Diseases of the Human Body, 6th

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PREFACE
This totally new and completely updated text provides
clear, succinct, and basic information about common
medical conditions. Diseases of the Human Body, 6th edi-
tion, is carefully designed to meet the unique educa-
tional and professional needs of health-care personnel.
The book focuses on human diseases and disorders that
are frequently first diagnosed or treated in ambulatory
health care. Each entry considers what the disease or
disorder is, how it might be diagnosed and treated, and
the likely consequences of the disease or disorder for the
person experiencing it.
Chapters 1 through 7 provide a solid foundation for
subsequent chapters and include:
• The Disease Process
• Integrative Medicine and Complementary
Therapies
• Pain and Its Management
• Infectious and Communicable Diseases
• Cancer
• Congenital Diseases and Disorders
• Mental Health Diseases and Disorders
The remaining 10 chapters cover major conditions
organized by body system. This pattern of organization
is easily integrated with medical terminology or
anatomy and physiology courses that health-care pro-
fessional students often take concurrently with the study
of human disease. Within each system chapter, there is
an anatomy and physiology review of that system for
further assistance. Each disease condition is highlighted
by means of a logical, nine-part format consisting of:
• Description
• Etiology
• Signs and Symptoms
• Diagnostic Procedures
• Treatment
• Complementary Therapy
• Client Communication
• Prognosis
• Prevention
The balance of information in each of these subsec-
tions varies according to the relative frequency and
severity of the condition. In every case, the information
selected is chosen to reflect the need for thorough yet
concise information about the condition.
Research for this edition indicates that alternative
and complementary therapies are now more often
viewed as “integrative medicine,” providing the best of
both traditional and complementary therapies for treat-
ing clients. Viable complementary or alternative therapy
was included when documentation was found regarding
effectiveness and lack of harm.
The organization of the text is thoroughly contem-
porary and designed to help you retain and understand
basic concepts within the context of your chosen pro-
fession. Color in the interior further enhances its ap-
peal. Features include clear chapter outlines, chapter
learning outcomes that can be easily matched to ques-
tions in the electronic test bank, pronunciation of key
terms, review questions, and case studies to encourage
critical thinking. Client Communication sections will
remind you to think about teaching opportunities for
your clients. You will also find reference to the most
common “reportable diseases” as required by state
and/or federal government. This feature prompts you to
recall your reporting responsibility.
The “Chapter Episode” feature makes a particular
disease or disorder very personal and asks you to re-
spond to related questions at the end of each episode.
The episode appears at the beginning of the chapter and
is further explained throughout the chapter, becoming
more complex each time. There also is a Reality Episode
in each chapter as well as accompanying questions. An-
swers to the episode questions, review questions, and
case studies are found in the Instructor’s Guide to
this textbook. Throughout the text, carefully chosen
illustrations help you visualize body structures and
conditions.
The sixth edition provides the International Classifi-
cation of Diseases, 10th revision, Clinical Modification
(ICD-10-CM) codes for each disease. This valuable tool
reinforces the importance of proper coding for reim-
bursement and research. See the note at the end of this
preface regarding this update on coding.
The comprehensive glossary appears at the end of
the text, using Taber’s Cyclopedic Medical Dictionary,
22nd edition, as the main reference. The appendices in-
clude succinct descriptions of most of the diagnostic
procedures mentioned in the text and a comprehensive
list of over 200 commonly used abbreviations, along
with a reference list that includes Internet sites. These
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viii Preface
features help make Diseases of the Human Body, 6th edition,
a valuable classroom text and a useful reference after you
begin your professional career. Finally, in addition to a
general subject index, a specialized index of diseases
covered in this text directs the reader to the nine-part
presentation of each disease covered.
Herman cartoons, a special favorite of the author,
provide a little levity to what can be “worrisome” topics
of disease. Jim Unger, their creator, has a unique
understanding of human nature, of life, and of all its
travails. We hope you will giggle and even laugh out
loud. Such “internal jogging” is good for the soul.
The study of human disease is never easy. Every ef-
fort has been made to make it clear and accessible by
presenting information to benefit both students and
health-care professionals. Students will be able to access
many online ancillary pieces to enhance their study and
learning process. There are numerous interactive exer-
cises that include case studies, and 17 podcasts can be
downloaded for listening and review. New to this
edition is the inclusion of nine videos that illustrate one
or more applications of the chapter content. These re-
sources are available at http://davisplus.fadavis.com
(keyword Tamparo). Twice yearly, updated information
on diseases and disorders is provided on DavisPlus by
F.A. Davis. To assist instructors, there is an Instructor’s
Guide, an electronic test bank, and PowerPoint presen-
tations, which are available to adopters.
—C AROL D. T AMPARO
ICD-10-CM
The implementation of ICD-10-CM occurred
October 1, 2015. After many extensions granted by the
U.S. Department of Health and Human Services
(HHS), the transition from ICD-9-CM to the new
ICD-10-CM code set became a reality.
The implementation of ICD-10-CM coding expanded
the ICD-9-CM codes from approximately 17,000 codes
to approximately 69,000 in the ICD-10-CM. The in-
crease is due to the greater level of specificity in the coding
process. More extensive and accurate documentation is
necessary to be able to code to the highest level of speci-
ficity. ICD-10-CM is an alphanumeric classification
system that has been expanded from five to seven charac-
ters. ICD-10-CM uses the letter “X” as a placeholder
to allow for expansions in the future. This placeholder is
used in the fifth, sixth, and seventh character positions.
ICD-10-CM has been used in other countries for many
years. Once the United States adopted ICD-10-CM
coding, we are now able to compare health data and sta-
tistics worldwide. Proponents of ICD-10-CM state that
areas such as public health, research, and reimbursement
will greatly benefit from using the new codes.
The health-care industry has taken many steps in
preparation for the conversion to ICD-10-CM. System
updates needed to be installed to be compatible with the
new format. Changes were necessary on any forms that
previously utilized ICD-9-CM. Internal and external
testing was conducted to ensure payers are able to receive
data with ICD-10-CM codes. Training on the new
coding system was offered in various formats. Online
courses, seminars, and boot camps were just some of the
options in becoming proficient in ICD-10-CM. Several
studies predict a shortage of coders in the next several
years. This is a great opportunity for anyone interested
in a career as a certified coding professional.
I would like to take this opportunity to thank my
mentor, Richard K. Brown, for his willingness to share
his skills, knowledge, and expertise.
—D ONNA F IRN , CPC, CMA (AAMA), CRCS-I
Masters of Arts in Counseling Psychology
Kitsap Mental Health Services
Bremerton, Washington
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CONTRIBUTORS
JENNIFER T. DAVIS, BSN, RN, CBC
Medical Assisting Program Director
Harcum College
Bryn Mawr, Pennsylvania
NICU RN and ECMO Specialist
St. Christopher’s Hospital for Children
Philadelphia, Pennsylvania
Jennifertdavisrn@verizon.net
DONNA M. FIRN, CPC, CMA (AAMA), CRCS-I
Medical Assisting Clinical Coordinator
Harcum College
Bryn Mawr, Pennsylvania
MARTIANN C. LEWIS, MA, LMHC
Lewis and Clark College
Portland, Oregon
ix
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REVIEWERS

LISA MICHELLE BAKER, BS, CMA DEBORAH R FLOWERS, MS

Medical Office Administration Medical Assisting
Forsyth Tech Community College Guilford Technical Community College
Winston-Salem, North Carolina Jamestown, North Carolina

TRICIA BERRY, PhD, MATL, OTR/L TRACIE FUQUA, BS, CMA (AAMA)
Medical Assisting Medical Assisting
Kaplan University Wallace State Community College
Chicago, Illinois Hanceville, Alabama

DARLENE BOSCHERT, RHIA, CPC, COC, CPC-I CAROLYN JEAN GAARDER, MLA RHIA
Medical Programs Health
Bayside Medical Consultants MN State Community and Technical College
Holiday, Florida Moorhead, Minnesota

JENNIFER BOYER, CMA (AAMA), AAT DOLLY HORTON, CMA, EdD

Medical Assisting Allied Health
Lanier Technical College Asheville Buncombe Technical Community
Oakwood, Georgia College
Asheville, North Carolina
SONYA M. BURNS, BBA, RHIA, CMA (AAMA)
Allied Health Sciences and Nursing SUSAN W. KINNEY, RN, BSN, CNOR, RMA
Augusta Technical College Health Science
Augusta, Georgia Piedmont Technical College
Greenwood, South Carolina
WILLIAM TRAVIS BUTLER, MHA
Health Science JUDITH KIMELMAN KLINE, NCRMA
ECPI University Health Science
Raleigh, North Carolina Miami Lakes Educational Center & Technical
College
SCOTT CRAWFORD, MS, ATC, CSCS Miami Gardens, Florida
Athletics/College of Health and Human Services
Concordia University GREG KLINGLER, MPAS, DHSc, PA-C
Portland, Oregon Health, Recreation, Human Performance
Brigham Young University
BRIAN DICKENS, RMA, MBA, CHI Rexburg, Idaho
Dean of Academic Affairs of Southeastern College
Lakeland, Florida JENNIFER LAME, MPH, RHIT
Health & Human Services
SANDRA M. ERLEWINE, CMA (AAMA), CPC Southwest Wisconsin Technical College
Allied Health Technology Department Fennimore, Wisconsin
Yakima Valley Community College
Yakima, Washington EBONY S. LAWRENCE, BS, MHA, DrPH (ABD)
Medical Assisting/Medical Administration
DONNA FIRN, CMA (AAMA), CPC, CRCS-I ECPI University—Medical Careers Institute
Allied Health Science Charlotte, North Carolina
Harcum College
Bryn Mawr, Pennsylvania

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xii Reviewers

DEB LEHEW, CMA SUSAN D. STOCKMASTER, MHS

Medical Assisting Patient Care Services
Anoka Technical College Trident Technical College
Anoka, Minnesota Charleston, South Carolina

BARBARA MARCHELLETTA, BS, CMA (AAMA), RHIT, HOLLY A. TUMBARELLO, RN, BSN
CPC, CPT, AHI Certified Allied Health Instructor
Allied Health Allied Health
Beal College Clatsop Community College
Bangor, Maine Astoria, Oregon

NIKKI A. MARHEFKA, EdM, MT (ASCP), CMA (AAMA) PAM VENTGEN, CMA (AAMA), CCS-P, CPC, CPC-I
School of Health Sciences Medical Assisting
Central Penn College University of Alaska Anchorage
Summerdale, Pennsylvania Anchorage, Alaska

MARY M. MARKS, FNP, RMA (AMT) KARON G. WALTON, BS, AAS, CMA
Nursing, Public Service, and Allied Health Medical Assisting
Mitchell Community College Augusta Technical College
Mooresville, North Carolina Augusta, Georgia

JUDY MARTIN, MEd KARI WILLIAMS, BS, DC

Continuing Education Medical Office Technology
Trident Technical College Front Range Community College
Charleston, South Carolina Longmont, Colorado

TATYANA PASHNYAK, CHIS-TR, COI STACEY F. WILSON, MT/PBT (ASCP), AHI, CMA
Health Sciences & Professional Studies (AAMA), MHA
Bainbridge State College General Education
Bainbridge, Georgia Cabarrus College of Health Sciences
Concord, North Carolina
VICTOR SCHUELLER, DC
General Education BARBARA D.S. WORLEY, BS, DPM, RMA (AMT)
Lakeshore Technical College Medical Assisting
Cleveland, Wisconsin King’s College
Charlotte, North Carolina
ROBIN SNIDER-FLOHR, EdD, RN, CMA (AAMA)
Health & Public Services SANDRA WRIGHT, PhD
Eastern Gateway Community College Administration
Steubenville, Ohio Atlanta Medical Academy
Palmetto, Georgia
LORI STARNES, CMA (AAMA)
Allied Health—Medical Assisting
South Piedmont Community College
Monroe, North Carolina
4451_FM_i-xxiv 08/01/16 9:28 AM Page xiii
ACKNOWLEDGMENTS
There is the saying, “It takes a village to raise a child.”
The same can be said for the creation of a book. So
many individuals, working in concert with just the
proper instrumentation at the correct time, are essential
to the process. It began with a time of development,
strategy planning, and decision making in the
F.A. Davis conference room with two days of discus-
sion. We discovered we would be the first team to work
through a new process where all the ancillary pieces
would be completed at the time each chapter was sub-
mitted. While it appeared cumbersome in the begin-
ning, it soon became fun to visualize the entire picture
for each chapter. The result was a more cohesive and
comprehensive package to be delivered to students.
Jennifer Davis, BSN, RN, CBC, is the primary au-
thor of Chapters 8, 16, and 17. Martiann Lewis, MA,
LMHC, is the primary author of Chapter 7. Jennifer
and Martiann were a part of the team lending their ded-
ication, wisdom, and support for their particular chapters
and the entire book. Their unique knowledge and ex-
pertise was essential to the finished product. Donna
Morrissey, developmental editor, provided valuable ed-
iting along the way and assisted in the incorporation of
Blooms taxonomy into our learning outcomes and test
questions. Donna Firn, CMA (AAMA), CPC, CRCS-
I, provided all the ICD-10-CM codes for each chapter
in a timely and efficient manner. The ICD-10-CM
coding is much more complex and detailed than the
ICD-9-CM and required a great deal of deliberation on
her part in order to determine the specificity of each
code for the purposes of the book.
All the staff at F.A. Davis make delivery of the 6th
edition most pleasurable. Andy McPhee, Senior Acqui-
sitions Editor, is not only visionary in his thinking, but
he is also gracious, lends delightful humor to the proj-
ect, and hosts a wonderful meal gathering. The time and
talent of the reviewers who made helpful suggestions is
invaluable to the caliber of the finished product.
I acknowledge all the authors of the many reference
resources used in this edition. The content of this text
cannot be entirely new because it is based on the work
of a community of researchers, clinicians, and authors;
it is hoped, however, that it has been presented in a
manner that is unique and in a style that is useful to all
readers.
Finally, without my husband and my family, this
book would never have been finished. Tom knew just
when to say, “It looks like nothing has been started for
dinner; how about I take you out to eat.” His loving
support and encouragement were vital to my well-being
and stamina. Interestingly enough, some grandchildren
are now beginning to refer to this text for use in their
classes at three different universities in Washington
State. I am honored to be able to make that small con-
tribution to them.
—C AROL D. T AMPARO , CMA (AAMA) PhD
ctamparo@comcast.net
My love for the medical world paired with my desire to
take my knowledge and teach beyond the bedside
and classroom have come true. I am truly thankful to
Carol Tamparo, Donna Morrissey, Andy McPhee,
F.A. Davis, and the entire team that offered and helped
guide me through this wonderful opportunity.
Special thanks to Troy, my wonderful husband, who
is my rock; MacKenzie and Aiden, my awesome chil-
dren who inspire me to be a better person every day;
Jill Tillman, my mom, nurse, mentor, and amazing
friend; Craig Tillman, my dad, #1 fan, and supporter;
and the many friends and family who have provided
constant love and support.
If it weren’t for others believing in me when I didn’t,
I wouldn’t be where I am today. Remember, life is full
of opportunities to learn, so take it in, always look for
opportunities to learn, and share that knowledge with
the world.
—J ENNIFER D AVIS , BSN, RN, CBC
jennifertdavisrn@verizon.net
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CONTENTS

chapter 1 Other Causes of Disease, 18

The Disease Process, 1 Summary, 19
Introduction, 3 Online Resources, 19
Predisposing Factors, 3 Case Studies, 19
Hereditary Diseases, 4 Review Questions, 21
Classification of Hereditary Diseases, 4
Chromosomal Disorders, 7 chapter 2
Multifactorial Disorders, 7
Integrative Medicine and
Inflammation and Infection, 7
Fungi, 7 Complementary Therapies, 23
Protozoa, 8 The Changing Climate for
Viruses, 8 Complementary and Alternative
Bacteria, 9 Therapies, 25
Parasites, 9
Definition of Terms, 25
Trauma, 10
Head Trauma, 10 History of Conventional Medicine, 25
Chest Trauma, 11 History of Alternative Medicine, 25
Abdominopelvic Trauma, 11
Neck and Spine Trauma, 11 Integration of Both Worlds, 25
Extremities Trauma, 11 Separating Fact From Fallacy, 26
Effects of Physical and Chemical Alternative Systems of Medical Practice, 26
Agents, 11 Additional Therapies Referred to as
Extreme Heat and Cold, 11 Alternative, 27
Ionizing Radiation, 12 The Mind’s Connection With Health
Extremes of Atmospheric Pressure, 12 and Disease, 28
Electric Shock, 12 Managing Negative Emotions, 28
Poisoning, 12
Enhancing Positive Emotions, 29
Near Drowning, 12
Bites of Insects, Spiders, and Snakes, 12 Personal Responsibility, 30
Asphyxiation, 13 Influence of Lifestyle, 30
Burns, 13 Value of Good Nutrition, 30
Neoplasia and Cancer, 15 Stress and Distress, 31
Immune-Related Factors in Disease, 15 Love, Friendship, and Spirituality, 31
The Immune Response, 15 Summary, 31
Nutritional Imbalance, 17 Online Resources, 32
Malnourishment, 17
Vitamin Deficiencies and Excesses, 17 Case Studies, 32
Mineral Deficiencies and Excesses, 17 Review Questions, 33
Obesity, 17
Starvation, 18

xv
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xvi Contents

chapter 3 Infectious Disease as Potential

Pain and Its Management, 35 Weapons, 57
Anthrax, 57
Pain and Its Treatment Models, 36 Botulism, 58
Effective Pain Management, 37 Plague (Bubonic and Pneumonic), 59
Smallpox (Variola), 60
What Is Pain?, 37 Tularemia (Typhoidal or Pneumonic), 61
Definition of Pain, 37 Viral Hemorrhagic Fevers, 61
The Experience of Pain, 38
Mosquito-Borne Diseases, 62
Gate Control Theory of Pain, 39 West Nile Virus, 62
Assessment of Pain, 40 Malaria, 63
Treatment of Pain, 40 Viral Infections, 64
Medications, 40 Common Cold, 64
Influenza, 65
Complementary Therapies, 42
Physical Therapy, 42 Multidrug-Resistant Organisms, 66
Biofeedback, 43 Methicillin-Resistant Staphylococcus
Relaxation, 43 Aureus, 66
Imagery/Visualization, 43 Immunosuppressant Diseases, 67
Hypnosis, 43 Chronic Fatigue Syndrome, 67
Transcutaneous Electrical Nerve HIV Infection/AIDS, 68
Stimulation, 43
Massage, 43 Infectious and Communicable Diseases
Humor, Laughter, and Play, 43 of Childhood and Adolescence, 69
Music, 44 Infectious Diarrheal Diseases, 70
Acupuncture, 44 Rubeola (Measles), 70
Aromatherapy, 44 Rubella (German Measles), 71
Therapeutic Touch and Reiki, 44 Mumps, 72
Yoga/Tai Chi, 44 Varicella (Chickenpox), 73
Erythema Infectiosum (Fifth Disease), 74
Summary, 45 Pertussis (Whooping Cough), 75
Online Resources, 45 Diphtheria, 75
Tetanus (Lockjaw), 76
Case Studies, 45
Immunization, 77
Review Questions, 47
Summary, 78
chapter 4 Online Resources, 79
Infectious and Communicable Case Studies, 79
Diseases, 49 Review Questions, 81
Etiology of Infectious and Communicable
Diseases, 51 chapter 5
Emerging and Reemerging Infectious Cancer, 83
Diseases, 52 Description of Cancer, 84
Pandemics, 53 Definitions, 84
H1N1 Flu, 53 Statistics, 85
Escherichia coli O157:H7, 54 Etiology of Cancer, 85
Lyme Disease, 55 Carcinogens, 85
Coronaviruses: Severe Acute Respiratory Other Factors That Influence Cancer
Syndrome and Middle East Respiratory Development, 85
Syndrome, 56
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Contents xvii

Classification of Cancers, 87 Musculoskeletal System Diseases

Carcinomas, 87 and Disorders, 113
Sarcomas, 87 Clubfoot (Talipes), 113
Cancers of the Blood and Lymph, 87 Congenital Hip Dysplasia, 113
Duchenne Muscular Dystrophy, 114
Signs and Symptoms of Cancer, 87
Metabolic Errors, 115
Diagnostic Procedures for Cancer, 88
Cystic Fibrosis, 115
Grading and Staging Cancer, 88
Phenylketonuria, 115
Treatment of Cancer, 89
Syndromes, 116
Preventing Cancer, 92 Down Syndrome (Trisomy 21), 116
Summary, 93 Fetal Alcohol Syndrome, 117
Tourette Syndrome, 118
Online Resources, 93
Summary, 119
Case Studies, 93
Online Resources, 119
Review Questions, 95
Case Studies, 120
chapter 6 Review Questions, 121
Congenital Diseases
chapter 7
and Disorders, 97
Mental Health Diseases
Description, 99
and Disorders, 123
Cardiovascular System Diseases
and Disorders, 99 Integration of Health Care and Mental
Congenital Heart Defects, 99 Health Care, 125
Circulatory System Diseases Cost of Mental Health Care, 125
and Disorders, 103 Mental Health Insurance Coverage, 125
Sickle Cell Anemia, 103 Stigma, Safety, and Access to Mental
Health Treatment, 126
Nervous System Diseases
and Disorders, 104 Diagnostic Procedures, 126
Neural Tube Defects: Spina Bifida, Mental Status Examination, 126
Meningocele, and Myelomeningocele, 104
Hydrocephalus, 105 Nature Versus Nurture, 127
Cerebral Palsy, 106 Culture, Race, Age, and Gender, 127
Digestive System Diseases and Mental Health Disorders, 127
Disorders, 107 Depressive Illness, 127
Cleft Lip and Palate (Orofacial Clefts), 107 Bipolar, 130
Tracheoesophageal Fistula and Esophageal Schizophrenia, 132
Atresia, 108 Anxiety, 134
Pyloric Stenosis, 109 Trauma- and Stressor-Related Disorders,
Malrotation With Volvulus, 109 135
Hirschsprung Disease (Congenital Personality Disorders, 137
Aganglionic Megacolon), 110 Substance-Related and Addictive
Omphalocele, 111 Disorders, 138
Genitourinary System Diseases and Disorders Generally Diagnosed During
Disorders, 111 Childhood or Adolescence:
Undescended Testes (Cryptorchidism), 111 Neurodevelopmental Disorders, 142
Congenital Defects of the Ureter, Bladder,
and Urethra, 112
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Intellectual Disability (Intellectual Herpes-Related Skin Lesions, 177

Developmental Disorder), 142 Cold Sores and Fever Blisters, 177
Autism Spectrum Disorders, 143 Herpes Zoster (Shingles), 178
Attention Deficit-Hyperactivity Cancer, 179
Disorder, 144 Skin Carcinomas, 179
Feeding and Eating Disorders, 145 Malignant Melanoma, 180
Anorexia Nervosa, 145 Common Symptoms of Skin Diseases
Bulimia Nervosa, 146 and Disorders, 182
Sexual Dysfunctions, 147 Summary, 182
Genito-Pelvic Pain/Penetration
Disorder, 148 Online Resources, 182
Erectile Disorder, 148 Case Studies, 182
Female Sexual Interest/Arousal
Disorder, 149 Review Questions, 183
Premature Ejaculation, 150
Summary, 151 chapter 9
Online Resources, 151 Musculoskeletal Diseases
Case Studies, 151 and Disorders, 185
Review Questions, 153 Musculoskeletal System Anatomy
and Physiology Review, 186
chapter 8 Diseases and Disorders of Bones, 188
Deformities of the Spine: Lordosis,
Skin Diseases and Disorders, 155 Kyphosis, and Scoliosis, 188
Integumentary System Anatomy Herniated Intervertebral Disk, 190
and Physiology Review, 156 Osteoporosis, 191
Osteomyelitis, 193
Skin Lesions, 157 Paget Disease (Osteitis Deformans), 194
Psoriasis, 157 Fractures, 195
Urticaria (Hives), 160 Dislocations, 196
Acne Vulgaris, 160
Rosacea, 162 Joints, 197
Keratosis Pilaris, 162 Osteoarthritis, 197
Alopecia Areata, 163 Rheumatoid Arthritis, 198
Furuncles and Carbuncles, 164 Gout, 200
Pediculosis, 165 Muscles and Connective Tissue, 201
Decubitus Ulcers, 166 Sprains and Strains, 201
Corns and Calluses, 167 Bursitis and Tendonitis, 202
Dermatophytoses, 168 Carpal Tunnel Syndrome, 202
Scabies, 169 Plantar Fasciitis, 203
Impetigo, 170 Myasthenia Gravis, 204
Warts, 170 Polymyositis, 205
Vitiligo, 171 Systemic Lupus Erythematosus, 206
Scleroderma, 172 Fibromyalgia, 207
Dermatitis, 173 Cancer, 208
Seborrheic Dermatitis, 173
Contact Dermatitis, 174 Common Symptoms of Musculoskeletal
Latex Allergy, 175 Diseases and Disorders, 208
Atopic Dermatitis (Eczema), 175 Summary, 208
Neurodermatitis, 176
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Contents xix

Online Resources, 208 Chronic Neurological Diseases

and Disorders, 239
Case Studies, 209
Narcolepsy, 239
Review Questions, 211 Restless Leg Syndrome, 240
Cancer, 241
chapter 10 Tumors of the Brain, 241
Nervous System Diseases Common Symptoms of Nervous System
and Disorders, 213 Diseases and Disorders, 242
Nervous System Anatomy and Physiology Summary, 242
Review, 215 Online Resources, 242
Neurons, 215
Central Nervous System, 215 Case Studies, 242
Peripheral Nervous System, 216 Review Questions, 245
Autonomic Nervous System, 217
Meninges and Cerebrospinal Fluid, 218
chapter 11
Headache, 218
Acute and Chronic Headache, 218 Endocrine System Diseases
Migraine Headache, 220 and Disorders, 247
Head Trauma, 221 Endocrine System Anatomy and
Traumatic Brain Injury, 222 Physiology Review, 248
Cerebral Concussion, 222 Pituitary Gland Diseases
Cerebral Contusion, 223 and Disorders, 249
Subdural Hematoma (Acute), 224 Hyperpituitarism (Gigantism,
Abusive Head Trauma (Shaken Baby Acromegaly), 249
Syndrome), 225 Hypopituitarism, 252
Paralysis, 226 Diabetes Insipidus, 253
Hemiplegia, 226 Thyroid Gland Diseases and Disorders:
Paraplegia and Quadriplegia, 227 Hyperthyroidism, 254
Infections of the Central Nervous Simple Goiter, 255
System, 228 Graves Disease, 256
Meningitis, 228 Thyroid Gland Diseases and Disorders:
Peripheral Nervous System Diseases Hypothyroidism, 257
and Disorders, 230 Hashimoto Thyroiditis (Chronic
Peripheral Neuropathy, 230 Thyroiditis), 257
Bell Palsy, 230 Hypothyroidism (Cretinism, Myxedema), 258
Thyroid Cancer, 258
Cerebral Diseases and Disorders, 231
Cerebrovascular Accident (Stroke or Brain Parathyroid Gland Diseases and
Attack), 231 Disorders, 259
Transient Ischemic Attacks, 232 Hyperparathyroidism (Hypercalcemia), 259
Cerebral Aneurysm, 233 Hypoparathyroidism (Hypocalcemia), 261
Epilepsy, 234 Adrenal Gland Diseases and
Degenerative Neural Diseases and Disorders, 261
Disorders, 235 Cushing Syndrome, 262
Alzheimer Disease, 235 Addison Disease, 262
Parkinson Disease, 236
Multiple Sclerosis, 237
Amyotrophic Lateral Sclerosis, 238
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Pancreas and the Islets of Langerhans Anemias, 293

Diseases and Disorders, 263
Diabetes Mellitus, 263
Gonadal Diseases and Disorders, 266
Polycystic Ovary Syndrome, 266
Leukemias, 297
Common Symptoms of Endocrine
System Diseases and Disorders, 267
Summary, 268
Online Resources, 268
Iron-Deficiency Anemia, 293
Folic Acid Deficiency Anemia, 294
Pernicious Anemia, 295
Aplastic Anemia, 296
Acute Myeloid Leukemia, Acute
Lymphoblastic Leukemia, Chronic
Myeloid Leukemia, Chronic
Lymphocytic Leukemia, 297

Case Studies, 268 Lymphatic Diseases and Disorders, 299

Lymphedema, 299
Review Questions, 269
Lymphomas, 300
Hodgkin Lymphoma, 300
chapter 12 Non-Hodgkin Lymphoma
Cardiovascular and Lymphatic (Lymphosarcoma), 301
System Diseases and Common Symptoms of Cardiovascular
and Lymphatic Systems Diseases and
Disorders, 271 Disorders, 301
Cardiovascular and Lymphatic Systems
Summary, 302
Anatomy and Physiology Review, 273
Heart, 273 Online Resources, 302
Blood and Blood Vessels, 273 Case Studies, 302
Lymph and Lymph Vessels, 273
Review Questions, 305
Diseases of the Heart Muscle, 274
Pericarditis, 275
Myocarditis, 277 chapter 13
Endocarditis, 278 Respiratory System Diseases
Valvular Heart Diseases and and Disorders, 307
Disorders, 279
Mitral Insufficiency/Stenosis, 280 Respiratory System Anatomy
Aortic Insufficiency/Stenosis, 281 and Physiology Review, 309
Hypertensive Heart Disease, 282 Upper Respiratory Diseases
Essential Hypertension, 282 and Disorders, 311
Allergic Rhinitis, 311
Coronary Diseases and Disorders, 283 Sinusitis, 312
Coronary Artery Disease, 283 Pharyngitis, 313
Angina Pectoris, 284 Laryngitis, 314
Atrial Fibrillation, 285 Epiglottitis, 315
Myocardial Infarction (Heart Attack), 286 Infectious Mononucleosis, 315
Congestive Heart Failure, 287 Sleep Apnea, 316
Cardiac Arrest, 288
Lower Respiratory Diseases
Blood Vessel Diseases and Disorders, 289 and Disorders, 317
Aneurysms: Abdominal, Thoracic, and Pneumonia, 317
Peripheral Arteries, 289 Legionella Pneumonia (Legionnaires
Arteriosclerosis/Atherosclerosis, 291 Disease), 318
Thrombophlebitis, 292
Varicose Veins, 293
4451_FM_i-xxiv 08/01/16 9:28 AM Page xxi
Chronic Obstructive Pulmonary Disease:
Pulmonary Emphysema and Chronic
Bronchitis, 319
Asthma, 321
Lung Abscess, 322
Pulmonary Tuberculosis, 323
Pneumoconiosis, 324
Silicosis, 324
Asbestosis, 325
Berylliosis, 325
Anthracosis, 326
Respiratory Mycoses, 326
Pneumothorax (Collapsed Lung), 327
Atelectasis, 328
Pleurisy (Pleuritis), 329
Pleural Effusion, 330
Pulmonary Hypertension, 330
Pulmonary Edema, 331
Cor Pulmonale, 332
Pulmonary Embolism, 332
Respiratory Acidosis (Hypercapnia), 333
Respiratory Alkalosis (Hypocapnia), 334
Lung Cancer, 335
Childhood Respiratory Diseases
and Disorders, 336
Sudden Infant Death Syndrome, 336
Acute Tonsillitis, 337
Adenoid Hyperplasia, 337
Thrush, 338
Croup, 338
Common Symptoms of Respiratory
Diseases and Disorders, 339
Summary, 339
Online Resources, 339
Case Studies, 340
Review Questions, 341
chapter 14
Digestive System Diseases
and Disorders, 343
Digestive System Anatomy and
Physiology Review, 345
Upper Gastrointestinal Tract, 347
Stomatitis (Herpetic and Aphthous), 347
Gastroesophageal Reflux Disease (Barrett
Esophagus), 349
Contents xxi
Gastritis, 350
Peptic Ulcers, 351
Gastroenteritis, 352
Infantile Colic, 353
Lower Gastrointestinal Tract, 353
Celiac Disease (Gluten-Induced
Enteropathy), 353
Irritable Bowel Syndrome, 355
Inflammatory Bowel Disease, 356
Crohn Disease (Regional Enteritis,
Granulomatous Colitis), 356
Ulcerative Colitis, 357
Diverticular Disease (Diverticulosis and
Diverticulitis), 358
Acute Appendicitis, 359
Hemorrhoids, 360
Problematic Digestive System
Symptoms, 361
Constipation, 361
Diarrhea, 362
Hernias, 363
Hiatal Hernia, 363
Abdominal and Inguinal Hernias, 364
Diseases of Accessory Organs of
Digestion: Pancreas, Gallbladder,
and Liver, 365
Pancreatitis, 365
Cholelithiasis and Cholecystitis, 366
Cirrhosis, 367
Viral Hepatitis (A, B, C, D, E), 368
Cancers of the Digestive System and
Accessory Organs, 370
Colorectal Cancer, 370
Pancreatic Cancer, 371
Common Symptoms of Digestive System
Diseases and Disorders, 372
Summary, 372
Online Resources, 372
Case Studies, 373
Review Questions, 375
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xxii Contents

chapter 15 Sexually Transmitted Diseases, 402

Urinary System Diseases Gonorrhea, 402
Genital Herpes, 403
and Disorders, 377 Genital Human Papillomavirus (HPV)
Urinary System Anatomy and Physiology Infection, 404
Review, 378 Syphilis, 405
Trichomoniasis, 406
Infections of the Urinary System, 380 Chlamydial Infections, 407
Cystitis and Urethritis, 380 Common Symptoms of Sexually
Pyelonephritis (Acute), 382 Transmitted Diseases (STDs), 408
Glomerulonephritis (Acute), 383
Male Reproductive Diseases and
Kidney Diseases and Disorders, 384 Disorders, 408
Renal Calculi (Uroliths or Kidney Benign Prostatic Hyperplasia, 408
Stones), 384 Prostatitis, 409
Hydronephrosis, 385 Epididymitis, 410
Acute Tubular Necrosis, 386 Prostatic Cancer, 410
Nephrotic Syndrome, 387 Testicular Cancer, 411
Polycystic Kidney Disease, 388 Common Symptoms of Male Reproductive
End-Stage Renal Disease, 388 Diseases and Disorders, 412
Other Urinary Diseases and Female Reproductive Diseases
Disorders, 390 and Disorders, 412
Neurogenic or Overactive Bladder, 390 Premenstrual Syndrome, 412
Cancers of the Urinary System, 391 Amenorrhea, 413
Bladder Cancer, 391 Dysmenorrhea, 414
Renal Cell Carcinoma or Kidney Ovarian Cysts and Tumors, 414
Cancer, 392 Endometriosis, 415
Uterine Leiomyomas, 416
Common Symptoms of Urinary System Pelvic Inflammatory Disease, 417
Diseases and Disorders, 393 Menopause, 418
Summary, 393 Ovarian Cancer, 419
Online Resources, 393 Diseases and Disorders of the
Breasts, 420
Case Studies, 393 Fibrocystic Breasts, 420
Review Questions, 395 Benign Fibroadenoma, 420
Carcinoma of the Breast, 422
chapter 16 Common Symptoms of Female
Reproductive System Diseases Reproductive System Diseases
and Disorders, 424
and Disorders, 397
Diseases and Disorders of Pregnancy
Reproductive System Anatomy and and Delivery, 424
Physiology Review, 399 Spontaneous Abortion, 424
Male Reproductive System, 399 Ectopic Pregnancy, 425
Pregnancy-Induced Hypertension
Female Reproductive System, 400 (Preeclampsia and Eclampsia), 425
Sexual Health, 401 Placenta Previa, 426
Abruptio Placentae, 427
Infertility, 401 Premature Labor/Premature Rupture of
Male Infertility and Female Infertility, 401 Membranes, 427
4451_FM_i-xxiv 08/01/16 9:28 AM Page xxiii

Contents xxiii

Common Symptoms of Diseases and Ear Diseases and Disorders, 447

Disorders of Pregnancy and Delivery, 428 External Otitis (Swimmer’s Ear), 448
Otitis Media, 448
Summary, 428
Otosclerosis, 450
Online Resources, 428 Motion Sickness, 450
Case Studies, 429 Ménière Disease, 451
Hearing Loss and Deafness, 452
Review Questions, 431 Common Symptoms of Ear Diseases
and Disorders, 453
chapter 17 Summary, 453
Eye and Ear Diseases Online Resources, 453
and Disorders, 433 Case Studies, 453
Eye and Ear Anatomy and Physiology Review Questions, 455
Review, 434
Eyes, 434 Appendix 1: Diagnostic Procedures, 457
Ears, 435 Appendix 2: References, 467
Eye Diseases and Disorders, 436 Appendix 3: Abbreviations, 471
Refractive Errors, 436
Nystagmus, 438 Glossary, 475
Stye (Hordeolum), 438 Subject Index, 485
Corneal Abrasion, 439
Cataract, 440 Index of Diseases and Disorders, 505
Glaucoma, 440
Retinal Detachment, 441
Age-Related Macular Degeneration, 442
Strabismus, 444
Eye Inflammations, 445
Conjunctivitis, 445
Uveitis, 445
Blepharitis, 446
Keratitis, 447
Common Symptoms of Eye Diseases and
Disorders, 447
4451_FM_i-xxiv 08/01/16 9:28 AM Page xxiv
4451_Ch01_001-022 28/12/15 2:37 PM Page 1
All interest in disease and death is only another expression of interest in life.
—T H O M A S M A N N
● chapter outline
INTRODUCTION
PREDISPOSING FACTORS
HEREDITARY DISEASES
Classification of Hereditary Diseases
Chromosomal Disorders
Multifactorial Disorders
INFLAMMATION AND INFECTION
Fungi
Protozoa
Viruses
Bacteria
Parasites
TRAUMA
Head Trauma
Chest Trauma
Abdominopelvic Trauma
Neck and Spine Trauma
Extremities Trauma
EFFECTS OF PHYSICAL AND CHEMICAL
AGENTS
Extreme Heat and Cold
Ionizing Radiation
● key words
Amino acid (ă•mē'nō ă'sı̆d)
Analgesic (ăn''ăl•jē'sı̆k)
Anaphylaxis (ăn''ă•f ı̆•lăk'sı̆s)
1
The Disease Process
Extremes of Atmospheric Pressure
Electric Shock
Poisoning
Near Drowning
Bites of Insects, Spiders, and Snakes
Asphyxiation
Burns
NEOPLASIA AND CANCER
IMMUNE-RELATED FACTORS IN DISEASE
The Immune Response
NUTRITIONAL IMBALANCE
Malnourishment
Vitamin Deficiencies and Excesses
Mineral Deficiencies and Excesses
Obesity
Starvation
OTHER CAUSES OF DISEASE
SUMMARY
ONLINE RESOURCES
CASE STUDIES
REVIEW QUESTIONS
Antibody (ăn'tı̆•bŏd''ē) Chromosome (krō'mō•sōm)
Antiemetic (ăn''tı̆•ē•mĕt'ı̆k) Diuretic (dī''ū•rĕt'yk)
Antigen (ăn'tı̆•jĕn) Dyspnea (dı̆sp•nē'ă)
(key words continues)
1
4451_Ch01_001-022 28/12/15 2:37 PM Page 2

(key words continued)

Edema (ĕ•dē'mă)
Erythema (ĕr''ı̆•the'mă)
Genotype (jĕn'ō•tīp)
Heterozygous
(hĕt''er•ō•zī'g ŭs)
Homeostasis
(ho''mē•ō•stā'sı̆s)
Homozygous (hōm''ō•zī'g ŭs)
Hypovolemic shock
(hī''pō•vō•lē'mı̆k shŏk)
Hypoxemia (hī''pŏks•ē'mē•ă)
Incontinence (ı̆n•kŏn'tı̆•nĕns)
Lymphadenopathy
(lı̆m•făd''ĕ•nŏp'ă•thē)
Macrophage (măk'rō•fāj)
Metastasis (mĕ•tăs'tă•sı̆s)
Nosocomial (nŏs''ō•kō'mē•ăl)
Osteomalacia
(ŏs''tē•ō•măl•ā'shē•ă)
Pathogenic (păth''ō•jĕn'ı̆k)
Phagocytosis (făg''ō•sī•tō'sı̆s)
Phenotype (fē'nō•tīp)
Polymorphonuclear
leukocyte
(pŏl''ē•mōr''fō•nū'klē•ăr
loo'kō•sīt)
Pruritus (proo•rī't ŭs)
Sequela (sē•kwē'lă)
Stridor (strī'dōr)
Syncope (sı̆n'kō•pē)
Syndrome (sı̆n'drōm)
Tachycardia (tăk''ē•kăr'dē•ă)
Urticaria (ŭr''tı̆•kā'rē•ă)

● learning outcomes
On successful completion of this chapter, you will be able to:
• Interpret key terms.
• Explain three ways the body is protected from
disease.
• Contrast illness and disease.
• Restate the predisposing factors of disease.
• Identify the three classifications of hereditary
diseases.
• Describe the genetic activity of DNA.
• Distinguish between genotype and phenotype.
• Categorize the common types of monogenic
disorders, giving an example of each.
• Explain chromosomal disorders and give at least
one example.
• Summarize multifactorial disorders and give at least
one example.
• Restate the process of inflammation.
• Describe how infections are transmitted.
• Compare the five main groups of microorganisms.
• Recall trauma statistics and major trauma injuries.
• Compare/contrast concussion, traumatic brain
injury, and contusion.
• Restate the physical and chemical agents that may
cause disease.
• Compare “Rule of Nines” and “Lund and
Browder’s” burn charts.
• Compare neoplasm to cancer.
• Contrast benign and malignant tumors.
• Differentiate between:
• Natural and acquired immunity
• Humoral and cell-mediated immunity
• B-cell and T-cell immunity
• Active and passive immunity
• Describe three malfunctions of the immune
response and recognize an example of each.
• Recognize allergic reactions.
• Explain how anaphylactic shock can occur in any
of the allergic reactions.
• Recognize the main examples of nutritional
imbalance.
• Calculate your personal body mass index.
• Differentiate between idiopathic and iatrogenic
causes of disease.

2
4451_Ch01_001-022 28/12/15 2:37 PM Page 3
CHAPTER EPISODE—PART I
Ian Sumner was a rough-and-tumble kid. He was a
daredevil. He played junior peewee football when he
was only 8 years old. On many occasions, he hurt his
head in play and practice but never experienced any
problems as a result. When he discovered soccer, he
quit football because he did not like having to wear
all the heavy protective gear. He was a good player,
good enough to play in college. He butted the ball
with his head too many times to keep track. One
time, he got hit exceptionally hard and afterward was
confused and disorientated. Another time he was in-
volved in an automobile crash, which threw him into
the windshield. He was unconscious when the medics
arrived but did not seem to suffer any serious injury.
• Should Ian be concerned about his personal and med-
ical history?
• Justify your response.
INTRODUCTION
Despite a rapid increase in the number of medical
research discoveries and the phenomenal development
in technology, accompanied by society’s increased
awareness of wellness and health, we have not been able
to eradicate disease. An ideally designed body would be
free from disease, and a careful study of body chemistry
and cellular function does reveal a blueprint for main-
taining a disease-free state. The body is protected
in three ways: (1) Normal body structures function
to block the entry of germs through the use of tears,
mucous membranes, intact skin, cilia, and body pH;
(2) the inflammatory response rushes leukocytes to a
site of infection, where the invading organisms are en-
gulfed and destroyed in a process called phagocytosis;
(3) specific immune responses of the body react to
foreign antigens to protect and defend against disease.
Disease is a pathological condition of the body that
occurs in response to an alteration in the normal body
harmony. Disease is usually tangible or measurable. It
may be the direct result of trauma, physical agents, and
poisons, or it may be the indirect result of genetic
anomalies and metabolic and nutritional disturbances.
There is a difference between illness and disease.
Illness describes the condition of a person who is expe-
riencing a disease. It encompasses the way in which
individuals perceive themselves as suffering from a dis-
ease. Illness is highly individual and personal. A disease,
on the other hand, is known by its medical classification
and distinguishing features. For most health-care
providers, a disease is easier to treat than an illness.
Proper and effective medical management, however,
attends to both the disease and the illness.
The Disease Process 3
Fear, anxiety, embarrassment, and concern about
the cost of treatment or about possible incapacity or
disfigurement may be some of the troubling emotions
persons feel when faced with an illness. Some people
desire to know everything about their particular dis-
ease; others choose complete ignorance. The medical
community is generally expected to have a “cure,” but
not many individuals understand the importance of
their participation in the “getting well” process.
This chapter provides a brief synopsis of the causes
of disease and disorders. When considering the dishar-
mony that occurs in the body in the form of disease,
remember the harmony that exists most of the time.
PREDISPOSING FACTORS
A predisposing factor is a condition or situation that may
make a person more at risk or susceptible to disease.
Some predisposing factors include heredity, age, gen-
der, environment, and lifestyle.
Heredity is a predisposing factor when a trait inher-
ited from a parent puts an individual at risk for certain
diseases. Heredity is not easily controlled, changed, or
altered. Cystic fibrosis (ICD-10: E84.9), sickle cell
anemia (ICD-10: D57.1), and trisomy 21 or Down
syndrome (ICD-10: Q90.9) are examples of heredi-
tary diseases related to genetic abnormalities.
Age is a risk factor related to the life cycle. For ex-
ample, adenoid hyperplasia (ICD-10: J35.2), acute ton-
sillitis (ICD-10: J03.90), and otitis media (ICD-10:
H66.90) are more common among children than
adults. Older adults are at greater risk than younger
adults for degenerative arthritis (ICD-10: M15.9 or
M19.90) and senile dementia (ICD-10: F03.9). Older
adults have unique problems that arise from the aging
process itself. Physiological changes occur in the body
systems, and some of these changes can cause functional
impairment. Older persons generally experience prob-
lems with temperature extremes, have lowered resist-
ance to disease as the result of decreased immunity, and
have less physical activity tolerance.
Gender is a predisposing factor when the disease is
physiologically based. For example, prostate cancer
(ICD-10: C61, C79.82, D07.5) occurs only in men;
ovarian cancer (ICD-10: C56.9, C79.60, D09.10, or
D09.19) occurs only in women. Men are more likely to
develop gout (ICD-10 M10.00), whereas osteoporosis
(ICD-10: M81.0) is more common in women. How-
ever, lung cancer (ICD-10: C34.90, C78.00, D02.20)
is as prevalent in women as in men. Also, women
experience heart disease as often as men do.
The external environment can be a risk factor. Expo-
sure to air, noise, and other environmental pollutants
may predispose individuals to disease. For example,
drinking water became contaminated with methane
during drilling at some fracking sites because of faulty
4451_Ch01_001-022 28/12/15 2:37 PM Page 4
4 Diseases of the Human Body
well construction. With a warming climate and in-
creased logging in our forests, new fungal growths are
now identified where they previously did not exist.
Some geographical locations have a higher incidence of
insect bites and exposure to venom. Living in rural areas
where fertilizers and pesticides are commonly used can
predispose individuals to disease. Even office employees
may be affected by environmental or occupational
health problems, as seen with carpal tunnel syndrome
(ICD-10: G56.00) and eye strain, which can result
from heavy computer use.
Lifestyle choice may predispose some diseases.
Lifestyle is the consistent, integrated way of life of an
individual, as typified by mannerisms, attitudes, and
possessions. From the time a person is born, lifestyle
is influenced by (1) modeling of family members
and peers, (2) education and knowledge, (3) personal
attitudes, (4) degree of self-confidence, (5) individual
responsibilities, and (6) life’s opportunities. Lifestyle
choices have great influence, whether positive or
negative, on personal health and the health of
others.
An increasing number of individuals suffer from such
diseases as diabetes, heart disease, and some cancers that
are preventable or delayed when lifestyle factors are
appropriately addressed. Numerous medical studies
identify highly effective preventive measures and
lifestyle choices that include following a healthy diet,
exercising regularly, maintaining an ideal weight, man-
aging stress, and quitting smoking.
HEREDITARY DISEASES
The problem with the gene pool is there is no lifeguard. —
David Gerrold
Hereditary diseases are the result of a person’s
genetic makeup. It is uncertain to what extent
environmental factors influence the course of a hered-
itary disease, but the two do interact. Hereditary dis-
eases do not always appear at birth. Mild hemophilia
(ICD-10: D66) and muscular dystrophy (ICD-
10: G71.0) may go undetected until adolescence or
adulthood.
Thousands of genetic diseases are identified in
humans—some are fatal. All genetic information is
contained in DNA, a complex molecular structure
found in the nucleus of cells. The DNA is incorpo-
rated into structures called chromosomes. The
normal number of chromosomes in humans is 46
(23 pairs). In the formation of the ovum and sperm
cells (sex cells, or gametes), this number is reduced by
half, with each gamete having 23 chromosomes.
When the two sex cells unite at the time of fertiliza-
tion, the 23 chromosomes from the ovum combine at
random with the 23 chromosomes from the sperm,
producing a cell with a full complement of 46 chromo-
somes. Two of these chromosomes determine sex.
A gene is the basic unit of heredity. Each gene con-
sists of a fixed segment of the DNA on a specific chro-
mosome. Physical traits are the result of the expression
of gene pairs. Gene pairs are homozygous when they
possess identical genes from each parent for a particular
trait and when they are both dominant (one parent con-
tributes) or both recessive (both parents contribute) in
their expression of a trait. Gene pairs are heterozy-
gous when they possess different genes from each par-
ent for a particular trait and if one gene is dominant and
one is recessive. Recessive genes are expressed only
when the gene pair is homozygous, whereas dominant
genes are expressed whether the gene pair is homozy-
gous or heterozygous.
To determine a person’s genetic makeup, a family
history is taken to ascertain their genotype, which
is a description of the combination of a person’s genes
with respect to either a single trait or a larger set of
traits. Genotype includes all of the genes that are in-
herited from one’s parents. The phenotype consists
of the observable physical characteristics, determined
by the combined influences of a person’s genetic
makeup and the effects of environmental factors.
Phenotype is revealed in a person’s appearance—the
color and texture of the hair, shape of the nose,
height, and so on.
An X- or sex-linked hereditary disease can occur
when one parent contributes a defective gene from the
sex chromosome. In color blindness (ICD-10: H53.50),
the inability to distinguish reds from greens is the result
of a recessive gene located on the X chromosome. The
trait shows up when there is no dominant gene for
normal color vision to override the recessive gene.
Changes in the structure of genes, called mutations,
may cause disturbances in body functions. Mutations
occur when the normal sequence of DNA units is dis-
rupted. How such a disruption is manifested depends
on whether the affected gene is dominant or recessive
and whether it is homozygous or heterozygous. The
causes of mutations are largely unknown, but they could
be the result of environmental factors, such as exposure
to certain chemicals or radiation.
Classification of Hereditary Diseases
Genetic diseases are the result of monogenic (Mendelian)
alterations, chromosome aberrations, and multifactorial
errors and are classified similarly.
Monogenic (Mendelian) Disorders
Monogenic disorders are those caused by mutation in a
single gene. The way in which the disorder is passed on
to succeeding generations (the pattern of inheritance) is
determined by whether the gene is dominant, recessive,
4451_Ch01_001-022 28/12/15 2:38 PM Page 5

The Disease Process 5

or sex-linked. (A sex-linked gene is carried on the X chro- have the defect. Examples of autosomal-dominant
mosome. Because males have only one X chromosome, a diseases include:
sex-linked gene will be expressed in males whether it is
• Huntington disease (ICD-10: G10): Also called
dominant or recessive.) Figure 1.1 illustrates the three
Huntington chorea, this disease is caused by a
most common patterns of inheritance of monogenic dis-
genetic defect on chromosome 4 that results in
orders. Monogenic disorders are classified as autosomal
the degeneration of neurons in certain areas of
dominant, autosomal recessive, X- or sex-linked, chro-
the brain. Individuals show signs of uncontrolled
mosomal, and multifactorial. They are described below.
movements, emotional disturbances, and mental
deterioration. Symptoms often do not develop
Autosomal Dominant until the affected person is in their 30s or 40s. Beta
Only one abnormal gene from a parent is needed for an blockers are often given to minimize abnormal
autosomal-dominant gene disease to be inherited. One movements and behavior. The medications tetra-
parent often has the disease. When one parent has the benazine (Xenazine) and amantadine (Symmetrel)
faulty gene, there is a 50% chance the offspring will can reduce the jerky, involuntary movements of the

Patterns of Inheritance
Monogenic Disorders

I
1 2

II
1 2 3

III
1 2 3
A. Autosomal dominant

I 1 2

II
1 2 3 4

III F i g u re 1 . 1 Patterns of inheritance monogenic

1 2 3 4 5
disorders.
A. Pedigree displaying autosomal-dominant
B. Autosomal recessive inheritance. Autosomal-dominant traits can
be inherited by either gender. The female
individual I-1 is heterozygous autosomal
I dominant. If she were homozygous for the
1 2 mutant trait, then all progeny in generation II
would show the trait.
B. Pedigree displaying autosomal-recessive
II inheritance. Autosomal recessive traits can be
1 2 3 inherited by either gender. A recessive allele
needs to be inherited from both the mother
and the father for the trait to be seen. Reces-
III sive traits may not be seen for several genera-
1 2 3 4 5 6 tions, as shown by the progenies III-3 and III-4,
who received both alleles.
C. Pedigree showing sex-linked inheritance. Males
IV
are most often affected by sex-linked disor-
1 2 3 4 5 6 7 ders due to a mutation on the X chromo-
C. Sex linked some. The II-3 male is affected, so his mother,
individual I-1, must have been a carrier. The
Key: female individuals II-2 and III-3 each had a son
with the trait, so both are carriers. Notice
Female Affected Female Parents
that the female individual III-1 had progeny
with a male that carries the mutant trait. The
female progeny IV-1 shows the trait because
Male Affected Male Siblings she inherited two mutant X chromosomes,
so III-1 must also be a carrier.
4451_Ch01_001-022 28/12/15 2:38 PM Page 6
6 Diseases of the Human Body
disease by increasing the amount of dopamine avail-
able in the brain.
• Retinoblastoma (ICD-10: C69.20): A rare type of
eye cancer that develops in the retina, retinoblas-
toma appears in early childhood and tends to occur
in only one eye. The cancer often can be cured if
diagnosed early, but it can spread to other areas of
the body and become life-threatening. Treatment
is varied and partially dependent on the spread of
the disease.
Autosomal Recessive
There must be two copies (both parents) of the abnor-
mal gene in order for an autosomal-recessive disease or
trait to develop. Some examples include:
• Cystic fibrosis: This is a chronic, generalized disease
that affects the cells that produce mucus, sweat,
and digestive juices. The defective gene makes the
secretions thick and sticky, causing tubes, ducts,
and passageways to become clogged. The glands
primarily affected are the pancreas, respiratory
system, and sweat glands (see Chapter 6).
• Tay-Sachs disease (ICD-10: E75.02): This disease is
a rare lipid abnormality in which harmful amounts
of fatty substances build up in the nerve cells of the
brain and spinal cord. It is distinguished by progres-
sive neurological deterioration and a cherry-red spot
with a gray border on both retinas. It chiefly affects
infants of Eastern European Jewish (Ashkenazi)
ancestry. It is also seen in certain French Canadian
areas of Quebec, the Old Order Amish community
in Pennsylvania, and the Cajun population of
Louisiana. The progressing disease can result in
deafness, blindness, and paralysis. Recurrent
bronchopneumonia is a problem after age 2.
Death usually occurs by age 5.
• Phenylketonuria (PKU): PKU is a rare inherited
disease caused by an inability to metabolize phenyl-
alanine, an essential amino acid. Amino acids
are organic compounds that constitute the primary
building blocks of proteins. Mental disability results
unless a special diet begins within the first few
weeks of life (see Chapter 6).
• Sickle cell anemia: A disease affecting mostly black
populations around the world, it is one of the most
common single-gene disorders. It occurs because
the body produces a defective form of hemoglobin
that causes red blood cells to roughen and become
sickle shaped when deoxygenated. These cells clump
together, making it difficult for them to pass
through blood vessels (see Chapter 6).
X- or Sex-Linked
Dominant X-linked diseases occur when a single abnor-
mal gene on the X chromosome can cause a disease;
this abnormal gene dominates the gene pair. There
are only a few known dominant X-linked diseases,
including:
• Vitamin D–resistant rickets (ICD-10: E83.39,
E83.31, E83.30, E83.32): This disease is defined
as such because it is resistant to the vitamin D
treatment usually given for rickets and is evidenced
by deficient amounts of mineral in the cartilage
growth plates and by osteomalacia, or softening
of the bones.
• Rett syndrome (ICD-10: F84.2): This is a severe
disorder affecting the way the brain develops. It oc-
curs most frequently in girls, producing symptoms
similar to autism. Children with Rett syndrome
have problems with motor functions that affect
their ability to speak, walk, chew, use their hands,
and even breathe. They may need a feeding tube in
order to get sufficient dietary nutrients.
Recessive X-linked diseases occur when both of the
genes in a pair are abnormal. If only one gene in the
pair is abnormal, the disorder is quite mild or does not
show at all. The two identified here are hemophilia and
Duchenne muscular dystrophy:
• Hemophilia: This rare bleeding disorder is caused
by a deficiency of specific types of serum proteins
called clotting factors. A person with hemophilia
bleeds longer following any kind of injury because
the blood does not clot normally. Hemophilia can
be mild, moderate, or severe, depending on how
much clotting factor is in the blood. It is more
common in males.
• Duchenne muscular dystrophy: This disorder
manifests as a progressive bilateral wasting of
skeletal muscles in males. Symptoms appear
between ages 2 and 5 and include difficulty
walking. The child has a stumbling gait and
falls easily (see Chapter 6).
Chromosomal Disorders
Chromosomal disorders are caused by abnormalities
in the number of chromosomes or by changes in chromo-
somal structure, such as additions (more than necessary),
deletions (missing genes), or translocations (genes shifted
from one chromosome to another or to a different loca-
tion on the same chromosome). Diseases caused by
chromosomal alterations include:
• Klinefelter syndrome (ICD-10: Q98.4): This condi-
tion occurs when there is an additional X chromo-
some in males. The male body shape is elongated,
the testes are small, the mammary glands are abnor-
mally large, and men with this syndrome do not
produce sperm.
• Turner syndrome (ICD-10: Q96.9): This condi-
tion is caused by the loss of or an incomplete
4451_Ch01_001-022 28/12/15 2:38 PM Page 7
X chromosome in either the ovum or the sperm.
It affects only females and is often characterized
by shortened stature; swollen hands and feet; and
coarse, enlarged, prominent ears. Most females
affected are infertile.
• Trisomy 21 or Down syndrome: This is a condition
in which an individual has three copies of chromo-
some 21 instead of two; it is more likely to occur in
children born to parents aged 35 to 50. Infants with
this condition typically have a sloping forehead and
folds of skin over the inner corners of their eyes,
and they may have heart defects. They generally
show evidence of moderate to severe mental disabil-
ity. This condition is one of the most common birth
defects (see Chapter 6).
Multifactorial Disorders
Multifactorial disorders result from the interaction of
many factors, both hereditary (mutations in multiple
genes) and environmental. Among the multifactorial
diseases are:
• Diabetes mellitus: This disorder of carbohydrate,
fat, and protein metabolism is due primarily to
insufficient insulin production by the pancreas
(see Chapter 11).
• Congenital heart anomalies: This category includes
six major anatomic defects that change the blood
flow through the heart, causing circulatory problems
(see Chapter 6).
INFLAMMATION AND INFECTION
Inflammation is the body’s immunologic response
to tissue damage caused by the invasion of foreign
bodies, microorganisms, or harmful chemicals. This
invasion may result from trauma; physical agents
(e.g., temperature extremes, radiation) or chemical
agents (e.g., poisons, venoms); allergens; and disease-
producing, or pathogenic, organisms (e.g., bacteria,
viruses, fungi). Inflammation occurs when microor-
ganisms gain entry into the body, most likely through
a break in the skin. How well the body responds
to inflammation depends on (1) an individual’s
general health, nutritional state, and age; (2) tissue
factors; and (3) type of physical irritant.
Inflammation may be acute or chronic. In its acute
phase, there is redness, swelling, pain, heat, and maybe
even loss of function. At a site of injury, there are a large
number of polymorphonuclear leukocytes, which
are white blood cells (WBCs) that possess a nucleus
composed of 200 or more lobes or parts. Examples
of acute inflammation include insect bites, mild burns,
and minor abrasions and cuts. The inflammation may
persist, spread to adjacent or distant tissue, and become
chronic. In chronic inflammation, there is an increase
The Disease Process 7
in the number of lymphocytes, monocytes, and plasma
cells.
When microorganisms gain entry into the body, they
release a toxin that causes the capillaries of the host to
become permeable and allow access to WBCs—hence,
the redness, swelling, heat, and pain. Factors that help
in abating the inflammatory response include topical
applications of ice packs, adequate hydration and
nutrition, rest, and good blood supply. NSAIDs such
as ibuprofen (e.g., Aleve, Advil) are useful in managing
inflammation.
Inflammation is a beneficial biological response in
most instances; however, if it becomes chronic, inflam-
mation can be debilitating, as is the case in rheumatoid
arthritis. Whatever the cause of inflammation, it is the
body’s protective response.
Infection is the invasion and multiplication of
pathogenic or disease-producing microorganisms in
the body. Most microorganisms in the body are
nonpathogenic and are often necessary to maintain
homeostasis, a state of stability that the body tries
to maintain even though it is exposed to continually
changing outside forces. When one or more of the
requisite factors in the infectious process are present,
a microorganism can become a potential pathogen.
People as well as animals serve as hosts for organ-
isms. A host does not necessarily have to be “diseased”
or “sick” but simply serves as a reservoir for the
microorganisms. Transmission can be through expo-
sure to a host’s coughing or sneezing, through touch-
ing something contaminated by the infected host, or
through direct contact with the microorganism. If the
receiving host is not susceptible, then the microorgan-
ism has little chance of becoming a pathogen. The
susceptible host, however, may have low resistance
or provide the microorganism with an unusual means
of entry, such as an open wound.
Whenever a pathogenic microorganism finds a suit-
able environment for growth in an appropriate host,
disease may result. Growth factors for microorganisms
vary and include the presence or absence of oxygen, a
ready source of food, an optimal temperature, moisture,
and darkness.
The most common microorganisms that cause
disease can be classified as fungi, protozoa, viruses,
bacteria, and parasites.
Fungi
This group includes yeasts and molds that may be
present in the soil, air, and water. Only a few species
cause disease (Fig. 1.2). Fungal diseases, called mycoses,
usually develop slowly, are resistant to treatment, and
are rarely fatal. The more common mycoses include
histoplasmosis, coccidioidomycosis, and thrush (see
Chapter 13); tinea corporis, or ringworm; and tinea
pedis, or athlete’s foot (see Chapter 8).
4451_Ch01_001-022 28/12/15 2:38 PM Page 8

8 Diseases of the Human Body

A Yeast (x 750) B Rhizopus (x 40) C Aspergillis (x 40)

Figu r e 1 .2 Fungi. (From Scanlon, VC,

and Sanders, T: Essentials of Anatomy and
Physiology, ed. 5. FA Davis, Philadelphia, D Ringworm (x 750) E Cryptococcus (x 500) F Pneumocystis jiroveci
2007, p 513, with permission.) (x 1200)

Protozoa
These single-celled organisms have animal-like charac-
teristics (Fig. 1.3). Malaria (ICD-10: B50.9 or B50.8),
amebic dysentery (ICD-10: A06.0), and African
sleeping sickness (ICD-10: B56.9) are examples of pro-
tozoan diseases. Trichomonas vaginalis is a protozoon
that causes trichomoniasis or vaginitis, a disease fairly
common among women.
Viruses
These are the smallest microorganisms, visible only
through the use of electron microscopy. Figure 1.4
illustrates common viruses and compares the size of the
three viruses with that of the Escherichia coli bacillus.
Viruses are independent of host cells, they are difficult
to isolate, and few respond to drug therapy. Viruses
may remain dormant in a host for long periods before

Red blood
cells

A Entamoeba histolytica B Giardia lamblia C Trypanosoma

(x 800) (x 1200) (x 500)

Red blood
cells

Figu r e 1 .3 Protozoa. (From Scanlon, VC,

and Sanders, T: Essentials of Anatomy and Physiol-
ogy, ed. 5. FA Davis, Philadelphia, 2007, p 514, with D Plasmodium E Toxoplasma gondii F Babesia microti
(x 500) (x 1200) F Babesia
(x 1000)microti
permission.)
(x 1200)
4451_Ch01_001-022 28/12/15 2:38 PM Page 9
A B C
D VC, and Sanders, T: Essentials of Anatomy and
E
becoming active. Viral infections include the common
cold, West Nile virus, measles, mumps, rabies (ICD-10:
A82.9), chickenpox, herpesviruses, poliomyelitis,
hepatitis, influenza, and certain types of pneumonia
and encephalitis.
Bacteria
There are many varieties of these single-celled organisms.
Most are nonpathogenic and useful. Bacteria, including
those that cause disease, are classified according to their
shape (Fig. 1.5).
• Bacilli are rod-shaped bacteria. Diseases caused
by bacilli include tuberculosis, whooping cough,
tetanus, typhoid fever, and diphtheria.
• Spirilla are spiral-shaped bacteria. Diseases caused
by spirilla include syphilis and cholera (ICD-10:
A00.0).
• Cocci are dot-shaped bacteria. Diseases caused
by cocci include gonorrhea, meningitis, tonsillitis
(ICD-10: J03.90), bacterial pneumonia, boils
(ICD-10: L02), scarlet fever (ICD-10: A38.9),
sore throats (ICD-10: J02.9), and certain skin and
urinary infections.
Parasites
This is a group of host-requiring organisms that in-
cludes external and internal parasites. External parasites
A Bacillus B Spirillum
The Disease Process 9
F i g u re 1 . 4 Viruses: representative
shapes and relative sizes. (From Scanlon,
Physiology, ed. 5. FA Davis, Philadelphia, 2007,
p 511, with permission.)
include lice and mites (insects) and are discussed in
Chapter 8. Helminths (ICD-10: B83.9) are wormlike
internal parasites that are typically transmitted from
person to person via fecal contamination of food, water,
or soil. Three classes of helminths may infect humans
(Fig. 1.6):
• Pinworms (ICD-10: B80) are the most common
worm infection in the United States. They look like
small threads about the size of a staple and often
live in the human colon and rectum. During an indi-
vidual’s sleep, female pinworms leave the intestine
via the anus to deposit their eggs on the surrounding
skin tissue, causing itching and restlessness.
• Tapeworms (ICD-10: B68) are long and narrow, as
their name indicates, and they depend on two hosts,
one human and one animal, from the development
of the egg to the larva to the adult. The easiest way to
remember their names is by the name of the animal
that acts as the second host: beef tapeworm (ICD-10:
B68.1), pork tapeworm (ICD-10: B68.0), fish tape-
worm (ICD-10: B70.0), and dog tapeworm (ICD-10:
B71.8 or B71.1). Intestinal infection occurs when raw
or contaminated meat or fish is eaten.
• Flukes (ICD-10: B66.0) are small, leaf-shaped, flat,
nonsegmented worms. Fluke infection occurs from
eating uncooked fish, plants, or animals from water
infested with flukes.
F i g u re 1 . 5 Bacteria (magnification
x2000). (From Scanlon, VC, and Sanders, T:
Essentials of Anatomy and Physiology, ed. 5. FA
C Coccus Davis, Philadelphia, 2007, p 509, with permission.)
4451_Ch01_001-022 28/12/15 2:38 PM Page 10
10 Diseases of the Human Body
A Fluke (x4)
Figur e 1.6 Helminths. (From Scanlon, VC, and
Sanders, T: Essentials of Anatomy and Physiology, ed. 5.
FA Davis, Philadelphia, 2007, p 515, with permission.)
TRAUMA
The Centers for Disease Control and Prevention
(CDC) reports that the leading cause of death in the
United States for persons younger than 35 is physical
trauma, an injury or a wound caused by external force
or violence, which occurs in one person every 3 minutes.
According to the National Center for Health Statistics
(NCHS), trauma is the fifth leading cause of death in
the United States, following cardiovascular disease,
cancer, chronic respiratory diseases, and stroke.
CHAPTER EPISODE—PART II
After college, Ian entered the military. During his
second term in Iraq, the Humvee he was driving was
hit by an improvised explosive device. The buddy next
to him died, but Ian survived. He spent many weeks
in rehabilitation and was later discharged from service
because of injuries to his brain. The physician
explained to his spouse that brain injuries can change
the way a person thinks, acts, feels, and moves the
body. The physician also noted that while he believed
Ian’s traumatic brain injury (TBI) was permanent, Ian
could learn to cope.
• Where might Ian and his spouse turn for help?
• What special needs might Ian have?
Head Trauma
Injuries to the head include concussion; traumatic brain
injury; cerebral contusion; skull, nose, and jaw fractures;
and perforated eardrum.
Scolex head (x20)
Hooks
Sucker
B Tapeworm (actual size)
Muscle tissue
C Hookworm (x3) D Pinworm (x2) E Trichinella (x100)
Concussions cause temporary neural dysfunction but
are not severe enough to cause a contusion. A concus-
sion results from a closed-head type of injury and does
not include injuries in which there is bleeding under the
skull or into the brain. This kind of trauma is normally
the result of a fall, a severe blow to the head area, or a
motor vehicle accident. A mild concussion may involve
no loss of consciousness, may leave a person feeling
“dazed,” or may result in a very brief loss of conscious-
ness. A severe concussion may cause prolonged loss of
consciousness and a delayed return to normal.
Traumatic brain injury occurs when the brain collides
with the inside of the skull, bruising the brain and tear-
ing nerve fibers. It is often the result of an external force
so strong that temporary or permanent impairment of
cognitive, physical, and psychosocial functions may
occur. Many returning veterans suffer from TBIs.
Cerebral contusions, a form of TBI, are more serious
than concussions because they bruise the brain tissue
and disrupt normal nerve function. Damage to a major
blood vessel within the head can cause a hematoma or
heavy bleeding into or around the brain when a contu-
sion occurs. The main causes of cerebral contusions are
motor vehicle accidents, sports activities, and assaults.
Falls are a common cause for individuals over age 65.
Contusions may cause loss of consciousness, hemor-
rhage, and even death.
If unconsciousness, convulsions, forceful and persist-
ent vomiting, blurred vision, staggering walk, or hemor-
rhage occurs after a blow to the head, the person should
be immediately taken to a hospital where the seriousness
of the event can be assessed and proper treatment given.
(See further discussion in Chapter 10.)
Skull fractures often are accompanied by scalp
wounds and profuse bleeding. The concern in the
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN