Michael Crichton - Five Patients

Cerebrospinal fluid - The fluid which bathes the brain and spinal chord.

Cirrhosis - From the Greek for "tawny," and the early observation that scarred organs became yellowish in appearance. The term refers to destruction of parts of an organ and replacement of the damaged areas by fibrous scar tissue. One can speak of cirrhosis of breasts, kidney, or lung, but the term usually refers to scarring of the liver, following damage from alcohol or other causes.

CPK - Creatinine phosphokinase, an enzyme. When the concentration of this enzyme in the blood is increased, it suggests tissue damage, particularly heart muscle damage.

CSF - Cerebrospinal fluid (q.v.).

Digitalis - A drug to improve the strength of heart muscle.

Disseminated cancer - Widespread or metastatic (q.v.).

Diuretic - A drug that promotes excretion of urine.

Diverticulitis - Inflammation of a diverticulum, generally the tiny diverticula of the lower intestine.

Diverticulum - Literally a pouch opening out from some hollow organ, such as the gut or bladder.

Edema - Accumulation of excessive fluid in tissues; dropsy. It can be observed in a wide range of disease states.

Electrocardiogram - A graphic record of the electrical activity of the heart, revealing information about the rhythm, the electrical conduction within the heart, the health and thickness of heart muscle, and so on.

Encephalitis - Inflammation of the brain.

Glomerulonephritis - Inflammation of the kidney; specifically, of a part of the kidney known as the glomerulus.

Guarding - In medical reference, it refers to a patient's tensing his muscles in a painful area when he is touched there.

Hematocrit - A centrifuge for separating cells from the liquid portion of the blood. In medica-lese, the volume percentage of red cells to fluid in blood. Normally 40 to 45 per cent.

Hepatitis - Inflammation of the liver, usually caused by a virus.

Idiopathic - Of unknown origin.

IVP - Intravenous pyelogram, an X-ray study of kidneys made while they excrete a special dye.

Jaundice - A yellow staining of skin and eyes, from accumulation of bilirubin (g.v.) in the body.

Lacerations - Cuts.

LDH - Lactic dehydrogenase, an enzyme. Blood levels are increased with tissue destruction in various organs.

Lumbar puncture - Passage of a needle between lumbar vertebrae in the lower spine, in order to enter the spinal canal and remove for analysis some of the fluid that bathes the brain and spinal cord.

Metastatic cancer - Cancer that has spread throughout the body to distant sites. myocardial infarction Heart attack. morphology Physical appearance.

Obtunded - Literally blunted, in medical reference to demonstrate decreased mental alertness and acuity.

Pancreatitis - Inflammation of the pancreas. pathological Diseased, abnormal.

Platelet A small, flat, plate-like cell in the blood that aids in clotting.

Platelet count - A count of such cells. prognosis Foretelling of the outcome of a disease.

Reticulocyte - An immature blood cell.

Reticulocyte count - A counting of the number of immature red cells in circulation. Normally only a small percentage of red cells are immature; if the bone marrow is making more blood, the number of reticulocytes in circulation will increase.

Tap - As in thoracic or abdominal tap, medicalese for passage of a needle into the chest or abdomen to drain off ("tap") fluid inside; centesis.

Toxin - Poison.

Triage officer - An emergency-ward physician who decides which patient requires treatment first.

Ventricles - The paired lower chambers of the heart.

Sequestered - Hidden.

SCOT - Serum glutamic oxaloacetic transaminase, an enzyme. When present in elevated concentrations in blood, it implies tissue damage.

Stenosis - Narrowing of any canal or aperture, such as aortic stenosis, narrowing of the aortic valve of the heart.

Sternum - Breastbone.

Steroids - A class of chemical agents with a characteristic ring structure that are produced within the body (as well as artificially). Many sex hormones are steroids. Cortico-steroids, which are produced in the cortex of the adrenal glands, have the power to suppress inflammation and the immune response.

All cited sources are listed below, as well as others which provide the general background for the book.

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"Annual Reports, Massachusetts General Hospital, 1821-1967."

Aub, J. C., et al: Management of the Cocoanut Grove Burns at the Massachusetts General Hospital. Philadelphia: Lippincott; 1943.

Bowditch, N. I.: History of the Massachusetts General Hospital, 1810-1872. Boston: Griffith-Stillings; 1872.

Burrage, W. L.: A History of the Massachusetts Medical Society, 1781-1922. Norwood, Massachusetts: Privately Printed; 1923.

Churchill, E. D.: At Work in the Vineyards of Surgery; the Reminiscences of J. Collins Warren, 1842-1927. Edited with appendices, notes, and comments by E. D. Churchill. Cambridge: Harvard University Press; 1958.

"Commonwealth of Massachusetts, Registration Report, 1883-1903."

Faxon, N. W.: The Massachusetts General Hospital, 1935-1955. Cambridge: Harvard University Press; 1959.

Garland, J. E.: Every Man Our Neighbor, A Brief History of the Massachusetts General Hospital, 1811-1961. Boston: Little, Brown; 1961.

Harrington, T. P.: The Harvard Medical School, 1872-1905, a History, Narrative and Documentary. Edited in three volumes by J. G. Mumford. New York: Lewis; 1905.

"Massachusetts General Hospital, Directions as to the Diet of Patients." Boston: Privately Printed; 1850.

Massachusetts General Hospital Memorial and Historical Volume (together with proceedings of the Centennial of the opening of the Hospital). Boston: Griffith-Stillings; 1921.

Massachusetts General Hospital, Rules Concerning the Decease of a Patient. Boston: Privately Printed; 1850.

Massachusetts General Hospital, Rules for House Officers. Boston: Privately Printed; 1850.

Means, J. H.: Ward 4, The Mallinkrockdt Research Ward of the Massachusetts General Hospital. Cambridge: Harvard University Press; 1958.

Myers, G. W.: History of the Massachusetts General Hospital, 1872-1900. Boston: Griffith-Stillings; 1929.

Washburn, F. A.: The Massachusetts General Hospital. Its Development 1900-1935. Boston: Houghton Mifflin; 1939.

Fulton, J. F.: Harvey Cushing, A Biography. Springfield, Illinois: Thomas; 1946.

Garrison, F. H.: Contributions to the History of Medicine. New York: Hafner; 1966.

Inglis, B.: A History of Medicine. New York: World; 1965.

Major, J. H.: Classic Descriptions of Disease. Third Edition. Springfield, Illinois: Thomas; 1945.

Moore, F. D.: The Gastrointestinal Tract: Surgery. Edited by Richard Warren. Philadelphia: Saunders; 1963.

Richardson, R. G.: The Surgeon's Tale. London: Allen and Unwin; 1958.

Riesman, D.: The Story of Medicine in the Middle Ages. New York: Hoeber, 1935.

Rogers, F. B.: A Syllabus of Medical History. Boston: Little, Brown; 1962.

Roueche, B.: Curiosities of Medicine. Boston: Little, Brown; 1958.

Sigerist, H.: A History of Medicine. Oxford: Oxford University Press; 1951.

Henry E. Sigerist on the History of Medicine. Edited by Felix Martf-Ibanez. New York: MD Publications; 1960.

Barnett, G. O.: "Computers in Patient Care." New England Journal of Medicine, 279 (1968), pp. 1314-18.

Beeson, P. B.: "Review of Sickness and Society." Yale Journal of Biology and Medicine, 41 (1968), pp. 226-41.

Bell, D.: Toward the Year 2000: Work in Progress. Edited by Daniel Bell. Boston: Beacon; 1969.