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Commonly Used Abbreviations
NOTE: Abbreviations in common use can vary widely from place to place. Each institution’s
list of acceptable abbreviations is the best authority for its records.

a– 
Before CABG  Coronary artery bypass
abd  Abdominal/abdomen graft
ABG  arterial blood gas CAD  Coronary artery disease
ABO  Three basic blood groups C&S  Culture and sensitivity
ACLS  Advanced cardiac life CAT  Computerized (axial)
­support tomography scan
ADD  Attention deficit disorder CBC; cbc Complete blood count
ADH  Antidiuretic hormone CC Chief complaint
ADL  Activities of daily living CCU  Coronary care unit; critical
AE  Above the elbow care unit
AF  Atrial fibrillation CF Cystic fibrosis
AFB  Acid-fast bacillus CHD  Congenital heart disease;
AICD  Automatic implantable coronary heart disease
cardiac defibrillator CHF  Congestive heart failure
AIDS  Acquired immunodefi- CK  Creatinine kinase
ciency syndrome CMV  Cytomegalovirus
AK  Above the knee CNS  Central nervous system
ALS  Advanced life support; c/o 
Complaints of
amyotrophic lateral CO  Carbon monoxide; cardiac
­sclerosis output
ALT  Alanine aminotransferase CO2  Carbon dioxide
AM  Morning COLD  Chronic obstructive lung
ama  Against medical advice disease
AMI  Acute myocardial COPD  Chronic obstructive pulmo-
­infarction nary disease
A-P; AP; A/P Anterior-posterior CP Cerebral palsy; cleft palate
ASD  Atrial septal defect CPAP  Continuous positive airway
ASHD  Arteriosclerotic heart pressure
disease CPK  Creatine phosphokinase
AST  Aspartate aminotransferase CPR  Cardiopulmonary
(formerly SGOT) ­resuscitation
A-V; AV; A/V Arteriovenous; CSF  Cerebrospinal fluid
­atrioventricular CT  Computed tomography
Ba  Barium CVA  Cerebrovascular accident;
BBB  Blood-brain barrier costovertebral angle
BCLS  Basic cardiac life support CVP  Central venous pressure
BE  Barium enema; below the CXR  Chest x-ray
elbow D&C  Dilation (dilatation) and
bid; b.i.d. Twice a day (bis in die) curettage
BK  Below the knee dc; DC; D/C Discontinue
BM  Bowel movement DIC  Disseminated intravascular
BMR  Basal metabolic rate coagulation
BP  Blood pressure; diff Differential blood count
­buccopulpal DKA  Diabetic ketoacidosis
BPH  Benign prostatic DM  Diabetes mellitus; diastolic
hypertrophy murmur
bpm  Beats per minute DNA  Deoxyribonucleic acid
BRP  Bathroom privileges DNR  Do not resuscitate
BSA  Body surface area DOA  Dead on arrival
BSE  Breast self-examination DOB  Date of birth
BUN  Blood urea nitrogen DOE  Dyspnea on exertion
Bx  Biopsy DPT  Diphtheria-pertussis­
–
c  With tetanus
Ca  Calcium; cancer; carcinoma DRG  Diagnosis-related group
 DSM-5  Diagnostic and Statisti- HIV  Human immunodeficiency
cal Manual of Mental virus
­Disorders h/o History of
DT  Delirium tremens H2O2  Hydrogen peroxide
DTR  Deep tendon reflex HPI  History of present illness
D5W  Dextrose 5% in water HR  Heart rate
Dx  Diagnosis HSV  Herpes simplex virus
EBV  Epstein-Barr virus HT; HTN Hypertension
ECF  Extended care facility; hx; Hx History
extracellular fluid I&O  Intake and output
ECG  Electrocardiogram, IBW  Ideal body weight
electrocardiograph ICP  Intracranial pressure
ECHO  Echocardiography ICU  Intensive care unit
ECT  Electroconvulsive IDDM  Insulin-dependent diabetes
therapy mellitus
ED  Emergency department; Ig 
Immunoglobulin
effective dose IM  Intramuscular
EDD  Estimated date of delivery IPPB  Intermittent positive-
EEG  Electroencephalogram, pressure breathing
electroencephalograph IRV  Inspiratory reserve
EENT  Eye, ear, nose, and throat volume
ELISA  Enzyme-linked immuno- IUD  Intrauterine device
sorbent assay IV Intravenous
EMG  Electromyogram IVP  Intravenous pyelogram;
EMS  Emergency medical intravenous push
service K Potassium
EMT  Emergency medical KCl  Potassium chloride
technician KUB  Kidney, ureter, and
ENT  Ear, nose, and throat ­bladder
ER  Emergency room (hospi- KVO  Keep vein open
tal); external resistance L Left; liter; length;
ERV  Expiratory reserve ­lumbar; lethal; pound
­volume lab  Laboratory
ESR  Erythrocyte sedimentation L&D  Labor and delivery
rate LDL  Low-density lipoprotein
ESRD  End-stage renal disease LE  Lower extremity; lupus
FBS  Fasting blood sugar erythematosus
Fe  Iron LLE  Left lower extremity
FEV  Forced expiratory volume LLL  Left lower lobe
FH, Fhx Family history LLQ  Left lower quadrant
FHR  Fetal heart rate LMP  Last menstrual period
FTT  Failure to thrive LOC  Level/loss of
FUO  Fever of unknown origin ­consciousness
fx  Fracture LP  Lumbar puncture
GB  Gallbladder LR  Lactated Ringer’s
GC  Gonococcus or ­gonorrheal LUE  Left upper extremity
GI  Gastrointestinal LUL  Left upper lobe
Grav I, II, etc. Pregnancy one, two, LUQ  Left upper quadrant
three, etc. (Gravida) LV  Left ventricle
GSW  Gunshot wound LVH  Left ventricular
gtt  Drops (guttae) ­hypertrophy
GU  Genitourinary MABP  Mean arterial blood
Gyn  Gynecology ­pressure
H&P  History and physical MCH  Mean corpuscular
HAV  Hepatitis A virus ­hemoglobin
Hb  Hemoglobin MCHC  Mean corpuscular hemo-
HBV  Hepatitis B virus globin concentration
HCG  Human chorionic MCV  Mean corpuscular volume
­gonadotropin MD  Muscular dystrophy
HCT  Hematocrit MDI  Medium dose inhalant;
HDL  High-density lipoprotein metered dose inhaler
HEENT  Head, eye, ear, nose, and mEq  Milliequivalent
throat MI  Myocardial infarction
Hg  Mercury mm Hg Millimeters of mercury
EIGHTH EDITION

MOSBY’S POCKET
DICTIONARY
of Medicine, Nursing & Health Professions
This page intentionally left blank

     
EIGHTH EDITION

MOSBY’S POCKET
DICTIONARY
of Medicine, Nursing & Health Professions

Editor
Marie T. O’Toole, EdD, RN, FAAN
Senior Associate Dean & Professor
School of Nursing—Camden
Rutgers University
Camden, New Jersey
3251 Riverport Lane
St. Louis, Missouri 63043

MOSBY’S POCKET DICTIONARY OF MEDICINE,

NURSING & HEALTH PROFESSIONS, EIGHTH EDITION ISBN: 978-0-323-41432-6

Copyright © 2017 by Elsevier Inc. All rights reserved.

No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Details on how to seek
permission, further information about the Publisher’s permissions policies and our arrange-
ments with organizations such as the Copyright Clearance Center and the Copyright Licens-
ing Agency, can be found at our website: www.elsevier.com/permissions.

This book and the individual contributions contained in it are protected under copyright by
the Publisher (other than as may be noted herein).

Notices

Knowledge and best practice in this field are constantly changing. As new research
and experience broaden our understanding, changes in research methods, professional
practices, or medical treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluat-
ing and using any information, methods, compounds, or experiments described herein. In using such
information or methods they should be mindful of their own safety and the safety of others, including
parties for whom they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the
most current information provided (i) on procedures featured or (ii) by the manufacturer of each prod-
uct to be administered, to verify the recommended dose or formula, the method and duration of admin-
istration, and contraindications. It is the responsibility of practitioners, relying on their own experience
and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for
each individual patient, and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume
any liability for any injury and/or damage to persons or property as a matter of products liability,
negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas
contained in the material herein.

Previous editions copyrighted 2014, 2010, 2006, 2002, 1998, 1994, and 1990.
International Standard Book Number 978-0-323-41432-6
Content Strategist: Tamara Myers
Content Development Manager: Billie Sharp
Content Development Specialist: Sarah Vora
Publishing Services Manager: Jeff Patterson
Senior Project Manager: Jodi M. Willard
Design Direction: Paula Catalano
Cover Illustrations:
Diabetic retinopathy: (Goldman and Shafer, 2012)
Giemsa’s stain: (Conlon and Snydman, 2000)
Osteoarthritis: (Sueki and Bretcher, 2010)
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
CONTENTS

Consultantsix
Forewordxiii
Guide to the Dictionary xv
Vocabulary1

vii
This page intentionally left blank

     
EDITOR
Marie T. O’Toole, EdD, RN, FAAN
EDITORIAL BOARD MEMBERS
Charles R.B. Beckmann, MD, MHPE
Anne Brittain, PhD, RT(R)(M)(QM),
CPHQ, FASRT
Boyd H. Davis, PhD
Melodie Hull, RPN, MSC, MEd
Florence Lambolez, PhD
Janice Neil, PhD, RN, CNE
CONSULTANTS
Donna Adkins, PharmD, CGP, FASCP
Kassem Taha Al Sara, MD
Margaret E. Barnes, RN, MSN
Sarah Barnes, RN, DNP
Juliana Basko-Plluska, MD
Anuj Bhardwaj, MS
William O. Brant, MD, FACS, FECSM
Amanda Buckallew, PharmD
Karen Ann V. Cameron, PhD, OTD, MEd,
OTR/L
Leslie Cantrell, BSDH, MSDH, PhD
Michele T. Cimino, MSN, RN
Jamie Collins, RDH, CDA
Richard J. Crowell Jr., DPT
Nancy Wilson Darland, RN, BC, MSN,
CNS, APRN
Dominick DeMichele, MSEd, RT(R)(CT)
Susan Denham, EdD, OTR/L, CHT
Gautam J. Desai, DO, FACOFP
Kathy J. Dusthimer, RN, MSN, FNP-BC
Tammie Ferguson, MSN
Janet Fitts, RN, BSN, CEN, TNS, EMT-P
Marnita Guinn, AASN, BSN, MSN, PhD
Sandra Hertkorn
Alice Hildenbrand, RN, MSN, CNE
Marjorie “Meg” Holloway, MS, RN, APRN
Melissa Humfleet, EdS, MSN, RN
Kari Inda, PhD, OTR
Alireza Hamidian Jahromi, MD
Tamara Kear, PhD, RN, CNS, CNN
Amy Lankford, RN, MSN
Amanda Lorinc, MD
Christine M. Malik, BA, MFA
Laura Mallett, MSN
Nelly Mangarova, MD
Dan McGuire, PhD
Janis McMillan, RN, MSN, CNE
Cheryl Miller, MBA, HCM, BSEd
Anne Moscony, OTR/L, MA, CHT
ix
Jane Clifford O’Brien, PhD, OTR/L,
FAOTA
Marcel Pop, PhD
Raymond Scarpa, DNP, APN, C, AOCN
Allan Schwartz, DDS, CRNA
Rachel Spiering, PhD
Frances Munet-Vilaro, PhD, RN
Mimi Myers, RDH, MAEd
Dawn Nelms, BS
Edmond F. O’Donnell, DVM
Krishan K. Pandey, PhD
Valinda Pearson, PhD, MS, BSN
Wendy Pentland, BSc (OT), MEd, PCC,
PhD
Rosalynde Peterson, DNP, RN
Stephen M. Picca, MD
Kevin Pierce, MBA, NCBTMB
Nancy Powell, PhD, CNM, RNC-OB
Katherine Soss Prihoda, DNP, APN
Rhonda Priola, BA
David Rhode, PhD
Joseph William Robertson, DDS, BS
Krista Lee Rompolski, MS, PhD
Tyshaneka Saffold, BSN, MSN
Allan Schwartz, DDS, CRNA
Deborah Selm-Orr, BSN, MS, DNP
Sabine Marie Simmons, EdD, MSM,
RHIA, CHOS, CPAR
Nicole Smirl, BS, BSN
Rachel Spiering, PhD
Jennifer Michelle Stevenson, MS
Matt Stewart, MD, PhD
Gary Thibodeau, PhD
Megan Varellas, MMSc, CAA
Anup Amit Vora, MD
Kajal Pandya Vora, FNP-C, MSN, APRN
Nirav Amit Vora, MD
Karen S. Ward, PhD, MSN
Patti Ward, RN, PhD
Paige Wimberley, BSN, MSN, PhD(c),
APN, RNP, RN-CS, CNE
Nancee Wozney, RN, PhD
Nancy H. Wright, RN, BS, CNOR(R)
Alan H.B. Wu, PhD
Nicole Zeller, MSN, RN, CNE
This page intentionally left blank

     
This edition is dedicated to my students—past, present,
and future—who understand the importance
of communication in a complex health
care system and who inspire me;

To my colleagues, who understand the critical nature

of using language appropriately to improve
health care and who assist me;

And to my understanding and patient family,

who understand and support me.
This page intentionally left blank

     
FOREWORD
The complexity and continuing evolution of health science vocabularies require that students
and professionals alike have an affordable, compact, and thorough quick reference to the
language of their fields. Mosby’s Pocket Dictionary of Medicine, Nursing & Health Profes-
sions provides students and practitioners of the health sciences with a succinct and portable
abridgement of Mosby’s Dictionary of Medicine, Nursing & Health Professions, which has
been used by hundreds of thousands of nurses, health professionals, and physicians in their
education and practice. Mosby’s Pocket Dictionary of Medicine, Nursing & Health Profes-
sions was the first pocket dictionary to address the broad spectrum of health science terminol-
ogy in the medical, nursing, and health professions.
To reflect new developments in many facets of health care, all new and former entries
were reviewed by experts from disciplines spanning the spectrum of health science today.
This extensive review process resulted in a revision that accurately reflects current knowl-
edge and practice.
To assist our readers in recognizing alternate spellings, selected British spellings have
been added where appropriate. In addition, we have provided a list of abbreviations com-
monly used in health care on the inside of the front and back covers.
The extensive vocabulary of the larger dictionary has been retained by restructuring and
condensing its many encyclopedic entries while retaining the essential content of the defi-
nitions. The pocket dictionary shares a tradition of excellence with the parent dictionary,
Mosby’s Dictionary of Medicine, Nursing and Health Professions, by providing a portable,
usable reference for the clinical area. The user will continue to find many of the valuable
features from our larger dictionary, including clear pronunciations and etymologies for thou-
sands of terms.
Development of this eighth edition of Mosby’s Pocket Dictionary has taken the effort
of many people. I appreciatively acknowledge the work of all who have participated. The
valuable contributions by all who were involved in the parent work and in particular the
authors whose works were consulted are also gratefully acknowledged. I have been involved
with several dictionaries published by Elsevier. The care that is taken with the vocabulary
of health care is admirable. In particular, the team that worked on this dictionary, led by
Tamara Myers, is exemplary. Sarah Vora and Jodi Willard are enthusiastic colleagues with
excellent attention to detail. I am grateful for their expertise and commitment to excellence.
Babette Morgan has extraordinary skills in assisting in the presentation of complex topics in
concise, meaningful entries. My colleagues and students at Rutgers, the State University of
New Jersey, provide a rich and collaborative environment in which to explore vocabularies.
I would like to acknowledge the contributions of all of my students, past and present, but in
particular Steven Hale and Dzianis Sulkouski. The faculty and colleagues at Nazareth Col-
lege in Rochester, New York, are also resources that can be consistently depended upon for
consultation and advice. Over the years, students and colleagues who use the language of
health care to better understand or improve practice have been generous with suggestions.
Those suggestions are incorporated.
The extremely positive response to the first seven editions leads me to believe that
­Mosby’s Pocket Dictionary of Medicine, Nursing & Health Professions will remain an emi-
nently useful and usable resource. I welcome your comments and suggestions for improving
future editions.
— Marie T. O’Toole, Editor

xiii
This page intentionally left blank

     
GUIDE TO THE DICTIONARY
A. Alphabetic order Vowels
The entries are alphabetized in diction- SYMBOLS KEY WORDS
ary style; that is, letter by letter, disregard- /a/ hat
ing spaces or hyphens between words: /ä/ father
anion /ā/ fate
anion-exchange resin /ė/ flesh
anion gap /ē/ she
aniridia /er/ air, ferry
The alphabetization is alphanumeric: words /i/ sit
and numbers form a single list with numbers /ī/ eye
positioned as though they were spelled-out /ir/ ear
numerals: Fourier transform imaging / 4 n /o/ proper
/ Four-poster orthosis. (An example of the /ō/ nose
few exceptions to this rule is the sequence /ô/ saw
17-hydroxycorticosteroid / 11-hydroxy- /oi/ boy
etiocholanolone / 5-hydroxyindoleacetic /oo
¯/ move
acid, which can be found between the /oo
˘/ book
entries hydroxychloroquine sulfate and /ou/ out
hydroxyl, not, as may be expected, 17-… /u/ cup, love
in letter “S,” 11-… in letter “E,” and 5-… /ur/ fur, first
in letter “F.”) /ə/ the neutral vowel, always
Small subscript and superscript numbers unstressed, as in ago, focus
are disregarded in alphabetizing: No / NO / /ər/ teacher, doctor
N2O / NOC. /œ/ as in (French) feu /fœ/;
Compound headwords are given in their (German) schön /shœn/
natural word order: abdominal surgery, /Y/ as in (French) tu /tY/;
not surgery, abdominal; achondroplastic (German) grün /grYn/
dwarf, not dwarf, achondroplastic. /N/ This symbol does not
(NOTE: In this guide, the term “head- represent a sound but
word” is used to refer to any alphabetized indicates that the preced-
and nonindented definiendum, be it a single- ing vowel is a nasal, as in
word term or a compound term). French bon /bôN/, or inter-
In some cases, there may be one or more national /aNternäsyōnäl/.
terms that are synonymous with a headword
or derived from a headword. If the synonym Consonants
or derivation would immediately precede SYMBOLS KEY WORDS
or follow the definition, it is not included /b/ book
as a separate entry. Therefore, if a term is /ch/ chew
not listed at the expected place, the reader /d/ day
might find it among the boldface terms of /f/ fast
the immediately preceding or immediately /g/ good
following entry. /h/ happy
/j/ gem
B. Etymology /k/ keep
ETYMOLOGY is shown for principal /l/ late
entries and in other instances where it con- /m/ make
tributes immediately to a better understand- /n/ no
ing of the meaning. /ng/ sing, drink
C. Pronunciation /ng·g/ finger
All sounds, both English and non-English, /p/ pair
are represented by letters or combinations of /r/ ring
letters of the alphabet with few adaptations, /s/ set
and with the schwa (/ə/), the neutral vowel. /sh/ shoe, lotion
Pronunciations are shown between slants. /t/ tone
The following pronunciation key shows the /th/ thin
symbols used: /th/ than
/v/ very
/w/ work

xv
Guide to the Dictionary
/y/ yes
/z/ zeal
/zh/ azure, vision
/kh/ as in (Scottish) loch /loch/;
(German) Rorschach /rôr′
shokh/
/nyə/ Occurring at the end of
French words, this sym-
bol is not truly a separate
syllable but an /n/ with a
slight /y/ (similar to the
sound in “onion”) plus a
near-silent /ə/, as in Bois
de Boulogne (boo ¯/lō′ nyə/)
   
ACCENTS: Pronunciation is shown with
primary and secondary accents. A raised dot
shows that two vowels (or occasionally, two
consonants) are pronounced separately.
Many of the numerous Latin terms in this
dictionary are not given with pronunciation,
mainly because there are different ways (all
xvi
of them understood) in which Latin is pro-
nounced by the English speaker and may be
pronounced by speakers elsewhere. How-
ever, guidance is given in many cases, often
to reflect common usage.
LATIN AND GREEK PLURALS: The
spelling of Latin and Greek plurals is shown
in most instances. However, when the plural
formation is regular according to Latin and
Greek rules, the pronunciation is usually not
included.
NOTE: Notwithstanding the listing of
Latin and Greek plurals in this dictionary,
and the rules of Latin and Greek pluraliza-
tion, in most instances it is acceptable or even
preferable to pluralize Latin and Greek words
according to the rules of English words. (For
certain kinds of entries, both the English and
the foreign plurals are given in this diction-
ary, usually showing the English form first,
as, for example, in nearly all-oma nouns:
hematoma, pl. hematomas, hematomata.)
 A
Å, symbol for angstrom, a unit for dis-
tance. 1Å = 10−10 m.
A68, symbol for a protein found in the
brain tissue of patients with Alzheimer’s
disease.
AA, 1. abbreviation for achievement
age. 2. abbreviation for Alcoholics Anon-
ymous. 3. abbreviation for amplitude
of accommodation. 4. abbreviation for
anesthesiologist assistant. 5. abbreviation
for amino acid. 6. abbreviation for ante-
rior apical. 7. abbreviation for aortic arch.
8. abbreviation for arm-ankle (pulse rate).
AAA, 1. abbreviation for American Asso-
ciation of Anatomists. 2. abbreviation for
acquired aplastic anemia. 3. abbreviation
for abdominal aortic aneurysm.
āa, aa, AA, (in prescriptions) indicating
an equal amount of each ingredient to be
compounded. Abbreviation for ana.
AAAAI, abbreviation for American Acad-
emy of Allergy, Asthma, and Immunology.
AACE, 1. abbreviation for American
Association of Clinical Endocrinologists.
2. abbreviation for Association for the
Advancement of Computing in Education.
AACN, 1. abbreviation for American
Association of Colleges of Nursing.
2. abbreviation for American Associa-
tion of Critical Care Nurses.
AAFP, abbreviation for American Acad-
emy of Family Physicians.
AAI, abbreviation for ankle-arm index.
AAIN, abbreviation for American Asso-
ciation of Industrial Nurses.
AAL, abbreviation for anterior axillary
line.
AAMC, abbreviation for American
Association of Medical Colleges.
AAMI, abbreviation for Associa-
tion for the Advancement of Medical
Instrumentation.
AAN, abbreviation for American Acad-
emy of Nursing.
AANA, abbreviation for American Asso-
ciation of Nurse Anesthetists.
AAO–HNS, abbreviation for American
Academy of Otolaryngology–Head and
Neck Surgery.
AAOMS, abbreviation for American Asso-
ciation of Oral and Maxillofacial Surgeons.
AAPA, abbreviation for American Acad-
emy of Physician Assistants.
1
A
Aaron’s sign /ˈa-rəns ˈsīn/ [Charles
D. Aaron, American physician, 1866–
1951], a clinical sign in acute appendi-
citis indicated by referred pain or feeling
of distress in the epigastric or precordial
region when continuous firm pressure is
applied over McBurney’s point.
AARP, a non-profit U.S. organization
of older persons, who may or may not be
retired, with the goal of improving the wel-
fare of persons over 50 years of age. The
AARP advocates for older individuals on
legislative, consumer, education, and legal
issues.
Aarskog’s syndrome /ärs′kog/ [Dagfinn
Charles Aarskog, Norwegian pediatrician,
1928–2014], an X-linked syndrome
characterized by wide-set eyes, nostrils
that are tipped upward, a broad upper lip, a
scrotal shawl, and small hands.
Aase’s syndrome /äz/ [Jon Morton Aase,
American pediatrician, b. 1936], a famil-
ial syndrome characterized by mild delayed
growth, hypoplastic anemia, heart defects,
variable leukocytopenia, triphalangeal
thumbs, narrow shoulders, and late closure of
fontanels, and occasionally by cleft lip, cleft
palate, retinopathy, and web neck. Autosomal-
dominant transmission has been suggested.
AAUP, abbreviation for American Asso-
ciation of University Professors.
AAV, abbreviation for adenoassociated
virus.
Ab, abbreviation for antibody.
abacavir /a-BAK-a-vir/, an antiviral
that is a nucleoside reverse transcriptase
inhibitor.
abacterial /ab′aktir″ē·əl/, any atmosphere
or condition free of bacteria; literally, with-
out bacteria.
Abadie’s sign /āb’ə-dēz’/, 1. [Jean Marie
Charles Abadie, French physician, 1842–
1932] spasm of the muscle that raises the
upper eyelid, seen in patients with exoph-
thalmic goiter. 2. [Jean Abadie, French
physician, 1873–1934] loss of feeling in
the Achilles tendon, associated with the
progressive loss of deep tendon reflexes,
as seen in diabetes mellitus or syphilis.
abaissement /ä′bāsmäN″/ [Fr, a lower-
ing], 1. a falling or depressing. 2. (in
ophthalmology) the displacement of a
lens.
Ab amyloid
Ab amyloid, an abnormal peptide varying
from 40 to 43 amino acids in length and
found in aggregates in the cerebrovascu-
lar walls and the cores of the plaques in
Alzheimer’s disease.
A band, in muscle tissue, the dark area
between two I bands of a sarcomere. It is
marked by partial overlapping of actin and
myosin filaments and extends the entire
length of the myosin filaments.
abandonment of care /əban″dənment/, (in
law) wrongful cessation of the provision of
care to a patient, usually by a physician or
a nurse.
abapical /abap″əkəl/, opposite the apex.
abarelix, a gonadotropin-releasing hor-
mone antagonist used in the palliative
treatment of prostate cancer.
abarognosis /aber′agnō″sis/ [Gk, a, not,
baros, weight, gnosis, knowledge], an
inability to judge or compare the weight of
objects, particularly those held in the hand.
abarticular /ab′ärtik″yo͝olər/ [L, ab, away
from, articulus, joint], 1. pertaining to
a condition that does not affect a joint.
2. pertaining to a site or structure remote
from a joint.
abarticular gout, extraarticular gout that
affects structures other than joints, such as
ligaments.
abarticulation /ab′ärtik′yəlā″shən/, 1. dis-
location of a joint. 2. a synovial joint.
abasia /əbā″zhə/ [Gk, a, basis, not
step], the inability to walk, caused by
lack of motor coordination. −abasic,
abatic, adj.
abatacept, an antirheumatic agent used to
treat acute or chronic rheumatoid arthritis
that has not responded to other disease-
modifying agents.
abate /əbāt″/ [ME, abaten, to beat
down], to decrease or reduce in severity
or degree.
abatement /əbāt″mənt/, a decrease or less-
ening in severity of symptoms. −abate, v.
abatic, pertaining to an inability to walk.
abaxial /abak″sē·əl/ [L, ab, axis, from
axle], 1. pertaining to a position outside
the axis of a body or structure. 2. pertain-
ing to a position at the opposite extremity
of a structure.
Abbe-Estlander flap /ab″ē·est″landər/ [Rob-
ert Abbe, American surgeon, 1851–1928;
Jakob A. Estlander, Finnish surgeon, 1831–
1881], a surgical procedure that transfers
a full-thickness section of one lip of the oral
cavity to the other lip, using an arterial pedi-
cle for ensuring survival of a graft.
Abbokinase, a plasminogen activator.
Brand name for urokinase.
ABC, a mnemonic for airway, breathing,
circulation or compression. Now known
as CAB, for circulation, airway, breathing.
2 abdominal binder
abciximab /ab-sik′si-mab/, a human-
murine monoclonal antibody Fab fragment
that inhibits the aggregation of platelets, used
in the prevention of thrombosis in percuta-
neous transluminal coronary angioplasty,
administered by intravenous infusion.
Abdellah, Faye Glenn [b. 1919], a nurs-
ing theorist who introduced a typology of
21 nursing problems in 1960 in Patient-
Centered Approaches to Nursing.
abdomen /ab″dəmən, abdō″mən/ [L,
abdominis, belly], the portion of the
body between the thorax and the pelvis.
The abdominal cavity is lined by the peri-
toneum; contains the inferior portion of the
esophagus, the stomach, the intestines, the
liver, the spleen, the pancreas, and other
organs; and is bounded by the diaphragm
and the pelvic cavity. −abdominal, adj.
abdominal adhesion /abdom″inəl/, the
binding together of tissue surfaces of
abdominal organs, usually involving the
intestines and causing obstruction. The
condition may be a response to surgery
or result from trauma or chronic inflam-
mation. The patient experiences abdomi-
nal pain, nausea, vomiting, and increased
pulse rate. Surgery may be required.
abdominal aorta, the portion of the
descending aorta that passes from the aor-
tic hiatus of the diaphragm into the abdo-
men, descending ventral to the vertebral
column and ending at the fourth lumbar
vertebra, where it divides into the two
common iliac arteries. It supplies blood
to abdominal structures such as the testes,
ovaries, kidneys, and stomach. Its branches
are the celiac, superior mesenteric, inferior
mesenteric, middle suprarenal, renal, tes-
ticular, ovarian, inferior phrenic, lumbar,
middle sacral, and common iliac arteries.
abdominal aortic aneurysm (AAA), abnor-
mal dilatation of the abdominal aorta, usu-
ally in an area of severe atherosclerosis.
abdominal aortography, a radiographic
study of the abdominal aorta after the
introduction of a radiopaque contrast
medium through a catheter. The catheter
is usually inserted in the aorta through the
femoral artery.
abdominal aponeurosis, the conjoined
sheetlike tendons of the oblique and trans-
verse muscles of the abdomen.
abdominal arteries, the arteries that
branch from the anterior surface of the
abdominal aorta to supply the gastrointes-
tinal tract, as well as the liver, pancreas,
and gallbladder. The celiac artery supplies
the foregut, the superior mesenteric artery
supplies the midgut, and the inferior mes-
enteric artery supplies the hindgut.
abdominal binder, a bandage or elasti-
cized wrap that is applied around the lower
abdominal breathing
part of the torso to support the abdominal
musculature or to hold dressings in place.
abdominal breathing, a pattern of inspi-
ration and expiration in which most of the
ventilatory work is done with the abdomi-
nal muscles. The contractile force of the
abdomen is used to elevate the diaphragm.
abdominal cavity, the space within the
abdominal walls lying anterior to the ver-
tebrae, between the diaphragm and the
pelvic area, containing the liver, stomach,
small intestine, colon, spleen, gallbladder,
kidneys, and associated tissues and blood
and lymphatic vessels, surrounded by the
abdominal fascia.
abdominal decompression, 1. para-
centesis or laparotomy to relieve the
intraabdominal pressure associated with
abdominal compartment syndrome. 2. an
obsolete obstetric technique in which the
abdomen was enclosed in a chamber that
permitted surrounding pressure to be con-
trolled during the first stage of labor.
abdominal examination, the physical
assessment of a patient’s abdomen by visual
inspection and the use of auscultation, per-
cussion, and palpation. Visual inspection of
the normally oval shape of the abdominal
surface while the patient is supine may
reveal abnormal surface features indicat-
ing effects of disease, surgery, or injury.
Subsurface tumors, fluid accumulation, or
hypertrophy of the liver or spleen may be
observed as an abnormal surface feature.
Auscultation may reveal vascular sounds
that provide information about arterial dis-
orders such as aortic aneurysms and bowel
sounds that indicate intestinal function.
In pregnancy, auscultation can detect fetal
heartbeat and blood circulation in the pla-
centa. Percussion helps to detect the condi-
tion of internal organs. Palpation is used to
detect areas of tenderness or rigidity, muscle
tone and skin condition, and shapes and
sizes of subsurface organs or masses.
abdominal fascia, an inclusive term for
the fascia that forms part of the general
layer lining the walls of the abdominal cav-
ity and surrounding the abdominal organs.
abdominal fistula, an abnormal passage
or tract leading from an abdominal organ
to the external surface of the abdomen.
abdominalgia /abdom′ənal″jə/ [L, abdo-
men, belly; Gk, algos, pain], a pain in the
abdomen.
abdominal girth, the circumference of
the abdomen, usually measured at the
umbilicus.
abdominal hernia, a hernia in which a
loop of bowel protrudes through a defect
in or weakened portion of the abdominal
musculature, often through the site of an
old surgical scar or abdominal trauma.
3 abdominal pregnancy
abdominal hysterectomy, a surgical
procedure in which the uterus is removed A
through an incision in the abdominal wall.
abdominal inguinal ring, an opening of
the inguinal canal on the abdominal wall,
through which the male spermatic cord or
the female round ligament pass.
abdominal nephrectomy [L, abdominis,
belly; Gk, nephr, kidney, ektomē, cutting
out], the surgical removal of a kidney
or kidneys through an abdominal incision.
abdominal nerves, the network of
nerve fibers passing through the posterior
abdominal region anterolateral to the lum-
bar vertebral bodies, including the sym-
pathetic trunks and associated splanchnic
nerves, the abdominal prevertebral plexus
and ganglia, and the lumbar plexus.
abdominal pain, acute or chronic, local-
ized or diffuse pain in the abdominal cavity.
Abdominal pain is a significant symptom
because its cause may require immediate
surgical or medical intervention. The most
common causes of severe abdominal pain
are inflammation, perforation of an intraab-
dominal structure, circulatory obstruction,
intestinal or ureteral obstruction, intestinal
cramping, or rupture of an organ located
within the abdomen. Specific conditions
include appendicitis, perforated peptic ulcer,
strangulated hernia, superior mesenteric arte-
rial thrombosis, diverticulitis, and small and
large bowel obstruction. Gynecologic causes
that may require surgery include PID, rup-
tured ovarian cyst, and ectopic pregnancy.
Abdominal pain associated with pregnancy
may be caused by the weight of the enlarged
uterus; rotation, stretching, or compres-
sion of the round ligament; or squeezing
or displacement of the bowel. In addition,
uterine contractions associated with preterm
labor may produce severe abdominal pain.
Chronic abdominal pain may be functional
or may result from overeating or aerophagy.
When symptoms are recurrent, an organic
cause is considered. Organic sources include
peptic ulcer, hiatal hernia, gastritis, chronic
cholecystitis and cholelithiasis, chronic
pancreatitis, pancreatic carcinoma, chronic
diverticulitis, intermittent low-grade intes-
tinal obstruction, and functional indiges-
tion. Some systemic conditions may cause
abdominal pain.
abdominal paracentesis [L, abdominis,
belly; Gk, para, near, kentesis, punctur-
ing], a surgical procedure in which
there is a puncture of the abdominal cav-
ity for the removal of fluid for diagnosis
or treatment.
abdominal pregnancy, an extrauterine
pregnancy in which the conceptus develops
in the abdominal cavity after being extruded
from the fimbriated end of the fallopian tube
abdominal pressure
or through a defect in the tube or uterus. The
placenta may implant on the abdominal or
visceral peritoneum. Abdominal pregnancy
may be suspected when the abdomen has
enlarged but the uterus has remained small
for the length of gestation.
abdominal pressure, a sensation or
application of pressure surrounding struc-
tures within the abdomen.
abdominal prevertebral plexus, the
network of nerve fibers surrounding the
abdominal aorta. It extends from the aortic
hiatus of the diaphragm to the bifurcation of
the aorta into the right and left common iliac
arteries. Along its route, it is subdivided
into the celiac plexus, the abdominal aortic
plexus, and the superior hypogastric plexus.
abdominal pulse, the rhythmic transmis-
sion of blood turbulence in the abdominal
aorta.
abdominal quadrant, any of four topo-
graphic areas of the abdomen divided by
two imaginary lines, one vertical and one
horizontal, intersecting at the umbilicus.
The divisions are the left upper quadrant
(LUQ), the left lower quadrant (LLQ), the
right upper quadrant (RUQ), and the right
lower quadrant (RLQ).
abdominal reflex, a superficial neurolog-
ical reflex obtained by firmly stroking the
skin of the abdomen around the umbilicus.
It normally results in a brisk contraction of
abdominal muscles in which the umbilicus
moves toward the site of the stimulus. This
reflex is often lost in diseases of the pyra-
midal tract and can also be lost with age or
abdominal surgery.
abdominal regions, the nine topographic
subdivisions of the abdomen, determined
by four imaginary lines imposed over the
anterior surface in a tic-tac-toe pattern.
The upper horizontal line passes along the
level of the cartilages of the ninth rib, the
lower along the iliac crests. The two verti-
cal lines extend on each side of the body
from the cartilage of the eighth rib to the
center of the inguinal ligament. The lines
divide the abdomen into three upper, three
middle, and three lower zones: right hypo-
chondriac, epigastric, and left hypochon-
driac regions (upper zones); right lateral
(lumbar), umbilical, and left lateral (lum-
bar) regions (middle zones); right inguinal
(iliac), pubic (hypogastric), and left ingui-
nal (iliac) regions (lower zones).
abdominal salpingectomy, removal of
the fallopian tube or tubes through a surgi-
cal incision in the abdomen.
abdominal splinting, a tensing or tight-
ening of the abdominal wall muscles, usu-
ally occurring as an involuntary reaction to
the pain of a visceral disease or disorder or
to postoperative discomfort.
4 abdominoperineal
abdominal sponge, a special type of
gauze pad used as an absorbent and sterile
covering for the viscera.
abdominal surgery, any one of a num-
ber of procedures that involve the surgical
management of the abdomen or abdomi-
nal organs. An open procedure requires a
surgical incision that is closed with staples
or sutures. Laparoscopic and robotic pro-
cedures require small incisions in which
instruments are placed through long, hol-
low tubes attached to a camera.
abdominal testis, an undescended tes-
ticle located in the abdominal cavity that
has not moved into its normal location in
the scrotum.
abdominal thrust, quick, hard move-
ments directed inward and upward toward
the diaphragm to assist an adult to expel
foreign objects in the airway.
abdominal ultrasound test, a diagnostic
study that provides accurate visualization
of the abdominal aorta, liver, gallbladder,
pancreas, biliary ducts, kidneys, ureters,
and bladder. This test is used to diagnose
and locate cysts, tumors, calculi, and
malformations; to document the progres-
sion of various diseases; and to guide the
insertion of instruments during surgical
procedures.
abdominal viscera, the internal organs
enclosed within the abdominal cavity,
including the stomach, liver, intestines,
spleen, pancreas, and components of the
urinary and reproductive tracts.
abdominal wall, the boundaries of
the abdominal cavity that enclose the
abdominal cavity and the viscera within.
It is multilayered, beginning superficially
with skin, followed by subcutaneous tis-
sue and fat, superficial fascia, abdominal
musculature and fascia, and most deep, the
peritoneum.
abdominal wound, a break in the conti-
nuity of the abdominal wall. A wound that
exposes or penetrates the viscera raises the
danger of infection or peritonitis.
abdominocardiac reflex /-kär″dē·ək/, an
immediate, involuntary response of the
heart to stimulation of the abdominal vis-
cera. The reflex is mediated through the
vagus nerve.
abdominogenital /-jen″itəl/, pertaining to
the abdomen and reproductive system.
abdominopelvic cavity /-pel″vik/, the
space between the diaphragm and the pel-
vis. There is no structurally distinct sepa-
ration between the abdomen and pelvic
regions.
abdominoperineal /-per′inē″əl/, pertain-
ing to the abdomen and the perineum,
including the pelvic area, female vulva and
anus, and male scrotum and anus.
abdominoplasty
abdominoplasty, a surgical procedure
that removes excess fat and skin and tight-
ens the abdominal muscles to create a
smoother abdominal profile.
abdominoscopy /abdom′inos″kəpē/ [L,
abdomen; Gk, skopein, to view], a pro-
cedure for examining the contents of the
peritoneum in which an electrically illu-
minated tubular device is passed through a
trocar into the abdominal cavity.
abdominoscrotal /-skrō″təl/, pertaining
to the abdomen and scrotum.
abdominothoracic arch /-thôras″ik/, the
boundary between the thorax and the
abdomen.
abdominovaginal /-vaj″inəl/, pertaining
to the abdomen and vagina.
abdominovesical /-ves″ikəl/, pertaining
to the abdomen and bladder.
ABD pad, a gauze pad, ranging in size
from 5 × 9 to 12 × 16, with a filler for
absorbency of wound drainage.
abducens muscle, the extraocular lat-
eral rectus muscle that moves the eyeball
outward.
abducens nerve [L, abducere, to take
away], either of the paired sixth cranial
nerves. It arises in the pons near the fourth
ventricle, leaves the brainstem between the
medulla oblongata and pons, and passes
through the cavernous sinus and the supe-
rior orbital fissure. It controls the lateral
rectus muscle, turning the eye outward.
abducent /abdoo″sənt/ [L, drawing
away], pertaining to a movement away
from the median line of the body.
abduction [L, abducere, to take
away], movement of a limb away from
the midline or axis of the body. −abduct, v.
abduction boots, an orthopedic cast or
orthotic for the lower extremities, avail-
able in both short- and long-leg configura-
tions, with a bar incorporated at ankle level
to provide hip abduction.
abductor /abduk″tər/ [L, abducere], a
muscle that draws a body part away from
the midline or axis of the body, or one part
from another.
abductor digiti minimi of the foot, a
muscle on the lateral side of the foot that
abducts the little toe at the metatarsopha-
langeal joint. It is innervated by the lateral
plantar branch of the tibial nerve.
abductor digiti minimi of the hand, a
muscle that is the principal abductor of the
little finger.
abductor hallucis, a muscle that forms
the medial margin of the foot and contrib-
utes to a soft tissue bulge on the medial
side of the sole. It abducts and flexes the
great toe at the metatarsophalangeal joint
and is innervated by the medial plantar
branch of the tibial nerve.
5 ability
abductor pollicis brevis, one of the three
thenar muscles. It abducts the thumb, prin- A
cipally at the metacarpophalangeal joints.
abductor pollicis longus, a muscle that
originates from the proximal posterior
surfaces of the radius and ulna and from
the related interosseous membrane. It
forms a tendon that passes into the thumb
and inserts on the lateral side of the base
of the first metacarpal. Its major func-
tion is to abduct the thumb at the joint
between the first metacarpal and trape-
zium bones.
abembryonic /ab′embrē·on″ik/, the area
of a blastocyst opposite the early embryo.
Abernethy’s sarcoma /ab″ərnē′thēz/
[John Abernethy, British surgeon, 1764–
1831], a malignant neoplasm of fat cells,
usually occurring on the trunk.
aberrant, moving away from the usual
standard, deviating from the natural type.
aberrant goiter, an enlargement of a
supernumerary or ectopic thyroid gland.
aberrant ventricular conduction
(AVC), the temporary abnormal intra-
ventricular conduction of a supraventricu-
lar impulse.
aberration /ab′ərā″shən/ [L, aberrare, to
wander], 1. any departure from the usual
course or normal condition. 2. abnormal
growth or development. 3. (in psychology)
an illogical and unreasonable thought or
belief, often leading to an unsound mental
state. 4. (in genetics) any change in the
number or structure of the chromosomes. 5.
(in optics) any imperfect image formation
or blurring caused by unequal refraction or
focalization of light rays through a lens. 6.
(in botany and zoology) pertaining to an
abnormal individual, such as certain atypi-
cal members of a species. −aberrant, adj.
abetalipoproteinemia (ABL) /əbā′təlīp′
ōprō′tinē″mē·ə/ [Gk, a + beta, not beta,
lipos, fat, proteios, first rank, haima,
blood], a group of rare inherited dis-
orders of fat metabolism, characterized
by the absence of apoprotein β-100 and
manifested by acanthocytosis, low or
absent serum beta-lipoprotein levels, and
hypocholesterolemia. In severe cases, ste-
atorrhea, ataxia, nystagmus, motor incoor-
dination, and retinitis pigmentosa occur.
abeyance /əbā″əns/ [Fr], a temporary
state of inaction or temporary interruption
of function.
ABG, abbreviation for arterial blood gas.
ABI, abbreviation for ankle-brachial
index.
abient /ab″ē·ənt/ [L, abire, to go
away], characterized by a tendency to
move away from stimuli. −abience, n.
ability /əbil″itē/, the capacity to act in a
specified way because of the possession of
AbioCor
appropriate sensory, motor, and life skills
coupled with the mental or physical fitness
necessary to become proficient.
AbioCor, an implantable artificial heart
device for patients with end-stage heart
failure. It is normally powered by an exter-
nal console or battery packs but also has
an internal battery to power the pump for
approximately 20 minutes when the exter-
nal power supply is disconnected.
abiogenesis /ab′ē·ōjen″əsis/ [Gk, a + bios,
not life, genein, to produce], the theory
that life can originate from inorganic, inan-
imate matter. −abiogenetic, adj.
abiosis /ab′ē·ō″sis/ [Gk, a + bios not
life], a nonviable condition or a situation
that is incompatible with life. −abiotic, adj.
abiotrophy /ab′ē·ot″rəfē/ [Gk, a + bios +
trophe nutrition, growth], degeneration
or loss of function that is not due to any
apparent injury. −abiotrophic, adj.
ablastemic /ab′lastem″ik/, nongerminal or
not germinating.
ablation /ablā″shən/ [L, ab + latus, car-
ried away], 1. vaporization or an exci-
sion of any part of the body, or removal of
a growth or harmful substance. 2. (in car-
diology) a procedure used in the manage-
ment of rapid or irregular rhythms in which
cardiac tissue is destroyed. −ablate, v.
ABLB test, abbreviation for alternate
binaural loudness balance test.
ablepharia /ab′ləfer″ēə/, a defect or con-
genital absence of the eyelids (partial or
total).
ablepsia /əblep″sē·ə/ [Gk, a + blepein, not
to see], the condition of being blind.
ABLS, abbreviation for advanced burn
life support.
ablution /abloo″shən/ [L, abluere, wash
away], 1. the act of washing or bathing.
2. the act of cleaning the body.
ABMS, abbreviation for American Board
of Medical Specialties.
abnerval current /abnur″vəl/ [L, ab,
from; Gk, neuron, nerve], an electrical
current that passes from a nerve to and
through muscle.
abneural /abno͝or″əl/, away from the cen-
tral nervous system or the neural axis.
abnormal behavior /abnôr″məl/ [L, ab
+ norma, away from rule], behavior that
deviates from what is commonly accepted
by a group or society.
abnormality /ab′nôrmal″itē/ [L, ab +
norma, away from rule], a condition that
differs from the usual cultural or scientifi-
cally accepted standards.
abnormal psychology, the study of emo-
tional/behavioral, mental, or neuropsycho-
logical disorders.
abnormal tooth mobility, excessive
movement of a tooth within its alveolus
6 abouchement
(socket) as a result of injury or disease in
the supporting peridontium.
ABO blood group, a system for classifying
human blood on the basis of the antigenic
components of red blood cells (RBCs) and
their corresponding antibodies. The ABO
blood group is identified by the presence or
absence of two different antigens, A and B,
on the surface of the RBC. The four blood
types in this grouping, A, B, AB, and O, are
determined by and named for these antigens.
aboiement /ä′bô·ämäN″/, an involuntary
making of abnormal, animal-like sounds,
such as barking. Aboiement may be a clini-
cal sign of Gilles de la Tourette’s syndrome.
abort /əbôrt″/ [L, ab, away from, oriri,
to be born], 1. (Nontechnical) to deliver
a nonviable fetus; to miscarry. 2. to ter-
minate a pregnancy before the fetus has
developed enough to be viable. 3. to ter-
minate in the early stages or to discontinue
before completion, as to arrest the usual
course of a disease, to stop growth and
development, or to halt a project.
abortifacient /əbôr′tifā″shənt/, 1. causing
abortion. 2. an agent or medication that
causes abortion.
abortion /əbor″shən/ [L, ab + oriri], the
spontaneous or induced termination of
pregnancy before the fetus has developed
to the stage of viability, before 20 weeks
of gestation or when the fetus weighs less
than 500 grams.
abortionist, a person performing elective
and/or therapeutic terminations of preg-
nancy by surgical or medical means.
abortion on demand, removal by medical
or surgical methods of a normally implanted
intrauterine pregnancy at maternal request
regardless of reason when no restrictive
legal statutes prohibit the request.
abortive infection /əbôr″tiv/, an infection
in which some or all viral components
have been synthesized but no infective
virus is produced. The situation may
result from an infection with defective
viruses or because the host cell is nonper-
missive and prohibits replication of the
particular virus.
abortus /əbôr″təs/, a fetus of less than 500
grams in weight.
abortus fever, a form of brucellosis
caused by Brucella abortus, an organ-
ism so named because it causes abortion
in cows. Humans can become infected
through broken skin by direct contact with
tissue, blood, urine, vaginal secretions,
aborted fetuses, or placentas of infected
animals or by ingestion of infected raw
dairy products.
abouchement /ä′bo͝oshmäN″/ [Fr, a tube
connection], the junction of a small
blood vessel with a large blood vessel.
above-elbow (AE) amputation
above-elbow (AE) amputation, (Obso-
lete) historical terminology for an amputa-
tion of the upper limb between the elbow
and the shoulder.
ABP, abbreviation for arterial blood
pressure.
ABR, 1. abbreviation for auditory
brainstem response. 2. abbreviation for
absolute bed rest.
abrachia /əbrā″kē·ə/ [Gk, a + brachion,
without arm], the absence of arms.
−abrachial, adj.
abrasion /əbrā″zhən/ [L, abradere, to
scrape off], a scraping or rubbing
away of a surface, such as skin or teeth,
by a substance or surface with a hard-
ness greater than that of the tissue being
scraped or rubbed away. −abrasive, adj.,
−abrade, v.
abrasion arthroplasty, reshaping of a
joint by using a small tool or burr to grind
down the surface inducing bleeding and
fibrocartilaginous repair tissue to form a
new articular surface that serves as a better
joint covering.
abrasive, a substance used for grinding or
polishing a surface.
abreaction /ab′rē·ak″shən/ [L, ab, from,
re, again, agere, to act], an emotional
release resulting from mentally reliving
or bringing into consciousness, through
the process of catharsis, a long-repressed,
painful experience. −abreact, v.
abruption [L, ab, away from, rumpere,
rupture], a sudden breaking off or tear-
ing apart.
abruptio placentae [L, ab, away from,
rumpere, to rupture], abnormal separa-
tion of a normally implanted intrauterine
pregnancy. There are three types: complete
(entire placenta separates), partial (part of
placenta separates), marginal (separation
limited to placental edge).
abscess /ab″səs/ [L, abscedere, to go
away], 1. a cavity containing pus and
surrounded by inflamed tissue, formed
as a result of suppuration in a localized
infection, characteristically caused by
staphylococci but also caused by parasites
and foreign substances. Healing usually
occurs when an abscess drains, is incised,
or is surgically removed. 2. an abscess that
develops anywhere along the root length
of a tooth.
abscissa /absis″ə/ [L, ab, away; scind-
ere, to cut], the horizontal coordinate in
a graph along which are plotted the units
of one of the variables considered in the
study, as time in a time-temperature study.
abscission /absish″ən/ [L, abscinere, to
cut away], the process of cutting away,
as in corneal abscission, removal of the
prominence of the cornea.
7 absolute bed rest
absconsio /abskon″shō/ [L, ab, away
from, condo, hidden], a cavity or fossa. A
abscopal /abskō″pəl/, pertaining to the
effect of irradiated tissue on remote tissue
not exposed to radiation.
absence seizure, an epileptic seizure
characterized by a sudden, momentary
loss of consciousness. Occasionally it is
accompanied by minor myoclonus of the
neck or upper extremities, frequent blink-
ing, slight symmetric twitching of the face,
or loss of tonus. Seizures usually occur
many times a day without a warning aura
and are most frequent in children and ado-
lescents, especially at puberty. Children
often outgrow them.
absenteeism /ab′səntē″izəm/, (for health
or related reasons) absence from work, a
location, or place where one is expected.
The most common causes of absentee-
ism include influenza and occupationally
related skin diseases, such as contact der-
matitis from a latex allergy.
absent without leave (AWOL)
/ā″wôl/ [L, absentia], a military term
that is also used in the medical field to
describe a patient who departs from a psy-
chiatric, day-care, or medical facility with-
out authorization.
abs feb, a rarely used, shortened form of
a Latin phrase meaning “in the absence of
fever.”
absolute /ab″səloot/, unconditional,
unrestricted, or independent of arbitrary
standards.
absolute agraphia [L, absolutus, set loose;
Gk, a, not, graphein, to write], a com-
plete inability to write caused by a cen-
tral nervous system lesion. The person
is unable to write even the letters of the
alphabet.
absolute alcohol, a clear, colorless,
highly hygroscopic liquid with a burning
taste, containing at least 99.5% ethyl alco-
hol by volume.
absolute (A) temperature, temperature
that is measured from a base of absolute
zero on the Kelvin scale or the Rankine
scale.
absolute bed rest [abbreviated ABR],
restriction of a patient’s activities, either
partially or completely. A person on abso-
lute or strict bed rest must remain in bed
at all times. Bed rest may be prescribed to
maintain a pregnancy, in cases of severe
pain associated with movement, or with
orthopedic conditions in which it would
be unsafe to be out of bed. It is associ-
ated with many hazards of immobility.
Numerous research studies have demon-
strated that bed rest is a greater stressor to
the patient in many conditions than a less
restrictive activity prescription would be.
absolute discharge
absolute discharge [L, absolutus, set
free], a final and complete termination of
the patient’s relationship with a caregiving
agency.
absolute glaucoma /ab′səloot/ [L, abso-
lutus + Gk, cataract], complete blind-
ness in which a glaucoma-induced increase
in intraocular pressure results in permanent
vision loss. The optic disc is white and
deeply excavated, and the pupil is usually
widely dilated and immobile.
absolute growth, the total increase in
size of an organism or a particular organ
or part, such as the limbs, head, or trunk.
absolute humidity, the actual mass or
content of water in a measured volume
of air. It is usually expressed in grams per
cubic meter or pounds per cubic foot or
cubic yard.
absolute neutrophil count (ANC), the
number of neutrophils in a milliliter of
blood. The ANC is a measure of a person’s
immune status.
absolute threshold [L, absolutus, set loose;
AS, therscold], 1. the lowest point at
which a stimulus can be perceived. 2. per-
taining to millivolts of electrical charge
determined by ion fluctuations or move-
ment across plasma membranes that result
in nerve or muscle stimulation.
absolute zero, the temperature at which
all molecular activity except vibration
ceases. It is a theoretical value derived
by calculations and projections from
experiments with the behavior of gases
at extremely low temperatures. Absolute
zero is estimated to be equal to −273° C
or −460° F.
absorb, the act of reception or blending
of space, situations, liquids, people’s emo-
tions, or circumstances.
absorbable gauze /əbsôr″bəbəl/, a mate-
rial produced from oxidized cellulose that
can be absorbed. It is applied or sutured
directly to tissue to stop bleeding. After a
clot forms, the gauze turns into a gel.
absorbable surgical suture [L, absorbere,
to suck up; Gk, cheirourgos, surgery; L,
sutura], a suture made from material
that can be completely incorporated by the
body, facilitating healing but eliminating
the need for suture removal.
absorbance /əbsôr″bəns/, the degree of
absorption of light or other radiant energy
by a medium exposed to the energy.
Absorbance varies with factors such as
wavelength, solution concentration, and
path length.
absorbed dose, the energy imparted by
ionizing radiation per unit mass of irradi-
ated material at the place of interest. The SI
unit of absorbed dose is the gray (Gy); the
non-SI (traditional) unit is referred to as
8 abstinence
rad, radiation absorbed dose. 1 Gy equals
1 J/kg; and 1 Gy equals 100 rad.
absorbefacient /absôr′bifā″shənt/ [L,
absorbere, to suck up, + facere, to
make], 1. any agent that promotes or
enhances the quality and ability to soak
liquids more readily. 2. causing or enhanc-
ing absorption.
absorbent /absôr″bənt/ [L, absorbere, to
suck up], 1. capable of attracting and
incorporating substances into itself. 2. a
product or substance that can absorb liq-
uids or gases.
absorbent dressing, a clean or sterile
covering applied to a wound or incision to
suck secretions into itself. Kinds of absor-
bent dressings are Teflon-coated gauze
squares, fluffed gauze, and abdominal
bandages.
absorbent gauze, a fabric or pad with
various forms, weights, and uses, primar-
ily designed to take in fluid and/or excre-
tions. It may be a rolled, single-layered fine
fabric for spiral bandages, or it may be a
thick, multilayered pad for a sterile pres-
sure dressing. There may also be an adhe-
sive backing.
absorption /absôrp″shən/ [L, absorp-
tio], 1. the incorporation of matter by
other matter through chemical, molecular,
or physical action, such as the dissolution
of a gas in a liquid or the taking up of a
liquid by a porous solid. 2. (in physiol-
ogy) the passage of nutrients and sub-
stances across and into tissues, such as
the passage of digested food molecules
into intestinal cells or the passage of liq-
uids into kidney tubules. 3. (in radiology)
the process of absorbing electromagnetic
radiation in which a photon of energy is
taken up by living or nonliving matter.
−absorb, v.
absorption coefficient, the factor by
which the intensity of electromagnetic
energy decreases as it interacts with a unit
thickness of an absorbing material. It is
usually expressed per unit thickness.
absorption rate constant, a value
describing how much drug is absorbed per
unit of time.
absorption spectrum, a plot of percent
transmittance, absorbance, logarithm of
absorbance, or absorptivity of a compound
as a function of wavelength, wave number,
or frequency of radiation.
absorptivity /ab′sôrptiv″itē/, absorbance
at a particular wavelength divided by the
product of the concentration of a substance
and the sample path length.
abstinence /ab″stinəns/, voluntarily
avoiding a substance, such as food or alco-
hol, or refraining from the performance of
an act, such as sexual intercourse.
abstract
abstract /ab″strakt, abstrakt″/ [L, abstra-
here, to drag away], 1. a condensed
summary of a scientific article, liter-
ary piece, or address. 2. to collect data
and extract files, including coding and
billing information, from a medical
record. 3. (in pharmacology) the base
in which other components are mixed
and dissolved. 4. difficult to understand
because of lack of practicality. 5. the
process of gathering theoretical informa-
tion to develop ideas with reference to
the main idea.
abstraction /abstrak″shən/ [L, abstra-
here, to drag away], (in dentistry) a con-
dition in which teeth or other maxillary and
mandibular structures are inferior to their
normal position, away from the occlusal
plane.
abulia /əboo″lyə/ [Gk, a + boule, without
will], a loss of the ability or a reduced
capacity to exhibit initiative or to make
decisions.
abuse /abyoos″/ [L, abuti, to waste,
abusus, using up], 1. improper use of
equipment, a substance, or a service, such
as a drug or program, either intentionally
or unintentionally. 2. Using words and/
or physical action to hurt, attack and do
harm.
abused person [Fr, abuser, to disuse, L,
persona, a role played], an individual
who has been harmed or maltreated emo-
tionally, verbally, sexually, or physically
by another person or by a situation; a
victim.
abutment /əbut″mənt/ [Fr, abouter to
place end to end], a tooth, root, or
implant that supports and provides reten-
tion for a fixed or removable dental
prosthesis.
abutment tooth, a tooth selected to sup-
port a prosthesis.
ABVD, an anticancer drug combination
of doxorubicin, bleomycin, vinblastine,
and dacarbazine.
Ac, abbreviation for acetyl.
AC, 1. abbreviation for alternating cur-
rent. 2. abbreviation for accommodative
convergence.
a.c., (in prescriptions) denoting a Latin
phrase meaning “before meals.”
A-C, abbreviation for alveolar capillary.
acacia gum /ə-ˈkā-shə gəm/, a dried,
gummy exudate of the acacia tree (Acacia
senegal) used as a binding, suspending, or
emulsifying agent in medicines.
academic ladder /ak′ədem″ik/ [Gk,
akademeia, school], the hierarchy of
faculty appointments in an academic set-
ting (university, college, or community
college) through which a faculty member
advances from the rank of instructor to
9 acanthoma
assistant professor to associate professor
to professor. A
Academy of Nutrition and Dietetics, an
organization that advances the nutritional
well-being of the American public. Mem-
bership is primarily registered dietitians.
acalculia /a′kalkoo″lyə/ [Gk, a, not;
L, calculare, to reckon], the inability
to perform simple mathematic calcula-
tions the patient previously knew. Com-
monly seen in neurological disorders, it
is assessed by having a patient count for-
ward or backward or do mental addition
or subtraction.
acamprosate, an antialcoholic agent used
for the maintenance of abstinence from
alcohol.
acampsia /əkamp″sē·ə/ [Gk, a +
kampsein, not to bend], a condition in
which a joint is rigid.
acanthamebiasis /əkan′thəmēbī″əsis/, a
potentially fatal meningoencephalitis
infection caused by Acanthamoeba cas-
tellani, a free-living ameboflagellate. It
is commonly acquired by swimming in
water contaminated by the microorganism.
Cleaning contact lenses in contaminated
solution can also cause keratitis.
Acanthamoeba /əkan′thəmē″bə/, a genus
of free-living ameboid protozoa typically
found in moist soil and water. The organ-
isms may enter the body through a break in
the skin, causing a localized infection, or
even through the nose or eyes, causing sys-
temic infections of the lung, genitourinary
system, brain, or CNS.
acanthesia /ak′anthē″zhə/, pinprick par-
esthesia; an abnormality of cutaneous sen-
sory perception that causes a simple touch
to be felt as a painful pinprick.
acanthiomeatal line /əkan′thē·ō′mē·ā″təl/,
a hypothetical line extending from the
external acoustic meatus to the acanthion.
In dentistry, a full maxillary denture is con-
structed so that its occlusal plane is parallel
with this line. The line is used for radio-
graphic positioning of the skull.
acanthion, a craniometric point at the
center of the base of the anterior nasal
spine.
acanthocyte /əkan″thəsīt′/ [Gk, akantha
+ kytos, cell], an abnormal peripheral
blood film erythrocyte with irregular spur-
like projections. Predominant in abetalipo-
proteinemia; fewer occur in liver disease.
acanthocytosis /akan′thōsītō″sis/ [Gk,
akantha + kytos + osis, condition], the
presence of acanthocytes on a peripheral
blood film.
acanthoid, resembling a spinous process.
acanthoma /ak′anthō″mə/ [Gk, akantha
+ oma, tumor], hypertrophy that arises
from the stratum spinosum and is localized
acanthoma fissuration
rather than diffuse. It may be benign or
malignant.
acanthoma fissuration, the development
of a fissure bordered by increased thick-
ening at sites of friction of the stratum
spinosum.
acanthoma fissuratum, a benign, firm,
skin-colored or erythematous nodule,
grossly resembling basal cell carcinoma,
occurring on the bridge of the nose or
behind the ear, resulting from constant
minor mechanical trauma caused by poorly
fitting glasses.
acanthorrhexis /əkan′thôrek″sis/, the
rupture of intercellular bridges of the stra-
tum spinosum, as in eczema or allergic
contact dermatitis.
acanthosis /ak′ənthō″sis/ [Gk, akantha
+ osis, condition], an abnormal, diffuse
hypertrophy of the stratum spinosum, as
in eczema and psoriasis. −acanthotic,
adj.
acanthosis nigricans /nē″grikanz′/, a
skin disease characterized by dark, vel-
vety thickening of the skin, common in
the neck, axilla, and groin, and frequently
associated with obesity and endocrine
disorders.
acapnia /akap″nē·ə/, a deficiency of car-
bon dioxide in the blood.
AC/A ratio, (in ophthalmology) the pro-
portion between accommodative conver-
gence (AC) and accommodation (A), or
the amount of convergence automatically
resulting from the dioptric focusing of the
eyes at a specified distance. The ratio of
accommodative convergence to accommo-
dation is usually expressed as the quotient
of accommodative convergence in prism
diopters divided by the accommodative
response in diopters.
acarbia /akär″bē·ə/ [Gk, a, not; L, carbo,
coal], a decrease in the bicarbonate level
in the blood.
acarbose, an oral alpha glucosidase
inhibitor, prescribed in the treatment of
type 2 diabetes mellitus.
acardia /akär″dē·ə/ [Gk, a + kardia, with-
out heart], a rare congenital anomaly
in which the heart is absent. It is almost
exclusively seen in a monozygous twin
whose survival depends on the circulatory
system of its twin. It is considered the most
extreme form of twin-twin transfusion.
−acardiac, adj.
acardius acephalus, a fetus that lacks a
head, heart, and most of the upper part of
the body.
acardius acormus, a fetus that lacks a
heart and has a defective trunk.
acardius amorphus, an acardiac fetus
with a rudimentary body that does not
resemble the normal form.
10 acceleration-deceleration injury
acariasis /ak′ərī″əsis/ [Gk, akari, mite,
osis, condition], a disease, usually of the
skin, caused by infestation with parasitic
worms.
acarid /ak″ərid/, one of the many mites
and ticks that are members of the order
Acarina, which includes a great number
of parasitic and free-living organisms.
Adults have four pairs of legs and round
bodies, living as ectoparasites. Those
associated with disease act as intermedi-
ate hosts of pathogenic agents, directly
cause skin or tissue damage, and cause
loss of blood or tissue fluids. Important
as vectors of scrub typhus and other rick-
ettsial diseases are the six-legged larvae
of mites from the family Trombiculidae,
which are parasites of humans, many
other mammals, and birds.
acarodermatitis /ak′ərōdur′mətī″tis/ [Gk,
akari, mite, derma, skin, itis, inflamma-
tion], a skin inflammation caused by
mites or ticks.
acarophobia /-fō″bē·ə/, 1. a morbid
dread of tiny parasites or the delusion that
tiny insects such as mites have invaded the
skin. 2. a fear of itching, particularly from
parasites.
acaudal /ākô″dəl/ [Gk, a, without; L,
cauda, tail], without a tail.
acc, Acc, abbreviation for accommodation.
ACC, abbreviation for American College
of Cardiology.
accelerated idiojunctional rhythm, an
automatic junctional rhythm whose rate is
greater than 59 beats/min but less than 100
beats/min.
accelerated idioventricular rhythm
(AIVR), an automatic ectopic ventricu-
lar rhythm whose rate is greater than 49
beats/min but less than 100 beats/min,
without retrograde conduction to the atria.
In acute myocardial infarction an AIVR
can be a sign of spontaneous reperfusion
or a result of thrombolytic therapy.
accelerated junctional rhythm, an ecto-
pic junctional heart rhythm whose rate
exceeds the normal firing rate of junctional
tissue, with or without retrograde atrial
conduction.
accelerated respiration, an abnormally
rapid rate of breathing, usually more than
25 breaths per minute.
acceleration /aksel′ərā″shən/ [L, accel-
erare, to quicken], a change in the speed
or direction of a moving object. Increasing
speed is positive acceleration; decreasing
speed is negative acceleration. −acceler-
ate, v.
acceleration-deceleration injury, an injury
resulting from a collision between a body
part and another object or body part while
both are in motion.
acceleration phase
acceleration phase, (in bacteriology) a
period of increased growth occuring prior
to the lag phase in a culture of microbes.
accelerator /aksel″ərā′tər/ [L, accelerare,
to quicken], 1. a nerve or muscle that
increases the rate of performance of some
function. 2. a slender nerve fiber passing
through the sympathetic ganglion to the
heart, causing an increase in heart rate.
3. an agent or apparatus used to increase
the rate at which a substance acts or a
function proceeds.
accentuation /aksen′choo·ā″shən/ [L,
accentus, accent], an increase in distinct-
ness or loudness, as in heart sounds.
acceptable daily intake (ADI), the maxi-
mum amount of any substance that can
be safely ingested by a human. Ingestion
that exceeds this amount may cause toxic
effects. This term is usually applied to
additives, residues, or chemicals not nor-
mally found in foods.
acceptance of individuality, (in psy-
chiatry) an index of family health in which
differentiation or individuation is a valued
goal.
acceptance of separation, an indicator of
mental well-being in which a loss is dealt
with in a healthy manner, indicating pro-
ductive adaptability.
acceptor /aksep″tər/ [L, accipere, to
receive], 1. an organism that receives
living tissue, such as transfused blood or
a transplanted organ, from another organ-
ism. 2. a substance or compound that com-
bines with, or accepts, a part of another
substance or compound, such as an atom,
an ion, an electron, or an electron pair.
access /ak″ses/, a means of approach, such
as the space needed for the manipulation of
dental or surgical instruments.
accessibility /ak″ses ă bil ity/, characteris-
tics of an environment that allow individuals
with disabilities to enter and use the space.
access cavity [L, accedere, to approach], a
coronal opening to the center (pulp cham-
ber) of a tooth, required for effective clean-
ing, shaping, and obturation of the pulp
canals and chamber during endodontic or
root canal therapy.
accessory /akses″ərē/ [L, accessonis,
appendage], 1. a supplementary item,
desirable but not necessary, used chiefly
for convenience or for safety, such as the
electric elevator mechanisms for hospital
beds. 2. a structure that contributes to the
function of one of the main anatomical sys-
tems, such as the accessory sex organs in
men and women or the accessory organs of
the skin, including the hair, the nails, and
the skin glands.
accessory diaphragm, a rare congenital
anomaly in which a second diaphragm or
11 accessory pathway
portion of a diaphragm develops in the
chest. It is usually found on the right side A
and is oriented upward and backward to
the posterior chest wall. It may be sepa-
rated from the true diaphragm by a lobe
of a lung.
accessory gland, glandular tissue that
contributes in a secondary way to the
function of a similar gland, which may be
nearby or some distance away.
accessory ligament [L, accessus, extra,
ligare, to bind], a ligament that helps
strengthen a union between two bones,
even though it is not part of a joint capsule.
accessory movement, movement that
occurs between adjacent joint surfaces that
is necessary for a full range of motion but
is not under direct voluntary control.
accessory muscle, a relatively rare ana-
tomic duplication of a muscle that may
appear anywhere in the muscular system.
accessory muscle of respiration, any of
the muscles of the neck, back, and abdo-
men that may assist the diaphragm and the
internal and external intercostal muscles in
respiration, especially in some breathing
disorders or during exercise.
accessory nasal sinuses [L, accessus, extra,
nasus, nose, sinus, hollow], the parana-
sal sinuses that occur as hollows within the
skull but open into the nasal cavity and are
lined with a mucous membrane continuous
with the nasal mucous membrane.
accessory nerve, either of a pair of cra-
nial nerves essential for speech, swallow-
ing, and certain movements of the head
and shoulders. Each nerve has a cranial
and a spinal portion, communicates with
certain cervical nerves, and connects to the
nucleus ambiguus of the brain.
accessory organ, an organ or other dis-
tinct collection of tissues that contributes
to the function of another similar organ,
such as the ocular muscles and eyelids,
which contribute to the function of the
eye.
accessory organs of the eye, the acces-
sory organs of the eye: the eyelids,
eyelashes, eyebrows, conjunctival sac,
lacrimal apparatus, and extrinsic muscles
of the eye.
accessory pancreas [L, accessus, extra;
Gk, pan, all, kreas, flesh], small clusters
of pancreatic cells detached from the pan-
creas and sometimes found in the wall of
the stomach or intestines.
accessory pancreatic duct, the small
duct that branches from the pancreatic
duct and opens into the duodenum near the
mouth of the common bile duct.
accessory pathway, an abnormal con-
duction pathway between an atrium and
a ventricle. Ventricular activation via an
accessory phrenic nerve
accessory pathway slows initial ventric-
ular contraction, producing preexcitation
and the delta wave of Wolff-Parkin-
son-White syndrome. The delta wave
shortens the P-R interval, and broadens
the QRS complex. The most common
associated arrhythmias are paroxysmal
supraventricular tachycardia and atrial
fibrillation.
accessory phrenic nerve, the nerve
that joins the phrenic nerve at the root of
the neck or in the thorax, forming a loop
around the subclavian vein.
accessory placenta [L, accessionis, a thing
added, placenta, flat cake], a small sec-
ondary placental unit attached only by pla-
cental vessels.
accessory root canal, an anatomical lat-
eral branching of the pulp canal in a tooth,
usually occurring in the apical third of the
root.
accessory sign, an unusual sign that is
not typical or characteristic of a particular
disease.
accessory spleen [L, accessus, extra; Gk,
splen], small nodules of splenic tissue
that may occur in the gastrosplenic liga-
ment, greater omentum, or other visceral
sites.
accessory thymus [L, accessus, extra; Gk,
thymos, thymelike], a nodule of thymic
tissue that is isolated from the gland.
accessory tooth, a supernumerary tooth
that does not resemble a normal tooth in
size, shape, or position.
accident /ak″sidənt/ [L, accidere, to hap-
pen], any unexpected or unplanned event
that may result in death, injury, property
damage, or a combination of serious
effects.
accident-prone, describing a person who
experiences accidents and accompanying
injuries at a much greater than average
rate.
acclimate /əklī″mit, ak″limāt/ [L, ad,
toward; Gk, klima, region], to adjust
physiologically to a different climate or
environment or to changes in altitude or
temperature. −acclimation, acclimatiza-
tion, n.
accommodation (A, acc, Acc) /əkom′
ədā″shən/ [L, accommodatio, adjust-
ment], 1. the state or process of adapt-
ing or adjusting one thing or set of things
to another. 2. the continuous process or
effort of the individual to adapt or adjust
to surroundings to maintain a state of
homeostasis, both physiologically and psy-
chologically. 3. the adjustment of the eye
to variations in distance. 4. (in sociology)
the reciprocal reconciliation of conflicts
between individuals or groups concern-
ing habits and customs, usually through
12 acculturation
a process of compromise, arbitration, or
negotiation.
accommodation reflex, an adjustment
of the eyes for near vision, consisting of
pupillary constriction, convergence of the
eyes, and increased convexity of the lens.
accommodative strabismus /əkom″
ədā′tiv/ [L, accommodatio, adjustment;
Gk, strabismos, squint], 1. strabis-
mus resulting from abnormal demand on
accommodation, such as esotropia result-
ing from uncorrected hyperopia or exo-
tropia resulting from uncorrected myopia.
2. strabismus resulting from the act of
accommodation in association with a high
AC/A ratio.
accountability /əkoun′təbil″itē/, account-
ability or responsibility for the moral and
legal requirements of proper patient care.
accreditation /əkred′itā″shən/, a pro-
cess whereby a professional association
or nongovernmental agency grants rec-
ognition to a school or health care insti-
tution for demonstrated ability to meet
predetermined criteria for established
standards.
Accreditation Council for Occupational
Therapy Education (ACOTE), the
national body that accredits educational
programs for occupational therapy and
occupational therapy assistant programs.
Accreditation Review Committee on Edu-
cation in Surgical Technology (ARC-
ST), a monitoring organization created
in 1972 to establish, maintain and promote
standards of quality for the training, curricu-
lum, and content of instruction in surgical
technology and surgical assisting recog-
nized through programmatic accreditation
in cooperation with the Commission on
Accreditation of Allied Health Education
Programs (CAAHEP), the American Col-
lege of Surgeons (ACS), and the Associa-
tion of Surgical Technologists (AST).
accrementition /ak′rəmentish″ən/, a
growth or an increase in size by the addi-
tion of similar tissue or material, as in
cell division, binary fission, budding, or
gemmation.
accretio cordis /əkrē″shē·ō/ [L,
accrescere, to increase, cordis, heart], an
abnormal condition in which the pericar-
dium adheres to the plurae, diaphragm, or
chest wall.
accretion /əkrē″shən/ [L, accrescere, to
increase], 1. growth by the addition of
material similar to that already present. 2. the
adherence or growing together of parts that
are normally separated. 3. an accumulation
of foreign material, especially within a cav-
ity. −accretive, adj., −accrete, v.
acculturation /əkul′chərā″shən/, 1. the
process of adopting the cultural traits or
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 This passive or defensive policy did not suit the Spaniards, while
it encouraged the Aztecs. Therefore two corps were formed, each of
two hundred men, besides allies, under Cortés and Ordaz. Clearing
a path with a volley of artillery, they sallied in different directions to
drive back the assailants, who hurried for safety into lanes and
houses, and behind barricades. This comparative freedom of
advance appears to have been permitted to entice the Spaniards
into a disadvantageous position, for soon the natives reappeared in
swarms in the rear and along the flanks, showering arrows and
stones, and coming to close quarters with spears and swords. The
heaviest attack was from the roofs, on which large supplies of
missiles had been collected, and from which commanding position
the enemy was able to direct the discharges with terrible effect,
particularly upon the naked Tlascaltecs. Several Spaniards also fell,
and the greater number were wounded. Ordaz received three cuts,
and Cortés a wound which maimed two fingers of the left hand.[767]
The assailants were comparatively safe, for those on the roofs could
be picked off only by archers and musketeers, and those below took
refuge when pressed, only to return to fresh attack. Efforts were
made to fire the houses, but this was slow work, since they were
constructed almost wholly of adobe or stone, and were filled with
defenders. Nor would the fire spread, owing to the detached form of
the buildings, separated by alleys or canals, so that the torch had to
be applied to each.
Thus matters continued until Ordaz, who was engaged on the
street to the west of the fort, sent word to Cortés, who was pressing
forward in the direction of the Iztapalapan causeway, that he was
losing ground. Leaving his own forces, the general hurried to the
scene with a few horsemen, and heading the charge, drove back the
warriors at the most exposed point, so as to relieve the infantry in the
retreat which was now found necessary. Returning to his men he
found them also retreating, those who headed the column, including
Andrés Duero, the Cuban secretary, having been cut down. “Shame
upon you!” exclaimed Cortés to the corps, as he led the horsemen to
the rescue of the fallen cavaliers. He was just in time to save them,
for a moment more and Duero, at least, would have been slain. The
elated warriors fell back before the charge of the terrible Malinche,
although they soon recovered. Cortés then concluded to retreat, but
this proved no less dangerous than the advance, and among others
Lezcano was dragged from his horse and killed, after having
distinguished himself for bravery and execution. The fort had
meanwhile sustained an active siege, and when the retreating corps
approached it they found more enemies in waiting, who, fearful of
losing their prey, rushed forward with greater fury than ever. An
entrance was finally effected, the forces in the temple being at the
same time withdrawn for the greater safety of themselves and the
fort.[768]
Swelling with triumph the Aztecs now directed all their efforts
against the Spanish quarters. Burning arrows and whirling brands
began to mingle with their missiles. Although the building itself was
of stone, the roof and portions of the outwork, and the Tlascaltec
camp in the yards, were of inflammable material, and more than
once the flames burst forth, filling the whole place with suffocating
smoke, and calling for the greatest exertions to subdue them. The
little water at hand could not be spared, and so earth was cast up,
and portions of the wall were torn down to check the fire and to stop
the gaps. The assault continued all day, till darkness sent most of the
warriors to their homes.[769]

FOOTNOTES
[744] Which speaks little to the credit of either Mary or Santiago. Bernal Diaz, Hist.
Verdad., 102. ‘Otro miraglo ... é fué muy notorio.’ ‘Ya sé que los incrédulos ... dirán
que mi ocupaçion en esto de miraglos, pues no los ví, es supérflua ... é yo hablo
que esto é más se puede é debe creer;’ for did the Indians have mysteries and
miracles, surely God, the virgin, and the saints could effect greater deeds. Oviedo,
iii. 511. He quotes from Livy and others concerning the reliable miracles of Roman
times. Prescott and others transfer the miracles to the siege under Cortés for
greater effect. Bustamante, the modern champion of the shrines of Mexico, who is
ready to uphold any deed attributed to these images, is rather incredulous about
miracles recorded in favor of Spanish cutthroats. See Chimalpain, Hist. Conq., i.
283 et seq. ‘Si no oviéssemos miedo de esse del caballo blanco, ya vosotros
estaríedes coçidos,’ cried some, Oviedo, iii. 511, while the more valiant added that
‘con todo esto si no soltays a Motecçumacin, y os vays luego, presto sereys
muertos.’ Gomara, Hist. Mex., 152.

[745] Cortés, Cartas, 127. Bernal Diaz, Hist. Verdad., 101-2, says seven, two
having been taken alive. ‘Mataron a Peña, el querido de Motezuma,... Valdibia, y
Juan Martin Narizes.’ Herrera, dec. ii. lib. x. cap. vii.

[746] ‘Tuvieron guerra con los yndios en esta Cibdad dos medios dias que fueron
jueves e viernes.’ ‘Guerra casy dos dias.’ Lopes and Flores, in Ramirez, Proceso
contra Alvarado, 131, 134. ‘Dieron bateria los Mexicanos á los Españoles siete
dias, y los tuvieron cercados veinte y tres dias.’ Sahagun, Hist. Conq., 29.
‘Cercados los españoles ocho dias.’ Id. (ed. 1840), 105. ‘Pelearõ y combatieron la
casa diez dias arreo.’ Gomara, Hist. Mex., 151. Torquemada explains this by
assuming two days of fighting and eight days of close siege, with attacks upon all
who sallied, i. 490. Sahagun states that Itzquauhtzin, governor of Tlatelulco,
accompanied Montezuma to the roof and spoke to the people, representing that
the Spaniards, as the mightier race, would inflict great injury on them unless they
ceased to fight, and that the emperor would be murdered. The Mexicans
responded with insults and missiles, but as the soldiers interposed their shields no
harm was done. They appear to have stopped active operations, however. Hist.
Conq., 28-9. The insults and missiles belong no doubt to the later siege under
Cortés. Duran states, however, that Montezuma was henceforth looked on as an
accomplice of the Spaniards, and discarded as a ruler, it being resolved to kill him
and his family. Hist. Ind., MS., ii. 463. According to Oviedo the news came at this
time of the victory over Narvaez, ‘é Monteçuma mandó á los indios que dexassen
de pelear é dexassen venir los otros chripstianos, porque á todos juntos
matassen; é aquesto se cree que fué su intento.’ iii. 512. That he may have urged
this with intent or as a bait is not unlikely, but it should apply equally to Narvaez’
men, since it appears that their defeat could not yet have been known. When
known, however, it must have had its effect. ‘Quando supieron nuestra vitoria,
cessarõ de dalle guerra.’ Bernal Diaz, Hist. Verdad., 101. Yet Gomara writes that
on learning of the large forces coming against them, the besiegers resumed the
attack at one time. Hist. Mex., 151.
[747] This spring was rediscovered during the reign of Viceroy Revilla Gigedo.
Bustamante, Mem. Piedad Mex., 7. A pool of sweet water was the chief
inducement for founding the city on this site in 1325. Native Races, ii. 559-61; v.
345 et seq.

[748] Cortés, Cartas, 126. The Spanish messenger from Mexico returned
wounded. Peter Martyr, dec. v. cap. v. With him, or about the same time, arrived
four chiefs sent by Montezuma to complain that Alvarado had attacked the nobles
without cause. While defending themselves six soldiers had fallen. Cortés told the
chiefs with stern countenance that he was returning to investigate the matter. A
letter was sent to Alvarado enjoining him to guard the emperor closely. Bernal
Diaz, Hist. Verdad., 101.

[749] And the zealous aid of Velazquez de Leon, who did so much toward
securing the Goazacoalco command for Cortés when Narvaez sent letters to win it
over. Cortés, Residencia, i. 409; ii. 6, 31, 165-6. He is accused by his enemies of
impiety and licentiousness, and as one whom the general favored above more
worthy men. Solis assumes that Sandoval nominally retained the command of the
coast province, Rangel being merely his lieutenant. Hist. Mex., ii. 108.

[750] ‘Llegò aquel dia [the first] à la Rinconada, el segundo caminò siete Leguas
... llegò à Tlaxcalla à diez y siete de Junio.’ Torquemada, i. 492. Herrera tells a
long story of suffering from hunger and thirst during the march through the desert.
Marquez and Ojeda were sent ahead to Tlascala for supplies, and came back with
1200 carriers laden with fowl, bread, fruit, and other refreshments. Cortés, among
others, was found starving, and a number were discovered on the road almost
dead. All, it seems, were rescued. dec. ii. lib. x. cap. vii. There are several reasons
for believing that Herrera, who is somewhat confused about this period, has
confounded the present march with the flight from Mexico to Tlascala of a month
later, when the people were really starving. This seems confirmed by the
erroneous statement that the troops arrived at Tlascala July 17th, the time,
according to Herrera’s own later statement, when they reached that place after the
flight. The account also intimates that the starving army was met among the Otomí
settlements, where food could readily be obtained, without the necessity for
Marquez and Ojeda to go ten leagues farther, to the capital, to obtain it. These and
other discrepancies are overlooked by all who refer to the march. Prescott dwells
in particular on the suffering from thirst, forgetful of the statement on a previous
page that the rainy season had begun about three weeks before, and that water
must have been abundant along the whole route. Solis finds that the effeminate
followers of Narvaez endured the suffering remarkably well. Hist. Mex., ii. 109.

[751] ‘Embiò a fray Bartolome de Olmedo ... a Motezuma.’ Herrera, dec. ii. lib. x.
cap. vii. It is unlikely that so valuable a man would have been sent while affairs
were threatening.

[752] Narvaez landed with about 900 soldiers, including 80 horsemen, 120 with
bows, and 80 with fire-arms. A number had been picked up at Cozumel, but an
equal proportion perished by shipwreck. Cortés had about 250 men, and 200 were
probably left on the coast, of garrison, guards, and invalids. To the 950 soldiers
thus taken may be added at least 150 from the crews of the dismantled or
destroyed vessels. Prescott manages to mysteriously increase the horses and
projectile arms beyond what he previously assigns to Narvaez and Cortés. One
thousand infantry, 100 horsemen, and many allies, say Gomara and Herrera. The
Probanza de Lejalde, in Icazbalceta, Col. Doc., i. 425, indicates 80 horses. Bernal
Diaz places the figures as high as 1300 soldiers, including 96 or 97 horsemen, 80
archers, 80 musketeers, and 2000 Tlascaltec warriors; while Cortés, with a
prudent desire to cover the subsequent losses at Mexico, reduces them to 500
infantry and 70 cavalry. Solis gives the reason of the profound historian for the
small number of allies taken to Mexico: ‘Por no escandalizar á Motezuma, ó poner
en desesperacion á los rebeldes.’ Hist. Mex., ii. 111.

[753] The arrival at Tezcuco is evidence enough that a more northern road was
taken than the one previous. The middle route by Telapon appears somewhat
more direct for Mexico, but requires a detour to reach the Acolhua capital, and it is
not likely that an army in hurried march could afford to go out of its way. Hence the
Calpulalpan road must have been followed.

[754] See Native Races, ii. 162-3, 168-73, 569; v., passim; Motolinia, Hist. Ind.,
181-3.

[755] Cortés writes that he was on the point of sending a Spaniard to Mexico with
Tezcucan rowers, a chief being taken as hostage, but just then came this canoe.
Cartas, 127.

[756] Two, named Santa Clara and Pedro Hernandez, says Herrera, dec. ii. lib. x.
cap. vii.

[757] ‘Parò en Tepeaquilla, lugar a legua de Mexico.’ Id. Now the shrine of
Guadalupe. Prescott assumes that the Iztapalapan road was taken, as before, but
it was avoided probably because Cortés feared the fort Xoloc, which guarded the
centre. It was also longer, and had more movable bridges than the other
causeways.

[758] ‘Riñas por San Iuan pazes para todo el año.’ Vetancvrt, Teatro Mex., pt. iii.
139. The following day a dress was found hanging from a beam, and in a square a
pile of bread, with over 500 fowl, without a guard. This Cortés considered less
favorable, and said ‘que serian riñas de por San Iuan.’ Herrera, dec. ii. lib. x. cap.
vii.-viii.

[759] ‘Para dar á entender con esto que ellos estaban de guerra y muy ofendidos
de los españoles que él habia dejado.’ Sahagun, Hist. Conq. (ed. 1840), 108. His
account of deserted streets, applied to Cortés’ first arrival in Mexico, belongs no
doubt to this occasion. Duran argues that had the massacre taken place before
Cortés’ arrival he would not have been allowed to enter. Hist. Ind., MS., ii. 470.
Equally in the dark is Acosta, who assumes that the Indians were openly at war,
but the custom being to rest every fourth day, Cortés managed to enter during the
cessation of hostilities. Hist. Ind., 522. Oviedo looks on the non-resistance of the
Indians as a wile to entrap all the Spaniards. iii. 510.

[760] Herrera writes amusingly that Cortés shouted before the closed gates,
‘Open!’ ‘Who is there?’ demanded Alvarado. ‘I,’ replied Cortés. ‘Do you come with
full liberty, and power to command, as before?’ ‘Yes, and with victory, and greater
forces.’ Alvarado thereupon opened, kissed his hand, and surrendered the keys!
dec. ii. lib. x. cap. viii.

[761] ‘Con que aventuró la mayor parte de sus fuerzas.’ Solis, Hist. Mex., ii. 120.
Or perhaps because he had not had recourse to some safer measure, such as
arresting the leaders of the proposed plot, for hostages. ‘Le dixo muy enojado, q̄
era muy mal hecho, y grande desatino, y poca verdad ... no le hablò mas en ello.’
Bernal Diaz, Hist. Verdad., 102. Cortés would hardly have told him that he lied,
since his statements were confirmed by so many; they certainly were years after.
Vetancurt supposes that Cortés told him he should have allowed the emperor to
attend the festival, and should have awaited the attack rather than opened the
war. Teatro Mex., pt. iii. 140. ‘Dissimulo por no enojar a los que lo hizieron.’
Gomara, Hist. Mex., 151.

[762] Solis supposes, however, that the two met in friendly intercourse, and takes
Bernal Diaz and Herrera to task for asserting the contrary. Hist. Mex., ii. 112-14.
He refers to Cortés’ friendly message from Tezcuco, which is doubtful, and to
Gomara, who certainly allows Cortés to refer to Montezuma and his courtiers as
‘dogs.’ Hist. Mex., 153. In the testimony during Cortés’ residencia the discourtesy
is asserted. Cortés, Residencia, i. 42 etc. Clavigero suggests ‘ch’era d’uopo il far
sembianza di credere il Re colpevole dell’inquietudine.’ Storia Mess., iii. 121.

[763] Native Races, ii. 134-6; v. 462-4; ‘Il y joignait, comme de coutume, la charge
du grand prêtre de Huitzilopochtli.’ Brasseur de Bourbourg, Hist. Nat. Civ., iv. 309.
Gomara assumes that Cortés orders a chief to open the market. He, offended at
the insults used, goes only to rouse the people. Hist. Mex., 153. Ixtlilxochitl
supposes that the chief is offended at the reprimand administered for delaying to
open the market. Hist. Chich., 301. ‘Mandò Hernando Cortes llamar a los mas
principales caualleros, hizoles vna larga platica diziẽdo, que les perdonaua lo
passado, con que para adelãte fuessen ... amigos: ... sin responder ... se fueron.’
Herrera, dec. ii. lib. x. cap. viii.

[764] Duran enumerates some of the provinces summoned, as Xilotepec and

Matlaltzinco. ‘Mandó llamar á ... Encantadores y Hechiceros para que los
asombrasen y los mostrasen algunas visiones de noche, ... para que alli muriesen
de espanto.’ Hist. Ind., MS., ii. 462-6.

[765] Cortés describes first a brief attack, then a sally, succeeded by a fresh
assault on the fort, while Bernal Diaz and Herrera let a force advance against the
Indians before they reached the palace. I follow Cortés as the chief guide,
because his account of all this period was written while quite fresh in his mind, and
appears the most sensible and correct, while the other versions depend more or
less on faint recollection and hearsay. Cortés as a rule did not wait till the enemy
approached, but he may not have been prepared for the sudden attack. Yet it is
probable that he wished in his report to lay the responsibility of the attack upon the
enemy. I do not think Cortés inclined to misrepresent in general or without an
object.

[766] For war customs see Native Races, ii. 400-32.

[767] ‘Sinistræ manus digitis duobus mutilis.’ Peter Martyr, De Insvlis, 5. Cortés
also says ‘quedé manco,’ Cartas, 142, 131, yet Cano ridicules the statement, and
declares ‘nunca fué manco dellos ni le faltan.’ Oviedo, iii. 551-2.

[768] Cortés, Cartas, 128-9. Bernal Diaz speaks of a sally by Ordaz, with 400
men, before the natives reach the fort. He is sorely beset, as related, and retires
with a loss of 23 soldiers. Hist. Verdad., 102-3. Herrera’s account, as usual, is
confused. After Rio returns wounded to report the uprising of warriors, five
horsemen rally to reconnoitre. The following day Ojeda and Marquez set out to
forage, and come to announce the approach of assailants. Two hundred men now
make a sortie and kill a multitude without losing a man. dec. ii. lib. x. cap. viii. It is
useless to follow this author here except for incidents.

[769] Bernal Diaz places the dead at 35 soldiers, besides a large number of allies.
Eight fell during the first discharge upon Ordaz’ party and fifteen more before he
regained the fort, while of the 46 wounded among the garrison twelve died. Hist.
Verdad., 103. Cortés, with his usual prudent suppression of evil news, allows four
deaths and over 80 wounded. He never refers to those who die of wounds.
Gomara follows him. Hist. Mex., 153.
 CHAPTER XXIV.
FIGHT UPON THE TEMPLE SUMMIT.

June, 1520.

The Natives Continue the Assault—Their Fierce Bravery—The Spaniards

Build Turrets—Still the Mexicans Prove too Strong for Them—
Montezuma Called to Intercede—He is Insulted and Stoned by his
Subjects—Cortés Attempts Egress by the Tlacopan Causeway—Failure
of Escobar to Take the Pyramid—Cortés Gains the Slippery Height—
The Gladiatorial Combat there.

At dawn the assault was renewed with the same fierceness as

before, and with even less regard for the sweeping volleys of the
cannon, which were fired without aim into the packed masses of the
natives, bringing them down by the score. The gaps were quickly
closed, and the rapidly repeated shots seemed to make no more
impression on the surging mass than pebbles dropped into the
boiling surf. It was a critical time for Cortés, who seemed not yet to
recognize the full extent of the danger. He felt the necessity of open
communication with the mainland, for obvious reasons, and to this
end, in the course of the morning, he arranged another sortie like
that of the preceding day, but in one direction only. The Indians
retired, as before, into lanes and buildings, and beyond canals,
raising; the bridges behind them. Barricades having been thrown up
to impede the advance since the last sally, some guns were brought
to the front, and with their aid a few of the obstructions were
demolished and more than one bridge was gained, together with a
number of houses, to which the torch was applied. The discharges
from the roofs were kept up with galling pertinacity, although the
effect was not so fatal as during the preceding day, owing to the
experience then gained. The forces below, who had retired before
the charges of the advance, rolled back like recurring billows, and in
ever increasing number, upon flank and rear, as if to overwhelm
them. Such were their numbers and stubborn recklessness that ten
thousand Hectors and Rolands, says Bernal Diaz, could have
effected nothing against them, and soldiers from the Italian war
swore that never among Christians or Turks had they witnessed
such fierceness. Considerable alarm was also created by the
appearance of long pikes, like those of the Chinantecs, directed
particularly against the cavalry. Fortunately they were not numerous,
nor were the pikemen sufficiently practised to be very dangerous.
Worn out in the unequal contest Cortés turned to gain his camp,
which was no easy task, since the natives were massed in greatest
number in the rear, determined to cut off retreat. The fort was gained,
nevertheless, although hardly a man escaped uninjured, while about
a dozen were killed; one unfortunate soldier being captured and
sacrificed in full view of the garrison.[770]
It had been found that the greatest danger to the sallying parties
came from the roofs, whence discharges could be directed with
comparative impunity and with greater effect than from the ground.
In order to counteract them, three mantas, or movable turrets, were
planned, whose occupants were to devote their attention wholly to
clearing the roofs of assailants. The completing of these machines
and other preparations kept the garrison busy all the 27th of June, so
that no sally was made. Ascribing this to fear, the Indians became
more pressing in their assault, and more profuse with their insults.
“Dogs!” cried some, “of hunger and thirst shall you die!” Others
shouted, “Here is a piece of my tortilla!” at the same time flinging
them unpalatable fragments of toasted bread. “Eat it, you perjured
villains, who can fight only on the backs of animals; for soon shall
your own bodies be cut up for food and cast before the beasts!” The
enemy appeared more numerous than ever, and the roofs and yards
were literally covered with their missiles. The greatest danger to the
Spaniards lay in the operations of the battering and mining parties,
who, regardless of bullets from the wall turrets, sought steadily to
open fresh breaches. Conspicuous in the hostile camp was a richly
dressed Indian, surrounded by a staff of finely attired warriors, who
seemed to direct operations, and whose orders were received with
the deepest reverence. This personage the prisoners declared to be
Cuitlahuatzin, and the next in rank Quauhtemotzin.[771] Charge after
charge was made by his direction, and with a vehemence that
threatened to carry everything before it; and loudly rang the yells,
whether of delight at some advantage gained or of fury over a
repulse.
Thus the besieged were harassed beyond endurance. Large
numbers were wounded, and all were exhausted from vigils, hard
fighting, trying work, and the want of sufficient water and food; for in
view of the stoppage of supplies, rations had been reduced. Those
of the Narvaez expedition were particularly disheartened, and
bestowed freely their maledictions, first on Velazquez, who had sent
them to such a country, and then upon Cortés, whose promises of
golden treasures and well stocked encomiendas had lured them to
this plight. Perceiving, however, that unity of purpose alone could
save them, they stifled regrets and showed Cortés that something
must immediately be done to stay the onslaught, lest the building fall
about their ears. It was exceedingly disagreeable, but it must be
done; the proud Spanish general must sue to the greatly injured
captive king, pleading for his influence in behalf of peace.[772]
Montezuma had all these days been closely confined to his rooms
brooding over the insults offered him, and apparently indifferent to
the danger from without. When the message was brought he sullenly
said, “Why does Malinche address himself to me, who care no
longer for life? I will not listen to him, for he it is who has brought me
into this plight.” He intimated further that the promises of the general
could not be relied upon, and that his words carried a double
meaning. Olmedo and Olid, who had come to urge the request, had
recourse to soothing words and persuasion, and succeeded in
mollifying him somewhat.[773] He replied, however, that it was
probably too late to appease the Mexicans by promises. “They have
now a new leader,” he said, “who is resolved to spare no Spaniard,
and I believe that you have all to die in this city.”[774] Nevertheless he
yielded, and as befitted the momentous point at issue, he arrayed
himself in the richly bejewelled robes of state, and placed upon his
head the mitred copilli, beneath whose precious feathers gleamed
the golden plate.[775] Carefully guarded he ascended to the roof and
stepped to the parapet, preceded by a courtier who bore the triple
wand of the empire, as was customary on such occasions. Instantly
the tumult was hushed, even before the leaders could issue orders
for a stay of hostilities; instantly a thousand heads were bent in
humble adoration before the august majesty of their sovereign. This
attitude, however, was assumed but for a moment; soon these same
heads were held higher than ever. Then the chiefs drew near to
listen to the unhappy monarch.
Montezuma had appeared with a feeling of mingled fear and
doubt as to what his reception might be, and he did not fail to
observe that the accustomed reverence was shown only for an
instant, involuntarily, as it were, and that silence was prompted
rather by curiosity than respect. The urgency of the moment
demanded that he should speak, but it was rather as supplicant than
ruler that he turned to his people.
 “You are in arms, my children,” he said, “in hot battle. Why is
this? You will be slain, and there will be heard throughout the land for
many years the wail of wives and little ones. You would give me my
liberty, and I thank you. You do not turn from me in anger, and I
thank you. You have not chosen another king in my stead, and I
thank you. Such an act would displease the gods, and bring
destruction on all. And see! I am no prisoner. Go your way; I am free.
By divine command I must remain the guest of the Spaniards yet a
little longer, and you must not molest them, for soon they will return
whence they came. Alas, my people, my country, my crown!”[776]
With a heavy sigh, and midst copious tears, his head fell on his
breast. The monarch’s strength had indeed departed. The people
knew that he spoke falsely, that he was little better than imbecile,
unfit to be their sovereign. Oh, if he but had the good fortune to die
while helping them to grind to powder these hated enemies! Only a
little while ago his words would have been received as the
utterances of a deity. Now the scales had fallen from their eyes, and
they saw him as he was. They could bear no more. Jeers and
groans reached him from every direction. “Coward! chicken! Woman
to the Spaniards, fit only for the gown and the spindle! Murderer of
your nobles!” Such were the cries which now reached his ears as he
stood stupefied with agony. Presently came a shower of arrows and
stones, and before the Spanish guard could interpose their shields
several missiles struck him, one on the left temple, which caused
him to fall senseless into the arms of the by-standers.[777]
Startled by the crime they had committed, awe fell upon the
multitude as the stricken sovereign was led away. Taking advantage
of this feeling Cortés beckoned the chiefs to a parley with a view to
explain what Montezuma had intended to convey. He had always
wished them well, he said, and felt grieved to wage war for what had
occurred during his absence. He desired peace, yet the desire was
not prompted by fear, but by consideration for their safety and that of
the city. The chiefs replied that the Spaniards must leave the country
to the natives, and depart at once. That was exactly what they
wished to do, replied Cortés, but they would not be driven away. If
the Mexicans desired them to go, they must abandon the siege, tear
down the barricade, and retire to their homes; they must likewise
restore the bridges and supply provisions. To this the chiefs declined
to listen, declaring that they would not lay down their arms so long as
there was a Spaniard left on whom to use them.[778] The evident
desire of the besieged for peace served only to encourage the
Indians, and the assault was renewed with an increased ardor that
taxed the defenders to the utmost.
And now, whatever the cost, a way out of this place must be
opened. Cortés knew of three causeways which led to the mainland,
the only means of exit for his forces. He knew that they were low and
narrow, exposed on both sides to the attacks of canoe fleets, and
intersected by a number of bridges which were perhaps by this time
raised. Each of these openings was an almost impassable chasm.
The southern causeway to Iztapalapan was two leagues in length,
and provided with seven drawbridges, besides a strong fortress,
which rendered it impassable to an enemy. The northern, leading to
Tepeyacac, was one league long, while the shortest, conducting
westward to Tlacopan, half a league distant, was broken by only
three bridges.[779] Cortés resolved to undertake the passage by this
last named causeway. During the night had been completed three
mantas, of light framework and planks, each to hold twenty
musketeers and archers, with which it was hoped to check the
assailants on the roofs. These mantas were built with two chambers,
provided with loop-holes; the upper ranged on a level with the
house-tops of ordinary one-story buildings of the city, and had doors,
so as to allow of sallies upon the roofs.[780]
 The following morning, June 28th, Cortés placed himself at the
head of five hundred Spaniards and over three thousand allies, and
took the direction of the Tlacopan causeway.[781] By a sudden
charge the cavalry drove back the Indians and allowed the free
passage of the mantas, which were drawn and pushed by
Tlascaltecs, and protected by bodies of infantry. A corps of pioneers
accompanied them with pickaxes, mattocks, crow-bars, and ladders,
to destroy barricades and walls, and to scale buildings. Four cannon
were also brought. The rear was protected by a portion of the
cavalry. The Aztecs were at first amazed at the curious moving
turrets, and feared that they might contain more terrible destroyers
even than the grape-charged guns; but finding them less dangerous,
they continued their efforts, and fast and thick poured the stones and
arrows on the line of advance, particularly on the engines, which
were severely damaged. The march proceeded, however, with more
or less interruption till a raised bridge was reached on the main road,
where the Indians had gathered in vast numbers, with an evident
determination to check the expedition. The turrets were brought
alongside the houses adjoining the canal in order to clear the
crowded roofs, but regardless of the volleys from the firelocks, the
natives on the roofs plied their missiles only the faster, letting fly
heavy rocks[782] upon the engine coverings, so as to render them
untenable and hinder the manœuvring of the cannon. This success
enabled the warriors beyond the canal and behind the barricades to
maintain their assault with great effect, and to prevent a further
advance. They gained a considerable advantage by a change of
tactics in directing the missiles to a great extent against the legs of
the Spaniards, to their serious discomfiture.[783] After spending the
greater part of the forenoon in an unsuccessful attempt to destroy
the houses nearest the canal, and to fill a passage across it, the
troops retired to the fort greatly disheartened. Even the Tlascaltecs,
who were usually so glib of tongue in replying to Aztec taunts, for
once held their peace.[784]
Meanwhile the battle raged fiercely round the fort. The temple in
front of it, since its evacuation by the Spaniards, had been occupied
by some five hundred Mexicans, chosen men,[785] who introduced a
large quantity of ammunition and supplies, and began to batter the
besieged quarter. It was this shower which had first damaged the
turrets and harassed the march. Perceiving the danger of leaving so
commanding a position in hostile hands, Cortés had sent his
chamberlain, Escobar, with one hundred men[786] and some allies to
dispossess them. This was no easy task, for the pyramid was of
great extent and over eighty feet in height, composed of a series of
abrupt stone terraces, each receding about six feet from the one
beneath, and so arranged that the ascent led along the entire circuit
of each ledge before the steps conducting to the next could be
gained.[787] Twenty men, says Cortés, could have held it against a
thousand; yet the one hundred were to attempt it. Step by step they
fought their way, beneath showers of arrows, and against javelins,
and sword and lance thrusts from the upper ledges. More dangerous
even than these weapons were the cumbrous missiles in the shape
of heavy stones and timber which came crashing down upon them.
Three times[788] did Escobar lead his men to the charge, only to see
them repulsed and sent rolling down the steps and over the ledges.
Finally he sent word to Cortés that the task was impracticable. The
general received this notice while vainly battling at the canal, and he
eagerly seized upon it as excuse for changing his base of operation.
He hurried to the spot, threw a cordon round the pyramid, and
although badly wounded in the left hand he immediately led his men
to the charge. The Spaniards were making fair progress, when two
heavy beams, which had been reserved at the summit for the last
extremity, were loosened and sent tumbling down the side, so
directed as to sweep to destruction the assailants along its entire
length. At about the centre of their terrible passage, full before them,
stood Cortés. Immediate death for himself and his brave comrades
seemed inevitable, when behold! by some unseen finger the beams
were turned end foremost and shot harmlessly through the opening
made for them by the soldiers. “Thanks be to God and the virgin,
whose image was placed in this tower!” cried Cortés, as without the
loss of a moment he sprang forward and speedily gained the
summit. There the fight assumed the form of a gladiatorial combat, a
hand-to-hand and line-to-line conflict, poised in mid-air on this
narrow slippery summit, and in full view of the whole city. As if by
common consent the combatants below paused in their bloody work
and stood breathless, lost in the more thrilling sight above.
At the eastern end of the platform stood the two three-story
chapels, over fifty feet in height, originally dedicated to Huitzilopochtli
and Tezcatlipoca. Against this the Indians had massed themselves,
fierce in their desperation. The Castilians had taken their stand at the
other end. It was an awful situation, dire destruction being inevitable
to one side or the other. With nerves and sinews strained to their
utmost tension, they stood between attacks regarding each other,
regarding every motion, anon picking from the other’s number with
javelin, dart, or musket, as they were able. It was with difficulty the
Spaniards could stand, and there was no railing round the slippery
height; but fortune again assisted by unveiling the sun and sending
its blinding rays full in the face of the enemy. Every now and then the
soldiers charged in solid phalanx into the centre of the opposite
mass, only to be obliged to retire under the pressure of its weight,
and to receive the counter-charge, encouraged by wildly
gesticulating priests, who flitted to and fro in bloody robes and
dishevelled hair. Aware of the inferiority of their weapons, the natives
sought rather to seize hold of the Spaniards, singly or in groups, and
with the recklessness of doomed men to hurl themselves with their
victims from the dizzy height. In one instance Cortés himself was
selected for this terrible fate. Inspired to martyrdom and revenge, two
young nobles watched their opportunity, and approached him on
their knees, as if pleading for mercy. Ere he had time to consider the
situation they had seized him in their arms and were struggling to
gain the edge. One moment more and he would have been dashed
to death, but by putting forth his whole strength, nerved by
desperation, he succeeded in freeing himself from their grasp. Ojeda
was singled out for a similar attempt, and would have perished had
not a Genoese come to his aid.[789]
For three hours the struggle lasted, while one Indian after
another was picked off by the bullet and the arrow, or pierced by the
pike and sword, or sent headlong over the platform, either to be
crushed by the fall or to be transfixed by the Spaniards on the ledges
below. As their number diminished, many a one sought the higher
martyrdom by leaping from the sacred spot into paradise. Thus
melted away that fated band of Aztec warriors. At the portal of
Huitzilopochtli’s chapel fell the last defender; and two priests, one of
them the high-priest, alone remained to offer themselves as
captives. On entering the chapel consecrated to the virgin no traces
appeared of the holy emblems, only evidences of idolatrous rites,
and upon the altar stains from the blackened hands of the temple
attendants.[790] In the adjoining chapel the war-god was found
reinstalled in all its glittering hideousness. Some consolation for this
sacrilegious intrusion was offered to the victors in despoiling it of the
rich ornaments, while the cacao and other provisions stored here by
the garrison proved a prize to the half-famished Spaniards. The
Tlascaltecs, so long deprived of meat, pounced upon the bodies of
the slain heroes to secure them for a feast, which should not only
satisfy the cravings of hunger, but infuse their hearts and minds with
some of the qualities of the valiant dead.[791] The chapels were then
fired. The upper portion of the structure being of wood, the flames
rose in columns heavenward, heralding the triumph of the Spaniard,
and striking the Indian with awe. It was a great and thrilling feat, this
fight upon the temple top; and so the natives regarded it, their heart,
and mind, and paintings being all stained sanguine over its
remembrance.[792]

FOOTNOTES
[770] Bernal Diaz mentions the death of ten or twelve, but Cortés acknowledges
only three score of wounded. On this occasion, apparently, Herrera allows Cortés
to gain Tacuba, whither he might have retreated in safety with all his forces and
wealth; yet he states that the return fight proved most severe, the fort being
regained with difficulty, after the loss of two guns and several soldiers, one taken
alive. dec. ii. lib. x. cap. ix. Solis manages to transform the operation into a victory,
wherein Cortés stays the slaughter out of mercy. Prescott is quite arbitrary in the
use of the chronicles. He combines the incidents of several days into one and
transposes them at pleasure, with the sole aim apparently of presenting an
exciting description of what the siege might have been. A few facts are elaborated,
and the rest sacrificed to style.

[771] Marina asked Montezuma if a new king had been chosen, but he did not
think they would elect one while he lived. Vetancvrt, Teatro Mex., pt. iii. 141.

[772] ‘Fue acordado de demandalles pazes para salir de Mexico, ... acordò
Cortes, que el gran Monteçuma les hablasse.’ Bernal Diaz, Hist. Verdad., 104.
‘Muteczuma ... dijo que le sacasen ... y que él hablaria á los capitanes.’ Cortés,
Cartas, 129-30. The latter statement may be Herrera’s authority for saying that
Montezuma was the first to propose speaking to the Mexicans. dec. ii. lib. x. cap.
x. Observing Cuitlahuatzin’s regal authority over the besieging forces, Montezuma
was seized with a fit of jealous alarm for throne and life. ‘Chiamò Cortès, ...
pregandolo instantemente di non differir più la sua partenza.’ Clavigero, Storia
Mess., iii. 124. This implies that the emperor was not aware of the vain efforts
made to open communication with the mainland, or even to approach it. Cortés
had to urge him in any case to speak to his subjects, an unwelcome task in view of
his declining influence and of the merely partial success of the former appeal.

[773] Among other reasons it was represented that Cortés was not to blame for
the late massacre. ‘Que si la indignacion de los mexicanos podia templarse con el
castigo de los culpados ... le prometia castigar.’ So says the native version of
Tezozomoc, Recop. tradiciones, MS., cap. vi.; Chimalpain, Hist. Conq., 287-8.

[774] He felt no eagerness to plead in behalf of those who had caused all his
misfortunes, and he was only too conscious that his pusillanimity must have
degraded him in the eyes of his subjects, while the elevation of his brother to the
leadership must have diminished the influence which till then may have remained
with him. He could hardly avoid a feeling of jealousy at the thought of this
elevation; and if he, during an impulse of anger against Cortés, had counselled the
proceedings of Cuitlahuatzin, he now felt probably both grieved and terrified at the
storm he had raised. He also harbored a wholesome fear of Malinche, and the
prospect of his speedy departure helped to stir anew the embers of hope. All might
yet be well: the capital might be spared further desolation, and he again resume
his former grandeur.

[775] See description of his first meeting with Cortés, Native Races, ii. This
appearance of the emperor took place on the 27th of June, as Cortés states, but
Bernal Diaz, Herrera, and Ixtlilxochitl place it respectively on the 5th, 6th, and 7th
day of the siege.

[776] Herrera, dec. ii. lib. x. cap. x.; Bernal Diaz, Hist. Verdad., 104. ‘No
molestàsen à los estrangeros y fuésen sus amigos, pues su persona corria
riesgo.’ Tezozomoc, Recop. tradiciones, MS., cap. vi. Cortés, followed by Gomara,
gives him no time to speak ere the people assault.

[777] They would no longer recognize him as emperor, etc. Saying this, a chief
threw a stone which struck Montezuma on the forehead. Duran, Hist. Ind., MS., ii.
468. Acosta attributes this first throw to ‘Quicuxtemoc,’ the later king of Mexico.
Hist. Ind., 523. ‘Ma io nol credo,’ says Clavigero, Storia Mess., iii. 126. ‘Aunque vn
Castellano tenia cuydado de arrodelar a Motezuma ... le acertò vna piedra en las
sienes.’ Herrera, dec. ii. lib. x. cap. x. Had not the Spaniards held up a shield
before Montezuma the people would have known it was he and not thrown the
stone which killed him, says Cano, his later son-in-law. Oviedo, iii. 550. Gomara is
inclined to believe this, for his people ‘no lo quisieran hazer mas que sacarse los
ojos.’ Hist. Mex., 154. ‘Una saéta alcanzó al emperador en el estòmago que lo
atravezó por el baso, y una piedra le dió en la sien izquierda.’ The people would
never have thrown missiles, for they pitied him, and were prepared to obey his
injunctions, but Cacama, who stood behind the emperor, made signs that they
should continue the attack without regard for him or for the monarch. Tezozomoc,
Recop. tradiciones, MS., cap. vi. According to Bernal Diaz, the four chiefs who had
approached to confer with him expressed their sympathy for his misfortunes. They
had now chosen as leader ‘Coadlabacan, señor de Iztapalapa,’ and had sworn to
the gods to continue the war till all Spaniards were exterminated. Yet they prayed
daily to the gods for his safety, and if all went well he would more than ever be
their lord. They had hardly finished when showers of missiles fell, of which three
stones and an arrow hit him, on the head, arm, and leg. Hist. Verdad., 104.
‘Remorse succeeded to insult,’ and they fled, says Robertson, Hist. Am., 90, a
statement which Prescott improves by stating that the square before the fort was
left empty. But remorse must have been brief, for the main authorities, Cortés,
Gomara, Bernal Diaz, and Torquemada, either declare or intimate that the assault
never stopped. ‘No por eso cesó la guerra y muy mas recia y muy cruda de cada
dia.’ Cortés, Cartas, 130.

[778] ‘Esta Fortaleza casi no tiene exemplar,’ exclaims Lorenzana, forgetting that
Cortés’ firmness was due to the justifiable fear that a trap was intended. Cortés,
Hist. N. España, 136-7. Cortés concludes the sentence about Montezuma’s being
wounded by saying that he died within three days. He thereupon resumes the
account of parleys and siege operations, leaving the impression that these took
place after his death, while such was not the case. Nevertheless, Gomara,
Herrera, and others, Bernal Diaz not excluded, are misled, by this vagueness
evidently, into extending the siege and confounding the events, so that modern
historians have all more or less remained mystified. Solis assumes that during
Montezuma’s illness the siege was conducted only by straggling parties, the main
forces being occupied with crowning the new emperor. Hist. Mex., ii. 155-6. This is
probably due to a misconstruction of Bernal Diaz.

[779] ‘En esta auia tres no mas, y en la de Yztapalapà, siete.’ Herrera, dec. ii. lib.
x. cap. xi.; Native Races, ii. 561 et seq.

[780] Cortés, Cartas, 130, 133. ‘Quatro ingenios ... en que pudiessen yr veynte y
cinco hombres,’ says Bernal Diaz, Hist. Verdad., 103. ‘Tres mantas ... cõ sus
ruedas; leuauan treynta hombres a cada vna, cubierta con tablas gruessas de tres
dedos.’ Herrera, loc. cit. Drawn by men within, adds Peter Martyr, dec. v. cap. v.
‘Cabia cada vno veynte hombres, con picas escopetas y ballestas y vn tiro.’
Gomara, Hist. Mex., 154.

[781] Herrera unwisely assumes that the three towers with their forces were
respectively directed against the three causeway approaches.

[782] ‘De tres y quatro arrouas, que maltrataron a los que yuan en los ingenios, y
rompieron las tablas.’ Herrera, dec. ii. lib. x. cap. xi.

[783] ‘Hirieron a mas de docientos Castellanos.’ Id., cap. ix.

[784] ‘Nos mataron un español y hirieron muchos.’ Cortés, Cartas, 130-1.