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Human Diseases
Sixth Edition Marianne Neighbors, EdD, RN
Ruth Tannehill-Jones, MS, RN
Australia ● Brazil ● Canada ● Mexico • S i n g a p o r e ● United Kingdom ● United States
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Ruth Tannehill-Jones
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Printed in the United States of America

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

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

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

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

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

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

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

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

Digestive Diseases 490 Inhalants 512
Anabolic Steroids 512
Fluid Imbalances 490
Organic Mental Disorders 512
Food Allergies 490
Psychosis 514
Eating Disorders 490
Mood or Affective Disorders 516
Cardiovascular Diseases 491 Dissociative Disorders 518
Musculoskeletal Diseases 491 Anxiety Disorders 519
Blood Diseases 492 Somatoform Disorders 520
Neurologic Diseases 493 Personality Disorders 521
Gender Dysphoria 522
Eye and Ear Diseases 494 Sleep Disorders 523
Strabismus 494 Trauma 524
Trauma 494 Grief 524
Child Abuse 494 Suicide 524
Suicide 495 Rare Diseases 524
Drug Abuse 495
Poisoning 495 Mental Health Disorders in the Older Adult 524
Summary 498 Summary 525
Review Questions 498 Review Questions 525
Case Studies 500 Case Studies 527
CHAPTER 21 Appendix A:
References 529
Mental Health Diseases and Disorders 501
Common Signs and Symptoms 502 Appendix B:
Diagnostic Tests 502 Common Laboratory Values 537
Common Mental Health Diseases and Disorders 502
Developmental Mental Health Disorders 502 Appendix C:
Substance-Related Mental Disorders 506 Metric Conversion Tables 539
Methamphetamine Abuse 509
Caffeine and Nicotine Abuse 509
Sedatives or Depressants Abuse 510 Glossary 541
Amphetamine Abuse 510
Hallucinogen Abuse 510 Index 557
List of Tables
CHAPTER 1 CHAPTER 6
1–1 Types of Pathologists 4 6–1 Classification of Joints by Movement 89
1–2 xamples of Acute and Chronic Diseases/
E 6–2 Risk Factors for Osteoporosis 95
Disorders 5 6–3 Risk Factors for Osteoarthritis 97
1–3 Examples of Common Diagnostic Tests and
Procedures 8 CHAPTER 7
7–1 RBC Blood Donor and Recipient Chart 121
CHAPTER 2
7–2 Blood Cell Abnormalities and Associated
2–1 Classification of Hereditary Disease with Symptoms 122
Examples 14
7–3 CBC Normal Values 123
2–2 Examples of Neoplasms or Tumors 16
CHAPTER 13
CHAPTER 3
13–1 Urinalysis Values 259
3–1 Neoplasm vs. Nonneoplasm 26
3–2 Origins and Names for Benign and CHAPTER 14
Malignant Neoplasms 28 14–1 The Endocrine Glands: Their Hormones
3–3 Comparison of Benign and Malignant and Hormone Functions 281
Neoplasms 29 14–2 Emergency Treatment of Diabetic Coma or
3–4 Comparison of Carcinomas and Sarcomas 32 Insulin Shock 296
3–5 L ifetime Risk of Being Diagnosed with
Cancer—Both Sexes, All Races 37 CHAPTER 15
3–6 L ifetime Risk of Dying from Cancer—Both 15–1 The Cranial Nerves 306
Sexes, All Races 37
CHAPTER 21
CHAPTER 4 21–1 Genetic and Acquired Causes of Intellectual
4–1 ome of the Leading Causes of Death
S Disability 503
in the World Due to Infections 53 21–2 Physical Causes of Dementia and Delirium 514
4–2 Some Common Infections Caused by 21–3 Phobias 520
Microorganisms in Humans 53
21–4 Dr. Elisabeth Kübler-Ross’s Five Stages
of Grief/Death and Dying 524
CHAPTER 5
5–1 Types and Functions of Leukocytes 64
5–2 Types of Immunity 65
xii
Preface
A
llied health professionals are required to be and physiology before introducing the most common
knowledgeable about the common diseases and diseases related to each system and specialty area.
disorders health care providers see and treat. As Common diseases and disorders for each body system
the medical field continues to grow and change and new are presented consistently through a description of the
diseases emerge, the need for these careers will continue disease or disorder, the etiology, symptoms, diagnosis,
to expand. This book includes the most current research treatment, and prevention.
and reflects the latest practices from actual practice. Simulated real-world activities provide learn-
ers with hands-on experience applying key concepts
Conceptual Approach learned in the chapters into practice.
Several dilemmas immediately emerge when one
Many pathophysiology books have been written considers writing a textbook for such a large and diverse
to address the informational needs of the medical audience as the health care field. Questions arise as to
community, but learners in allied health professional how much content to include, what to exclude, how
programs require an essential pathophysiology detailed the content should be, and how to organize the
text geared specifically for these programs. Human content in the most understandable manner. Another
Diseases, Sixth Edition is designed and specifically common concern is the question of the appropriate
written for learners in health care programs pursuing reading level.
careers as allied health professionals, including but not In an attempt to resolve these dilemmas, it was
limited to medical assistants, medical coders, surgical decided to organize the book in such a way that blocks
technologists, respiratory therapist assistants, physical of material or even entire chapters could be omitted or
therapist assistants, radiologic technologists, medical covered in detail, depending on the format of the course
transcriptionists, emergency medical technicians, and needs of the learner. At the same time, informa-
nursing assistants. The book is intended to meet the tion on each disease is written in such a way that it can
needs of learners enrolled in an allied health career stand alone or be viewed as all inclusive. This concept
program as well as serve as a valuable resource for health allows the instructor, learner, or individual to select and
care professionals on the job. It is also ideal as a resource study only those specific diseases or individual disease
on basic diseases by anyone within the medical arena of interest. Not all health conditions are covered in the
or individuals interested in human diseases. Current text, so the conditions chosen to be included are those
information for this book was based on the authors’ own that are most common, along with the new and emerg-
experiences and research sought from current literature, ing diseases. A few rare conditions are also included. Of
books, Internet resources, and physician consultations. the conditions chosen for the text, only general infor-
Students will understand this text best if a basic mation is covered. The text is designed to be a basic
medical terminology or anatomy and physiology overview of common diseases and disorders, not an
course has been completed before this course of study. in-depth study. Thus, the diseases presented are not
However, this book is designed to make difficult patho- described on a cellular physiological level, which would
physiology concepts easier to understand by using a be too complex for the intended audience. The intention
consistent organization, and including pronunciations, also was to keep the reading level of the text at an easy-
boxed features, and full-color illustrations and photos to-read basic level to promote understanding. We did
of diseases and disorders. Organized into three units, not want to write beneath the level of the learner but, at
the book begins with basic concepts of human diseases, the same time, felt that a difficult reading level would
introduces common diseases and disorders of the only increase the complexity of the material and thus
body systems, followed by genetic and developmental, fail to promote understanding of the subject matter.
childhood, and mental health diseases and disorders. The boxed features within the chapters either add
Chapters progress through a basic review of anatomy interesting information about staying healthy, present
xiii
xiv Preface
new research on the chapter topics, or present infor- Appendices and Glossary
mation about alternative treatments. The pharmacology
Appendix A presents common laboratory values.
boxed features list some of the possible medications for
Appendix B includes metric conversion tables. The
diseases or disorders in the chapter. These drugs are
glossary includes key terms and their definitions.
listed with generic names only since there are many
trade names for the same generic medication. It is
not intended to be an exhaustive list of possible med- New to This Edition
ications, but just to give the reader some information
Changes to the sixth edition include:
about common medications that might be prescribed
for certain diseases or disorders reviewed in the chapter.
The “Consider This” feature presents interesting facts to Changes in All Chapters
engage learners in the material. Cengage is committed to providing quality and inclusive
learning materials. As we adapt our learning materials to
Organization of The Text the continually evolving areas of inclusion and diversity,
the below strategies were adopted for this edition.
Human Diseases, Sixth Edition, consists of 21 chapters,
two appendices, glossary, index, and bibliography. To ■ Use age and gender-appropriate terms with the fol-
gain the most benefit from your use of this text, take lowing exceptions:
advantage of the review questions and case studies that ■ Use the terms male and female when discussing
are included at the end of each chapter. anatomical structures and physiology based on
biological sex assignment to ensure alignment of
Unit I Chapters terminology learners see in other scientific courses.
Chapters 1 through 4 lay the foundation for some basic ■ Use the terms male(s) and female(s) when refer-
disease concepts, including mechanisms of disease, ring to different age groups based on biological
neoplasms, inflammation, and infection. sex assignment rather than using terms based on
various age groups (for example, a disease affects
female adolescents, women, and older adult).
Unit II and Unit III Chapters
■ Use terms that appear in ICD-10 coding as diagnosis
Unit II includes chapters 5-18 which are organized
codes to ensure consistency of the medical language
by body systems and begin with a basic anatomy and
learners are exposed to in the text and will see in
physiology review of each system before discussing
actual practice.
that system’s common diseases and disorders. Included
with this discussion, where appropriate, are common ■ In an effort to keep the text as current as possible, the
signs and symptoms, diagnostic tests, trauma, and rare Glimpse of the Future boxes were eliminated because
diseases. In addition, a unique section toward the end this content quickly becomes outdated.
of each chapter discusses the effects of aging on each
system to help learners understand the natural aging
Chapter-Specific Changes
process of the human body.
Unit III includes chapters 19 through 21 on spe- Chapter 1
cialty areas covering genetics, childhood diseases, and ■ Added the term healthcare-associated infection
mental health disorders. (HAI)
Each disease in Units II and III is broken down
(where applicable) into the following sections: ■ Added material to clarify the difference between an
Description, Etiology, Symptoms, Diagnosis, Treatment, epidemic and a pandemic
and Prevention. Although this may appear to be very
title-heavy when there is only a sentence or two in each Chapter 2
section, this breakdown will assist the learner to clearly ■ Updated the list of deaths caused by trauma
identify these components of each disease. It also main-
tains consistency throughout the textbook. ■ Updated the BMI scale
Preface xv
■ Updated Consumer Responsibility in Disease Pre- ■ Added a new Healthy Highlight: Increasing Iron in
vention Healthy Highlight to include COVID-19. the Diet
■ Added material on comorbidity ■ Updated the treatment section for aplastic anemia
■ Updated the treatment section for Hodgkin’s lym-
Chapter 3 phoma, Non-Hodgkin’s lymphoma, and multiple
■ Updated cancer statistics myeloma
■ Updated personal risk behaviors for cancer ■ Added a new Complementary and Alternative Ther-
apy: Hematologic Disorders Treated with Stem Cell
■ Updated material on smoking and tobacco product Transplants
use
■ Updated cancer prevention with the latest recom- Chapter 8
mendations from the American Cancer Society
■ Updated the Pharmacology Highlight
■ Updated the section on diagnosis of cancer
■ Added a new Complementary and Alternative Ther-
■ Added a new Complementary and Alternative Ther- apy: Quercetin for Cardiovascular Disease
apy: Kombucha Beverage for Some Forms of Cancer
■ Updated the Healthy Highlight: Prevent High Blood
Chapter 4 Pressure
■ Updated the treatment section for coronary artery
■ Added a new Healthy Highlight: Emerging Infectious disease
Diseases: How to Stay Healthy
Chapter 5 apy: Low Fat Diets: Are They Necessary?
■ Updated the section on common signs and ■ Added a new Complementary and Alternative Ther-
symptoms apy: Salidroside Use in Heart Disease
■ Added a new Healthy Highlight: The Importance of
Sleep to the Immune System Chapter 9
■ Updated the Pharmacology Highlight with the bio- ■ Updated the Healthy Highlight: Why Do I Sneeze?
logics category ■ Updated the Diagnostic Tests section
■ Added a new Healthy Highlight: There’s a Difference ■ Updated the Pharmacology Highlight with the anti-
Between Food Allergy and Food Intolerance cholinergics and mucolytics categories, added exam-
■ Added a new Complementary and Alternative Ther- ples of decongestants, and information on drugs used
apy: How to Boost the Immune System to treat COVID-19
■ Updated the section on Acquired Immunodeficiency ■ Added a new Complementary and Alternative Ther-
Syndrome (AIDS) apy: Echinacea for Colds and Influenza Prevention
Chapter 6 apy: Nutritional Supplements as a Treatment for
■ Added information on arthroscopy. COVID-19?
■ Added a new Complementary and Alternative Ther- ■ Added a Healthy Highlight: Coronavirus 2019
apy: Stem Cell Therapy for Knee Osteoarthritis (COVID-19)
■ Added a new Complementary and Alternative Ther- ■ Updated the pulmonary tuberculosis section
apy: Honey for Bone Health? ■ Updated the Healthy Highlight: The Harmful Effects
of Smoking
Chapter 7 ■ Added a Healthy Highlight: Are Electronic Cigarettes
■ Updated the Pharmacology Highlight with the anti- Safe?
coagulants and plasminogen activators category ■ Updated the Healthy Highlight: Abdominal Thrust
xvi Preface
Chapter 10 ■ Updated the renal calculi section
■ Updated the Pharmacology Highlight with the ■ Updated the renal failure section
immunotherapy category and added examples of ■ Added a new Complementary and Alternative Ther-
medications apy: Herbal Medicine for Incontinence
■ Added a new Complementary and Alternative Ther- ■ Updated the urinary incontinence section
apy: Acupuncture for Lymphedema Treatment
Chapter 14
Chapter 11 ■ Updated the Diagnostic Tests section
■ Updated the Diagnostic Tests section ■ Updated the Pharmacology Highlight with the
alpha-glucosidase inhibitors, thioglitazones, hor-
■ Updated the Pharmacology Highlight with the pro-
mone agonists, hormone antagonists, and anti-
motility agent category and updated the examples of
cancer agents categories, and updated the examples
medications
of medications
■ Updated the Healthy Highlight: What Does the
Tongue Tell You?
apy: Berberine for Hyperglycemia
■ Updated the Healthy Highlight: What You Need to
apy: Essential Oils for Relief of Nausea and Vomiting
Know About Type 2 Diabetes and Taking Dietary
■ Updated the Healthy Highlight: How to Tell Heart- Supplements
burn from a Heart Attack
■ Added a new Complementary and Alternative Ther- apy: Luteolin to Maintain Blood Glucose Levels
apy: Curcumin
■ Added a new Complementary and Alternative Ther- apy: Acupuncture for Diabetic Neuropathy
apy: Natural Therapies for Irritable Bowel Syndrome
Chapter 15
■ Updated the Healthy Highlight: Screening Tests for
Colon Cancer ■ Updated the Diagnostic Tests section
■ Updated the Pharmacology Highlight with the dopa-
Chapter 12 mine agonists category and added and updated the
■ Updated the Diagnostic Tests section examples of medications
■ Updated the Pharmacology Highlight with the alco- ■ Updated the treatment section for shingles
hol abuse treatment, kinase inhibitor, and immune ■ Updated the diagnosis section and added a new
system booster categories, and updated the examples image for cerebrovascular accident
of medications ■ Added a new Complementary and Alternative Ther-
■ Updated the Complementary and Alternative Ther- apy: Using Acupuncture for Dysphagia
apy: Dietary Supplements for Hepatitis C ■ Added a new Complementary and Alternative Ther-
■ Added a new Complementary and Alternative Ther- apy: Meditation for Dementia
apy: Liver Cancer Treatment ■ Updated the Healthy Highlight: Hand Tremors
■ Updated the Healthy Highlight: Brain Foods (New
Chapter 13
title: The MIND Diet for Brain Health)
■ Updated the Diagnostic Tests section ■ Added a new Complementary and Alternative Ther-
■ Updated the Pharmacology Highlight with the apy: Aromatherapy for Better Sleep
immunotherapy category and updated the examples
Chapter 16
of medications
■ Added a new Complementary and Alternative ■ Updated the Diagnostic Tests of the Eye section
Therapy: New Ways to Treat Lower Urinary Tract ■ Updated the example medications in the Pharmacol-
Problems ogy Highlight for eye disorders
Preface xvii
■ Updated the Diagnostic Tests of the Ear section Chapter 18

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

■ Updated the Complementary and Alternative Ther-
■ Updated the Diagnostic Tests section apy: Using Meditation to Improve Health
■ Updated the Pharmacology Highlight for Female ■ Updated the Diagnostic Tests section
Reproductive Disorders with the Fertility drugs cat-
egory and updated the examples of medications ■ Updated the examples of medications in the Pharma-
cology Highlight
■ Updated the Pharmacology Highlight for Male
Reproductive Disorders with the Phosphodiesterase ■ Updated the Microcephaly section
inhibitors category and example medications ■ Updated the Huntington’s Disease section
■ Added a new Complementary and Alternative Ther- ■ Added a new Healthy Highlight: Genetic Testing
apy: The Chaste Tree Berry Benefits ■ Added a new Complementary and Alternative Ther-
■ Updated the section on breast cancer apy: Herbs for Treatment of Phenylketonuria (PKU)
■ Added a new Complementary and Alternative Ther- ■ Updated the Autism Spectrum Disorder section
apy: Art and Music Therapy to Improve Quality of
Life for Breast Cancer Patients Chapter 20
■ Updated the Complementary and Alternative Ther- ■ Updated the Acquired Immunodeficiency Syndrome
apy: Supplements for Men’s Health section
■ Added a new Complementary and Alternative Ther- ■ Updated statistics in the Diphtheria section
apy: Apitherapy for Benign Prostatic Hyperplasia
(BPH) ■ Updated the Healthy Highlight: Epinephrine for
Allergic Reactions
■ Updated the statistics in the genital herpes section
■ Updated the Healthy Highlight: Preventing Sexually apy: Managing Food Allergies
Transmitted Infections: Practice Safe Sex
■ Updated the Healthy Highlight: Some Facts about apy: Herbs for Children
Human Papillomavirus (HPV)
■ Updated statistics in the Suicide section
apy: Alternative Ways to Boost Testosterone Levels
xviii Preface
■ Updated the Healthy Highlight: Immunization ■ The Cognero® Test Bank includes 60 questions per
Schedule for Children chapter, including multiple-choice and scenario mul-
tiple-choice questions and feedback; true/false ques-
Chapter 21 tions were deleted.
■ Updated the Diagnostic Tests section
■ Added a new Healthy Highlight: Staying Positive to Mindtap
Improve Life
■ Updated the examples of medications in the Pharma- MindTap is a fully online, interactive learning
cology Highlight experience built upon authoritative Cengage Learning
content. By combining readings, multimedia, activities,
■ Updated the Intellectual Disability section
and assessments into a singular learning path, MindTap
■ Added a new Healthy Highlight: The National elevates learning by providing real-world application
Helpline for Mental Health and/or Substance Use to better engage students. Instructors customize the
Disorders learning path by selecting Cengage Learning resources
■ Updated the Caffeine and Nicotine Abuse section and adding their own content via apps that integrate
into the MindTap framework seamlessly with many
■ Added a new Healthy Highlight: Naloxone for
learning management systems.
Overdoses
■ To learn more, visit www.cengage.com/training
■ Added a new Healthy Highlight: Preventing Opioid /mindtap.
Overdoses
apy: Aromatherapy for Mood Elevation About the Authors
apy: Exercise for Relief from Depression Dr. Marianne Neighbors has been in nursing practice
and nursing education for more than 40 years. She
■ Added a section on Gender Dysphoria received her bachelor’s degree in nursing at Mankato
State, a master’s degree in health education at the
University of Arkansas, a master’s degree in nursing
Instructor and Student Resources at the University of Oklahoma, and a doctoral degree
in education with a focus on health science at the
Additional instructor and student resources for University of Arkansas. Dr. Neighbors has taught in
this product are available online. Instructor assets associate degree nursing education for 18 years, focusing
include an Instructor’s Manual, Educator’s Guide, on medical/surgical nursing, and in baccalaureate
PowerPoint® slides, Solution and Answer Guide, and a nursing education for 23 years, focusing on health
test bank powered by Cognero®. Student assets include promotion and community health. She also taught
PowerPoint® slides. Sign up or sign in at www.cengage advanced health promotion and nurse educator classes
.com to search for and access this product and its online at the master’s level. She has coauthored many research
resources. articles; four medical/surgical nursing texts, along with
■ The Instructor’s Manual includes a sample course two medical/surgical handbooks; a health assessment
syllabus and outline as a guide for setting up a course. handbook; and a home health handbook, in addition to
Additional materials for each chapter include detailed the six editions of Human Diseases. Dr. Neighbors has
content outlines, learning objectives, expanded chap- also written chapters for other nursing authors’ books.
ter summaries, discussion topics and learning activi- She is currently an Emeritus professor in the Eleanor
ties, and discussion questions. Mann School of Nursing at the University of Arkansas,
Fayetteville, Arkansas.
■ The Solution and Answer Guide includes answers to Ruth Tannehill-Jones worked as a registered
the text chapter review questions and case studies. nurse for more than 30 years. She began her nursing
The PowerPoint® slides include chapter objectives, education at the University of Arkansas, Fayetteville,
content and activity slides, and a self-assessment. with completion of an associate degree in nursing.
Preface xix
Ms. Tannehill-Jones was not a newcomer to this cam-

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

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

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

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

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

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

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

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

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

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

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

benign (beh-NINE) or malignant (mah-LIG-nant).
Generally, benign tumors have limited growth, are
encapsulated (enclosed in a capsule) and thus easily
removed, and are not deadly. Malignant tumors are
just the opposite. These tumors grow uncontrollably;
have fingerlike projections into surrounding tissue,
making removal very difficult; and are usually deadly.
Malignant means deadly or progressing to death.
With these definitions, it is understandable why the
terms tumor, malignancy, and cancer bring fear to an
individual. Some -omas, or tumor diseases, are com-
monly called cancer. Cancer is defined as any malig-
nant tumor.
The fingerlike or crab-like projections that char-
acterize malignant tumors give cancer its name, from
the Greek karkinos, meaning “crab.” This character-
Courtesy of Mark L. Kuss

istic makes surgical removal of cancer quite difficult
(Figure 2–2). Another characteristic of malignant
neoplasms is that they metastasize (meh-TAS-tah-
sighz), or spread. Metastatic (MET-ah-STAT-ic)
cancers spread from a site of origin to a secondary
Figure 2–2 Crab-like appearance of cancer in a kidney.
site in the body. For example, lung cancer com-
monly metastasizes to the bone. Chapter 3 discusses
more detailed information about hyperplasias and
neoplasms.
Consider This...
Nutritional Imbalance Lack of water is the number one trigger of
Good nutrition is important in maintaining good health daytime fatigue.
and reducing the chance of disease. Nutritional disor-
ders can cause problems with physical growth, mental
and intellectual changes, and even death in extreme
cases. Most nutritional diseases are related to overcon- Malnutrition
sumption or under-consumption of nutrients. Specific Malnutrition can be due to inadequate nutrient intake
problems are malnutrition, obesity, and excessive or or to intake of an adequate amount with poor nutritive
deficient vitamins, minerals, or both. value. Diseases that cause a problem with the absorption of
Persons who are unable to eat enough to maintain

their body weight can receive nutritional supplements in
a liquid drink. Another way to supplement or provide
for total nutritional intake is not through the alimentary
canal or digestive system but through a parenteral (pah-
REN-ter-al; to administer by injection) route. Parenteral
routes can include subcutaneous (sub 5 under, cutane-
ous 5 skin), intramuscular (intra 5 within, muscular 5
muscle), or intravenous (intra 5 within, venous 5 vein)
administration. The intravenous route is the most com-
monly used parenteral route. Providing the total nutri-
tion needed by giving nutritive liquid through a venous
(vein) route is called total parenteral nutrition (TPN).

Nutrition can also be provided through an enteral
(small intestine) route. A nasogastric (naso 5 nose, gas-
tric 5 stomach) tube or a tube running through the nose
and into the stomach can be used for feedings if the sup-
plement is planned short term. For longer-term enteral
Figure 2–3 Cachexia. feeding, a gastrostomy (gastro 5 stomach, ostomy 5 open-
ing; opening into the stomach) procedure is performed
nutrients can also lead to malnutrition. Children and older to place a tube through the abdominal and stomach wall
persons are the age groups most affected by malnutrition. (Figure 2–4A). Enteral feeding, commonly called “tube
Persons suffering with cancer often experience prob- feeding,” is accomplished by this method (Figure 2–4B).
lems with malnutrition and develop cachexia. Cachexia
(ca-KECK-see-ah) is a term that describes any individual
who has an ill, thin, wasted appearance (Figure 2–3).
(B)
Gastrostomy
Rumruay/Shutterstock.com
(A) (C)
Figure 2–4 Gastrostomy. (A) Feeding. (B) Insertion site. (C) internal location.
18 Chapter 2
Obesity consume large amounts of vitamins for an extended

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

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

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

Hypertrophy Metaplasia (meta 5 changed, plasia 5 growth) is a cel-
lular adaptation in which the cell changes to another
type of cell (Figure 2–9). An example is the colum-
nar epithelial cells of the respiratory tree, which often
change to stratified squamous epithelial cells when
exposed to the irritants of cigarette smoking. This pro-
tective adaptation might be reversible if the individual
Figure 2–6 Normal cell versus hypertrophied cell. quits smoking.
22 Chapter 2
Normal Normal
Nucleus Nucleus
Basement membrane Basement membrane
Dysplasia Neoplasia
Figure 2–8 Normal tissue versus dysplasia. Figure 2–10 Normal tissue versus neoplasia.
Neoplasia Cellular death, called necrosis (neh-CROW-sis),

Neoplasia (neo 5 new, plasia 5 growth) is the develop- can involve a group of cells and, thus, tissue. When
ment of a new type of cell with an uncontrolled growth referring to dead cells or tissue, one would describe
pattern (Figure 2–10). Neoplasia is discussed in more the area as necrotic. When necrosis occurs due to
detail in Chapter 3. ischemia, the area of dead cells (ischemic necrosis) is
called an infarct (IN-farkt). Infarcts are commonly due
Cell and Tissue Death to obstruction of arteries. The most common infarct
affects tissues of the heart, leading to a myocardial
Cell death, as previously mentioned, can be caused infarction, or heart attack.
by trauma, hypoxia, anoxia, drug or bacterial toxins, Cells that are injured and not able to recover even-
or viruses. The most common causes of cell death are tually die. The cause of cell death can be determined by
hypoxia and anoxia. a pathologist because the gross (visible with the eye) and
Cell hypoxia caused by decreased blood flow is microscopic appearance of the tissue differs with the type
called ischemia (iss-KEE-me-ah; isch 5 hold back, of death. There are several types of necrosis, primarily
emia 5 blood). A cell without oxygen cannot produce named by the microscopic appearance of the dead cells.
needed energy and eventually dies. The most common type of necrosis is called coag-
ulation necrosis and is due to cellular anoxia. Coagula-
Normal tion necrosis is the type of cell death experienced with
myocardial infarction.
Nucleus A common alteration in necrosis occurs when sapro-
phytic (dead tissue–loving) bacteria become involved in
the necrotic tissue. With this occurrence, the necrotic tis-
Basement membrane sue is now described as gangrenous or having gangrene
(GANG-green). The type of gangrene can be wet, dry, or
Metaplasia gas, depending on the appearance of the necrotic tissue.
Wet gangrene usually occurs when the necrosis has
been caused by the sudden stoppage of blood flow, as in
the trauma of burning, freezing, or embolism.
Dry gangrene occurs when blood flow has been
slowed for a long period of time before necrosis
occurred, as in the case of arteriosclerosis and advanced
Basement membrane diabetes. In dry gangrene, the tissue is black, shriveled,
or mummified. This type of gangrene occurs on the
Figure 2–9 Normal tissue versus metaplasia. extremities only, primarily on the feet and toes.
Gas gangrene occurs with dirty, infected wounds. so extreme that the individual’s quality of life is severely
The tissue becomes infected with anaerobic (growing limited. This is often seen in cases of severe brain injury
without oxygen) bacteria that produce a toxic gas. This or even in some congenital disorders.
is an acute, painful, and often fatal type of gangrene. It is very common for individuals to have more than
one disease or condition at the same time. When two or
more conditions occur at the same time, this is called
Organism Death comorbidity and often complicates the individual’s abil-
Human death can be related to any of the aforemen- ity to heal or overcome the first or primary condition.
tioned causes of disease. The aging process leads to Prior to death, major organs such as the heart, lungs,
death due to a change in the normal structure of the and brain stop functioning. When the brain ceases
individual’s organs or a decrease in the ability to fight to function, the individual is considered brain dead.
disease. Diseases that would not be lethal in our younger Although death is difficult to define and difficult to deter-
years, such as respiratory infections, can be the cause of mine in some cases, one guideline used is that of brain
death in an older individual. death. The criteria for determining brain death include
According to the CDC, the most common cause ■ a lack of response to stimuli.
of death in the United States is heart disease, followed
by cancer and strokes (cerebrovascular accident). ■ a loss of all reflexes.
Although heart disease is the leading cause of death, ■ an absence of respiration or breathing effort.
stroke is the leading cause of serious, long-term disabil- ■ a lack of brain activity as shown by an electroen-
ity in the United States. (See Chapter 8, “Cardiovascular cephalogram.
System Diseases and Disorders,” for more information.)
Many times, the human organism—like the cell— This issue of defining death and when an individ-
does not die but becomes disabled. Disability is called ual is actually dead is still controversial in the medical
morbidity (state of being diseased). Often, morbidity is profession.
Summary
H uman diseases are caused by heredity; trauma; inflammation, infection, or both; hyperplasias, neoplasms, or both;
nutritional imbalances; impaired immunity; or some or all of these. Lifestyle behaviors can also be contributing
factors to disease development, as can the aging process. Eventually, all organisms die, and the process of death can occur
at the cellular, tissue, or whole-organism level.
Review Questions
Matching
1. Match the cause of diseases in the left column with the example of a disease for that category in the right column.
Heredity a. Pneumonia
Trauma b. Motor vehicle accident
Inflammation/infection c. Cancer
Hyperplasias/neoplasms d. Obesity
Nutritional imbalance e. Allergies
Impaired immunity f. Cystic fibrosis
True or False
2. T F In autoimmunity, the body’s immune system attacks itself.
3. T F Some medications used to prevent or cure some diseases can cause immunodeficiency.
24 Chapter 2
4. T F Diseases related to the aging process are called regenerative disorders.

5. T F All congenital disorders are easily recognized at birth.
6. T F Heart and brain cells are easily injured by hypoxia.
7. T F Heredity does not affect the aging process.
8. T F Cellular death occurs only in the event of hypoxia (lack of oxygen).
Short Answer
9. List the factors that affect a cell’s ability to survive after injury.
10. How do cells adapt when exposed to adverse conditions?
11. What are the definitions of the following terms?

a. Inflammation
b. Infection
c. Neoplasm
d. Immunity
12. What are two important habits for a healthy lifestyle?
a.
b.
Case Studies
■ Cann Ragland, age 29, was seriously injured in a motorcycle accident. He is comatose and on life support
equipment to maintain his breathing. He has not improved in 2 weeks with aggressive medical treatment. The
family is questioning whether he is alive or dead at this time. What criteria can be used to determine this? What
are the issues surrounding this determination? How could you help the family through this difficult time? What
resources are available to help people make decisions about end-of-life care?
■ Jessie Leher, age 69, is concerned about her aging status and loss of short-term memory at times. Her sister
told her to take Ginkgo biloba and CoQ10, over-the-counter herbal products. Jessie has high blood pressure
and some circulatory problems. She takes several prescription medications for these disorders and for a couple
of other problems, such as arthritis. Should she be cautioned about also taking the herbal remedies? How much
should she actually know about her medications? Should health care providers provide more education for
patients? Are consumers more interested in knowing about their health care treatments in today’s world than in
the past? Is that a good change?
3
Neoplasms
Key Terms
Anaplastic (p. 32) Carcinoma in situ (p. 31) Hematoma (p. 26) Neoplasm(s) (p. 26)
Angiogenesis (p. 29) Chemotherapy (p. 39) Hyperplasia(s) (p. 29) Palliative (p. 39)
Benign (p. 26) Curative (p. 39) Invasion (p. 26) Pap test (p. 37)
Biopsy (p. 32) Cytology (p. 38) Leukemia (p. 26) Preventive (p. 35)
Cachexia (p. 29) Differentiation (p. 28) Lymphomas (p. 27) Radiation (p. 30)
Carcinogen (p. 30) Dysplasia (p. 31) Malignant (p. 26) Sarcoma (p. 27)
Carcinogenesis (p. 32) Frozen section (p. 38) Metaplasia (p. 32) Staging (p. 32)
Carcinoma (p. 27) Grading (p. 32) Metastasis (p. 26) Tumor (p. 26)
Learning Objectives
1. Define basic terminology used in the study 6. Identify some common carcinogenic substances.
of neoplasms. 7. Identify high-risk behaviors for cancer
2. Explain the system used to classify neoplasms. development.
3. Compare hyperplasias to neoplasms. 8. State the frequency of cancer development in the
4. Identify the progression of cancer development. population.
5. State the signs and symptoms of cancer. 9. Describe the curative, palliative, and preventive
methods used in cancer treatment.
Overview
T housands of individuals are diagnosed with neoplasms each year. The diagnostic statement “You have a tumor”
often causes instant fear, dread, and tears for the individuals and families involved; few statements in our society
carry the emotional impact this one does. To most people, this diagnosis is equivalent to a pronouncement of death.
But not all tumors are malignant, and not all are deadly. However, more than 1.8 million individuals are diagnosed
with malignant neoplasms each year. This includes all types of cancers. Approximately 1,640 die each day, with
25
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In such passages as these three we find a movement which entered
the pianoforte style as a necessity (to keep harmonies in vibration)
metamorphosed into a line of melody which still retains the power to
suggest harmonies. It demands the virtuoso but is in no sense
virtuoso music. For virtuoso music is a music in listening to which
one hardly knows whether it is sound itself or the rapid movement of
sound that thrills. Figures have little musical significance in it. Notice
how in the music of the two greatest virtuoso composers for the
piano, D. Scarlatti and Liszt, a few figures are repeated endlessly
with no variation. The necessity of movement has become a luxury,
oftenest not truly beautiful, nor of any but a gymnastic worth.
It was Chopin who entirely appreciated the true value of movement

on the keyboard; who where it was necessary made it beautiful, and
never made it an end in itself. Hence it may be questioned if there is
figure work, mere display, in Chopin’s music. There is hardly a
passage of rapid notes in his music which has not a pure melodic
significance and which does not weave itself about harmonies that
are constantly varied. He delighted in rapid notes. The coda of the
waltz in A-flat major, op. 34, No. 2, the study in F minor, op. 25, No.
2, the scherzo of the sonata in B minor, the variation of the chief
subject in the third part of the fourth ballade, these come to mind
among a host of other examples of his inimitable grace and musical
worth in such music. And when he combined such a fleet
melodiousness with broader themes and harmonies did he not prove
himself a master of the science of music in a new light? Not without
a reason are the preludes and fugues of the ‘Well-Tempered
Clavichord’ a masterpiece of everlasting and inimitable worth. We
may call it concentration, intensity, economy of musical means which
gives them their enduring firmness. And much of this firmness is in
the music of Chopin, because there are no empty notes, none
without two and even threefold significance. This complication of
movement with melody, this ever-whispering inner melodiousness,
these spring from Bach, the greatest of masters.
Other essentials of the pianoforte style may be found in the work of
other masters as well as in that of Chopin. Such are the contrast of
registers and the variety of rhythm. One more feature of his style,
however, is pronounced enough to demand attention. This will be
observed in his treatment of many melodies. Here any composer will
find himself face to face with one of the most difficult problems the
piano presents; for, as we have said, he must if possible arrange his
melody in such a way that one will not feel it would have been more
suitable to the voice or the violin. Movement is again necessary.
Without belittling the value of an accepted masterpiece one may call
attention to the long pause of the melody at the end of the first
phrase of Schumann’s Warum?, which barely escapes destroying
the piece as a work for the piano. There must be not only a
pronounced but a secondary melodic movement in such pauses in
pianoforte music, as Schumann himself introduced subsequently in
Warum? In many cases the composer contents himself with giving a
touch of melodic life to the accompaniment, as Chopin does, for
example, in the pauses of the second theme in the first movement of
the B-flat minor sonata. But most remarkable in Chopin’s treatment
of melodies, noticeably in his later and broader style, is his fondness
for secondary melodies that have almost the consecutive movement
of an obbligato part. This is one step in organization beyond the
inner melodiousness of his accompaniments. Without selecting
examples from a number of his works, one may call attention to the
study in C-sharp minor, opus 25, No. 7, to the various treatments of
the melodic material in the fourth ballade, to the whole Barcarolle,
especially to the imitations in the middle section and in the coda. By
means of this the piano speaks with a voice made sonorous by its
own peculiar abilities, and Chopin’s melodies stand apart from
melodies for violin or voice.
What has been said of his ability to give to rapid notes a genuinely
musical significance applies in general to the ornaments which now
and again are brought into his music. Of the older standardized
ornaments which were thickly sprinkled through the music of
Couperin and Emanuel Bach, only a few survived the harpsichord, to
which they were appropriate. The turn, the trill and the grace-note
are the chief of these, all of which, it will be noted, are used as
frequently in music for other instruments as in music for the
pianoforte. The others were expanded into much greater form or
gave way entirely to a new sort of ornament which covered wide
intervals and a wide range, and was intended less to add grace to
the melodic line than to introduce a variety of sonority into the music.
These more pretentious frills were added ex tempore by men like

Hummel, Field, and even Liszt, not only to their own music but to
that of other composers. Liszt, in his remarks prefatory to an edition
of Field’s ‘Nocturnes,’ said that the little pieces as they appeared on
the engraved page hardly gave more than a suggestion of the
richness which their composer gave to them by means of his
improvised adornments. Whatever may have been the practice of
Chopin in playing, he angrily resented the addition of extemporized
ornaments to his own music by any player whatsoever, even one so
brilliant as Liszt. It seems likely that such ornaments d’occasion were
pretty conventional stuff. Liszt has filled up his music with a great
deal of them, laboriously written out. Chopin’s ornaments rarely lack
the distinction which is characteristic of his style in general; that is to
say they are rarely a series of figures, oftenest a tracery of melody.
Those such as we find in the nocturne in F-sharp major, the
impromptu in the same key, and even in the first polonaise, are finely
and carefully drawn, and their effect in the piece, like the effect of the
piece as a whole, calculated down to the smallest note. Even in this
regard Chopin’s music is perfected, and the addition of extra notes,
especially of the breathless, virtuoso kind, cannot, as Chopin himself
well knew, but distort its proportions. There is practically none of
these passages which is massive, which has not a value in detail
that the pianist must reveal.
Excepting always the music of Bach, there is almost no keyboard

music save Chopin’s in which every note is thus fraught with
meaning and delight. Therein lies the secret of his style, its
clearness, flexibility and charm. As a work of art it is flawless, and in
that may well rest its best assurance of an immortal life.
IV
There is little to be said of the quality of Chopin’s music in general,
and that little has often been fervidly spoken, now in praise, now in
blame. His music may be variously classified. There are works of his
young manhood, works of more mature stamp, finally works written
in the last years of his relatively short life which are very noticeably
more profound and more involved than earlier ones. To study his
music in the order of its creation is to trace the deepening and the
sobering of his emotional life. An intensity is common to it all, a
fervor which a long and painful illness had not the power to assuage.
Neither the Ballade in F minor nor the Polonaise-Fantaisie is less
impassioned than the study in C minor, opus 10, No. 12. Outwardly
they all show the same restlessness and tumultuousness. But the
passion of the later works is deeper if not more calm than that of the
earlier, and the expression of it is more varied and full of contrasts.
Works like the fourth Scherzo, the fourth Ballade, and the Barcarolle
have an under meaning so hard to grasp that perhaps the majority of
those who study them or hear them find fault with the structure and
say they are rambling. There is in all his music a reserve which puts
it beyond the touch of most who would play it. In these last great
pieces one discerns vaguely something of the holiness of that inner
life of his which no one ever heard him speak of, of the intense,
yearning idealism that tortured him. His was a spirit that underwent
the chastening brought upon us by suffering in body and mind in
silence, this fastidious, dainty, malicious, little man, for ever suffering,
for ever unconquerable in pride.
But the compositions may be more definitely classified than by the

signs they show of Chopin’s general development. There are, for
example, three distinct groups: salon pieces, such as the Waltzes
and Nocturnes; pieces in which he speaks as it were his native
Polish language, such as the Mazurkas and the Polonaises, and
finally works which seem the unrestricted expression of his
emotions: the Ballades, Scherzos, Sonatas, Preludes, and Études.
All the salon pieces are characterized by elegance. In addition, the
Waltzes have in most cases a sparkle, the Nocturnes a discrete
melancholy. Yet Chopin is full of surprises, and there are waltzes like
that in A minor and that in C-sharp minor which pass out of the
category of elegant salon music based on dance rhythms, and may
be treated as among the most thoughtful and the sad expressions of
his experience. The first two waltzes, and the great waltz in A-flat
major, opus 42, reveal him delighting in poignant and lively rhythms,
in a grace from which a certain chivalric gallantry is not lacking, and
above all in the captivating qualities of his instrument.
Perhaps the majority of the Nocturnes show a sentiment a little too

much perfumed for the salon. They are commonly considered the
weakest of his compositions; and it can hardly be denied that some
of them lack virility and health. On the other hand, one like that in C
minor is fit to stand among the most impassioned and noble of his
compositions; and those in G major and in D-flat major must long be
redeemed from commonplaceness by the perfection of their style as
pianoforte music.
In the Mazurkas, harmonies, rhythm, and melodies have a distinctly

Polish character. In the Polonaises only the rhythm is national; and
this has been so long in the favor of the international world of music
that it carries with it little of Polish spirit. Most of the Mazurkas and
the Polonaises never shake off an under mood of deep sadness, and
there is none of them, however gracious, which does not sing of a
national pride. Pride and sorrow are the keynote to them, sorrow that
is often hopeless, pride that rises to anger and defiance. There are
among the Mazurkas many which have an elegiac sadness, which
are poems of meditation and lamentation, as if by the ruins of his
beloved country he, like the great prophet, sat down and wept. They
are often as short as the short preludes, but share with them a
vividness and intenseness that place them among the most
remarkable of compositions for the instrument.
The Polonaises are in broad form. Those in A major, A-flat major,

and F-sharp minor are truly colossal works, ringing, clashing,
marching music, without a touch of bombast. It is astonishing how all
polonaises, polaccas, and even marches by other composers lose
their light beside them. Those in C minor and in E-flat minor are
sombre and gloomy, the former full of heaviness, the latter of
mysterious agitation as of a band of conspirators, in the apt phrase
of Professor Niecks. That in C-sharp minor lacks the dignity of its
companion pieces. The first part is fretful and nervous. The Trio
section in D-flat has, however, a more measured, though an
effeminate speech.
Of his other great works one would be glad to say nothing. We have
already attempted to analyze the perfection of their style, the
richness of their harmonies, the firm proportions of their form. To the
discovery of their particular beauties each lover must be led by his
own enthusiasm. The rapture they may charm him to is his own joy.
Chopin the artist may be held up to the critical inspection of the
whole world, and in such an inspection few will pass with higher
praise than his.
But Chopin the musician speaks to each ear apart. His music is a
fervid, aristocratic, essentially noble soul made audible, if so we may
translate Balzac’s remark that he was une âme qui se rendait
sensible. Illness held him in an inexorable grip during those years of
his life when he wrote many of his greatest works. His pride, which
no one may measure, made his life one agony with that of his broken
country. Yet there was the saving streak of iron in him, and that is in
his music behind all the vehemence, the fever, and the passion.
And what may not be overlooked is his love of gaiety. His wit was
malicious and keen, but he had a pleasing humor as well, one that
overflowed in mimicry and an almost childish love of fun. This too is
constantly coming to the surface in his music. It would be wholly
mistaken to think of Chopin as a composer of only sad or turbulent
music. A whole list of masterpieces could be chosen from those of
his compositions which are gay without arrière-pensée, which are
witty and vivacious, and clear as happy laughter. It is perhaps this
very spirit which saves his music always from heaviness, which
makes it in the last analysis more healthy and more sane than much
of that of Schumann or Brahms. Never are his moods heavy,
stagnant, or inert. Intense as they may be they are swift-changing
and vivid.
Are they not thus in their nature suited to the piano more than to all
other instruments? To the piano, the sounds of which are no sooner
struck than they float away, the very breath of whose being is in
constant movement?
The mass of Chopin’s compositions remains unique in the literature

of pianoforte music as an expression of emotion that is without alloy.
There is no trace in it of experiment, of theory, or of symbolism. Its
idealism is the idealism of beauty of sound, both in form and detail. If
we call it poetical it is because it seems a fire of the imagination. Yet
here is a faculty in Chopin which deals only with sound. His music is
most decidedly abstract and absolute. Poetical as it may be, there is
no meaning in it but the meaning of sound. Not only does it not call
for supplementary explanations in terms of another art or of definite,
emotional activities in life; it defies the effort that would so relate it to
a world of perceptions. Like fire it burns the thought that would frame
it.
FOOTNOTES:
[35] ‘Chopin the Composer.’ New York, 1914.
[36] Professor Frederick Niecks in his ‘Frederic Chopin’ (1888) has presented
practically all that is known of Chopin to the public, in a manner that is no less
accurate than it is wholly just and impartial. Needless to say that we are greatly
indebted for this chapter to that excellent and wise book, especially in the matter
of biographical and personal details.
CHAPTER VIII
HERZ, THALBERG, AND LISZT
The career of Henri Herz, his compositions and his style; virtuosity
and sensationalism; means of effect—Sigismund Thalberg: his
playing; the ‘Moses’ fantasia, etc.; relation of Herz and Thalberg
to the public—Franz Liszt: his personality and its influence; his
playing; his expansion of pianoforte technique; difficulties of his
music estimated—Liszt’s compositions: transcriptions; fantasia on
Don Giovanni—Realistic pieces, Années de pèlerinage—Absolute
music: sonata in B minor; Hungarian Rhapsodies; Conclusion.
There is no doubt that Chopin was one of the greatest players of his
day. In some respects he was probably the greatest, for it is hard to
believe that he could have been matched in delicacy, in beauties of
veiled harmony and melody, and in poetry. Yet as far as playing was
concerned his life was spent virtually in retirement; and this was, as
we have hinted in the preceding chapter, bitter to him. It was not
easy for him, we may be sure, to hear from the outer world the
echoes of uproarious applause raised to greet one battling virtuoso
after another. These men strode like conquering heroes over the
earth. The years Chopin spent in Paris were the very hey-day of the
virtuosi. He was excluded from such public triumphs as they
enjoyed, partly because he was too nervous and too sensitive to
endure contact with great audiences, partly because he lacked
physical strength, and partly, also, because to the general taste at
that time his style of playing and his music were too fine to be
palatable. Mendelssohn wondered whether or not Herz was
prejudiced when he said that the Parisians could understand and
appreciate nothing but variations.
HENRI HERZ
I
This Henri Herz was, between the years 1830 and 1835, the most
celebrated pianist in Europe. He was Austrian by birth but in his
youth was taken to Paris to study at the Conservatoire, and
thereafter made Paris his home, and himself a Parisian.
Everywhere he played he was tremendously successful, whether in

France, Germany, or playing duets with Moscheles or Cramer in
London, or wandering over the continent of North America, and the
islands near it. He had terriblement voyagé, as he himself said in the
introduction to his most amusing book on his travels in America, Mes
voyages. His technique was, of course, quite out of the ordinary; but
so far as we may judge by his programs and by his compositions, he
put it to no exalted purpose. It was the day of variations and of
fantasias. Any time might serve for the former, and the virtuoso who
was also a keen man of business, with an eye on the public before
which he displayed himself and another on the publishers, generally
made use of airs popular in whatever land he might chance to be
making a present success. For example, among the publications of
Henri Herz one finds variations on the favorite air, Le petit tambour,
on the famous Irish air, ‘The Last Rose of Summer,’ on the Scotch
air, ‘We’re a’ noddin’,’ on the old song beloved of our grandmothers
in this country, ‘Gaily the Troubadour’; and La Parisienne, marche
nationale, avec variations charactéristiques. He published an
arrangement of the Marseillaise, an Austrian march, General
Harrison’s quick-step, Empress Henrietta’s waltz, numerous sets of
quadrilles and other dances. Perhaps we may never be sure how
many of these publications he would have acknowledged. In Mes
voyages he recounted how he found upon a piano in a music shop a
certain ‘Mlle. Sontag’s Waltz’ published as one of his compositions.
This was in the United States. The dealer in the shop told Herz that
this of all his compositions had made him famous in the new country.
Herz was about to protest that the music was none of his, but was
prevented by the counsel of his manager Ulmann, a man very nearly
as wily as the immortal P. T. Barnum, of whom, perhaps at bottom a
congenial soul, Herz had much to tell.
Fantasias were usually constructed on airs from the favorite operas

of the day. These, in the case of Herz, rarely amounted to more than
a series of variations, preceded by an introduction, and concluded
with a finale. Few showed much thought in structure, and indeed,
such men as Herz, Thalberg, and Liszt, could, and were expected to,
improvise such fantasias before the public.
But it would be a mistake to suppose that Herz’s elaborate fantasias

and variations lack cleverness and a very genuine brilliance. An
examination of many of them will prove to one even at this day, when
all are nearly or quite forgotten, that Herz knew his piano
astonishingly well. Let us look for a moment at the Variations
brillantes, opus 105, on a favorite motive from Bellini’s Sonnambula.
There is first an introduction. This is withal desperately
commonplace. It suggests posturings, meaningless formalities, a
whole technique of specious oratory. Yet it is a technique. The
weakness in such music is that it is ready-made. There is no
originality in it, nor any vitality. The eye discerns the stock figures of
the virtuoso laid one after the other across the page. First, there are
three measures of the chromatic scale, each measure running
through the octave, so that the second repeats the first, and the third
the second, with only the change of register. Moreover, each
measure is phrased by itself, and at the beginning of each there is
placed a mark of emphasis; so that there is not even an effect of
rushing or roaring from bottom to top, but only one of movement
from one point to another, like the leaping of the frog up the steep
sides of the well of our algebra problems. The final leap to the
pinnacle of high F, is worthy of the mountain goat.
This figure jumps its stages across our ears and out of sound. Then
follows a welling up of emotion. The orator condescends. He is
affably sentimental, will take us into his confidence, not without
dignity, however. Listen to the strains of this immortal melody! Here a
heart sings. What if it were Bellini’s heart, we now add upon our
instrument a long tremulous sigh of our own.
Once more the opening phrases. Here again the directions read,
capriccioso; and again the goat leaps up the scale from low F to
high. But here follows a passage of trills, long trills on F, on G, on A,
on B-flat, and so on, up and up to the highest of all F’s on the
keyboard; while the left hand surges and falls back in broken chords
of changing harmonies. Nothing could be more brilliantly effective.
The concluding measures of the introduction play with long, light
scales over a phrase or two of melody; and a long-drawn half-
cadence, and a fermata, announce at last that the piece is about to
begin.
The statement of the theme itself is perfectly simple. One notices the
practically unvaried bass, the tum-tum of Hummel and Weber, and of
the lesser virtuosi. The first variation is, however, a masterpiece in
pianoforte style as far as the right hand is concerned. The mixture of
double and single notes is technically almost worthy of Chopin. But
the tum-tum bass perseveres and blights the whole. Still this
variation has a bright sparkle, the line of the upper part has a flowing
grace, and there is necessarily little of that repetition of one or two
stereotyped figures which in longer works almost strangles the life in
most music of the virtuoso type.
The second variation is hopelessly commonplace. The melody,

scarcely varied, is in octaves for the right hand, and the tum-tum for
the left is changed to a rat-a-tat-tat-a-ta-tat. The raison d’être of the
variation is the crossing of the right hand over the left in the second
half of the first beat of every measure, in order to dive, as it were,
into the deep accented note of the second beat. One cannot but
think of the leap of children from some upper loft to a hay-filled mow
beneath. Herz makes the right hand take such a flight here, over and
over again. One laughs with the delight of a child, yet wherein lies
the joy? Is it in the taking flight? The movement through the air? The
ultimate shock of landing?
The virtuoso is not a child. He is a clever man who plays upon what
is and ever will be the child in man,—his bump of wonder. And he
does not strike it with music, but with movement. It is not the notes of
his scales or of his runs, but the speed with which he accomplishes
them. Here in this second variation is proof of the case in point. If in
every measure the right hand, instead of taking its bold flight, were to
glide only one half as far and quietly relieve the left hand of its
accompanying chords of the second beat; and if the left hand, so set
free, were to play that resounding low note which was the hay-mow
to the right, but to the left is only a step downstairs, the musical
effect and the musical value of the piece would remain quite
unchanged. But Herz would not have played it so; for the reason that
he wrote this variation merely to show his right hand and arm in free,
sweeping movement through the air. Mark you, then: the great effect
of this second variation is wholly one of movement. Not only is there
no question of music; there is not even one of sound.
The third variation gives the theme to the left hand, and the right flies
up the keyboard in arpeggios and down in scales, at a high rate of
speed. From here the music expands freely into a sort of fantasia.
Fundamentally there are still variations, but they are not cut off
definitely from each other. Notice from here on, likewise, some
excellent writing for the keyboard, something of an independent and
melodious part for the left hand, brilliant chromatics, trills, and runs
that drop in whirling circles, tremolos, filigree scales over smooth
basses à la John Field. Then there is a Final in which the theme is
broken up into a lilting, extremely rapid waltz, and in which the
pianist is called upon to surmount difficulties of no trivial kind. The
series comes to an end in a coda, which, like many a classical coda,
swells big as the frog in the fable till it bursts.
These variations and all other variations of Herz are dead as the
facile hand that wrote them. There is nothing of musical life in them,
and consequently they never had a chance to prove themselves
immortal. But the point is not the lack of musical value in these
pieces, but the very striking presence of high technical skill. This, as
found not only here but in his concertos and other compositions, is
the gauge of his skill as a player, which by these signs was
extraordinary. As a musician he may very well have been a
charlatan, but as a virtuoso he was an adept. His universal success
is, finally, proof that such a man was the man that the public most
wanted to hear.
Another indication of the public taste at that time, which, be it

remembered, was the time of Schumann and Chopin, is the fact that
such variations and fantasias as Herz now composed on familiar airs
from operas or household songs were, perhaps above all else,
acceptable. This again must mean that the general audience was
interested not in what we know as music, but in a movement of
hands, arms, fingers, and incidentally sounds, upon a musical
structure with which they had not to bother themselves. In other
words one went to hear or to see what the player could do, not to
listen to what he could express of his own emotion, or reveal of the
emotional content of pianoforte music.
The pianoforte was, after all, a relatively new instrument. Though

Clementi, Mozart and Beethoven had written for it, they had not
forgotten that in the houses whither their music would find its way,
there were likelier to be harpsichords than pianofortes. It was not
until the time of Herz that the pianoforte had become familiar to the
household touch of prosperous tradesmen and artisans. Here was
created a new public, one which wished to relish its new possession,
to prune itself beside the blazing glory in which it might now boast
part-ownership.
There is an amusing passage in Von Lenz’s book[37] on the great

virtuosos. It was written in connection with Tausig, almost twenty
years after the death of Chopin. ‘His [Tausig’s] distinguishing
characteristic was,’ he wrote, ‘that he never played for effect, but
was always absorbed in the piece itself and its artistic interpretation.
This objectivity the general public never understood; whenever
serpents are strangled, it always wants to know just how big and
dangerous they are, and judges of this by the performer’s behavior.
The general public thinks that whatever appears easily surmounted,
is not really difficult, and that son or daughter at home might do it just
as well!’ The opera fantasias and variations of Herz, of Thalberg, and
even of Liszt had the advantage, from the manager’s point of view,
of making self-evident the bigness and dangerousness of the
serpent; for, that which was added to the familiar tune was no less
than fangs, coils, and fiery breath of the beast itself, which the knight
of the piano both created and destroyed.
II
As there were soldiers of fortune who, like Herz, made up by an
abundance of shrewd and witty sense, what they lacked in
refinement, there were others, like Sigismund Thalberg, whose
outstanding quality was elegance. Von Lenz called Thalberg the
‘only correct “gentleman rider” of the piano.’ This may be taken to
refer to his playing rather than to his compositions. It was most
beautiful playing, according to all testimony, perfectly smooth, clear,
sonorous, liquid, singing, enriched by every quality, in fact, which
may be derived from a perfect and delicate mechanism governed by
a fine ear. As a player he was by many preferred to Liszt. This was a
purely sensuous preference, based entirely upon the qualities of
sound which the two men were able to win from the piano. In this
regard Liszt and Thalberg may be considered rivals of an equal
endowment.
We must, however, limit ourselves to the quality of Thalberg’s

compositions, for astride of these he rode into the general pianistic
fray. He published eighty-three pieces or sets of pieces. Three-
quarters of these are variations or fantasias. As in the list of Herz’s
compositions, we find in that of Thalberg’s variations on popular
songs of many nations: on ‘God Save the King’ and ‘Rule Britannia,’
on Viennese airs, and Styrian melodies, on ‘Home, Sweet Home,’
‘The Last Rose of Summer,’ and ‘Lily Dale.’ Then there are fantasias
and grand fantasias on two dozen or more operas: Norma,
Sonnambula, La Muette de Portici, Oberon, Der Freischütz,
Guillaume Tell, Robert le Diable, Don Pasquale, La Fille du régiment,
Un Ballo in Maschero and many others. The original works are of no
particular merit except that of being amiable and pleasingly written
for the piano. The most successful of the grand fantasias seems to
have been that on airs from Rossini’s Moïse, over which we may
pause to find evidence of his purposes and his style.
This was indeed one of the grand pieces of the century. A glance
through the pages is enough to show that Thalberg was a master of
the stupendous. Herz had nothing to show like the colossal climax
and close of this fantasia on ‘Moses.’ On the other hand, it seems
that nowhere in this grandiose composition is there any writing so
fine as that of the first variation of Herz’s we have just discussed.
But Thalberg is much more of a musician, or is more willing to show

himself one, than Herz. There are touches of good part-writing, of
skillful imitation, and of the combining of two melodies. There is an
introduction, beginning as quietly as Moses slept in the rushes,
which Thalberg builds up more solidly, if not more effectively, than
Herz built up his. The accompaniment to the first theme, simple
enough as it is, shows a touch of flesh—is not the skin and bones of
the ‘tum-tum.’ On the whole the left hand part is more varied
throughout. There is an episode in D-minor in which the left hand
figures are flexible, and upon the taking up again of reminiscences of
the first broad theme in the right hand, the left hand plays with
phrases of the theme of the section to come.
There is little unity in the piece, hardly a perceptible architecture. We

have now a section in B-flat minor, and here we have many a tum-
tum-tum in the left hand. Rossini’s melody in the right, however, is
interesting enough in itself to carry the music along. This section is
extended by variants of the theme and a great deal of rapid finger
work—single notes for the most part. The last section begins after a
fermata with a few ponderous introductory measures in broken
chords, rather thickly scored, but portentous. The stalwart melody is
played by the right hand, crossed over the left or mixed in with it.
And now watch Thalberg, and see how the man can ride.
This is a march theme, simply started at first, then played with the
thumb of the right hand, which has time between its separate notes
to scamper up and down the keyboard. Notice, too, that when the
right hand is soaring too high to be brought back in time for the
thumb to perch again on its melody, the thumb of the left hand jumps
into the breach and saves the line. Right thumb, left thumb, left
thumb, right thumb, either will do. And so the hands are free to jump
and run and fly. This emancipation was said to be Thalberg’s
accomplishment; but instances of dividing the melody between the
two hands may be found in the work of Beethoven, Schubert, and
Weber. It were needless to mention Bach in this connection.
However, it is just the sort of thing Thalberg needs, and he uses it
skillfully and successfully.
Meanwhile, the accompaniment grows apace. There are runs of

thirds for the right hand, which can thus indulge itself, knowing it
need not be home before dark, so to speak, that the left hand thumb
can wind the clock and keep the fire burning. There is next a
suggestion of pounding chords, but this gives way to a strange
shivering run of repeated notes—one remembers how Kuhnau told
the story of the frightened Israelites two hundred and fifty years
before, there are growing agitation, shrieks of the rising wind,
dreadfully raucous repeated octaves, now on E and, with a flash, on
F, and a pounding left hand that marches and rushes. It is like the
shriek of the approaching locomotive above the roar of its thundering
speed. And just as it should crash into view, or into something, there
is the sudden stillness of infinite night, and then our march theme,
spun like a thread of silver through flying runs. From thumb to thumb
it winds, and always pianissimo. The effect must have been one to
make a listener breathless with amazement. Little by little crescendo,
a change from B-flat major to G-major, a substitution of full chords or
octaves for the single thumb notes, and an extension of the runs into
the clouds, these bring about the close, a last page where left and
right hand together pound out the theme in repeated solid chords,
with tutta la forza. Sheer noise it is, here; and with all this
overpowering bombast the fantasia on ‘Moses’ comes to an end.
Such a work is well worth considering. We may not flatter ourselves

that even at this day we could resist its power under the hands of a
virtuoso. It would not by any means sound flat. But the instinctive
response to such sonority would perhaps be a cause for shame to
those who were conscious of even a little musical learning. The word
trash comes quickly to the lips, and the more readily when we know
our sensational heart has beat a trifle faster in spite of our better
reason. It is not, then, that the music is feeble or unsuccessful, but
that we distrust sensationalism and cherish a professional shame of
it.
The paraphernalia of the sensationalist composer is necessarily

limited, and Thalberg’s fantasias and variations suffer principally
because of these limitations. He has a great knowledge and control
of the pianoforte, but can find only scant variety of use for them. He
must depend most upon speed and upon noise, and both are what
we may call cumulative effects. In other and less elegant words, he
must use lots of speed and lots of noise. His runs are masses of
notes, very frequently no more than arpeggios or chromatic scales.
He throws a run up from a melody note as you throw a ball into the
air. It covers its distance and drops. It is no more the style of Chopin
than your ball is like the flight of a bird. But the very fact that it goes
up and down with no more freedom of movement than the ball that is
thrown in the air, is what makes it purely sensational, purely a matter
of speed in a mass of sound. If it went otherwise than upon its
automatic way, your ears would be pricked from feeling into listening.
In the matter of noise the effect must still be massive. The

sensationalist composer must always write for the feeling, not the
listening ear, and he can best overpower the former by repeating
chords rapidly; for in doing this he not only makes a very mountain of
noise but adds the mountain of movement upon it. Of all the tricks of
the pianist this is the most vulgarly sensational; and yet, when it
comes to a matter of noise how else can he accomplish his
purpose? In no other way can he make such a din, and if he tries
any other he shocks the ear into listening.
So in many a way Thalberg is a slave to his purpose. The ear that

has been trained to listen cannot but be wearied or outraged; but
forget our recently acquired habit of listening (for even among many
of the exalted it is only half acquired) and Thalberg may still today
become what Schumann called him more than half a century ago,—
a god—at the piano. Rubinstein, by the way, was hardly the man to
call him a grocer, even though he dealt, as we have had to admit,
with masses of notes. There was a splendor about him, something
fine and grand as well; but like gods in general he was not to be, or
may not now be approached, else he loses his godhead, which
resolves into an agitation of the ear. There is no splendor in his
music but the splendor of sensation.
If we examine the fabric of his music with a more technical eye we

shall find that he makes relatively little use of double notes, relatively
little demand upon the left hand as far as broad figures are
concerned, but much upon the lightness and freedom of the wrist in
both hands. There is, besides, the dividing of the melody between
the thumbs of both hands, already mentioned.
He had a very unusual power over melody on the piano. For this we
have the word of his none too amiable rival, Liszt, that Thalberg
alone could make the piano sing like the violin. He was invited to
publish an instruction book on L’art du chant, appliqué au piano. This
is composed of a few introductory paragraphs, and a dozen
transcriptions of melodies upon which the student was expected to
work out the precepts he had just read. The remarks may still be of
some interest to the pianist, but surely the transcriptions will be more
so. The day for that sort of music has gone by, but one may still
delight in the skill with which Thalberg was able to write melody,
originally conceived for voices or violin, with orchestral
accompaniment, upon the piano. None of these is so pretentious as
some of the big transcriptions of symphonies and overtures made by
Liszt; but from the point of view of workmanship all are quite equal to
Liszt. The eighth—on a scene from Meyerbeer’s Il Crociato—is
tremendously effective in places. The ninth—on a ballade from
Preciosa—is exceedingly well done. The tenth is a wholly charming
transcription of one of the Müller-Lieder.
We may speak, in passing, of a nocturne in E major, opus 28, as

representative of the best of his original compositions. It is by no
means great music either in the sense of inspired emotion or of richly
varied workmanship; but it is well adapted to the piano, sweet in
melody, and not too sweet in mood. The obbligato treatment of the
left hand in the middle section is worthy of note as a sign of
considerable technical ability, the development of which probably
atrophied under the close pressure of a constant adulation. This
Nocturne seems on the whole rather above the average of
Mendelssohn’s ‘Songs without Words,’ by virtue of the treatment of
the piano in it; and may, with other of his original works, be gently
slid into the company of Liszt’s ‘Consolations’ and ‘Love Dreams.’
Most of the music of Herz and Thalberg has been forgotten, and that
which might still be successfully played, is now banished from the
concert stage as trash. It is true not only that one finds a great
sameness in it, but also that in the light of a longer familiarity with the
instrument and of strides in executive skill on the keyboard little of it
presents what may seem to us today even ingenuity. Yet to estimate
its value as well as its significance in the world of pianoforte music
one must not forget the purpose for which it was written; namely, to
display the composer’s skill as a performer, and the brilliant and
powerful resources of the instrument, and at the same time to win a
livelihood from the world by stirring its inhabitants to a frenzied
delight. The aim to succeed with the public, no matter what the
means, has something of the heroic in it, and in music which has
been the means of such success there must be some element of
bigness. This bears no relation to the greatness of service to an ideal
which is sacred. It is in every way profane. Yet it is at the same time
a force always to be reckoned with, the more so as the development

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List of Tables xii Hyperplasias and Neoplasms 15

Development of Malignant Neoplasms (Cancer) 30 Fibrinous Exudate 47

CHAPTER 6 Von Willebrand’s Disease 133

Trauma 193 Gluten-Induced Enteropathy 234

Review Questions 277 Effects of Aging on the System 332

Sexually Transmitted Diseases 392

Respiratory Diseases 487 Narcotics 511

Chapter 10 ■ Updated the renal calculi section

■ Updated the Diagnostic Tests of the Ear section Chapter 18

Chapter 17 ■ Added a new Healthy Highlight: Gene Mutations

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

TABLE 1–1 Types of Pathologists

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

TABLE 1–2 Examples of Acute and Chronic

become, the higher the risk for diseases such as

TABLE 1–3 Examples of Common Diagnostic Tests and Procedures

intervention be funded? If costs are funded by individ-

Fill in the Blank

Chromosomal and genetic abnormalities might or

TABLE 2–1 Classification of Hereditary Disease with Examples

Single Gene Polygenic Chromosomal

Cystic fibrosis Gout Klinefelter’s syndrome

and infection. On arrival at an emergency department,

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

TABLE 2–2 Examples of Neoplasms or Tumors

Neoplasms or tumors (-omas) may be classified as

Courtesy of Mark L. Kuss

Persons who are unable to eat enough to maintain

Courtesy of Mark L. Kuss

Obesity consume large amounts of vitamins for an extended

Immunodeficiency understood but is progressive and irreversible. Diseases

Basement membrane Basement membrane

Figure 2–5 Normal cell versus atrophied cell.

Basement membrane Metaplasia

Basement membrane Basement membrane

Neoplasia Cellular death, called necrosis (neh-CROW-sis),

4. T F Diseases related to the aging process are called regenerative disorders.

10. How do cells adapt when exposed to adverse conditions?

11. What are the definitions of the following terms?

It was Chopin who entirely appreciated the true value of movement

These more pretentious frills were added ex tempore by men like

Excepting always the music of Bach, there is almost no keyboard

But the compositions may be more definitely classified than by the

Perhaps the majority of the Nocturnes show a sentiment a little too

In the Mazurkas, harmonies, rhythm, and melodies have a distinctly

The Polonaises are in broad form. Those in A major, A-flat major,

The mass of Chopin’s compositions remains unique in the literature

Everywhere he played he was tremendously successful, whether in

Fantasias were usually constructed on airs from the favorite operas

But it would be a mistake to suppose that Herz’s elaborate fantasias

The second variation is hopelessly commonplace. The melody,

Another indication of the public taste at that time, which, be it

TABLE 1–2 Examples of Acute and Chronic