used to advantage.
Of living foreign bodies information can be obtained more promptly,
as the annoyance caused by their movements will at once disturb the
patient.
Relief has often been promptly afforded by filling the meatus with
water or glycerin as warm as can be borne, by which the insect is
killed, after which it may be removed by irrigation or by forceps,
assisted by good illumination.
That which is essentially a foreign body may be produced by an
accumulation of cerumen in wax-like form within the auditory canal.
Neglectful patients sometimes allow this to accumulate until it
constitutes not only a source of irritation but an obstacle to hearing. Its
removal is not ordinarily accompanied by difficulty, but requires
patience and often considerable effort, not only with instruments, but
with irrigation, especially with an alkaline solution, by which the waxy
substance is softened.
A phenomenon noted in many of these cases, where
instrumentation has to be practised within the vicinity of the middle
ear, is coughing or sneezing, sometimes to a degree which interferes
with the work to be done. This is a reflex to be explained through
connection with the pneumogastric nerve.

THE EXTERNAL AUDITORY CANAL.

In the fibrocartilaginous as well as in the more richly cellular portions
of this passage-way small phlegmonous processes frequently occur.
They give rise to an amount of suffering, and even of sympathetic
reaction, disproportionate to the extent of the difficulty. They are called
furuncles, or boils, sometimes occurring singly, often in groups. A
commencing process of this kind may be cut short by the use of an
ointment of 1 to 2 per cent. yellow sulphate of mercury, but after the
furuncle is well developed it is best treated by free incision, which can
be made with the freezing spray, and without much pain to the patient.
More extensive phlegmonous destruction, assuming even
carbuncular form, is occasionally met with in this region. There will be
more or less necrosis of tissue in such cases, which will require
removal, usually with the sharp spoon. These cases are not without
their danger, since the veins connect so freely with the interior of the
cranium.
Hyperostosis and exostosis produce either a narrowing of the
auditory canal or its complete obstruction, and sometimes even the
formation of an osseous tumor of considerable size. A thickening and
even new formation of bone may be the result of the chronic irritative
processes which frequently occur in the middle ear, but many of these
conditions occur in the newborn, in whom they are to be regarded as
congenital excesses and in whom they frequently cause permanent
impairment or loss of hearing. Some of the osteomas in this region are
of bone-like hardness, their density being sufficient to dull or even to
break the finest tempered steel instruments.
A small exostosis may be removed with the ordinary instruments of
the surgeon or the dental engine, but the larger and more dense
growths offer formidable difficulties for the operator and uncertain
results for the patient. When growths of this kind attain considerable
size they should not be attacked through the natural passages, but the
auricle should be separated and pushed forward and the auditory
canal opened.
 THE MIDDLE EAR.
The middle ear has for its external boundary the membrana
tympani, which, for clinical purposes, constitutes a limit beyond which
the general surgeon should not trespass, the structures within being
those within the field of the aural surgeon. Nevertheless the student of
surgery should realize that the membrane of the drum may be
ruptured in consequence of a blow upon the external ear, or perhaps
by the sudden condensation of air produced by explosions, etc. It may,
moreover, be lacerated in consequence of various injuries to the head,
basal fractures, etc., even those involving the opposite side of the
head; it may also be injured by foreign bodies, introduced usually from
without and through the canal. While this membrane has normally an
opening by which air pressure is equalized on either side, this seems
to play but a small part in the liability to or exemption from injury such
as just described. The membrane has its own blood supply, which can
become congested to a degree permitting considerable escape of
blood after laceration. It does not follow that bleeding from the ear is
necessarily an indication of basal fracture, after injuries of the head,
unless the hemorrhage is continuous and considerable, in which case
it may be stated that the injury must be deeper and more extensive
than one of the membrane alone. If, however, cerebrospinal fluid can
be detected as escaping with and diluting the blood, or escaping
independently, then the diagnosis of basal fracture may be regarded
as certain.
After such injuries as lead to hemorrhages from the ear the external
auditory canal, should be irrigated and protected against infection by
light tamponing, etc.
It is the writer’s opinion that the general surgeon should abstain
from operative intervention in the ordinary diseases of the middle ear,
save in the presence of symptoms which accompany mastoiditis,
acute infections of the sinuses, or even of the brain itself. When it
comes to an extensive operation, such as is often required in such
instances, including not merely opening of the mastoid antrum and
cells, but exposing the dura and judging of the condition of the sinus,
with perhaps the simultaneous ligation of the jugular in the neck and
washing out of the intervening portion, then these are measures
requiring such surgical judgment and operative skill that it would seem