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HUMAN DISEASES (Part 2 of 7)   Leave a comment

What Happens When Immunity Backfires

Paradoxically, a person’s immunity system can backfire and develop auto-antibodies against his own body tissue. In many diseases of unknown cause, doctors have found many unusual antibodies in the blood serum of patients.

Rheumatoid arthritis (RA), chronic disease of the connective tissue, causing painful sensations in joints and muscles.

Doctors think the patients become sensitive to something made by their own bodies. Only a slight change in certain proteins in normal body tissue is necessary for them to become antigens. Most diseases marked by the production of auto-antibodies cannot be traced to infection or drug allergy. In rheumatoid arthritis, for example, the rheumatoid factor is the presence of auto-antibodies in the victim’s blood. These auto-antibodies may stick to the membranes lining the bone joints and cause a reaction that destroys tissue in the joints. In other disorders associated with reversed immunity, auto-antibodies strike red blood cells, tissues surrounding small blood vessels, or other target areas. Ulcerative colitis, a disorder marked by an inflamed portion of the intestine, often with ulcers, is also believed to be an autoimmune disease.

In some cases, lymphocyte defects or discrepancies in antibody production lead to an immune deficiency. The victim is then helpless against recurring infections. A simple head cold can soon become pneumonia. Antibiotics or serums with antibody-rich gamma globulin offer temporary relief in such cases.

1796: Inoculation against disease. The simple medical procedure known as vaccination first came into use in about 1713 as a means of preventing smallpox. Such inoculation sometimes proved dangerous, because individuals sometimes caught a severe case of the disease instead of a mild one. This problem was solved by Edward Jenner, a British physician, in 1796. He realized that individuals inoculated with the much milder cowpox virus became immune to smallpox. Jenner tested his theory in May 1796.

This kind of inoculation earned the name vaccine, from the Latin word vaccinus, meaning “from cows.” Since Jenner’s day vaccines have been developed to fight polio, diphtheria, whooping cough, measles, typhoid fever, cholera, tetanus, and other diseases.

1928: Penicillin. In 1928 the Scottish bacteriologist Alexander Fleming was doing research on the Staphyloccus bacteria when he noticed that a growth of mould Penicillium notatium was contaminating the culture. There was no bacteria where the mould was present. Following up on this fact, Fleming found there was something in the mould that prevented bacterial growth. He named this substance penicillin.

By continued experiment Fleming learned that penicillin is capable of killing many common disease-causing bacteria. His discovery proved to be one of the first and most useful antibiotics used in medicine today. By 1940 penicillin had been turned into an injectable medicine. Its use grew dramatically during World War II as an infection-preventing agent.

HOW DRUGS FIGHT DISEASE

With the advent of drug therapy in the 20th century, doctors began to use lifesaving drugs to fight disease. The clinical use of sulphanilamide, the predecessor of sulphur drugs, in the 1930s and the mass production of penicillin, the first antibiotic, in the 1940s gave physicians extremely powerful tools with which to fight infection. A disease-fighting drug never acts by itself. It always works in conjunction with the body’s immunity system. Vaccines have also become available for the prevention of certain diseases.

How Certain Drugs Quell Infection

Such antibiotics as penicillin, streptomycin, and tetracycline are very effective against bacterial infections. The name “antibiotic” comes from antibiosis, or the use of substances made by one living thing to kill another. Antibiotics are made by bacteria and moulds that are specially cultured in commercial drug laboratories.

Antibiotics kill bacteria and other disease organisms in various ways. Some destroy the cell walls of bacteria. Others interfere with bacterial multiplication or fatally alter the way bacteria make vital proteins. Still others mix up the genetic blueprints of the bacteria.

Ordinarily, an antibiotic tricks bacteria into using the antibiotic’s chemicals instead of closely related ones that the organisms really need for making the key enzymes required for their growth and reproduction. With the antibiotic assimilated into their systems instead of the vital chemicals, an essential activity or structure of the pathogens is lacking and they die.

Sulphur drugs act in a somewhat similar but less effective way. Weakened but not killed by the sulphur drugs, the pathogens fall easy prey to the body’s scavenger cells. Drugs are also available against parasitic worms, infectious amoeba, and other pathogenic organisms.

Antibiotics are not very effective against viruses because the drugs cannot get into the body cells where viruses hide and multiply. However, the body produces a protein called interferon that inhibits viral reproduction.

A drug is sometimes recognized by the body’s immunity system as an antigen. It then triggers a severe reaction. In some cases, a person can suffer anaphylaxis, or extreme sensitivity, to penicillin after repeated injections. Without quick medical aid, severe cases of anaphylactic shock can be fatal.

How Bacteria Become Drug Resistant

Once in every several hundred million cell divisions a mutation makes a bacterium immune to an antibiotic drug. The mutation alters the bacterium’s genetic code and thus its ability to use certain chemicals for its life activities. Mutations can be caused by the radiations from outer space that stream into the Earth’s atmosphere, as well as by some atmospheric chemicals. As a result of the mutation, all bacteria that stem from the immune germ will be resistant to the drug unless any of them undergoes a mutation that makes the strain susceptible again. Hence, whenever a new antibiotic is developed, there will be a chance that bacteria will develop an immunity against it. But because mutations are fairly rare, doctors have a good chance of fighting a bacterial disease with the new drug before future strains become resistant.

Some members of a bacterial strain are resistant to certain drugs naturally. In the course of time they can eventually become selected through evolutionary forces to become the dominant drug-resistant forms of a pathogenic strain.

More importantly, some bacteria can pass on their drug resistance to bacteria of another strain by “infection.” Since the passing of resistance factors does not depend upon the lengthy process of mutation, it poses a much greater problem of drug immunity. As a consequence, doctors often must prescribe more than one antibiotic to fight certain diseases in the hope that this will slow bacterial resistance.

Use of Vaccines and Hormones

A person can become artificially immune to some diseases by means of a vaccine. Vaccines contain antigens that stimulate the production of protective antibodies. Immunity to smallpox, polio, measles, rabies, and certain other diseases, is induced by injecting a person with vaccines containing living but attenuated, or weakened, disease organisms.

A vaccine containing only dead organisms protects against typhoid fever and whooping cough, as well as against measles and polio. Vaccines containing toxins, or poisons, are used to prevent diphtheria and tetanus. When injected into a person, they trigger the production of special antibodies called antitoxins.

Some body disorders are caused by too much or too little hormone production. Hormones are body chemicals that influence many vital biochemical reactions. When someone suffers a hormone deficiency, a doctor usually can treat the deficiency with hormone shots.

1347: Black Death. The plague is one of the most devastating diseases that has ever afflicted mankind. It is a highly contagious fever caused by the bacillus Yersinia pestis, which is carried by fleas that infest rats.

The plague, commonly called bubonic plague or the Black Death, has been known since ancient times, but the best documented instance was its deadly appearance in Europe in 1347. It raged throughout all of Europe, killing at least one-fourth of the population probably 25 million people. Without understanding how it is spread, people had no defence against the disease. Poor sanitary conditions and the disruption of war only worsened the epidemic.

In Europe the epidemic started in Sicily and was spread by shipboard rats to other Mediterranean ports. It moved to North Africa, Italy, Spain, England, and France. By 1349 it made its way to Austria, Germany, Switzerland, and the Low Countries. By 1350 it reached Scandinavia and the Baltic states.

In general, the population of Europe did not recover to its size before the plague until the 16th century, and some towns never recovered. The immediate results of the plague a general collapse of economies, a breakdown of class relationships, and a halt to wartime hostilities forced a massive restructuring of society. It has had a lasting impact on art, literature, and religious thought.

INFECTIOUS DISEASES

Infectious diseases can be transmitted in many ways. They can be spread in droplets through the air when infected persons sneeze or cough. Whoever inhales the droplets can then become infected. Some diseases can be passed through contaminated eating or drinking utensils. Some can be spread through sexual activity. Others can even be spread in the course of medical or surgical treatment, or through the use of dirty injection equipment, especially by drug abusers.

Cold (also called common cold, or coryza), illness, acute inflammation of upper respiratory tract.

Once an infectious organism gains a foothold in the body, it begins to thrive and multiply. Its success is slow or fast, depending upon the nature of the pathogen. The symptoms of the common cold, for example, appear within a few days of infection. However, the symptoms of kuru, an uncommon disease of the nervous system, often appear three years or longer after infection.

Incubation period, length of time before the symptoms of a disease appear.

Every infectious disease has an incubation period. This is the length of time between the pathogen’s gaining a foothold in the body and the appearance of the first symptoms of the disease.

Several factors also determine whether a person will become the victim of a disease after being infected. The number of invading germs the dose of the infection influences the outbreak of disease. So does the virulence of the pathogens; that is, their power to do harm. In addition, the condition of the body’s immunological defences also affects the probability of catching a disease.

Contagious Disease

A great many infectious diseases are contagious; that is, they can easily be passed between people. To acquire certain contagious diseases someone need only be in the presence of someone with it, or come in contact with an infected part of the body, or eat or drink from contaminated utensils.

Someone can be a carrier of a contagious disease in several ways. He can be an asymptomatic carrier, or have a disease without ever developing its symptoms. He can be an incubationary carrier and pass on the pathogens at any time during the “silent” incubation period. He can be a convalescent carrier and transmit some of the infectious organisms remaining in the body even after recovery. Of course, anyone suffering the frank symptoms of a contagious disease can pass it on to others while the disease is running its course.

HEART AND BLOOD SYSTEM DISEASES

Disease of the heart or of the blood vessels, called cardiovascular disease, is the leading cause of death in the United States and Canada. It claims more than a million lives each year in the United States; more than 70,000 each year in Canada.

The heart is a muscular pump. When its own tissue or blood vessels become diseased, serious and sometimes fatal harm can follow.

Coronary Artery Disease

Disease of the coronary arteries that supply oxygen and nutrients to the heart is the most common heart ailment. Coronary artery disease accounts for more than a third of all deaths among males in the United States between the ages of 35 and 55. It also strikes many women past the age of 50. Hypertension (high blood pressure), overweight, cigarette smoking, diabetes mellitus, excess cholesterol, triglycerides and other fats in the blood, and probably lack of regular exercise contribute to the chance of getting coronary artery disease.

Coronary artery disease is characterized by an atheroma, a fatty deposit of cholesterol beneath the inner lining of the artery. The atheroma obstructs the passage of blood, thereby reducing the flow of nourishing blood to the heart muscle. It also sets up conditions for a blood clot in the coronary artery. Atheroma formation seems to run in families. Eating foods rich in saturated animal fat and cholesterol is also thought to contribute to atheroma formation.

Many persons with coronary artery disease do not experience symptoms. If the obstruction is bad enough, however, it may cause angina pectoris, myocardial infarction, or heart enlargement and failure.

Angina pectoris, brief paroxysm of severe chest pain with feeling of suffocation.

Angina pectoris is a chest pain that feels like something is squeezing or pressing the chest during periods of physical exertion. It takes place when the heart’s oxygen needs cannot be met because of a blocked coronary artery. Rest will relieve the pain. Some persons have angina pectoris for years and still live active lives.

Myocardial infarction is commonly called heart attack. Tissue death that results from a lack of blood is called infarction. When the coronary artery becomes so obstructed that the myocardium, or heart muscle, does not receive oxygen, it dies.

Heart attack (also called myocardial infarction, or coronary occlusion), an acute episode of heart disease.

Once, it was believed that a blood clot occluded the coronary artery and caused the infarction. This is why a heart attack is sometimes called a coronary occlusion. However, it now appears that most clots form in the artery after the infarction.

The first few hours after a heart attack are the most critical because abnormal heart rhythms may develop. Ventricular fibrillation is the most dangerous. The ventricles of the heart contract so fast that the pumping action is baulked Death follows in three or four minutes. Heart attack patients are usually treated in the coronary care unit of a hospital for a few days to enable electronic monitoring of the heart rate and rhythm.

Heart failure, condition that develops when repeated heart attacks occur.

Heart failure can occur when repeated heart attacks put too much strain on the remaining healthy heart muscle. As attacks destroy more and more heart muscle, the remaining muscle hypertrophies, or enlarges, to maintain effective pumping. Pressure builds up in a weakened heart, however, and causes fluid backup in the lungs. As a result, the heart output cannot keep pace with the body’s oxygen demands.

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HUMAN DISEASES (Part 6 of 7)   Leave a comment

Other Metabolic Diseases

Gout is faulty metabolism of purine, an amino acid, resulting in the accumulation of uric acid in the blood and urate salts in the tissues, especially the joints where they cause painful arthritis. It may stem from an inborn error of metabolism or from other diseases. It usually strikes middle-aged men. The joint at the base of the big toe is the typical site of a sudden acute attack of gout. The affected joint becomes red, hot, swollen, and painful. Fever accompanies the attack. Joints of other limbs might become similarly affected. Attacks of gout recur, but the sufferer enjoys complete relief in between them. Some patients develop chronic arthritis from gout. Gout is treated with low-purine foods and such drugs as allopurinol that lower the uric acid level of the blood.

Cystic fibrosis, an inherited disease in which the pancreas fails to provide secretions necessary for normal digestion of food; commonly associated with chronic lung disease.

Cystic fibrosis is a genetic disorder involving the pancreas and the lungs. It appears during the first 10 years of life, although sometimes it is not discovered until later. Certain glands of the pancreas become plugged by thick mucus, which bottles important digestive enzymes. Intestinal troubles result.

Furthermore, the lungs suffer scarring, infection, and eventual emphysema. Cystic fibrosis is treated with substitute pancreatic enzymes, vitamins, and a high-calorie diet. Antibiotics are given to fight the lung troubles.

Other metabolic disorders include phenylketonuria (PKU) and galactosemia. PKU is an inherited inability to metabolize phenylalanine, an amino acid. Galactosemia is an inherited inability to change galactose, one type of sugar, into sucrose, another, because a necessary enzyme is missing. Both diseases can result in mental retardation of children if not corrected in time.

Arthritis and Lupus

Rheumatoid arthritis (RA), chronic disease of the connective tissue, causing painful sensations in joints and muscles.

When the body fails to recognize itself, it makes antibodies against its own tissues. Rheumatoid arthritis and systemic lupus erythematosus are two among a rising number of such autoimmune diseases.

Rheumatoid arthritis is a chronic crippling disease that deforms bone joints and their adjacent tissues. It can strike nearly anyone. Although arthritis is not especially prevalent in damp climates, its symptoms are more bothersome there. It is marked by inflammation of an entire joint, including its synovial lining. Tendon coverings and bursas, or fluid-filled cushions, can become inflamed too. Cartilage in the joint and adjacent bone are destroyed, causing painful stiffness and eventual ankylosis, or “freezing,” of the joint. Skin over the joint is taut, shiny, and clammy. Arthritics often suffer aches and pains. The rheumatoid factor, a large protein molecule, is present in the blood of so many adult patients that it aids in the diagnosis of the disease. Rheumatoid arthritis is usually treated with rest, physical therapy, and aspirin and other salicylates.

Systemic lupus erythematosus (SLE), or lupus, is a serious degenerative disease that can strike one or many body systems over a period of years. The blood serum of afflicted persons contains a number of peculiar proteins, including the so-called L.E. factor, the antibody characteristic of the disease. Symptoms of SLE resemble other diseases, including cancer and tuberculosis, but lesions around the nail beds and fingertips that destroy the skin in those areas earmark lupus. In addition, the spleen and lymph glands of the neck and armpits may enlarge. The pericardium and heart valves are affected too. The kidneys and portions of the central nervous system may also become damaged. Although anyone may be affected, females between the ages of 20 and 40 years most often develop this incurable disease.

Osteoarthritis is a painfully disabling disease of the spine and other weight-bearing joints. Cartilage in the joint is destroyed, followed by overgrowth of nearby bone. The incurable but non deforming disease develops with advancing age.

Ankylosing spondylitis is a disabling and deforming disease of the spine, sacroiliac joints, and sometimes the shoulders, hips, and knees. The synovial lining of the affected joint becomes inflamed, the bone is weakened by loss of calcium, and the spine is bent forward. Eventually, the spinal vertebrae fuse and the spine becomes locked in the deformed position.

KIDNEY AND GENITAL DISEASES

Disease can affect any of the parts of the closely related urinary and genital systems. Both can be infected or malfunction because of a shortcoming in development.

Kidney Inflammations

Kidney disease, commonly result of inflammation or damage to blood vessels of kidneys; severe forms lead to breakdown of normal elimination of waste products.

Glomerulonephritis is a serious inflammatory disease of the kidneys. It usually is triggered by a prior infection, often by streptococcal bacteria, which inflames the glomeruli, the tiny tufts through which blood is filtered. The inflammation may go away after a few weeks or may slowly destroy all the glomeruli. In the early stages, the inflammation may reduce filtration enough to cause blood to retain some excess fluid, salts, and wastes. Blood pressure might also rise. If the inflammation persists, the glomeruli are destroyed, blood pressure soars, and urine formation may stop. Mechanical means must be taken to cleanse the blood.

Pyelonephritis, bacterial infection of the inner portions of the kidneys and the urine.

Pyelonephritis is a bacterial infection of the inner portions of the kidneys and the urine. If quickly treated, the infection can be cured. If untreated, however, the infection may scar and eventually destroy kidney tubules, resulting in a need for mechanical cleansing of the blood. Once damaged by a bout of pyelonephritis, the kidneys are easily reinfected.

Toxaemia of pregnancy is a disorder stemming from other kidney problems experienced by some women in the last half of pregnancy. During a pregnancy, the kidneys must work more than usual. However, a woman entering pregnancy with a kidney disease such as Glomerulonephritis may not be able to step up kidney function enough to meet the new demands. In severe cases of toxaemia, the foetus may die or have to be aborted to save the mother’s life. In lesser cases, however, medical treatment poses little risk to either life. Once a woman develops toxaemia, she is likely to develop it again in later pregnancies.

Calculi and Other Urinary Disorders

Calculus disease, condition that occurs when certain substances in urine crystallize into compact stones.

Calculus disease occurs when certain substances in urine crystallize into compact stones called calculi. A stone may be formed within a kidney and become swept by urine into the ureters and the bladder. It may cause pain, obstruct urine flow, or grow large enough to damage the kidney or bladder. Small calculi may be passed in urine, and large ones can be pulverized without surgery by means of energetic sound waves. Calculi can consist of calcium, urates, cystine, or other crystals. The tendency to form kidney stones sometimes runs in families.

Polycystic disease, an inherited failure of normal kidney development, strikes infants as well as adults. Many fluid-filled cysts spring up throughout the kidneys and cause them to malfunction. Polycystic disease sufferers eventually become uraemic

Uraemia means “urine in blood.” It describes the condition in which the kidneys almost totally fail to operate. The blood then retains the nitrogenous products of protein metabolism instead of having them removed by the kidneys. Also, the concentration of many of the electrolytes, or salts, in the blood rises too high. The breath or perspiration of affected persons smells of urine. Each of the previously mentioned kidney ailments could cause uraemia Artificial kidneys have been developed to cleanse the blood of uraemic patients. In some cases, patients with destroyed kidneys can receive a human kidney transplant.

Genital Disorders

Sometimes portions of the genital system fail to develop normally. In some rare cases, the gonads male testes and female ovaries or other sex structures fail to develop at all. Without gonads, a person neither achieves puberty nor develops secondary sexual characteristics, such as breasts and uterus growth in females and penis growth and muscle development in males.

Infections such as gonorrhoea can cause sterility by blocking the oviducts, or egg passages, of females or the vas deferens, or sperm passages, of males. In males, gonorrhoea may also interfere with urination.

The prostate gland at the neck of the bladder in males enlarges slowly with age. It eventually may hamper urination and need surgical correction.

REHABILITATION

Rehabilitation is a fairly new medical speciality, although the notion of helping someone cope with a disabling disease or disorder is an old one. As an increasing number of people become disabled by stroke, paraplegia (paralysis of the lower body), limb losses, and many chronic nervous system and other physical disorders, it has been shown that medical rehabilitation can help many of them live a reasonably normal life. This is true even when the handicapping problem is not medically correctable.

Rehabilitation means getting utmost use from the limbs, senses, or other body systems that remain in operation after a chronic disability. Its goal is to help the patient become as independently active as possible. The disabling condition might result from a disease, birth defect, or severe accident. Sometimes rehabilitation involves fitting an amputee with an artificial limb, fitting a lame person with a brace, or teaching a paraplegic how to manoeuvre a wheelchair. Sometimes it only involves counselling and other psychological techniques for persons who are mentally disabled.

In its early days medical rehabilitation concentrated on helping people who had walking and other movement problems. The advances made in rehabilitating them sparked efforts to aid people who were stricken by stroke, chronic arthritis, and spinal cord disease and other chronic nervous system disorders. Afterwards, it was learned that rehabilitation could also help patients with heart disease, chronic lung disease, and a variety of conditions that slowed recovery from surgery. Bio engineers have been successful in devising artificial limbs and other life support structures that function so much like natural ones that recipients no longer suffer a disabling handicap.

Rehabilitation is a team effort. It requires the work and dedication of physicians, physical therapists, occupational therapists, psychologists, social workers, and vocational counsellors The doctor and the physical and occupational therapists work to restore those body functions impaired by the disability. The psychologist, social workers, and vocational counsellor help the patient get a mental grip on himself to better deal with the emotional and social problems brought on by the disability. Members of a coordinated rehabilitative team can do wonders in restoring a handicapped person to a functional life.

In addition, the rehabilitative team works with a disabled person to prevent the physical deterioration that takes place when muscles are not used. Furthermore, the team aims at getting the maximum output from the patient’s remaining body functions. Exercises and other means are used to develop fully the remaining physical reserves because disabled persons expend more energy and need more stamina to do ordinary things than do non disabled persons.

Teaching new tasks to the disabled is an integral part of physical rehabilitation. For example, a crippled person may be trained to use a wheelchair or other motive device well enough to manage into the driver’s seat of an auto mobile and thus achieve a measure of independence, the important goal of the entire rehabilitative process.

A chronically disabled person often suffers mental depression. The rehabilitation team tries to restore that person’s confidence so that he can take an optimistic view on resuming daily activities. Positive attitudes of patient, friends, and family toward any disability are important factors in the success of rehabilitation. During rehabilitation the patient is encouraged to find meaning in life, overcome feelings of being a “permanent patient,” and resume his place as an active member of society. Counselling is also important in rehabilitating alcoholics and the mentally ill.

Treatment for the disabled is given at special rehabilitation centres or in the rehabilitation departments of some hospitals. Rehabilitation units are designed so that patients can do many things by themselves; the quarters are built to simulate conditions the patients will encounter when discharged. As a consequence, patients get practice in dealing with such problems as opening and closing doors, going up and down stairs, and a host of other environmental situations that they will face when the rehabilitation program is over.

HUMAN DISEASES (Part 7 of 7)   Leave a comment

RESEARCH AGAINST DISEASE

Although medical science has made great strides to eradicate disease, a number of ailments remain to be conquered. Medical scientists have not yet discovered what causes muscular dystrophy, an inherited disorder that strikes nerve tissue and cripples its victim. Nor do they know what causes sudden death syndrome, or crib death, a disease that fatally strikes infants less than a year old. Nevertheless, research is under way against these and other baffling diseases in the hope that someday they will be wiped out or at least made manageable.

Medical scientists perform many kinds of experiments when they are on a research adventure. They may grow tiny cells in test tubes, infect them with the germs or chemicals they think might cause the disease, and watch the after effects Or they might infect a laboratory animal with a disease and observe how its body fights off or succumbs to the ailment. At other times medical scientists test the effects of a drug, a pathological environment, or a possible disease organism on human volunteers. However, before human experimentation ethically can be permitted, the volunteers must give their informed consent to any unconventional treatment. That is, they must be fully aware of the harmful as well as helpful consequences possible before taking part in the research. Also, prior experiments should have been made on laboratory animals to establish some idea of the project’s safety.

Medical research is an ongoing endeavour at many laboratories and scientific institutions throughout the world. Medical schools and major hospitals maintain research programs for the benefit of their patients with unchecked or rare diseases. Research programs are also undertaken at many universities where scientists divide their time between teaching and laboratory study. Government agencies such as the National Institutes of Health also engage in research against disease.

Research programs are delving into the problems of ageing As more and more is learned about the biochemical changes that go on in the body as it grows older, scientists may someday be able to modify those changes to ensure better health for the aged. The biochemical basis of certain forms of mental illness are being explored, too, as are the causes and possible remedies of drug abuse.

Some physical disorders still require surgery for correction. As a result, there has been research into improving surgical techniques and into devising artificial parts for the body. Surgeons, for example, have been trying to improve their ability to rejoin severed limbs. Bio engineers have designed heart pacemakers, sensory aids for the blind, and many other spare parts for the body.

The very foundations of life are being explored in genetic engineering. This recent endeavour is an attempt to alter the genetic make-up of developing embryos in the hope that inborn errors of metabolism can be corrected.

Although some scientists doubt that genetic engineering will ever be practical, if it became so, the ability to alter mistaken genes in unborn children would open a remarkable medical frontier. In the meantime, doctors have encouraged genetic counselling, in which couples planning marriage can learn of the possible consequences of childbearing when they are the carriers of certain inherited disorders, such as Down’s syndrome, also called mongolism, or sickle-cell anaemia

Assisted by Theodore R. Van Dellen, M.S., M.D., late Associate Professor of Medicine, Northwestern University, and syndicated medical columnist; Thomas Killip, M.D., Chief of Cardiology and Attending Physician, The New York Hospital; Albert M. Kligman, M.D., Ph.D., Professor of Dermatology, Hospital of the University of Pennsylvania, Philadelphia; William C. Thomas, Jr., M.D., Professor of Medicine, University of Florida College of Medicine; Bernard S. Leibel, M.D., Associate Professor of Medicine, University of Toronto; and Daniel J. Feldman, M.D., former Adjunct Professor, College of Medicine, University of California at Irvine.

BIBLIOGRAPHY FOR DISEASE

Berger, Melvin. Germs Make Me Sick! (Harper Junior, 1987).

Berkow, Robert, ed. Merck Manual: General Medicine (Merck, 1987).

Brown, Fern. Hereditary Disease (Watts, 1987).

Eagles, Douglas. Nutritional Diseases (Watts, 1987).

Hansherr, Rosmarie. Children and the AIDS Virus (Ticknor and Fields, 1989).

Hughes, Barbara. Drug Related Diseases (Watts, 1987).

McKeown, Thomas. The Origins of Human Disease (Basil Blackwell, 1988).

Metos, T.H. Communicable Diseases (Watts, 1987).

Zinsser, Hans. Rats, Lice, and History (Little, 1984).