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Biology of Humans: Concepts, Applications, and Issues, 6e (Goodenough)
Chapter 6 The Muscular System
6.1 Multiple Choice Questions
1) Which of the following is not a function of muscle?

A) destabilize joints
B) generate heat
C) move blood in veins
D) move lymph in lymphatic vessels
Answer: A
Bloom's Taxonomy: Knowledge/Comprehension
Learning Outcome: 6.1
Section: 6.1
2) Overuse, misuse, and age are some of the factors that contribute to excessive stress on a
tendon, causing inflammation known as ________.
A) bursitis
B) tetanus
C) tendinitis
D) spasms
Answer: C
Section: 6.2
3) The arrangement of muscles so that the action of one muscle is opposite to that of its partner is
referred to as ________.
A) synergistic
B) antagonistic
C) dual
D) insertion
Answer: B
Section: 6.2
4) If it were possible to have antagonistic muscle pairs in an arm contract simultaneously, what
movement would the arm make?
A) The arm would move away from the body.
B) The arm would move toward the body in a curling movement.
C) The arm would be locked in position.
D) The arm could move easily in each direction.
Answer: C
Bloom's Taxonomy: Application/Analysis
Section: 6.2
1
Copyright © 2017 Pearson Education, Inc.
5) The attachment point of a muscle to a bone that can move is called the ________.
A) origin
B) insertion
C) synergistic
D) antagonistic
Answer: B
Section: 6.2
6) Which of the following attaches the end of the muscle to a bone?

A) synergistic
B) tetanus
C) ligaments
D) tendons
Answer: D
Section: 6.2
7) Which structure delivers a signal from the motor neuron to all the sarcomeres of a muscle
cell?
A) myosin filament
B) filaments-line
C) T tubule
D) sarcoplasmic reticulum
Answer: C
Section: 6.3
8) Which of these muscles would be most involved in a forcible exhalation, as in a sneeze?

A) rectus abdominis
B) sartorius
C) gastrocnemius
D) deltoid
Answer: A
Section: 6.3
2
9) Which of the following are protein filaments that function in muscle contraction and are
shaped like a golf club with two heads?
A) intermediate filaments
B) myosin filaments
C) myofilaments
D) actin filaments
Answer: B
Section: 6.3
10) Which substance is released by motor neurons to stimulate a contraction?

A) myosin
B) acetylcholine
C) dopamine
D) calcium
Answer: B
Section: 6.3
11) Which of these structures is part of a muscle cell's plasma membrane that delivers signals to
the sarcomere?
A) myosin head
B) actin fiber
C) endoplasmic reticulum
D) T tubule
Answer: D
Section: 6.3
12) When a myosin head binds to an actin molecule in order to contract a muscle, this is formed:
________.
A) myosin filament
B) actin filament
C) cross-bridge
D) troponin
Answer: C
Section: 6.3
3
13) Which component of a muscle does the calcium ion combine with to allow a contraction to
occur?
A) myosin head
B) actin
C) troponin
D) T tubule
Answer: C
Section: 6.3
14) Why must tropomyosin cover the thin filament in just the right position before the muscle
can relax?
A) It covers the myosin-binding sites and, if left exposed, will allow the myosin to bind and pull.
B) Without tropomyosin in the correct position, calcium cannot be released.
C) It is needed in the proper location, or ATP cannot be used.
D) It has a particular binding place that facilitates the removal of calcium.
Answer: A
Section: 6.3
15) The sarcoplasmic reticulum stores ions that are necessary for skeletal muscle contractions.
Which of the following ions does it store?
A) magnesium
B) iron
C) sodium
D) calcium
Answer: D
Section: 6.3
16) Muscle contraction results from the repeated cycle of interactions between myosin and actin.
What is the last step of this cycle, after which the cycle starts over again?
A) New ATP molecules bind to the myosin heads, causing them to disengage from the actin.
B) The myosin heads split the ATP into ADP and Pi and store the energy.
C) The myosin head bends (the power stroke).
D) Myosin heads extend toward the Z lines at the ends of the sarcomere.
Answer: B
Section: 6.3
4
17) Which of these junctions represents the connection between the tip of a neuron and a skeletal
muscle cell from which acetylcholine diffuses?
A) neurotic
B) tight
C) neuromuscular
D) desmosome
Answer: C
Section: 6.3
18) Which of these muscle types permit(s) voluntary movement?

A) cardiac
B) skeletal
C) smooth
D) All of the above permit voluntary movement.
Answer: B
Section: 6.4
19) When a muscle is stimulated before the muscle can fully relax, it can cause ________.
A) muscle twitch
B) summation
C) muscle failure
D) tendinitis
Answer: B
Section: 6.4
20) When a muscle is stimulated prior to full relaxation of a previous contraction and the second
stimulus is added to the first contraction, this phenomenon is referred to as ________.
A) tetanus
B) twitch
C) fatigue
D) summation
Answer: D
Section: 6.4
5
21) After a period of exercise, a person will breathe heavily for some time after the activity has
ceased. What is happening during this time as the oxygen debt is being paid?
A) Lactic acid is being removed.
B) Creatine phosphate is being regenerated.
C) Glycogen stores are being regenerated.
D) All of the above are true.
Answer: D
Section: 6.5
22) Why is ATP needed for muscle contraction?

A) It causes tropomyosin to slide off the myosin-binding sites of actin.
B) It's needed for calcium release from the sarcoplasmic reticulum.
C) It causes calcium to bind to troponin.
D) Myosin must contact the actin filament and move to pull it toward the midline of the
sarcomere.
Answer: D
Section: 6.5
23) Why does a person continue to breathe heavily after prolonged activity?
A) because of lack of water
B) to relieve fatigue
C) to relieve O2 debt
D) no reason
Answer: C
Section: 6.5
24) Which of these cell types can be described as muscle cells that contract rapidly, are rich in
glycogen deposits, and depend on anaerobic respiration to produce ATP?
A) slow-twitch cells
B) fast-twitch cells
C) myoglobin
D) hemoglobin
Answer: B
Section: 6.6
6
25) Which muscle cells are designed for endurance?
A) slow-twitch cells
B) fast-twitch cells
C) myoglobin
D) hemoglobin
Answer: A
Section: 6.6
26) What is the result of resistance exercise?

A) Existing muscle cells increase in diameter.
B) The number of muscle cells increases.
C) More mitochondria develop.
D) New blood vessels develop.
Answer: A
Section: 6.7
27) Someone who has broken an arm and has had a cast on it for months will notice a distinct
shrinking of the arm once the cast is removed. Why does this happen?
A) The cast has reduced blood flow to the muscle tissue to reduce swelling.
B) Muscles that are not used will atrophy.
C) The other arm was used more to compensate for the unused one, and it has become stronger.
D) If the person was right-handed, he or she will become left-handed.
Answer: B
Section: 6.7
28) Some insecticides interfere with the removal of acetylcholine from the synaptic cleft. What
effect will this have on muscle contraction?
A) The muscle cell will lose all of its supply of calcium.
B) The muscle cell will be unable to be stimulated again.
C) The muscle cell will be in a state of constant stimulation, leading to a tetany response.
D) The muscle cell will have a single twitch and will be unable to contract again.
Answer: C
Section: 6.7
7
29) Tetanus is a very serious disease caused by a toxin from a bacterium. Which of the following
is the most obvious symptom?
A) excessive sneezing
B) dissolving bones
C) excessive weight gain
D) muscle paralysis
Answer: D
Section: 6.7
30) A person may have a muscle injury that really affects the tendon and not the muscle tissue
itself. Why is it that after a hard workout, muscle pain will go away in a few days at most, but
tendinitis lasts so much longer?
A) Muscle cells are more elastic, so they are harder to damage.
B) Unlike a tendon, muscle tissue has an ample blood supply, so it's easier to repair.
C) Muscle cells can be rested, but tendons have to be used all the time.
D) The electrical signals that muscle cells generate are used to aid in healing.
Answer: B
Section: 6.7
31) What causes delayed onset muscle soreness?

A) exercise in which a muscle lengthens while it contracts
B) walking on level ground
C) running on level ground
D) gentle stretching
Answer: A
Section: 6.7
6.2 Fill-in-the-Blank Questions
1) All muscles share four traits. All are excitable, contractile, extensible, and ________.
Answer: elastic
Section: 6.1
2) A(n) ________ is the attachment point of a muscle to a bone that remains stationary during
movement.
Answer: origin
Section: 6.2
8
3) A band of connective tissue that aids in the attachment of muscle to bone is a(n) ________.
Answer: tendon
Section: 6.2
4) ________ is a condition in which there is an excessive stress on a tendon, causing

inflammation.
Answer: Tendinitis
Section: 6.2
5) The muscle that extends and rotates the thigh when walking is called the ________.
Answer: gluteus maximus
Section: 6.3
6) ________ pairs up with troponin proteins to form a complex that blocks muscle contractions.
Answer: Tropomyosin
Section: 6.3
7) A muscle will ________ if levels of calcium and potassium decrease in the blood.
Answer: cramp
Section: 6.3
8) The myofibrils contain two protein filaments that contract the muscle. Of these, the ________
are the thinner filaments.
Answer: actin filaments
Section: 6.3
9) The ________ is a modified form of endoplasmic reticulum that stores and releases calcium
ions when a muscle contracts.
Answer: sarcoplasmic reticulum
Section: 6.3
9
10) The striations (lines) of skeletal muscles are caused by the arrangement of many elongated
________.
Answer: myofibrils
Section: 6.3
11) ________ are the proteins that appear as dark bands that mark the ends of the sarcomeres.
Answer: Z lines
Section: 6.3
12) A bundle of muscle cells is called a(n) ________.

Answer: fascicle
Section: 6.3
13) The release of acetylcholine into the neuromuscular junction is shortly followed by the
release of ________ ions from the sarcoplasmic reticulum.
Answer: calcium
Section: 6.3
14) During muscle contraction, the heads of myosin filaments pull actin filaments toward the
center of a ________ (the contractile unit of muscle).
Answer: sarcomere
Section: 6.3
15) Your skeletal muscles might make a lot of these fast contractions when you are
cold:________.
Answer: twitches
Section: 6.4
16) A(n) ________ consists of a motor neuron and all the muscle cells that it stimulates.
Answer: motor unit
Section: 6.4
10
17) ________ is a sustained, powerful contraction of a muscle that results from frequent
stimulation with no time between stimuli for relaxation.
Answer: Tetanus
Section: 6.4
18) George liked to go for very long runs; we can assume that this chemical becomes depleted
during those marathons: ________.
Answer: glycogen
Section: 6.5
19) ________ provides the energy required for voluntary muscle contraction in an individual's
body.
Answer: ATP
Section: 6.5
20) When the O2 in the muscles of an individual who has exercised for a long period of time is
used up, this condition is known as ________.
Answer: oxygen debt
Section: 6.5
21) Muscle cells that contract slowly when stimulated but with enormous endurance are called
________.
Answer: slow-twitch cells
Section: 6.6
22) The type of exercise that creates new blood vessels and makes the heart pump more
efficiently is ________.
Answer: aerobic
Section: 6.7
11
6.3 Matching Questions
Match each definition in the first column to the correct term in the second column.
A) T tubules
B) Muscle twitch
C) Testosterone
D) Troponin
E) Myosin
F) Calcium ions
G) Tropomyosin
H) Slow-twitch muscle fibers
I) Tendons
J) Fast-twitch muscle fibers
K) Actin
1) Anabolic steroids are chemically related to this type of hormone.

Section: 6.7
2) A rapid, very brief muscle contraction.

Section: 6.4
3) Delivers the signals from the motor neuron to every sarcomere of the muscle cell.
Section: 6.3
4) Calcium binds to this protein to initiate a contraction.

Section: 6.3
5) Covers the myosin-binding sites on actin.

Section: 6.3
6) Protein that makes up the thin myofilament.

Section: 6.3
12
7) Protein that makes up the thick myofilament.
Section: 6.3
8) Functions in the attachment of muscle to bone.

Section: 6.2
9) Muscle fibers designed for rapid and powerful responses.

Section: 6.6
10) Muscle fibers that are designed for endurance, contract slowly, and have a steady supply of
energy.
Section: 6.6
11) Bind to troponin in the sarcomere to initiate muscle contraction.

Section: 6.3
Answers: 1) C 2) B 3) A 4) D 5) G 6) K 7) E 8) I 9) J 10) H 11) F
6.4 Short Answer and Essay Questions
1) Describe the four traits that all muscle types share.

Answer: Muscles have the ability to shorten and are contractile. Muscles are excitable and can
respond to stimuli. Muscles are extensible and have the ability to stretch. Muscles are elastic and
can return to their original length after being either lengthened or shortened.
Section: 6.1
2) How do calcium ions affect muscle contractions?

Answer: The tropomyosin-troponin complex situates itself at the actin-myosin binding sites,
preventing the formation of the cross-bridges. The tropomyosin-troponin complex can be moved
once calcium ions bind to the troponin, exposing the myosin heads to the actin filaments and
allowing the contraction to proceed.
Global LO: G8
Section: 6.3
13
3) In former times, surgeons used small doses of curare to relax the patient's abdominal and other
muscles during operations. Why did this compound work? What additional precautions do you
think the medical staff needs to put into place when a patient is under anesthesia?
Answer: Curare prevents acetylcholine from connecting to muscles. Since the diaphragm is
likely to stop working, patients may stop breathing because of this, so assisted breathing devices
are usually used.
Global LO: G5|G7
Section: 6.3
4) Explain the function of ATP in muscle contractions.

Answer: ATP binds to the myosin heads, allowing the myosin heads to disengage from the actin.
The myosin heads split the ATP molecules and store the energy, which allows the myosin heads
to swivel in preparation to form the cross-bridges.
Global LO: G8
Section: 6.3
5) Myasthenia gravis is a disease caused by the immune system that attacks the acetylcholine
receptors found on muscle cells. What effect would blocking these receptors have on muscle
contraction?
Answer: Acetylcholine is needed to initiate an action potential on the surface of a muscle cell.
Without it, the muscle will not contract. If a diseased state destroys or blocks the receptors that
acetylcholine normally binds to, the signal will not be sent, and the muscle will not contract.
Global LO: G7|G8
Section: 6.3
6) Rigor mortis sets in after the death of humans and other animals because the supply of ATP
decreases to the point at which calcium can no longer be removed from the cell. At this point, the
myosin molecules attach to the thin filament. The muscles stiffen, and limbs cannot be moved.
Why and for how long does the muscle then remain in this continuously contracted state?
Answer: If the myosin molecules cannot disengage from the actin filaments (i.e., the cross-
bridges cannot be broken), the muscle cannot rebound back to its starting position, and the
muscle will stay locked in that position. Eventually, the actin and myosin proteins themselves
will break down, and the muscles will be moveable again.
Global LO: G7|G8
Section: 6.3
14
7) Steve decides to make a meal for some of his friends. He uses a variety of foods to prepare the
meal, including some canned mushrooms. Unfortunately, he gives his friends a mild case of
botulism food poisoning. His friends report blurred vision and trouble speaking due to a flaccid
paralysis of the muscle cells by the botulinum toxin. Propose a mechanism by which this toxin
would inhibit muscle contraction.
Answer: If the muscles become flaccid, they cannot be stimulated to contract. The most likely
cause would be that the toxin is somehow interfering with the action of acetylcholine. The toxin
may be blocking acetylcholine release, or it may be blocking the binding of acetylcholine to the
receptors on the muscle.
Global LO: G5|G7|G8
Section: 6.3
8) Turkey is often served at Thanksgiving meals in which family members vie for portions of
white or dark meat. Why is the breast meat of a turkey whiter in appearance than the darker meat
found in the leg muscles?
Answer: The breast muscles of a turkey provide the force necessary for flight. Since turkeys are
not exceptional fliers and do not migrate, the flight muscles are not frequently used. Therefore,
the breast meat consists of fast-twitch fibers that lack much myoglobin. Turkeys rely instead on
running to escape predators, so the leg muscles get far more exercise. These tend to be slow-
twitch fibers containing lots of myoglobin and are thus darker in appearance.
Global LO: G7|G8
Section: 6.6
9) Compare and contrast the physiological effects of steroid use to increase and improve
performance in both genders.
Answer: Steroid use may promote a false sense of invincibility, increased aggression, and severe
depression. Abuse of these drugs can severely affect the liver, cardiovascular system, and
reproductive system. Males often have a reduction in natural testosterone production, causing
atrophy of the testicles, which leads to sterility and impotence. Many females exhibit irreversible
development of masculine traits, such as growth of body hair, deepening of the voice, loss of
scalp hair, smaller breasts, and enlarged clitoris.
Global LO: G5|G7|G8
Section: 6.7
15
10) Aerobic exercises do not increase skeletal muscle size, but they do cause various changes in
the body. Explain what changes aerobic exercises initiate.
Answer: Aerobic exercises initiate the development of new blood vessels to muscles and more
mitochondria within muscle cells. Muscle coordination, digestive tract movement, and the
cardiovascular and respiratory system will also benefit. The strength of the skeleton also
increases because of the increased force on the bones.
Global LO: G8
Section: 6.7
16
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minutes, although the organ is physically perfect. This weakness of
the eye may long be the most troublesome manifestation of the
disorder.
In some instances, before any loss of muscular strength is marked,

vaso-motor weakness is prominent. Excessive blushing on the
slightest provocation, great flushing of the face after the use of
alcohol or other stomachic irritant, waves of heat passing over the
body, occasional pallors provoked by exertion or apparently
causeless, and cold extremities, are some of the phenomena which
mark the lack of power in the centres that control the blood-vessels.
Closely allied to these disturbances are those of secretion. In my
own experience the most marked of these is a tendency to night-
sweats, but in some cases the hands, and more rarely the palms of
the feet, are perpetually bathed in perspiration, which may be greatly
increased by any emotional disturbance. In some patients there is a
very great tendency to serous diarrhœa, which in its turn of course
increases the nervous exhaustion.
In many neurasthenics the heart as well as the vaso-motor system

sympathizes in the weakness, so that palpitation and shortness of
breath not rarely follow even slight exertion: a more characteristic
symptom is, however, a peculiar dropping of the heart's beat, which
is to the patient at first very alarming, but which is entirely
independent of any lesion of the heart itself. The true nature of this
cardiac intermission is to be recognized by the existence of other
symptoms of neurasthenia, and by the fact that it is not constant, and
that it is very prone to follow eating or gastric irritation of any kind.
Not rarely it is relieved at once by the belching up of wind. When
tobacco has been very freely used the cardiac symptoms of
neurasthenia usually come on very early, and may be very severe.
Under these circumstances it is really a mixture of neurasthenia and
tobacco-poisoning with which we have to deal.
The muscular strength may finally fail almost altogether. It is almost

characteristic that the patient should be capable of much exertion
under excitement, and should suffer from the results of such
exercise not immediately, but after one or two days.
In many cases of neurasthenia atonic dyspepsia exists, but it is

always a question for careful consideration how far a nervous
condition is due to the dyspepsia and how far the dyspepsia is
caused by the nervous condition.
Disturbances of sensation are common in neurasthenia, these

disturbances taking the form in many instances of itchings or
formication or other similar minor ills. Neuralgia is often severe and
its attacks frequent, but I am convinced that something more than
simple nervous exhaustion is responsible for its production. I believe
that there is a neuralgic diathesis or temperament which is often
associated with neurasthenia, but may exist without it, and which
probably has, at least on many occasions, relations to a gouty
ancestry. When such temperament exists the neuralgic attacks are
greatly aggravated by the coming on of neurasthenia.
Hyperæsthesia and anæsthesia mark the line where simple
neurasthenia passes into hysteria. The same also is true of the
peculiar tenderness over the spinal processes of the vertebræ, which
is especially frequent in women, and is the chief symptom of the so-
called spinal irritation or spinal anæmia—an affection which I believe
to be a form of neurasthenia allied to hysteria.
In neurasthenia disturbances of the sexual organs are very common;

in women great pain on menstruation, ovarian irritation, the so-called
irritable uterus of Hodge, are closely connected with a general nerve
weakness. In not a small proportion of the cases of uterine disorders
which are often locally treated I believe the local disease is largely
the expression of the general condition. It is well known that
masturbation and sexual excess in the male may produce an
exhaustion of the nerve-centres especially implicated and also a
general nervous exhaustion. This is the common history of
spermatorrhœa. It is no less true that a general neurasthenia may
produce a local weakness of the sexual centres, with symptoms at
least resembling those of spermatorrhœa—namely, great irritability
of the sexual organs, with a practical impotence due to immediate
seminal discharge whenever coition is attempted. I have certainly
seen this condition result from excessive intellectual labor when
there has been no sexual excess, and at a time when the muscular
strength was still good. Such cases may, perhaps, be distinguished
by the fact that unprovoked emissions are not nearly so apt to occur
as in true spermatorrhœa.
TREATMENT.—The natural cure for neurasthenia is rest, and my own

experience coincides with the logical inferences to be drawn from an
etiological consideration of the subject—namely, that medicines are
only of limited value, and unless very judiciously administered may
readily do harm. Disturbing symptoms should be met and tonics may
be used, especially strychnine and arsenic, but all drugs hold a
secondary position in the relief of a pure neurasthenia. In using
remedies the practitioner must be guided by general principles, and I
shall not engage in any detailed consideration of the subject, but
employ the space at my disposal with a discussion of rest.
When nervous exhaustion has been produced by over-use of any

one organ or system of organs, absolute rest of such organ is a
primary necessity. Thus, when there has been sexual excess
absolute avoidance of use of the sexual organs must be enjoined,
and in married Americans it is often essential to insist upon man and
wife occupying distinct apartments1 or even to separate them by a
journey.
1 Because in this country man and wife habitually occupy one bed. Sexual continence
under these circumstances can only be obtained at the cost of a suppressed sexual
excitement worse than moderate indulgence.
Again, in cases of brain-tire it is the brain which should be rested. To

rest an overwearied, excited brain is often not an easy task. In
attempting it the effort should be to obtain the following results: 1st.
The removal of all cares, anxieties, and all brain-work, especially
those of such character as have been connected with the
breakdown. 2d. The maintenance of the interest of the patient, so
that the past shall for the time being be forgotten, and the present
not overweighted with irksomeness. 3d. Invigoration of the physical
health of the whole body, and especially of the nervous system. In
order to obtain the first of these measures of relief, isolation of some
sort is essential; for the second mental occupation is usually
required; for the third fresh air, exercise, or some substitute is to be
superadded to abundant food and rest.
The proper method of meeting these indications varies greatly, not

only with the varying physical conditions and idiosyncrasies of
patients, but also with their diverse domestic and pecuniary relations.
To give detailed directions for every case is impossible, and I shall
therefore limit myself first to simple cases of brain-tire in which the
muscular strength is preserved; second, to cases of profound
general neurasthenia.
In brain-tire travel is usually recommended, and travel affords, when

properly directed, separation from old cares and thoughts, a
maintenance of interest by a succession of novel sights and
experiences, and the physical stimulation of fresh air and exercise.
In bad cases general travel is too stimulating, and ocean-voyaging is
much better. Upon the ocean is to be found nothing provocative of
thought, only complete isolation, fresh air, enjoyment if the patient be
fond of the sea, and a sufficient exercise, especially if the sufferer in
any large measure works in the management of a sailing vessel.
Hence prolonged yachting affords in many cases our best method of
relief. The isolation of the North Woods or any other large primeval
wilderness may be complete, the air most fresh, and the exercise to
be had also boundless, but at the same time controllable; the man
may, according to his will, lie in his tent and be fed by his guide or be
unceasingly active. If the life be agreeable to the sufferer, and
sufficient care against undue exposure be exercised, the camp-cure
is most efficient. European travel may serve almost equally well,
provided hard journeying, sight-seeing, and even cities are avoided.
The quiet of Switzerland or the Tyrol may bring restoration when the
bustle of London and Paris might complete the ruin.
To those who cannot travel extensively the seashore, mountains, or
lowlands of the United States are open, and the best way of meeting
the indications in any individual case must be determined by a joint
consultation between doctor and patient.
There are cases of neurasthenia in which the slightest exercise does

harm, and in which even the unconscious effort of company and
conversation is an injury. Between the extremely exhausted and the
slightly brain-tired is every grade of case, and much tact is often
required in properly regulating the treatment of the individual case.
It is only the most severe forms of neurasthenia which require the

use of the so-called rest-cure. For such, however, it is a very
valuable method of treatment. It finds its most brilliant application
undoubtedly in neurasthenic women, but, more or less modified
according to circumstances, it has a wide scope in the treatment of
both sexes. When the bodily condition is developed by prolonged
lactation, nursing, grief, overwork, acute disease, or other temporary
or removable cause, the rest-cure may give permanent relief; and
even when the cause of the neurasthenia is largely inherited
feebleness of constitution, it is a valuable though a more temporary
remedy. This method of treatment has long been used in this city,
and was especially dwelt upon in its general scope by Samuel
Jackson, but in its modern form it has become a very valuable
method of treatment, essentially different in its details from what it
was formerly, and far more potent in its influence. To S. Weir Mitchell
is due a great debt of gratitude, for by him has this improvement
been made.
The principles of the rest-cure are absolute rest, forced feeding, and
passive exercise. Absolute rest is often prescribed by the physician
without being sufficiently definite and insisted upon. When it is
desired to apply it most strictly, it should be clearly explained that the
patient is not to be allowed to get out of bed even to pass urine or
feces, not to feed himself or herself, or perform any act of the toilet
whatsoever. The rest also must be for the mind as well as for the
body, and it is essential that the patient be isolated. Separation from
friends should especially be insisted upon in the case of women. It
may be possible to separate a man in his own house completely
from his daily cares, but a woman in her own house is in the midst of
her daily business, and is like a man placed in the corner of his
factory. In obstinately severe cases of neurasthenia complete and
absolute isolation is a sine quâ non, and especially when there is a
decidedly hysterical element is it necessary to separate the patient
entirely from her friends. Under these circumstances there must be a
well-trained nurse who is personally agreeable to the patient. The
confinement would be very irksome to any except the most
exhausted patient were it not for the daily visit of those engaged in
the treatment; to further provide against ennui the nurse should be a
good reader, so that under the definite instructions of the physician
she can occupy a certain portion of the time in reading to the patient.
In order to maintain the functions of the skin the patient should be

well sponged in bed every morning after breakfast. A strong solution
of salt, or, better, sea-brine, is to be preferred to simple water, and
frequently it may be followed by the use of alcohol. In very feeble
cases the alcohol may be employed alone. I have seen very good
effects from momentarily rubbing each portion of the skin with ice
just after the bathing.
The question of feeding is one of great importance, and requires the

utmost care and attention from the physician. The end to be attained
is to feed the patient as much as can be digested, but not to overdo
and derange the digestion. Food should be given at intervals of two
or three hours, and must be both light and nutritious. It should, at
least at first, largely consist of milk, except in those rare cases in
which that fluid does really disagree, and not merely is thought to do
so. The milk should be skimmed or given in the form of koumiss.
Beef and other concentrated meat-essences are valuable as
stimulants, and may be used, especially as the basis of soups.
Various farinaceous articles of food may be added to them, or if an
egg be broken into the concentrated bouillon or beef-essence just as
it ceases boiling a nutritious, and to many persons palatable, dish is
obtained. When constipation exists, oatmeal porridge, Graham
bread, fresh or dried fruits may be allowed if readily digested by the
patient. In order to give an idea of the general plan of the dietary, the
following schedule of the daily life is given. Such a schedule should
always be put into the hands of the nurse, who should be required to
follow it strictly. It must be altered from day to day, so as not to weary
the patient with monotony. It is especially important to remember that
the diet must be carefully studied for each patient, and be adapted to
the individual requirements of the case. Success will in a great
measure depend upon the practical skill and tact of the physician in
this adaptation:
8 A.M. Rolls or toast; cocoa or weak coffee, or roasted wheat coffee;

beefsteak tenderloin or mutton chop.
9 A.M. Bathing.
11 A.M. Oatmeal porridge, with milk, or else a pint of koumiss.
12 M. Massage.
2 P.M. Dinner: Bouillon with or without egg; beefsteak; rice; roast
white potatoes; dessert of bread pudding, blanc mange, or
similar farinaceous article of diet.
4 P.M. Electricity.
5 P.M. Milk toast.
9 P.M. Half pint of skimmed milk or koumiss.
In many cases the patient at first can take very little food, and it is
very frequently best to begin the treatment with an entirely liquid diet,
giving milk every two hours, or using Liebig's raw-meat soup, with
milk or plain farinaceous food, and only after a time gradually
accustoming the patient to solid food. Not rarely a prolonged
treatment by the so-called milk diet is of avail. The rest-cure is
indeed largely based upon a careful regulation of the food; but a full
discussion of the various dietaries to be used would require a
treatise upon dietetics.
Passive exercise is to be obtained by the use of electricity and

massage, the object being to get the effects of exercise upon the
nutrition and circulation without the expenditure of the patient's
nerve-force. By the use of electricity muscular contractions are
secured which simulate those which are voluntary and more or less
thoroughly replace them. By the general application of the current to
the whole body we probably affect the tone of all of the minute blood-
vessels, and certainly in this or some other way stimulate the general
nutrition, and, as has been shown by S. Weir Mitchell, for the time
being elevate the bodily temperature.
The faradic current is alone used. It is applied in two ways: first, to

the individual muscles; second, to the whole body. The séances
should be daily, the operator beginning at the hand or foot, and
systematically faradizing each muscle of the extremities and trunk.
The slowly-interrupted current is generally preferable, but advantage

is sometimes gained by varying the rapidity of the interruptions. The
general rule is to select that current which produces most muscular
contraction with the least pain. The poles should be applied
successively to the motor points of the muscles, so as to contract
each firmly and thoroughly. This process should occupy from thirty to
forty minutes. The electrodes are then to be replaced by large
sponges well dampened with salt water: one of these should be put
at the nape of the neck and the other against the soles of the feet,
and a rapidly-interrupted current, as strong as the patient can bear,
should be sent through the body for twenty minutes or half an hour. It
is not necessary for the operator to remain during this time. In some
cases the electrical programme may be varied so as to get a local
stimulant action from the general current; thus, when digestion is
enfeebled and the bowels costive for a portion of the time one of the
sponges may be placed upon the epigastric region. In women when
there is great abdominal and pelvic relaxation one pole may be
placed high up in the vagina. I have seen old-standing prolapses
cured in this way. Some electro-therapeutists claim great advantage
from galvanization of the cervic sympathetic ganglia, but I do not
myself believe that they ever succeeded in reaching these ganglia
with the current.
Massage, like electricity, affects greatly the peripheral circulation,
empties the juice-channels, and gives tone to the muscular system.
It must be clearly distinguished from rubbing of the skin. It consists in
manipulations of such of the muscles as are not too deep to be
reached, and of the cellular tissue: in order to lessen as much as
may be the skin friction by these manipulations, it is often well to
anoint the surface with cocoanut or other bland oil. As sold in the
drug-stores, cocoanut oil is very often rancid, and at any time it is
well substituted by the cheaper cottonseed oil. In practising massage
it is essential to remember that the natural course of the venous
blood and the juices of the cellular tissue is toward the centre of the
body; therefore, all general movements should be practised in this
direction.
The manipulations are percussion, rolling, kneading, and spiral. They

consist of movements made with the pulpy ends of the fingers and
thumbs, and spiral movements with the whole hand so folded as to
adapt its palm to the limb. In percussion the strokes should be from
the wrist, and should be quick and short. It is probably not possible,
even by long strong strokes, to affect deep muscles. In the rolling
manipulation the effort is to roll the individual muscles beneath the
pulps of the fingers. This manipulation may be varied by pinching the
muscles, not the skin, and kneading. In each case it is intermittent
pressure upon the muscles which is aimed at. The circular
movements are to be in opposite directions with both hands
simultaneously, the limb being grasped by one hand a little above
the other, and a spiral sweep made up the limb, the ball of the thumb
and the palm of the hand resting upon the patient, and the pulpy
parts of the thumb and the fingers grasping the limb. It is especially
such motions as these which affect the circulation of the flesh-juices.
The length of time the patient is to be kept in bed and treated in the
manner described varies of course with the individual case, but
usually less than four weeks is not sufficient, and rarely are more
than six weeks required. In getting up, the patient should begin by
sitting up one or two hours a day, increasing daily, but not too rapidly,
the time of being out of bed and the amount of exertion made. The
electrical treatment should be gradually intermitted: in many cases
massage twice a week seems to be of service even after the patient
is about. In the going back to ordinary daily life great care is to be
exercised to proportion the amount of exertion to the newly-obtained
strength, so as not to lose what has been gained. In cases of natural
or of long-standing acquired severe neurasthenia the mode of life
must be arranged to correspond with the small daily product of
nervous energy.
In dismissing this subject I desire to caution against a routine

employment of this so-called rest-cure, which might readily
degenerate into a species of quackery; and, again, to call attention to
the widespread value of the principles which underlie it, and the
importance of the physician applying those principles with endless
modifications of detail.
SLEEP, AND ITS DISORDERS.
BY HENRY M. LYMAN, A.M., M.D.
The regularly-recurring incidence of natural sleep forms one of the

most important subjects of physiological investigation. Occurring
ordinarily at stated intervals connected with the diurnal revolution of
the earth, it may for a time be postponed by an effort of the will, but
an imperious necessity for repose finally overcomes all opposition,
and the most untoward circumstances cannot then prevent the
access of unconsciousness. Thus produced, the relation of cause
and effect between weariness and sleep becomes very apparent.
The refreshing influence of such repose points clearly to the
restorative character of the physical processes that continue despite
the suspension of consciousness; it also renders evident the final
cause of that periodical interruption of activity which the brain
experiences in common with every other living structure.
Careful observation of the manner in which sleep invades the body

indicates that its evolution is not associated with a simultaneous
suspension of every mode of nervous function. The sense of sight is
the first to yield. The eyelids close and the muscles that support the
head give way. The body seeks a recumbent position; quiet and
seclusion are instinctively sought. The purely intellectual faculties are
not yet depressed, and the reflex energies of the spinal cord are
exalted. Soon, however, the other senses fail; hearing persists the
longest of all. Released from the control of external impressions, the
internal senses preserve their functions after a strangely-disordered
fashion, dependent upon the progressive suspension of activity in
the various cerebral organs. First the power of volition ceases; then
the logical association of ideas comes to an end. Presently the
reasoning faculties disappear, and judgment is suspended. We thus
become no longer capable of surprise or astonishment at the
vagaries of memory and imagination, the only mental faculties that
remain in action. To their unrestrained function we owe the
presentation in consciousness of the disorderly picture which we call
a dream. During the early stages of this somnolent state we often
remark the fact of dreaming, and an effort at attention may produce a
partial awakening; but usually the subsidence of cerebral function is
progressive and rapid. The fire of imagination fades; the field of
consciousness becomes less and less vividly illuminated; the entire
nervous apparatus yields to the advancing tide; and, finally, the
dominion of sleep is fully confirmed.
During the act of awaking the order of sequences is reversed. From
the end of the first hour of repose the depth of sleep, at first rapidly,
then more gradually, diminishes.1 Dreams disturb its quiet, mental
activity increases, the power of volition revives; once more the
individual is awake.
1 Kohlschütter, Messungen der Festigkeit des Schlafes, Dissert., Leipzig, 1862, and
Zeitschr. f. Rat. Med., 1863.
Sleep, then, is that condition of physiological repose in which the

molecular movements of the brain are no longer fully and clearly
projected upon the field of consciousness. This condition is normal,
and must, consequently, be differentiated from all pathological states
which produce its counterfeit by the more or less complete abolition
of consciousness. This distinction becomes the more necessary
because the presence of the common factor, unconsciousness, in
the result has frequently led to the mistake of supposing a
community of antecedents in the changes by which the passage
from sensibility and consciousness to insensibility and
unconsciousness is effected. It needs no argument to show that the
insensibility of artificial anæsthesia is a very different thing from the
unconscious condition which obtains during natural sleep. Between
the stupor of intoxication and the healthful restoration of cerebral
energy which accompanies genuine sleep there can be no rational
comparison. It is therefore in the phenomena of syncope that the
likeness of sleep has usually been sought. The well-known fact that
a copious hemorrhage can speedily develop a condition of muscular
relaxation, insensibility, and unconsciousness has led certain
observers to the belief that natural sleep is, after all, only a species
of physiological syncope. The antecedent conditions of syncope are
so different from the prodromata of sleep that it is difficult to see how
either state can be properly likened to the other. The bloodless
condition of the brain which occasions syncope is always the result
of pathological or accidental causes, and is not identical with the
comparatively insignificant reduction of blood-pressure which may be
observed in the brain of the healthful sleeper. It is, moreover, worthy
of note that sleep is the normal condition of the unborn child, despite
the fact that the growing brain receives a richer supply of oxygenated
blood than the trunk and the lower limbs—a state of the circulation
quite unlike that of syncope.
Fully impressed by the force of such considerations, certain

physiologists2 have reasoned from the analogies suggested by the
results of muscular fatigue, and have imagined an hypothesis
accounting for the occurrence of sleep by a supposed loading of the
cerebral tissues with the acid products of their own disassimilation
during wakeful activity. The acid reaction of the brain and of the
nerves after exertion suggested the probability that an excessive
presence of lactic acid and its sodic compounds might be the real
cause of cerebral torpor and sleep. Could the hypothesis be proved,
ordinary sleep would take its place in the anæsthetic category and
sodic lactate should be the very best of hypnotic agents.
Unfortunately for this doctrine, the administration of the lactates has
yielded only the most contradictory and unsatisfactory results. It,
moreover, furnishes no explanation of intra-uterine sleep nor of the
invincible stupefaction produced by cold.
2 Obersteiner, “Zur Theorie des Schlafes,” Zeitschr. f. Psych., xxix.; Preyer, “Ueber die
Ursachen des Schlafes,” Vortrag. Stuttgart, bei Enke, 1877; and Centralbl. f. d. Med.
Wiss., 1875, S. 577.
Far more comprehensive is the hypothesis of Pflüger.3 According to

this view, the cortical tissues of the brain are recruited by the
assimilation of nutrient substances derived from the blood. By this
process oxygen is stored up in chemical combination, forming
explosive compounds whose precise composition is not fully
understood. Under the influence of the various nervous stimulations
that reach the brain these unstable compounds break up into simple
forms. The motion thus liberated by these explosions is, in some way
at present utterly unintelligible to us, projected into the field of
consciousness where the mind dwells, and we are thus brought into
conscious relation with the external world. That the capacity for thus
signalling across the gulf which separates matter from mind is the
result of a certain perfection and complexity of material structure is
rendered probable by the utter failure of the infracortical organs of
man to impress the conscious intelligence by any amount of
independent activity. It is also indicated by the unconscious sleep of
the rudimentary fœtal brain and by the brevity of the intervals of
wakefulness which mark the life of the new-born babe. That this
capacity is dependent upon the mobility of the atoms of the brain is
shown by the speedy cessation of intelligence which follows great
reduction of temperature, as in hibernation or during exposure to
severe frost. That its exercise is largely dependent upon the activity
of the senses is proved by the effects of interference with their
function. A recent observation, recorded by Strümpell,4 is very
significant in this connection: A young man had lost all power of
sensation excepting through the right eye and the left ear. A
bandage over the eye and a plug in the ear arrested all
communication between his brain and the external world. Thus
imprisoned within himself, he gave utterance to an expression of
surprise, and sought in vain, by clapping his hands, to arouse the
sense of hearing. At the end of two or three minutes these efforts
ceased; respiration and pulsation were deepened and retarded, and
removal of the bandage exhibited the patient with his eyes closed in
genuine sleep.
3 “Theorie des Schlafes,” Arch. f. d. Ges. Physiol., x. 468.
4 “Beobachtungen ueber ausgebreitete Anästhesien und deren Folgen,” Deutsch.

Arch. f. klin. Med., xxii.
The dependence of the waking state upon the presence and

functional activity of a sufficient quantity of a peculiarly unstable form
of protoplasm in the brain is an hypothesis which presents no great
difficulty of comprehension. But how may we explain the passage
from the vivacity of that waking state into the inactivity of sleep? I
have elsewhere5 discussed the manner in which artificial sleep is
produced by impregnation of the brain with anæsthetic substances,
and the same general line of argument may be extended to cover
the action of every stupefying agent with which the blood may
become overcharged. Could the hypothesis of Obersteiner and
Preyer be accepted, it would be an easy matter to explain the advent
of sleep when it gradually supervenes; but we cannot thus explain
the rapid and intentional passage from wide-awakefulness into the
profoundest sleep, such as becomes a matter of habitual experience
with sailors and with others who have formed the habit of going at
once to sleep at regularly-recurring periods of time. Certain writers
have endeavored to account for this fact by imagining a special
mechanism at the base of the brain (choroid plexuses of the fourth
ventricle, etc.), by means of which the current of blood through the
brain may be voluntarily diminished, with a consequent arrest of
conscious activity. But, still adhering to the hypothesis of Pflüger, we
shall find a clearer explanation of the facts by considering the
phenomena connected with the succession of impressions upon the
organs of sense. It has been ascertained6 that such impressions
must persist for a certain measurable length of time in order to excite
conscious perception. A sound must be prolonged for at least 0.14″,
a ray of light must agitate the retina for 0.188″–0.2″, ordinary contact
with the surface of the body must continue during 0.13″–0.18″, in
order to produce any knowledge of sound and light and common
sensation. For the simplest act of perception 0.02″–0.04″ are
necessary. It is therefore perfectly reasonable to suppose that when
the explosive material of the brain has been sufficiently reduced in
quantity and quality by prolonged cerebral effort, the impression of
sense may no longer suffice to excite in the cortical substance
vibrations of sufficient length, or following each other in sufficiently
rapid succession, to sustain the conscious state. The cortex of the
brain may then be likened to the surface of a body of water into
which bubbles of soluble gas are introduced from below. When the
bubbles are large and succeed each other rapidly, the surface is
maintained in a state of continual effervescence. But if the size of the
bubbles be diminished or if the solvent capacity of the liquid be
increased, its surface will become almost, if not quite, perfectly
tranquil. In some such way, without any great amount of error, may
we picture forth the molecular changes that determine the advent of
sleep.
5 Artificial Anæsthesia and Anæsthetics, pp. 15-17.
6 Carpenter's Physiology, 8th ed., p. 852.
Returning now to the subject of the rapid induction of sleep, we find

that it usually occurs among people who lead an active life in the
open air, like children and laborers, and are perhaps compelled to
endure frequent interruptions of their rest. The sailor who is trained
to sleep and to work in rapidly-successive periods of time—four
hours on deck and four hours below—has virtually become
transformed by this habit into a denizen of a planet where the days
and the nights are each but four hours long. His functions become
accommodated to this condition; his nervous organs store up in
sleep a supply of protoplasm sufficient only for an active period of
four or five hours, so that when his watch on deck is ended he is in a
state as well qualified for sleep as that of a laborer on shore at the
end of a day of twelve or fifteen hours. Moreover, the majority of
those who manifest the ability thus to fall asleep are individuals
whose waking life is almost entirely sustained by their external
perceptions. So soon, therefore, as such excitants are shut out by
closing the eyes and by securing shelter against the sounds and
impressions of the air, comparatively little remains for the production
of ordinary consciousness, and sleep readily supervenes, especially
if the excitable matter of the brain has been already depleted by
active exertion.
It is well known that a predisposition to sleep may be very quickly

induced by extraordinary expenditures of force; witness the effect of
the venereal act and the consequences of an epileptic fit. That
analogous predispositions may indeed be very rapidly developed by
modifications of cerebral circulation is shown by the sudden
reduction of cerebral excitability during the act of fainting. But this
does not prove that cerebral anæmia should be elevated to the rank
of the principal cause of natural sleep. In all such cases the nervous
process is the primary factor and the direct cause of change in the
circulation.7 The character of these changes has been admirably
illustrated by the observations of Mosso.8 By the aid of the
plethysmograph this experimenter was enabled to compare the state
of the circulation in the human brain, laid bare by erosion of the
cranial bones, with the movement of the blood in other portions of
the body. The occurrence of sleep caused a diminution in the
number of respirations and a fall of six or eight beats in the pulse.
The volume of the brain and its temperature were at the same time
slightly reduced through the diversion of a portion of the blood-
current to other regions of the body. If during sleep a ray of light was
allowed to fall upon the eyelids, or if any organ of sense was
moderately excited without waking the patient, his respiration was at
once accelerated, the heart began to beat more frequently, and the
blood flowed more copiously into the brain. Similar incidents
accompanied the act of dreaming. The renewal of complete
consciousness was followed by an immediate increase in the activity
of the intracranial circulation.
7 W. T. Belfield, “Ueber depressorische Reflexe erzeugt durch Schleimhautreizung,”
Du-Bois Reymond's Archiv, 1882, p. 298.
8 Ueber den Kreislauf des Blutes im menschlichen Gehirn, Leipzig, 1881.
In all these variations it is worthy of note that the nervous impression

was the primary event. The changes of blood-pressure and
circulation were invariably secondary to the excitement of nerve-
tissue. Sleep, therefore, is the cause, rather than the consequence,
of the so-called cerebral anæmia which obtains in the substance of
the brain during repose. This condition of anæmia is nothing more
than the relatively lower state of circulation which may be discovered
in every organ of the body during periods of inactivity. Every
impression upon the sensory structures of the brain occasions a
corresponding liberation of motion in those structures. The
movement thus initiated arouses the vaso-dilator nerves of the
cerebral vessels and excites the vaso-constrictor nerves of all other
portions of the vascular apparatus. Hence the superior vascularity of
the brain so long as the organs of sense are fresh and receptive;
hence the diminishing vascularity of the brain as its tissues become
exhausted and unexcitable; hence the unequal and variable
vascularity of different departments of the brain as sleep becomes
more or less profound. These modifications of the brain and of its
circulation are well illustrated by the effects of a moderate degree of
cold applied to the cutaneous nerves of the body, as not infrequently
happens when the night air grows cool toward morning. Such
moderate refrigeration of the skin excites its sensitive nerves, which
transmit their irritation to the brain. The excitement of this organ
causes dilatation of its vessels, with increased irritability of the
cortex, vigorous projection into the field of consciousness, and the
consequent occurrence of dreams denoting imperfect slumber or
even complete awakening. The remedy consists in the application of
gentle heat to the surface of the body. By this means the
transmission of peripheral irritation is checked; the brain becomes
tranquil; sleep supervenes. A similar wakefulness is in like manner
produced by unusual heat. The remedy here consists in the
employment of measures calculated to reduce the temperature of
the skin to the normal degree. Sometimes wakefulness is maintained
by some less general irritant. The feet alone may be cold, either
because of previous refrigeration or because of local hyperæmia
occurring elsewhere in an anæmic subject. There, again,
equalization of the circulation—that is, the removal of cerebro-spinal
irritation—may be all-sufficient to procure sleep. Noteworthy also is
the tranquillizing effect of foot-baths or of the wet sheet in many
cases of cerebral excitement and wakefulness. In like manner, that
form of sleeplessness which often follows intense mental activity
may generally be obviated by a light supper just before going to bed.
Activity of the stomach is thus substituted for activity of the brain,
and the consequent diversion of blood is sufficient to reduce the
production of excitable matter in the brain to a point that permits the
occurrence of sleep. A morbid exaggeration of this process is
sometimes witnessed in the soperose condition that accompanies
digestion in patients whose blood has been reduced by hemorrhage
or by disease. In such cases the nutrition of the brain proceeds at so
slow and imperfect a rate that any considerable diversion of blood
toward other organs produces a syncopal slumber which resembles
normal sleep only by the fact of unconsciousness. If, however, food
be taken in excessive quantity or of irritable quality, the consequent
indigestion will produce nervous excitement, reaching perhaps to the
brain, and preventing sleep.
Dreams.
The most interesting question regarding sleep concerns the

condition of the mind during repose. We know that while the body is
awake the mind is always active: does this activity entirely cease
during the period of sleep? The phenomena of certain varieties of
trance indicate that the mere semblance of death is not incompatible
with great mental activity. In like manner, the phenomena of dreams
serve to prove that various intellectual processes, such as memory,
imagination, attention, emotion, and even volition, may still be
exercised while every external avenue of special sense is closed by
sleep. The result of the exercise of mental activity under such
conditions constitutes a dream. The fact that observers who have
made trial in their own persons have always found themselves
engaged with the details of a dream when suddenly awakened from
deep sleep has been supposed to afford valuable proof of the
proposition that the mind is never wholly inactive during the deepest
sleep. To say nothing of the significance of certain somnambulic
states (double consciousness), in which intelligence evidently exists
for a long period of time without leaving any subsequent trace in
memory, the mere fact that we remember very few of the events that
occupy the mind in dreams cannot be urged against the doctrine of
continuous mental action, for we remember very few of the images
and ideas that have stirred the depths of consciousness during the
waking state. Our recollection of dreams is exceedingly variable.
Sometimes we retain in memory all the events of a long and
complicated vision, but usually, though entranced by the vivid beauty
of the spectacle that unrolls its splendor before the eye of the mind in
sleep, and though the intensity of its seeming action may be
sufficient to awaken the dreamer, who recalls each incident as he
reviews the picture during the first waking moments, the impression
soon fades, and the coming day finds him incapable of reproducing a
single scene from the nocturnal drama.
The space allotted to this article will not admit a full discussion of the
physiology of dreams. A brief reference to the definition of sleep
must suffice to indicate what is signified by the process. Sleep does
not wholly arrest the functions of the brain. A certain amount of
projection into the field of consciousness seems to continue even
during the most perfect repose, and the ideas thus aroused form the
material of our dreams. Our waking hours are occupied with the
ideas and with the associated trains of thought that are presented in
consciousness through the action of our several senses. As a
consequence of the harmonious function of these senses, correcting
and supplementing each other, a continuous process of logical
thought is maintained. But along with the procession of ideas which
are distinctly conceived by the mind, the field of consciousness is
also invaded by a cloud of half-formed perceptions that are too
imperfect and too fleeting to occupy the attention. As in the act of
sight, though the periphery of the visual field is clouded with a whole
world of objects dimly perceived without arresting particular
attention, the centre of that field alone presents a clear image before
the brain, so the eye of the mind perceives clearly only a few of the
impressions which enter the sphere of consciousness. These
neglected perceptions, however, are none the less the result of
abiding impressions graven in the substance of the brain, from
which, through the action of memory, they may at any favorable
opportunity re-enter consciousness. It is well known that a
suspension of the functions of any portion of the nervous apparatus
tends to increase the energy of the remaining organs; consequently,
it becomes highly probable that with the arrest of external perception
in sleep the activity of certain portions of the brain must be
considerably exalted, so that the impressions which they have
previously registered may now more clearly reach the seat of
consciousness. The probability of this hypothesis is greatly
strengthened by numerous facts that lie open to observation. During
the first moments that succeed the closing of the eyes mental activity
and the power of attention are not diminished, but are rather
increased. As the controlling influence of the cerebrum is withdrawn
the reflex energy of the spinal cord becomes temporarily exalted.
Witness the paroxysms of cough that sometimes harass a sleeping

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6.1 Multiple Choice Questions

1) Which of the following is not a function of muscle?

6) Which of the following attaches the end of the muscle to a bone?

8) Which of these muscles would be most involved in a forcible exhalation, as in a sneeze?

10) Which substance is released by motor neurons to stimulate a contraction?

18) Which of these muscle types permit(s) voluntary movement?

22) Why is ATP needed for muscle contraction?

26) What is the result of resistance exercise?

31) What causes delayed onset muscle soreness?

6.2 Fill-in-the-Blank Questions

4) ________ is a condition in which there is an excessive stress on a tendon, causing

12) A bundle of muscle cells is called a(n) ________.

1) Anabolic steroids are chemically related to this type of hormone.

2) A rapid, very brief muscle contraction.

4) Calcium binds to this protein to initiate a contraction.

5) Covers the myosin-binding sites on actin.

6) Protein that makes up the thin myofilament.

8) Functions in the attachment of muscle to bone.

9) Muscle fibers designed for rapid and powerful responses.

11) Bind to troponin in the sarcomere to initiate muscle contraction.

Answers: 1) C 2) B 3) A 4) D 5) G 6) K 7) E 8) I 9) J 10) H 11) F

6.4 Short Answer and Essay Questions

1) Describe the four traits that all muscle types share.

2) How do calcium ions affect muscle contractions?

4) Explain the function of ATP in muscle contractions.

In some instances, before any loss of muscular strength is marked,

In many neurasthenics the heart as well as the vaso-motor system

The muscular strength may finally fail almost altogether. It is almost

In many cases of neurasthenia atonic dyspepsia exists, but it is

Disturbances of sensation are common in neurasthenia, these

In neurasthenia disturbances of the sexual organs are very common;

TREATMENT.—The natural cure for neurasthenia is rest, and my own

When nervous exhaustion has been produced by over-use of any

Again, in cases of brain-tire it is the brain which should be rested. To

The proper method of meeting these indications varies greatly, not

In brain-tire travel is usually recommended, and travel affords, when

There are cases of neurasthenia in which the slightest exercise does

It is only the most severe forms of neurasthenia which require the

In order to maintain the functions of the skin the patient should be

The question of feeding is one of great importance, and requires the

8 A.M. Rolls or toast; cocoa or weak coffee, or roasted wheat coffee;

Passive exercise is to be obtained by the use of electricity and

The faradic current is alone used. It is applied in two ways: first, to

The slowly-interrupted current is generally preferable, but advantage

The manipulations are percussion, rolling, kneading, and spiral. They

In dismissing this subject I desire to caution against a routine

SLEEP, AND ITS DISORDERS.

BY HENRY M. LYMAN, A.M., M.D.

The regularly-recurring incidence of natural sleep forms one of the

Careful observation of the manner in which sleep invades the body

Sleep, then, is that condition of physiological repose in which the

Fully impressed by the force of such considerations, certain

Far more comprehensive is the hypothesis of Pflüger.3 According to

4 “Beobachtungen ueber ausgebreitete Anästhesien und deren Folgen,” Deutsch.