Ed Friedlander, M.D., Pathologist

No texting or chat messages, please. Ordinary e-mails are welcome.

This website is certified by Health On the Net Foundation. Click to verify. This site complies with the HONcode standard for trustworthy health information:
verify here.

Search only trustworthy HONcode health websites:

Cyberfriends: The help you're looking for is probably here.

This website collects no information. If you e-mail me, neither your e-mail address nor any other information will ever be passed on to any third party, unless required by law.

This page was last modified January 1, 2016.

I have no sponsors and do not host paid advertisements. All external links are provided freely to sites that I believe my visitors will find helpful.

Welcome to Ed's Pathology Notes, placed here originally for the convenience of medical students at my school. You need to check the accuracy of any information, from any source, against other credible sources. I cannot diagnose or treat over the web, I cannot comment on the health care you have already received, and these notes cannot substitute for your own doctor's care. I am good at helping people find resources and answers. If you need me, send me an E-mail at scalpel_blade@yahoo.com Your confidentiality is completely respected. No texting or chat messages, please. Ordinary e-mails are welcome.

I am active in HealthTap, which provides free medical guidance from your cell phone. There is also a fee site at www.afraidtoask.com.

If you have a Second Life account, please visit my teammates and me at the Medical Examiner's office.

Freely have you received, give freely With one of four large boxes of "Pathguy" replies.

I'm still doing my best to answer everybody. Sometimes I get backlogged, sometimes my E-mail crashes, and sometimes my literature search software crashes. If you've not heard from me in a week, post me again. I send my most challenging questions to the medical student pathology interest group, minus the name, but with your E-mail where you can receive a reply.

Numbers in {curly braces} are from the magnificent Slice of Life videodisk. No medical student should be without access to this wonderful resource.

I am presently adding clickable links to images in these notes. Let me know about good online sources in addition to these:

Freely have you received, freely give. -- Matthew 10:8. My site receives an enormous amount of traffic, and I'm still handling dozens of requests for information weekly, all as a public service.

Pathology's modern founder, Rudolf Virchow M.D., left a legacy of realism and social conscience for the discipline. I am a mainstream Christian, a man of science, and a proponent of common sense and common kindness. I am an outspoken enemy of all the make-believe and bunk that interfere with peoples' health, reasonable freedom, and happiness. I talk and write straight, and without apology.

Throughout these notes, I am speaking only for myself, and not for any employer, organization, or associate.

Special thanks to my friend and colleague, Charles Wheeler M.D., pathologist and former Kansas City mayor. Thanks also to the real Patch Adams M.D., who wrote me encouragement when we were both beginning our unusual medical careers.

If you're a private individual who's enjoyed this site, and want to say, "Thank you, Ed!", then what I'd like best is a contribution to the Episcopalian home for abandoned, neglected, and abused kids in Nevada:

I've spent time there and they are good. Write "Thanks Ed" on your check.

Help me help others

My home page
More of my notes
My medical students

Especially if you're looking for information on a disease with a name that you know, here are a couple of great places for you to go right now and use Medline, which will allow you to find every relevant current scientific publication. You owe it to yourself to learn to use this invaluable internet resource. Not only will you find some information immediately, but you'll have references to journal articles that you can obtain by interlibrary loan, plus the names of the world's foremost experts and their institutions.

Alternative (complementary) medicine has made real progress since my generally-unfavorable 1983 review. If you are interested in complementary medicine, then I would urge you to visit my new Alternative Medicine page. If you are looking for something on complementary medicine, please go first to the American Association of Naturopathic Physicians. And for your enjoyment... here are some of my old pathology exams for medical school undergraduates.

I cannot examine every claim that my correspondents share with me. Sometimes the independent thinkers prove to be correct, and paradigms shift as a result. You also know that extraordinary claims require extraordinary evidence. When a discovery proves to square with the observable world, scientists make reputations by confirming it, and corporations are soon making profits from it. When a decades-old claim by a "persecuted genius" finds no acceptance from mainstream science, it probably failed some basic experimental tests designed to eliminate self-deception. If you ask me about something like this, I will simply invite you to do some tests yourself, perhaps as a high-school science project. Who knows? Perhaps it'll be you who makes the next great discovery!

Our world is full of people who have found peace, fulfillment, and friendship by suspending their own reasoning and simply accepting a single authority that seems wise and good. I've learned that they leave the movements when, and only when, they discover they have been maliciously deceived. In the meantime, nothing that I can say or do will convince such people that I am a decent human being. I no longer answer my crank mail.

This site is my hobby, and I do not accept donations, though I appreciate those who have offered to help.

During the seventeen years my site has been online, it's proved to be one of the most popular of all internet sites for undergraduate physician and allied-health education. It is so well-known that I'm not worried about borrowers. I never refuse requests from colleagues for permission to adapt or duplicate it for their own courses... and many do. So, fellow-teachers, help yourselves. Don't sell it for a profit, don't use it for a bad purpose, and at some time in your course, mention me as author and William Carey as my institution. Drop me a note about your successes. And special thanks to everyone who's helped and encouraged me, and especially the people at William Carey for making it still possible, and my teaching assistants over the years.

Whatever you're looking for on the web, I hope you find it, here or elsewhere. Health and friendship!


More of Ed's Notes: Ed's Medical Terminology Page

Perspectives on Disease
Cell Injury and Death
Accumulations and Deposits
What is Cancer?
Cancer: Causes and Effects
Immune Injury
Other Immune
HIV infections
The Anti-Immunization Activists
Infancy and Childhood
Environmental Lung Disease
Violence, Accidents, Poisoning
Red Cells
White Cells
Oral Cavity
GI Tract
Pancreas (including Diabetes)
Adrenal and Thymus
Nervous System
Lab Profiling
Serum Proteins
Renal Function Tests
Adrenal Testing
Arthritis Labs
Glucose Testing
Liver Testing
Spinal Fluid
Lab Problem
Alternative Medicine (current)
Preventing "F"'s: For Teachers!
Medical Dictionary

Courtesy of CancerWEB

KCUMB Students
"Big Robbins" -- Environmental / Nutritional
Lectures follow Textbook

QUIZBANK: Respiratory #'s 43-65, 150-169


* * * 

... And for the vanities committed in this filthy custom, is it not both great vanity and uncleanness, that at the table, a place of respect, of cleanliness, of modesty, men should not be ashamed, to sit tossing of tobacco pipes, and puffing of the smoke of tobacco one to another, making the filthy smoke and stink thereof, to exhale across the dishes, and infect the air, when very often men that abhor it are at their repast?... It makes a kitchen also often-times in the inward parts of men, soiling and infecting them, with an ... oily kind of soot, as has been found in some great tobacco takers, that after their death were opened.... Have you not reason then to be ashamed and to forbear this filthy novelty ... a custom loathsome to the eye, hateful to the nose, harmful to the brain, dangerous to the lungs, and in the black stinking fume thereof, nearest resembling the horrible Stygian smoke of the Pit that is bottomless....?

The incessant, witless repetition of advertisers' moron-fodder has become so much a part of life that if we are not careful, we forget to be insulted by it.

A few years ago I interviewed a rugged-looking, jut-jawed fellow named David Goerlitz, a former model who was once known as the Winston Man because he had appeared in Winston cigarette ads for the R.J. Reynolds Tobacco Company.

Mr. Goerlitz described an outdoor photo session in which several cartons of Winstons were scattered around. A number of Reynolds executives were at the session and Mr. Goerlitz asked if it would be all right if he took a few cartons for himself.

One of the executives said, sure, take them all.

Mr. Goerlitz, surprised, said, "Don't any of you smoke?"

The executive shook his head. "Are you kidding?" he asked. "We reserve that right for the poor, the young, the black, and the stupid."

        -- Bob Herbert, New York Times columnist, November 28, 1993

Huckleberry Finn
Huckleberry Finn smoking

TOBACCO SMOKING: Med. Clin. N.A. 76: 355, 1992. Here are some facts you may find handy in talking with patients.

THE PNEUMOCONIOSES: A group of diseases, ancient and modern, resulting from dust inhalation. (* "Conios" means "dust" in Greek.) Occupational lung disease: Disease-A-Month 44: 41, 1998.

Pneumoconiosis Images
University of Washington
Pictures and comments

Pneumoconiosis I
From Chile
In Spanish

Pneumoconiosis II
From Chile
In Spanish

Occupational Lung Disease
Bryan Lee

{27639} bowling ball manufacture; rumors of dust disease
{27623} taxidermy; a bad career choice for the person allergic to animals

COAL WORKER'S PNEUMOCONIOSIS (CSP, "black lung"): Path standards: Arch. Path. Lab. Med. 103(8), 375-432, 1979 (still the best); update for clinicians Am. J. Resp. Crit. Care Med. 187: 1178, 2013.

{27458} coal miner
{27514} coal workers

Russian coal workers
Note the dust and masks
Early 2000's

BOOP simulating coal dust disease
Short paper by your instructor
For your enjoyment

Great labels
Romanian Pathology Atlas

Anthracosis, bad

WebPath Photo

Polarizer picture
WebPath Photo

Ordinary anthracosis of the lung
Brazil Pathology Cases
In Portuguese

Hut lung
From indoor air pollution
Dr. Warnock's Collection

Lung pathology series
Dr. Warnock's Collection

Text and photomicrographs. Nice.
Human Pathology Digital Image Gallery

{08762} anthracosilicosis

{49094} progressive massive fibrosis
{35063} progressive massive fibrosis

SILICOSIS: Common and deadly; until recently the most serious occupational disease. All about silicosis: Lancet 379: 2008, 2012; Arch. Path. Lab. Med. 112: 673, 1988 (great pictures); historians see Science 256: 116, 1992.

{27461} sandblaster
{27462} sand mold lining
{34985} sandblaster

{12437} silicotic nodules
{28760} silicosis
{28763} silicosis
{28766} silicosis
{28769} silicosis
{35000} silicosis
{49096} silicosis
{35057} anthracosilicosis

Silicosis and silicatosis
Lung pathology series; follow the arrows
Dr. Warnock's Collection

Silicotic nodule

WebPath Photo

Silicotic nodule

WebPath Photo

Miner's lung, a little carbon, but
this is obviously NOT silicosis.
Human Pathology Digital Image Gallery

ASBESTOSIS: Update Chest 125: 744, 2004. The mineral Sci. Am. 272(1): July 1997. Counting asbestos fibers for pathologists: Arch. Path. Lab. Med. 134: 457, 2010.

{27472} asbestos on the pipes
{36190} ferruginous body
{39685} ferruginous body
{09834} ferruginous body, special preparation (darkfield?)

Ferruginous body
Inside an epithelioid giant cell
Urbana Atlas of Pathology





Asbestos, pleural plaques


Asbestos, pleural plaque


Fibrous pleural plaque
Asbestos worker's diaphragm
AFIP / Wikimedia Commons

Lung pathology series
Dr. Warnock's Collection

{27494} asbestos and lung cancer

Autopsy specimen
KU Collection

BERYLLIOSIS (Chest 109(3S): 40-S, 1996)

{27503} berylliosis

Beryllium lung and sarcoid
Lung pathology series
Dr. Warnock's Collection

* PAINT-SPRAYER'S LUNG resulted when poor workers were forced to inhale spray-paint in a Spanish factory, the bosses falsely reassuring them that the respiratory distress was harmless. The histopathology was that of a cryptogenic organizing pneumonia (Arch. Bronch. 31: 89, 1995).


Hypersensitivity pneumonitis
Lung pathology series
Dr. Warnock's Collection

{27489} farmers in moldy hay

Now this is serious.... Without a history, you will probably not be able to tell chronic hypersensitivity pneumonia from "usual interstitial pneumonia" / "idiopathic pulmonary fibrosis". Even with a history, you may need a biopsy. Again, the keys are (1) fibrosis in chronic hypersensitivity pneumonitis centers around the bronchioles, and (2) chronic hypersensitivity pneumonitis usually has granulomas, which are generally loose unlike those in sarcoidosis. Despite the term "hypersensitivity", you will not see eosinophils in the chronic form. Review Chest 134: 126, 2008.

BYSSINOSIS / "COTTON DUST LUNG DISEASE" (cotton, flax, hemp processing; update Curr. Op. Pulm. Med. 13: 137, 2007)

WORLD TRADE CENTER LUNG (WTC-SLGPD, or "sarcoid-like granulomatous pulmonary disease"): Chest 131: 1414, 2007


New visitors to www.pathguy.com
reset Jan. 30, 2005:

Ed at homeDrop by and meet Ed

Ed says, "This world would be a sorry place if people like me who call ourselves Christians didn't try to act as good as other good people ." Prayer Request

If you have a Second Life account, please visit my teammates and me at the Medical Examiner's office.

Teaching Pathology

Pathological Chess

Taser Video
83.4 MB
7:26 min
Click here to see the author prove you can have fun skydiving without being world-class.

Click here to see the author's friend, Dr. Ken Savage, do it right.