Jitendar P Vij

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Jaypee-Highlights Medical Publishers Inc., City of Knowledge, Bld. 237, Clayton,

© 2010, Harsh Mohan

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.

First Edition : 1992

Second Edition : 1994

Third Edition : 1998

Fourth Edition : 2000

Fifth Edition : 2005

Sixth Edition: 2010

Assistant Editors: Praveen Mohan, Tanya Mohan, Sugandha Mohan

Typeset at JPBMP typesetting unit

Printed at Ajanta Press

A few years ago I wrote the Foreword to the Fifth Edition of this Textbook. For details and reasons why I liked Professor Mohan's book and why I recommended it then, please refer to my previous foreword below. My positive reaction to the previous Edition probably gives some clues on why I accepted the second invitation, this time to introduce the Sixth Edition to new students of Pathology and other potential readers.

As the Book Review Editor of the journal Modern Pathology, the official journal of the United States-Canadian Academy of Pathology I am used to receiving medical books. These books are sent to my office from publishers, with a standard request for a potential review in the Journal. Nevertheless a recent package from New Delhi caught me by surprise.

Question 1: Is this a good book?

Answer: Yes. This is a modern Textbook written by an expert who knows his pathology; an experienced teacher who knows what is important and what is not, and who has obviously taught pathology for many years; a well informed academician who is au courant with modern trends in medical education, and knows how to present pathology as a preparatory step for future clinical education of medical students.

Question 2: How does the book compare with the leading textbooks of pathology in the USA, Great Britain and Germany?

Answer: Very favorably. This Indian Textbook covers more or less the same topics as the equivalent Textbooks currently used in the Western Hemisphere. Like the Western textbooks it covers the traditional fields of General and Systemic Pathology: one-third of the book 8is devoted to General Pathology, whereas the remaining two-thirds cover Systemic Pathology. The emphasis is on classical anatomic pathology. In that respect the Indian textbook resembles more the European than the American textbooks, which have become more clinically-oriented. In my opinion this approach gives excellent results, but only if the students have enough time to devote to Pathology. In most US medical schools this is not the case any more, and thus pathology is not taught as extensively as before. Histopathology has been deleted from most curricula, and most American medical students do not know to use efficiently the microscope, which is unfortunate.

Question 3: Is the material presented in a “student-friendly” manner?

Answer: The material is presented in a systematic manner in the best tradition of classical British textbooks, a tradition that can be traced to the classical writers of ancient Greece and Rome. This time tested teaching will be most appreciated by students who are methodical and do not take shortcuts in their effort to acquire encyclopedic knowledge of pathology. On the other hand, even if your learning method is based on “cherry-picking”, i.e. you concentrate only on the most important facts in each chapter, the structure of the text will allow you to do it quite easily as well. There are no ideal books that would satisfy everybody in every respect, but there is no doubt that Professor Mohan's book is close to ideal for a classical pathology course and I predict that it will be popular with many students.

Question 4: What are the most salient features of this textbook?

Answer: Clear writing. As we all know clear writing reflects clear thinking, and clear thinking in my opinion, is an absolute prerequisite for good teaching. Judging from the book at hand, Professor Mohan (whom I do not know personally) is not only a clear thinker, but he must be also an exceptionally talented teacher.

Clear and visually pleasing presentation. The exposition is logical and well structured. Each chapter is subdivided into smaller entities, which are further divided into paragraphs, ideally suited for easy reading. Color coded headings and the added emphasis in form of words printed in bold or capital letters are additional attractions that facilitate learning.

Exceptionally good illustrations, flow-charts and tables. Unique to this Textbook are the numerous hand-drawn color illustrations, including many renditions of histopathologic slides. These drawings are simple, but to the point and well annotated. Students will most likely understand them much easier than the relatively impersonal original microphotographs of the same histopathologic lesions. Flow-charts are most efficiently used to explicate the pathogenesis of various lesions or the pathophysiology of disease processes. The tables are good for classifications and comparative listings of closely related diseases and their pathologic features.

Companion pocket book (baby-book of pathology). I always recommend to my students to buy a major textbook and a smaller review book containing a digest of the most important concepts; or a book of questions and answers, so that the student could test his/her knowledge of pathology and the understanding of the material in the main textbook. I was pleased to see that Professor Mohan shares my teaching philosophy and has taken upon himself to prepare for his students a shorter version of main text. This pocket book is also garnered with review questions.

Question 5: Do I have to know all that is in this book for my final examination?

Answer: No!! This is the most common question my students ask me and I hope that you believe me when I say that you do not have to know it all. First of all, neither I nor Professor Mohan know it all. Second, few of us have photographic memory and infinite storage space in our brains and thus even theoretically, very few of us could learn this book by heart. I can assure you that the book was not written for those geniuses, but for the average persons like most of us. Third, your goal should not be to memorize all the facts listed in the textbook, but rather to understand the main concepts. Since the concepts cannot be fully understood or taught without specific examples, by necessity you will have to learn “some nitty-gritty details”. The more details you know, the deeper your understanding of the basic concepts will be. Memorizing the details without the understanding of concepts that hold them together is not something that I would recommend. The beauty of it all is that you can decide for yourself how deep to dig in, when to stop, what to keep and memorize, and what to eliminate. And remember, deciding on what to eliminate is almost as important as choosing what to retain. As the educational gurus teach us, that is the gist of what they call active learning. And to repeat again, this Textbook is ideally suited for that approach.

The overwhelming success and all-round acceptance of the last edition of the textbook was very encouraging and quite stimulating but at the same time put an onerous responsibility and expectation to do better in the new edition than the best of last edition. In preparing 6th revised edition of my Textbook of Pathology, I pursued this goal with profound enthusiasm and passionate zeal. I am, thus, pleased to present to users a wholly transformed appearance and updated contents in the revised edition. While full colour printing had been introduced in the last edition 5 years back maturing the book into an international edition, the present redesigned and revised edition has utlilised the contemporary technological advances in its full form in illustrations, lay-out and in printing. The revised edition has almost thrice the number of illustrations of large number of common diseases placed along with the text, and it is hoped that it will enhance understanding and learning of the subject readily, besides being a visual treat.

Thorough Textual Revision and Updating: All the chapters and topics have undergone thorough revision and updating of various aspects, including contemporary diagnostic modalities. While most of the newer information has been inserted between the lines, a few topics have been rewritten, e.g. current concepts on cell injury, immunopathology, carcinogenesis, newer infectious diseases, lymphomas-leukaemias, hypertension, interstitial lung diseases, etc. to name a few. In doing so, the basic accepted style of the book —simple, easy-to-understand and reproduce the subject matter, and emphasis on clarity and accuracy, has not been disturbed. Past experience has shown that the readers find tables on contrasting features and listing of salient features as a very useful medium for quick learning; considering their utility 15 new tables have been added in different chapters in the revised edition.

Reorganisation of the Book: In a departure from the conventional division of study of the subject into General and Systemic Pathology, the revised edition has been reorganised into 3 major sections—General Pathology and Basic Techniques (Chapters 1 to 11), Haematology and Lymphoreticular Tissues (Chapters 12 to 14) and Systemic Pathology (Chapters 15 to 30), followed by Appendix (containing Normal Values), Further Readings for references and Index. In my considered judgement, a separate section on haematology and lymphoid tissues and redistribution of their subtopics was necessitated for two reasons—firstly, reclassification of leukaemias-lymphomas by the WHO as an integrated topic, making the segregation of study of diseases of ‘circulating’ and ‘tissue’ leucocytes superfluous; and secondly, due to advances in haematology, transfusion medicine and diseases of lymphoreticular tissues, these subspecialties of pathology have developed a lot in recent times, requiring the students to focus on them separately for learning and they are evaluated too on these topics by separate experts. Similarly, in the revised edition, two chapters on laboratory techniques—Techniques for the Study of Pathology (Chapter 2) and Basic Diagnostic Cytology (Chapter 11) have been included in Section-I in view of technological advances in pathology which have gone beyond remaining confined as research tool but have increasingly become part of diagnostic work-up.

Profusely Illustrated: Majority of illustrations in the revised Edition are new additions while a few old ones have been done again. All the line-drawing and schematic cartoons have been updated and improved in content as well as their presentation by preparing them again on CorelDraw in soft colours, eliminating the shortcomings noticed in them in previous edition. All free-hand labelled sketches of gross specimens and line-drawings of microscopic features of an entity have been placed alongside the corresponding specimen photograph and the photomicrograph respectively, enhancing the understanding of the subject for the beginner students in pathology. In doing so, the number of figures has gone up by about three-folds in the present edition, some incorporated as an inset with focus on a close-up microscopic view.

Truly User-friendly: Rational use of various levels of headings and subheadings in different colours, bold face and in italics has been done in the text in order to highlight key points. All the citations of figures and tables in the text have been shown in colour now to make the related text vividly visible and to help user locate the same quickly on a page. It is hoped that these features will enable the user with rapid revision at the end of a topic, making the book truly user-friendly.

Much More Content but Unaltered Volume: While the new edition has a lot more updated textual material, more tables and a marked increase in the number of figures than the previous edition, a meticulous and rational page management has helped in retaining almost the same girth of the book as before.

10Images and Tables on the Web: All the illustrations and tables included in this edition are being put on the website with a scratch key word on the inner page of the cover jacket. The students would find these useful for quick review and for self-assessment in which an unlabelled image (gross specimen or a photomicrograph) appears, followed by the labelled image with diagnosis corresponding to the same figure and table in the textbook. Besides, ready availability of these downloadable images and tables would be useful to fellow teachers for possibly including the same in their lectures.

Revised Pathology Quick Review and MCQs: The sixth edition of textbook is accompanied with the new revised baby-book popular with many students and interns. This small book has been found profoundly useful by the students just before practical examination to face viva voce when they need to revise huge course content in a short time, or by those preparing to take postgraduate entrance examinations. The revised edition has over 100 more new MCQs while some old ones have either been edited or replaced.

A Word on Foreword: The Foreword by Prof Ivan Damjanov, MD, PhD, from Kansas University, US, for the previous edition and now for the sixth edition so generously and meticulously prepared with an eye to the details of the book, has been most welcome development, and has helped to bring the book closer to users in other parts of the world; I express our sincere gratitude to this eminent teacher and well-known author whom I have yet to meet in person.

The revision work was indeed a mammoth task to accomplish and would not have been possible without active cooperation from friends and colleagues and continuous encouragement from well-wishers in general, and my departmental staff in particular who could bear with me for prolonged spells of my sabbatical leave. All the photomicrographs included in the present edition have been exposed afresh which has been made possible by the most valuable and selfless assistance rendered by my colleagues, Drs Shailja, Tanvi and Ujjawal, Senior Residents in Pathology, all of whom worked tirelessly for endless hours for months, much to the sacrifice of their personal comfort and time of their families, for which I am indebted to them. Here, I also recall the help accorded by my former students and colleagues in preparation of earlier editions of the book and thank once again, even though much of that may have been replaced. As always, I remain indebted to those from whom I had the opportunity to learn pathology; in particular to Prof K Joshi, MD, PhD, PGIMER, Chandigarh, Late Prof TS Jaswal, MD, and Prof Uma Singh, MD, formerly at PGIMS, Rohtak.