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Human Diseases
Sixth Edition Marianne Neighbors, EdD, RN
Ruth Tannehill-Jones, MS, RN
Australia ● Brazil ● Canada ● Mexico • S i n g a p o r e ● United Kingdom ● United States
Copyright 2023 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s).
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some third party content may be suppressed. Editorial review has deemed that any suppressed
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Important Notice: Media content referenced within the product description or the product
text may not be available in the eBook version.
Human Diseases, Sixth Edition Last three editions, as applicable: © 2023, © 2015, © 2010
Marianne Neighbors and Copyright © 2023 Cengage Learning, Inc. ALL RIGHTS RESERVED. WCN: 02-300
Ruth Tannehill-Jones
No part of this work covered by the copyright herein may be reproduced
or distributed in any form or by any means, except as permitted by U.S.
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Notice to the Reader

Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection
with any of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation to obtain
and include information other than that provided to it by the manufacturer. The reader is expressly warned to consider and adopt
all safety precautions that might be indicated by the activities described herein and to avoid all potential hazards. By following
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Printed in the United States of America

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

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

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

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

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

Pneumothorax and Hemothorax 193 Intestinal Polyps 234
Suffocation 193 Effects of Aging on the System 234
Rare Diseases 195 Summary 235
Pneumoconioses 195 Review Questions 235
Fungal Diseases 195 Case Studies 237
Legionnaires’ Disease 195
Effects of Aging on the System 196
CHAPTER 12
Summary 196
Review Questions 196 Liver, Gallbladder, and Pancreatic
Case Studies 197 Diseases and Disorders 239
CHAPTER 10 Common Signs and Symptoms 241
Lymphatic System Diseases
Common Diseases of the Accessory
and Disorders 199 Organs of Digestion 241
Anatomy and Physiology 200 Liver Diseases 241
Common Signs and Symptoms 201 Other Diseases of the Liver 244
Diagnostic Tests 201 Gallbladder Diseases 250
Pancreatic Diseases 252
Common Diseases of the Lymphatic System 201 Rare Diseases 253
Lymphoma 204
Primary Biliary Cirrhosis 253
Mononucleosis 204
Gilbert’s Syndrome 253
Rare Diseases 204 Hemochromatosis 253
Kawasaki Disease 204 Effects of Aging on the System 253
Effects of Aging on the System 204 Summary 253
Summary 204 Review Questions 254
Review Questions 205 Case Studies 255
Case Studies 205
CHAPTER 13
CHAPTER 11
Urinary System Diseases and Disorders 257
Digestive System Diseases Anatomy and Physiology 258
and Disorders 207 Common Signs and Symptoms 258
Anatomy and Physiology 208 Diagnostic Tests 259
Common Signs and Symptoms 209 Common Diseases of the Urinary System 260
Diagnostic Tests 210 Urethritis 264
Common Diseases of the Digestive System 213 Cystitis 264
Pyelitis 264
Diseases of the Mouth 213
Pyelonephritis 264
Diseases of the Throat and Esophagus 215
Diseases of the Kidney 265
Diseases of the Stomach 219
Diseases of the Bladder 272
Diseases of the Small Intestine 222
Diseases of the Colon 225 Trauma 275
Diseases of the Rectum 233 Straddle Injuries 275
Trauma 234 Rare Diseases 276
Trauma to the Mouth 234 Goodpasture Syndrome 276
Trauma to the Stomach and Intestines 234 Interstitial Cystitis 276
Rare Diseases 234 Effects of Aging on the System 276
Achalasia 234 Summary 277
Contents ix
Review Questions 277 Effects of Aging on the System 332

Case Studies 278 Summary 332
Review Questions 333
CHAPTER 14 Case Studies 334
Endocrine System Diseases
CHAPTER 16
and Disorders 279
Anatomy and Physiology 280 Eye and Ear Diseases and Disorders 335
Common Signs and Symptoms 282 Anatomy and Physiology 336
Diagnostic Tests 283 Eye 336
Common Diseases of the Endocrine System 284 Ear 337
Pituitary Gland Diseases 284 Common Signs and Symptoms 338
Thyroid Gland Diseases 286 Diagnostic Tests 338
Parathyroid Gland Diseases 289 Diagnostic Tests of the Eye 338
Adrenal Gland Diseases 290 Diagnostic Tests of the Ear 339
Hyperadrenalism 290 Common Diseases of the Eye 340
Other Diseases of the Adrenal Glands 292 Inflammation and Infection 344
Pancreatic Islets of Langerhans Diseases 292 Common Diseases of the Ear 350
Reproductive Gland Diseases 298
Infection 350
Trauma 299 Serous 350
Rare Diseases 299 Suppurative 350
Effects of Aging on the System 299 Deafness 354
Summary 299 Trauma 357
Review Questions 300 Rare Diseases 359
Case Studies 302 Retinoblastoma 359
Ménière’s Disease 359
Otitis Interna 359
CHAPTER 15 Effects of Aging on the System 359
Nervous System Diseases Summary 360
and Disorders 303 Review Questions 361
Case Studies 362
The Central Nervous System 304
The Peripheral Nervous System 305 CHAPTER 17
Common Signs and Symptoms 306
Reproductive System Diseases
and Disorders 363
Common Diseases of the
Nervous System 309 Anatomy and Physiology 364
Infectious Diseases 309 Female Anatomy and Physiology 364
Vascular Disorders 312 Male Anatomy and Physiology 365
Functional Disorders 315 Common Signs And Symptoms 366
Dementias 320 Diagnostic Tests 366
Sleep Disorders 324 Common Diseases of The
Tumors 325 Reproductive System 369
Trauma 326 Female Reproductive System Diseases 369
Rare Diseases 330 Other Female Reproductive
Amyotrophic Lateral Sclerosis 330 System Diseases and Disorders 374
Guillain–Barré Syndrome 330 Diseases of the Breast 381
Huntington’s Disease 330 Disorders of Pregnancy 384
Multiple Sclerosis 332 Male Reproductive System Diseases 387
x Contents
Sexually Transmitted Diseases 392

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

Digestive Diseases 490 Inhalants 512
Anabolic Steroids 512
Fluid Imbalances 490
Organic Mental Disorders 512
Food Allergies 490
Psychosis 514
Eating Disorders 490
Mood or Affective Disorders 516
Cardiovascular Diseases 491 Dissociative Disorders 518
Musculoskeletal Diseases 491 Anxiety Disorders 519
Blood Diseases 492 Somatoform Disorders 520
Neurologic Diseases 493 Personality Disorders 521
Gender Dysphoria 522
Eye and Ear Diseases 494 Sleep Disorders 523
Strabismus 494 Trauma 524
Trauma 494 Grief 524
Child Abuse 494 Suicide 524
Suicide 495 Rare Diseases 524
Drug Abuse 495
Poisoning 495 Mental Health Disorders in the Older Adult 524
Summary 498 Summary 525
Review Questions 498 Review Questions 525
Case Studies 500 Case Studies 527
CHAPTER 21 Appendix A:
References 529
Mental Health Diseases and Disorders 501
Common Signs and Symptoms 502 Appendix B:
Diagnostic Tests 502 Common Laboratory Values 537
Common Mental Health Diseases and Disorders 502
Developmental Mental Health Disorders 502 Appendix C:
Substance-Related Mental Disorders 506 Metric Conversion Tables 539
Methamphetamine Abuse 509
Caffeine and Nicotine Abuse 509
Sedatives or Depressants Abuse 510 Glossary 541
Amphetamine Abuse 510
Hallucinogen Abuse 510 Index 557
List of Tables
CHAPTER 1 CHAPTER 6
1–1 Types of Pathologists 4 6–1 Classification of Joints by Movement 89
1–2 xamples of Acute and Chronic Diseases/
E 6–2 Risk Factors for Osteoporosis 95
Disorders 5 6–3 Risk Factors for Osteoarthritis 97
1–3 Examples of Common Diagnostic Tests and
Procedures 8 CHAPTER 7
7–1 RBC Blood Donor and Recipient Chart 121
CHAPTER 2
7–2 Blood Cell Abnormalities and Associated
2–1 Classification of Hereditary Disease with Symptoms 122
Examples 14
7–3 CBC Normal Values 123
2–2 Examples of Neoplasms or Tumors 16
CHAPTER 13
CHAPTER 3
13–1 Urinalysis Values 259
3–1 Neoplasm vs. Nonneoplasm 26
3–2 Origins and Names for Benign and CHAPTER 14
Malignant Neoplasms 28 14–1 The Endocrine Glands: Their Hormones
3–3 Comparison of Benign and Malignant and Hormone Functions 281
Neoplasms 29 14–2 Emergency Treatment of Diabetic Coma or
3–4 Comparison of Carcinomas and Sarcomas 32 Insulin Shock 296
3–5 L ifetime Risk of Being Diagnosed with
Cancer—Both Sexes, All Races 37 CHAPTER 15
3–6 L ifetime Risk of Dying from Cancer—Both 15–1 The Cranial Nerves 306
Sexes, All Races 37
CHAPTER 21
CHAPTER 4 21–1 Genetic and Acquired Causes of Intellectual
4–1 ome of the Leading Causes of Death
S Disability 503
in the World Due to Infections 53 21–2 Physical Causes of Dementia and Delirium 514
4–2 Some Common Infections Caused by 21–3 Phobias 520
Microorganisms in Humans 53
21–4 Dr. Elisabeth Kübler-Ross’s Five Stages
of Grief/Death and Dying 524
CHAPTER 5
5–1 Types and Functions of Leukocytes 64
5–2 Types of Immunity 65
xii
Preface
A
llied health professionals are required to be and physiology before introducing the most common
knowledgeable about the common diseases and diseases related to each system and specialty area.
disorders health care providers see and treat. As Common diseases and disorders for each body system
the medical field continues to grow and change and new are presented consistently through a description of the
diseases emerge, the need for these careers will continue disease or disorder, the etiology, symptoms, diagnosis,
to expand. This book includes the most current research treatment, and prevention.
and reflects the latest practices from actual practice. Simulated real-world activities provide learn-
ers with hands-on experience applying key concepts
Conceptual Approach learned in the chapters into practice.
Several dilemmas immediately emerge when one
Many pathophysiology books have been written considers writing a textbook for such a large and diverse
to address the informational needs of the medical audience as the health care field. Questions arise as to
community, but learners in allied health professional how much content to include, what to exclude, how
programs require an essential pathophysiology detailed the content should be, and how to organize the
text geared specifically for these programs. Human content in the most understandable manner. Another
Diseases, Sixth Edition is designed and specifically common concern is the question of the appropriate
written for learners in health care programs pursuing reading level.
careers as allied health professionals, including but not In an attempt to resolve these dilemmas, it was
limited to medical assistants, medical coders, surgical decided to organize the book in such a way that blocks
technologists, respiratory therapist assistants, physical of material or even entire chapters could be omitted or
therapist assistants, radiologic technologists, medical covered in detail, depending on the format of the course
transcriptionists, emergency medical technicians, and needs of the learner. At the same time, informa-
nursing assistants. The book is intended to meet the tion on each disease is written in such a way that it can
needs of learners enrolled in an allied health career stand alone or be viewed as all inclusive. This concept
program as well as serve as a valuable resource for health allows the instructor, learner, or individual to select and
care professionals on the job. It is also ideal as a resource study only those specific diseases or individual disease
on basic diseases by anyone within the medical arena of interest. Not all health conditions are covered in the
or individuals interested in human diseases. Current text, so the conditions chosen to be included are those
information for this book was based on the authors’ own that are most common, along with the new and emerg-
experiences and research sought from current literature, ing diseases. A few rare conditions are also included. Of
books, Internet resources, and physician consultations. the conditions chosen for the text, only general infor-
Students will understand this text best if a basic mation is covered. The text is designed to be a basic
medical terminology or anatomy and physiology overview of common diseases and disorders, not an
course has been completed before this course of study. in-depth study. Thus, the diseases presented are not
However, this book is designed to make difficult patho- described on a cellular physiological level, which would
physiology concepts easier to understand by using a be too complex for the intended audience. The intention
consistent organization, and including pronunciations, also was to keep the reading level of the text at an easy-
boxed features, and full-color illustrations and photos to-read basic level to promote understanding. We did
of diseases and disorders. Organized into three units, not want to write beneath the level of the learner but, at
the book begins with basic concepts of human diseases, the same time, felt that a difficult reading level would
introduces common diseases and disorders of the only increase the complexity of the material and thus
body systems, followed by genetic and developmental, fail to promote understanding of the subject matter.
childhood, and mental health diseases and disorders. The boxed features within the chapters either add
Chapters progress through a basic review of anatomy interesting information about staying healthy, present
xiii
xiv Preface
new research on the chapter topics, or present infor- Appendices and Glossary
mation about alternative treatments. The pharmacology
Appendix A presents common laboratory values.
boxed features list some of the possible medications for
Appendix B includes metric conversion tables. The
diseases or disorders in the chapter. These drugs are
glossary includes key terms and their definitions.
listed with generic names only since there are many
trade names for the same generic medication. It is
not intended to be an exhaustive list of possible med- New to This Edition
ications, but just to give the reader some information
Changes to the sixth edition include:
about common medications that might be prescribed
for certain diseases or disorders reviewed in the chapter.
The “Consider This” feature presents interesting facts to Changes in All Chapters
engage learners in the material. Cengage is committed to providing quality and inclusive
learning materials. As we adapt our learning materials to
Organization of The Text the continually evolving areas of inclusion and diversity,
the below strategies were adopted for this edition.
Human Diseases, Sixth Edition, consists of 21 chapters,
two appendices, glossary, index, and bibliography. To ■ Use age and gender-appropriate terms with the fol-
gain the most benefit from your use of this text, take lowing exceptions:
advantage of the review questions and case studies that ■ Use the terms male and female when discussing
are included at the end of each chapter. anatomical structures and physiology based on
biological sex assignment to ensure alignment of
Unit I Chapters terminology learners see in other scientific courses.
Chapters 1 through 4 lay the foundation for some basic ■ Use the terms male(s) and female(s) when refer-
disease concepts, including mechanisms of disease, ring to different age groups based on biological
neoplasms, inflammation, and infection. sex assignment rather than using terms based on
various age groups (for example, a disease affects
female adolescents, women, and older adult).
Unit II and Unit III Chapters
■ Use terms that appear in ICD-10 coding as diagnosis
Unit II includes chapters 5-18 which are organized
codes to ensure consistency of the medical language
by body systems and begin with a basic anatomy and
learners are exposed to in the text and will see in
physiology review of each system before discussing
actual practice.
that system’s common diseases and disorders. Included
with this discussion, where appropriate, are common ■ In an effort to keep the text as current as possible, the
signs and symptoms, diagnostic tests, trauma, and rare Glimpse of the Future boxes were eliminated because
diseases. In addition, a unique section toward the end this content quickly becomes outdated.
of each chapter discusses the effects of aging on each
system to help learners understand the natural aging
Chapter-Specific Changes
process of the human body.
Unit III includes chapters 19 through 21 on spe- Chapter 1
cialty areas covering genetics, childhood diseases, and ■ Added the term healthcare-associated infection
mental health disorders. (HAI)
Each disease in Units II and III is broken down
(where applicable) into the following sections: ■ Added material to clarify the difference between an
Description, Etiology, Symptoms, Diagnosis, Treatment, epidemic and a pandemic
and Prevention. Although this may appear to be very
title-heavy when there is only a sentence or two in each Chapter 2
section, this breakdown will assist the learner to clearly ■ Updated the list of deaths caused by trauma
identify these components of each disease. It also main-
tains consistency throughout the textbook. ■ Updated the BMI scale
Preface xv
■ Updated Consumer Responsibility in Disease Pre- ■ Added a new Healthy Highlight: Increasing Iron in
vention Healthy Highlight to include COVID-19. the Diet
■ Added material on comorbidity ■ Updated the treatment section for aplastic anemia
■ Updated the treatment section for Hodgkin’s lym-
Chapter 3 phoma, Non-Hodgkin’s lymphoma, and multiple
■ Updated cancer statistics myeloma
■ Updated personal risk behaviors for cancer ■ Added a new Complementary and Alternative Ther-
apy: Hematologic Disorders Treated with Stem Cell
■ Updated material on smoking and tobacco product Transplants
use
■ Updated cancer prevention with the latest recom- Chapter 8
mendations from the American Cancer Society
■ Updated the Pharmacology Highlight
■ Updated the section on diagnosis of cancer
■ Added a new Complementary and Alternative Ther-
■ Added a new Complementary and Alternative Ther- apy: Quercetin for Cardiovascular Disease
apy: Kombucha Beverage for Some Forms of Cancer
■ Updated the Healthy Highlight: Prevent High Blood
Chapter 4 Pressure
■ Updated the treatment section for coronary artery
■ Added a new Healthy Highlight: Emerging Infectious disease
Diseases: How to Stay Healthy
Chapter 5 apy: Low Fat Diets: Are They Necessary?
■ Updated the section on common signs and ■ Added a new Complementary and Alternative Ther-
symptoms apy: Salidroside Use in Heart Disease
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Preface xvii
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apy: Aromatherapy for Mood Elevation About the Authors
apy: Exercise for Relief from Depression Dr. Marianne Neighbors has been in nursing practice
and nursing education for more than 40 years. She
■ Added a section on Gender Dysphoria received her bachelor’s degree in nursing at Mankato
State, a master’s degree in health education at the
University of Arkansas, a master’s degree in nursing
Instructor and Student Resources at the University of Oklahoma, and a doctoral degree
in education with a focus on health science at the
Additional instructor and student resources for University of Arkansas. Dr. Neighbors has taught in
this product are available online. Instructor assets associate degree nursing education for 18 years, focusing
include an Instructor’s Manual, Educator’s Guide, on medical/surgical nursing, and in baccalaureate
PowerPoint® slides, Solution and Answer Guide, and a nursing education for 23 years, focusing on health
test bank powered by Cognero®. Student assets include promotion and community health. She also taught
PowerPoint® slides. Sign up or sign in at www.cengage advanced health promotion and nurse educator classes
.com to search for and access this product and its online at the master’s level. She has coauthored many research
resources. articles; four medical/surgical nursing texts, along with
■ The Instructor’s Manual includes a sample course two medical/surgical handbooks; a health assessment
syllabus and outline as a guide for setting up a course. handbook; and a home health handbook, in addition to
Additional materials for each chapter include detailed the six editions of Human Diseases. Dr. Neighbors has
content outlines, learning objectives, expanded chap- also written chapters for other nursing authors’ books.
ter summaries, discussion topics and learning activi- She is currently an Emeritus professor in the Eleanor
ties, and discussion questions. Mann School of Nursing at the University of Arkansas,
Fayetteville, Arkansas.
■ The Solution and Answer Guide includes answers to Ruth Tannehill-Jones worked as a registered
the text chapter review questions and case studies. nurse for more than 30 years. She began her nursing
The PowerPoint® slides include chapter objectives, education at the University of Arkansas, Fayetteville,
content and activity slides, and a self-assessment. with completion of an associate degree in nursing.
Preface xix
Ms. Tannehill-Jones was not a newcomer to this cam-

pus; some years previously, she had completed a bach-
Acknowledgments
elor’s degree in home economics. On receiving her A special thanks goes out to all our colleagues, friends,
RN license, she worked at St. Mary-Rogers Memorial and family members who have supported us throughout
Hospital in Rogers, Arkansas, in the capacities of staff this project.
nurse, head nurse, and nursing supervisor. Her other
nursing experience includes assisting orthopedic sur-
geons while employed by Ozark Orthopedic and Sports Feedback From The User(S)
Medicine Clinic located in the Northwest Arkansas The authors would like to hear from instructors, learners,
area. Ms. Tannehill-Jones gained experience in edu- or anyone using the textbook about its strengths and/
cation by working as an instructor of surgical technol- or suggestions for revisions. They are truly interested in
ogy while serving as the Divisional Chair of Nursing making the textbook user-friendly and comprehensive
and Allied Health Programs at Northwest Technical but not too detailed or too in-depth for the reader. The
Institute in Springdale, Arkansas. She obtained her authors want to know how the text is being used and
bachelor’s degree in nursing from Missouri Southern what features are most helpful. Please feel free to forward
State College in Joplin and her master’s degree in health comments to the authors through Cengage Learning or
service administration at Southwest Baptist University directly by e-mail to Dr. Neighbors at neighbo@uark
in Bolivar, Missouri. She worked for St. Mary’s— .edu and Ms. Tannehill-Jones at rjonesnwark@hotmail
Mercy Health System for more than 20 years in a vari- .com.
ety of nursing positions, with her last position being
Vice President of Patient Care Services, Chief Nurse Marianne Neighbors, EdD, RN
Executive. Ms. Tannehill-Jones retired from Regency Ruth Tannehill-Jones, MS, RN
Hospital of Northwest Arkansas in 2011.
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TABLE XII
Plate Distance 1.6 cm. Distance of Fall .0975 cm. Volts 1,015.
Temperature 230 C. Radius of Drop .000063 cm.
No. of No. of
No. of charges No. of charges
Charges on Charges on
on drop Ion on drop Ion
Caught Caught
19.0 100.0 1P 20.0 10.0* 1N
16.0 2P 1P 20.0* 0 1P
8.0 3P 1P 100.0 1P 1P
20.0* 0 1P
20.0 16.0 2P 1P 100.0 1P 1P
8.0 3P 16.0 2P 1P
100.0 1P
17.0 2P 1P 104.0 1P
8.2 3P 1P 15.0 2P 1P
6.0 4P 1P 9.0 3P 1P
6.0 4P
7.0* 2N
9.8* 1N 1P 6.5* 2N
7.0* 2N 10.0* 1N 1P
20.0* 0 1P
21.0 20.0* 0 100.0 1P 1P
No. of No. of
No. of charges No. of charges
Charges on Charges on
on drop Ion on drop Ion
Caught Caught
95.0 1P 1P 15.5 2P 1P
16.5 2P 1P 8.0 3P 1P
8.0 3.P 1P 8.0 3P 1P
6.0 4P
100.0 1P 16.5 2P
16.0 2P 1P
8.4 3P 20.0* 0
20.0 106.0 1P 16.5 2P
16.0 2P 1P
8.4 3P 5.7 4P
10.0* 1N 100.0 1P
20.0* 0 1P 20.0* 0 1N
100.0 1P 1P 10.0* 1N 1N
16.0 2P 10.0* 1N 1N
100.0 1P 1P
16.0 2P 1P
8.0 3P
44 catches, all singles

It will be seen from Table XII that in 4 cases out of 44 we caught
negatives, although it would appear from the arrangement shown in
Fig. 12 that we could catch only positives. These negatives are
doubtless due to secondary rays which radiate in all directions from
the air molecules when these are subjected to the primary X-ray
radiation.
Toward the end of Table XII is an interesting series of catches. At
the beginning of this series, the drop was charged with 2 negatives
which produced a speed in the direction of gravity of 6.5 seconds. It
caught in succession 6 single positives before the field was thrown
off. The corresponding times were 6.5*, 10*, 20*, 100, 15.5, 8.0, 6.0.
The mean time during which the X-rays had to be on in order to
produce a “catch” was in these experiments about six seconds,
though in some instances it was as much as a minute. The majority
of the times recorded in column were actually measured with a
stop watch as recorded, but since there could be no possibility of
mistaking the 100-second speed, it was observed only four or five
times. It will be seen from Table XII that out of 44 catches of ions
produced by very hard X-rays there is not a single double. As a
result of observing from 500 to 1,000 catches in the manner
illustrated in Table XII, we came to the conclusion that, although we
had entered upon the investigation with the expectation of proving
the existence of valency in gaseous ionization, we had instead
obtained direct, unmistakable evidence that the act of ionization of
air molecules by both primary and secondary X-rays of widely
varying degrees of hardness, as well as by - and -rays, uniformly
consists, under all the conditions which we were able to investigate,
in the detachment from a neutral molecule of one single elementary
electrical charge.
III. RECENT EVIDENCE AS TO NATURE OF IONIZATION

PRODUCED BY ETHER WAVES
Although Townsend and Franck and Westphal dissented from the
foregoing conclusion, all the evidence which has appeared since has
tended to confirm it. Thus Salles,[60] using a new method due to
Langevin of measuring directly the ratio of the mobility to the
diffusion coefficient, concluded that when the ionization is produced
by -rays there are no ions bearing multiple charges. Again, the very
remarkable photographs (see plate opposite p. 190) taken by C. T.
R. Wilson in the Cavendish Laboratory of the tracks made by the
passage of X-rays through gases show no indication of a larger
number of negatively than of positively charged droplets. Such an
excess is to be expected if the act of ionization ever consists in these
experiments in the detachment of two or more negative electrons
from a neutral molecule. Further, if the initial act of ionization by X-
rays ever consists in the ejection of two or more corpuscles from a
single atom, there should appear in these Wilson photographs a
rosette consisting of a group of zigzag lines starting from a common
point. A glance at the plate opposite p. 192 shows that this is not the
case, each zigzag line having its own individual starting-point.
There are two other types of experiments which throw light on
this question.
When in the droplet experiments the X-rays are allowed to fall
directly upon the droplet, we have seen that they detach negative
electrons from it, and if the gas is at so low a pressure that there is
very little chance of the capture of ions by the droplet, practically all
of its changes in charge have this cause. Changes produced under
these conditions appear, so far as I have yet been able to discover,
to be uniformly unit changes. Also, when the changes are produced
by the incidence on the droplet of ultra-violet light, so far as the
experiments which have been carried out by myself or my pupils go,
they usually, though not always, have appeared to correspond to the
loss of one single electron. The same seems to have been true in
the experiments reported by A. Joffé,[61] who has given this subject
careful study.
Meyer and Gerlach,[62] it is true, seem very often to observe
changes corresponding to the simultaneous loss of several
electrons. It is to be noted, however, that their drops are generally
quite heavily charged, carrying from 10 to 30 electrons. Under such
conditions the loss of a single electron makes but a minute change in
speed, and is therefore likely not only to be unnoticed, but to be
almost impossible to detect until the change has become more
pronounced through the loss of several electrons. This question,
then, can be studied reliably only when the field is powerful enough
to hold the droplet balanced with only one or two free electrons upon
it. Experiments made under such conditions with my apparatus by
both Derieux[63] and Kelly[64] show quite conclusively that the act of
photo-emission under the influence of ultra-violet light consists in the
ejection of a single electron at each emission.
Table XIII contains one series of observations of this sort taken
with my apparatus by Mr. P. I. Pierson. The first column gives the
volts applied to the plates of the condenser shown in Fig. 7, p. 111.
These were made variable so that the drop might always be pulled
up with a slow speed even though its positive charge were
continually increasing. The second and third columns give the times
required to move 1 cm. under gravity and under the field
respectively. The fourth column gives the time intervals required for
the drop to experience a change in charge under the influence of a
constant source of ultra-violet light—a quartz mercury lamp. The fifth
column gives the total charge carried by the drop computed from
equation (12), p. 91. The sixth column shows the change in charge
computed from equation (10), p. 70. This is seen to be as nearly a
constant as could be expected in view of Brownian movements and
the inexact measurements of volts and times. The mean value of
is seen to be , which yields with the aid of equation (16),
p. 101, after the value of found for oil drops has been inserted,
, which is in better agreement with the result
obtained with oil drops than we had any right to expect. In these
experiments the light was weak so that the changes come only after
an average interval of 29 seconds and it will be seen that they are all
unit changes.
Table XIII
MERCURY DROPLET OF RADIUS
DISCHARGING
ELECTRONS UNDER THE INFLUENCE OF ULTRA-VIOLET LIGHT
Drop Time
No. 1 Interval No.
Sec. Charge
Volts Sec. between Electrons
per in
Discharges Emitted
per Cm. Cm.
in Seconds
2.260 11.0 - 1200} {49.4}
3.070 11.0 + 32.8} {50.5}
11 4.4 1
1.960 + 194 54.4
12.8
1.960 + 190 60.8 6.4 1
23
1.820 11.2 + 220 65.0 4.2 1
40.0
1.690 + 230 69.8 4.8 1
15.2
1.550 + 332 75.1 5.3 1
Drop
3.040 No. 2 + 98 43.5
10.4
5.6
Drop Time
No. 1 Interval No.
Sec. Charge
Volts Sec. between Electrons
per in
Discharges Emitted
per Cm. Cm.
in Seconds
2.540 + 200 49.4 5.9 1
18.6
2.230 + 300 55.2 5.8 1
35.0
2.230 + 76 60.7 5.5 1
42.0
1.930 + 200 65.0 4.3 1
54
1.810 + 176 69.6 4.6 1
70
1.650 + 250 75.2 5.6 1
45
1.520 + 500 79.4 4.2 1
9.8
1.520 + 119 85.1 5.5 1
Mean 29 Mean 5.1
So long, then, as we are considering the ionization of neutral

atoms through the absorption of an ether wave of any kind, the
evidence at present available indicates that the act always consists
in the detachment from the atom of one single negative electron, the
energy with which this electron is ejected from the atom depending,
as we shall see in chap. X, in a very definite and simple way upon
the frequency of the ether wave which ejects it.
IV. IONIZATION BY -RAYS
When the ionization is due to the passage of -rays through
matter, the evidence of the oil-drop experiments as well as that of C.
T. R. Wilson’s experiments (see chap. IX) on the photographing of
the tracks of the -rays is that here, too, the act consists in the
detachment of one single electron from a single atom. This
experimental result is easy to understand in the case of the -rays,
when it is remembered that Wilson’s photographs prove directly the
fact, long known from other types of evidence, that a -ray, in
general, ionizes but a very minute fraction of the number of atoms
through which it shoots before its energy is expended. If, then, its
chance, in shooting through an atom, of coming near enough to one
of the electronic constituents of that atom to knock it out is only one
in one thousand, or one in one million, then its chance of getting
near enough to two electronic constituents of the same atom to
knock them both out is likely to be negligibly small. The argument
here rests, however, on the assumption that the electrons within the
atom are independent of one another, which is not necessarily the
case, so that the matter must be decided after all solely by
experiment.
The difference between the act of ionization when produced by a
-ray and when produced by an ether wave seems, then, to consist
wholly in the difference in the energy with which the two agencies
hurl the electron from its mother atom. Wilson’s photographs show
that -rays do not eject electrons from atoms with appreciable
speeds, while ether waves may eject them with tremendous energy.
Some of Wilson’s photographs showing the effect of passing X-rays
through air are shown in the most interesting plate opposite p. 190.
The original X-rays have ejected electrons with great speeds from a
certain few of the atoms of the gas, and it is the tracks of these
electrons as they shoot through the atoms of the gas, ionizing here
and there as they go, which constitute the wiggly lines shown in the
photograph. Most of the ionization, then, which is produced by X-
rays is a secondary effect due to the negative electrons, i.e., the -
rays which the X-rays eject. If these -rays could in turn eject
electrons with ionizing speeds, each of the dots in one of these -ray
tracks would be the starting-point of a new wiggly line like the
original one. But such is not the case. We may think, then, of the -
rays as simply shaking loose electronic dust from some of the atoms
through which they pass while we think of the X-rays as taking hold
in some way of the negative electrons within an atom and hurling
them out with enormous energy.
V. IONIZATION BY -RAYS
But what happens to the electronic constituents of an atom when
an -particle, that is, a helium atom, shoots through it? Some of
Bragg’s experiments and Wilson’s photographs show that the -
particles shoot in straight lines through from 3 to 7 cm. of air before
they are brought to rest. We must conclude, then, that an atom has
so loose a structure that another atom, if endowed with enough
speed, can shoot straight through it without doing anything more
than, in some instances, to shake off from that atom an electron or
two. The tracks shown in Figs. 14 and 15, facing p. 190, are Wilson’s
photographs of the tracks of the -particles of radium. They ionize
so many of the atoms through which they pass that the individual
droplets of water which form about the ions produced along the path
of the ray, and which are the objects really photographed, are not
distinguishable as individuals. The sharp changes in the direction of
the ray toward the end of the path are convincing evidence that the
-particle actually goes through the atoms instead of pushing them
aside as does a bullet. For if one solar system, for example,
endowed with a stupendous speed, were to shoot straight through
another similar system, but without an actual impact of their central
bodies, the deflection from its straight path which the first system
experienced might be negligibly small if its speed were high enough,
and that for the simple reason that the two systems would not be in
each other’s vicinity long enough to produce a deflecting effect. In
technical terms the time integral of the force would be negligibly
small. The slower the speed, however, the longer this time, and
hence the greater the deflection. Thus it is only when the -particle
shown in Fig. 15 has lost most of its velocity—i.e., it is only toward
the end of its path—that the nuclei of the atoms through which it
passes are able to deflect it from its straight path. If it pushed the
molecules aside as a bullet does, instead of going through them, the
resistance to its motion would be greatest when the speed is highest.
Now, the facts are just the opposite of this. The -particle ionizes
several times more violently toward the end of its path than toward
the beginning, and it therefore loses energy more rapidly when it is
going slowly than when it is going rapidly. Further, it is deflected
more readily, then, as the photograph shows. All of this is just as it
should be if the -particle shoots straight through the molecules in
its path instead of pushing them aside.
These photographs of Wilson’s are then the most convincing
evidence that we have that the atom is a sort of miniature stellar
system with constituents which are unquestionably just as minute
with respect to the total volume occupied by the atom as are the sun
and planets and other constituents of the solar system with respect
to the whole volume inclosed within the confines of this system.
When two molecules of a gas are going as slowly as they are in the
ordinary motion of thermal agitation, say a mile a second, when their
centers come to within a certain distance—about 0.2 . (millionths
of a millimeter)—they repel one another and so the two systems do
not interpenetrate. This is the case of an ordinary molecular collision.
But endow one of these molecules with a large enough energy and it
will shoot right through the other, sometimes doubtless without so
much as knocking out a single electron. This is the case of an -
particle shooting through air
But the question to which we are here seeking an answer is,
does an individual -particle ever knock more than one electron
from a single atom or molecule through which it passes, so as to
leave that atom doubly or trebly charged? The oil-drop method used
at low pressures[65] has given a very definite answer to this question.
In no gas or vapor except helium, which we have as yet tried, is
them any certain evidence that an individual -ray in shooting
through an atom is able to remove from that atom more than one
single electron at a time.
The foregoing result has been obtained by shooting the -rays
from polonium through a rarefied gas in an oil-drop apparatus of the
type sketched in Fig. 12, catching upon a balanced oil drop the
positively charged residue of one of the atoms thus ionized, and
counting, by the change in speed imparted to the droplet, the
number of electrons which were detached from the captured atom by
the passage of the -ray through or near it.[66]
This mode of experimenting extended to helium, however, has
yielded the most interesting result[67] that every sixth one on the
average of all the passages, or “shots,” which detached any
electrons at all from the helium atom detached both of the two
electrons which the neutral helium atom possesses. Since some of
the ionization produced along the path of an -ray is probably due to
slow-speed secondary -rays produced by the -ray, it is probable
that the fraction of the actual passages through helium atoms of -
rays themselves which detach both electrons is greater than the
foregoing one in six. It has been estimated by Fowler at as high as
three in four.
The foregoing experimental result of one in six was obtained only
at the very end of the range of the -rays where they have their
maximum ionizing power. When these rays were near the beginning
of their range, and therefore were moving much more rapidly, the
fraction of the number of double catches to total catches was only
about half as much, i.e., the chance of getting both electrons at a
single shot is much smaller with a high-speed bullet than with a slow-
speed one. This is to be expected if the two electrons are
independent of each other, i.e., if the removal of one does not carry
the other out with it.
The foregoing is, I think, the only experiment which has yet been
devised in which the act of ionization is isolated and studied as an
individual thing.
Since 1913, however, very definite evidence has come in from
two different sources that multiply-valent. ions are often produced in
discharge tubes. The most unambiguous proof of this result has
been furnished by the spectroscope. Indeed, Mr. Bowen and the
author have recently found with great definiteness that high-voltage
vacuum sparks give rise to spectral lines which are due to singly-,
doubly-, trebly-, quadruply-, and quintuply- charged atoms of the
elements from lithium to nitrogen, and even to sextuply-charged
ones in the case of sulphur.[68] In view of the foregoing studies with
X-rays, -rays, and -rays, it is probable that these
spectroscopically discovered multiply-charged ions are produced by
successive ionizations such as might be expected to take place in a
region carrying a very dense electron current, such as must exist in
our “hot-sparks.”
Again, J. J. Thomson has brought forward evidence[69] that the
positive residues of atoms which shoot through discharge tubes in a
direction opposite to that of the cathode rays have suffered multiple
ionization. Indeed, he thinks he has evidence that the act of
ionization of atoms of mercury consists either in the detachment of
one negative electron or else in the detachment of eight. His
evidence for the existence in the case of mercury of multiple charges
from one up to eight is certainly very convincing, and it is possible,
also, that under his conditions the act of ionization itself may consist
in the detachment either of one or of eight electrons as he suggests.
Further evidence upon this point must be sought.
VI. SUMMARY
The results of the studies reviewed in this chapter may be
summarized thus:
1. The act of ionization by -rays seems to consist in the shaking
off without any appreciable energy of one single electron from an
occasional molecule through which the -ray passes. The faster the
-ray the less frequently does it ionize.
2. The act of ionization by ether waves, i.e., by X-rays or light,
seems to consist in the hurling out with an energy which may be very
large, but which depends upon the frequency of the incident ether
wave, of one single electron from an occasional molecule over which
this wave passes.
3. The act of ionization by rapidly moving -particles consists
generally in the shaking loose of one single electron from the atom
through which it passes, though in the case of helium, two electrons
are certainly sometimes removed at once. It may be, too, that a very
slow-moving positive ray, such as J. J. Thomson used, may detach
several electrons from a single atom.
CHAPTER VII
BROWNIAN MOVEMENTS IN GASES
I. HISTORICAL SUMMARY
In 1827 the English botanist, Robert Brown, first made mention of
the fact that minute particles of dead matter in suspension in liquids
can be seen in a high-power microscope to be endowed with
irregular wiggling motions which strongly suggest “life.”[70] Although
this phenomenon was studied by numerous observers and became
known as the phenomenon of the Brownian movements, it remained
wholly unexplained for just fifty years. The first man to suggest that
these motions were due to the continual bombardment to which
these particles are subjected because of the motion of thermal
agitation of the molecules of the surrounding medium was the
Belgian Carbonelle, whose work was first published by his
collaborator, Thirion, in 1880,[71] although three years earlier
Delsaulx[72] had given expression to views of this sort but had
credited Carbonelle with priority in adopting them. In 1881
Bodoszewski[73] studied the Brownian movements of smoke
particles and other suspensions in air and saw in them “an
approximate image of the movements of the gas molecules as
postulated by the kinetic theory of gases.” Others, notably Gouy,[74]
urged during the next twenty years the same interpretation, but it
was not until 1905 that a way was found to subject the hypothesis to
a quantitative test. Such a test became possible through the brilliant
theoretical work of Einstein[75] of Bern, Switzerland, who, starting
merely with the assumption that the mean kinetic energy of agitation
of a particle suspended in a fluid medium must be the same as the
mean kinetic energy of agitation of a gas molecule at the same
temperature, developed by unimpeachable analysis an expression
for the mean distance through which such a particle should drift in a
given time through a given medium because of this motion of
agitation. This distance could be directly observed and compared
with the theoretical value. Thus, suppose one of the wiggling
particles is observed in a microscope and its position noted on a
scale in the eyepiece at a particular instant, then noted again at the
end of (for example, 10) seconds, and the displacement in that
time along one particular axis recorded. Suppose a large number of
such displacements in intervals all of length are observed,
each one of them squared, and the mean of these squares taken
and denoted by : Einstein showed that the theoretical value of
should be
in which is the universal gas constant per gram molecule, namely,

, the temperature on the absolute scale,
the number of molecules in one gram molecule, and a resistance
factor depending upon the viscosity of the medium and the size of
the drop, and representing the ratio between the force applied to the
particle in any way and the velocity produced by that force. If
Stokes’s Law, namely, , held for the motion of the
particle through the medium, then would have the value
, so that Einstein’s formula would become
This was the form which Einstein originally gave to his equation, a
very simple derivation of which has been given by Langevin.[76] The
essential elements of this derivation will be found in Appendix C.
The first careful test of this equation was made on suspensions in
liquids by Perrin,[77] who used it for finding the number of
molecules in a gram molecule. He obtained the mean value
, which, in view of the uncertainties in the
measurement of both and , may be considered as proving
the correctness of Einstein’s equation within the limits of error of
Perrin’s measurements, which differ among themselves by as much
as 30 per cent.
II. QUANTITATIVE MEASUREMENTS IN GASES

Up to 1909 there had been no quantitative work whatever on
Brownian movements in gases. Bodoszewski had described them
fully and interpreted them correctly in 1881. In 1906
Smoluchowski[78] had computed how large the mean displacements
in air for particles of radius ought to be, and in 1907
Ehrenhaft[79] had recorded displacements of the computed order
with particles the sizes of which he made, however, no attempt to
measure, so that he knew nothing at all about the resistance factor
. There was then nothing essentially quantitative about this work.
In March, 1908, De Broglie, in Paris,[80] made the following
significant advance. He drew the metallic dust arising from the
condensation of the vapors coming from an electric arc or spark
between metal electrodes (a phenomenon discovered by Hemsalech
and De Watteville[81]) into a glass box and looked down into it
through a microscope upon the particles rendered visible by a beam
of light passing horizontally through the box and illuminating thus the
Brownian particles in the focal plane of the objective. His addition
consisted in placing two parallel metal plates in vertical planes, one
on either side of the particles, and in noting that upon applying a
potential difference to these plates some of the particles moved
under the influence of the field toward one plate, some remained at
rest, while others moved toward the other plate, thus showing that a
part of these particles were positively electrically charged and a part
negatively. In this paper he promised a study of the charges on these
particles. In May, 1909, in fulfilling this promise[82] he made the first
quantitative study of Brownian movements in gases. The particles
used were minute droplets of water condensed upon tobacco smoke.
The average rate at which these droplets moved in Broglie’s
horizontal electric field was determined. The equation for this motion
was
The mean was next measured for a great many particles and
introduced into Einstein’s equation:
From these two equations was eliminated and obtained in terms

of . Introducing Perrin’s value of , De Broglie obtained from one
series of measurements ; from another series on
larger particles he got a mean value several times larger—a result
which he interpreted as indicating multiple charges on the larger
particles. Although these results represent merely mean values for
many drops which are not necessarily all alike, either in radius or
charge, yet they may be considered as the first experimental
evidence that Einstein’s equation holds approximately, in gases, and
they are the more significant because nothing has to be assumed
about the size of the particles, if they are all alike in charge and
radius, or about the validity of Stokes’s Law in gases, the -factor
being eliminated.
The development of the oil-drop method made it possible to
subject the Brownian-movement theory to a more accurate and
convincing experimental test than had heretofore been attainable,
and that for the following reasons:
1. It made it possible to hold, with the aid of the vertical electrical
field, one particular particle under observation for hours at a time and
to measure as many displacements as desired on it alone instead of
assuming the identity of a great number of particles, as had been
done in the case of suspensions in liquids and in De Broglie’s
experiments in gases.
2. Liquids are very much less suited than are gases to convincing
tests of any kinetic hypothesis, for the reason that prior to Brownian-
movement work we had no satisfactory kinetic theory of liquids at all.
3. The absolute amounts of the displacements of a given particle
in air are 8 times greater and in hydrogen 15 times greater than in
water.
4. By reducing the pressure to low values the displacements can
easily be made from 50 to 200 times greater in gases than in liquids.
5. The measurements can be made independently of the most
troublesome and uncertain factor involved in Brownian-movement
work in liquids, namely, the factor , which contains the radius of
the particle and the law governing its motion through the liquid.
Accordingly, there was begun in the Ryerson Laboratory, in 1910,
a series of very careful experiments in Brownian movements in
gases. Svedberg,[83] in reviewing this subject in 1913, considers this
“the only exact investigation of quantitative Brownian movements in
gases.” A brief summary of the method and results was published by
the author.[84] A full account was published by Mr. Harvey Fletcher in
May, 1911,[85] and further work on the variation of Brownian
movements with pressure was presented by the author the year
following.[86] The essential contribution of this work as regards
method consisted in the two following particulars:
1. By combining the characteristic and fully tested equation of the
oil-drop method, namely,
with the Einstein Brownian-movement equation, namely,

it was possible to obtain the product without any reference to the
size of the particle or the resistance of the medium to its motion. This
quantity could then be compared with the same product obtained
with great precision from electrolysis. The experimental procedure
consists in balancing a given droplet and measuring, as in any
Brownian-movement work, the quantity , then unbalancing it
and measuring , and ( ; the combination of (24) and
(25) then gives
Since it is awkward to square each displacement before

averaging, it is preferable to modify by substituting from the Maxwell
distribution law, which holds for Brownian displacements as well as
for molecular velocities, the relation
We obtain thus
or
The possibility of thus eliminating the size of the particle and with
it the resistance of the medium to its motion can be seen at once
from the simple consideration that so long as we are dealing with
one and the same particle the ratio between the force acting and
the velocity produced by it must be the same, whether the acting
force is due to gravity or an electrical held, as in the oil-drop
experiments, or to molecular impacts as in Brownian-movement
work. De Broglie might have made such an elimination and
calculation of in his work, had his Brownian displacements and
mobilities in electric fields been made on one and the same particle,
but when the two sets of measurements are made on different
particles, such elimination would involve the very uncertain
assumption of identity of the particles in both charge and size.
Although De Broglie did actually make this assumption, he did not
treat his data in the manner indicated, and the first publication of this
method of measuring as well as the first actual determination
was made in the papers mentioned above.
Some time later E. Weiss reported similar work to the Vienna
Academy.[87]
2. Although it is possible to make the test of in just the
method described and although it was so made in the case of one or
two drops, Mr. Fletcher worked out a more convenient method,
which involves expressing the displacements in terms of the
fluctuations in the time required by the particle to fall a given
distance and thus dispenses with the necessity of balancing the drop
at all. I shall present another derivation which is very simple and yet
of unquestionable validity.
In equation (28) let be the time required by the particle, if there
were no Brownian movements, to fall between a series of equally
spaced cross-hairs whose distance apart is . In view of such
movements the particle will have moved up or down a distance
in the time . Let us suppose this distance to be up. Then the actual
time of fall will be , in which is now the time it takes the
particle to fall the distance . If now is small in comparison
with , that is, if is small in comparison with (say ⅒ or less),
then we shall introduce a negligible error (of the order ¹⁄₁₀₀ at the
most) if we assume that in which is the mean
velocity under gravity. Replacing then in (28) ( , by in
which is the square of the average difference between an

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III. RECENT EVIDENCE AS TO NATURE OF IONIZATION

So long, then, as we are considering the ionization of neutral

in which is the universal gas constant per gram molecule, namely,

II. QUANTITATIVE MEASUREMENTS IN GASES

From these two equations was eliminated and obtained in terms

with the Einstein Brownian-movement equation, namely,

Since it is awkward to square each displacement before

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