General Pathology [antikvár]

Preface For over a hundred years pathology has been one of the keystones of medicine, and as an academic subject it has been taught as part of the medical curriculum to prepare the student for the more nebulous clinical programme that completes his training. Unfortunately the practice of pathology has come to be relegated to the full-time pathologist and clinical medicine to the specialised clinician. This separation of pathological practice from the direct care of the patient is quite artificial, and indeed is unnecessary and undesirable. Recently this cleavage has been bridged, and the process is being accelerated by the advances that have taken place during the last two decades in clinical pathology, namely cytology, biochemistry, haematology, and microbiology. Even the isolation of histopathology, surely the last bastion of the nonclinical medical pathologist, has eroded before the advancing techniques of needle biopsy and the various types of endoscopy. Diseases even of previously inaccessible organs like the kidneys, pancreas, and central nervous system can now be adequately investigated during life and their progress mapped with precision. The necropsy has ceased to be the final event of revelation, but has rather assumed the role of an epilogue to a drama already well documented. Nevertheless, the epilogue quite frequently provides engaging and disquieting twists to the story—but it is no longer the major part of the record of the tale itself. Pathology is the scientific study of disease: it follows the morbid process from its inception to its termination and it investigates the lesions produced. Wherever possible it uses accurate measurement, for the scientific method demands reproducible data. Thus, the size of a cancer cell, its content of DNA, its characteristics in tissue culture, and the life span of the patient in whom it is found can all be measured; all these considerations fall within the scope of pathology. The subject is therefore the concern of clinicians no less than pathologists, a fact well attested by the many valuable contributions made to pathology by clinicians and to clinical medicine by pathologists. The medical graduate whose practice is restricted either to the bedside or the laboratory can be sure of having only an incomplete and unbalanced understanding of medicine. The fifth edition of General Pathology is our continued effort to provide an account of the fundamental processes of pathology in relationship to medical practice. A full understanding of the subject involves the disciplines of morbid anatomy, biochemistry, haematology, microbiology, physiology, and clinical medicine; all these aspects of disease process are dealt with in this book, and in particular we have tried to give a careful description of the basic pathological processes, for both these and the terms that are commonly used to describe them are a constant source of difficulty to the beginner. We do not aim at giving a comprehensive account of recent advances; many fine books and reviews are available for such information. Five years have now elapsed since the last edition, and although no outstanding breakthroughs in medicine have been evident, the many advances that have been recorded have necessitated a complete revision. Worn-out type and aged blocks have required that the whole text be reset, and we have taken advantage of this situation to recast the book. Three entirely new chapters have been added; in Chapter 33, Some Disorders of Metabolism, the section on glucose metabolism includes an account of diabetes mellitus and the glycogen-storage diseases; an account of gout and the porphyrias follows. Chapter 34, Disorders of Nutrition, encompasses the important topics of starvation, the role of vitamins, and the malabsorption syndrome. Chapter 35, Disturbances of Endocrine Function, includes a section on the APUD system of cells. The topic of calcium metabolism has been expanded and added to the existing section on heterotopic calcification: this now constitutes a new Chapter 36. The remaining new addition to the book is Appendix 4 which is devoted to the HLA histocompatibility antigens. Over 150 illustrations have been added, either to replace unsatisfactory figures or to provide new material. Sections in which major revision has been necessary are those describing the chemical mediators of acute inflammation, the granuloma, the bactericidal mechanisms in polymorphs in relationship to immunity, immunology, viral diseases (especially the section on the oncogenic viruses and the viruses of hepatitis), rickettsial and chlamydial infections, and the pathogenesis of amyloidosis. Among numerous topics which have either been expanded or introduced for the first time are the techniques and uses of freeze etching, horseradish-peroxidase staining, gel-filtration chromatography, banding of chromosomes, counter-current electrophoresis, the structure and function of the cell membrane, the Golgi complex, microtubules and microfilaments, Noonan's syndrome, myelin figures, unscheduled DNA synthesis, DNA repair, the metabolism of mucoproteins, the chemical composition of collagen, the collagenases, the functions of macrophages, axial regeneration in amphibians, regeneration of muscle, the tissue reactions in leprosy, silicosis, and asbestosis, the Jarisch-Herxheimer reaction, apoptosis, the anion gap, the platelet release reaction, the pathogenesis of atheroma, vasculitis, the Prinzmetal type of angina pectoris, mountain fever, and the clonal origin of tumours. There have been two other departures from our previous custom. SI units have been introduced for the first time, since these are commonly used in many parts of the world. The traditional units have been retained for readers who are unfamiliar with the new nomenclature. The references at the end of each chapter have been rigorously scrutinised, and