The eye is a complex organ with many specialized parts and layers.

The eye is delicate and is protected from injury by the skull and eyebrows,
and is kept clean by eyelids and eyelashes. The eyeball is a sphere about
an inch in diameter. It is held in place inside the eye sockets of the skull by
small muscles. These muscles are called extra ocular muscles and allow
the eye to move up and down and side to side. On the outside of the eyeball
is white protective layer of fibrous tissue known as the sclera, or the white
of the eye. The sclera keeps the eyeballs round shape. At the front of the
eye is a curved, clear, rounded membrane called the cornea. Behind the
cornea is a chamber filled with fluid that is called the aqueous humor.
The eye has a round circle of tiny muscles called the iris. The iris
has pigment and can be green, hazel, brown, or blue, giving the eye its
color. The iris surrounds a tiny hole called the pupil. Most of the time, the
pupil does not look like a hole because it glints in the light. But what is
seen as the sparkle in the eye is actually a clear, finely layered flexible
lens. It can be seen by looking through the hole that is called the pupil.
Tiny fibers hold the lens in place and connect it to eye muscles called
ciliary muscles. Behind the lens, most of the rest of the eye is filled with a
thick jelly-like fluid called the vitreous humor.
Covering 65 percent of the lining of the back of the eye is a thin,
light sensitive layer called the retina. The retina itself has many layers
photosensitive cells called rods and cones that pick up light and color,
bipolar cells which convert light into electrical impulses, and ganglion
cells that form nerve fibers to transmit signals to the brain. Closest to the
back of the eyeball is a single cell layer that contains pigment. Its purpose
is to absorb light and prevent it from bouncing back through the eye once
it has reached the retina. Vision is clearest at the center of the retina in an
oval, yellowish area called the macula, or macula luteus. And at the center
of the macula is an area known as the fovea.
THE SENSES
8
Nerve fibers form bundles at the back of the eye. The bundles come
together at the optic disk, or blind spot and pass out of the back of the
eye to a large nerve called the optic nerve. The left and the right side
optic nerves cross behind the eye and meet at an area called the optic
chiasma. Nerve signals travel back to the areas in the brain where vision
is processedthe thalamus, brainstem and visual cortex.
HEARING
After the sense of sight, the sense of hearing is the most developed sense in
the human anatomy. The ear is a precise and efficient organ that performs
its sensory duties in a compact area. The ear is comprised of three main
partsthe outer ear, the middle ear, and the inner ear. The visible part of
the ear is called the pinna (sometimes also called the auricle) and is made
up of folds of cartilage covered in skin. At the base of the pinna is the
lobule, or ear lobe. The pinna surrounds an opening called the external
auditory canal. This is a one-inch tube that tunnels through a bone in
the skull known as the temporal bone. This tube is lined with tiny hairs,
oil-producing sebaceous glands, and sweat glands called ceruminous
glands, which produce earwax, or cerumen. As sound waves move down
the external auditory canal, they come upon the final portion of the outer
ear, the temporal membrane.
Beyond the temporal membrane is the middle ear. The middle ear
is madeup of three tiny bones, which are the smallest bones in the body.
Collectively they are called the ossicles and individually they are known
as the malleus, incus, and stapes. Their more common names come from
their shapethe hammer, anvil, and stirrups. Both the outer ear and the
middle ear are filled with air, while the inner ear is filled with fluid.
Between the middle ear and the inner ear are two membranes, called the
oval window and the round window.
9
What Are the Human Senses?
The inner ear, or labyrinth, has three winding chambers deep
inside the temporal bone of the skull. The front part is the cochlea, which
is a coiled chamber that holds the organ of Corti. The organ of Corti
is a mass of tiny hairs that are the sound receptor cells. The vestibule
chamber, which contains sensory cells related to balancethe utricle and
the sacculeconnects the cochlea to the final chamber, the semicircular
The human ear is made up of external parts located outside of the head, and a collection of tiny
internal parts inside the skull.
THE SENSES
10
canals. Nerve signals leave the ear and travel to the brain through the
vestibulocochlear nerve. This nerve is actually two nerves, the cochlear
nerve, which transports information about sound, and the vestibular nerve
that delivers information about balance.
PROPRIOCEPTION
The fifth sense, proprioception, or equilibrium and balance, is managed
by sensors in the ear. Often called the vestibular system, the semicircular
Special hairs, called cilia, and other cells found in the inner ear help with hearing and
balance.
11
What Are the Human Senses?
canals and the vestibule region sense movement, speed, and stasis (the
state of being still). The semicircular canals exist at right angles to
each other. At the base of each of the canals lies a widened duct called
the ampulla. Inside each ampulla is a jelly-like mass called the cupula.
This mass contains hair cells that are attached to nerves. As fluid called
endolymph circulates in the canals and vestibule it stimulates receptor
cells. In the vestibule, the utricle and saccule sense movement and action
of the head.
Structures in the inner ear and brain allow a person to balance, stand upright, move, and
perform
athletic activities.
THE SENSES
12
TASTE
The sense of taste, or
gustation, as it is also known,
determines not only the flavor
of food, but also provides an
awareness of whether or not
something put in the mouth
is safe or good to eat. There
are five basic tastes, one of
which was not agreed upon
in the scientific community
until only recently. The
tastes are salty, sweet,
sour, bitter, and umami.
Umami was established by
a Japanese scientist named
Kikunae Ikeda. He wrote
about umami being a taste
that responds to glutamate,
a chemical found in foods, such as bacon, corn, mushrooms, tomatoes,
some seaweed, fish, and other foods.
The taste organ is a collection of specialized cells called taste buds.
There are approximately 10,000 taste buds found on the top of the tongue,
and more found in the throat, soft palate (soft tissue found at the back
of the roof of the mouth), and the epiglottis (the flap of cartilage at the
base of the tongue). Each taste bud bears between 50 to 150 sensory taste
receptors. Along the top and sides of the tongue are various small bumps
called lingual papillae.
The different parts of the tongue are responsible for
various taste sensations.
13
What Are the Human Senses?
There are four types of papillae, three of which contain taste buds.
On the sides of the tongue are the foliate papillae, which appear as a series
of ridges. Fungiform papillae are small, rounded projections found all
over the tongue, especially at the tip and along the top of the sides. Each
of this type of papilla contains up to five taste buds. There are only five
to twelve of the largest papillae, called the circumvallate papillae, but
they contain more than 250 taste buds each. They form a V shape near
the back of the tongue. The fourth type of papillae, filiform papillae, are
found all over the tongue and though they are the most numerous, they do
not carry any taste sensors.
A nerve called the facial nerve carries sensory information from
the taste receptors in the front of the tongue. The glassopharyngeal nerve
carries information from the rear of the tongue. A third nerve, the vagus
nerve, carries information from the back of the mouth. These nerves deliver
taste sensations to part of the brainstem, then travel on to the thalamus,
and finally arrive in the cerebral cortex of the brain.
SMELL
The olfactory sense, or sense of smell, is a powerful sense. The human
nose can detect thousands of distinctly different odors. The sense of smell
identifies odors in the air around us and assists the sense of taste by
enhancing or discouraging appetite and contributing to the appreciation
or the rejection of flavors. It also protects us from breathing unsafe air or
fumes and stops us from eating anything spoiled or poisonous. The sense
of smell also helps with human memory recall.
There is a large cavity located between the roof of the mouth and the
bottom of the skull called the nasal cavity. It is divided into left and right
sections by a piece of cartilage called the nasal septum. Inside each side of
the nasal cavity are three bony shelves folded with ridges called conchae.
THE SENSES
14
The conchae create passageways
for air to travel before entering
the respiratory tract.
The nasal cavity is lined
with a membrane that contains
mucus-producing cells. On the
uppermost part of the nasal
cavity is a layer of tissue called
the olfactory epithelium. On one
end of each olfactory cell are
long hairs called cilia. The cilia
are coated in mucus and contain
sensory receptors. At the other
end of each olfactory cell are
nerve endings called axons. The
axons of the olfactory cells come
together to form the olfactory
nerve. The nerve passes through
the skull and enters the end of
the olfactory tract, where a pair of olfactory bulbs is beneath the front
of the brain. Inside the olfactory bulbs, nerve cells receive signals and
transfer them to parts of the brain.
TOUCH
The sense of touch involves a wide network of nerve endings and sensory
receptor cells. There are three overall types of receptor cellsvisceral
cells, which are cells found in internal organs, somatic, which are found in
joints and bones, and cutaneous, which are found in the skin. The skin, the
largest organ of the body, contains most of the sensory receptors for touch.
Special olfactory cells aid in identifying smells and
other information that comes in through the nose.
15
What Are the Human Senses?
It is itself composed of several layers. The visible top layer of skin is called
the epidermis and it provides protection for the layers of skin below and
also protects the rest of the body. Of the many types of cells found in the
epidermis, very sensitive touch sensors provide information to the brain.
The second layer is a thick layer containing sweat glands, hair follicles,
oil glands, blood vessels, nerve endings and touch receptors. There are
four basic types of touch receptors: mechanoreceptors, thermoreceptors,
pain receptors, and proprioceptors. Each is responsible for recognizing
different types of sensation, such as pressure, pain, or temperature.
Nerves beneath our skin allow us to feel things and use our sense of touch to react to and
interact
with the environment.

17
How the Senses
Work
2
M
VISION
Everything the eye sees comes from reflected light. In other words,
the eye cannot view an object unless some form of light shines on the
object. As light hits the object and bounces off, it travels in the form
of light waves. These waves of light enter the eye through the cornea.
The brain and the rest of the nervous system process all of
the sensory information that is delivered by the sensory
organs.
any different organs and body parts work together to form the
human senses. Sometimes more than one sense rely on the
same structures.
THE SENSES
18
19
How the Senses Work
The cornea slows down the speed of light. It is curved, causing the cornea
to bend the rays of light toward each other. The process of bending light
rays is known as refracting light.
The refracted light waves move through the aqueous humor and
pass through the pupil toward the lens. If the light is very bright, the
muscles of the iris relax, decreasing the size of the opening of the pupil,
and letting in less light. The iris also reduces the size of the opening of the
pupil when the eye is trying to concentrate its focus on an object that is
close by. Conversely, if the light is dim, or if the eye is viewing an object in
the distance, the iris muscles contract. This dilates, or opens up, the pupil,
to let in more light.
The lens of the eye is extremely flexible. It is able to focus on an
object that is just inches away, but is equally able to quickly adjust to
viewing a distant planet in the sky. Bright light travels to the cornea in
ever-widening waves. However, the cornea can bend the rays only so far.
The lens must further refract the light in order to focus properly. The lens
is composed of more than 2,000 fine layers called lamellae. As the light
passes through each layer, the rays of light are bent in tiny degrees of
refraction. When the eye focuses on closer objects or is receiving bright
light, the muscles holding the lens relax causing the lens to become more
rounded. The rounder the lens, the greater its ability becomes to refract
light. On the other hand, light coming from a more distant source travels
toward the eye in an almost parallel pattern. The eye does not need to
refract light to the same degree. As a result, most of the refraction in this
instance can be done by the cornea. The muscles holding the lens contract
and flatten the lens. Light passes through nearly unchanged.
After light has been focused by the lens, it passes through the
vitreous humor. The thick liquid retains the sharp focus of the refracted
light and ushers the light toward the retina at the back of the eye. The
THE SENSES
20
retina receives the refracted light rays and turns them into electrical
impulses that are fed to the brain. The retina is covered in arteries and
veins and is an uneven surface. Some areas of the retina are more light
sensitive than others and are better able to perceive images with greater
sharpness, or acuity. Arteries and veins bypass the most light-sensitive
area of the retina, which is called the fovea. To achieve the most acute
vision, light must fall on the fovea. However, light enters the eye from
many directions, so the eye must compensate in order for light to be
directed to the fovea. Eyes do so by constantly moving up and down and with increasing
prevalence of obesity more children are now presenting
with type 2 diabetes, particularly from ethnic minorities. In
the USA, in some areas, up to 50% of children with diabetes are
now presenting with the type 2 form.
Latent autoimmune diabetes in adults (LADA) is thought to
comprise about 5% of all patients with type 2 diabetes. These
people have autoantibodies usually seen in type 1 diabetes, but their
clinical presentation is like someone with type 2 diabetes. This is
a group that may present an excellent opportunity for subsequent
prevention of diabetes if an effective intervention can be developed
to prevent further beta cell destruction.
Monogenic diabetes (previously referred
to as maturity onset diabetes in the
young, MODY)
Monogenic diabetes is the term used for a collection of conditions
that cause diabetes now shown to result from single gene
defects. One feature of these conditions is that they show autosomal
dominant inheritance patterns where the disease appears to be
vertically transmitted (e.g. through several generations). It is also
diagnosed before the age of 25 years, but, unlike type 1 diabetes
patients, monogenic diabetes patients do not often require insulin
for at least 5 years after diagnosis. Genetic testing in these cases
can confirm the particular sub-type of diabetes. This can have
significant clinical implications. Patients with HNF1a (hepatocyte
nuclear factor 1a) mutations, for example, exhibit exquisite sensitivity
to sulphonylureas and can be successfully treated with tablets.
Knowledge of the mutation, therefore, can help in the management
of this disorder, even in children who would otherwise have been
put onto insulin. This is also one form of type 2 diabetes where
we would use a sulphonylurea in preference to metformin when
initiating therapy. Patients with HNF1 have renal cysts. Patients
with glucokinase mutations are less common but the diagnosis is
significant for the individual and their families. Such patients are
much less likely to develop complications of diabetes because they
mainly have mild fasting hyperglycaemia without significant post
meal hyperglycaemia.
Maternally inherited diabetes
with deafness (MIDD)
This is a form of diabetes due to mutations in mitochondria, most
commonly related to 3243A > G mitochondrial DNA mutation.
Mitochondria in an individual are inherited from the mother
rather than from the father, therefore one clue would be evidence
of strong maternal transmission of diabetes, particularly when this
is associated with a sensorineural deafness. Some patients may also
have peripheral vision problems, particularly night blindness. These
patientsAbuse is a complex psychosocial problem that
affects large numbers of adults as well as children
throughout the world. It is listed in the Diagnostic and
Statistic Manual of Mental Disorders (DSM-IV-TR)
under the heading of Other Conditions That May Be a
Focus of Clinical Attention. Although abuse was first
defined with regard to children when it first received sustained
attention in the 1950s, clinicians and researchers
now recognize that adults can suffer abuse in a number of
different circumstances. Abuse refers to harmful or injurious
tlude not
only the direct costs of immediate medical and psychiatric
treatment of abused people but also the indirect
costs of learning difficulties, interrupted education,
workplace absenteeism, and long-term health problems
of abuse survivors.
Types of abuse
Physical often require insulin. Infusion strategy
Initially reduce total daily insulin dose by 30%.
Give half the daily insulin dose as the constant basal pump
rate (usually around 1 unit/hour).
Give half the daily insulin dose divided between the three
main meals, giving the insulin boost immediately before the
meal.
The patient is taught to count carbohydrate portions
(see page 12) and thereafter will give the bolus doses in
direct relation to the amount of carbohydrate consumed
(for example, 1 unit for every 10 g of carbohydrate).
During the first few days adjustments need to be made as
follows:
basal rate determined by assessment of fasting and 3 am
blood glucose readings
preprandial boosts are adjusted by assessment of postprandial
blood glucose readings.
Note: Specific instructions are given for exercise, and basal
rates should be reduced during and after exercise.
Dose adjustment for normal eating
(DAFNE)
A more liberal dietary pattern for Type 1 diabetic patients has
become possible by using the DAFNE approach, ideal for some
people who thus regain considerable freedom while at the same
time maintaining good control. It is based on:
a 5-day structured, group education programme delivered by
quality assured diabetes educators
the educational approach is based on adult educational
principles to facilitate new learning
two injections of medium acting insulin each day
(see page 21)
injections of short acting insulin every time meals are taken
testing blood glucose before each injection.
This programme enables people to eat more or less what
they like when they like, and not to eat if they do not wish to do
so. It depends on a quantitative understanding of the
carbohydrate values of individual foods, and calculating by trial
and error the correct amount of soluble insulin needed for a
specified quantity of carbohydrate, developing an
insulin/carbohydrate ratio for each individual patient.
DAFNE has been used in continental Europe for many
years: the- tongue covered with fur. Bell, (white and clammy, which can be pulled off in strings),
Phos. (black
crusts).
- tongue c. with mucus. Bell, (brown), Carbo. veg. (yellow-brown), Kali bi. (ropy), Merc, sol.,
Nitr.- ac.
(tough, ropy, with ulcers), Phos. ac. (clammy, tough). Puls, (tenacious), Psorin,(whitish-yellow),
Rhus.
tox. (brown), Sil.(brownish).
- tongue c. with ulcers. Caps, (flat, sensitive, spreading), Kali bi. (small, painful), Natr. mur. (also
vesicles).
- tongue c. with vesicles, Ars. (painful, burning), Apis* (stinging), Canth. (at base). Hell., Natr.
mur.
(smarting and burning when touched by food), Spong., Zinc.
Cracked. Ailanth., Apis, Arum., Bapt., Bar., Bell., Benz. ac, Bry., Calc. fl., Cham., China, Cic,
Cur., Hyos.,
Kali bi, I^yc, Magn. mur., Nux-vom., Phos., Phos. ac, Plb., Podo., Puls., Ran.sc, Rhus tox.,
Sacch., Spig.,
Sulph., Ver. alb.
- edges, Nux vom. (rest black or red).
- middle, across the, Cobalt.
- tip, Lach.
- tongue dry, parched and cracked, Ailanth.
- tongue dry, parched and cracked in typhus, Bapt.
- chronic inflammation of tongue; c, swollen and bleeding, Podo.
- tongue swollen, dry, c, sore, ulcerated, covered with vesicles. Apis
- tongue, painful and burning. Arum.
- tongue yellow along center, first white with reddish papillae; followed by yellow-brown coating
in
center, edges dark red and shining; dry brown down center (Plb.); c, sore, ulcerated, Bapt.,
(Apis, Ars.,
Rhus tox).
- smarting, burning pain in tip of tongue, sore and c. Bar. carb.
- tongue rough, c, and often of a dark- brown color, Bry.
- tongue dry, smooth, red, c. (in dysentery). Kali bi.
- tongue dry, red, brown, c, and tremulous, Hyos.
- tongue dry, red, c, black stiff, Lach., Rhus tox.
- tongue coated yellow, burning with blisters, c, Spig.
- tongue smooth, red and c, dry and red, coated
- thick whitish-yellow, ulcerated. Kali bi.
- mouth very sore, parched and dry, mucous membrane c. and bleeding, tongue swollen and
covered
- with blisters on each side, Lach.
- dry, black or c. tongue, Lj^c. (Ars., Lach., Phos., Rhus tox. )
- tongue cold, dry, blackish, c, red and swollen, Ver. alb.
- brown, parched, c. tongue, Sulph.
- tongue c. or coated yellow, with red tip and edges, Ver. alb.
- and burning, Arum tr.. Bell., Bry., Ran. sc., Sulph., Ver. alb.
- black and dry, stiff as a board, Ars.
- on edges, black or dark red, Nux. vom.
- and dry (tip). Kali bi., Lach., Rhus tox., Sulph.
Crack deep, Adverse reactions
Common: drowsiness.
Serious: hypotension, bradycardia, tachycardia, confusion,
respiratory depression, physical and psychologic dependence,
addiction.
Clinically important drug interactions: Drugs that increase
effects/toxicity of narcotic analgesics: Alcohol, benzodiazepines,
antihistamines, phenothiazines, butyrophenones, triyclic antidepressants,
MAO inhibitors.
Parameters to monitor
Signs and symptoms of pain: restlessness, anorexia, elevated
pulse, increased respiratory rate. Differentiate restlessness
associated with pain and that caused by CNS stimulation
caused by the drug. This paradoxical reaction is seen mainly in
women and elderly patients.
Monitor respiratory status prior to and following drug administration.
Note rate, depth, and rhythm of respirations. If rate
falls below 12/min, withhold drug unless patient is receiving
ventilatory support. Consider administering an antagonist, eg,
naloxone 0.10.5 mg IV every 23 min. Be aware that respiratory
depression may occur even at small doses. Restlessness
may also be a symptom of hypoxia. Monitor character of cough
reflex. Encourage postoperative patient to change position frequently
(at least every 2 hours), breathe deeply, and cough at
regular intervals, unless coughing is contraindicated. These
steps will help prevent atelectasis.
Signs and symptoms of urinary retention, particularly in
patients with prostatic hypertrophy or urethral stricture.
Monitor output/intake and check for oliguria or urinary
retention.
Signs of tolerance or dependence. Determine whether patient
is attempting to obtain more drug than prescribed as this may
indicate onset of tolerance and possibility of dependence. If tolerance
develops to one opiate, there is generally cross-tolerance
to all drugs in this class. Physical dependence is generally not
a problem if the drug is given for less than 2 weeks.
126 BUTORPHANOL
Monitor patients BP. If systolic pressure falls below 90 mm
Hg, do not administer the drug unless there is ventilatory support.
Be aware that the elderly and those receiving drugs with
hypotensive properties are most susceptible to sharp fall in BP.
Patients heart rate. Withhold drug if adult pulse rate is below
60 bpm. Alternatively, administer atropine.
Respiratory status of newborn baby and possible withdrawal
reaction. If the mother has received an opiate just prior to
delivery, the neonate may experience severe respiratory
depression. Resuscitation, as well as a narcotic antgonist, eg,
Narcan, may be necessary. Alternatively, the neonate may
experience severe withdrawal symptoms 14 days after birth.
In such circumstances, administer opium tincture or paregoric.
Signs and symptoms of constipation. If patient is on drug for
more than 23 days, administer a laxative. For patients on longterm
therapy, administer a bulk or fiber laxative, eg, psyllium,
1 teaspoon in 240 mL liquid/d. Encourage patient to drink large
amounts of fluid, 2.5 to 3 L/d.
Editorial comments: This drug is indicated for treatment of moderate
to severe pain. Intranasal formulation allows for rapid
onset of pain relief.
BUTORPHANOL 127
Calcitonin
Brand names: Calcimar (salmon), Cibacalcin (human), Miacalcin
(salmon).
Class of drug: Calcium-lowering agent, treatment for Pagets
disease, antiosteoporosis agent.
Mechanism of action: Promotes renal excretion of calcium and
phosphate, inhibits osteoclastic bone resorption
Indications/dosage/route: IM, SC, intranasal. Note: Prior to treatment,
a skin test must be performed (see Warnings/ Precautions).
Pagets disease
Adults, salmon calcitonin: Initial: SC or IM 100 units/d.
Maintenance: 50 units/d.
Adults, human calcitonin: Initial: SC 0.5 mg/d. Maintenance:
0.5 mg 2 or 3 times/wk.
Hypercalcemia
Adults, salmon calcitonin: IM, SC 4 units/kg q12h.
Maximum: 8 units/kg q6h.
Postmenopausal osteoporosis
Adults, salmon calcitonin: IM, SC 100 units/d.
Intranasal: 1 spray (200 units)/day. Combine with oral calcium
carbonate, vitamin D.
Osteogenesis imperfecta
Adults: IM, SC 2 units/kg 3 times/wk. Combine with oral
calcium.
Children: Safety and efficacy have not been established.
Onset of Action Duration
Hypercalcemia 2 h 68 h
Pregnancy: Category C.
Lactation: No data available. Best to avoid.
Contraindications: Hypersensitivity reaction to salmon calcitonin
or its gelatin diluent.
128 CALCITONIN
Warnings/precautions
When using salmon calcitonin determine whether patient is
allergic by performing skin test before administration. One unit
is injected into the skin. Observe for 15 minutes for development
of erythema or wheal. Have emergency equipment available
during administration.
Potential for hypocalcemic tetany.
Advice to patient
Learn the correct way to use the nasal spray.
Calcium and vitamin D supplements are part of the treatment
for osteoporosis.
Employ sterile techniques for injection.
Alternate injection sites.
Adverse reactions
Common: None.
Serious: Allergic reactions, hypocalcemia, tetany (overdose).
Clinically important drug interactions: None reported.
Parameters to monitor
Serum electrolytes, calcium, alkaline phosphatase.
Signs of hypersensitivity reactions.
BP, pulse, ECG.
Signs and symptoms of hypercalcemia: bone pain, thirst, nausea,
vomiting, anorexia, constipation. Algebraic Proof:
Case ( i ):
Let the two numbers N1 and N2 be less than the selected base say x.
N1 = (x-a), N2 = (x-b). Here a and b are the corresponding deviations of the
numbersN1 and N2 from the base x. Observe that x is a multiple of 10.
Now N1 X N2 = (x-a) (x-b) = x.x x.b a.x + ab
= x (x a b ) + ab. [rule e(iv), d ]
= x [(x a) b] + ab = x (N1b) + ab[rulee(i),d]
or = x [(x b) a] = x (N2 a) + ab. [rule e (ii),d]
x (x a b) + ab can also be written as
x[(x a) + (x b) x] + ab = x[N1+N2 x] + ab [rule e(iii),d].
A difficult can be faced, if the vertical multiplication of the deficit digits or
deviationsi.e., a.b yields a product consisting of more than the required digits.
Then rule-f will enable us to surmount the difficulty.
Case ( ii ) :
When both the numbers exceed the selected base, we have N1 = x + a,N2 = x +
b, x being the base. Now the identity (x+a) (x+b) = x(x+a+b) + a.b holds
good, of course with relevant details mentioned in case(i).
25
Case ( iii ) :
When one number is less and another is more than the base, we can use (xa)(
x+b) = x(xa+ b)ab. and the procedure is evident from the examples
given.
Find the following products by Nikhilam formula.
1) 7 X 4 2) 93 X 85 3) 875 X 994
4) 1234 X 1002 5) 1003 X 997 6) 11112 X 9998
7) 1234 X 1002 8) 118 X 105
Nikhilam in Division
Consider some two digit numbers (dividends) and same divisor 9. Observe the
following example.
i) 13 9 The quotient (Q) is 1, Remainder (R) is 4.
since 9 ) 13 ( 1
9
____
4
ii) 34 9, Q is 3, R is 7.
iii) 60 9, Q is 6, R is 6.
iv) 80 9, Q is 8, R is 8.
Now we have another type of representation for the above examples as given
hereunder:
i) Split each dividend into a left hand part for the Quotient and right - hand part
for the remainder by a slant line or slash.
Eg. 13 as 1 / 3, 34 as 3 / 4 , 80 as 8 / 0.
ii) Leave some space below such representation, draw a horizontal line.
26
Eg. 1 / 3 3 / 4 8 / 0
______ , ______ , ______
iii) Put the first digit of the dividend as it is under the horizontal line. Put the
same digit under the right hand part for the remainder, add the two and place
the sumi.e., sum of the digits of the numbers as the remainder.
Eg.
1 / 3 3 / 4 8 / 0
1 3 8
______ , ______ , ______
1 / 4 3 / 7 8 / 8
Now the problem is over. i.e.,
13 9 gives Q = 1, R = 4
34 9 gives Q = 3, R = 7
80 9 gives Q = 8, R = 8
Proceeding for some more of the two digit number division by 9, we get
a) 21 9 as
9) 2 / 1 i.e Q=2, R=3
2

2 / 3
b) 43 9 as
9) 4 / 3 i.e Q = 4, R = 7.
4

4 / 7
The examples given so far convey that in the division of two digit numbers by 9,
we canmechanically take the first digit down for the quotient column and that,
by adding the quotient to the second digit, we can get the remainder.
Now in the case of 3 digit numbers, let us proceed as follows.
i)
9 ) 104 ( 11 9 ) 10 / 4
99 1 / 1
27
as
5 11 / 5
ii)
9 ) 212 ( 23 9 ) 21 / 2
207 2 / 3
as
5 23 / 5
iii)
9 ) 401 (44 9 ) 40 / 1
396 4 / 4
as
5 44 / 5
Note that the remainder is the sum of the digits of the dividend. The first digit
of the dividend from left is added mechanically to the second digit of the
dividend to obtain the second digit of the quotient. This digit added to the third
digit sets the remainder. The first digit of the dividend remains as the first digit
of the quotient.
Consider 511 9
Add the first digit 5 to second digit 1 getting 5 + 1 = 6. Hence Quotient is 56.
Now second digit of 56 i.e., 6 is added to third digit 1 of dividend to get the
remainder i.e., 1 + 6 = 7
Thus
9 ) 51 / 1
5 / 6

56 / 7
Q is 56, R is 7.
Extending the same principle even to bigger numbers of still more digits, we can
get the results.
Eg : 1204 9
i) Add first digit 1 to the second digit 2. 1 + 2 = 3
ii) Add the second digit of quotient 13. i.e., 3 to third digit 0 and obtain the
Quotient. 3 + 0 = 3, 133
28
iii) Add the third digit of Quotient 133 i.e.,3 to last digit 4 of the dividend and
write the final Quotient and Remainder. R = 3 + 4 = 7, Q = 133
In symbolic form 9 ) 120 / 4
13 / 3

133 / 7
Another example.
9 ) 13210 / 1 132101 9
gives
1467 / 7 Q = 14677, R = 8

14677 / 8
In all the cases mentioned above, the remainder is less than the divisor. What
about the case when the remainder is equal or greater than the divisor?
Eg.
9 ) 3 / 6 9) 24 / 6
3 2 / 6
or
3 / 9 (equal) 26 / 12 (greater).
We proceed by re-dividing the remainder by 9, carrying over this Quotient to
the quotient side and retaining the final remainder in the remainder side.
9 ) 3 / 6 9 ) 24 / 6
/ 3 2 / 6

3 / 9 26 / 12

4 / 0 27 / 3
Q = 4, R = 0 Q = 27, R = 3.
When the remainder is greater than divisor, it can also be represented as
9 ) 24 / 6
2 / 6

26 /1 / 2
/ 1

1 / 3
29

27 / 3
Now consider the divisors of two or more digits whose last digit is 9,when
divisor is 89.
We Know 113 = 1 X 89 + 24, Q =1, R = 24
10015 = 112 X 89 + 47, Q = 112, R = 47.
Representing in the previous form of procedure, we have
89 ) 1 / 13 89 ) 100 / 15
/ 11 12 / 32

1 / 24 112 / 47
But how to get these? What is the procedure?
Now Nikhilam rule comes to rescue us. The nikhilam states all from 9 and the
last from 10. Now if you want to find 113 89, 10015 89, you have to apply
nikhilam formula on 89 and get the complement 11.Further while carrying the
added numbers to the place below the next digit, we have to multiply by this
11.
89 ) 1 / 13 89 ) 100 /15

/ 11 11 11 / first digit 1 x 11

1 / 24 1 / 1 total second is 1x11
22 total of 3rd digit is 2 x 11

112 / 47
What is 10015 98 ? Apply Nikhilam and get 100 98 = 02. Set off the 2
digits from the right as the remainder consists of 2 digits. While carrying the
added numbers to the place below the next digit, multiply by 02.
Thus
98 ) 100 / 15

02 02 / i.e., 10015 98 gives
0 / 0 Q = 102, R = 19
/ 04

102 / 19
30
In the same way
897 ) 11 / 422

103 1 / 03
/ 206

12 / 658
gives 11,422 897, Q = 12, R=658.
In this way we have to multiply the quotient by 2 in the case of 8, by 3 in the
case of 7, by 4 in the case of 6 and so on. i.e., multiply the Quotient digit by the
divisors complement from 10. In case of more digited numbers we apply
Nikhilam and proceed. Any how, this method is highly useful and effective for
division when the numbers are near to bases of 10.
* Guess the logic in the process of division by 9.
* Obtain the Quotient and Remainder for the following problems.
1) 311 9 2) 120012 9 3) 1135 97
4) 2342 98 5) 113401 997
6) 11199171 99979
Observe that by nikhilam process of division, even lengthier divisions involve no
division or no subtraction but only a few multiplications of single digits with
small numbers and a simple addition. But we know fairly well that only a special
type of cases are being dealt and hence many questions about various other
types of problems arise. The answer lies in Vedic Methods.
31
3. Urdhva - tiryagbhyam
Urdhva tiryagbhyam is the general formula applicable to all cases of
multiplication and also in the division of a large number by another large
number. It means
(a) Multiplication of two 2 digit numbers.
Ex.1: Find the product 14 X 12
i) The right hand most digit of the multiplicand, the first number (14) i.e.,4 is
multiplied by the right hand most digit of the multiplier, the second number
(12)i.e., 2. The product 4 X 2 = 8 forms the right hand most part of the answer.
ii) Now, diagonally multiply the first digit of the multiplicand (14) i.e., 4 and
second digit of the multiplier (12)i.e., 1 (answer 4 X 1=4); then multiply the
second digit of the multiplicand i.e.,1 and first digit of the multiplier i.e., 2
(answer 1 X 2 = 2); add these two i.e.,4 + 2 = 6. It gives the next, i.e., second
digit of the answer. Hence second digit of the answer is 6.
iii) Now, multiply the second digit of the multiplicand i.e., 1 and second digit of
the multiplieri.e., 1 vertically, i.e., 1 X 1 = 1. It gives the left hand most part of
the answer.
Thus the answer is 16 8.
Symbolically we can represent the process as follows :
The symbols are operated from right to left .
Step i) :
32
Step ii) :
Step iii) :
Now in the same process, answer can be written as
23
13

2 : 6 + 3 : 9 = 299 (Recall the 3 steps)
Ex.3
41
X 41

16 : 4 + 4 : 1 = 1681.
33
What happens when one of the results i.e., either in the last digit or in the
middle digit of the result, contains more than 1 digit ? Answer is simple. The
right hand most digit there of is to be put down there and the
preceding,i.e., left hand side digit or digits should be carried over to the left
and placed under the previous digit or digits of the upper row. The digits carried
over may be written as in Ex. 4.
Ex.4: 32 X 24
Step (i) : 2 X 4 = 8
Step (ii) : 3 X 4 = 12; 2 X 2 = 4; 12 + 4 = 16.
Here 6 is to be retained. 1 is to be carried out to left side.
Step (iii) : 3 X 2 = 6. Now the carried over digit 1 of 16 is to be added.
i.e., 6 + 1 = 7.
Thus 32 X 24 = 768
We can write it as follows
32
24

668
1

768.
34
Note that the carried over digit from the result (3X4) + (2X2) = 12+4 = 16
i.e.,1 is placed under the previous digit 3 X 2 = 6 and added.
After sufficient practice, you feel no necessity of writing in this way and simply
operate or perform mentally.
Ex.5 28 X 35.
Step (i) : 8 X 5 = 40. 0 is retained as the first digit of the answer and 4 is
carried over.
Step (ii) : 2 X 5 = 10; 8 X 3 = 24; 10 + 24 = 34; add the carried over 4 to
34. Now the result is 34 + 4 = 38. Now 8 is retained as the second digit of the
answer and3 is carried over.
Step (iii) : 2 X 3 = 6; add the carried over 3 to 6. The result 6 + 3 = 9 is the
third or final digit from right to left of the answer.
Thus 28 X 35 = 980.
Ex.6
48
47

1606
65

2256
Step (i): 8 X 7 = 56; 5, the carried over digit is placed below the second
digit.
Step (ii): ( 4 X 7) + (8 X 4) = 28 + 32 = 60; 6, the carried over digit is
placed below the third digit.
Step (iii): Respective digits are added.
Algebraic proof :
a) Let the two 2 digit numbers be (ax+b) and (cx+d). Note that x = 10. Now
consider the product
35
(ax + b) (cx + d) = ac.x2 + adx + bcx + b.d
= ac.x2 + (ad + bc)x + b.d
Observe that
i) The first term i.e., the coefficient of x2 (i.e., 100, hence the digit in the100th
place) is obtained by vertical multiplication of a and c i.e.,the digits in10th place
(coefficient of x) of both the numbers;
ii) The middle term, i.e., the coefficient of x (i.e., digit in the 10th place) is
obtained by cross wise multiplication of a and d; and of b and c; and the
addition of the two products;
iii) The last (independent of x) term is obtained by vertical multiplication of the
independent terms b and d.
b) Consider the multiplication of two 3 digit numbers.
Let the two numbers be(ax2 + bx + c) and (dx2 + ex + f). Note that x=10
Now the product is
ax2 + bx + c
x dx2 + ex + f

ad.x4+bd.x3+cd.x2+ae.x3+be.x2+ce.x+af.x2+bf.x+cf
= ad.x4 + (bd + ae). x3 + (cd + be + af).x2 + (ce + bf)x + cf
36
Note the following points :
i) The coefficient of x4 , i.e., ad is obtained by the vertical multiplication of the
firstcoefficient from the left side :
ii)The coefficient of x3 , i.e., (ae + bd) is obtained by the cross wise
multiplication of the first two coefficients and by the addition of the two
products;
iii) The coefficient of x2 is obtained by the multiplication of the first coefficient
of the multiplicand(ax2+bx +c) i.e., a; by the last coefficient of the multiplier
(dx2 +ex +f)i.e.,f ; of the middle one i.e., b of the multiplicand by the middle
one i.e., e of the multiplier and of the last onei.e., c of the multiplicand by the
first one i.e., d of the multiplier and by the addition of all the three productsi.e.,
af + be +cd :
iv) The coefficient of x is obtained by the cross wise multiplication of the second
coefficienti.e., b of the multiplicand by the third one i.e., f of the multiplier, and
conversely the third coefficienti.e., c of the multiplicand by the second
coefficient i.e., e of the multiplier and by addition of the two products,i.e., bf +
ce ;