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 Human
Anatomy Sixth Edition

Digital Author Kenneth S. Saladin

Christina A. Gan Distinguished Professor of Biology, Emeritus
Highline College Georgia College & State University

sal1026X_fm_i-xx.indd 1 12/11/18 9:42 AM

 PREFACE
Saladin’s Human Anatomy goes beyond descriptions of body struc-
ture to read as a story that weaves together basic science, clinical
applications, the history of medicine, and the evolutionary basis
of human structure. Saladin combines this humanistic perspective
with vibrant photos and art to convey the beauty and excitement of
the subject to beginning students.
Changes to the Sixth Edition
Attending scientific conferences, subscribing to several scien-
tific and medical journals, and engaging in online forums and
answering public questions on anatomy, physiology, and health
help Ken Saladin stay abreast of advances in the field. In this
edition, he introduces newly discovered functions of osteocytes,
astrocytes, dendritic cells, the greater omentum, the corneal epi-
thelium, and even eyelashes. He reports new research insights on
peroxisome production, tracing white matter tracts of the brain,
and endocrine disruptors; new discoveries of cerebral lymphat-
ics, and pulmonary production of blood platelets; and clinical
advances in asthma and cancer mortality and survival, cord blood
transplants, stem-cell harvesting, and regenerative medicine.
These and more examples are listed chapter by chapter later in
this section.
In response to users and reviewers, the sixth edition has
more concise treatments of gametogenesis, sperm capacitation,
fertilization, aneuploidy, and embryology of the sense organs, car-
diovascular system, and digestive tract. The muscle chapters are
reorganized for better flow, with chapter 10 focusing on the cellular
level; chapter 11 on whole-muscle organization, accessory connec-
tive tissues, musculoskeletal biomechanics, and the axial muscu-
lature; and chapter 12 on the appendicular musculature. Ken has
also upgraded some of the book’s pedagogical features. There are
new, challenging thought questions, and the Study Guide section
presents “What’s Wrong with These Statements?”—10 statements
that all have subtle errors, prompting students to identify what is
wrong with them.
New and Enhanced Perspectives
This sixth edition details enhancements to topics already in the pre-
vious edition, including new anatomical imaging techniques, ethnic
variations in anatomy, osteon structure and microfractures, vascu-
lar aging and hypertension, the scope of the immune system, T cell
selection, clinical importance of the cricothyroid ligament, colonic
histology, photosensory effects on the pineal gland, musculoskel-
etal biomechanics, and more.
New Art and Photography
This edition includes new drawings of motor units, sectional
anatomy of the head, hand innervation, the course of the vagus
viii
sal1026X_fm_i-xx.indd 8
nerve, the pediatric auditory tube, lumbar puncture, epidermal
histology, flat bone structure, gastric and colonic histology, the
mechanical advantage of levers, and the spermatic cord. Always
watching for opportunities to enhance topics with photos or to
replace old photos with better ones, this edition has new photos
of diabetic gangrene, rickets, shingles, endemic goiter, muscle his-
tochemistry, rod and cone cell SEMs, an intravenous pyelogram,
and ovulation.
Detailed List of Changes
Chapter by chapter, the sixth edition’s most significant changes
are as follows:
Chapter 1, The Study of Human Anatomy, has added descrip-
tions of dynamic spatial reconstruction, open MRI, and Doppler
ultrasound.
Chapter 2, Cytology—The Study of Cells, has new clinical topics
including mitochondrial diseases and birth defects arising from pri-
mary cilium dysfunctions. It has updates on mitochondrial DNA,
the role of gap junctions in the lens and cornea, and peroxisome
production. It describes the vascular corrosion cast technique seen
in many of the book’s SEM photos.
Chapter 3, Histology—The Study of Tissues, has new Clinical
Applications on biopsy and regenerative medicine, and functional
updates on urothelium (transitional epithelium) and epithelial base-
ment membranes.
Chapter 4, Human Development, has reduced the level of detail, at
reviewer and user suggestions, on gametogenesis, sperm capacita-
tion, fertilization, and aneuploidy.
Chapter 5, The Integumentary System, has a new Clinical Applica-
tion on sunscreens, sunburn, and skin cancer.
Chapter 6, The Skeletal System I: Bone Tissue, has new clinical
coverage of osteomalacia, rickets, and osteosarcoma, and updates
on osteoporosis, the endocrine role of osteocytes, and limitation of
microfractures by osteon structure. It includes enhanced art on flat
bone structure.
Chapter 7, The Skeletal System II: Axial Skeleton, has a new sec-
tional view of the head and its cavities, and new clinical coverage of
cleft palate and lip.
Chapter 8, The Skeletal System III: Appendicular Skeleton, had little
need for change but has an upgraded illustration of the clavicle for
improvement in its surface features.
Chapter 9, The Skeletal System IV: Joints, updates the material
science of joint prostheses.
Chapter 10, The Muscular System I: Muscle Cells, has improved
illustrations of the neuromuscular junction, motor units, and
the histochemistry of muscle fiber types, and new clinical cover-
age of rigor mortis and fibromyalgia. Chapters 10 to 12 on the
12/11/18 9:43 AM

muscular system are reorganized so that chapter 10 focuses on the
cellular level; chapter 11 discusses the accessory connective tissues
of muscle, whole-muscle structure and organization, musculoskel-
etal biomechanics, and the axial muscles; and chapter 12 discusses
the appendicular muscles.
Chapter 11, The Muscular System II: Axial Musculature, now incor-
porates material moved from chapters 10 and 12 and has enhanced
coverage of accessory connective tissues, muscle compartments,
muscle–bone attachments, musculoskeletal biomechanics, a new
illustration of lever biomechanics, and a clinical update on types
and treatment of inguinal hernias.
Chapter 12, The Muscular System III: Appendicular Musculature,
updates the treatment of carpal tunnel syndrome.
Chapter 13, The Nervous System I: Nervous Tissue, updates astro-
cyte functions and the role of electrical synapses in neuronal
synchrony.
Chapter 14, The Nervous System II: Spinal Cord and Spinal
Nerves, now covers lumbar puncture and adds new illustrations
of shingles and the distribution of hand innervation from the
brachial plexus.
Chapter 15, The Nervous System III: Brain and Cranial Nerves,
has new drawings of regional functions of the cerebral cortex and
distribution of the vagus nerve; new clinical coverage of stroke
and trigeminal neuralgia; and scientific updates on brain senes-
cence, functions of the red nucleus and insula, and mapping of
the brain with diffusion tensor imaging.
Chapter 16, The Nervous System IV: Autonomic Nervous System
and Visceral Reflexes, has a redrawn figure 16.2 to better compare
sympathetic, parasympathetic, and somatic efferent pathways,
and it expands slightly on pre- and postganglionic fibers and their
neurotransmitters.
Chapter 17, The Nervous System V: Sense Organs, has scientific
updates on the roles of the eyelashes, corneal epithelium, and vitre-
ous body; new clinical coverage of phantom pain, macular degen-
eration, and diabetic retinopathy; new SEM photos of rod and cone
cells; a new drawing of the pediatric and adult auditory tubes as
related to middle-ear infection; and a more concise treatment of ear
and eye embryology.
Chapter 18, The Endocrine System, has enhanced discussions of
pineal gland innervation and function, melatonin, the endocrine
pancreas, and endemic goiter (with a new photo), and a new inter-
pretation of anterior pituitary chromophobes. It has new clinical
coverage of congenital absence of the pituitary gland (panhypopi-
tuitarism) and hypo- and hyperthyroidism, and has added a basic
pathophysiology of diabetes mellitus.
Chapter 19, The Circulatory System I: Blood, updates the status
of cord blood transfusions and the harvesting of stem cells from
circulating blood; enhances coverage of the role of blood circula-
tion in thermoregulation and of the role of erythroblasts; and
reports a startling new finding on where most blood platelets are
produced.
Chapter 20, The Circulatory System II: The Heart, updates the treat-
ment options for patent ductus arteriosis and has a more concise
treatment of cardiac embryology.
sal1026X_fm_i-xx.indd 9
P R E FAC E ix
Chapter 21, The Circulatory System III: Blood Vessels, gives an
updated multicultural perspective on vascular aging and hyperten-
sion; adds new challenge questions on identifying arteries in a mag-
netic resonance angiogram and identifying blood vessels used for
routine clinical purposes; and treats blood vessel embryology more
concisely.
Chapter 22, The Lymphoid System and Immunity, now takes an
expanded, more contemporary view of the meaning of immune
system. It reports the recent discovery of cerebral lymphatics and
has enhanced discussions of lymphatic vessel peristalsis and lymph
flow, the maturation and selection of T cells, and the antigen-
presenting role of dendritic cells.
Chapter 23, The Respiratory System, has improved descriptions
of the nasal and tracheal mucosae, the bronchial tree, and the cri-
cothyroid ligament in relation to tracheostomy. It updates asthma
mortality rates and lung cancer survival, and reports the newly dis-
covered role of the lungs in producing blood platelets.
Chapter 24, The Digestive System, has new clinical coverage of
diverticulosis, diverticulitis, hepatitis, cirrhosis, gastroesophageal
reflux disease, and gallstones. It has enhanced discussions of mes-
entery structure and omentum function; dental anatomy and pro-
prioception; salivary gland innervation; anatomy of the ileocecal
junction; and ethnic variation in colonic anatomy. It has new illus-
trations of histology of the stomach and colon, and a more concise
treatment of GI embryology.
Chapter 25, The Urinary System, adds new coverage of intravenous
pyelography and kidney stone treatment, and corrects a common
misconception about female urethral sphincters.
Chapter 26, The Reproductive System, has added substantial new
clinical content, with Clinical Applications and other discussions of
varicocele, uterine fibroids, uterine cancer, endometriosis, sexually
transmitted diseases, contraception, testicular cancer, male breast
cancer, and male reproductive tract disorders. It has a new endo-
scopic photo of ovulation, a revision of penile anatomy to focus
more on the uncircumcised state, and an update on environmental
endocrine disruptors and their effect on fertility.
A Storytelling Writing Style
Students and instructors alike cite Saladin’s prose style as the
number one attraction of this book. Students doing blind compari-
sons of Ken Saladin’s chapters and those of other anatomy books
routinely find Saladin clearly written, easy to understand, and a
stimulating, interesting read. Saladin’s analogy-rich writing enables
students to easily ­visualize abstract concepts in terms of everyday
experience. Consider, for example, from chapter 13:
The dimensions of human neurons are more impressive when
we scale them up to the size of familiar objects. If the soma of a
spinal motor neuron was the size of a tennis ball, its dendrites would
form a huge bushy mass that could fill a 30-seat classroom from
floor to ceiling. Its axon would be up to a mile long but a little nar-
rower than a garden hose. This is quite a point to ponder. The neuron
must assemble molecules and organelles in its “tennis ball” soma
and deliver them through its “mile-long garden hose” to the end of
the axon.
12/11/18 9:43 AM
 EVOLUTION OF A STORYTELLER

Ken Saladin’s penchant for writing began early. For his tenth-grade
biology class, he wrote a 318-page monograph on hydras with
53 original India ink drawings and 10 original photomicrographs. We
at McGraw-Hill think of this as Ken’s “first book.” At a young age, Ken

Courtesy of Ken Saladin

already was developing his technical writing style, research habits, and
illustration skills. Courtesy of Ken Saladin

Courtesy of Ken Saladin

Courtesy of Ken Saladin

Ken Saladin’s “first book,” Some of Ken’s first
Hydra Ecology (1965) pen-and-ink artwork (1965) Ken in 1964

Ken served as an A&P textbook reviewer and testbank writer for several
years and then embarked on his first book for McGraw-Hill in 1993. He
published the first edition of Anatomy & Physiology: The Unity of Form and
Function in 1997 and his first edition of Human Anatomy in 2004. The story
continues with Human Anatomy, sixth edition.

Human
ABOUT THE COVER
The front cover shows a human iris against a background of retinal cells. The tall gray columns are the light-absorbing
segments of the rods; the two light green cells are cones; and the basal cell bodies are in violet. The iris is so intricate,
unique to the individual, and forgery-proof that iris recognition technology is rapidly supplementing or replacing other
forms of identity confirmation such as fingerprints, PINs, national identification cards, and even passports. Saladin

McGraw-Hill Education Connect® for Anatomy & Physiology

Anatomy
Human Anatomy

NOW INCLUDES:

Fueled by McGraw-Hill LearnSmart® —the most
widely used and intelligent adaptive learning
resource—LearnSmart Prep® is designed to get
students ready for an upcoming course by quickly
and effectively addressing prerequisite knowledge
gaps that may cause problems down the road.
Sixth Edition
SmartBook® is the first and only adaptive reading
experience designed to create personalized
learning for students. SmartBook highlights the
most impactful concepts a student needs to learn
at that moment in time.

Practice Atlas for A&P is an interactive tool that
pairs images of common anatomical models with
stunning cadaver photography, allowing students
to practice naming structures on both models
and human bodies, anytime and anywhere.
APR is an interactive cadaver dissection tool to
enhance lecture and lab. Make use of the custom
structure list to focus learning! Now, APR is
mobile—get the experience anywhere, anytime!

Ken’s first textbook published in 1997

Connect is the only integrated learning system that empowers students by continuously
adapting to deliver precisely what they need, when they need it.
©McGraw-Hill Education
At McGraw-Hill Education we work every day to unlock the full potential of
each learner, providing data-driven solutions to help students get from
their first college-level course to program readiness.

Sixth
ISBN 978-1-260-21026-2
Edition
MHID 1-260-21026-X
9 0000

9 7 8 1 2 6 0 2 1 02 6 2

Saladin

The story continues in 2019 Essentials book published in 2013

©McGraw-Hill Education ©McGraw-Hill Education

sal1026X_fm_i-xx.indd 10 12/11/18 9:43 AM

 GUIDED TOUR

Instructive Artwork for Visual

Learners

©McGraw-Hill Education/Al Telser

Pancreatic Tail of pancreas
islets
Saladin’s stunning illustrations and photos entice students Bile duct

who regard themselves as “visual learners.”

Vivid Illustrations with rich textures and shading and
bold, bright ­colors bring anatomy to life. (c) Pancreatic islet
Exocrine acinus

©Biophoto Associates/Science Source

Bone marrow Trabecula

Pancreatic Duodenum Head of
©B Christopher/Alamy

ducts pancreas Beta cell

(a) Alpha cell
Delta cell
(b) Pancreatic islet
Compact bone
Figure 18.9 The Pancreas. (a) Gross anatomy and relationship to the duodenum. (b) Cells of a pancreatic islet. PP cells are not shown; they are few
Spongy bone
in number and cannot be distinguished with ordinary histological stains. (c) Light micrograph of a pancreatic islet amid the darker exocrine tissue.
∙ What is the function of the exocrine cells in this gland?
(c) ©McGraw-Hill Education/Al Telser
(a)
digestive gland, and its gross anatomy is therefore discussed in sec- regulate the speed of digestion and nutrient absorption, and
(c) tion 24.6c. Dispersed throughout the exocrine tissue, however, are perhaps modulates the activity of other pancreatic islet cells.
about 1 to 2 million endocrine cell clusters called the pancreatic 4. PP cells, which secrete pancreatic polypeptide (PP) for 4 or
islets (islets of Langerhans22). Although they are less than 2% of the 5 hours after a meal. By acting on receptors in the brain, PP
Nerve
Blood vessel
mass of the pancreas, the islets secrete hormones of vital impor- inhibits stimulation of the pancreas by the vagus nerve.
tance to metabolism—especially insulin and glucagon. The major
Spicules effect of these hormones is to regulate glycemia, the concentration The proportions of these pancreatic cells are about 20% alpha,
of glucose in the blood. 70% beta, 5% delta, and small numbers of PP and other cells.
A typical pancreatic islet measures about 75 × 175 μm. Islets
Trabeculae contain from a few to 3,000 cells, belonging primarily to three classes: 18.3g The Gonads
Spongy bone Like the pancreas, the gonads (ovaries and testes) function as both
Endosteum 1. Alpha (α) cells, or glucagon cells, which secrete glucagon.
endocrine and exocrine glands. Their exocrine products are eggs
Periosteum Glucagon is secreted between meals when the blood glucose
and sperm, and their endocrine products are the gonadal hormones,
Perforating fibers level falls. Its effects are to stimulate the release of stored glucose
most of which are steroids. Their gross anatomy is described in sec-
Perforating canal from the liver and fatty acids from adipose tissue, thereby
tions 26.2b and 26.3a.
providing the body with blood-borne fuel until the next meal.
The ovaries secrete chiefly estrogen, progesterone, and
2. Beta (β) cells, or insulin cells, which secrete insulin and
Process Figures relate numbered steps in the art with
amylin. Insulin is secreted during and immediately after a
inhibin. Each egg develops in its own bubblelike follicle
(fig. 18.10a), which is lined by a wall of granulosa cells and
©Custom Medical Stock Photo/Newscom

meal in response to rising levels of blood-borne nutrients surrounded by a capsule, the theca. The theca and granulosa cells col-
Central
canal Osteon ­corresponding numbered text descriptions.
such as glucose and amino acids. It stimulates most body laborate to produce estrogen. Midway through the monthly ovarian
Lacuna tissues to absorb these nutrients and store or metabolize cycle, the follicle ovulates (releases the egg) and begins to secrete an
Collagen them. Amylin enhances the effects of insulin and influences abundance of progesterone. Estrogen and progesterone contribute
fibers gastric emptying and bile secretion. to the development of the reproductive system and feminine phy-
Lacunae
Concentric
3. Delta (δ) cells, or somatostatin cells, which secrete somatostatin sique, regulate the menstrual cycle, sustain pregnancy, and prepare
lamellae (growth hormone–inhibiting hormone). Somatostatin is the mammary glands for lactation. Inhibin, which is also secreted
Circumferential
lamellae
Canaliculi secreted under the same conditions as insulin. It helps to by the follicle, is a signal from the ovaries to the anterior pituitary.
Central It inhibits the secretion of follicle-stimulating hormone (FSH). The
(b) canal 22
Paul Langerhans (1847–88), German anatomist effects of these hormones are further considered in chapter 26.
Lamella

(d) 1 SA node fires.

20 μm
Figure 6.4 The Histology of Osseous Tissue. (a) Compact and spongy bone in a frontal section of the femur. (b) The three-dimensional structure
of bone. Lamellae of one osteon are telescoped to show their alternating arrangement of collagen fibers. (c) Microscopic appearance of spongy
bone and bone marrow. (d) Microscopic appearance of a cross section of compact bone. 2 Excitation spreads through
• Which type of osseous tissue has more surface area exposed to osteoclast action? Right atrium 1 2 atrial myocardium.
(a) ©B Christopher/Alamy; (c) ©Biophoto Associates/Science Source; (d) ©Custom Medical Stock Photo/Newscom

Sinuatrial node
(pacemaker) Left 3 AV node fires.
atrium
2
Subendocardial
Atrioventricular 3
conducting network 4 Excitation spreads down AV
node bundle.
Bundle
Atrioventricular branches 5 Subendocardial conducting
bundle 4 network distributes excitation
5
through ventricular
myocardium.

Subendocardial
conducting network
Figure 20.13 The Cardiac Conduction System. Electrical signals travel along the pathways indicated by the arrows.
• Which atrium is the first to receive the signal that induces atrial contraction?

4 The atrioventricular (AV) bundle, a cord of modified
cardiomyocytes by which signals leave the AV node. The bundle
soon forks into right and left bundle branches, which enter the
interventricular septum and descend toward the apex of the heart.
5 The bundle branches give rise to conducting cardiac myofibers
(formerly called Purkinje cells), which turn upward at the
apex of the heart and spread throughout the ventricular
myocardium. These myofibers distribute electrical excitation
to the cardiomyocytes of the ventricles. Collectively, they
form the subendocardial conducting network. The network is
more elaborate in the left ventricle than in the right.
After we examine the structure of cardiac muscle, we will see how
this conduction system relates to the heart’s cycle of contraction
and relaxation.
sal1026X_fm_i-xx.indd 11
branches, each cardiomyocyte contacts several other cells, so collec-
tively they form a network throughout a heart chamber. A cardiomyo-
cyte usually has only one, centrally placed nucleus, often surrounded
by a mass of the energy-storage carbohydrate, glycogen; one-quarter
to one-third of the cells, however, have two or more nuclei. The sar-
coplasmic reticulum is less developed than in skeletal muscle; it lacks
terminal cisterns, although it does have footlike sacs associated with
the T tubules. The T tubules are much larger than in skeletal muscle.
During excitation of the cell, they admit calcium ions from the extra-
cellular fluid to activate muscle contraction. Cardiomyocytes have
especially large mitochondria, which make up about 25% of the cell
volume, compared to skeletal muscle mitochondria, which are much
smaller and comprise only 2% of the cell volume.
C L I N I C A L A P P L I C AT I O N 20.2
12/11/18 9:43 AM
 xii P R E FAC E

C LOrientation
I N I C A L A P P L ITools, such 12.2
C AT I O N as dissection planes and a compass The Psychology of Learning
on the anatomical art, clarify the perspective from which a
Carpal Tunnel Syndrome
Prolonged, repetitive motions of the wrist and fingers can cause pianists, meat cutters, and others who spend long hours making Having taught human anatomy and histology for 40 years,
structure
tissues in the carpal tunnel tois viewed.
become inflamed, swollen, or repetitive wrist motions. It can also be caused by other factors
fibrotic. Since the carpal tunnel cannot expand, swelling puts that reduce the size of the carpal tunnel, including tumors, infec- Saladin knows what works in the classroom and incorporates
pressure on the median nerve, which passes through the carpal tions, and bone fractures. Carpal tunnel syndrome is treated
tunnel with the flexor tendons (fig. 12.9). This pressure causes
tingling and muscular weakness in the palm and lateral side of
with aspirin and other anti-inflammatory drugs, immobilization of
the wrist, and sometimes surgical division (splitting) of the flexor
those approaches into the pedagogy of Human Anatomy.
the hand and pain that may radiate to the arm and shoulder. This retinaculum to relieve pressure on the nerve.
condition, called carpal tunnel syndrome, is common among

Palmaris longus tendon (cut) Flexor digitorum superficialis

tendon
Chapters Organized for Preview and Review
Flexor carpi radialis tendon Flexor digitorum profundus
tendon
Flexor carpi ulnaris tendon
Chapter Outline provides a content preview and
Flexor pollicis longus tendon
Ulnar artery facilitates review and study.
Palmar carpal ligament (cut)
Ulnar nerve
Radial artery
Flexor retinaculum covering
carpal tunnel
Clinical Applications pique the interest of health-science
Median nerve
Bursa students by showing the clinical relevance of the core
Trapezium Superficial palmar
arterial arch science.
(a) Anterior view Brushing Up reminds students of the relevance of earlier
chapters to the one on which they are currently
Palmaris longus
tendon Median nerve
embarking.
Thenar muscles Ulnar artery

Anatomy & Physiology REVEALED® icons indicate

Flexor digitorum Flexor retinaculum
superficialis tendons
Carpal tunnel
Trapezium
Flexor digitorum
profundus tendons
Hypothenar muscles

Ulnar bursa
which area of this interactive cadaver dissection
Radial artery
Anterior
Trapezoid
Hamate program corresponds to the chapter topic.
Capitate
Lateral Medial
Scaphoid Extensor tendons

Posterior
(b) Cross section
Figure 12.9 The Carpal Tunnel. (a) Dissection of the wrist (anterior aspect) showing the tendons, nerve, and bursae that pass under the flexor
retinaculum. (b) Cross section of the wrist, viewed as if from the distal end of a person’s right forearm extended toward you with the palm up. Note
how the flexor tendons and median nerve are confined in the tight space between the carpal bones and flexor retinaculum. That tight packing and
repetitive sliding movements of the flexor tendons through the tunnel contribute to carpal tunnel syndrome.

Colorized X-ray of the flexed cervical spine of a 20-year-old female.

©Science Photo Library-ZEPHYR/Getty Images
CHAPTER
THE SKELETAL SYSTEM II
AXIAL SKELETON 7
C HAP T E R OUT LI N E C LI N I CAL AP P LI CAT I ONS
7.1 Overview of the Skeleton 7.1 Injury to the Ethmoid Bone
7.1a Bones of the Skeletal System 7.2 Cleft Palate and Lip
7.1b Anatomical Features of Bones 7.3 Abnormal Spinal Curvatures

7.2 The Skull

7.2a Cranial Bones BRUSHI N G UP
7.2b Facial Bones
7.2c Bones Associated with the Skull To understand this chapter, you may find it helpful
7.2d Adaptations of the Skull for to review the following concepts:
● Directional terms (table 1.1)
Bipedalism
● The axial and appendicular body regions

7.3 The Vertebral Column and Thoracic Cage (section 1.2d)

● The neural tube, somites, and pharyngeal
7.3a General Features of the Vertebral
Column arches of the embryo (section 4.2b)
● General features of bones (section 6.1c)
7.3b General Structure of a Vertebra
● Intramembranous and endochondral
7.3c Intervertebral Discs
7.3d Regional Characteristics of Vertebrae ossification (sections 6.3a, b)
7.3e The Thoracic Cage

7.4 Developmental and Clinical Perspectives

7.4a Development of the Axial Skeleton
7.4b Pathology of the Axial Skeleton

Study Guide

Module 5: Skeletal System

sal1026X_fm_i-xx.indd 12 12/11/18 9:43 AM

 delicate organs. The vertebral column, for example, is only four major categories: bony,­fibrous,­cartilaginous, and synovial­joints.
moderately mobile, for it must allow for flexibility of the torso and yet protect the delicate spinal cord and support much of the
This section will describe the first three of these and the subclasses of each. The rema
and the
A serrate suture is one in which yet protect
adjoiningthebones
delicate spinal cord
firmly and support much of the
Synchondroses of each. The remainder of the chapter will then be concerned pri-
marily
body’s weight. Bones of the cranium must protect the brain and marily with synovi
body’s weight. Bones
interlock by their serrated margins, like pieces of a jigsaw puz- of the cranium must protect the
8 brain and
A synchondrosis (SIN-con-DRO-sis) is a with
joint synovial
in whichjoints.
the bones
zle. It is analogous to a dovetail sense organs,
wood joint. Onbut theneed not allow
surface, it for movement (except during
are bound by hyaline cartilage. An example is the temporary joint sense organs, but need not allow for movement (except during
appears as a wavy line between the birth);
two thus,
bones,they
as we areseelocked
in thetogether by immobile joints, thediaphysis of a long bone in a child,
between the epiphysis and 9.1a Bony Joints birth); thus, they are locked together by immobile joints, the
bones.
suturesthat
coronal, sagittal, and lambdoid sutures studied
borderin section 7.2.
the parietal
In everyday life, we take the greatest
formed by the cartilage of the epiphysial plate. Another is 3the
attachment notice
of theof the
first most
rib to theA sternum
bony joint,by aor hyaline sutures studied in section 7.2.
synostosis
costal(SIN-oss-TOE-sis), is an immobile 9.1a Bony J
A lap (squamous) suture is one freely movable
in which joints ofbones
the adjacent the limbs,cartilage
and it is(fig.
here that(The
9.3a). people jointcartilages
other costal formed when the gap
are joined between two bones ossifies and they
to the
feel most severely compromised
have overlapping beveled edges, like a miter joint in carpentry. by disabling diseases
sternum by synovial joints.) such become, in effect, a single bone. In everyday life, we take the greatest notice of the most
Bony joints can form by ossifica- A bony joint, or
as arthritis. Much of the of
worktheof physical therapists focuses on tion of either fibrous or cartilaginous joints. An infant is born with
An example is the squamous suture that encircles most freely movable joints of the limbs, and it is here that people joint formed whe
temporal bone. Its beveled edge canlimbbemobility.
seen in In this 7.10b.
figure chapter,Onwe will survey all types of joints, right and left frontal and mandibular bones, for example, but these P R E FAC E xiii
from
the surface, a lap suture appears as the utterly
a relatively smoothimmobile
(nonser- to the Symphyses
most mobile, but with an
9
feel most severely compromised by disabling diseases such
soon fuse seamlessly into a single frontal bone and mandible. Three become, in effect,
rated) line. emphasis on the latter. This surveyIn of joint anatomy
a symphysis and move- two
(SIM-fih-sis), bones are
childhood joined ilium,
bones—the by fibro-
ischium, and pubis—fuse to form a sin-
A plane (butt) suture is one ments
in whichwill provide
the adjacenta foundation
bones forcartilage
the study(fig.
of muscle
9.3b, c). actions
One example is the
gle hip bonepubic symphysis,
on each as arthritis. Much of the work of physical therapists focuses on
side of aninadult. The epiphyses and diaphyses tion of either fibro
in chapters 11 and 12. which the right and left pubic bones
of are
the joined
long bonesby the
are cartilagi-
joined by cartilaginous joints in childhood
have straight nonoverlapping edges. The two bones merely bor-
nous interpubic disc. Another is the
andjoint between and
adolescence, the these
bodiesbecome
of
limb mobility. In this chapter, we will survey all types of joints,
synostoses in early adulthood.
right and left fron
der each other, like two boards glued together in a butt joint. An
example is seen in the intermaxillary suture in the roof of the two vertebrae, united by an intervertebral
In old age,disc.
someThe surface
cranial from
of become obliterated
sutures the utterly immobile to the most mobile, but with an
by ossification soon fuse seamless
mouth. each vertebral body is covered with hyaline
and the cartilage.
adjacent cranialBetween
bones, such as the parietal bones, become
emphasis
Reinforced Learning
9.1 Joints and Their the Classification
vertebrae, this cartilage becomes infiltrated
one. The withofcollagen
attachment the first rib to the sternum also becomes ona the latter. This survey of joint anatomy and move- childhood bones—
Gomphoses
bundles to form fibrocartilage. synostosis
Each intervertebral
in old age. disc per- ments will Each
providesection is a conceptually
a foundation unified
for the study topic, actions
of muscle gle hip bone on ea
Expected Learning mits only slight movement between adjacent vertebrae, but
Outcomes
Even though the teeth are not bones, the attachment of a tooth
the collective effect of all 23 discs gives the spine considerable in chapters framed
11 andbetween
12. a pair of learning “bookends”—a of the long bones
to its socket is classified as a gomphosis (gom-FOE-sis). The term
When you have completed this section, you should be able to 9.1b Fibrous Joints
refers to its similarity to a nail hammered into wood.5 The tooth is
flexibility.
a. explain what joints are, how they are named, and what set of learning objectives at the beginning and a set
A fibrous joint is also called a synarthrosis4 (SIN-ar-THRO-sis). It and adolescence, a
held firmly in place by a fibrous periodontal ligament, which con-
functions they serve;
sists of collagen fibers that extend from the bone matrix of the jaw
b. name and describe the four major classes of joints;
is a point at which adjacent bones are bound by collagen fibers
that emerge from the matrix of one bone, cross the space between
of review and self-testing questions at the end. Each In old age, some c
into the dental tissue (fig. 9.1b). The ligament allows the tooth to
c. name some joints that become solidly
move or give a little under the stress of chewing. Along with associ-
Applyfused
What byYoubone
Know as section is numbered for easy reference in lecture,
them, and penetrate into the matrix of the other (fig. 9.1). There are and the adjacent c
they age;
ated nerve endings, this slight tooth movement enables us to sense
d. describe the three types of fibrous
how hard we’re biting and to sense a particle of food stuck between
The intervertebral
joints and
joints
give an
are three kinds
symphyses
through the lumbar region. How would
ofthe
only in
In sutures
fibrous
cervical
and gomphoses,
you classify the 9.1 Joints
joints: sutures,­gomphoses, and syndesmoses.
the fibers are very short and allow for andandTheir
assignments, ancillaryClassification
materials. These “book- one. The attachme
the teeth.
example of each;
e. distinguish between the three types
little or no movement.
intervertebral joints of the sacrum and coccyx in a middle-aged
of sutures; and
In syndesmoses, the fibers are longer and the
ends” provide the student an optimistic impression synostosis in old a
adult? attached bones are more movable.

Syndesmoses
f . describe the two types of cartilaginous joints and give
an example of each.
Expected Learning
of short, Outcomes
easily digestible sections manageable in
Sutures
A syndesmosis6 (SIN-dez-MO-sis) is a fibrous joint at which two
bones are bound by relatively long collagenous fibers. The separa-
Sutures are immobile or only slightly mobile fibrous joints that short bits of reading time.
When you have completed this section, you should be able to
closely bind the bones of the skull to each other; they occur nowhere 9.1b Fibrou
tion between the bones and lengthAny of the fibers
point givetwo
where these meet isBefore
joints
bones You
called a joint Go On
(articulation), else. In chapter 7, we did not take much notice of the differences
more mobility than a suture or gomphosis. An especially mov-
whether or not the bones are movable at that interface. The science a. explain
between one suture and another, but some differences might have what joints
Expected are, howOutcomes
Learning they are named, and
give the what
student A fibrous joint is
able syndesmosis exists between the Answer the following questions 1 to test your understanding of the
of shafts of the radius
joint structure, and ulna,
function, and dysfunction is called arthrology. functions they serve;
caught your attention as you studied the diagrams in that chapter or
which are joined by a broad fibrous Theinterosseous­membrane.
study of musculoskeletal This preceding section:
movement is kinesiology2 (kih-NEE- examined laboratory specimens. Sutures can be classified as serrate,­ a preview of key points to be learned within the is a point at whic
syndesmosis permits such movements as pronation and supina- 1. What is the difference between arthrology and kinesiology?
see-OL-oh-jee). This is a branch of biomechanics, which deals with b. name and describe the four major classes of joints;
lap, and plane­sutures. Readers with some knowledge of woodwork- that emerge from
tion of the forearm. A less mobile
binds the distal ends of the tibia and
syndesmosis
a broad
fibula
variety isofthe
together,
movements 2. Explainprocesses
one that and mechanical the distinction
in the
sis, and synarthrosis.
between
ingamaysynostosis,
recognizeamphiarthro-
that the structures and functional properties of
c. name some nextjoints
few pages.
that become solidly fused by bone as them, and penetra
body, including the side by side
physics of blood circulation, respiration, and these sutures have something in common with basic types of car-
(fig. 9.1c). hearing. 3. Give some examples of joints that become synostoses
pentry joints (fig. 9.2). they age; three kinds of fibr
4.
with age.
Define suture, gomphosis, and syndesmosis, and explain
Before
d. describe You Go
the three Onofprompts
types the student
fibrous joints to pause
and give an In sutures and gom
9.1c Cartilaginous Joints 1 3
syn = together; ost = bone; osis = condition
example and spot-check his or her mastery of the
arthro = joint; logy = study of what these three joints have in common.
2
kinesio = movement; logy = study of
A cartilaginous joint is also called an amphiarthrosis7 (AM-fee-ar- 5.
4
syn = together; arthr = joined; osis = condition
Name the three types of sutures and describe how they
of each; little or no movem
THRO-sis). In these joints, two bones are linked by cartilage differ. e. distinguish between
previous fewthe three
pages typesprogressing
before of sutures; to
andnew attached bones are
(fig. 9.3). The two types of cartilaginous joints are synchondroses 6. Name two synchondroses and two symphyses.
and symphyses. f . describe material.
the two types of cartilaginous joints and give
an example of each. Sutures
Sutures are immo
4. Chorionic villi develop from 8. The feature that distinguishes a fetus from 13. The brain and spinal cord develop from a
5
gomph = nail, bolt; osis = condition
closely bind the bo
6 8
syn = together; desm = band; osis = condition syn = together; chondr = cartilage; osis = condition
7 9
amphi = on all sides; arthr = joined; osis = condition
a. the zona
Vocabulary pellucida. sym = together; physis = growth
Building an embryo is that the fetus has longitudinal ectodermal channel called the
Any point where two bones meet is called a joint (articulation), else. In chapter 7,
a. all of the organ systems. _____.
Severalb. features
the endometrium.
help build a student’s level of comfort with medical whether or not the bones are movable at that interface. The science between one sutur
c. the syncytiotrophoblast. b. three germ layers. 14. Attachment of the conceptus to the uterine
vocabulary.
d. the embryoblast. c. a placenta.
of joint structure, function, and dysfunction is called arthrology.1
wall is called _____.
caught your attent
2
e. the epiblast. d. an amnion. The study of musculoskeletal 15. Fetalmovement
blood flowsis kinesiology (kih-NEE-
through growths called examined laborato
Pronunciation Guides Knowing proper pronunciation is key see-OL-oh-jee). This is a branch lap, and plane­sutu
5. Which of these results from aneuploidy? e. arm and leg buds. _____, which project into thedeals
of biomechanics, which with
placental
to remembering and spelling terms. Saladin gives simple, a broad variety of movements sinus. and mechanical processes in the ing may recognize
a. Down syndrome 9. The first blood and future egg and sperm
intuitive body, including the physics of enzymes
blood circulation, respiration,
a sperm and these sutures have
b. fetal“pro-NUN-see-AY-shun”
alcohol syndrome guides to helpcells students over
come from 16. The with which pen-
this hearing. etrates an egg are contained in an organelle pentry joints (fig.
c. hurdle and widen the student’s comfort zone
nondisjunction a. for
themedical
mesoderm.
d. mutation b. the hypoblast. called the _____.
vocabulary.
e. polyspermy c. the syncytiotrophoblast.
1 17.
arthro = joint; logy = study of
Fertilization occurs in a part of the female 3
syn = together; ost =
2 reproductive tract called the _____. 4
syn = together; arthr
Word Origins Accurate spelling
6. Fetal urine accumulates in the _____ and and insight into d.
medical the placenta.
terms kinesio = movement; logy = study of
e. the used
yolk sac. 18. Bone, muscle, and dermis arise from
arecontributes
greatly enhanced
to the fluidbythere.
a familiarity with commonly word segments of mesoderm called _____.
a. placental
roots, prefixes,sinus
and suffixes. 10. For the first 8 weeks of gestation, a concep-
19. The egg cell has fast and slow blocks to
b. yolk sac tus is nourished mainly by
_____, or fertilization by more than one
c. allantois
Footnotes throughout the chapters help build the student’s a. the placenta.
sperm.
d. chorion b. amniotic fluid.
working lexicon of word elements. An end-of-book Glossary 20. A developing individual is first classified as
e. amnion c. colostrum.
provides clear definitions of the most important a/an _____ when the three primary germ
7. A preembryo has d.ordecidual
frequently
cells.
layers have formed.
used
a. aterms.
neural tube. e. yolk cytoplasm.
b. a heart bulge. 11. Viruses and chemicals that cause congenital
Answers in appendix A
Building Your Medical
c. a cytotrophoblast. Vocabulary An exercise atanatomical
the end deformities
of are called _____.
each
d. achapter
coelom.helps students creatively use their 12. Aneuploidy
knowledgeisofcaused by _____, the failure
e. decidual cells. of a pair of chromosomes to separate in
new medical word elements. meiosis.

Building Your Medical Vocabulary

State a meaning of each word element and give 3. zygo- 9. meso-
a medical term from this chapter that uses it or a 4. tropho- 10. terato-
slight variation of it. 5. cephalo-
6. gyneco- Answers in appendix A
1. haplo- 7. -genesis
2. gameto- 8. syn-

What’s Wrong with These Statements?

Briefly explain why each of the following 5. The nervous system arises from the meso- 9. A developing individual is first called a fetus
statements is false, or reword it to make it true. derm of the embryo. when the three germ layers have formed—
6. The “bag of waters” that breaks and dis- ectoderm, mesoderm, and endoderm.
sal1026X_fm_i-xx.indd 13 1. Freshly ejaculated sperm are more capable charges fluid when a woman is about to give 10. The energy for sperm motility comes from 12/11/18 9:43 AM
 ments are named and illustrated in our later discu
wastes, and makes movements at synovial joints almost friction-free. joints, and tendons are more fully considered in ch
A connective tissue joint (articular) capsule encloses the cavity and 12 along with the gross anatomy of muscles.
retains the fluid. It has an outer fibrous capsule continuous with the A bursa13 is a fibrous sac filled with synov
periosteum of the adjoining bones, and an inner, cellular synovial between adjacent muscles, between bone and skin,
membrane. The synovial membrane consists mainly of fibroblast-like passes over a bone (see fig. 9.19). Bursae cush
cells that secrete the fluid, and is populated by macrophages that tendons slide more easily over the joints, and some
remove debris from the joint cavity. Joint capsules and ligaments are mechanical effect of a muscle by modifying the dir
supplied with sensory nerve endings that monitor joint movements. tendon pulls. Bursae called tendon sheaths are el
In a few synovial joints, fibrocartilage grows inward from the cap-
xiv P R E FAC E sule and forms a pad between the articulating bones. In the jaw and
wrapped around a tendon. These are especially num
and foot (fig. 9.5), and allow easier longitudinal m
distal radioulnar joints, and at both ends of the clavicle (sternocla- don as forearm muscles pull on bones of the hand.
vicular and acromioclavicular joints), the pad crosses the entire joint mation of a bursa, usually due to overexertion of a
Self-Assessment
(b) Tools capsule and is called an articular disc (see fig. 9.18c). In the knee, two a form of bursitis in which a tendon sheath is infla
cartilages extend inward from the left and right but do not entirely
Saladin provides students with abundant opportunities to evaluate
ome. (a) A child with Down syndrome (center) and her sisters. (b) The karyotype, a chart of the chromosomes of a Figure cross
Legend
the jointQuestions posed
(see fig. 9.23d). Each in many
is called of12 the
a meniscus figure
because of
. Notice that all chromosomes are paired except for three copies of chromosome 21, hence the alternative name of
their comprehension of concepts. A wide variety of questions from
(The karyotype is for a boy, XY, not a girl.) legends prompt the student to interpret the art and apply
9.2b Classes of Synovial Joints
zana Egertova / Alamy Stock Photo
simple recall to analytical evaluation cover all six cognitive levels of
11
= egg
it to ovi
the 12reading.
men = moon, crescent; iscus = little
There are six fundamental classes of synovial joi
by patterns of motion determined by the shape
Bloom’s Taxonomy of Educational Objectives. surfaces of the bones (table 9.1). We will exam
y pregnancy, often before they knew which are not noticed until a child begins school. Alcohol
he time it was removed from the world abuse during pregnancy can cause fetal alcohol syndrome (FAS), descending order of mobility, from multiaxial to m
Before
fected an estimated 10,000 to 20,000
You Go On questions test simple recall and lower-level
characterized by a small head, malformed facial features, car-
them born with unformed arms orinterpretation
legs of information
diac and central nervous systemread instunted
defects, the previous
growth, andfew pages. 13
burs = purse
defects of the ears, heart, and intestines. behavioral symptoms such as hyperactivity, nervousness, and a
ess obvious effects, including physical or poor attention span. Cigarette smoking also contributes to fetal
Apply
rritability, inattention, strokes, seizures,What
and You
infant Know
mortality, tests
ectopicapregnancy,
student’s ability to
anencephaly think of the
(failure C L I N I C A L A P P L I C AT I O N
Proximal
th, and cancer. of the cerebrum to develop), cleft lip and palate, and cardiac
birth defects than any other terato-
deeper abnormalities.
implications or clinical applications of a point he or phalanx

man taking one drink a day canshe have just read.

and childhood development, some of
Diagnostic medical X-rays and prenatal infections such as her-
pes simplex, rubella, and human immunodeficiency virus can also
be teratogenic.
Some congenital anomalies and other developmental disorders
are described in table 4.6 and Clinical Application 4.4.
Apply What You Know
Martha is showing a sonogram of her unborn baby to her
coworkers. Her friend Betty tells her she shouldn’t have
sonograms made because X-rays can cause birth defects. Is
Betty’s concern well founded? Explain.
Before You Go On
Answer the following questions to test your understanding of the
preceding section:
12. In what sense can spontaneous abortion be considered a
protective mechanism?
13. Mutation and nondisjunction both produce chromosomal
abnormalities. What is the difference between them?
Exercise and Articular Cartilage
When synovial fluid is warmed by exercise, it beco
viscous), like warm oil, and more easily absorbed
cartilage. The cartilage then swells and provides
cushion against compression. For this reason, a
Ligament before vigorous exercise helps protect the articu
undue wear and tear.
Joint cavity Articular
containing cartilages Because cartilage is nonvascular, its repetitive
ing exercise is important to its nutrition and waste re
synovial fluid
8. The locations and functional differences 2. The differences between afferent and 14.3 Somatic Reflexes a cartilage is compressed, fluid and metabolic was
between the posterior horn, anterior horn,Periosteumefferent nerve fibers; somatic and visceral Fibrous
1. The general characteristics of a reflex, and
out of it. When weight is taken off the joint, the c
and lateral horn of the spinal gray matter fibers; and general and special fibers capsule
how visceral reflexes differ from somatic Joint
9. The funiculi and tracts of spinal white matter 3. The difference between sensory, motor,
Bone and mixed nerves reflexes
capsule synovial fluid like a sponge, and the fluid carries oxy
10. The general function of the ascending tracts; 2. The components of aSynovial
reflex arc and the
the system used for naming most of them; 4. The structure of a ganglion; where ganglia
membrane
path followed by the afferent and efferent to the chondrocytes. Lack of exercise causes the a
and their individual names, locations, and are found; and the relationship between a nerve signals of a somatic reflex
functions ganglion and a nerve 3. The differences between a monosynaptic to deteriorate more rapidly from lack of nutrition,
11. First- through third-order neurons; decussa- 5. The number of spinal nerves and the sys-
tion in the ascending tracts; and the implica- tem for naming and numbering them
and a polysynaptic reflex arc
4. The differences between ipsilateral,
waste removal.
Middle
tion of this decussation for the relationship
between the cerebral hemispheres and the
6. The structure of the proximal portion
ofphalanx
a spinal nerve, including its posterior
contralateral, and intersegmental reflex Weight-bearing exercise builds bone mass and
arcs, and some reflexes that would
origin of sensory signals from the lower body and anterior roots, their rootlets, and employ each type muscles that stabilize many of the joints, thus reduci
12. The general function of the descending
tracts; the system for naming them; and their
the posterior root ganglion; and how the
posterior and anterior roots relate to the
5. The nature of a stretch reflex, flexor
reflex, crossed extension reflex, and ten- dislocations. Excessive joint stress, however, can ha
individual names, locations, and functions posterior and anterior horns of the spi-
13. Upper and lower motor neurons; decus- nal cord
don reflex
sion of osteoarthritis by damaging the articular car
Figure 9.4 Structure of a Simple Synovial
sation in the descending tracts; and the
implication of this decussation for the rela-
7. The structure of the distal portion of a
spinal nerve, particularly its division into
14.4 Clinical Perspectives
Joint. Most synovial and bicycling are good ways of exercising the jo
1. Causes and risk factors for spinal cord
joints are more complex than the interphalangeal
tionship between the cerebral hemispheres a posterior ramus, anterior ramus, and
trauma joint shown here. damage.
14.2 The Spinal Nerves
•
and motor control of the lower body meningeal branch, and where these three
branches lead
2. The effects of spinal cord trauma includ-
Why is a meniscus unnecessary in an interphalangeal joint?
ing spinal shock, hyperreflexia,
8. The five plexuses of spinal nerves—their
and flac-
cid and spastic paralysis
1. The structure of a nerve, including its names, locations, and structure; the nerves 3. The differences between paraplegia, quad-
three layers of connective tissue and how that arise from them; and the structures riplegia, and hemiplegia with respect to
they relate to the organization of nerve
fibers into fascicles
innervated by these nerves (tables 14.3
through 14.6)
their causes and parts of the body affected

14. Why is a baby more likely to be born with anatomical Testing Your Recall
howing the Effect of Thalidomide defects stemming from teratogen exposure at 30 days
1. Below L2, the vertebral canal is occupied 5. A patient has a gunshot wound that caused d. the arachnoid mater.
than from exposure at 10 days? by a bundle of spinal nerve roots called a bone fragment to nick the spinal cord. e. the dura mater.
a. the terminal filum. The patient now feels no pain or tempera- 9. The intercostal nerves between the ribs
b. the descending tracts. ture sensations from that level of the body arise from which spinal nerve plexus?
c. the gracile fasciculus. down. Most likely, the _____ was damaged. a. cervical
d. the medullary cone. a. gracile fasciculus b. brachial
e. the cauda equina. b. medial lemniscus c. lumbar
2. The brachial plexus gives rise to all of the c. tectospinal tract d. sacral
following nerves except d. lateral corticospinal tract e. none of them
a. the axillary nerve. e. spinothalamic tract
10. All somatic reflexes share all of the follow-
b. the radial nerve. 6. Which of these is not a region of the spinal ing properties except
c. the obturator nerve. cord? a. they are quick.
d. the median nerve. a. cervical b. they are monosynaptic.
e. the ulnar nerve. b. thoracic
Testing Your Recall sections at the end of each chapter
c. they require stimulation.
3. Between the dura mater and vertebral bone, c. pelvic d. they are involuntary.
one is most likely to find d. lumbar e. they are stereotyped.
e. sacral
offer 20 simple recall questions to test retention of a. arachnoid mater.
b. denticulate ligaments.
c. cartilage.
7. In the spinal cord, the neurosomas of the
lower motor neurons are found in
11. Outside the CNS, the neurosomas of neu-
rons are clustered in swellings called _____.
12. Distal to the intervertebral foramen, a spi-

terminology and basic ideas. d. adipose tissue.

e. spongy bone.
a. the cauda equina.
b. the posterior horns.
c. the anterior horns.
nal nerve branches into a posterior and
anterior _____.
13. The cerebellum receives feedback from the
4. Which of these tracts carries motor signals
destined for the postural muscles? d. the posterior root ganglia. muscles and joints by way of the _____
a. the gracile fasciculus e. the funiculi. tracts of the spinal cord.

What’s Wrong with These Statements? requires b. the cuneate fasciculus

c. the spinothalamic tract
8. The outermost connective tissue wrapping
of a nerve is called
14. Motor innervation of the leg proper comes
predominantly from the _____ plexus.
d. the vestibulospinal tract a. the epineurium. 15. Neural circuits called _____ in the spinal

students to concisely explain why the false statements e. the tectospinal tract b. the perineurium.
c. the endoneurium.
cord produce the rhythmic muscular con-
tractions of walking.

are untrue.
What’s Wrong with These Statements?

Testing Your Comprehension questions are clinical

Briefly­explain­why­each­of­the­following­ 5. Reaching behind you to take something out 8. At a cartilaginous joint, the facing surfaces
statements­is­false,­or­reword­it­to­make­it­true. of your hip pocket involves hyperextension of the two bones are covered with layers of
of the elbow. cartilage and there is a narrow space with

application and other interpretive essay questions that 1. More people get rheumatoid arthritis than
osteoarthritis.
2. A doctor who treats arthritis is called a
6. The lateral and medial malleoli are protru-
sions of the two sides of the tibia in the
lubricating fluid between them.
9. Synovial fluid is secreted by the bursae.
tarsal region. 10. Several sutures can be found in the long
require the student to apply the chapter’s basic science kinesiologist.
3. Synovial joints are also known as synarthroses.
7. To stand on tiptoes to reach something on
a high shelf, you would use dorsiflexion of
bones of the upper and lower limbs.

4. The lateral and medial menisci are shock-

to clinical or other scenarios.
the calcaneus. Answers in appendix A
absorbing cartilages in the elbow joint.

Testing Your Comprehension

1. Why are there menisci in the knee joint but
not in the elbow, the corresponding joint of
the upper limb? Why is there an articular
disc in the temporomandibular joint?
2. What ligaments would most likely be torn
if you slipped and your foot was suddenly
forced into an excessively inverted posi-
tion: (a) the posterior talofibular and cal-
caneofibular ligaments, or (b) the medial
ligament? Explain. What would the result-
ing condition of the ankle be called?
3. In order of occurrence, list the joint actions
(flexion, pronation, etc.) and the joints
where they would occur as you (a) sit
down at a table, (b) reach out and pick
up an apple, (c) take a bite, and (d) chew
it. Assume that you start in anatomical
position.
4. What structure in the elbow joint serves the
same purpose as the anterior cruciate liga-
ment (ACL) of the knee?
5. List the six types of synovial joints and
for each one, if possible, identify a joint in
the upper limb and a joint in the lower limb
that fall into each category. Which of these
six joints have no examples in the lower
limb?

sal1026X_fm_i-xx.indd 14 12/11/18 9:43 AM

 P R E FAC E xv

C L I N I C A L A P P L I C AT I O N 14.2

Poliomyelitis and Amyotrophic Lateral Sclerosis

u should be Poliomyelitis15 and amyotrophic lateral sclerosis16 (ALS) are two
diseases that result from the destruction of motor neurons. In both
diseases, the skeletal muscles atrophy from lack of innervation.
a in general; Poliomyelitis (polio) is caused by the poliovirus, which destroys
o the spinal motor neurons in the brainstem and anterior horn of the spinal cord.
Signs of polio include muscle pain, weakness, and loss of some
nerve distal reflexes, followed by paralysis, muscular atrophy, and sometimes
respiratory arrest. The virus spreads through water contaminated by
d describe feces. Historically, polio afflicted many children who contracted the
virus from contaminated public swimming pools. For a time, the polio
each plexus vaccine nearly eliminated new cases, but the disease has lately begun
to reemerge among children in some countries because of antivac-
cination politics.
he spinal
ALS is also known as Lou Gehrig17 disease after the baseball
player who succumbed to it. It is marked not only by the degenera-
tion of motor neurons and atrophy of the muscles, but also sclerosis
(scarring) of the lateral regions of the spinal cord—hence its name.
Most cases occur when astrocytes fail to reabsorb the neurotrans-
mitter glutamate from the tissue fluid, allowing it to accumulate to a
neurotoxic level. The early signs of ALS include muscular weakness
and difficulty in speaking, swallowing, and using the hands. Sensory
and intellectual functions remain unaffected, as evidenced by the
accomplishments of astrophysicist and best-selling author Stephen
body by way of Hawking (fig. 14.7), who was stricken with ALS while he was in college.
nerves, however, Despite near-total paralysis, he had a slowly progressive form of the
rves and ganglia disease, remained intellectually undiminished, and communicated with
the aid of a speech synthesizer and computer. Tragically, many people
e fibers (axons) are quick to assume that those who have lost most of their ability to
we compare a communicate their ideas and feelings have no ideas and feelings to
communicate. To a victim, this may be more unbearable than the loss
Figure 14.7 Stephen Hawking (1942–2018). “When I was first
nt in one direc- diagnosed with ALS, I was given two years to live. Now 45 years later,
of motor function itself. I am doing pretty well” (CNN interview, 2010).
able composed
e directions. A ©Geoff Robinson Photography/REX/Shutterstock

to more than a
r and resemble
aller branches.
Purely sensory nerves, composed only of afferent fibers, are rare;
ches are called Apply What You Know they include the olfactory and optic nerves described in table 15.3.
ly called periph-
How does the structure of a nerve compare to that of a skeletal Motor nerves carry only efferent fibers. Most nerves, however, are
are ensheathed Making it Relevant
muscle? Which of the descriptive terms for nerves have similar mixed. A mixed nerve consists of both afferent and efferent fibers
counterparts in muscle histology? and therefore conducts signals in two directions, although any one
often a myelin
he neurilemma, Clinical Application essays cover the clinical relevance of fiber within the nerve carries signals in one direction only. Many
nerves often described as motor are actually mixed because they
en a thin sleeve basic science. carry sensory signals of proprioception from the muscles back to
In most nerves, Peripheral nerve fibers are of two kinds: sensory (afferent) fibers, the CNS.
fascicles, each which carry signals from sensory receptors to the CNS, and motor If a nerve resembles a thread, a ganglion18 resembles a knot in
perineurium is (efferent) fibers, which carry signals from the CNS to muscles and the thread. A ganglion is a cluster of neurosomas outside the CNS.
ous, epithelium- glands. Both sensory and motor fibers can also be described as It is enveloped in an epineurium continuous with that of the nerve.
er and wrapped somatic or visceral and as general or special depending on the organs Among the neurosomas are bundles of nerve fibers leading into
hole. The tough they innervate (table 14.2). and out of the ganglion. Figure 14.9 shows a type of ganglion asso-
nnective tissue
ciated with the spinal nerves.
Nerves have a
upply, which is 15
polio = gray matter; myel = spinal cord; itis = inflammation
onnective tissue 16
a = without; myo = muscle; troph = nourishment
17 18
Lou Gehrig (1903–41), American baseball player gangli = knot

sal1026X_fm_i-xx.indd 15 12/11/18 9:43 AM

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 For Students
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 ACKNOWLEDGMENTS

I wish to thank the hundreds of colleagues who have reviewed my writing over the years and tremendously contributed to the factual
accuracy, scientific currency, and presentation style of the book before you. Much of this has come about through revising my flagship
book, Anatomy & Physiology: The Unity of Form and Function, through eight editions. Human Anatomy and my book coauthored with Robin
McFarland, Essentials of Anatomy & Physiology, have derived their own content improvements as they follow in the wake of the heavily
reviewed two-semester textbook.
I wish to thank specifically all of the reviewers of the fifth edition text (listed below). Their feedback has been instrumental to the revi-
sion process for this sixth edition. In addition to these commissioned reviews of my chapters, spontaneous feedback from other instructors
and from students all over the world has been enormously stimulating and helpful in the incessant effort to approach that elusive asymptote
called textbook perfection. I’m deeply appreciative of all the encouragement, information, corrections, and suggestions these readers have
sent, and I look forward to many more years of such productive correspondence.
Christina Gan updated the question bank and test bank to closely correlate with the intricate changes made in this sixth edition, and
greatly increased the educational value of these books through her work to create self-assessment tools and align McGraw-Hill’s Connect
resources with the textbook. This has contributed greatly to student and instructor satisfaction with our overall package of learning media,
and to the students’ success as they master A&P en route to their career aspirations. I am delighted to have Christina on my team.
I would also like to extend appreciation to members of the Life Sciences Book Team at McGraw-Hill Education who have worked with
me on this project, including Matthew Garcia, Portfolio Manager; Donna Nemmers, Senior Product Developer; Vicki Krug, Senior Content
Project Manager; Lori Hancock, Lead Content Licensing Specialist; Brent dela Cruz, Senior Content Project Manager; David Hash, Lead
Designer; and Jeanne Patterson, freelance copy editor. Their efforts have yielded another great edition of the text and its companion media
suite of Connect products.

Ken Saladin
Georgia College & State University

Reviewers
Fazal K. Aasi Tamara Davault David S. McLeod
Compton Community College University of Texas of the Permian Basin James Madison University
Yael Avissar Bryan Essien Ronald D. Norris
Rhode Island College Ball State University Azusa Pacific University
Guoying Bing Michael T. Griffin Jacqueline Pal
University of Kentucky Angelo State University East Los Angeles College
Erika Brockmann April Richardson Hatcher Behnaz Parhami-Seren
Los Angeles Valley College University of Kentucky Moorpark College
Becky Brown Candi K. Heimgartner Lula Smith
College of Marin University of Idaho Alabama State University
Pamela Byrd-Williams Deborah C. Henry Robert Stow
Los Angeles Valley College Coastline Community College University of Wisconsin—Eau Claire
Jennifer Carr Nicole Houston Curt Walker
Tufts University Indiana University Kokomo Dixie State University
Julie K. Collins Wilfredo López-Ojeda Colonel (Ret.) Michael Yard
Eastern Oklahoma State College UCF-COM Indiana University Purdue University
Kathleen Coughlan Chris T. McAllister Indianapolis (IUPUI)
Redlands Community College Eastern Oklahoma State College—Idabel

xviii

sal1026X_fm_i-xx.indd 18 12/11/18 9:44 AM

 LETTER TO STUDENTS

Dear Students,

When I was a young boy, I became interested in what I then called “nature study” for two reasons. One was the sheer beauty of nature.
I reveled in children’s books with abundant, colorful drawings and photographs of animals, plants, minerals, and gems. It was this esthetic
appreciation of nature that made me want to learn more about it and made me happily surprised to discover I could make a career of it.
At a slightly later age, another thing that drew me still deeper into biology was to discover writers who had a way with words—who could
captivate my imagination and curiosity with their elegant prose. Once I was old enough to hold part-time jobs, I began buying zoology and
anatomy books that mesmerized me with their gracefulness of writing and fascinating art and photography. I wanted to write and draw like
that myself, and I began learning from “the masters.” I spent many late nights in my room peering into my microscope and jars of pond
water, typing page after page of manuscript, and trying pen and India ink as an art medium. My “first book” was a 318-page paper on some
little pond animals called hydras, with 53 illustrations, that I wrote for my tenth-grade biology class when I was 16.
Fast forward about 30 years to when I became a textbook writer, and I found myself bringing that same enjoyment of writing and illus-
trating to my own anatomy and physiology textbooks. Why? Not only for its intrinsic creative satisfaction, but because I’m guessing that
you’re like I was—you can appreciate a book that does more than simply give you the information you need. You appreciate, I trust, a writer
who makes it enjoyable for you through scientific, storytelling prose and a conceptualized way of illustrating things to spark interest and
facilitate understanding. Some of you probably think of yourselves as “visual learners” and others as “verbal learners.” Either way, I hope
this book will serve your learning style.
I know from my own students, however, that you need more than captivating illustrations and enjoyable reading. Let’s face it—A&P is
a complex subject and it may seem a formidable task to acquire even a basic knowledge of the human body. It was difficult even for me to
learn (and the learning never ends). So in addition to simply writing this book, I’ve given a lot of thought to pedagogy—the art of teaching.
I’ve designed my chapters to make them easier for you to study and to give you abundant opportunity to check whether you’ve understood
what you read—to test yourself (as I advise my own students) before the instructor tests you. Christina Gan, digital author, also produces rich
Connect interactive questions that test your understanding as you progress through each chapter. Students have commended these online
questions as extremely helpful in learning human anatomy.
Each chapter is broken down into short, digestible bits with a set of learning goals (Expected Learning Outcomes) at the beginning of
each section, and self-testing questions (Before You Go On) just a few pages later. Even if you have just 30 minutes to read during a lunch
break or a bus ride, you can easily read or review one of these brief sections. There are also numerous self-testing questions at the end of each
chapter, in some of the figure legends, and the occasional Apply What You Know questions dispersed through each chapter. The questions
cover a broad range of cognitive skills, from simple recall of a term to your ability to evaluate, analyze, and apply what you’ve learned to new
clinical situations or other problems.
The Guided Tour takes you through the learning aids we’ve created for you within the book itself and additional study aids available
within Connect. I hope you will take a little time to look at the Guided Tour to see what we have to offer you.
I hope you enjoy your study of this book, but I know there are always ways to make it even better. Indeed, what quality you may find in
this edition owes a great deal to feedback I’ve received from students all over the world. If you find any typos or other errors, if you have any
suggestions for improvement, if I can clarify a concept for you, or even if you just want to comment on something you really like about the
book, I hope you’ll feel free to write to me. I correspond quite often with students and would enjoy hearing from you.

Ken Saladin
Georgia College & State University
TwainStation@gmail.com

xix

sal1026X_fm_i-xx.indd 19 12/11/18 9:44 AM

sal1026X_fm_i-xx.indd 20 12/11/18 9:44 AM
 PART O N E
Colorized X-ray of the human skeleton in the style of Leonardo da Vinci’s Vitruvian Man
©Devrimb/Getty Images
CHAPTER

THE STUDY OF
HUMAN ANATOMY 1
C HA P TER OU TLI N E CLI NI CAL AP P LI CAT I ONS
1.1 The Scope of Human Anatomy 1.1 Situs Inversus and Other Unusual Anatomy
1.1a The Anatomical Sciences 1.2 Cardiac Tamponade
1.1b Methods of Study
1.1c Variation in Human Structure

1.2 The Human Body Plan

1.2a Levels of Human Structure
1.2b The Human Organ Systems
1.2c The Terminology of Body Orientation
1.2d Major Body Regions
1.2e Body Cavities and Membranes

1.3 The Language of Anatomy

1.3a The Origins of Medical Terms
1.3b Analyzing Medical Terms
1.3c Variant Forms of Medical Terms
1.3d The Importance of Accuracy

Study Guide

Module 1: Body Orientation

sal1026X_ch01_001-023.indd 1 12/8/18 3:00 PM

 2 PA R T O N E Organization of the Body
T
his book is an introduction to the structure of the human
body. It is meant primarily to provide a foundation for
advanced study in fields related to health and fitness.
Beyond that purpose, however, the study of anatomy can also
provide a satisfying sense of self-understanding. Even as chil-
dren, we’re curious about what’s inside the body. Dried skele-
tons, museum exhibits, and beautifully illustrated atlases of the
body have long elicited widespread public fascination.
This chapter lays a foundation for our study of anatomy by
­considering some broad, unifying themes. We will consider what
this science encompasses and what methods are used for the
study of anatomy. We will lay out a general “road map” of the
human body to provide a context for the chapters that follow.
We will also get some insights into how a beginning anatomy
student can become comfortable with medical terminology.
1.1 The Scope of Human Anatomy
Expected Learning Outcomes
When you have completed this section, you should be able to
a. define anatomy and some of its subdisciplines;
b. name and describe some approaches to studying
anatomy;
c. describe some methods of medical imaging; and
d. discuss the variability of human anatomy.
Human anatomy is the study of the structural basis of body function.
It provides an essential foundation for understanding p­ hysiology,
the functional relevance of that structure; anatomy and physiol-
ogy ­together are the bedrock of the health sciences. You can study
­human anatomy from an atlas; yet as beautiful, fascinating, and
valuable as atlases are, they teach almost nothing but the locations,
shapes, and names of things. This book is different; it deals with
what biologists call functional ­morphology1—not just the structure
of organs, but the functional reasons behind it.
Anatomy and physiology complement each other; each makes
sense of the other, and each molds the other in the course of human
development and evolution. Thus, we can say that the human body
exhibits a unity of form and function. We can’t delve into the details
of physiology in this book, but enough will be said of function to
help you make sense of human structure and to more deeply appre-
ciate the beauty of human form.
1.1a The Anatomical Sciences
Anatomy is an ancient human interest, undoubtedly older than any
written language we know. We can only guess when people began
deliberately cutting into human bodies out of curiosity, simply to
know what was inside. Some of the earliest and most influential
books of anatomy were written by the Greek philosopher Aristotle
(384–322 bce), the Greek physician Galen (129–c. 200 ce), and
1 4
morpho = form, structure; logy = study of
sal1026X_ch01_001-023.indd 2
the Persian physician Avicenna (Ibn Sina, 980–1037 ce). For nearly
1,500 years, medical professors in Europe idolized these “ancient
masters” and considered their works above reproach. Modern
human anatomy, however, dates to the sixteenth century, when
Flemish physician and professor Andreas Vesalius (1514–64) ques-
tioned the accuracy of the earlier authorities and commissioned the
first accurate anatomical illustrations for his book, De Humani Cor-
poris Fabrica (On the Structure of the Human Body, 1543) (fig. 1.1).
The tradition begun by Vesalius has been handed down to us
through such famous contemporary works as Gray’s Anatomy, Frank
Netter’s Atlas of Human Anatomy, and many others, to the richly
illustrated textbooks used by college students today.
For all its attention to the deceased body, or cadaver,2 human anat-
omy is hardly a “dead science.” New techniques of study continually
produce exciting new insights into human structure and its functional
relevance; anatomists have discovered far more about the human body in
the last century than in the 2,500 years before. Anatomy now embraces
several subdisciplines that study human structure from different per-
spectives. Gross anatomy is the study of structure visible to the naked
eye, using methods such as surface observation, dissection, X-rays, and
MRI scans. Surface anatomy is the external structure of the body, and is
especially important in conducting a physical examination of a patient.
Radiologic anatomy is the study of internal structure, using X-rays and
other medical imaging techniques described in the next section.
Systemic anatomy is the study of one organ system at a time and is
the approach taken by most introductory textbooks such as this one.
Regional anatomy is the study of multiple organ systems at once in a
given region of the body, such as the head or chest. (See the Atlas of
Regional and Surface Anatomy following chapter 12.) Medical schools
and anatomy atlases typically teach anatomy from a regional perspec-
tive, ­because it is more practical to dissect all structures of the head
and neck, the chest, or a limb, than it would be to try to dissect the
entire digestive system, then the cardiovascular system, and so forth.
Dissecting one system almost invariably destroys organs of other sys-
tems that stand in the way. Furthermore, as surgeons operate on a
particular area of the body, they must think from a regional ­perspective
and attend to the inter­relationships of all structures in that area.
Ultimately, the structure and function of the body result from its
individual cells. To see those, we usually take tissue specimens, thinly
slice and stain them, and observe them under the microscope. This
approach is called histology (microscopic anatomy). Histopathology3
is the microscopic examination of tissues for signs of disease. Cytol-
ogy4 is the study of the structure and function of individual cells.
Many important aspects of human structure are so small we can see
them only with the electron microscope (see chapter 2, section 2.1).
Structure at the subcellular to molecular level is called ultrastructure.
1.1b Methods of Study
There are several ways to examine the structure of the human body.
The simplest is inspection—simply looking at the body’s appearance
in careful detail, as in performing a physical examination or making
a clinical diagnosis from surface appearance. Observations of the
2
from cadere = to fall down or die
3
histo = tissue; patho = disease; logy = study of
cyto = cell; logy = study of
12/8/18 3:00 PM

(a)
Figure 1.1 Evolution of Medical Art. Two illustrations of the skeletal system made about 500 years apart. (a) From an eleventh-century work
attributed to Persian physician Avicenna. (b) From De Humani Corporis Fabrica (1543) by Andreas Vesalius.
©NLM/Science Source
skin and nails, for example, can provide clues to such underlying
problems as vitamin deficiencies, anemia, heart disease, and liver
disease. Physical examinations involve not only looking at the body
for signs of normalcy or disease, but also touching and listening to it.
Palpation5 means feeling a structure with the hands, such as palpat-
ing a swollen lymph node or taking a pulse. Auscultation6 (AWS-cul-
TAY-shun) is listening to the natural sounds made by the body, such
as heart and lung sounds. In percussion, the examiner taps on the
body, feels for abnormal resistance, and listens to the emitted sound
for signs of abnormalities such as pockets of fluid, air, or scar tissue.
A deeper understanding of the body depends on dissection
­(dis-SEC-shun)—the careful cutting and separation of tissues to
reveal their relationships. The very words anatomy7 and dissection8
both mean “cutting apart”; until the nineteenth century, dissection
was called “anatomizing.” In many schools of health science, cadaver
dissection is one of the first steps in the training of students.
Dissection, of course, is not the method of choice when study-
ing a living person! Not long ago, it was common to diagnose
disorders through exploratory surgery—opening the body and tak-
ing a look inside to see what was wrong and what could be done
about it. Any breach of the body cavities is risky, however, and
most exploratory surgery has now been replaced by medical imag-
ing techniques—methods of viewing the inside of the body without
surgery. The branch of medicine concerned with imaging is called
radiology. Anatomy learned in this way is called radiologic anat-
omy, and those who use radiologic methods for clinical purposes
include radiologists and radiologic technicians.
Some radiologic methods involve high-energy ionizing ­radiation
such as X-rays or particles called positrons. These penetrate the
5
palp = touch, feel; ation = process
6
auscult = listen; ation = process
7
ana = apart; tom = cut
8
dis = apart; sect = cut
sal1026X_ch01_001-023.indd 3
CHAPTER ONE The Study of Human Anatomy 3
(b)
tissues and can be used to produce images on X-ray film or through
electronic detectors. The benefits of ionizing radiation must always
be weighed against its risks. It is called ionizing because it ejects
electrons from the atoms and molecules it strikes. This effect can
cause mutation and trigger cancer, so ionizing radiation ­cannot be
used indiscriminately. Used ­judiciously, however, the benefits of a
mammogram or dental X-ray substantially outweigh the small risk.
Some of the imaging methods to follow are considered
­noninvasive because they do not involve any penetration of the skin
or body orifices. Invasive imaging techniques may entail inserting
­ultrasound probes into the esophagus, vagina, or rectum to get
closer to the organ to be imaged, or injecting substances into the
bloodstream or body passages to enhance image formation.
Any anatomy student today must be acquainted with the basic
techniques of radiology and their respective advantages and limita-
tions. Many of the images printed in this book have been produced
by the following techniques.
Radiography
Radiography, first performed in 1895, is the process of photograph-
ing internal structures with X-rays. Until the 1960s, this was the only
widely available imaging method; even today, it accounts for more than
50% of all clinical imaging. X-rays pass through the soft ­tissues of the
body to a photographic film or detector on the other side, where they
produce relatively dark images. They are absorbed, however, by dense
matter such as bones, teeth, ­tumors, and tuberculosis nodules, which
leave the image lighter in these areas (fig. 1.2a). The term X-ray also
applies to a photograph (radiograph) made by this method. Radiogra-
phy is commonly used in dentistry, mammography, diagnosis of frac-
tures, and examination of the chest. Hollow organs can be visualized
by filling them with a contrast medium that absorbs X-rays. Barium
sulfate, for example, is given orally for examination of the esophagus,
stomach, and small intestine, or by enema for examination of the large
12/8/18 3:00 PM
 4 PA R T O N E Organization of the Body
(a) X-ray (radiograph) (b) Cerebral angiogram
(d) Magnetic resonance image (MRI) (e) Positron emission tomographic
(PET) scan
intestine. Other substances are given by injection for a­ ngiography, the
examination of blood vessels (fig. 1.2b). Some disadvantages of radi-
ography are that images of overlapping ­organs can be confusing and
slight differences in tissue density are not easily detected.
Blood vessels can be seen much more sharply, however, with
a new radiographic method called digital subtraction angiography
(DSA). This entails taking X-rays before and after injecting a con-
trast medium into a vessel. A computer then “erases” the first image
from the second, leaving a clear, dark image of just the injected ves-
sels without the overlying and surrounding tissues. This is useful for
showing vascular blockages and anatomical malformations, abnor-
malities of cerebral blood flow, and narrowing (stenosis) of renal
arteries, and as an aid in threading catheters into blood vessels.
Computed Tomography
Computed tomography (a CT scan) is a more sophisticated applica-
tion of X-rays. The patient is moved through a ring-shaped machine
that emits low-intensity X-rays on one side and receives them with
a detector on the opposite side. A computer analyzes signals from
the detector and produces an image of a “slice” of the body about
as thin as a coin (fig. 1.2c). The computer can “stack” a series of
sal1026X_ch01_001-023.indd 4
(c) Computed tomographic (CT) scan
Figure 1.2 Radiologic Images of the
Head. (a) X-ray (radiograph) showing the
bones and teeth. (b) An angiogram of
the cerebral blood vessels. (c) A CT scan
showing a brain tumor. (d) An MRI scan
at the level of the eyes. (e) A PET scan of
the brain. The metabolic activity of brain
regions is indicated by colors from red
(greatest activity) to yellow to green to
blue (lowest activity, representing brain
cavities filled with cerebrospinal fluid).
• What structures are seen better by MRI
than by X-ray? What structures are seen
better by X-ray than by PET?
(a) ©Science Photo Library/Alamy Stock Photo; (b) ©pang_oasis/
Shutterstock; (c) ©Puwadol Jaturawutthichai/Alamy Stock Photo;
(d) ©Alamy; (e) ©Lawrence Berkeley National Library/Getty Images
these images to construct a three-dimensional image of the body.
CT scanning has the advantage of imaging thin sections of the
body, so there is little organ overlap and the image is much sharper
than a conventional X-ray. It requires extensive knowledge of cross-
sectional anatomy to interpret the images. CT scanning is useful
for identifying tumors, aneurysms, cerebral hemorrhages, kidney
stones, and other abnormalities.
The dynamic spatial reconstructor (DSR) is a modified CT
scanner that produces dynamic, three-dimensional video images
rather than two-dimensional static ones. It shows organ motion and
volume changes, and is valuable for visualizing heart movements
and blood flow.
Magnetic Resonance Imaging
Magnetic resonance imaging (MRI) (fig. 1.2d) is better than CT for
visualizing soft tissues. The patient lies in either a tube or an open-
sided scanner surrounded by a powerful electromagnet. Hydrogen
atoms in the patient’s tissues alternately align themselves with this
magnetic field and with a radio-frequency field turned on and off
by the technologist. These changes in hydrogen alignment generate
signals that are analyzed by computer to produce an anatomical
12/8/18 3:00 PM

image. MRI can “see” clearly through the skull and spine to produce
images of the nervous tissue within, and it is better than CT for dis-
tinguishing between soft tissues such as the white and gray matter of
the brain. It has some disadvantages, however, such as the claustro-
phobic feeling some patients experience in the scanner, loud noises
generated by the machine, and long exposure times that prevent
sharp images being made of the constantly moving stomach and
intestines. Open-sided MRI machines are favored by some claustro-
phobic or obese patients, but have weaker magnetic fields, produce
poorer images, and may miss important tissue abnormalities.
Functional MRI (fMRI) is a form of MRI that visualizes moment-
to-moment changes in tissue physiology; fMRI scans of the brain,
for example, show shifting patterns of activity as the brain applies
itself to a specific task. This method has been very useful in clari-
fying which parts of the brain are involved in emotions, thought,
language, sensation, and movement.
Positron Emission Tomography
Positron emission tomography (the PET scan) is used to assess the meta-
bolic state of a tissue and to distinguish which tissues are most active at
a given moment (fig. 1.2e). The procedure begins with an injection of
radioactively labeled glucose, which emits positrons (electron-like par-
ticles with a positive charge). When a positron and electron meet, they
annihilate each other and give off gamma rays that can be detected by
sensors and processed by computer. The result is a color image that shows
which tissues were using the most glucose. In ­cardiology, PET scans can
show the extent of tissue death from a heart attack. Since damaged tissue
consumes little or no glucose, it appears dark. In neuroscience, PET scans
can similarly reveal the extent of brain damage from stroke or trauma.
PET scans are also used to diagnose cancer and evaluate tumor status;
they can often reveal small tumors earlier than they would be detected by
CT or MRI. The PET scan is an example of nuclear medicine—the use of
­radioisotopes to treat disease or to form diagnostic images of the body.
Sonography
Sonography9 is the second oldest and second most widely used
method of imaging. A handheld device pressed against the skin
emits high-frequency ultrasound waves and receives the signals
reflected back from internal organs. Sonography avoids the harm-
ful effects of X-rays, and the equipment is relatively inexpensive
and portable. Its primary disadvantages are that it cannot penetrate
bone and it usually does not produce a very sharp image. Although
sonography was first used medically in the 1950s, images of sig-
nificant clinical value had to wait until computer technology had
developed enough to analyze differences in the way tissues reflect
ultrasound. Sonography is not very useful for examining bones or
lungs, but it is the method of choice in obstetrics, where the image
(sonogram) can be used to locate the placenta and evaluate fetal
age, position, and development (fig. 1.3). Sonography can also be
used to view tissues in motion, such as fetal movements, a beating
heart, and blood ejection from the heart. Sonographic imaging of
the beating heart is called echocardiography. A Doppler ultrasound
scan is a sonographic method for visualizing heart actions and the
flow of blood through the vessels.
9
sono = sound; graphy = recording process
sal1026X_ch01_001-023.indd 5
CHAPTER ONE The Study of Human Anatomy 5
(a)
Figure 1.3 Fetal Sonography.
(a) A patient getting a fetal
sonogram. (b) A three-dimensional
fetal image made at 32 weeks of
gestation.
• Why is sonography safer for
the fetus than radiography or
computed tomography?
(a) ©Keith Brofsky/Getty Images; (b) ©Kenneth Saladin
(b)
Apply What You Know
The concept of MRI was conceived in 1948 but could not
be put into clinical practice until the 1970s. Speculate on a
possible reason for this delay.
1.1c Variation in Human Structure
A quick look around any classroom is enough to show that no two humans
look exactly alike; on close inspection, even identical twins exhibit differ-
ences. Anatomy atlases and textbooks can easily give you the impression
that everyone’s internal anatomy is the same, but this simply is not true.
Books such as this one can teach you only the most common structure—
the anatomy seen in approximately 70% or more of people. Someone who
thinks that all human bodies are the same internally would make a con-
fused medical student or an incompetent surgeon.
Some people completely lack certain organs. For example, most
of us have a palmaris longus muscle in the forearm and a plantaris
muscle in the leg, but not everyone. Most of us have five lumbar ver-
tebrae (bones of the lower spine), but some have four and some have
six. Most of us have one spleen, but some people have two. Most have
two kidneys, but some have only one. Most kidneys are supplied by
a single renal artery and drained by one ureter, but in some people, a
single kidney has two renal arteries or ureters. Figure 1.4 shows some
common variations in human anatomy, and Clinical Application 1.1
describes a particularly dramatic variation.
Apply What You Know
People who are allergic to penicillin or aspirin often wear
bracelets or necklaces that note this fact in case they need
emergency medical treatment and cannot communicate. Why
would it be important for a person with situs inversus (see
Clinical Application 1.1) to have this noted on a bracelet?
12/8/18 3:00 PM
Another random document with
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the various roads in the neighbourhood; he therefore sent for me on
the night previous to the day upon which it was insinuated that he
intended to have abandoned the position. He told me he expected to
be attacked by Marshal Soult in the morning, that he was determined
to stand his ground; but wished to know, if, before Lord Wellington
could come to his assistance, and if such a misfortune should
happen as that of his being obliged, by very superior numbers, and
the unforeseen events of a battle, to fall back, if I was sufficiently
acquainted with the roads around the city to enable me to undertake,
under such circumstances, to conduct the troops, so as to keep them
out of the range of the cannon upon the ramparts of the city. I
replied, that I knew the roads sufficiently for the purpose, and was
about to retire, when he repeated his determination to maintain his
position, and even betrayed a kind of feeling of delight at the idea of
giving Soult and his army battle, with only the few troops he could
oppose to him, until the arrival of Lord Wellington.
Almost at this moment, as I learnt afterwards, an engineer officer (I
don't remember his name) arrived to report himself, who had been
looking for the 3rd division amongst the mountains; I think he said he
had been sent to supply the place of Colonel Burgoyne, who had
been taken ill, and was obliged to go to the rear. Sir Thomas, who at
such a time, would have wished not to be plagued by a stranger,
desired him, partly, it was fancied, with the intention of getting rid of
him, to go and find out the different roads leading to the rear of
Pampeluna; and I have often since wondered if in this could have
originated the silly story of Sir Thomas Picton's intention of
abandoning the position in which the battle was fought, and in which
the 3rd division performed its usual brilliant part.
I think it but fair next to mention, that the dispositions made by the
French at Orthes, were not only superior to what we usually met
with, but they also fought that battle with seemingly more confidence
in themselves, and in their chief, than they had latterly done. For
some time after the action commenced, neither the 3rd nor 4th
divisions, whose movements came more particularly under my
observation, were able to gain any ground to their front, or to set
properly to work; indeed, it was next to impossible for the former to
advance, the position before them being judiciously and most
formidably occupied by a considerable part of Soult's army; and we
were aware that the moment we should attempt to go forward, we
would have been taken in flank by a large body of troops, of whom
part held very strong ground, and part possessed a wooded ravine,
which separated the 3rd from the 4th divisions. We were thus most
provokingly brought to a complete stand, exposed to a heavy
cannonade, and also to the fire of the infantry in our front; and the
French troops will fire away in that manner, and usually with
considerable effect, as long as their opponents please.
Sir Thomas Brisbane saw plainly how his brigade, the most
advanced of the three, was situated; and though most anxious to
push forward to assail the enemy, so well posted in his front, and to
fight as the 3rd division always did, yet in this state of things, it would
have been decidedly wrong to have done so. I was carefully
observing what the French before us, as well as those hitherto
successfully opposed to the 4th division, were about; and seeing a
body of cavalry assembling behind the infantry, with which we were
more particularly engaged, I pointed them out to Sir Thomas
Brisbane, who took such steps as he thought necessary in case of
their venturing to charge us. Impolitic as it was, with such a large
force to contend with, it was evident that there was nothing for it, but
to detach some companies into the ravine, to drive out the French
skirmishers, who invariably took in flank the 4th division, in the
several gallant attempts successively made on the narrow tongue of
land, by the regiments composing it, to get forward. I conclude Lord
Wellington saw how the two divisions were situated, and sent a
considerable part of the light division to our support, and to clear the
ravine; and to my delight, I saw Sir Andrew Bernard coming on at
their head for that purpose.
He soon completely scoured out the ravine, in the style the light
division were accustomed to do every thing they undertook; and it
was then no longer difficult for the 3rd and 4th divisions to advance,
and in a few minutes, the advantageous ground, upon which the
French had made so brave a stand, was in possession of the leading
brigade. A chase then commenced, during which it was found very
difficult to restrain the ardour of the troops, and had it been deemed
advisable for our cavalry to have charged sooner than they did, the
loss of the enemy must have been much greater than it was reported
to be.
I have been again rather minute in detailing the part performed in
this battle by the 3rd division, as I wish to attract attention to the
mode of fighting invariably practised, and with so much success, by
Sir Thomas Picton, who would have thought but little of any
commander of a brigade or regiment who did not instantly, but in
compact order, push forward upon the enemy; a mode of fighting
which he knew to be most suitable to British soldiers and the least
relished by their foes, who would always have preferred firing away,
either skirmishing or even in line.
It was not in the power of the British armies either at Talavera or
Waterloo (the actions which most resembled each other in fighting
under a heavy fire,) to go forward in the manner I have mentioned
against the French; and our losses were, consequently, in both these
actions, very great from the enemy's fire.—Since the battle of
Fontenoy, in which a long-continued steady advance of British
troops, in compact order, effected such wonders, and which would
have been completely successful if supported by the Dutch and the
rest of the Duke of Cumberland's army, down to the present day, I
cannot find that the style of fighting practised in the 3rd division was
ever unsuccessful; but, on the contrary, was always attended with
the best results, and even with much less loss than would have been
sustained in any other mode of acting: I therefore trust I may be
pardoned for having endeavoured to illustrate the correctness of the
opinion I entertain in this respect, not only by what I have related of
the battle of Orthes, but also by the rather minute description I
ventured to give of the achievements of the 3rd division at
Salamanca.
But even in acting as skirmishers on a large scale, when Sir Thomas
Picton's division had, at Vic Bigore, to contend with two French
divisions, each at least equal in number to the 3rd, the same system
of fighting was, as far as practicable, observed. Besides the 5th
battalion 60th, a battalion of Portuguese caçadores and our light
infantry companies, whole regiments, (and here we felt the want of
knowledge of light infantry movements in all corps,) only retaining
some companies in reserve and for support, were engaged as
sharpshooters. They were, however, constantly pushed forward
upon the French, and recommended not to throw away their fire in
long shots, but rather, as much as possible, to endeavour to close
with them; and if a halt was any where perceived in any part of the
advancing skirmishers a staff officer was invariably sent to the point
to ascertain the cause. The French, therefore, invariably gave way,
and in their confused retreat they became exposed, in running from
one enclosure to another, to the fire of our troops. After driving them
for a considerable distance before us in this style, the coming of
night stopped our career, but had we stood and fired, as usual upon
such occasions, this brilliant feat of the 3rd division would never
have been heard of. At dark, Lord Wellington came up to Sir Thomas
Brisbane's brigade, which was still warmly engaged.—He wished to
know how the French, we had so long followed up, were situated;
but so thickly wooded, enclosed, and covered with vineyards was the
neighbourhood of Vic Bigore, near to which this splendid affair
terminated, that it was impossible to give him any information about
them.
A soldier of the 88th, hearing what had been said, volunteered to get
up into a tree, and thereby to make himself an object to be shot at.
This he accomplished with some difficulty, and being asked what he
could see; replied, "Och, nothing but them wearisome vineyards, and
bad luck to them, and a power of their scrimigers." Night closed the
scene, the firing had ceased. The French sentinels and ours being
posted not twenty yards from each other, they, as usual, thought no
more of strife; but in the course of the night, the enemy silently and
quietly moved off towards Tarbes. The day following we crossed the
Adour at that town. Picton was again advancing against the enemy,
whose right having been turned by the divisions on our left, they
were marching, or rather running in great confusion along the road,
which passes through a wooded height above Tarbes to Tournay. Sir
Thomas Brisbane's dispositions were even made to have had a dash
at them; when an order, which greatly surprised us, came for the
troops to halt, when without almost meeting with any resistance, we
must have cut off and taken vast numbers of the fugitives, who were
thus allowed to "live to fight another day." Upon receiving this order
to halt from Sir Thomas Picton's aide de camp, (who was questioned
in order to ascertain if he was sure he was correct in the message he
delivered) I went back to find out what could possibly have
occasioned it. I soon met Sir Thomas, and venturing cautiously to
express my regret at such an opportunity having been allowed to
escape, of intercepting so considerable a number of the enemy's
troops, he replied, "That is no fault of mine; but go now, Sir, and
desire your general to move on." But before I could return to the
brigade, which were greatly amazed at being kept back, the last of
the French were just disappearing behind a hill about half a mile off.
Colonel Napier says, in speaking of French and British soldiers,
"place an attainable object of war before the French soldier, and he
will make supernatural efforts to gain it, but failing, he becomes
proportionally discouraged. Let some new chance be opened, some
fresh stimulus applied to his ardent sensitive temper, and he will rush
forward again with unbounded energy; the fear of death never
checks him, he will attempt any thing."
This is a well-drawn picture of the French, yet I hope he will excuse
me for saying, that I think an officer of great experience, like Colonel
Napier, must often have seen supernatural efforts made by French
officers, both to bring on their men and to make them stand their
ground, but all in vain, when they saw British troops about to close
with them. Again Colonel Napier speaks of the unrelenting vigour of
British infantry, and of their deafening shout, rolling over a field of
battle, more full and terrible than that of any other nation, and
followed by the strong and unwavering charge. All this must be fully
acquiesced in, and the British soldier well merits this praise; for I do
not think that Colonel Napier ever had any difficulty in getting his
men to stand or follow him, either to the charge or to the assault of
the most rugged and impracticable breach; on the contrary, I should
suppose he must have found more difficulty in restraining them in
their headlong course, with their officers, still more daring than
themselves, at their head. In the comparison, therefore, drawn
between French and British soldiers, I consider that Colonel Napier
scarcely does the undaunted brilliant courage of the latter justice,
when he only speaks of the unrelenting vigour of the British infantry. I
conclude, when Colonel Napier composed this passage, he had the
fields of Talavera and Waterloo before his eyes, where, certainly,
great endurance of fire was necessary on the part of British troops,
and where the French had full scope for displaying their best
qualities as soldiers; but in the 3rd division, when it fought in Picton's
style, and was led as he expected his officers to lead, he would, on
all occasions, have witnessed the fine qualities attributed to French
soldiers most amply displayed, and even surpassed. Much, however,
as I admire the undaunted courage of British soldiers in following the
bravest and most noble-minded officers in the world, I cannot be
blind to their imperfections, and especially to their conduct after
victory, and upon other occasions, which often threatened us with
the most serious consequences; and it is this makes me so anxious
to have more of the good and true men of the British empire brought
into our ranks, and of whom there are enough to be found to form a
well conducted invincible army.
But let us imagine such troops as these, in a high state of discipline,
and properly supported by our splendid heavy dragoons and artillery,
charging an enemy sword in hand, in the manner I have before
alluded to, and it may be readily allowed that the fate of a campaign,
or even that of a kingdom, would be decided in a single battle; for the
enemy's troops, thus closed with, could not well escape from the
field; and we should no longer be incredulous when we read of the
consequences resulting from a charge of Roman legions. It has
pleased Divine Providence to form the men of the British empire for
such a kind of warfare; having bestowed upon them daring hearts,
and powerful arms to execute whatever may be required of them.
If ever the plan of calling out men by ballot is adopted, I would beg
leave to suggest, that a certain number of battalions of the regular
army, from adjoining districts, should be permanently considered a
division; and when a force was wanted in any part of the world,
either the division, or a brigade of it, should compose the whole or a
part of that force; and would not thus an esprit du corps be
established in such a division, like what was found so admirably
calculated for mutual support amongst the battalions and brigades of
the light, 3rd, 4th, &c. divisions under the Duke of Wellington; and
which induced them readily to make any effort, or any sacrifice, to
aid each other in battle. And how often have I witnessed this feeling
prevail, to a great extent, among the officers and soldiers of the 45th,
74th, 88th regiments, and 5th battalion, 60th, which composed the
brigade to which I was so long attached as brigade-major. I can
never forget one instance of this kind in particular, which occurred at
the battle of Fuentes d'Onor. After a long and dreadful struggle in
that village, between the British and a large body of the French
Imperial Guard and other troops which supported them, the right
brigade of the 3rd division was at last brought up to take the place of
the fatigued regiments so long engaged, under a heavy fire, without
any decided advantage being gained by either party, the French
holding the lower and our troops the upper part of the village. The
88th, supported by the 45th, was ordered to charge into it and drive
out the enemy. They soon did so in the usual style of the 3rd
division. But I shall ever think with pleasure, of the extraordinary
eagerness evinced by the 45th to advance to the help of their old
friends the Rangers, who on that occasion wanted none. This
feeling, however, between these two corps in particular, was always
most strongly marked throughout the whole war; and I have no doubt
would be revived, if they ever met again in presence of an enemy.
It may, perhaps, be considered out of place, but, before closing this
chapter, I must beg leave to observe that I read—as I think every
one else must have done—with great interest what the Marquis of
Londonderry has told us in the account he has given of his visit to
Russia, of the enormous establishments of the Czar for the
instruction of those intended for the staff and other branches of his
military and naval services. The country ought always to feel
indebted to officers who can, like his Lordship, give useful
information upon such subjects; for we certainly, by some means or
other, should be made acquainted with what is going on in the
military and naval world. And although the grand reviews, or showing
off of troops and establishments were evidently got up in order to
produce strong impressions, I feel confident it must, hereafter, be
found that the expense of keeping up the latter will be much greater
than the advantages to be derived from them. But our army does not
require such an extended and overgrown system, which is neither
suited to the feelings, ideas, or the genius of the free people of the
British Empire.—An absolute government, which may one day have
cause to tremble at the effects of what it has produced, could alone
be supposed capable of creating and carrying out a plan of such
magnitude, and which must, I should fear, prove hazardous to the
safety of the country in which it is adopted, and also to its
institutions.—I certainly would require that all gentlemen intended for
commissions in our service should have had a certain military or
naval education, but I would not ask where it had been acquired,
provided they could pass the examinations I have already alluded to.
From our staff, at their own cost, well and probably expensively
educated, we might naturally expect that officers would be selected,
to be employed as consuls or otherwise, in ascertaining what might
be going forward in countries likely to be, or which have already
become the scenes of warfare, and about which, or the parties
engaged, Great Britain might be deeply interested, yet not altogether
justified in taking an active part in the contest, such as Circassia,
Persia, South America, and perhaps Spain; and, above all, we might
constantly have an eye upon our North American democratic
neighbours, who can only be properly dealt with by a military
governor-general of the whole of our North American territories, and
who should be entrusted with much authority, both civil and military,
so that he could act at all times with decision and promptitude.
Accomplished staff officers, such as I have in view, could give such
information as might be relied upon, and would enable those, who
direct the affairs of this great empire, to act judiciously and
advantageously; and when these officers wished to do so, they
ought to be allowed to go wherever war of any kind was carrying on,
if it were only with the view of acquiring greater knowledge of their
profession; for no matter what might be the nature of the warfare,
some things may always be learnt. But these officers should, at the
same time, be strictly prohibited from meddling with, or in any way
aiding, or advising either party, without permission to do so from our
Government. Civilians, in general, ought to be looked upon as not
calculated for employment such as that I speak of, and we had once
a lesson given us in this respect, if we will only profit by it, when Sir
John Moore's army was so nearly lost through the foolish
presumption of our agent or minister, sent out to the Spanish
government of that day.
Many think that France could not be better governed than it is at
present by Louis Philip, who is universally allowed to be an able
sovereign; but I have often heard the question asked, how it was,
that Paris, and all France in its train, fell so easily and unaccountably
into the hands of the men of July, 1830. Although I know Paris
tolerably well, and a good deal of France and Frenchmen, yet the
only answer, I believe, that can be given is, that it did not suit the
views, prejudices, or feelings of the military, that the existing order of
things should be maintained; many of them, very probably, at the
time belonging to the political coteries, with which Paris in particular
always abounds, and in which are broached and discussed the
strangest possible doctrines and dogmas. British officers can never
belong to such dangerous associations, if they even did exist in the
United Kingdom.
Any tumultuous assemblage of men, if even partially armed, can at
first, as was the case the other day at Newport, be easily dispersed
or put down, by rightly disposed and well officered regular troops. As
for the barricades, of which we heard so much, they could only have
led, had the troops done their duty, to the greater destruction of the
city and the rioters; but as they were put up, why did an able and
enlightened officer like Marshal Marmont, who commanded, send his
soldiers in the manner he did into the streets of Paris, for this was
quite as useless as our going headlong into those of Buenos Ayres,
where some streets, and almost every house, were strongly
barricaded, and yet I believe we forced them all; but probably, if he
had ever heard of our exploits there, he had forgotten them. It
appears strange to many, that Mont-Martre and other commanding
points in and about Paris were not occupied by the Marshal in force
with cannon and mortars, his communications with the country
secured by his cavalry, and that he did not, without delay, bring up to
the capital a sufficient number of troops to restore order. But even
before their arrival, it is likely, that the peaceable and well-disposed
part of the inhabitants, and especially the householders, would have
found it to be their interest to declare openly against a lawless mob
and their political leaders; and to have taken part with the troops
opposed to them; but should this not have been the case, and it then
clearly appearing, that all were leagued to resist the established
government, which it is the duty of armies in all countries to uphold,
the Marshal, however painful it might have been to his feelings,
could have had no alternative but to announce to the riotous people,
that if tranquillity and obedience to the laws, and to the constituted
civil authorities, were not instantly restored, Paris, with the view of
punishing its lawless inhabitants, would be laid in ruins. It will no
doubt be asked, if such reasoners would have consented to destroy
that large, beautiful, and populous city, the seat of the arts, and
where every thing magnificent is to be found? Blucher would have
done this for them sometime before, for he had a great fancy to treat
Paris as General Steinbock did Altona years ago, had it not been for
Lord Wellington; and for this, I fear, the French people were not
afterwards even grateful to him. But this question is very like one I
had put to me some time ago, when I ventured to hint, that a certain
determined mode of acting, would, in the end, but in another country,
prove to be the most humane, viz. "Would you shoot the people—the
poor misguided people of Ireland?" I answered, that as an officer, I
should be obliged to do so, however reluctant I might be to adopt
such a measure; but I would begin with their selfish agitators, if they
would not discontinue their wicked practices, and cease holding out
expectations to the people of a dismemberment of the empire, and
allow the laws, whatever they may be, to be obeyed. If the laws are
bad, or fancied to be bad, and if they do not please all men, without
regard to difference of religion, and in other respects, upon an
equality, let the Government, whose business it is, endeavour to
have them altered; but as long as they stand the laws of the realm, it
is the duty of officers and soldiers to uphold them, and the civil
authorities in the execution of them, and they have nothing more to
say to the matter. Had the French acted thus, and upon such
principles—for I cannot suppose that their officers had lost all
influence and command over their men—and as I am convinced,
British officers, if necessary, would act, we should not now have
before our eyes the awful example, of an established government
overturned, as was the case in 1830, and which, with what has
occurred in that country for many years past, ought to be held up for
ever as a lesson to the United Kingdom. I hope, however, that Great
Britain will never become so humbled, as to require salvation from
naval and military patriotism; but I boldly assert, and without fear of
contradiction, that no where on earth, amongst men, is this virtue to
be found so pure as in the hearts of the officers of our navy and
army.

FOOTNOTES:
[1] N.B. Many of the absentees did not, as was supposed, fall into
the hands of the enemy, but had gone off in search of liquor or
plunder.
 CHAP. VIII.
There is no country with which Great Britain is likely so soon to
come into hostile contact as the United States of America, and for
such a war we must certainly want an army such as I have in view.
It has long been the fashion, and I believe it is the object of many
interested and designing men, to endeavour to have the United
States of America considered as much more powerful and
dangerous to Great Britain then they really are. No nation, nor body
of men, be they who they may, composed of such heterogeneous
materials, scattered over so vast an extent of territory, in which the
laws, enacted by an often unruly legislature, are so powerless, and
in many places so weakly administered, as not to be able to prevent
aggressions upon an unoffending neighbour, or to afford sufficient
protection to the peaceably inclined against the hand of violence,
can possibly be considered powerful. I am aware that parts of the
United States ought, to a certain extent, to be looked upon as
exceptions, but, generally speaking, this is by no means an over-
drawn picture of what is the state of society in that part of the world.
If Great Britain was only prepared to convince the world of her
strength in steam ships, and to send forth even a portion of them
from the St. Lawrence, and from other points in our valuable North
American possessions, she must in a very short time destroy, or shut
up in their ports, in hopeless inactivity, all the so much boasted of
Navy or traders of the United States. And it might be asked—would
any other power, when they saw we were really in earnest, dare to
aid them in their difficulties; and what would then become of their
immense commerce, from which alone they derive their present
importance? Are not the feelings and interests of the Northern,
Southern and inland States directly opposed to each other; and
would not the continuance of the last war, for even a short time
longer, have had the effect of causing discontents and divisions
amongst the several States, already independent of each other,
which could never again, in all human probability, have been brought
in consequence to act in unison.
But to convince even the most incredulous of this, and of the kind of
spirit which was found to exist amongst the people of the States, and
to point out clearly with what zeal and patriotism we were opposed in
the last war in the march of our troops upon Plattsburg, I have only
to lay before them some Brigade orders which were issued by Sir
Thomas Brisbane at the time.
"No. 5. None of the inhabitants of the country are to be prevented
from passing the advanced posts either to the front or rear, from one
hour after sunrise till sunset; and they are to be permitted to drive in
cattle, or any thing else they may think fit; but officers commanding
picquets are to be very careful in examining those who pass; and
must take up, and send to the head-quarters of the Brigade (Dowy's
house) such as may appear suspicious.
"No. 7. Major-General Brisbane having received instructions to
advance with the troops under his command into the territory of the
United States, avails himself of the opportunity, to request that
commanding officers will use every exertion to maintain the strictest
discipline in their corps; and he holds them responsible, that in every
instance when a complaint is made to them of any injury sustained
by the inhabitants, that it is inquired into, and if necessary redressed;
and whatever damage is done, that it is instantly paid for and
charged against those concerned, and where this cannot be
ascertained to the corps in general, so that unoffending people may
not be sufferers.
"In taking the necessary precautions against individuals, who may so
far forget what is due to themselves and their country, as to commit
acts of plunder or violence, the Major-General is at the same time
fully convinced, that the troops in general are determined, that their
conduct shall not bring disgrace upon the British name; he therefore
calls upon them to discover those who may be guilty of acts of
plunder or oppression, that they may be brought to the punishment
they merit; and the soldiers must soon find that such a line of
conduct will add much to their comforts; for the inhabitants of the
country finding that they are properly treated and protected, will bring
every article requisite into the camp; for those who remain quiet in
their homes are not in the smallest degree to be molested, nor is
their property to be taken from them without their full consent and its
being paid for; as it is not against such persons that Great Britain
makes war, but against the Government whose folly and ambition
have brought the miseries of war into their country, and the army and
individuals in arms for its support.
"The Major-General commanding has requested the magistrates of
the country, to explain to the people his object and determination, on
entering the American territory; and he trusts that the conduct of the
soldiers will be such as to reflect no shade of dishonour on their
country."
The apparent state of indifference of the people was so great, and
the effects of these orders, which were widely circulated, so evident,
that we found all the houses occupied, and every thing might have
led us to suppose we were still marching through Canada; and I do
not remember that a shot was fired at us until we fell in with some of
the United States troops as we approached Plattsburg.
Owing to a want of arrangement, and of sufficient preparation on our
part, we were last war unsuccessful upon Lake Champlain, and upon
its shores; and I had the mortification of seeing our fleet discomfited
in Plattsburg Bay. In consequence of this, and of the advanced state
of the season, and as no calculations of any kind seemed to have
been made for contingencies, our fine, but feebly commanded, army
had to fall back upon Canada; and the extensive and important
conquests, which were supposed to have been the objects of those
who ordered us to advance into the States, had to be abandoned.
The Americans pretended, that, in our retreat, they hotly pursued,
and occasioned us great losses; but there was no foundation
whatever for what they in this respect asserted, or for what was said
on this subject in their newspapers; for our only loss, I may say,
consisted in some heavy shot and an old gun, taken from the
Americans, and which had been left many years before in the States
when General Burgoyne's expedition failed, and which the state of
the roads obliged us to throw into the swamps, and in some
worthless men who deserted from their corps; for, whatever might
have been said to the contrary, nothing could be more unhurried or
undisturbed than we were in all our movements during the retreat. I
do, however, recollect, that in crossing the bridge at Champlain with
the rear-guard, on our return, that a Yankee had the impudence to
say, when spoken to with civility: "I guess as how you are not playing
Yankee doodle now." Some of the soldiers were inclined to have
thrown him into the river, but of course this was not allowed.
I was attached as Brigade-Major to the strong brigade (about 5,000
men) of the army, which, under Sir Thomas Brisbane, formed its
rear-guard, and I can safely say, that although various stratagems
were practised, and every thing done by him so as to induce the
American commander to approach us, he never was able to
succeed. I only mention this to show what grounds they had for
boasting. But is it not also too bad and vexatious that works written
by American authors are patronized and lauded even in the United
Kingdom, not so much perhaps on account of their style of
composition, or literary merits, as for the subjects they contain; which
are intended to extol, chiefly at the expense of our navy, fierce and
lawless men, many of whom were actually British subjects? Yet who
can for a moment suppose, that sending British seamen or landsmen
to the other side of the Atlantic, can deprive them of their natural
courage. There is, however, a degree of moral depravity existing
throughout the Union, which must always prevent these
extraordinary Republicans, should they even become more powerful
than they are at present, from being able to cope with us in war. And
in speaking of the degree of liberty enjoyed in the United States and
in Great Britain, what comparison can be drawn in this respect
between the two countries?—for who would prefer the tyrannical rule
of a usually tumultuous Democracy to the mixed Government under
which all men enjoy protection and sufficient liberty in the United
Kingdoms, and all over our vast empire, without its being allowed to
become licentiousness?
As for the unfinished works at Plattsburg, had not Sir George
Prevost halted the troops, led by experienced and often before
distinguished generals, rapidly advancing against them, they must,
with their commander and all his troops, have been, I have no
hesitation in saying, in twenty minutes more in our possession; but
as for the idea which was foolishly entertained by some at the time,
of our being able, if successful in the assault of the works, to re-
capture our lost ship and vessels, it was too absurd to merit a
moment's consideration.
The following official document will, I expect, be read with interest,
as it certainly removes much of the blame from Sir George Prevost
for the attack having been made upon the American fleet by ours in
an unprepared state; at least our Commodore (whether he was
injudiciously urged to go forward or not I cannot tell) acted with a
perfect knowledge of what he was about to attempt, and it would
have been produced had the former been brought to a court-martial
as intended. But the question should have been, why was the fine
army, confided to Sir George Prevost, pushed forward at all into the
United States, especially in the month of September, before our
superiority on Lake Champlain had been established? Extract from a
communication to Major-General De Rottenburg, dated Friday
evening, 10 o'clock, p.m.:—
"I have this moment received from Captain Downie intelligence of his
intention to weigh and proceed with the squadron, from its
anchorage off Chazy, about midnight, with the expectation of
rounding into the Bay of Plattsburg about the dawn of day, and with
the intention of commencing an immediate attack on the enemy's
ship, vessels, and gun-boats, if the anchorage they are in affords
any chance of success; in consequence you are to hold the left
division in readiness to execute the contemplated service at six
o'clock to-morrow morning.
"The batteries directed to be completed and armed in the course of
the night, are to open on the enemy's position the instant the naval
action has commenced. You will cause the necessary preparations
to be made for the rocket service of each battery.
(Signed), "G. Prevost,
"Commander of the Forces."
I shall pass this over without any remark, leaving it to the reader to
judge for himself; but we had far too many commanders, for they
were actually in each other's way. Here was Sir George Prevost
himself, Baron De Rottenburg and his staff, a brilliant head-quarter
staff, consisting of Adjutant and Quarter-master-general, assistants
to both; Military Secretary, Aides-de-Camp, Chiefs of Engineers,
Artillery, &c. &c., in short, enough to have caused confusion in an
army three times our numbers, and much more so amongst the three
brigades, whose experienced generals and staff wanted no help.
The moment the naval action commenced, the batteries, which had
been constructed entirely under Sir Thomas Brisbane's directions,
opened such a well-directed fire, that they apparently demolished all
before them, and in a very short time nearly silenced that of the
enemy's guns in their works. Under the protection of our artillery, the
bridge over the Seranac, (the planks only of which the Americans in
their retreat had been able to destroy or take up,) was repaired in a
few minutes by materials we had ready for the purpose; part of the
troops, under Sir Thomas Brisbane were moving down to pass by it
to the assault, and the greater part were marching rapidly under
General Sir Manley Power, and Sir Frederick Robinson, with the
intention of effectually cutting off the enemy's retreat, when the order
from Sir George Prevost to halt arrived, in consequence of our fleet
having been discomfited upon the Lake. It is, however, to be
regretted that the works were not allowed to be carried, for it would
have prevented much boasting, and would have served in some
manner to counterbalance the loss of our vessels. But what I
witnessed during the whole of this unfortunate and miscalculated
business, convinced me that the enterprise which embraced, as we
understood, many extensive and important objects, no doubt
suggested from England, had been begun without almost any fixed
plan, carried on in considerable ignorance of the country, and
ultimately abandoned, because of an event, the probability of which
occurring, from the state of the two fleets, might, in a great measure,
have been calculated upon.
Any one of the three strong brigades into which our force was
divided was sufficient alone for all we had hitherto undertaken, and
also for the reduction of Plattsburg, if properly handled by an able
and experienced officer: but the ideas of military matters entertained
by the Generals and Staff we found in possession of power were
very different from ours; and I merely mention this to shew, that until
our Staff had acquired experience under the Duke of Wellington,
they were in general very deficient, and, as a further proof of this, I
must observe, that nothing could betray greater weakness and
indecision than the manner in which it was proposed to move upon
Plattsburg.
It was at first intended that we were to have had a large body of
Indian warriors along with us in our invasion of the States; and Sir
Thomas Brisbane, attended by his Staff and several other officers,
had to go through all the customary ceremonies of war councils,
speeches, dances, presents, feastings, drinkings, &c., but after all
we only took them with us as far as the village of Champlain, and
from thence, to my great delight, at the request of Sir Thomas
Brisbane, they were sent back into Canada.
It was also intended that the whole army were to have moved in one
column, by the road leading to Plattsburg, which crosses the Dead
Creek, near to its mouth, where there is a bridge, and a ford a little
lower down, where it enters the Lake, and there we knew the enemy
had for some time been preparing to receive us. Sir Thomas
Brisbane, who led the advance, not looking upon this plan as
judicious, and being also fully aware of the difficulties which this
Creek even naturally presented, sent me from Champlain,
accompanied by some flank companies and Indian warriors, which
altogether formed a strong reconnoitring party, to ascertain if a road
fit for the march of troops and cannon, (of which we had lately
heard), could not be found to our right, and by which the formidable
position of the Dead Creek might be turned. I marched by what is
called the Batemantown road, and very soon found that it had been
made, even as far as Plattsburg, fit for any military purposes, at
least, at that time of the year.
Sir Thomas Brisbane, at such an evident proof of want of necessary
and proper information on the part of our Staff, (for we were still
strangers in the country), had almost made up his mind to allow
them to take their own way and to march as they intended; but those
feelings he has so often evinced for the welfare of those placed
under his command, and for the good of the service; together with
being convinced, that his brigade must have suffered severely in
forcing the Creek, induced him to communicate in time with head-
quarters on the subject, and the consequence was, that the whole
arrangements were altered; his own column only marching towards
the mouth of the Creek, and the other two taking the road, which, it
had been ascertained, turned the enemy's position. The result was,
that the Americans had to retreat upon Plattsburg without being able
to offer almost any resistance; and the only loss, I may say, we did
sustain was from the fire from the enemy's gun-boats stationed at
the mouth of the creek, where we were obliged to ford it, as the
bridge had been nearly destroyed. Sir Thomas Brisbane was
anxious to have turned our field artillery against the gun-boats. But a
senior general, who happened to be present, would not allow this to
be done; as he said it would only the more attract the enemy's fire
towards a point upon which it was already directed with right good
will. He, however, at last went off, as my general had previously
done with the advance towards Plattsburg, when our rocket-brigade
was brought forward, and a rocket well laid by the officer
commanding it, having, I believe the very first discharge, struck one
gun-boat, and as we heard afterwards wounded the officer
commanding on board, and as it in its continued flight went close
over most of the others, the whole took to their oars in an instant,
and we were no more molested by them.
Up to this period the war had been carried on in a very irritating
manner, and in some instances in a way which could produce no
advantage to either party; for even sentinels on their posts were
cautiously approached and fired at.
Sir Thomas Brisbane proposed to the American generals Izard and
M'Combe, to put an end to such barbarities, and in future to carry on
military operations in the manner adopted by European nations. This
being readily agreed to by them, I did not hear of another instance of
the kind occurring upon either side as long as the war lasted; indeed,
this kind of polite intercourse between the generals was attended
with the best results, not only amongst those under them, but also
produced feelings of respect and offers of attention, if opportunity
offered, after the war was over.
Neither during our expedition to Plattsburg, nor for some time
afterwards were our affairs in the Lower Province well managed.
Just before the closing in of the ice on the lake, and when a part of
the United States fleet were still at Plattsburg, but, as we well knew,
from good authority, completely off their guard, and full of that
dangerous confidence often arising out of a victory too easily
achieved, it was arranged to surprise and capture them by our gun-
boats, and a number of batteaux manned by volunteers, of which
there were hundreds from the regiments. The attempt was intended
to have been made in the night; the soldiers in the batteaux being
armed with cutlasses, pistols, and with boarding pikes, of which
there were plenty at Isle aux Noix; and the following letter was
addressed, by order of Sir Thomas Brisbane, by me to the lieutenant
of the Navy in command of the gun-boats there; who, as it may be
well supposed, being delighted at an opportunity of retaliating upon
the Americans, most readily agreed to the proposal contained in it.
"St. Johns, November 12, 1814.

"Sir,
"Major-General Brisbane has desired me to communicate the
following circumstances to you, with a view to induce you to co-
operate in an attack upon such of the enemy's fleet as still remain in
the Bay of Plattsburg, upon which, with your assistance, it is
proposed by Sir George Prevost to make the attempt.
"The enemy's force there, by the latest information, consists of only
two sloops, and seven gun-boats, indifferently manned, and little or
no attention is paid to the common measures of precaution. It is
therefore natural to suppose, a sudden attack, or even surprise,
might be attempted with every prospect of success.
"On our part we can only employ batteaux for this enterprise,
manned by volunteers from the regiments, in such numbers as you
would think necessary to act along with your gun boats; and the