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Chapter 10 12.1b Muscles That Move the Glenohumeral Joint/Arm 357
12.1c Arm and Forearm Muscles That Move the Elbow
Muscle Tissue and Organization 287 Joint/Forearm 360
10.1 Properties of Muscle Tissue 288 12.1d Forearm Muscles That Move the Wrist Joint, Hand,
and Fingers 364
10.2 Characteristics of Skeletal Muscle Tissue 288
12.1e Intrinsic Muscles of the Hand 371
10.2a Functions of Skeletal Muscle Tissue 288
10.2b Gross Anatomy of Skeletal Muscle 288 12.2 Muscles of the Pelvic Girdle and Lower Limb 374
10.2c Microscopic Anatomy of Skeletal Muscle 291 12.2a Muscles That Move the Hip Joint/Thigh 374
12.2b Thigh Muscles That Move the Knee Joint/Leg 380
10.3 Contraction of Skeletal Muscle Fibers 297
12.2c Leg Muscles 382
10.3a The Sliding Filament Theory 297
12.2d Intrinsic Muscles of the Foot 383
10.3b Neuromuscular Junctions 297
10.3c Physiology of Muscle Contraction 298
10.3d Muscle Contraction: A Summary 300 Chapter 13
10.3e Motor Units 302
Surface Anatomy 394
10.4 Types of Skeletal Muscle Fibers 303
13.1 A Regional Approach to Surface Anatomy 395
10.4a Distribution of Slow Oxidative, Fast Oxidative,
and Fast Glycolytic Fibers 304 13.2 Head Region 395
13.2a Cranium 396
10.5 Skeletal Muscle Fiber Organization 305
13.2b Face 396
10.5a Circular Muscles 305
10.5b Parallel Muscles 305 13.3 Neck Region 396
10.5c Convergent Muscles 306 13.4 Trunk Region 398
10.5d Pennate Muscles 306 13.4a Thorax 398
© McGraw-Hill Education/
10.6 Exercise and Skeletal Muscle 307 13.4b Abdominopelvic Region 400 Jw Ramsey, photographer

10.6a Muscle Hypertrophy 307 13.4c Back 400

10.6b Muscle Atrophy 307 13.5 Shoulder and Upper Limb Region 401
10.7 Levers and Joint Biomechanics 307 13.5a Shoulder 402
10.7a Classes of Levers 307 13.5b Axilla 402
10.7b Actions of Skeletal Muscles 307 13.5c Arm 402
13.5d Forearm 403
10.8 The Naming of Skeletal Muscles 308
13.5e Hand 403
10.9 Characteristics of Cardiac and Smooth Muscle 310
10.9a Cardiac Muscle 310
13.6 Lower Limb Region 405
13.6a Gluteal Region 405
10.9b Smooth Muscle 310
13.6b Thigh 405
10.10 Aging and the Muscular System 311
13.6c Leg 406
10.11 Development of the Muscular System 311
13.6d Foot 406

Chapter 11 Chapter 14
Axial Muscles 320
11.1 Muscles of the Head and Neck 321 Nervous Tissue 411
11.1a Muscles of Facial Expression 321 14.1 Organization of the Nervous System 412
11.1b Extrinsic Eye Muscles 326 14.1a Structural Organization: Central and
Peripheral Nervous Systems 412
11.1c Muscles of Mastication 330
14.1b Functional Organization: Sensory and
11.1d Muscles That Move the Tongue 330
Motor Nervous Systems 412
11.1e Muscles of the Pharynx 331
11.1f Muscles of the Anterior Neck 332
14.2 Cytology of Nervous Tissue 414
14.2a Neurons 414
11.1g Muscles That Move the Head and Neck 335
14.2b Glial Cells 417
11.2 Muscles of the Vertebral Column 338
14.3 Myelination of Axons 421
11.3 Muscles of Respiration 340
14.3a Myelination 421
11.4 Muscles of the Abdominal Wall 343
14.3b Nerve Impulse Conduction 422
11.5 Muscles of the Pelvic Floor 346
14.4 Axon Regeneration 423
14.5 Nerves 424
Chapter 12 14.6 Synapses 426
Appendicular Muscles 351 14.6a Synaptic Communication 427
12.1 Muscles of the Pectoral Girdle and Upper Limb 352 14.7 Neural Integration and Neuronal Pools 428
12.1a Muscles That Move the Pectoral Girdle 352 14.8 Development of the Nervous System 430
vii
Chapter 15
Brain and Cranial Nerves 435
15.1 Brain Development and Tissue Organization 436
15.1a Embryonic Development of the Brain 437
15.1b Organization of Neural Tissue Areas in
the Brain 440
15.2 Support and Protection of
the Brain 442
15.2a Cranial Meninges 444
15.2b Brain Ventricles 446
15.2c Cerebrospinal Fluid 446
15.2d Blood-Brain Barrier 450
15.3 Cerebrum 450
15.3a Cerebral Hemispheres 450
15.3b Functional Areas of the Cerebrum 452
15.3c Central White Matter 455
15.3d Cerebral Nuclei 457
15.4 Diencephalon 458
15.4a Epithalamus 459
15.4b Thalamus 459
15.4c Hypothalamus 460
15.5 Brainstem 461
15.5a Midbrain 461
15.5b Pons 461
15.5c Medulla Oblongata 464
15.6 Cerebellum 465
15.6a Cerebellar Peduncles 466
15.7 Limbic System 466
15.8 Cranial Nerves 469
Chapter 16
Spinal Cord and Spinal
Nerves 482
16.1 Gross Anatomy of the
Spinal Cord 483
16.2 Spinal Cord Meninges 485
16.3 Sectional Anatomy of the Spinal Cord 487
16.3a Distribution of Gray Matter 487
16.3b Distribution of White Matter 489
16.4 Spinal Nerves 489
16.4a Spinal Nerve Distribution 489
16.4b Nerve Plexuses 491
16.4c Intercostal Nerves 492
16.4d Cervical Plexuses 492
16.4e Brachial Plexuses 493
16.4f Lumbar Plexuses 498
16.4g Sacral Plexuses 501
16.5 Reflexes 502
16.5a Components of a Reflex Arc 505
16.5b Examples of Spinal Reflexes 507
16.5c Reflex Testing in a Clinical Setting 507
16.6 Development of the Spinal Cord 508
viii
Chapter 17
Pathways and Integrative
Functions 513
17.1 General Characteristics of Nervous
System Pathways 514
17.2 Sensory Pathways 514
17.2a Functional Anatomy of Sensory Pathways 515
17.3 Motor Pathways 518
17.3a Functional Anatomy of Motor Pathways 518
17.3b Levels of Processing and Motor Control 523
17.4 Higher-Order Processing and Integrative Functions 523
17.4a Development and Maturation of Higher-Order
Processing 524
17.4b Hemispheric Lateralization 524
17.4c Language 524
17.4d Cognition 525
17.4e Memory 526
17.4f Consciousness 527
17.4g Electroencephalogram 528
17.4h Sleep 528
17.5 Aging and the Nervous System 530
Chapter 18
Autonomic Nervous System 535
18.1 Comparison of the Somatic and
Autonomic Nervous Systems 536
18.1a Motor Neurons of the Somatic Versus
Autonomic Nervous Systems 537
18.2 Divisions of the Autonomic Nervous
System 538
18.2a Functional Differences 538
18.2b Anatomic Differences in Lower Motor Neurons 539
18.3 Parasympathetic Division 540
18.3a Cranial Components 540
18.3b Pelvic Splanchnic Nerves 542
18.3c Effects and General Functions of the Parasympathetic
Division 542
18.4 Sympathetic Division 542
18.4a Organization and Anatomy of the
Sympathetic Division 542
18.4b Sympathetic Pathways 545
18.4c Effects and General Functions
of the Sympathetic Division 545
18.5 Other Features of the Autonomic Nervous System 547
18.5a Autonomic Plexuses 547
18.5b Enteric Nervous System 548
18.5c Overview of ANS Neurotransmitters 548
18.5d Autonomic Tone 549
18.5e Dual Innervation 550
18.5f Systems Controlled Only by the Sympathetic Division 550
18.5g Autonomic Reflexes 550
18.6 CNS Control of Autonomic Function 552
18.7 Development of the Autonomic Nervous System 553
 20.11 Development of the Endocrine System 625
Chapter 19 20.11a Adrenal Glands 625
Senses: General and Special 557 20.11b Pituitary Gland 625
19.1 Introduction to Sensory Receptors 558 20.11c Thyroid Gland 627
19.1a Properties of Sensory Receptors 558
19.1b Classification of Sensory Receptors 559
19.2 Tactile Receptors 562
Chapter 21
19.2a Unencapsulated Tactile Receptors 562 Blood 631
19.2b Encapsulated Tactile Receptors 562 21.1 General Composition and Functions of Blood 632
19.3 Gustation 563 21.1a Components of Blood 632
19.3a Papillae and Taste Buds of the Tongue 563 21.1b Functions of Blood 633
19.3b Gustatory Discrimination 565 21.2 Blood Plasma 633
19.3c Gustatory Pathways 566 21.2a Plasma Proteins 633
19.4 Olfaction 566 21.2b Differences Between Plasma and Interstitial Fluid 634
19.4a Olfactory Receptor Cells 568 21.3 Formed Elements in the Blood 634
19.4b Olfactory Discrimination 568 21.3a Erythrocytes 635
19.4c Olfactory Pathways 568 21.3b Leukocytes 642
19.5 Vision 568 21.3c Platelets 644
19.5a Accessory Structures of the Eye 568 21.4 Hemopoiesis: Production of Formed Elements 645
19.5b Eye Structure 570 21.4a Erythropoiesis 647
19.5c Visual Pathways 578 21.4b Thrombopoiesis 647
19.5d Development of the Eye 579 21.4c Leukopoiesis 647
19.6 Equilibrium and Hearing 581
19.6a External Ear 581 Chapter 22
19.6b Middle Ear 582
19.6c Inner Ear 583 Heart 650
19.6d Development of the Ear 594 22.1 Overview of the Cardiovascular System 651
22.1a Pulmonary and Systemic Circulations 651
22.1b Position of the Heart 652
Chapter 20 22.1c Characteristics of the Pericardium 652
22.2 Anatomy of the Heart 653
Endocrine System 601 22.2a Heart Wall Structure 654
20.1 Endocrine Glands and Hormones 602 22.2b External Heart Anatomy 654
20.1a Overview of Hormones 602 22.2c Internal Heart Anatomy: Chambers
20.1b Negative and Positive Feedback 604 and Valves 654
20.2 Hypothalamic Control of the Endocrine System 604 22.3 Coronary Circulation 660
20.3 Pituitary Gland 607 22.4 How the Heart Beats: Electrical Properties of
20.3a Anterior Pituitary 607 Cardiac Tissue 662
20.3b Posterior Pituitary 610 22.4a Characteristics of Cardiac Muscle Tissue 662
20.4 Thyroid Gland 611 22.4b Contraction of Heart Muscle 663
20.4a Synthesis of Thyroid Hormone by Thyroid Follicles 611 22.4c The Heart’s Conducting System 664
20.4b Thyroid Gland–Pituitary Gland Negative Feedback 613 22.5 Innervation of the Heart 665
20.4c Parafollicular Cells 614 22.6 Tying It All Together: The Cardiac Cycle 667
20.5 Parathyroid Glands 616 22.6a Steps in the Cardiac Cycle 667
20.6 Adrenal Glands 617 22.6b Summary of Blood Flow During the Cardiac Cycle 667
20.6a Adrenal Cortex 619 22.7 Aging and the Heart 670
20.6b Adrenal Medulla 621 22.8 Development of the Heart 671
20.7 Pancreas 621
20.8 Pineal Gland and Thymus 624
20.9 Endocrine Functions of the Kidneys, Heart,
Chapter 23
Gastrointestinal Tract, and Gonads 624 Vessels and Circulation 677
20.9a Kidneys 625 23.1 Anatomy of Blood Vessels 678
20.9b Heart 625 23.1a Blood Vessel Tunics 678
20.9c Gastrointestinal Tract 625 23.1b Arteries 679
20.9d Gonads 625 23.1c Capillaries 680
20.10 Aging and the Endocrine System 625 23.1d Veins 684
ix
23.2 Blood Pressure 685
23.3 Systemic Circulation 686
23.3a General Arterial Flow Out of the Heart 686
23.3b General Venous Return to the Heart 687
23.3c Blood Flow Through the Head and Neck 687
23.3d Blood Flow Through the Thoracic and
Abdominal Walls 691
23.3e Blood Flow Through the Thoracic Organs 694
23.3f Blood Flow Through the Gastrointestinal Tract 695
23.3g Blood Flow Through the Posterior Abdominal Organs,
Pelvis, and Perineum 699
23.3h Blood Flow Through the Upper Limb 699
23.3i Blood Flow Through the Lower Limb 703
23.4 Pulmonary Circulation 703
23.5 Review of Heart, Systemic, and Pulmonary
Circulation 706
23.6 Aging and the Cardiovascular System 708
23.7 Blood Vessel Development 708
23.7a Artery Development 708
23.7b Vein Development 709
23.7c Comparison of Fetal and Postnatal Circulation 710
25.4 Lungs 756
25.4a Pleura and Pleural Cavities 756
25.4b Gross Anatomy of the Lungs 756
25.4c Blood Supply To and From the Lungs 757
25.4d Lymphatic Drainage 759
25.5 Pulmonary Ventilation 760
25.6 Mechanics of Breathing 761
25.6a Skeletal Muscles of Breathing 761
25.6b Volume Changes in the Thoracic Cavity 761
25.7 Innervation of the Respiratory System 762
25.7a Ventilation Control by Respiratory Centers of the Brain 762
25.8 Aging and the Respiratory System 765
25.9 Development of the Respiratory System 768
Chapter 26
Digestive System 773
26.1 General Structure and Functions of the Digestive
System 774
26.1a Digestive System Functions 774
26.2 Oral Cavity 775
26.2a Cheeks, Lips, and Palate 775

Chapter 24 26.2b Tongue 776

26.2c Salivary Glands 776
Lymphatic System 718 26.2d Teeth 778
24.1 Functions of the Lymphatic System 719 26.3 Pharynx 779
24.2 Lymph and Lymph Vessels 720 26.4 General Arrangement of Abdominal GI Organs 781
24.2a Lymphatic Capillaries 720 26.4a Peritoneum, Peritoneal Cavity, and Mesentery 781
24.2b Lymphatic Vessels 720 26.4b General Histology of GI Organs (Esophagus to Large
24.2c Lymphatic Trunks 721 Intestine) 782
24.2d Lymphatic Ducts 721 26.4c Blood Vessels, Lymphatic Structures, and Nerve Supply 784
24.3 Lymphatic Cells 721 26.5 Esophagus 784
24.3a Types and Functions of Lymphocytes 723 26.5a Gross Anatomy 784
24.3b Lymphopoiesis 727 26.5b Histology 785
24.4 Lymphatic Structures 729 26.6 The Swallowing Process 786
24.4a Lymphatic Nodules 729 26.7 Stomach 787
24.4b Lymphatic Organs 729 26.7a Gross Anatomy 787
24.5 Aging and the Lymphatic System 735 26.7b Histology 788
24.6 Development of the Lymphatic System 735 26.7c Gastric Secretions 788
26.8 Small Intestine 791

Chapter 25 26.8a Gross Anatomy and Regions 791

26.8b Histology 793
Respiratory System 741 26.9 Large Intestine 793
25.1 General Organization and Functions of 26.9a Gross Anatomy and Regions 793
the Respiratory System 742 26.9b Histology 795
25.1a Respiratory System Functions 742 26.9c Control of Large Intestine Activity 796
25.2 Upper Respiratory Tract 744 26.10 Accessory Digestive Organs 797
25.2a Nose and Nasal Cavity 744 26.10a Liver 797
25.2b Paranasal Sinuses 744 26.10b Gallbladder 798
25.2c Pharynx 744 26.10c Biliary Apparatus 800
25.3 Lower Respiratory Tract 747 26.10d Pancreas 802
25.3a Larynx 747 26.11 Aging and the Digestive System 803
25.3b Trachea 751 26.12 Development of the Digestive System 804
25.3c Bronchial Tree 752 26.12a Stomach, Duodenum, and Omenta Development 804
25.3d Respiratory Bronchioles, Alveolar Ducts, 26.12b Liver, Gallbladder, and Pancreas Development 804
and Alveoli 754 26.12c Intestine Development 804
x
Chapter 27 28.2a Ovaries 838
28.2b Uterine Tubes 845
Urinary System 811 28.2c Uterus 847
27.1 General Structure and Functions of the 28.2d Vagina 849
Urinary System 812 28.2e External Genitalia 850
27.2 Kidneys 814 28.2f Mammary Glands 851
27.2a Gross and Sectional Anatomy of 28.3 Anatomy of the Male Reproductive System 855
the Kidney 814 28.3a Scrotum 855
27.2b Blood Supply to the Kidney 815 28.3b Spermatic Cord 857
27.2c Innervation of the Kidney 817 28.3c Testes 857
27.2d Nephrons 817 28.3d Ducts in the Male Reproductive System
  860
27.2e Collecting Tubules and Collecting Ducts: 28.3e Accessory Glands 861
How Tubular Fluid Becomes Urine 820 28.3f Semen 862
27.2f Juxtaglomerular Apparatus 822 28.3g Penis 863
27.3 Urinary Tract 822 28.4 Aging and the Reproductive Systems 865
27.3a Ureters 822 28.5 Development of the Reproductive Systems 866
27.3b Urinary Bladder 824 28.5a Genetic Versus Phenotypic Sex 866
27.3c Urethra 826 28.5b Formation of Indifferent Gonads and
27.4 Aging and the Urinary System 828 Genital Ducts 866
27.5 Development of the Urinary System 829 28.5c Internal Genitalia Development 868
27.5a Kidney and Ureter Development 829 28.5d External Genitalia Development 868
27.5b Urinary Bladder and Urethra Development 829
Appendix: Answers A-1

Chapter 28 Glossary G-1

Reproductive System 836
28.1 Comparison of the Female and Male Index I-1
Reproductive Systems 837
28.1a Perineum 837
28.2 Anatomy of the Female Reproductive System 838

xi
 Preface
What Makes
This Book Special?
H uman anatomy is a fascinating field that has many layers of
c­omplexity. The subject is difficult to teach, and students can
often be overwhelmed by its massive amount of material. Our goal in
writing Human Anatomy was to create a textbook that guides students
on a clearly written and expertly illustrated beginner’s path through the
human body. For all five editions it has been of paramount importance
to make this book enjoyable to read, easy to understand, pedagogically
efficient, and visually engaging. The following pages highlight the
enhancements we’ve made to the fifth edition, as well as the hallmark
features that define this book.
New to the Fifth Edition
New research findings, shifting terminology, technological advance-
ments, and the evolving needs of students and instructors in the
classroom require textbook authors to continually monitor and revise
their content. Throughout the fifth edition, changes have been made
to incorporate the latest information, bring terminology up to date,
and improve wording to make discussions easier for students to read
and understand. Highlights of these revisions are as follows.
Global Changes
The Fifth Edition received some global changes to increase stu-
dent understanding and success.
■ Learning objective numbers are now listed sequentially
throughout each chapter.
■ Clinical views are now numbered within each chapter for
easier reference.
Clinical View 2.2
Tay-Sachs Disease
Tay-Sachs is a rare, inherited “lysosomal storage disease” that
results in the buildup of fatty material in nerve cells. Healthy,
properly functioning lysosomes are essential for the health
of the cells and the whole body. Tay-Sachs disease occurs
because one of the approximately 50 different lysosomal
enzymes is missing or nonfunctional. Lysosomes in affected
individuals lack an enzyme that is needed to break down a
complex membrane lipid. As a result, the complex lipid accu-
mulates within cells. The cellular signs of Tay-Sachs disease
are swollen lysosomes due to accumulation of the complex
lipid that cannot be digested. Affected infants appear normal
at birth, but begin to show signs of the disease by the age of
6 months. The nervous system exhibits the most damage with
development of paralysis, blindness, and deafness followed
by death by the age of 4. Unfortunately, there is no treatment
or cure for this deadly disease.
xii
■ Updates to wording of content discussions have been made
via heat map data from LearnSmart/SmartBook where
appropriate to improve student understanding.
■ Page references have been removed throughout the text,
including outlines and chapter summaries, and replaced with
references to section numbers, for greater ease of navigation
of the content within digital formats.
■ More forward and backward references to appropriate topics
in other chapters have been included, to improve critical
thinking and to more greatly assist students in making
connections of concepts.
■ Removed blank lines in front of matching and MC questions
within the chapter review of each chapter, for greater ease of
reviewing within digital formats.
Chapter 1 A First Look at Anatomy Section 1.1, “History of Anatomy,”
is rewritten to make it more concise and more applicable. Section
1.4e was updated for clarity. Figures 1.2 and 1.5a are new and
multiple figures have been enhanced. Tables 1.2 and 1.3 have been
revised for precision.
Chapter 2 The Cell: Basic Unit of Structure and Function Terms and
wording have been updated to clarify content. Multiple figures have
been updated and Clinical View terms have been revised to refine and
illuminate topic coverage.
Chapter 3 Embryology Clinical views have been updated where
appropriate. Multiple figures have been revised and enhanced. The
section on ovulation has been modified for greater clarity and
accuracy. Clinical View 3.4 has been updated to reflect primary
terminology in use.
Chapter 4 Tissue Level of Organization Figure 4.3 was added to
provide a clearer classification of epithelium. Many tables have been
revised and enhanced. Content descriptions regarding tissue classi-
fication and classification by number of cell layers has been revised.
Clinical Views 4.1, 4.2, 4.4, and 4.5 have been updated.
Chapter 5 Integumentary System Terminology has been revised.
A more concise description of melanin has been included. Content
regarding hirsuitism has been added and the section on merocrine
gland functions has been tightened up. Clinical View 5.8 (Psoriasis)
is new.
Chapter 6 Cartilage and Bone Multiple figures have been improved.
The discussion regarding movement and hemopoiesis has been
refined. Clinical View 6.1 has been updated.
Chapter 7 Axial Skeleton Multiple figures have been enhanced for
clarity. Wording for the Clinical View on craniosynostosis has been
 More
prominent Clinical View 16.3
superciliary Brachial Plexus Injuries deep laceration of the wrist. Median nerve injury often results
in paralysis of the thenar group of muscles. The classic sign of
More blunt arch Injuries to parts of the brachial plexus are fairly common, especially median nerve injury is the ape hand deformity, which develops over
supraorbital in individuals aged 15–25. Minor plexus injuries are treated by simply time as the thenar eminence wastes away until the hand eventu-
resting the limb. More severe brachial plexus injuries may require ally resembles that of an ape (apes lack well-developed thumb
margin nerve grafts or nerve transfers; for very severe injuries, no effective muscles). The lateral two lumbricals are also paralyzed, and sensa-
treatment exists. Various nerves of the brachial plexus may be injured. tion is lost in the part of the hand supplied by the median nerve.

Axillary Nerve Injury Ulnar Nerve Injury

The axillary nerve can be compressed within the axilla, or it can be
damaged if the surgical neck of the humerus is broken (recall that the
axillary nerve travels posterior to the surgical neck of the humerus).
A patient whose axillary nerve is damaged has great difficulty
abducting the arm due to paralysis of the deltoid muscle, as well as
anesthesia (lack of sensation) along the superolateral skin of the arm.
Radial Nerve Injury
The radial nerve is especially subject to injury during humeral shaft
fractures or in injuries to the lateral elbow. Nerve damage results
in paralysis of the extensor muscles of the forearm, wrist, and
fingers. A common clinical sign of radial nerve injury is wrist drop,
meaning that the patient is unable to extend his or her wrist. The
patient also experiences anesthesia along the posterior arm, the
forearm, and the part of the hand normally supplied by this nerve.
Posterior Cord Injury
The posterior cord of the brachial plexus (which includes the
axillary and radial nerves) is commonly injured in the axilla. One
cause is improper use of crutches, a condition called crutch palsy.
Similarly, the posterior cord can be compressed if a person drapes
Squarish mental the upper limb over the back of a chair for an extended period of
protuberance time. Because this can happen if someone passes out in a drunken
stupor, this condition is also referred to as drunkard’s paralysis.
Fortunately, full function of these nerves is often regained after a
short period of time.
Median Nerve Injury
The median nerve may be impinged on or compressed as a result
of carpal tunnel syndrome because of the close confines of this
The ulnar nerve may be injured by fractures or dislocations of the
elbow because of this nerve’s close proximity to the medial epi-
condyle of the humerus. When you “hit your funny bone,” you have
actually hit your ulnar nerve. Most of the intrinsic hand muscles
are paralyzed (including the interossei muscles, the hypothenar
muscles, the adductor pollicis, and the medial two lumbricals), so
the person is unable to adduct or abduct the fingers. In addition,
the person experiences sensory loss along the medial side of the
hand. A clinician can test for ulnar nerve injury by having a patient
hold a piece of paper tightly between the fingers as the doctor
tries to pull it away. If the person has weak interossei muscles, the
paper can be easily extracted.
Superior Trunk Injury
The superior trunk of the brachial plexus can be injured by exces-
sive separation of the neck and shoulder, as when a person riding
a motorcycle is flipped from the bike and lands on the side of
the head. A superior trunk injury affects the C5 and C6 anterior
rami, so any brachial plexus branch that has these nerves is also
affected to some degree.
Inferior Trunk Injury
The inferior trunk of the brachial plexus can be injured if the arm
is excessively abducted, as when a neonate’s arm is pulled too
hard during delivery. Inferior trunk injuries also may happen when
grasping something above the head to break a fall—for example,
grabbing a branch to keep from falling out of a tree. An inferior
trunk injury involves the C8 and T1 anterior rami, so any brachial
plexus branch that is formed from these nerves (such as the ulnar

revised and refined. Table 7.4 has received new images to better narrow passage. Additionally, the nerve may be injured by any nerve) also is affected to some degree.

distinguish sex differences in the skull.

Chapter 8 Appendicular Skeleton Multiple figures have received

enhancements to clarify content. Clinical Views 8.5 and 8.6 have been
updated.

Chapter 9 Articulations Text updates have been made to make Chapter 17 Pathways and Integrative Functions Content discus-
descriptions and section discussions more concise. Table 9.2 has been sions regarding somatosensory pathways, motor pathways, and direct
enhanced and increased APR links for figures have been included. pathways have been revised to better scaffold learning.

Chapter 10 Muscle Tissue and Organization Several figures have
been improved. The section on sarcomere has been revised and
Section 10.3 has been modified. Sections on Muscle Atrophy and
Muscle hypertrophy have been reordered. Added a discussion for the
change in terminology from origin and insertions to proximal and
distal attachments or superior and inferior attachments.
Chapter 11 Axial Muscles A new paragraph was added to discuss
changing of origin and insertion in tables with superior and inferior
attachment. Writing in Clinical Views has been tightened and addi-
tional links and references for APR resources were added.
Chapter 12 Appendicular Muscles A paragraph on using proximal
and distal attachments was added. Multiple figures were upgraded and
a new photo for Clinical View 12.3 was selected.
Chapter 13 Surface Anatomy An increased number of references
forward and backwards to appropriate topics, provide greater integra-
tion of concepts.
Chapter 14 Nervous Tissue Clinical Views were numbered sequen-
tially and reviewed for enhancement. Clinical View 14.1, regarding
neuroplasticity, was created. Multiple figures were enhanced.
Chapter 15 Brain and Cranial Nerves Multiple figures and tables
were enhanced. A new Clinical View on Autism has been added.
Chapter 18 Autonomic Nervous System Multiple figures have been
replaced to provide greater clarity of concepts for students. Table 18.1
has been updated with new material and new sections on the Enteric
Nervous System and autonomic tone were added. Sections 18.1 and
18.2 were revised to highlight content for greater clarity.
Chapter 19 Senses: General and Special The tonic versus phasic
receptor discussion has been modified to include information regard-
ing adaptation. Table 19.1 has received a change of the text and layout
for consistency. Modality of stimulus section has been modified
through a modification of the mechanoreceptor discussion to include
baroreceptor as a type of mechanoreceptor.
Chapter 20 Endocrine System The introductory paragraph has
been rewritten to improve and enhance concepts being introduced.
Figure 20.8 and Clinical View 20.1 have been updated to reflect content
in a more complete and concise manner.
Chapter 21 Blood The content and descriptions have been made
more concise to enhance clarity. The Clinical View on Blood Doping
has been revised for a more informational approach.
Chapter 22 Heart Multiple figures have been updated. Clinical Views
22.2 and 22.3 have been revised to reflect the most recent information
in the field. Sections 22.2a and 22.2b, regarding heart-wall structure
and external heart anatomy have been revised to enhance clarity.

Chapter 16 Spinal Cord and Spinal Nerves Most tables and many
figures have been revised and upgraded. The Clinical View on lumbar
puncture has been revised and updated, and tables 16.2 and 16.3 were
clarified.
Chapter 23 Vessels and Circulation Numerous figures have been
updated. Figure 23.9a and figure 23.15 received special enhancements
to coloration and labels to make the figures easier to follow for greater
understanding.
xiii
 Chapter 24 Lymphatic System Figure 24.1 has been enhanced to
reflect lymph vessels as part of the dural sinuses. The section on types
Endocrine and functions of lymphocytes has been updated to clarify locations
gland
and functions of cells. Clinical View 24.1 on Lymphedema and 24.2
on HIV and AIDS have both been updated to reflect the most current
Neuron research and information.

Chapter 25 Respiratory System Clinical Views 25.1 on Cystic

Fibrosis and 25.3 on Aspirations of Foreign Materials, have been
tightened and enhanced for more concise presentation of the content.
Hormone Various images have been updated to promote greater clarity.

Nerve
Blood Chapter 26 Digestive System Multiple figures have been updated
impulse and enhanced with photo changes and function boxes to provide
Target cells a more succinct approach to the content. Clinical View 26.7 on
gallstones received new images. A new Clinical View on Cystic
Target cells Fibrosis effects on the pancreas has been added.
Neurotransmitter
Chapter 27 Urinary System Multiple figures have been revised to
reflect the most current information available and increase accuracy.
Text regarding the renal corpuscle has been modified to more clearly
describe the filtration membrane.

Chapter 28 Reproductive System Multiple tables and figures

have been updated and reorganized for clarity. Discussion and
(a) Nervous system (b) Endocrine system
images about ovarian follicle development have been modified to
Figure 20.1 clarify the length of these processes. Most of the Clinical Views
Nervous and Endocrine System Communication. (a) In the nervous throughout the chapter have been revised to reflect updates in
system, neurons release neurotransmitters into a synaptic cleft to stimulate
information.
their target cells. (b) In the endocrine system, hormones are secreted by
endocrine cells. The hormones enter the blood and travel throughout the body
to reach their target cells.

Clinical View 25.9

Smoking, Emphysema, and Lung Cancer
stomach, and pancreas. It also increases the risks associated with
human papillomavirus (HPV) infection linked to increased risk of
from damage caused by smoking. Once the tissue in the lung has
been destroyed, it cannot regenerate, and thus there is no cure
Squamous cell carcinoma

Smoking results in the inhalation of over 200 chemicals that
blacken the respiratory passageways and cause respiratory
changes that increase the risk of (1) respiratory infections, and
(2) cellular and genetic damage to the lungs that may lead to
emphysema or lung cancer.
Deleterious effects of smoking also include vasoconstric-
tion in the cardiovascular system due to nicotine, interference
with oxygen binding to hemoglobin by carbon monoxide, and
increased risk and severity of atherosclerosis. Reduced blood
flow results in decreased delivery of nutrients and oxygen to
cells in systemic tissues.
Smoking increases the risk of both stomach ulcers caused
by Helicobacter pylori infection and cancer of the esophagus,
cervical cancer, and the risk of Alzheimer disease. Secondhand for emphysema. The best therapy for an emphysema patient is
smoke is associated with an increased risk of bronchitis, asthma, to stop smoking and try to get optimal use from the remaining
and ear infections in children. lung tissue by using a bronchodilator, seeking prompt treatment
Emphysema (em′fi-sē′mă; en = in, physema = a blowing) for pulmonary infections, and taking oxygen supplementation
is an irreversible loss of pulmonary gas exchange areas due to if necessary.
inflammation of the terminal bronchioles and alveoli, in con-
junction with the widespread destruction of pulmonary elastic
connective tissue. These combined events lead to dilation of
individual alveoli, resulting in a decrease in the total number of
alveoli, and the subsequent loss of gas exchange surface area.
The patient is unable to exhale effectively, so that stagnant,
oxygen-poor air builds up within the abnormally large (but
numerically diminished) alveoli. Most cases of emphysema result

Gross section of a lung with squamous cell carcinoma (speckled white and
Dilated, nonfunctional air spaces black regions).
Alveoli
© Dr. E. Walker/Science Source

Adenocarcinoma of the lung arises from the mucin-

producing glands in the respiratory epithelium. It begins when
DNA injury causes one of these cells to become malignant and
begin to divide uncontrollably.
LM 30x
Small-cell carcinoma is a less common type of lung cancer;
it originates in the main bronchi and eventually invades the
mediastinum. This type of cancer arises from the small neuroen-
Alveoli are small, docrine cells in the larger bronchi; their secretions help regulate
An individual with advanced emphysema must rely on a
numerous, and muscle tone in the bronchi and vessels. As a consequence of
well formed. portable oxygen tank, such as this backpack tank.
© McGraw-Hill Education/ © CHAD Therapeutics, Inc. their endocrine heritage, some of these tumors secrete hor-
Al Telser, photographer mones. For example, a small-cell cancer of the lung occasion-
ally releases ACTH, producing symptoms of Cushing syndrome
Lung cancer is a highly aggressive and frequently fatal
(see Clinical View 20.5: “Disorders of Adrenal Cortex Hormone
(a) malignancy that originates in the epithelium of the respiratory
Dilated, nonfunctional alveoli Secretion” in section 20.6a).
system. Smoking causes about 85% of all lung cancers. Metastasis,
Nonsmoker’s lungs the spread of cancerous cells to other tissues, occurs early in the
© Stefan Zaklin/EPA/Newscom Small-cell
course of the disease, making a surgical cure unlikely for most carcinoma
Enlarged alveolus
patients. Pulmonary symptoms include chronic cough, coughing
Deposits
up blood, excess pulmonary mucus, and increased likelihood of
pulmonary infections. Some people are diagnosed based upon
symptoms that develop after the cancer has already metastasized
to a distant site. For example, lung cancer commonly spreads to
the brain, so in some cases lung cancer is not discovered until the
patient seeks treatment for a seizure disorder related to cancer in
LM 20x the brain.
Lung cancers are classified by their histologic appearance
into three basic patterns: squamous cell carcinoma, adenocarci-
Alveoli are enlarged,
less numerous, and LM 15x noma, and small-cell carcinoma.
contain black deposits. Squamous cell carcinoma (kar′si-nō′mă; karkinos = cancer,
© Astrid & Hanns-Frieder (b)
Michler/Science Source oma = tumor) may develop when the pseudostratified ciliated
Emphysema causes dilation of the alveoli and loss of elastic tissue, resulting columnar epithelium lining the lungs changes to a sturdier strati-
in poorly functioning alveoli. (a) A gross section of an emphysemic lung shows fied squamous epithelium to withstand the chronic inflammation
the dilated alveoli. (b) Microscopically, the alveoli are abnormally large and
and injury caused by tobacco smoke. If the chronic injury continues, Gross section of a lung with small-cell carcinoma (white regions) around
nonfunctional.
Smoker’s lungs: Lungs are blackened. (a) (top right) © CNRI/Science Source; (b) (bottom right) © McGraw-Hill Education/ these transformed epithelial cells may accumulate enough genetic a bronchus.
© Rex/Newscom Al Telser, photographer damage to become overtly malignant. © Javier Domingo/Phototake

xiv

Themes and Distinctive
Topic Approaches
T hrough our teaching experience, we have developed
a few approaches that really seem to help students
grasp certain topics or spark their interest. Thus, we
have tried to incorporate these successful ideas from
own courses into our book.
■ Embryology. Learning about embryologic events
can increase understanding of the adult anatomy.
For this reason, chapter 3, Embryology, appears
early in the book. In addition, “systems embryology”
sections in each systems chapter (e.g., integumentary
system, digestive system) provide a brief but thorough
overview of the developmental processes for that
particular system.
■ Forensic Anthropology. Forensic examples are a great way
to reinforce learning, and students enjoy the “real-life”
application of anatomic knowledge in forensic analysis.
The skeletal system chapters (6–8) feature discussions
on topics such as determining age of death by evaluating
epiphyseal plates and the pubic symphysis, and determining
sex by noting differences in the skull and pelvis.
Internal carotid artery
External jugular vein
Subclavian vein
(c) Head and neck vessels, right lateral view
Preface
ou r
The os coxae is not only a reliable indicator of sex, but it also can
provide a good estimate of a skeleton’s age at death. In particular, the
pubic symphysis undergoes age-related changes. The pubic symphysis
appears roughened or billowed in the teens and early 20s. Thereafter,
■ Surface Anatomy. To best serve our audience, we have
dedicated a full chapter (13) to surface anatomy. This chapter
contains beautiful photographs and clear, concise text as well
as numerous Clinical Views that illustrate the importance of
surface anatomy landmarks and how they are used daily in
health care.
■ Nervous System. In order to understand the workings of the
nervous system, it is best to learn how the brain controls all
aspects of the nervous system. Thus, in this text we examine
the brain first, followed by a chapter
Superficial temporal artery
comparing its similarities, differences, and
relationships to the spinal cord. It seemed
Facial vein (cut) appropriate to use central nervous system
terminology to describe the brain first and
then the spinal cord. Additionally, because
Facial artery the nuclei of the cranial nerves are housed
External carotid artery within the brain, we felt it made more
sense to present the cranial nerves along
Superior thyroid artery
with the brain.
Common carotid artery
■ Arteries and Veins. Arteries and veins
Internal jugular vein are covered in unison by region. For
example, we present the arteries and
veins of the upper limb together. This
approach emphasizes to students that
the arteries often have corresponding
veins and that both are responsible for
the blood flow in a general region.
xv
 Art Program

Accurate and Engaging

Illustrations
B ecause anatomy is a visual subject, quality illustrations are crucial to understanding and retention.
The brilliant illustrations in Human Anatomy bring the study of anatomy to life! Drawn by a team
of medical illustrators, all figures have been carefully rendered to convey realistic, three-dimensional
detail. Each drawing has been meticulously reviewed for accuracy and consistency, and precisely labeled to
coordinate with the text discussions.

Anterior rami: C5, C6, C7, C8, T1

Trunks: superior, middle, inferior
Anterior divisions
Posterior divisions
C5 vertebra Cords: posterior, lateral, medial C5
Terminal branches
T1 vertebra

C6
Nerve to subclavius
Superior trunk

C7

Middle trunk

Lateral pectoral nerve C8

Subscapular nerves
Lateral cord
T1
Posterior cord

Musculocutaneous nerve Long thoracic nerve

Inferior trunk
Medial pectoral nerve
Median nerve Thoracodorsal nerve
Axillary nerve Medial cord
Radial nerve Ulnar nerve

(a) Anterior view

Color Coding
Many illustrations
use color coding to
organize information
and clarify concepts
for visual learners.

xvi
 Art Program
View Orientation
Reference diagrams
clarify the view or
plane an illustration
represents.
Distal radioulnar joint
Radiocarpal joint

Articular disc
Ulnar collateral ligament
Radial collateral ligament
Lunate
Scaphoid
Intercarpal joints Triquetrum

Carpometacarpal
joint of thumb

Right radiocarpal joint, coronal section

Neuromuscular junction
Axon of a motor neuron

Synaptic knob

Sarcolemma
Skeletal
muscle fibers

(a)
Neuromuscular
junction
LM 100x
Path of nerve
impulse Synaptic knob

Endomysium
Sarcolemma Multilevel
Perspective
Illustrations depicting
Synaptic cleft
complex structures
Synaptic knob
connect macroscopic
and microscopic views to
Motor end plate show the relationships
between increasingly
Synaptic vesicles
detailed drawings.
Sarcolemma

(b) Acetylcholine (ACh)

ACh receptor
Acetylcholinesterase (AChE) Sarcoplasm

(c)

xvii
 Art Program

Atlas-Quality Photographs
H uman Anatomy features a beautiful collection of cadaver dissection images, bone photographs, surface
anatomy shots, and histology micrographs. These detailed images capture the intangible characteristics
of human anatomy that can only be conveyed in human specimens and help familiarize students with the
appearance of structures they will encounter in lab.

Diaphragm
Adrenal gland
Kidneys
Hilum
Renal artery
Renal vein
Inferior vena cava

Descending abdominal aorta

Ureters

Parietal peritoneum (cut)

Urinary
bladder

Urethra

(a) Anterior view

Complementary Views Cadaver Dissections

Drawings paired with Expertly dissected specimens
photographs enhance are preserved in richly colored
visualization of structures. photos that reveal incredible
Labels on art and photos mirror detail. Many unique views
each other whenever possible, show relationships between
making it easy to correlate anatomic structures from a new
structures between views. perspective.

xviii
 Art Program
Manubrium
Suprasternal
notch
1 Clavicular
Manubrium 1
notch
Costal 2
notch
2
3
Sternal angle
Body
True ribs 3 4
Sternum
(1–7)
Body
4 5
Costal notch

5 Xiphoid 6
process
6
Xiphoid 11 7
process
7 T12 8

8 T12 L1 9
Costal 12
9 12 cartilages
False ribs L1 10
(8–12)
10
Floating ribs
11 (11–12)

Bones
Crisp, clear bone photographs
paired with detailed drawings
offer dual perspectives—artist’s
rendition and actual specimen.

Surface Anatomy
Carefully posed and
Deltoid photographed, these images
clearly demonstrate surface
landmarks.
Long
head

Styloid process
Triceps brachii of radius Anatomic snuffbox

Biceps brachii
Lateral
head Brachialis
Brachioradialis

Lateral epicondyle Head and styloid process of ulna

of humerus Extensor carpi ulnaris
Extensor digitorum
Olecranon Extensor carpi radialis (longus and brevis)

Right upper limb, lateral view

xix
 Art Program

Mucosa of small intestine

Goblet cell
Uterine tube
Microvilli (brush border)
Nonciliated simple
columnar cell

Basement membrane
Cilia
LM 400x

Simple columnar
epithelial cell

Basement membrane

Goblet cell
LM 100x
Microvilli (brush border)
Nonciliated simple
columnar cell

Basement membrane
Cilia

Simple columnar
epithelial cell

Histology Micrographs
Basement membrane
Light micrographs, as well as
scanning and transmission
electron micrographs, are
used in conjunction with
illustrations to present a true
picture of microscopic anatomy.
Magnifications provide a reference
point for the sizes of the structures
shown in the micrographs.

xx
 Learning System

Helpful Pedagogical Tools

H uman Anatomy is built around a pedagogical framework designed to
foster retention of facts and encourage the application of knowledge
that leads to understanding. The learning aids in this book help organize
Learning Objectives
Numbered learning objectives at the
studying, reinforce learning, and promote critical-thinking skills. beginning of each section help focus
attention on critical information.
Online question banks are
Chapter Outline synchronized with these objectives.
Each chapter begins with a page-
referenced outline that provides
a quick snapshot of the chapter
contents and organization. 24.2 Lymph and Lymph Vessels
Headings are numbered throughout ✓ Learning Objectives
the chapter for easy reference. 2. Identify the components of lymph.
3. Outline the path of lymph from interstitial tissues to the
circulatory system.
Excess interstitial fluid and solutes are returned to the blood through
a lymph vessel network. When the combination of interstitial fluid,

25
solutes, and sometimes foreign material enters the lymph vessels,
the liquid mixture is called lymph (limf; lympha = clear spring
water). The lymph vessel network is composed of increasingly larger
vessels, as follows (from smallest to largest in diameter): lymphatic
Outline capillaries, lymphatic vessels, lymphatic trunks, and lymphatic
ducts. Thus, the term “lymph vessel” is a general term to describe
25.1 General Organization and Functions of the Respiratory all of these specific lymphatic capillaries, vessels, trunks, and ducts.
System
25.1a Respiratory System Functions
25.2 Upper Respiratory Tract

Respiratory
25.2a Nose and Nasal Cavity
25.2b Paranasal Sinuses
25.2c Pharynx
25.3 Lower Respiratory Tract

System
25.3a Larynx
25.3b Trachea
25.3c Bronchial Tree
25.3d Respiratory Bronchioles, Alveolar Ducts, and Alveoli
25.4 Lungs
25.4a Pleura and Pleural Cavities
25.4b Gross Anatomy of the Lungs
25.4c Blood Supply To and From the Lungs
25.4d Lymphatic Drainage
25.5 Pulmonary Ventilation
25.6 Mechanics of Breathing
25.6a Skeletal Muscles of Breathing
25.6b Volume Changes in the Thoracic Cavity
25.7 Innervation of the Respiratory System W H AT D I D YO U LE A R N ?
●
25.7a Ventilation Control by Respiratory Centers of the Brain
25.8 Aging and the Respiratory System 2 What is lymph?
●
25.9 Development of the Respiratory System
3 Describe the structure of lymphatic capillaries. Into what
structures do they drain?
●
4 Which major body regions drain lymph to the right
MODULE 11: RESPIRATORY SYSTEM
lymphatic duct?

What Did You Learn?

Review questions at the end of each
section prompt students to test their
comprehension of key concepts.
These mini self-tests help students
determine whether they have a
sufficient grasp of the information
before moving on to the next section
of the chapter.

xxi
 Learning System
Vocabulary Aids
Learning anatomy is, in many ways, like
learning a new language. The terms
used in this text follow the standards set
by the FCAT (Federative Committee on
Anatomical Terminology) and published
in Terminologia Anatomica (TA), the
international standard for anatomic
vocabulary. Descriptive terms are
emphasized, although eponyms are
provided to help students equate common
names with their proper anatomic
term. Pronunciation guides and word
origins derived from Stedman’s Medical
Dictionary are included throughout the
book to teach students how to say the
terms and give them helpful, memorable
hints for decoding meaning.

Anatomy & Physiology |

REVEALED 3.2
When applicable, icons indicate where
related chapter content can be found on
McGraw-Hill’s Anatomy & Physiology
REVEALED 3.2. These icons are
clickable in the eBook, allowing students
to hop directly to a specific area of
Anatomy & Physiology | REVEALED 3.2.

Key terms are set in boldface where they

are defined in the chapter, and many
terms are included in the glossary at the
end of the book.

Because knowing the derivation of a

term can enhance understanding and
retention, word origins are given when
relevant. Further, a handy list of prefixes,
suffixes, and combining forms is printed
on the inside back cover as a quick
reference for commonly used word roots.

xxii
 Learning System
What Do You Think?
These critical-thinking questions W H AT D O YO U TH I N K ?
actively engage students in application ● 3 What types of study habits best convert short-term memories
or analysis of the chapter material into long-term memories? Do you practice these habits when
you study for your exams?
and encourage students to think more
globally about the content. Answers
to What Do You Think? questions
are given at the end of each chapter,
allowing students to evaluate the logic
used to solve the problem.

816 Chapter Twenty-Seven Urinary System

Interlobar artery Arcuate artery Interlobular artery Afferent arteriole

Nephron
Segmental Glomerulus
artery
Renal
corpuscle
Interlobular
vein PCT

Renal artery Efferent arteriole

DCT
Cortex
Peritubular
capillaries Vasa recta
Arcuate Medulla (associated (associated with
vessels with convoluted nephron loop)
tubules)

Renal vein

Nephron loop

Interlobar vein Arcuate vein Interlobular vein

Figure 27.4
Blood Supply to the Kidneys. A coronal view depicts kidney circulation. An expanded view shows circulation to a nephron. Pink boxes indicate vessels
with arterial blood; lavender boxes indicate vessels where reabsorbed materials reenter the blood; blue boxes indicate vessels returning blood to the general
circulation.

Learning Strategy
arteries (or cortical radiate arteries) that project peripherally into
Many anatomy instructors
the cortex. provide students with
As the interlobular arteries enter the cortex, they extend small
branches called afferent (af′ĕr-ĕnt; ad = toward, ferre = to lead) Learning Strategy everyday analogies,
arterioles (or afferent glomerular arteriole). An afferent arteriole mnemonics, and other
The names of the blood vessels in the kidney can give you a clue as to their
then enters a structure called a renal corpuscle and forms a capillary
network called the glomerulus (glō-mer′yū-lŭs; glomus = ball of
location or appearance: useful tips to help them
yarn, ulus = small). Some blood plasma is filtered through the fenes- ■ Interlobar vessels are located between (“inter”) the lobes of the
trated epithelium of the glomerulus into the capsular space within the kidney. understand and remember
renal corpuscle. Once some of the blood plasma has been filtered, ■ Arcuate vessels form vessel “arcs” at the corticomedullary the information. Learning
the remaining blood leaves the glomerulus and enters an efferent junction.
(ef′ĕr-ent; efferens = to bring out) arteriole (or efferent glomerular ■ Interlobular vessels are located between the smaller lobules of the
Strategy boxes throughout
arteriole). The efferent arteriole is still carrying oxygenated blood kidney cortex. each chapter offer tried-
because gas and nutrient exchange with cells of the kidney has not Afferent arterioles carry blood to the glomerulus (remember,
yet occurred.
■

“afferent” means “toward”). and-tested practical learning

The efferent arterioles branch into one of two types of capil-
lary networks: peritubular capillaries or vasa recta (figure 27.4).
■ Efferent arterioles take blood away from the glomerulus strategies that students can
(remember, “efferent” means to take away, or “exit”).
These capillary networks are responsible for the actual exchange of
Peritubular capillaries are around (“peri”) the tubules (proximal and
apply as they read. These tips
gases, nutrients, and waste materials within the kidney. Peritubular ■

capillaries are associated with the convoluted tubules and primarily

distal convoluted tubules). are not just useful—they can
reside in the cortex of the kidney. Vasa recta (vā′să rek′tă; vasculum = ■ Vasa recta means “straight vessels,” and these vessels run parallel
also be fun!
small vessel, rectus = straight) are associated with the nephron loop to the long, straight tubules of the nephron loop.
and primarily reside in the medulla of the kidney.

xxiii
 Learning System
Clinical Context
S ometimes an example of what can go
wrong in the body helps crystallize
understanding of the “norm.” Clinical Views
interspersed throughout each chapter provide
insights into health or disease processes.
Carefully checked by a clinician for accuracy
with respect to patient care and the most recent
treatments available, these clinical boxes
expand upon topics covered in the text and
provide relevant background information for
students pursuing health-related careers.
Clinical Terms
Selected clinical terms are
defined at the end of each
chapter.
Clinical Terms
autoimmune disease Disease in which the body’s immune system
mistakenly attacks its own healthy tissues. Examples include
systemic lupus erythematosus (SLE), multiple sclerosis
(MS), rheumatoid arthritis, type 1 diabetes mellitus, and
scleroderma.
xxiv
Clinical View
Interesting clinical sidebars reinforce
or expand upon the facts and concepts
discussed within the narrative.
Clinical View 7.1
Craniosynostosis and Plagiocephaly
Sutures in the skull allow the cranium to grow and expand during child-
hood. In adulthood, when cranial growth has stopped, the sutures
fuse and are obliterated. Craniosynostosis (krā′nē-ō-sin′os-tō′sis)
refers to the premature fusion or closing of one or more of these
cranial sutures. If this premature fusion occurs early in life or in
utero, skull shape is dramatically affected. If not surgically treated,
a craniosynostotic individual often grows up with an unusual
craniofacial shape.
Sagittal synostosis is a condition where the sagittal suture
fuses prematurely. As a result, the skull cannot grow and expand lat-
erally as the brain grows, and compensatory skull growth occurs in
an anterior-posterior fashion. A child with sagittal synostosis devel-
ops a very elongated, narrow skull shape called scaphocephaly,
or dolicocephaly. Coronal synostosis refers to premature fusion of
the coronal suture, which causes the skull to be abnormally short
and wide.
Craniosynostosis appears to have multiple causes, includ-
ing genetics, teratogens (a drug or other agent that can cause
Sagittal synostosis Coronal synostosis
(sagittal synostosis, coronal synostosis) Courtesy of Dr. John A. Jane, Sr., David D. Weaver Professor of Neurosurgery, Department of Neurological Surgery, University of Virginia
Health System, Charlottesville, Virginia; (plagiocephaly) Used with permission and copyright of Cranial Technologies, Inc.
lymphadenectomy (lim-fad′ĕ-nek′tŏ-mē; = gland) Removal or
excision of lymph nodes.
lymphangitis (= vessel) Inflammation of the lymph vessels.
splenomegaly (splē′nō-meg′ă-lē; mega = large) Enlarged spleen,
often seen in association with infection (e.g., mononucleosis).
birth defects), and environmental factors. Many people with
craniosynostosis have no complications other than the unusual
skull shape. Those who do experience complications may have
increased intracranial pressure (leading to headache and seizures
if severe), optic nerve compression, and intellectual disability (due
to restricted brain growth).
Plagiocephaly is the term used to describe an asymmetric
head shape, where one part of the skull (usually the frontal or
occipital region) has an oblique flattening. Plagiocephaly may
be caused by unilateral coronal craniosynostosis or asymmetric
lambdoid synostosis. It also is commonly caused by normal defor-
mational factors, such as sleeping on the same side of the head.
Incidence of plagiocephaly has risen in the United States since
the 1990s, primarily due to the National Institute of Child Health
and Human Development Safe to Sleep Campaign (formerly called
the Back to Sleep Campaign), which encourages parents to place
children on their backs to sleep (instead of on their stomachs) so
as to reduce the incidence of SIDS. Mild forms of plagiocephaly
may be corrected by wearing a corrective helmet; more severe
forms may necessitate surgery.
Plagiocephaly
Another random document with
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 Tel est le militaire.
Avec le journal susnommé de Lisbonne qui reproduit en résumé les notes
biographiques du «Panthéon Fluminense», du «Novo-Mundo» de New-
York et du «Dictionnaire biographique brésilien», voyons maintenant les
traits principaux qui caractérisent dans le baron de Teffé l’homme
technique, le savant hydrographe et l’astronome distingué:

«On sait déjà que dans son traité d’hydrographie, Hoonholtz avait révélé
une aptitude rare pour la science hydrographique, jusque-là assez en retard
dans les écoles brésiliennes. Le gouvernement impérial utilisant le talent
manifeste de Hoonholtz, le chargea dès le début de sa carrière militaire, de
la direction d’une Commission qui devait relever la côte et l’île de Sainte-
Catherine. Le travail fut exécuté dans des conditions irréprochables; le
gouvernement en approuva le résultat et lui accorda les plus vifs éloges.
«Après la fin de la guerre du Paraguay, Hoonholtz fut nommé chef de la
Commission de démarcation des limites de l’Empire, au Nord. L’exposé qui
précède a montré comment il sut s’acquitter de cette difficile et pénible
mission. C’est à la suite de son glorieux succès qu’il fut créé baron de
Teffé.....
«Quand fut mise en vigueur la loi du 24 septembre 1873, qui accordait
une garantie d’intérêts au chemin de fer de Paranagua, dans la province du
Parana, de graves difficultés surgirent au sujet de celui des deux ports,
Antonina ou Paranagua, qui offrait les meilleures conditions techniques et
financières comme entrepôt maritime de la province. Hoonholtz fut encore
appelé pour cette difficulté, et avec la bonne volonté qu’il apportait toujours
au service de son pays, il accepta l’invitation du ministre de l’agriculture;
après des études sérieuses et des observations prolongées, il démontra que
le port de Antonina était celui qui réunissait les conditions requises. Le 5
novembre 1878, à l’Institut Polytechnique Brésilien, un distingué ingénieur,
M. André Rebouças, parlait ainsi à cet égard:

«Le rapport du baron de Teffé, publié en 1877 par l’Imprimerie

nationale, constitue aujourd’hui le plus savant et le plus irréfutable
document sur les ports et les lignes ferrées du Parana. On ne peut le nier: en
hydrographie, notre illustre collègue, auteur de l’unique compendium en
langue nationale sur la matière, n’a pas son supérieur dans l’Empire. Dans
tout autre pays, son avis serait décisif, aucun gouvernement ne saurait aller
à l’encontre. L’Institut a entendu et dûment apprécié ses irréfutables
arguments, techniques et économiques; il a admiré l’autorité et la sagacité
avec lesquelles notre illustre collègue a étudié ce problème complexe.
Comme tous les nobles cœurs, Hoonholtz se passionne pour la vérité; c’est
aujourd’hui un des défenseurs les plus convaincus de Antonina et des
véritables intérêts du Parana. Cette belle province, elle aussi, n’oubliera
jamais son nom; déjà elle l’a attaché à la route qui relie à Antonina la
colonie de Assunguy; son dernier discours, disent les lettres que je reçois du
Parana, court déjà imprimé à travers les Sertoès de Guarapuava,
popularisant là même un nom si cher à la patrie par ses actions glorieuses
dans la guerre et dans la paix».

Depuis, la question a été tranchée en sens contraire, mais le baron de

Teffé a été vengé par les événements, et aujourd’hui la Compagnie et le
gouvernement s’efforcent de construire le tronçon qui refera d’Antonina la
tête de ligne.

«Quand il s’est agi du litige entre le gouvernement et la Compagnie

Nord-Américaine de navigation à vapeur, litige qui reposait sur les bonnes
ou mauvaises conditions du port de Maranhao, c’est encore au baron de
Teffé que recourut le gouvernement. Celui-ci était alors occupé à la
désobstruction de la barre à Cabo Frio; il partit pour le Maranhao à la tête
d’une commission. Après une analyse minutieuse, il présenta son rapport
démontrant la possibilité de l’entrée des grands vapeurs dans la baie de S.
Marcos et dans les mouillages de Eira, Itaqui et de l’Ilha do Medo. Son
opinion fut admise et les paquebots se résignèrent à l’escale indiquée dans
son rapport.
«L’assainissement de la lagune Rodrigo de Freitas dans la banlieue de
Rio-de-Janeiro ayant été reconnu d’une urgente nécessité, le baron de Teffé,
sur la demande du gouvernement, présenta un projet qui, mis en parallèle
devant la Société (Club) des ingénieurs avec d’autres rapports, entre autres
celui du distingué ingénieur Milnor Roberts, obtint sur tous la préférence.
«En 1876, il parvint à résoudre une grave question suscitée par les
avaries qu’une roche sous-marine, non mentionnée sur les cartes, avait
causées à l’entrée de Santos, aux vapeurs français et allemands. Sous sa
direction cette roche fut détruite, en employant les plongeurs de l’Arsenal
de marine auxquels était encore inconnu l’usage de la dynamite et du
scaphandre.
«Récemment, un autre fait a attesté de façon éloquente la grande
capacité du baron de Teffé. Nous voulons parler des observations
astronomiques exécutées à l’occasion du passage de Vénus sur le disque du
soleil, observation qui fut faite aux Antilles, où il alla représenter le corps
savant du Brésil. En récompense de cette mission remplie avec tant de
distinction, le baron de Teffé a été élevé à la dignité de Grand de l’Empire.
«Le baron de Teffé est, en outre, un littérateur apprécié. Outre ses écrits
disséminés dans une foule de journaux et de revues, il est l’auteur d’un
drame maritime intitulé: la Justice de Dieu, et d’un roman, la Corvette
Diana, publié en feuilleton par la Patria de Montevideo, par le Diario de
Pernambuco, et par le Despertador de Sainte-Catherine. La Corvette Diana
a été publiée ensuite séparément par l’auteur qui l’a gracieusement
distribuée à ses amis.
«Nous avons eu occasion de lire les appréciations portées sur ce livre
dans le Diario de Pernambuco, le Diario de Bahia et le Pedro II, du Ceara.
Tous ces journaux sont unanimes à considérer l’œuvre du délicat littérateur,
comme une véritable primeur de littérature agréable, où l’imagination
s’allie à un langage choisi, sans jamais s’écarter du plan général de
l’ouvrage. La Reforma, de Rio-de-Janeiro, du 7 juin 1873, consacrait à ce
livre les paroles suivantes:

«La Corvette Diana est le titre d’un roman charmant, dû à la plume de

M. le capitaine de frégate Antonio Luiz von Hoonholtz, officier distingué
de notre marine. C’est un roman maritime, où l’auteur vous fait apprécier
de beaux et variés tableaux de la nature brésilienne. Les épisodes y sont
racontés avec vérité et les caractères des personnages bien dessinés. Le livre
est écrit avec élégance et agrément.»

«Comme écrivain, le baron de Teffé est d’une rare fécondité, puisqu’en

outre du compendium hydrographique et des livres précités, il a publié en
feuilletons divers mémoires, discours, etc.; il a encore inédits plusieurs
autres travaux, comme la traduction et l’organisation alphabétique du code
international des signaux maritimes; un mémoire sur l’invention de
l’ingénieur allemand Wilhelm Bauer pour retirer les navires du fond de la
mer; un livre où il décrit ses impressions durant le voyage qu’il fit aux ports
d’Europe sur la corvette Bahiana, et deux volumes décrivant son voyage
d’exploration sur l’Amazone et ses affluents.
«Parmi ses remarquables travaux scientifiques, il faut mettre à part ses
conférences sur l’Amérique préhistorique, faites aux applaudissements d’un
auditoire choisi, où se montraient à côté des hommes les plus distingués du
Brésil, S. M. l’Empereur Don Pedro II et S. A. le comte d’Eu.»

La Folha do Commercio énumère à la suite les titres et honneurs

accordés au baron de Teffé.
Il est Grand de l’Empire, officier général de la flotte (contre-amiral),
officier des Ordres Impériaux du Cruzeiro et de la Rose, commandeur de S.
Bento de Aviz, de l’Ordre Royal Américain de Isabelle la Catholique;
décoré des médailles de la bataille navale de Riachuelo; de la campagne
générale du Paraguay; de celle conférée par la République Argentine aux
vainqueurs de Corrientes et du Mérite militaire; membre titulaire de
l’Institut historique et géographique du Brésil; vice-président de l’Institut
polytechnique; membre des Sociétés de Géographie commerciale de Paris
et de Lisbonne, et vice-président de la Société de Géographie de Rio de
Janeiro; membre du conseil directeur de la Société centrale d’Immigration,
et directeur général du service hydrographique de l’Empire; chambellan de
S. M. l’Impératrice.
Dernièrement il a été nommé membre correspondant de l’Académie des
Sciences de Paris et de l’Académie des Sciences de Madrid.
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