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ANATOMY
PHYSIOLOGY
The Unity of Form and Function
Ninth Edition
KENNETH S. SALADIN
Distinguished Professor of Biology, Emeritus
Georgia College
Digital Authors
CHRISTINA A. GAN
Highline College
HEATHER N. CUSHMAN
Tacoma Community College
sal56006_fm_i-xxii.indd 1 11/26/19 7:07 PM

THE EVOLUTION OF A
STORYTELLER
Ken Saladin’s first step into authoring was a 318-page paper on the ecology
of hydras written for his tenth-grade biology class. With his “first book,”
featuring 53 original India ink drawings and photomicrographs, a true story-
teller was born.
When I first became a textbook writer, I found myself bringing the same
enjoyment of writing and illustrating to this book that I first discovered
when I was 15.
—Ken Saladin
Courtesy of Ken
Saladin
Ken’s “first book,” Hydra One of Ken’s drawings

Ecology, 1965 from Hydra Ecology
Courtesy of Ken Saladin Courtesy of Ken Saladin
Ken in 1964
Ken began working on his first

book for McGraw-Hill in 1993, and in
1997 the first edition of The Unity of
Form and Function was published. In
2020, the story continues with the
ninth edition of Ken’s best-selling
A&P textbook.
The first edition (1997)
The story continues (2020)
viii

PREFACE
Anatomy & Physiology: The Unity of Form and Function tells a story comprised of many layers, including core science, clinical applica-
tions, the history of medicine, and the evolution of the human body. Saladin combines this humanistic perspective on anatomy and physi-
ology with vibrant photos and art to convey the beauty and excitement of the subject to beginning students.
To help students manage the tremendous amount of information in this introductory course, the narrative is broken into short seg-
ments, each framed by expected learning outcomes and self-testing review questions. This presentation strategy works as a whole to create
a more efficient and effective way for students to learn A&P.
Writing Style and Level

Saladin’s text is written using plain language for A&P students who may be taking this course early in their curricula. Careful attention
has been given to word selection and paragraph structure to maintain the appropriate writing level for all students.
CHANGES TO THE NINTH EDITION

New Science
This edition draws on recent literature and scientific conferences attended by the author to update many topics, including but not limited
to molecular, vascular, and brain imaging techniques; peroxisome and mitochondrial behavior; the DNA damage response; gene regula-
tion; epigenetics; the tissue interstitium; regenerative medicine; osteoporosis; prosthetic joints; fibromyalgia; sleep physiology; trigeminal
neuralgia; pain physiology; endocrine functions of osseous and adipose tissue; diabetes mellitus; cord blood transplants; thrombopoiesis;
AIDS; prostate diseases; breast cancer; aging; life expectancy; and assisted reproductive technology.
New Deeper Insight sidebar essays have been added on cardiac tamponade; biopsy; stem-cell therapy; regenerative medicine; osteo-
malacia and rickets; vertebral disc herniation; rotator cuff injury; carpal tunnel syndrome; shinsplints; calcaneal tendon rupture; plantar
fasciitis; brain connectomics and diffusion tensor imaging; lumbar puncture; stroke; blindness; alcoholic ascites; diverticulosis and diver-
ticulitis; colorectal cancer; and cleft lip and palate.
While new science has been added, keeping up with such growth also means pruning back topics discredited by newer literature. For
this edition, these include adult cerebral neurogenesis; endorphins and runner’s high; human pheromones; pineal tumors and precocial
puberty; prophylactic use of low-dose aspirin; myocardial regeneration; female ejaculation; and the free-radical DNA damage theory of
senescence.
In consideration of user and reviewer suggestions to reduce detail in a few areas, this edition has more concise discussions of some
topics: chromatin coiling; apoptosis; skin grafting; the hair cycle; calcium and phosphate homeostasis; and spinal cord tracts.
New Art and Photography

This edition features new drawings of epidermal histology, flat bone structure, lever mechanics, Parkinson disease, lumbar puncture, hand
innervation, Bell palsy, the vagus nerve, olfactory pathways, erythropoiesis, cardiac innervation, regulation of cardiac output, air embo-
lism, colonic histology, lipoprotein structure, cleft lip and palate, and senescent muscle atrophy.
New photos in this edition include digital subtraction angiography, molecular-scale cryo-EM imaging, diabetic gangrene, embryonic
stem cells, albinism, jaundice, osteocyte SEM, rickets, muscle fiber histochemistry, diffusion tensor imaging of the brain connectome,
shingles, cataracts, glaucoma, forelimb veins used for phlebotomy, kidney stones, gallstones, hepatic cirrhosis, MRI of obesity, and intra-
cytoplasmic sperm injection.
Organizational Changes
For improved readability, narrative descriptions of some systems are moved from tables into chapter text; selected illustrations are moved
outside of the tables; and tables are distilled to more concise summaries. These include the skeletal muscles (chapter 10), spinal nerve
plexuses (chapter 13), cranial nerves (chapter 14), and blood vessels (chapter 20). A detailed list of changes by chapter follows.
ix

Detailed List of Changes
Chapter 1, Major Themes of Anatomy and Physiology, now includes digital subtraction angiography among the common clinical imag-
ing techniques.
Atlas A, General Orientation to Human Anatomy, has an added Deeper Insight A.1 on cardiac tamponade in relation to body cavities
and membranes.
Chapter 2, The Chemistry of Life, has added the Nobel-winning new technique of cryo-electron microscopic imaging of biological
structure at the atomic level.
Chapter 3, Cellular Form and Function, has enhanced discussions of limitations on cell size, the origin of peroxisomes, mitochondrial
fusion and fission, and clinical mitochondrial transfer and three-parent babies.
Chapter 4, Genes and Cellular Function, updates protein processing by the Golgi complex, epigenetics, the DNA damage response, and
the role of the nuclear lamina in gene silencing.
Chapter 5, The Human Tissues, has a new perspective on the tissue interstitium, updates on stem-cell therapy and regenerative medicine,
and a new Deeper Insight on biopsy methods.
Chapter 6, The Integumentary System, has a new drawing of epidermal histology, new discussion of the evolutionary genetics of apo-
crine glands, an update on skin-grafting technology, and a simpler description of the hair growth cycle.
Chapter 7, Bone Tissue, gives a less detailed overview of calcium and phosphate homeostasis, adds a Deeper Insight on osteomalacia
and rickets, and updates the pathology and treatment of osteoporosis.
Chapter 8, The Skeletal System, conforms the description of normal and pathological spinal curvatures to orthopedic terminology and
has a new Deeper Insight on herniated discs.
Chapter 9, Joints, improves the discussion of joint biomechanics and updates the discussions of temporomandibular joint dysfunction
and engineering of prosthetic joints.
Chapter 10, The Muscular System, pulls illustrations and narrative descriptions from the muscle tables, converts the narrative to easier-
to-read normal text, and condenses the tables to more concise summaries. It updates inguinal hernias and adds new Deeper Insights on
rotator cuff injury, shinsplints, calcaneal tendon rupture, and plantar fasciitis.
Chapter 11, Muscular Tissue, adds a photo of the histochemistry of fast glycolytic and slow oxidative muscle fiber types and updates
the discussion of fibromyalgia.
Chapter 12, Nervous Tissue, includes updates on astrocyte functions, beta-endorphin and enkephalin, mutations affecting neurotransmit-
ter reuptake and neurological disorders, and the implication of lipofuscin in some diseases. It introduces the frontier neuroscience of brain
connectomics and the use of diffusion tensor imaging to visualize the connectome. There is now an illustration of the midbrain histological
change and body posture characteristic of Parkinson disease.
Chapter 13, The Spinal Cord, Spinal Nerves, and Somatic Reflexes, adds a new Deeper Insight and illustration of lumbar puncture,
reduces detail on spinal cord tracts, reformats the tables of spinal nerve plexuses, illustrates regional innervation of the hand by the major
forearm nerves, and adds a photo of a shingles lesion.
Chapter 14, The Brain and Cranial Nerves, now adopts the concept of brainstem as excluding the diencephalon. It adds Deeper Insights
on stroke and diffusion tensor imaging, and updates the Deeper Insight on trigeminal neuralgia and Bell palsy, adding an illustration of
the latter. It updates sleep physiology and the functions of the midbrain colliculi and pretectal nuclei. It corrects a common misconception
about the subdural space. The discussion and table of cranial nerves are reorganized.
Chapter 16, Sense Organs, has an updated discussion of pain physiology and includes phantom limb pain. It updates the genetics and
functions of some taste sensations and flawed assumptions about human olfactory sensitivity. It deletes discredited or dubious views of
endorphins and runner’s high and human pheromones. It enhances the figure of olfactory projection pathways; adds the dorsal and ventral
streams of visual processing pathways; adds photos of cataracts and glaucoma; adds macular degeneration and diabetic retinopathy to the
Deeper Insight on blindness; and has better insights into the functions of the cornea, choroid, and vitreous body.
Chapter 17, The Endocrine System, updates the histology and cytology of the thyroid gland and pancreatic islets and the effects of mela-
tonin; adds new information on hormones of osseous and adipose origin; updates the enteroendocrine system; and adds effects of
lipocalin 2 on insulin action. It deletes the now-questionable idea about pineal tumors and precocial puberty. It updates the pathologies
of Addison disease and myxedema, and the genetic, immunological, and treatment aspects of diabetes mellitus.

Chapter 18, The Circulatory System: Blood, now explains how blood is fractionated to obtain plasma and then serum, and the uses of
blood serum. It has an enhanced explanation of the functional significance of the discoidal shape of erythrocytes, and includes cell pro-
liferation in the illustration of erythropoiesis. It reports updated clinical research on the number of known blood groups and RBC antigens,
cord blood transplants, other methods of bone marrow replacement, and pharmaceutical anticoagulants. It adds the surprising new discov-
ery of abundant platelet production by megakaryocytes in the lungs and megakaryocyte migration between the lungs and bone marrow.
Chapter 19, The Circulatory System: Heart, is reorganized at section 19.1 to place figures closer to their references. Cardiac innervation
is moved to section 19.6 on regulation of cardiac output, with a new illustration. The electrocardiogram is described with more detailed
attention to interpretation of each wave, segment, and interval, with an added table. The section on cardiac arrhythmias includes a fuller
explanation of atrial fibrillation.
Chapter 20, The Circulatory System: Blood Vessels and Circulation, has improved discussions of the vasa vasorum and metarterioles;
describes the measurement of blood pressure in more depth; adds photos of edema, circulatory shock, and upper limb veins most often
used for phlebotomy; and has a new drawing of air embolism. It discusses the difficulty of pancreatic surgery in light of the complex, deli-
cate branches of the celiac trunk. The Deeper Insight on ascites is rewritten to relate it to alcoholism. The tables of blood vessels and
routes of flow are now converted to normal, easier-to-read text.
Chapter 21, The Lymphatic and Immune Systems, updates bone marrow histology; the sources of macrophages; T cell diversity;
asthma and AIDS mortality; and the obstacles to treating AIDS in pandemic countries. It adds the risk in splenectomy and the role of ATP
and ADP as inflammatory chemoattractants.
Chapter 22, The Respiratory System, enhances descriptions of the nasal epithelium; the cricothyroid ligament in relation to emergency
tracheotomy; the Deeper Insight on tracheotomy; cor pulmonale; and squamous cell carcinoma. It adds a mutational cause of Ondine’s
curse; discovery of pulmonary platelet production; and the potential of electronic cigarettes and legalization of recreational marijuana as
emerging risk factors for lung cancer.
Chapter 23, The Urinary System, adds to the function of glomerular mesangial cells and has an improved Deeper Insight on kidney
stones, with a new photo.
Chapter 24, Fluid, Electrolyte, and Acid–Base Balance, has further information on sodium and the effects of hypernatremia, and has
added a new table summarizing the major electrolyte imbalances.
Chapter 25, The Digestive System, includes additions on the immune role of the omenta; dental proprioception; aspirin and peptic ulcer;
the cell-signaling function of the intestinal mucous coat; anatomical variability of the colon and a new drawing of its histology; an updated
Deeper Insight on gallstones, with a photo; a new Deeper Insight on diverticulosis and diverticulitis; a new Deeper Insight on colorectal
cancer; and an improved description of intestinal lymphatic nodules.
Chapter 26, Nutrition and Metabolism, includes new MRI images of a morbidly obese individual compared to one of normal BMI; a
new drawing of lipoprotein structure and chart of composition of the lipoprotein classes; new information on the effects of leptin on sym-
pathetic nerve fibers and lipolysis; and a new photo of hepatic cirrhosis.
Chapter 27, The Male Reproductive System, has a new table and discussion of the composition of semen and function of the bulboure-
thral preejaculatory fluid, and updates on benign prostatic hyperplasia and prostate cancer. It adds discussion of zinc deficiency as a cause
of infertility, hypothalamic maturation and GnRH in relation to the onset of puberty, and andropause in relation to declining androgen
secretion.
Chapter 28, The Female Reproductive System, has improvements in hymen anatomy and the figure of ovarian structure; a new perspec-
tive on morning sickness as a possible factor mitigating birth defects; and updates on contraception and on breast cancer genes, risk fac-
tors, and mortality.
Chapter 29, Human Development and Aging, adds the role of the sperm centrosome in fertilization; chromosomal defects as a leading
cause of first-trimester miscarriages; and the formation of monozygotic twins. It adds a new Deeper Insight and illustration of cleft lip
and palate. It updates the telomere theory of senescence but deletes the now-doubtful theory of DNA damage by endogenous free radicals.
It adds a new, MRI-based drawing of muscle atrophy in old age and a discussion of pineal gland senescence as a factor in the insomnia
experienced by some older people. It updates statistics on human life expectancy and the major causes of death. The final Deeper Insight
is retitled Assisted Reproductive Technology and has a new photo of intracytoplasmic sperm injection.
Appendix D, The Genetic Code and Amino Acids, now adds a table of the 20 amino acids and their symbols, and the structural formulae
of the amino acids.
xi

ACKNOWLEDGMENTS Valerie Kramer, Marketing Manager;
Donna Nemmers, Senior Product Devel-
Kyle P. Harris
Temple University
Peer review is a critical part of the scientific oper; Vicki Krug, Senior Content Project Karen L. Kandl
process, and very important to ensure the Manager; Lori Hancock, Lead Content Western Carolina University
content in this book continues to meet the Licensing Specialist; Brent dela Cruz, Stephen A. Kash
needs of the instructors and students who Senior Content Project Manager; Egzon Oklahoma City Community College
use it. We are grateful for the people who Shaqiri, Designer; and Jeanne Patterson, Stephanie Matlock
agree to participate in this process and thank freelance copy editor. Their efforts have Colorado Mesa University
them for their time, talents, and feedback. yielded another great edition of the text Deborah T. Palatinus
The reviewers of this text (listed here) have and its companion media suite of Connect Roane State Community College
contributed significant comments that help products. Jeffrey Alan Pence
us refine and update the print and digital Excelsior College
components of this program.
Timothy A. Ballard Carla Perry
Christina Gan and Heather Cushman University of North Carolina—Wilmington Community College of Philadelphia
have updated the question bank and test
Barry N. Bates Franz Sainvil
bank to closely correlate with the intricate
Atlanta Technical College Broward College–Central Campus
changes made in this ninth edition and
Christopher I. Brandon Jr. Brian Stout
have greatly increased the educational
Georgia Gwinnett College Northwest Vista College
value of these books through their work to
create self-assessment tools and align Nickolas A. Butkevich Andrew Van Nguyen
Schoolcraft College The City University of New York–
McGraw-Hill’s Connect resources with
the textbook. This has contributed signifi- John W. Campbell Queensborough Community College
cantly to student and instructor satisfac- Oklahoma City Community College Kimberly Vietti
tion with our overall package of learning Jennifer Cochran Biederman Illinois Central College
media and to the students’ success as they Winona State University Beth L. Williams
master A&P en route to their career Mary B. Colon Wallace State Community College
aspirations. Seminole State College of Florida Delon Washo-Krupps
I would also like to extend apprecia- Abdeslem El Idrissi Arizona State University
tion to members of the Life Sciences Book College of Staten Island, City University Samia Williams
Team at McGraw-Hill Education who have of New York Santa Fe College
worked with me on this project, including Bagie George
Matthew Garcia, Senior Portfolio Manager; Georgia Gwinnett College
xii

THE STORY OF
FORM AND FUNCTION
INNOVATIVE CHAPTER SEQUENCING

Some chapters and topics are presented in a sequence that is more instructive than the conventional order.
Early Presentation of Heredity Urinary System Presented Close to Circulatory

Fundamental principles of heredity are presented in the and Respiratory Systems
last few pages of chapter 4 rather than at the back of Most textbooks place this system near the end of the book because of
the book to better integrate molecular and Mendelian its anatomical and developmental relationships with the reproductive
genetics. This organization also prepares students system. However, its physiological ties to the circulatory and respiratory
to learn about such genetic traits and conditions as systems are much more important. Except for a necessary digression
cystic fibrosis, color blindness, blood types, hemophilia, on lymphatics and immunity, the circulatory system is followed almost
cancer genes, and sickle-cell disease by first teaching immediately with the respiratory and urinary systems, which regulate
them about dominant and recessive alleles, genotype blood composition and whose functional mechanisms rely on recently
and phenotype, and sex linkage. covered principles of blood flow and capillary exchange.
BRIEF CONTENTS
About the Authors iv

PART FOUR
CIRCULATION AND DEFENSE 655
PART ONE 18 The Circulatory System: Blood 655
ORGANIZATION OF THE BODY 1 19 The Circulatory System: Heart 689
1 Major Themes of Anatomy and 20 The Circulatory System: Blood Vessels and
Muscle Anatomy and Physiology 1 Circulation 724
Physiology Follow Skeleton ATLAS A General Orientation to Human 21 The Lymphatic and Immune Systems 782
Anatomy 27
and Joints 2 The Chemistry of Life 40 PART FIVE
3 Cellular Form and Function 74
The functional morphology of 4 Genes and Cellular Function 109
INTAKE AND OUTPUT 825
22 The Respiratory System 825
the skeleton, joints, and muscles 5 The Human Tissues 137
23 The Urinary System 866
is treated in three consecutive 24 Fluid, Electrolyte, and Acid–Base
PART TWO Balance 901
chapters, 8 through 10, so SUPPORT AND MOVEMENT 174 25 The Digestive System 925
when students learn muscle 6 The Integumentary System 174 26 Nutrition and Metabolism 974
attachments, these come only 7 Bone Tissue 198
8 The Skeletal System 223 PART SIX
two chapters after the names of 9 Joints 267 REPRODUCTION AND THE LIFE CYCLE 1007
the relevant bone features. When 10 The Muscular System 299
27 The Male Reproductive System 1007
ATLAS B Regional and Surface
they learn muscle actions, it is in Anatomy 362 28 The Female Reproductive System 1037
29 Human Development and Aging 1075
the first chapter after learning the 11 Muscular Tissue 384
terms for the joint movements. APPENDIX A: Answer Keys A-1

PART THREE APPENDIX B: Symbols, Weights, and Measures A-14
This order brings another INTERNAL COORDINATION AND CONTROL 420 APPENDIX C: Periodic Table of the Elements A-16
advantage: The physiology of 12 Nervous Tissue 420 APPENDIX D: The Genetic Code and Amino Acids A-17
13 The Spinal Cord, Spinal Nerves, and APPENDIX E: Medical Word Roots and Affixes A-19
muscle and nerve cells is treated Somatic Reflexes 459
in two consecutive chapters (11 14 The Brain and Cranial Nerves 492
Glossary G-1
Index I-1
and 12), which are thus closely 15 The Autonomic Nervous System and
Visceral Reflexes 542
integrated in their treatment of 16 Sense Organs 563
synapses, neurotransmitters, and 17 The Endocrine System 612
membrane electrophysiology. iii
xiii

THE STORY OF
FORM AND FUNCTION
LEARNING TOOLS
Engaging Chapter Layouts
∙∙ Chapters are structured around the way students learn.
CHAPTER
∙∙ Frequent subheadings and expected learning outcomes help
students plan their study time and review strategies.
BONE TISSUE
Deeper Insights highlight areas of interest
and career relevance for students.
Chapter Outlines provide quick previews

of the content.
A bone cell (osteocyte) surrounded by calcified bone matrix
Eye of Science/Science Source
CHA P T ER O U T L IN E 7.4 Physiology of Osseous Tissue D E E P E R I NS I G H TS

7.4a Mineral Deposition and Resorption
7.1 Tissues and Organs of the Skeletal 7.1 Medical History: Bone Contamination
7.4b Calcium Homeostasis
CHAPTER 3 Cellular Form and Function 75 System 7.2 Clinical Application: Achondroplastic
7.4c Phosphate Homeostasis
7.1a Functions of the Skeleton 7.4d Other Factors Affecting Bone Dwarfism
7.1b Bones and Osseous Tissue 7.3 Clinical Application: Rickets and
Schwann and other biologists originally believed that cells 7.5 Bone Disorders
BRUSHING UP 7.1c General Features of Bones Osteomalacia
came from nonliving body fluid that somehow congealed and 7.5a Fractures and Their Repair
acquired a membrane and nucleus. This idea of spontaneous 7.2 Histology of Osseous Tissue 7.4 Clinical Application: Osteoporosis
● The transport of matter through cell membranes follows the 7.5b Other Bone Disorders
principles of flow down gradients (see section 1.6e). generation—that living things arise from nonliving matter—was 7.2a Bone Cells
Connective Issues
7.2b The Matrix
● To adequately understand the structure of the cell surface, it rooted in the scientific thought of the times. For centuries, it Study Guide
7.2c Compact Bone
is essential that you understand glycolipids and glycoproteins, seemed to be simple common sense that decaying meat turned 7.2d Spongy Bone
as well as phospholipids and their amphipathic nature (see into maggots, stored grain into rodents, and mud into frogs. 7.2e Bone Marrow
sections 2.4c and 2.4d). Schwann and his contemporaries merely extended this idea to
7.3 Bone Development
● The proteins of cell membranes have a great variety of cells. The idea of spontaneous generation wasn’t discredited until
7.3a Intramembranous Ossification
functions. To understand those depends on an acquaintance some classic experiments by French microbiologist Louis Pasteur
7.3b Endochondral Ossification
with the functions of proteins in general and how protein in 1859. 7.3c Bone Growth and Remodeling
function depends on tertiary structure (see “Protein Structure” By the end of the nineteenth century, it was established be-
and “Protein Functions” in section 2.4e). yond all reasonable doubt that cells arise only from other cells and Module 5: Skeletal System
every living organism is composed of cells and cell products. The
cell came to be regarded, and still is, as the simplest structural and 198
functional unit of life. There are no smaller subdivisions of a cell
A ll organisms, from the simplest to the most complex, are

composed of cells—whether the single cell of a bacterium
or the trillions of cells that constitute the human body. These
or organism that, in themselves, have all or most of the fundamen-
tal characteristics of life described in section 1.6a. Enzymes and
organelles, for example, are not alive, although the life of a cell
cells are responsible for all structural and functional properties depends on their activity.
of a living organism. A knowledge of cells is therefore indispens- The development of biochemistry from the late nineteenth to
able to any true understanding of the workings of the human the twentieth century made it further apparent that all physiologi-
body, the mechanisms of disease, and the rationale of therapy. cal processes of the body are based on cellular activity and that
Thus, this chapter and the next one introduce the basic cell biol- the cells of all species exhibit remarkable biochemical unity. The
Tiered Assessments Based on

ogy of the human body, and subsequent chapters expand upon various generalizations of these last two paragraphs now constitute
this information as we examine the specialized cellular structure the modern cell theory.
and function of specific organs.
3 .1 Concepts of Cellular Structure

3.1b Cell Shapes and Sizes
We will shortly examine the structure of a generic cell, but the
Key Learning Outcomes
generalizations we draw shouldn’t blind you to the diversity of
Expected Learning Outcomes cellular form and function in humans. There are about 200 kinds
of cells in the human body, with a variety of shapes, sizes, and
∙∙ Chapters are divided into brief sections,
When you have completed this section, you should be able to
a. discuss the development and modern tenets of the cell
functions.
Descriptions of organ and tissue structure often refer to the
enabling students to set specific goals for
theory;
b. describe cell shapes from their descriptive terms;
shapes of cells by the following terms (fig. 3.1):
• Squamous2 (SKWAY-mus)—a thin, flat, scaly shape, often
short study periods.
c. state the size range of human cells and discuss factors
that limit their size;
with a bulge where the nucleus is, much like the shape of a
fried egg “sunny side up.” Squamous cells line the esopha-
∙∙ Section-ending questions allow students to
d. discuss the way that developments in microscopy have
changed our view of cell structure; and •
gus and form the surface layer (epidermis) of the skin.
Cuboidal3 (cue-BOY-dul)—squarish-looking in frontal
check their understanding before moving on.
e. outline the major components of a cell. sections and about equal in height and width; liver cells are
a good example.
• Columnar—distinctly taller than wide, such as the inner
lining cells of the stomach and intestines.
3.1a Development of the Cell Theory
• Polygonal4—having irregularly angular shapes with four, Each chapter begins with Brushing Up to
Cytology,1 the scientific study of cells, was born in 1663 when five, or more sides.
Robert Hooke observed the empty cell walls of cork and coined
• Stellate5—having multiple pointed processes projecting
emphasize the interrelatedness of concepts, which
the word cellulae (“little cells”) to describe them (see section 1.2).
from the body of a cell, giving it a somewhat starlike shape.
Soon he studied thin slices of fresh wood and saw living cells
“filled with juices”—a fluid later named cytoplasm. Two centuries
The cell bodies of many nerve cells are stellate. is especially useful for adult students returning to
later, Theodor Schwann studied a wide range of animal tissues and
concluded that all animals are made of cells. 2
the classroom, and serves as an aid for instructors
squam = scale; ous = characterized by
1
3
cub = cube; oidal = like, resembling
4
poly = many; gon = angles
5
when teaching chapters out of order.
cyto = cell; logy = study of stell = star; ate = resembling, characterized by
Each major section begins with Expected Learning Outcomes to help

focus the reader’s attention on the larger concepts and make the
course outcome-driven. This also assists instructors in structuring their
courses around expected learning outcomes.
xiv

CHAPTER 9 Joints 271
separation between the bones and length of the fibers give these (fig. 9.4a). (The other costal cartilages are joined to the sternum by
joints more mobility than a suture or gomphosis has. An especially synovial joints.)
mobile syndesmosis exists between the shafts of the radius and
ulna, which are joined by a broad fibrous interosseous membrane. Symphyses
This permits such movements as pronation and supination of the
In a symphysis9 (SIM-fih-sis), two bones are joined by fibrocarti-
forearm. A less mobile syndesmosis is the one that binds the distal
Questions in figure legends and Apply What You ends of the tibia and fibula together, side by side (see fig. 9.2c).
lage (fig. 9.4b, c). One example is the pubic symphysis, in which
the right and left pubic bones are joined anteriorly by the carti-
Know items prompt students to think more deeply 9.1c Cartilaginous Joints
laginous interpubic disc. Another is the joint between the bodies
of two vertebrae, united by an intervertebral disc. The surface of
about the implications and applications of what they A cartilaginous joint is also called an amphiarthrosis7 (AM-fee-
ar-THRO-sis). In these joints, two bones are linked by cartilage
each vertebral body is covered with hyaline cartilage. Between the
vertebrae, this cartilage becomes infiltrated with collagen bundles
to form fibrocartilage. Each intervertebral disc permits only slight
have learned. This helps students practice higher (fig. 9.4). The two types of cartilaginous joints are synchondroses
and symphyses. movement between adjacent vertebrae, but the collective effect of
all 23 discs gives the spine considerable flexibility.
order thinking skills throughout the chapter. Synchondroses
A synchondrosis8 (SIN-con-DRO-sis) is a joint in which the ▶ ▶ ▶ A PPLY W HAT YO U K NOW
bones are bound by hyaline cartilage. An example is the temporary The intervertebral joints are symphyses only in the cervi-
joint between the epiphysis and diaphysis of a long bone in a child, cal through the lumbar region. How would you classify
formed by the cartilage of the epiphysial plate. Another is the at- the intervertebral joints of the sacrum and coccyx in a
tachment of the first rib to the sternum by a hyaline costal cartilage middle-aged adult?
7
amphi = on all sides; arthr = joined; osis = condition
8 9
syn = together; chondr = cartilage; osis = condition sym = together; physis = growth
Clavicle Sternum
Rib 1
Intervertebral
Costal disc (fibrocartilage)
cartilage
296 PART TWO Support and Movement
ST U DY
(a) G U I DE
▶ Assess Your Learning Outcomes
(c) extension, hyperexten- Body of vertebra
To test your knowledge, discuss the following 3. Three essential components of a lever 12. The same for flexion,
FIGURE
topics 9.4partner
with a study or in writing,Joints.
Cartilaginous ideally 4. The meaning of mechanical advantage (MA); sion, and lateral flexion of the spine, and
from(a)
memory.
A synchondrosis, represented by how the MA of a lever can be determined right and left rotation of the trunk
from measurements of its effort and resis- 13. The same for elevation, depression, protrac-
9.1 the costal
Joints andcartilage joining rib 1 to the
Their Classification tance arms; and the respective advantages of tion, retraction, and lateral and medial excur-
sternum. (b) The pubic symphysis.
1. The fundamental definition of joint (articu- levers in which the MA is greater than or less sion of the mandible
(c) Intervertebral discs, which join
lation) and why it cannot be defined as a than 1.0 14. The same for dorsiflexion, plantar flexion,
adjacent vertebrae to each other by
point at which one bone moves relative to an 5. Comparison of first-, second-, and third-class inversion, eversion, pronation, and supina-
symphyses. Interpubic disc
adjacent bone levers, and anatomical examples of each tion of the foot
2. ? What is the
Relationships and difference
differences betweenbetween the 6. Variables that determine a joint’s range of (fibrocartilage)
9.3 Anatomy of Selected CHAPTER 9 Joints
Diarthroses 297
the pubic
sciences symphysis
of arthrology, and the
kinesiology, and motion (ROM), and the clinical relevance
Pubic symphysis
interpubic disc?
biomechanics of ROM (b) 1. Features of the jaw (temporomandibular)
3. The typical system for naming most joints 7. Axes of rotation and degrees of freedom in joint including the mandibular condyle,
ST U DY
after the bones they involve; examples of joint movement, and how this relates to the mandibular fossa, synovial cavity, articular
296 PART thisTWO Support and Movement
4. Basic criteria for classifying joints G U I DE classification of joints as monaxial, biaxial,
or multiaxial
disc, and principal ligaments
2. Features of the shoulder (glenohumeral)
5. Characteristics and examples of bony joints 8. Six kinds of synovial joints; how each is joint including the humeral head, glenoid
(synostoses) classified as monaxial, biaxial, or multiaxial; cavity and labrum, five major ligaments
ST U DY 4. Whichofoffibrous
6. Characteristics the following joints cannot be
joints (synar- imperfectionsd. always
in this produces
classification;an MA andless than 1.0. and four 12.bursae,
A fluid-filled
and tendons sac that eases
of the the movement
biceps
The end-of-chapter Study Guide offers several methods throses) and G U I DE
circumducted?
each of their subclasses, with
examples a. carpometacarpal
examples of e. each
9. The concept of
is applied
move
type inonthe
zeroaposition
one
resistance
bodyside of the fulcrum to brachii andoffour
andonhowtheitother side. 3. Features of the elbow;
a tendon
rotatorover
.
cuffa muscles
bone is called a/an
the three joints that
for assessment that are useful to both students and

b. metacarpophalangeal
7. Characteristics of cartilaginous joints (am- relates 8.
to the description of joint function
Which of the following joints has anterior occur 13. here;Athe olecranon bursa and
joint allows onefour
bone to swivel on
phiarthroses)c. glenohumeral
and each of their subclasses, 10. Examples and of each of thecruciate
following limb major ligaments
posterior ligaments? another.
▶ Assess Your Learning Outcomes
with examplesd. coxal movements, a. including
the shoulder an ability to 4. Features of the hip (coxal) joint including
instructors. 9.2 Synovial Joints
e. interphalangeal describe orb.demonstrate
the elbow them: flexion,
14. is the science
the femoral head, fovea capitis, acetabulum of movement.
To test your knowledge, 5. discuss the following terms3.denotes
Whichtheoffollowing gen-extension,
Three aessential c.hyperextension,
components hipa lever abduction, 12. The same for
the of and labrum,
flexion,
15. The and fivebetween
extension,
joint principal
hyperexten- ligaments
a tooth and the mandible
1. Thepartner
topics with a study definition
or in
eral and anatomical
writing,
condition ideally
that featuresthe
includes of
4. other four? adduction,
aThe meaning d.hyperabduction,
of mechanical theadvantage
knee hyperadduction,
(MA); sion, and5.lateral
Features ofis the
flexion kneea/an
of the
called (tibiofemoral
spine, and . and
from memory. synovial joint (diarthrosis), examples of this
a. gout how the MAcircumduction,
of a levere.canthe medial
be determined
ankle rotation, and lateralright and left patellofemoral
rotation of thejoints),trunk including the menisci,
type, and why this type is of greatest interest rotation cruciate16.andIn aother ligaments, suture, andthe articulating
four major bones
b. arthritis from measurements of its effort and resis- 13. The same for elevation, depression, protrac-
Assess Your Learning Outcomes provides students 9.1 Joints andfor Their
2. General
1. The fundamental
Classification
kinesiology
c. rheumatism
anatomy
definition ofofjoint
tendons,
d. osteoarthritis (articu-
11. The
tance arms;
ligaments, levers in which flexion,
9.respective
same
and the
the MA
To
for bend
andisradial
greater
backward
supination,
advantages
offlexion
the
atofthe waist
pronation,
thanvertebral
ofless
or
ulnarinvolves
column. sion of the
the forearm
bursae
tion, retraction,
have interlocking
andaround
lateralthe
Features oflike
6. mandible
andpatella
theaankle
medial excur-
dovetail
wavy margins, somewhat
joint in carpentry.
(talocrural) joint,
lation) and bursae, ande. tendon sheaths, aand their contri- than 1.0 and hand, a. androtation
opposition, reposition, abduc- including thekicking
malleoli, calcanealwhattendon,
typeand
a study outline for review, and addresses the needs of point at which
why it cannot
butions to joint
one bone
be defined
rheumatoid
function
moves
as
arthritis
relative to an
6. In the adult, the ischium and pubis
5. Comparisontion, of first-, b. hyperextension
and adduction
second-,
are and anatomicalc.examples
of the
and
dorsiflexion
thumb
third-class
14. The same for dorsiflexion,
17. In
major ligaments
inversion, eversion, pronation,
plantar
does the knee
flexion,
a football,
and supina-
joint exhibit?
of action
adjacent bone levers, of each tion of the foot

instructors whose colleges require outcome-oriented united
sciences of arthrology,a.kinesiology,
by
2. Relationships and differences between the
a synchondrosis.and motion (ROM), and the
d. abduction
6. Variables that determine a joint’s range of
e. clinical
flexionrelevance 9.3 Anatomy of Selected
18. The angle through which a joint can move is
called its
Diarthroses .
▶ Testing Your Recall

b. a diarthrosis. 19.(temporomandibular)
The menisci of theinknee are functionally
syllabi and assessment of student achievement of the biomechanics
3. The typical system forc.naming a synostosis.
d. external
most joints
an amphiarthrosis.
of ROM 10. The rotator cuff includes the 1.
7. Axes of rotation and degrees of freedom
of the following in
muscles
Features
tendons of the jaw
of all Answers
similar tocondyle,
except joint including the mandibular the
Appendix A
of the temporoman-
after the 1.
bones they and
Internal involve; examples
rotationof of the joint movement,
2. Which andof how thissubscapularis.
the the
a. relatesisto
following thetheleast mov- mandibular of dibular
fossa, synovial
3. Which joint.articular
cavity,
the following movements are
expected learning outcomes. this
4. Basic criteriaa. for
e.
classifying
pivot
a symphysis.
humerus is made possible by a
joints
7. In a second-class
classification
joint.
lever, the effortor multiaxial
of jointsb.as the
able?
a. a diarthrosis
monaxial,
c. the infraspinatus.
biaxial,
supraspinatus. disc, and principal
2. Features of a.
unique20. ligaments
to
shoulder
thethe
At
the dorsiflexion
ulate
foot?ankle, both the tibia and fibula artic-
(glenohumeral)
and inversion
with what tarsal bone?
5. Characteristics and examples
b. condylar of bony
a. is applied to joints
the end opposite 8. Sixthekinds ofb.synovial joints;
a synostosis
d. the how
biceps each is
brachii. joint including the humeral
b. elevation andhead, glenoid
depression
(synostoses)c. ball-and-socket fulcrum. classified asc.monaxial, e.biaxial,
a symphysis the teres or multiaxial;
minor. cavity and labrum, five major ligaments
c. circumduction and rotation
6. Characteristics of fibrous
d. saddle b. isjoints
applied(synar-
to the fulcrum itself. imperfectionsd. ina synovial
this classification;
joint and and four bursae, and tendons
d. abduction and of the biceps
adduction
11. The lubricant of a diarthrosis is called
End-of-chapter questions build on all levels of throses) ande.each
examples
of their subclasses, with
hinge c. is applied between the fulcrum and
resistance.
examples of each type in the
e. a condylar joint
.
body
9. The concept of zero position and how it
brachii and four rotator cuff muscles
e. opposition and reposition
3. Features of the elbow; the three joints that
7. Characteristics of cartilaginous joints (am- relates to the description of joint function occur here; the olecranon bursa and four
Bloom’s Taxonomy in sections to phiarthroses) and each of their subclasses,
with examples
10. Examples of each of the following limb
movements, including an ability to
major ligaments
4. Features of the hip (coxal) joint including
▶ Building Your Medical Vocabulary Answers in Appendix A
1. test simple recall and analytical thought; 9.2 Synovial Joints
describe or demonstrate them: flexion,
extension, hyperextension, abduction,
the femoral head, fovea capitis, acetabulum
and labrum, and five principal ligaments
State a meaning
1. The definition and anatomical features of a of each word element, and give 3. -ate
adduction, hyperabduction, hyperadduction, 5. Features of the knee 7. (tibiofemoral
kinesio- and
2. build medical vocabulary; and a medical term
synovial joint (diarthrosis),
type, and why this slight
typevariation
from this
examples chapter thatcircumduction,
of this
of it. interest
is of greatest
uses it or a
rotation
medial rotation, and lateral
4. cruci- patellofemoral joints),8. men- including the menisci,
cruciate and other ligaments, and four major
5. cruro- 9. supin-
3. apply the basic knowledge to new clinical for kinesiology 1. ab-
2. General anatomy of tendons, ligaments,
11. The same for supination,
flexion, and radial 6. flexion
-duc
pronation, ulnar
of the forearm 6.
bursae around the patella
Features of the ankle (talocrural)
10. -trac joint,
bursae, and tendon2.sheaths,
arthro-and their contri- and hand, and opposition, reposition, abduc- including the malleoli, calcaneal tendon, and
problems and other situations. butions to joint function tion, and adduction of the thumb major ligaments
▶ What’s Wrong with These Statements? Answers in Appendix A
▶ Testing Briefly
Yourexplain
Recall 4. Menisci occur in the elbow and knee joints. Answers in Appendix
8. The knuckles A
are amphiarthroses.
What’s Wrong with These Statements? questions
why each of the following state-
ments is false, or reword it to make it true.
5. Reaching behind you to take something out 9. Synovial fluid is secreted by the bursae.
1. Internal and external rotation of the 2. Which of the following is the least mov- 3. Which of the following movements are
1. More people get rheumatoid arthritis than of your hip pocket involves flexion of the
further address Bloom’s Taxonomy by asking humerus is made possible by a
a. pivot
osteoarthritis.
joint. able?
a. a diarthrosis
shoulder.
10. Like most ligaments, the periodontal liga-
unique to the foot?
ments attach one bone (the tooth) to another
a. dorsiflexion and inversion
b. condylar 2. A doctor who treats arthritis is called a
b. a synostosis 6. The cruciate ligaments are in theb.feet. (the mandible or maxilla).
elevation and depression
the student to explain why the false statements c. ball-and-socket kinesiologist.
d. saddle
c. a symphysis c. circumduction and rotation
7. The femur is held tightly in the acetabulum
d. a synovial joint d. abduction and adduction
3. Synovial joints are also known as mainly by the round ligament.
are untrue. e. hinge
298 e. a condylar joint
synarthroses. PART TWO Support and Movement
e. opposition and reposition
STUDY
Testing Your Comprehension questions address GUIDE
Bloom’s Taxonomy in going beyond recall to
▶ Testing Your Comprehension
application of ideas. 1. All second-class levers produce a mechani- the first interphalangeal joint of the index arm. Imagine a person holding a weight
cal advantage greater than 1.0 and all third- finger. (Do not bend the fingers of a wired in the hand and abducting the arm. On a
class levers produce a mechanical advantage laboratory skeletal hand, because they can laboratory skeleton, identify the fulcrum;
less than 1.0. Explain why. break off.) measure the effort arm and resistance arm;
determine the mechanical advantage of
2. For each of the following joint movements, 3. In order of occurrence, list the joint actions
this movement; and determine which of
state what bone the axis of rotation passes (flexion, pronation, etc.) and the joints
the three lever types the upper limb acts as
through and which of the three anatomical where they would occur as you (a) sit
when performing this movement.
planes contains the axis of rotation. You down at a table, (b) reach out and pick
may find it helpful to produce some of up an apple, (c) take a bite, and (d) chew 5. List the six types of synovial joints, and for
these actions on an articulated laboratory it. Assume that you start in anatomical each one, if possible, identify a joint in the
skeleton so you can more easily visualize position. upper limb and a joint in the lower limb that
the axis of rotation. (a) Plantar flexion; fall into each category. Which of these six
4. The deltoid muscle inserts on the deltoid
(b) flexion of the hip; (c) adbuction of the joints has/have no examples in the lower
tuberosity of the humerus and abducts the
thigh; (d) flexion of the knee; (e) flexion of limb?
xv

THE STORY OF
FORM AND FUNCTION
Medullary cords
ARTWORK THAT INSPIRES Stroma:

Capsule
Medullary sinus
LEARNING
Reticular tissue
Macrophage
Trabecula
Trabecula
The incredible art program in this textbook sets the standard Lymphocytes
in A&P. The stunning portfolio of art and photos was created Cortex: Reticular fibers
Subcapsular sinus
with the aid of art focus groups and with feedback from Lymphatic nodule Artery
and vein
Venule
Germinal center
hundreds of accuracy reviews. Cortical sinuses
(b)
Medulla:
Medullary sinus Efferent
lymphatic Lymphocytes
Medullary cord
vessel
Reticular fibers
Vivid Illustrations Afferent lymphatic

vessels
Rich textures and shading and bold,

bright colors bring structures to life.
(a) (c) 10 μm
Francis Leroy, Biocosmos/Science Source
Frontal sinus
Cribriform plate
Nasal conchae: Auditory tube
Superior
Middle Sites of respiratory control nuclei:
Inferior Pons
Medulla oblongata
Meatuses
Nasopharynx
Hard palate Uvula
Oropharynx
Tongue
Laryngopharynx
Larynx:
Epiglottis
Vestibular fold
Vocal cord
Trachea
Vertebral column
Cadaver dissections are paired with
Esophagus
carefully drawn illustrations to show
(a) intricate human detail.
Rebecca Gray/McGraw-Hill Education
Meatuses:
Frontal Superior
sinus Middle
Nasal conchae: Inferior
Superior Sphenoidal sinus
Middle Posterior nasal
aperture
Inferior Pharyngeal
Vestibule tonsil
Guard hairs Auditory Nasal septum:
tube
Naris (nostril) Perpendicular plate
Hard palate Soft palate
Upper lip Uvula Septal cartilage
Palatine tonsil Vomer

Tongue
Lower lip Lingual tonsil
Pharynx:
Mandible Epiglottis Nasopharynx
Oropharynx
Vestibular fold Laryngopharynx
Vocal cord
Larynx
Trachea
Esophagus
(b) (c)
xvi

Palmaris longus tendon (cut) Flexor digitorum superficialis
tendon
Orientation Tools Flexor carpi radialis tendon Flexor digitorum profundus
tendon
Saladin art integrates Flexor carpi ulnaris tendon
Flexor pollicis longus tendon
tools to help students Ulnar artery
quickly orient themselves Palmar carpal ligament (cut)
Ulnar nerve
within a figure and make
Radial artery
connections between ideas. Flexor retinaculum covering
carpal tunnel
Median nerve
Bursa
Trapezium Superficial palmar

arterial arch
(a) Anterior view
Palmaris longus
tendon Median nerve
Thenar muscles Ulnar artery
Flexor digitorum Flexor retinaculum
superficialis tendons
Carpal tunnel
Trapezium
Flexor digitorum Hypothenar muscles
profundus tendons
Ulnar bursa
Radial artery
Anterior Hamate
Trapezoid
Capitate
Lateral Medial
Scaphoid Extensor tendons
Posterior
(b) Cross section
Process Figures
Conducive to Learning Saladin breaks complicated physiological
∙∙ Easy-to-understand process figures processes into numbered steps for a
∙∙ Tools for students to easily orient themselves manageable introduction to difficult
concepts.
10
1 Blood enters right atrium from superior
and inferior venae cavae.
Aorta 2 Blood in right atrium flows through right

Left pulmonary AV valve into right ventricle.
11 artery
3 Contraction of right ventricle forces
5 5 pulmonary valve open.
9 4 Blood flows through pulmonary valve

Pulmonary trunk
Superior into pulmonary trunk.
vena cava
4 6 Left pulmonary 5 Blood is distributed by right and left
veins
Right 6 pulmonary arteries to the lungs, where it
pulmonary unloads CO2 and loads O2.
veins Left atrium
1
Aortic valve 6 Blood returns from lungs via pulmonary
7 veins to left atrium.
3 Left AV valve
7 Blood in left atrium flows through left AV
Right
8 valve into left ventricle.
atrium
Left ventricle 8 Contraction of left ventricle (simultaneous with
2
Right AV step 3) forces aortic valve open.
valve
9 Blood flows through aortic valve into
Right
ventricle ascending aorta.
Inferior 10 Blood in aorta is distributed to every organ in

vena cava 11 the body, where it unloads O2 and loads CO2.
11 Blood returns to right atrium via venae cavae.
xvii

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LETTER TO
STUDENTS
W
hen I was a young boy, I became interested in what I pedagogy—the art of teaching. I’ve designed my chapters to make
then called “nature study” for two reasons. One was the them easier for you to study and to give you abundant opportunity
sheer beauty of nature. I reveled in children’s books to check whether you’ve understood what you read—to test your-
with abundant, colorful drawings and photographs of animals, self (as I advise my own students) before the instructor tests you.
plants, minerals, and gems. It was this esthetic appreciation of Each chapter is broken down into short, digestible bits with a
nature that made me want to learn more about it and made me hap- set of Expected Learning Outcomes at the beginning of each sec-
pily surprised to discover I could make a career of it. At a slightly tion, and self-testing questions (Before You Go On) just a few
later age, another thing that drew me still deeper into biology was pages later. Even if you have just 30 minutes to read during a lunch
to discover writers who had a way with words—who could capti- break or a bus ride, you can easily read or review one of these brief
vate my imagination and curiosity with their elegant prose. Once I sections. There are also numerous self-testing questions in a Study
was old enough to hold part-time jobs, I began buying zoology and Guide at the end of each chapter, in some of the figure legends, and
anatomy books that mesmerized me with their gracefulness of the occasional Apply What You Know questions dispersed
writing and fascinating art and photography. I wanted to write and throughout each chapter. The questions cover a broad range of
draw like that myself, and I began teaching myself by learning cognitive skills, from simple recall of a term to your ability to
from “the masters.” I spent many late nights in my room peering evaluate, analyze, and apply what you’ve learned to new clinical
into my microscope and jars of pond water, typing page after page situations or other problems. In this era of digital publishing, how-
of manuscript, and trying pen and ink as an art medium. My “first ever, learning aids go far beyond what I write into the book itself.
book” was a 318-page paper on some little pond animals called SmartBook®, available on smartphones and tablets, includes all of
hydras, with 53 India ink illustrations that I wrote for my tenth- the book’s contents plus adaptive technology that can give you
grade biology class when I was 16 (see page viii). personalized instruction, target the unique gaps in your knowledge,
Fast-forward about 30 years, to when I became a textbook and guide you in comprehension and retention of the subject
writer, and I found myself bringing that same enjoyment of writing matter.
and illustrating to the first edition of this book you are now hold- I hope you enjoy your study of this book, but I know there are
ing. Why? Not only for its intrinsic creative satisfaction, but always ways to make it even better. Indeed, what quality you may
because I’m guessing that you’re like I was—you can appreciate a find in this edition owes a great deal to feedback I’ve received from
book that does more than simply give you the information you students all over the world. If you find any typos or other errors, if
need. You appreciate, I trust, a writer who makes it enjoyable for you have any suggestions for improvement, if I can clarify a con-
you through his scientific, storytelling prose and his concept of the cept for you, or even if you just want to comment on something
way things should be illustrated to spark interest and facilitate you really like about the book, I hope you’ll feel free to write to
understanding. me. I correspond quite a lot with students and would enjoy hearing
I know from my own students, however, that you need more from you.
than captivating illustrations and enjoyable reading. Let’s face it—
A&P is a complex subject and it may seem a formidable task to Ken Saladin
acquire even a basic knowledge of the human body. It was difficult Georgia College
even for me to learn (and the learning never ends). So in addition Milledgeville, GA 31061 (USA)
to simply writing this book, I’ve given a lot of thought to its ksaladin2@windstream.net
xxi

PART ON E : OR GAN IZ AT IO N O F TH E BO DY
1
CHAPTER
MAJOR THEMES
OF ANATOMY
AND PHYSIOLOGY
A colorized MRI scan of the human body

©Science Photo Library/Getty Images
C HA P T E R OU T LIN E 1.5 Human Structure DEEPER I NS I GHTS

1.5a The Hierarchy of Complexity
1.1 The Scope of Anatomy and Physiology 1.1 Evolutionary Medicine: Vestiges of
1.5b Anatomical Variation
1.1a Anatomy—The Study of Form Human Evolution
1.1b Physiology—The Study of Function 1.6 Human Function 1.2 Clinical Application: Situs Inversus and
1.6a Characteristics of Life Other Unusual Anatomy
1.2 The Origins of Biomedical Science
1.6b Physiological Variation 1.3 Medical History: Men in the Oven
1.2a The Greek and Roman Legacy 1.6c Negative Feedback and Homeostasis
1.2b The Birth of Modern Medicine 1.4 Medical History: Obscure Medical Word
1.6d Positive Feedback and Rapid Change
1.2c Living in a Revolution Origins
1.6e Gradients and Flow
1.3 Scientific Method 1.5 Clinical Application: Medical Imaging
1.7 The Language of Medicine
1.3a The Inductive Method 1.7a The History of Anatomical Terminology
1.3b The Hypothetico–Deductive Method 1.7b Analyzing Medical Terms
1.3c Experimental Design 1.7c Plurals, Adjectives, and Possessive
1.3d Peer Review Forms
1.3e Facts, Laws, and Theories 1.7d Pronunciation
1.4 Human Origins and Adaptations 1.7e The Importance of Spelling
1.4a Evolution, Selection, and Adaptation 1.8 Review of Major Themes
1.4b Our Basic Primate Adaptations
Study Guide Module 1: Body Orientation
1.4c Walking Upright
1
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2 PART ONE Organization of the Body
N o branch of science hits as close to home as the science of

our own bodies. We’re grateful for the dependability of our
hearts; we’re awed by the capabilities of muscles and joints dis-
a clinical diagnosis from surface appearance. Physical examina-
tions also involve touching and listening to the body. Palpation1
means feeling a structure with the hands, such as palpating a swol-
played by Olympic athletes; and we ponder with philosophers the len lymph node or taking a pulse. Auscultation2 (AWS-cul-TAY-
ancient mysteries of mind and emotion. We want to know how our shun) is listening to the natural sounds made by the body, such
body works, and when it malfunctions, we want to know what’s as heart and lung sounds. In percussion, the examiner taps on
happening and what we can do about it. Even the most ancient the body, feels for abnormal resistance, and listens to the emitted
writings of civilization include medical documents that attest to sound for signs of abnormalities such as pockets of fluid, air, or
humanity’s timeless drive to know itself. You are embarking on a scar tissue.
subject that is as old as civilization, yet one that grows by thou- But a deeper understanding of the body depends on d issection
sands of scientific publications every week. (dis-SEC-shun)—carefully cutting and separating tissues to reveal
This book is an introduction to human structure and function, their relationships. The very words anatomy3 and dissection4 both
the biology of the human body. It is meant primarily to give you mean “cutting apart”; until the nineteenth century, dissection was
a foundation for advanced study in health care, exercise physi- called “anatomizing.” In many schools of health science, one of
ology, pathology, and other fields related to health and fitness. the first steps in training students is dissection of the cadaver,5
Beyond that purpose, however, it can also provide you with a a dead human body. Many insights into human structure are
deeply satisfying sense of self-understanding. obtained from comparative anatomy—the study of multiple
As rewarding and engrossing as this subject is, the human species in order to examine similarities and differences and ana-
body is highly complex, and understanding it requires us to lyze evolutionary trends. Anatomy students often begin by dis-
comprehend a great deal of detail. The details will be more secting other animals with which we share a common ancestry
manageable if we relate them to a few broad, unifying concepts. and many structural similarities. Many of the reasons for human
The aim of this chapter, therefore, is to introduce such concepts structure become apparent only when we look at the structure of
and put the rest of the book into perspective. We consider the other animals.
historical development of anatomy and physiology, the thought Dissection, of course, is not the method of choice when
processes that led to the knowledge in this book, the meaning studying a living person! It was once common to diagnose dis-
of human life, some central concepts of physiology, and how to orders through exploratory surgery—opening the body and
better understand medical terminology. taking a look inside to see what was wrong and what could be
done about it. Any breach of the body cavities is risky, however,
and most exploratory surgery has now been replaced by medical
imaging techniques—methods of viewing the inside of the body
The Scope of Anatomy
1 .1 without surgery, discussed at the end of this chapter (see Deeper
and Physiology Insight 1.5). The branch of medicine concerned with imaging is
called radiology. Structure that can be seen with the naked eye—
Expected Learning Outcomes whether by surface observation, radiology, or dissection—is
When you have completed this section, you should be able to called gross anatomy.
Ultimately, the functions of the body result from its individ-
a. define anatomy and physiology and relate them to ual cells. To see those, we usually take tissue specimens, thinly
each other; slice and stain them, and observe them under the microscope.
b. describe several ways of studying human anatomy; and This approach is called histology6 (microscopic anatomy).
c. define a few subdisciplines of human physiology. Histopathology is the microscopic examination of tissues for
signs of disease. Cytology7 is the study of the structure and func-
tion of individual cells. Ultrastructure refers to fine detail, down
Anatomy is the study of structure, and physiology is the study of to the molecular level, revealed by the electron microscope.
function. These approaches are complementary and never entirely
separable. Together, they form the bedrock of the health sciences.
When we study a structure, we want to know, What does it do? 1.1b Physiology—The Study of Function
Physiology thus lends meaning to anatomy; conversely, anatomy is Physiology8 uses the methods of experimental science discussed
what makes physiology possible. This unity of form and function later. It has many subdisciplines such as neurophysiology (physi-
is an important point to bear in mind as you study the body. Many ology of the nervous system), endocrinology (physiology of
examples of it will be apparent throughout the book—some of
them pointed out for you, and others you will notice for yourself. 1
palp = touch, feel; ation = process
2
auscult = listen; ation = process
3
ana = apart; tom = cut
1.1a Anatomy—The Study of Form 4
dis = apart; sect = cut
5
There are several ways to examine the structure of the human from cadere = to fall down or die
6
histo = tissue; logy = study of
body. The simplest is inspection—simply looking at the body’s 7
cyto = cell; logy = study of
appearance, as in performing a physical examination or making 8
physio = nature; logy = study of
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CHAPTER 1 Major Themes of Anatomy and Physiology 3
hormones), and pathophysiology (mechanisms of disease). Partly usually considered to be the Greek physician Hippocrates
because of limitations on experimentation with humans, much (c. 460–c. 375 bce). He and his followers established a code
of what we know about bodily function has been gained through of ethics for physicians, the Hippocratic Oath, which is still
comparative physiology, the study of how different species have recited in modern form by graduating physicians at some medi-
solved problems of life such as water balance, respiration, and re- cal schools. Hippocrates urged physicians to stop attributing
production. Comparative physiology is also the basis for the de- disease to the activities of gods and demons and to seek their
velopment of new drugs and medical procedures. For example, natural causes, which could afford the only rational basis for
a cardiac surgeon may learn animal surgery before practicing on therapy.
humans, and a vaccine cannot be used on human subjects until Aristotle (384–322 bce) was one of the first philosophers to
it has been demonstrated through animal research that it confers write about anatomy and physiology. He believed that diseases and
significant benefits without unacceptable risks. other natural events could have either supernatural causes, which
he called theologi, or natural ones, which he called physici or phys-
BEFORE YOU GO ON iologi. We derive such terms as physician and physiology from the
latter. Until the nineteenth century, physicians were called “doctors
Answer the following questions to test your understanding of
of physic.” In his anatomy book, On the Parts of Animals, Aristotle
the preceding section:
tried to identify unifying themes in nature. Among other points, he
1. What is the difference between anatomy and physiology? argued that complex structures are built from a smaller variety of
How do these two sciences support each other? simple components—a perspective that we will find useful later in
2. Name the method that would be used for each of the fol- this chapter.
lowing: listening to a patient for a heart murmur; studying
the microscopic structure of the liver; microscopically
▶▶▶APPLY WHAT YOU KNOW
examining liver tissue for signs of hepatitis; learning the
When you have completed this chapter, discuss the
blood vessels of a cadaver; and performing a breast
relevance of Aristotle’s philosophy to our current thinking
self-examination.
about human structure.
Claudius Galen (129–c. 200), physician to the Roman gladi-

ators, wrote the most influential medical textbook of the ancient
The Origins of
1. 2 era—a book worshipped to excess by medical professors for cen-
Biomedical Science turies to follow. Cadaver dissection was banned in Galen’s time
because of some horrid excesses that preceded him, including
Expected Learning Outcomes public dissection of living slaves and prisoners. Aside from what
When you have completed this section, you should be able to he could learn by treating gladiators’ wounds, Galen was therefore
limited to dissecting pigs, monkeys, and other animals. Because
a. give examples of how modern biomedical science emerged
he was not permitted to dissect cadavers, he had to guess at much
from an era of superstition and authoritarianism; and
of human anatomy and made some incorrect deductions from ani-
b. describe the contributions of some key people who mal dissections. He described the human liver, for example, as
helped to bring about this transformation. having five fingerlike lobes, somewhat like a baseball glove, be-
cause that’s what he had seen in baboons. But Galen saw science
Any science is more enjoyable if we consider not just the cur- as a method of discovery, not a body of fact to be taken on faith.
rent state of knowledge, but how it compares to past under- He warned that even his own books could be wrong and advised
standings of the subject and how our knowledge was gained. Of his followers to trust their own observations more than any book.
all sciences, medicine has one of the most fascinating histories. Unfortunately, his advice was not heeded. For nearly 1,500 years,
Medical science has progressed far more in the last 50 years medical professors dogmatically taught what they read in Aris-
than in the 2,500 years before that, but the field didn’t spring totle and Galen, seldom daring to question the authority of these
up overnight. It is built upon centuries of thought and con- “ancient masters.”
troversy, triumph and defeat. We cannot fully appreciate its
present state without understanding its past—people who had
the curiosity to try new things, the vision to look at human 1.2b The Birth of Modern Medicine
form and function in new ways, and the courage to question In the Middle Ages, the state of medical science varied greatly
authority. from one religious culture to another. Science was severely re-
pressed in the Christian culture of Europe until about the six-
teenth century, although some of the most famous medical
1.2a The Greek and Roman Legacy schools of Europe were founded during this era. Their professors,
As early as 3,000 years ago, physicians in Mesopotamia and however, taught medicine primarily as a dogmatic commentary
Egypt treated patients with herbal drugs, salts, physical ther- on Galen and Aristotle, not as a field of original research. Medi-
apy, and faith healing. The “father of medicine,” however, is eval medical illustrations were crude representations of the body
sal56006_ch01_001-026.indd 3 11/23/19 2:59 PM

Another random document with
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looking as we do on Christian there before us, we see that the features of
her brilliant countenance are as like as brothers and sisters may be—like,
and yet unlike, for the pressure of that great sorrow has fallen lightly on
little Mary’s buoyant spirit. She is still “little Mary,” though her head is
higher now than Christian’s, who calls her so. Those two years have added
no less to her inner growth than to her stature, and Mary Melville, with all
the mirth and joyousness of her earlier girlhood, has the cultivated mind of
a woman now. There are many bright young faces shining in this gay room,
but there is not one like little Mary’s; not one eye in this assembly can boast
such a sunny glance as hers, graver than her peers when it is called to look
on serious things, and beaming then with a youthful wisdom, which tells of
holy thoughts and pure intents within, and anon illumined with such a flash
of genuine mirthfulness and innocent gaiety, so fresh and unconscious in its
happy light, as would startle the sternest countenance into an answering
smile. She is much loved, our sprightly Mary, and is the very sun and light
of the circle she moves in; and friends who have known her from her
childhood, tell one another how like she is to Halbert, and shake their
heads, and are thankful that she can never be exposed to similar
temptations. Do they think that Mary, like her brother, would have fallen,
that she must succumb too, before the adversary’s power, if tried as hardly?
Ah, it is not well that the innocent lamb, so tender, so guileless and gentle,
should be exposed to the power of the wolf, and who can tell but that there
may be deadly danger lurking about her even now.
Christian’s smile grows brighter as it falls on Mary, “little Mary’s”
sparkling face, and her voice is happier and more musical in its modulation
as she answers her affectionate inquiries. They speak truly who say that
Christian has no thought of herself: at this hour Christian would fain be on
her knees in her solitary room, pleading for her lost brother; not lost, deaf
Christian, say not lost—is there not a lingering tone of sweet assurance in
thy mournful heart, which, if thou would’st but hear it, speaks to thee out of
the unknown secret stillness and says, Not lost, not lost, dear Christian,
though thou yet knowest not how the faithful One has answered thy
weeping prayers.
But, hush! little Mary is singing; a simple plaintive melody, as natural in
its pleasant notes, as the dropping of the withered leaves around her absent
brother, in yon far American forest. There is a charm in these old songs
which far surpasses more artistic music, for scarce is there a single ear on
which they fall that has not many remembrances and associations
awakened, or recalled, it may be joyful, it may be sorrowful, connected
with their simple measure and well-known words, and in such, and in no
other, does Mary Melville delight. There is one sitting by Mary’s side who
seems to comprehend what few of the listeners do, or care to do, the
singer’s delicate and sweet expression of the feeling of her well-chosen
song. He has never seen her before to-night, but he seems to have made
wonderfully good use of the short time he has spent beside her; and Mary
has already discovered that the gentleman-like stranger, who devoted
himself to her all through the evening, is a remarkably well-informed,
agreeable man, and quite superior to the frivolous youths who generally
buzz about in Elizabeth’s drawing-room, and form the majority of her
guests. He has brilliant conversational powers, this stranger, and the still
more remarkable art of drawing out the latent faculty in others, and Mary is
half-ashamed, as she sees herself led on to display her hoards of hidden
knowledge, adorned with her own clear perceptions of the true and
beautiful, which, unknown to herself, she has acquired. It is a strange, an
unusual thing with Mary to meet with any mind, save Christian’s, which
can at all appreciate her own, and she is rejoicing in her new companion’s
congenial temperament, and, in a little while, there is a group of listeners
collected round them, attracted by something more interesting than the
vapid conversations which are going on in this large room. Mr. Forsyth’s
accomplishments are universally acknowledged, and he shines resplendent
to night; and one after another, dazzled by his sparkling wit and still more
engaging seriousness, join the circle, of which Mary is still the centre.
“Who would have thought,” say we, with Mrs. James, as she gazes
wonderingly over the heads of her guests on the animated face of her young
sister-in-law,—“who would have thought that Mary knew so much, or could
show it so well!”
Is Christian’s care asleep to-night; what is she doing that she is not now
watching over her precious charge? No, it is not; her eyes, which have
strayed for a moment, are now resting fixed on Mary. See! how her cheek
flushes at that man’s graceful deference. Listen to the laugh that rings from
the merry circle at some sally of his polished wit. Mary looks grave and
anxious for a moment, for his jest has just touched something which she
will not laugh at, and he perceives it, and at once changes his tone, and
turns with polished ease the conversation into a new channel. Is it well that
Christian should be ignorant of one who is engrossing so much of her
sister’s attention? No, it is not; and she feels that it is not; so she calls
James, and is even now, while Mary’s joyousness is returning, anxiously
inquiring of her brother who this stranger is. James does not even know his
name. A cousin of Elizabeth’s brought him to-night, and introduced him as
a friend who had been of great service to him; then Elizabeth herself is
appealed to; Mrs. James is quite sure that Mr. Forsyth is a very respectable,
as well as a very agreeable man; he could never have found his way into her
drawing-room had he been other than that; her cousin never would have
brought him had he not been quite certain and satisfied on that point. He is
very rich, she believes, and very accomplished, she is sure, and, being
unmarried, she is extremely pleased to see him paying so much attention to
Mary. Christian shudders—why, she does not know; but she feels that this is
not well, there is a something in his look—such nonsense! But Christian has
always such strange, such peculiar notions, and is so jealous of all that
approach Mary.
The gay young people that are around Mary make room for Christian, as
she glides in to sit down by her sisters’s side. She is very grave now, as
always; but some of them have heard her story, and all the nature in their
hearts speaks for her in tones of sympathy, and their voices are quieter
always when beside her. Over most of them she has some other power
besides this of sympathetic feeling; there is hardly one there to whom she
has not done some deed of quiet kindness, which would not even bear
acknowledgment; thus they all love Christian. She sits down by Mary’s
side, and her heart grows calmer, and more assured again; for Mary bends
over her, and seeks forgiveness for her momentary forgetfulness. Pardon
from Christian is easily obtained; yet, gentle as she is, it seems not so easy
to win her favour. Mr. Forsyth’s fascinating powers, displayed and exerted
to the full, are all thrown away. See how coldly she listens to and answers
him; nay, how impatient she is of his courteous attentions. What has he
done wrong? what can ail Christian?
Mr. James Melville’s party has been a very brilliant one; but it is all over
now: the street grows suddenly sombre and silent opposite the darkened
windows, and Mrs. James is not in the sweetest of moods: the baby, now
that all the other music has ceased, is exercising his vigorous lungs for the
amusement of the tired household; his weary mamma is aggravated into
very ill-humour, and unfortunately can find no better way of relieving
herself, nor any better object, than by railing at Christian’s folly. Mrs. James
is sure, if Mr. Forsyth were to think of Mary Melville, they might all of
them be both proud and pleased, for he would be an excellent match for her.
She could not think what Christian expected for her—some unheard-of
prodigy she fancied, that nobody but herself ever dreamt of—thus did the
lady murmur on to the great annoyance of James.
But we must leave Mrs. James and her indignation to themselves, that
we may follow the sisters home. They had little conversation on the way.
Christian was silent and absorbed in her own thoughts, and Mary wondered,
but did not disturb her; for Mary, too, has thoughts unusual, which she cares
not to communicate; and soon, again, we are in the old room, no way
changed since we saw it first, three years ago; and Mr. Melville—how shall
we excuse ourselves for passing him over so lightly and so long—is here
unaltered, as much a fixture in his wide, soft chair, as any piece of furniture
in the well-filled room; and Robert, we lost him amid the belles of Mrs.
James’s party! but here he is again, distinct, full grown and manly, and still
retaining the blithe look of old. Christian alone has yet a disturbed
apprehensive expression on her usually calm and placid face, and she
wonders,
“How can James like such parties? it is so different from his wont.”
“Yes,” says Mary innocently, “I wonder that Elizabeth likes them. If
there were just two or three intelligent people like Mr. Forsyth, it would be
so much better.”
Poor Christian!
The protection of the Almighty has been implored “through the silent
watches of the night,” and Mr. Melville’s household is hushed in sleep—all
but Christian; for this quiet hour when all are at rest, is Christian’s usual
hour of thoughtful relaxation and enjoyment. But she had a clouded brow
and an uneasy look when she entered her room to-night—that room of
many memories. At length there is no mist of disquietude to be seen upon
her peaceful face; no doubt in her loving heart: she has gone to the footstool
of the Lord, and borne with her there that child of her tenderness and
affection, over whose dawning fate she has trembled, and has committed
her into the keeping of the Father of all; and she has poured forth, with
weeping earnestness, the longings of her soul for that lost brother, whom
even yet she knows not to be within the reach of prayer. Often has she
thought that Halbert may be dead, since day after day these years have
come and gone, and no tidings from, or of him, have gladdened her heart.
Her spirit has been sick with deferred hope, as month after month went by
and brought no message. But she is calmer to-night; the load is off her soul;
she has entrusted the guardianship of the twain into His hands who doeth all
things well, and with whom all things are possible; and wherefore should
she fear!
The light in her chamber is extinguished, and the moonbeams are
streaming in through the window. A few hours since she watched their
silvery radiance stealing, unheeded and unseen, into yon crowded room,
drowned in the flood of artificial light which filled it, and then she had
thought these rays an emblem of Heaven’s Viceroy—conscience—unknown
and unnoticed, perchance, by those gay people round about her, but even
then marking with silent finger upon its everlasting tablets, the hidden
things of that unseen and inner life in long detail, moment, and hour, and
day, for each one of them. But now, in the silence of her own room, these
beams have another similitude to Christian, as they pour in unconfined,
filling the quiet chamber. They tell her of peace, peace full, sweet, and
unmeasured,—not the peace of a rejoicing and triumphant spirit,—the
sunbeams are liker it,—but of one borne down with trial and sorrow, with a
sore fight of affliction, with a fear and anguish in times past, yet now at rest.
Oh, happy contradiction! distracted with cares and anxieties, yet calm amid
them all, full of the memories of bygone sorrow, of forebodings of sorrows
yet to come, but peaceful withal, how blessed the possession!
It falls upon her form, that gentle moonshine, and her features are lit up
as with a twilight ray of heaven: it lingers over her treasures as though it
loved them for her sake. It streams upon that portrait on the wall, and
illuminates its pensive and unchanging face, as with the shadow of a living
smile; and Christian’s heart grows calm and still within her beating breast,
like an infant’s, and holy scenes of old come up before her liquid eyes, like
ancient pictures, with that steadfast face upon the wall shining upon her in
every one; not so constant in its sad expression, but varying with every
varying scene, till the gathering tears hang on her cheeks like dewdrops,
and she may not look again.
And there is peace in that household this night, peace and sweet serenity,
and gentle hopefulness; for a blessing is on its prayer-hallowed roof and
humble threshold, and angels stand about its quiet doorway, guarding the
children of their King—the King of Kings.
CHRISTIAN MELVILLE.
EPOCH IV.
There is no emblem of our lives so fit

As the brief days of April, when we sit
Folding our arms in sorrow, our sad eyes
Dimmed with long weeping; lo! a wondrous ray,
Unhoped-for sunshine bursting from the skies
To chase the shadow of our gloom away.
And lest the dazzling gladness blind us, lo!
An hour of twilight quiet followeth slow,
Moistening our eyelids with its grateful tears,
Strengthening our vision for the radiant beam
That yet shall light these unknown future years,—
Each joy, each grief, in its appointed room,
Ripening the precious fruit for heaven’s high harvest home.
CHAPTER I.
Benedict. Pray thee, sweet Mistress Margaret, deserve well

at my hands by helping me to the speech of Beatrice.
* * * * *
Sweet Beatrice, wouldst thou come when I called thee?
Much ado about Nothing.
E are half inclined to lament that the incidents of our story

confine us to one short month, nay, oftener to one little day of
every passing year, but nevertheless so it is, and we may not
murmur. Doubtless could we have sketched the glories of some
midsummer morning or autumnal night, or wandered by our heroine’s side
through the gowan-spotted braes in the verdant springtime, we should have
had pleasanter objects to describe, and a pleasanter task in describing them,
and our readers a less wearisome one in following us; but seeing that we
must, perforce, abide by “the chamber and the dusky hearth,” even so, let it
be. The hearth of our present sketch is in nowise dusky, however; there is
nothing about it that is not bright as the blazing fire itself. If you look from
the window you may see that everything without is chained down hard and
fast in the iron fetters of the frost, and covered with a mantle of dazzling
whiteness. With tenacious grasp the wintry king fixes the less obdurate
snow to the heavy housetops, decking them as with hood and mantle; with
malicious glee it rivets each drop of spilt water on the slippery pavement,
bringing sudden humiliation, downfall and woe, to the heedless passengers;
and from the southern eaves where the sun has for some short time exerted
a feeble power, hang long icicles in curious spirals, like the curls of
youthful beauty. Keen and cold, it revels in the piercing wind, which
coming from the bleak north in full gush round the chill street corner,
aggravates the wintry red and blue which battle for the mastery in the faces
of the shivering passengers, and screams out its chill laughter in the gale,
when some sturdy man who has but now chased its little glowing votaries
from their icy play is suddenly overthrown himself by one incautious step,
and with prostration lower than Eastern does homage to its power, to the
great and loudly expressed satisfaction of the urchins aforesaid, who have
resumed again their merry game with renewed zeal and vigour.
It is just the kind of morning to make dwellers at home hug themselves
on their comfortable superiority over those whom necessity calls abroad, to
dare the dangerous passage of these treacherous streets and meet the rough
encounters of the biting wind. The room we stand in is the very picture of
neatness and comfort; a beautiful infant of two years old is roaming with
unsteady step about the bright fireside and over the carpet, a wide world to
him, intently making voyages of discovery hither and thither, among the
chairs and tables, the continents and islands of his navigation; and beside a
pretty work-table, with her delicate fingers employed in still more delicate
work, sits Mrs. James Melville, her brow furrowed and curved in
deliberative wisdom, giving earnest heed to schemes which are being
poured into her attentive ear, and ever and anon responding with oracular
gravity. Who is this that seeks and has obtained the infinite benefit of Mrs.
James’s counsel, and that now with deferential courtesy lays before her the
inexpressible advantages he will derive from her advice and assistance, and
insinuates the unending gratitude of which he has already given earnest in
delicate and well-timed presents, such as delight a lady’s heart? He is
speaking of a brilliant establishment to be offered to some one whom he
seeks to win, and shall win all the more easily through his kind friend Mrs.
James’s advice and co-operation. He is speaking of wealth which hitherto
he laments,—and here the petitioner sighs and looks, or tries to look
pathetic,—he has not properly employed, wherewith that as yet nameless
third party shall be endowed, and he winds up all with an eulogium upon
the extraordinary ability, and undeserved, but not unappreciated kindness of
the lady who smiles so graciously at his well-timed compliments. Mrs.
James is completely won over, and her full assistance and co-operation
pledged, for the pleader is skilled in his craft, and wont to be successful.
Who can resist Mr. Forsyth’s eloquence and special reasonings? The work
of consultation goes on, the toils are laid for Mary, sweet Mary Melville’s
unwitting feet, and Forsyth, on the strength of his ally’s assurances, has
already brightened in anticipatory triumph, and if all things be as Mrs.
James says they are, and all Forsyth’s promises be realised, is not Mary’s lot
a bright one? Nay, but is this a man to hold in his hands the happiness of
Christian’s sister?
Mrs. James is determined to signalise herself as a match-maker, and
there are a thousand captivating circumstances which conspire to make her
eager in the furtherance of Forsyth’s suit. She reckons up some of them:
First, it will really be an excellent settlement for Mary; where among her
father’s hum-drum acquaintance could she ever have found one anything at
all like so good; secondly, Mrs. Forsyth’s wealth and style will bring even
her, Mrs. James Melville, into a more brilliant sphere; and above all, there
will be the crowning delight of overcoming, or rather being able to set at
nought, all Christian’s opposition. Mrs. James, self-confident as she is, very
bold, and even impertinent as she can be at some times, and strong in the
might of superior elegance and beauty, has always been awed in the
presence of Christian’s quiet dignity, and this had annoyed and galled her
greatly. There is something in that grave dignity which she cannot
comprehend, and still more aggravating is the fact, that do what she will,
she cannot quarrel with her gentle sister-in-law, and that all her innuendoes
fall pointless and harmless. Christian will not hear Mrs. James’s petulance,
be it ever so loud, for with one calm word she shows her its insignificance;
she smiles at her sarcasms against old maids, as she might smile at some
nick-name of childish sport; nay, sometimes, and it is the nearest approach
to mirth which Christian is ever known to make now, she will turn round in
defence of the maligned sisterhood, and chase with lightfooted raillery,
which savours of days of old, the heavy wit of her opponent off the field.
Mrs. James never saw Christian ruffled or disturbed by any speech of hers,
save on that occasion which introduced Forsyth to Mary, and she was too
watchful and too much delighted to let the opportunity of prolonging her
annoyance cease; and Mary, a frequent visitor at her brother’s house, has
since that time, nearly a year now, met her sister-in-law’s accomplished
acquaintance so often, that people begin to whisper about Forsyth’s
devotion, and to look forward to a bridal; and when he is spoken of before
Mary, they smile and look in her face, and the colour on her soft cheek
deepens, and the blood flushes on her forehead, and then when they wonder
at his versatile talents, as they often do, for he is intellectually in that
society a giant among dwarfs, Mary’s downcast eyelids grow wet with
pleasant moisture, and her heart thrills with pleasure, so that she, loving
Christian as she does, is unconsciously furthering Mrs. James in her plan of
annoyance. Our poor Mary!
But we are neglecting the conversation which is still going on between
Mrs. James and her visitor. Forsyth is preparing to go, his visit has been
already prolonged beyond all usual bounds, yet he lingers still,
endeavouring with his persuasive eloquence to bring about one other
arrangement.
“You will bring Mary here to meet me, on new year’s day morning, my
dear madam?” he says softly, and in the most insinuating tone, “will you
not?”
“New year’s morning,” interrupted Mrs. James, “that will never do. You
know I have always a party on the new year’s night, I shall not be able to
give you that morning.”
“Well,” answered Forsyth, as smoothly and persuasively as he could,
“but if you could give us your presence for a few minutes, Mary and I, I
hope, will be able to manage the rest ourselves, and you know, my dear
Mrs. Melville,” he added still more blandly, “I am anxious to come to an
understanding with Mary as soon as possible. Come, you must add this to
the many kindnesses you have done me already. You will consent, I see.”
Mrs. James could not resist. “Well then, on new year’s morning be here,
and Mary shall meet you,” she said, and her gratified friend bows over her
extended hand. “You may come, Mr. Forsyth, on new year’s morning.”
Mr. Forsyth can never sufficiently express his obligation; and having
succeeded in all things according to his wish with Mrs. James Melville, he
takes his leave at last, and rejoices as he hurries through the streets, so cold
and bitter to other passengers, but so bright and cheerful to him in his
present mood, that soon now he will be assured of Mary. He has no doubt
about it, none at all, and he is certain that all that he wants is just this
opportunity which Mrs. James is to secure him, and then Mary Melville will
be his own, plighted and pledged his own.
It is but a few days, yet new year’s morning is as tardy in approach as if,
so big with fate to that young, ingenious, and unfearful spirit, it lingered on
its way willing to prolong her state of happy unconsciousness. The elegant
Mr. Forsyth yawns through the long weary days; though it is the time of his
own appointing he is impatient and restless, and his yawning and
irksomeness is redoubled on that dull, cold, cheerless evening before its
dawn, and he gets really nervous as the time draws near. Strange that one so
practised in the world, whose heart has been so long a very superfluous
piece of matter, should have his dead affections so powerfully awakened by
the simple grace and girlish beauty of guileless Mary Melville. Strange,
indeed, and if he is successful in winning her—as who can doubt he will—
what hope is there for our sweet Mary when his sudden vehement liking
passes into indifference. Poor Mary’s constant heart should be mated only
with one as warm and as full of affection and tenderness as itself; but who
shall have the choosing of their own future—alas, who! or who, if the
choice was given them, would determine aright?—not Mary. But there is a
power, the bridegroom in anticipation wots not of, ordering the very words
which shall fall from his lips to-morrow, overruling the craftiness of his
crafty and subtle spirit, and guarding the innocent simplicity of the prayer-
protected girl, defending her from all ill.
CHAPTER II.
York. I’ll not be by, the while; My Liege, farewell;

What will ensue hereof, there’s none can tell;
But by bad courses may be understood
That these events can never fall out good.
King Richard the Second.
EW YEAR’S day at last arrived, the time so anxiously waited for

by Forsyth; a cold clear winter morning; and Mary, invited
specially by her sister-in-law, leaves home to help—to help in
some little preparations for the evening, was the reason or plea
assigned by Mrs. James to secure Mary on that morning; and even Christian
had nothing to object to a request so reasonable, though it must be said that
Christian did not like her sister to be much among Mrs. James’s friends.
Nor had Mary herself been wont to like it either, but the Mary of a year ago
is not the Mary of to-day; she has not grown indifferent to Christian’s
wishes; very far from that, Mary was perhaps more nervously anxious to
please Christian than ever in all lesser things; she felt that a kind of
atonement, a satisfaction to her conscience, for her encouragement of the
one engrossing feeling of her heart, of which she dared not indeed seek
Christian’s approval. For the thought that in this most important particular
she was deceiving, or at least disingenuous to her dearest friend, concealing
from her what it so concerned her to know, gave Mary, acting thus contrary
to her nature, many a secret pang. But though this secret clouded her brow
and disturbed her peace at home, she hid it in her own heart. Still how
strange that Mary should be lightsome and happier with her brother’s wife,
whose character was in every respect so inferior to her own, than with her
gentle sister; yet so it was, and Mary’s heart beat quicker when she entered
James’s house, and quicker still when she saw there was some other visitor
before her. Who it was she needed not to ask, for Forsyth sprung to her side,
as she entered the cheerful room, with low-voiced salutation, and a glance
that brought the blush to her cheek, and caused her fair head to bend over
the merry little boy that came running to her knee, and hailed her as “Aunt
Mary.”
“Call me uncle, James, that’s a good little fellow, call me Uncle Walter,”
said Forsyth.
Mary’s blush grew deeper; but James the younger was said to resemble
Aunt Christian in many things, and in nothing more than in disliking
Forsyth; and he was not to be conciliated, either with sugar-plum or toy, but
remained steadfast in his childish instinct of dislike, so he said bluntly,
“No,”—a bad omen this; but Forsyth was not to be discouraged, and Mrs.
James, nettled a little by it, proceeded at once to open the campaign. Some
new music was lying on the table, and she pointed to it.
“See, Mary, here is a present from Mr. Forsyth,” she said, laughingly,
“but there is a condition attached to it which depends on you for its
fulfilment.”
Mary, glad of anything to hide her confusion, bent over the table to look
at it. “Well,” she said, “and what is the condition that depends on me.”
“Nay, ask the giver,” said Mrs. James, “he must make his agreement
with you himself, I cannot make bargains for him.”
Mary was half afraid to lift her eyes to Forsyth’s face, but she did so, and
asked by a glance what it was he required.
“The condition is not a very difficult one,” said he, in his most bland and
soothing tone, “it was merely that Mrs. Melville would get you to sing this
song for me. I was afraid I should fail did I ask myself.”
“And why this song, Mr. Forsyth,” asked Mary, “is it such a favourite?”
“I heard you sing it a year ago,” was the answer, spoken too low, Mary
thought, to reach Mrs. James’s ear, and again the blood came rushing in
torrents to her face.
Mrs. James began to move about as though about to leave the room; this
silence would not do, it was too embarrassing, and Mary resumed, though
her voice had likewise grown imperceptibly lower. “Christian is very fond
of this song, and we all of us like it because she does.”
Mrs. James heard this, however, and, elated by Mary’s coming to her
house that morning, and her own expected triumph over Christian, she
could not resist the temptation. “Oh, Christian has such strange notions,”
she said gaily, “she likes things that nobody else does. I can’t conceive why
you are all continually quoting Christian—Christian! one hears nothing else
from James and you, Mary, but Christian, Christian.”
“Christian never set her own inclination in opposition to any other
person’s wish in her life,” said Mary, warmly; “you do not know Christian,
Elizabeth, or you would not speak of her so.”
“Miss Melville’s good qualities,” chimed in Forsyth, “Miss Melville’s
rare qualities, must gain as much admiration wherever she is seen, as they
seem to have gotten love and reverence from all who are within the range of
their beneficent exercise, and who have the privilege of knowing their value
fully;” and he smiled his sweetest smile in Mary’s face, as she looked up to
him with grateful glistening eyes, and inwardly thanked him for his
appreciation of dear Christian in her heart.
How superior, thought Mary, is he to such worldly people as Elizabeth,
and her coterie, he appreciates Christian, he can estimate her properly. Yet
Mary, all the time that her heart glowed under these feelings towards
Forsyth, felt that she had thwarted Christian’s warmest wishes, and is still
farther thwarting them by the very look with which she thanked Forsyth for
his championship. Mrs. James is at the window carefully examining the
leaves of some rare winter plants—another gift of Forsyth’s giving; and
there ensues another awkward silence. At length she breaks in once more.
“Am I to have my music, Mary? will you fulfil the conditions Mr.
Forsyth has attached to this, or shall I have to send it back again?”
Forsyth is leaning over her chair, anxiously waiting for her answer. Mary
is at a loss what to do, but cannot say, No. Again Mrs. James is occupied
with the flowers.
“This is an era with me, Miss Melville,” Forsyth whispered in Mary’s
ear; “this day twelve months I first saw you.”
Mary’s fingers still hold the music, but the sheets tremble in her hands.
“Is it, indeed?” she says. “Oh, yes! I remember, it was at Elizabeth’s annual
party! It is an era to us all, also. We too have many recollections connected
with the New Year, but they are all sorrowful.”
“Not mine,” returned Forsyth. “Do you know, Miss Melville, I was much
struck then by your resemblance to a young man I once knew in Edinburgh,
a very fine gentleman-like lad of your own name too. I often wonder what
has become of him. I had some hand in inducing him to change some
ridiculously rigid opinions of his; when a fit of superstitious fear came over
him, and I believe his regard for me changed to a perfect hatred.”
Here Mr. Forsyth looked over to Mrs. James, as much as to say, it was
full time for her to go away.
The light is swimming in Mary’s eyes, everything before her has become
dim and indistinct; and she trembles, not as she trembled a moment since,
with agitated pleasure—it is horror, dread, fear that now shakes her slender
frame, and looks out from her dim and vacant eyes. There is no trace now
of the blush which wavered but a little ago so gracefully upon her cheek, it
is pale as death, as she sinks back into her chair. Forsyth and Elizabeth both
rushed to her side. What is, what can be, the matter?
“Nothing, nothing, I shall be better immediately,” she said, shuddering
as she raised herself up again, and drew away the hand which Forsyth had
taken; “I am better now, much better.”
A look of intelligence and mutual congratulation passed between her
companions. Poor thing, she is agitated, and out of sorts with the novelty of
her position; but what matters that, they are quite sure of Mary now, and
Mrs. James glides quietly out of the room.
As soon as she has gone, and they are left alone together, Forsyth with
all the eloquence of look and tone and gesture he can command, pours his
suit into Mary’s ear. How entirely will he not be devoted to her, to her
happiness. How perfectly does she reign in his affections; but it seems,
unless from a shiver, which thrills through her frame from time to time, that
he speaks to a statue, alike incapable of moving from that charmed place, or
of articulating anything in answer to his petition. Forsyth becomes alarmed,
and entreats, beseeches her to speak to him, to look at him only, to return
the pressure of his hand, if nothing more definite is to be said or done; and
suddenly Mary does look up, pale and troubled though her countenance be,
into his face, and speaks firmly:—
“Where, Mr. Forsyth,” she said, gazing at him as though she could
penetrate the veil, and read his inmost heart; “where did that young man go,
that you were speaking to me of just now; the one,” she added, with hasty
irritation, as she marked his astonished and deprecating gesture—“the one
you thought resembled me; to what place or country did he flee? Answer
me.”
“Mary, dear Mary!” pleaded Forsyth, “why ask me such a question now?
why terrify me with such looks. That superstitious fellow can be nothing to
you; and you, dear Mary, are all in all to me.”
Mary’s voice is still trembling, notwithstanding her firmness, and the
very force of her agitation has made it clear. “Where did he go to?” she
repeats once more.
“I do not know; I believe to America, the universal refuge,” answered
Forsyth, half angrily. “But why do you torment me thus, and answer my
entreaties by such questions? What has this to do with my suit? Will you
not listen to me, Mary?”
As he spoke, she rose with sudden dignity, and repelled the proud man
who subdued and supplicating half knelt before her. “Much, Sir,” she said,
with emphasis; “it has much to do with what you have said to me. I, to
whom you address your love—I, who have been deceived into esteeming
you so long—I, am the sister of Halbert Melville; of the man whom your
seductions destroyed!”
It is too much, this struggle, the natural feeling will not be restrained,
and Mary Melville hides her face in her hands, and tries to keep in the
burning tears. Forsyth has been standing stunned, as though a thunderbolt
had broken upon his head, but now he starts forward again. She is melting,
he thinks, and again he takes her hand in his own. It is forced out of his hold
almost fiercely, and Mary, again elevated in transitory strength, bids him
begone; she will not look upon the destroyer of her brother with a
favourable eye, nor listen to a word from his lips.
A moment after, the passengers in the street are turning round in
astonishment, to look at that face so livid with rage and disappointment
which speeds past them like a flash of lightning, and Mrs. James Melville
was called up to administer restoratives to her fainting sister—sweet gentle
Mary.
CHAPTER III.
If I may trust the flattering eye of sleep,

My dreams presage some joyful news at hand;
My bosom’s lord sits lightly in his throne;
And, all this day, an unaccustom’d spirit
Lifts me above the ground with cheerful thoughts.
Romeo and Juliet.
HRISTIAN MELVILLE is seated alone by her fireside, engaged

in her usual occupations, and full of her wonted thoughts; but her
present anxiety about Mary has taught her to linger less in the
past, and to look oftener forward to the future than she has been
accustomed to do heretofore, since sorrow made that once bright prospect a
blank to her. Nay, Christian, in her happier hours, has grown a dreamer of
dreams, and all her architectural fancies terminate in the one grand object,
the happiness of Mary. She sees the imminent danger she runs of having to
relinquish her one remaining treasure, and that into the keeping of one she
distrusts so much as Forsyth. Christian cannot tell how it is that she has
such an unaccountable, unconquerable aversion to him. True, his name is
the same as that of Halbert’s tempter; and association is the root, doubtless,
of all her prejudice—as prejudice everybody calls it—and Christian tries, as
she has tried a hundred times, to overcome her repugnance, and to recollect
the good traits of character that have been told her of him, and to school her
mind into willingness to receive him as Mary’s choice; and she breathes,
from the depths of her heart, the fervent petition for guidance and
deliverance so often repeated for her innocent Mary—her child, her sister—
and then her thoughts speed away, and Halbert rises up before her mental
vision. What can be his fate? Long and wearily does she ponder, and bitter
fancies often make her groan in spirit as one burdened. Is he still a living
man?—still to be hoped and prayed for; or, is Halbert now beyond all
human hope and intercession? Her heart grows sick and faint as she thinks
of the possibility of this; but she almost instantly rejects it; and again her
soul rises to her Lord in earnest ejaculations. Oh! but for this power of
prayer, but for this well-ascertained certainty, that there is One who hears
the prayers of his people, how should Christian Melville have lived
throughout these three long anxious years; how should she have endured the
unbroken monotony of every uneventful day, with such a load upon her
mind, and such fancies coming and going in her heart; how possibly
subdued the longings of her anxious love through all this time of waiting
and suspense? But her prayer has never ceased; like the smoke of the
ancient sacrifice, it has ascended continually through the distant heaven: the
voice of her supplications and intercedings have risen up without ceasing;
and surely the Hearer of prayer will not shut his ears to these.
There is some commotion going on below, the sound of which comes up
to Christian in a confused murmur, in which she can only distinguish old
Ailie’s voice. At first she takes no notice of it; then she begins to wonder
what it can be, so strange are such sounds in this quiet and methodical
house, though still she does not rise to inquire what it is. Christian is
engrossed too much with her own thoughts; and as the sounds grow more
indistinct, she bends her head again, and permits herself to be carried away
once more in the current of her musings. But the step of old Ailie is coming
up the stairs much more rapidly than that old footstep was wont to come;
and as Christian looks up again in astonishment, Ailie rushes into the room,
spins round it for a moment with uplifted hands, sobbing and laughing
mingled, in joyful confusion, and then dropping on the floor, breathless and
exhausted with her extraordinary pirouetting, throws her apron over her
head, and weeps and laughs, and utters broken ejaculations till Christian,
hastening across the room in great alarm to interrogate her, afraid that the
old woman’s brain is affected,
“What is the matter, Ailie?” Christian asks. “Tell me, what is the
matter?”
“Oh, Miss Christian!” and poor Ailie’s wail of sobbing mixed with
broken laughter sounded almost unearthly in Christian’s ear. “Oh, Miss
Christian! said I not, that the bairn of sae monie prayers suld not be lost at
last?”
“Ailie! Ailie! what do you mean? Have you heard anything of Halbert?”
and Christian trembled like a leaf, and could scarce speak her question for
emotion. “Ailie! I entreat you to speak to—to answer me.”
And Christian wrung her hands in an agony of hope and fear, unwitting
what to think or make of all this almost hysterical emotion of the old
faithful servant, or of her enigmatical words. “Look up, dear Christian; look
up!” Ailie needs not answer. Who is this that stands on the threshold of this
well-remembered room, with a flush of joy on his cheek, and a shade of
shame and fearfulness just tempering the glow of happiness in his eyes?
“Halbert!”
“Christian!”
The brother and sister so fearfully and so long separated, and during
these years unwitting of each other’s existence even, are thus restored to
each other once more.
A long story has Halbert to tell, when Christian has recovered from her
first dream of confused joy, a three year long story, beginning with that
fearful night, the source of all his sorrows and his sufferings. Christian’s
heart is bent down in silent shuddering horror as he tells her of how he fell;
how he was seduced, as by the craftiness of an Ahithophel, into doubt, into
scoffing, into avowed unbelief, and finally led by his seducer—who all the
previous time had seemed pure and spotless as an angel of light—into the
haunts of his profligate associates, so vicious, so degrading, that the blush
mantles on Halbert’s cheek at the bare remembrance of that one night. He
tells her how among them he was led to acknowledge the change which
Forsyth had wrought upon his opinions, and how he had been welcomed as
one delivered from the bondage of priestly dreams and delusions; how he
was taken with them when they left Forsyth’s house—the host himself the
prime leader and chief of all—and saw scenes of evil which he shuddered
still to think of; and how in the terrible revulsion of his feelings which
followed his first knowledge of the habits of these men, whose no-creed he
had adopted, and whose principles he had openly confessed the night
before, sudden and awful conviction laid hold upon him—conviction of the
nature of sin; of his sin in chief—and an apprehension of the hopelessness
of pardon being extended to him; and how, turning reckless in his despair,
he had resolved to flee to some place where he was unknown, uncaring
what became of himself. He told her then of his long agony, of his fearful
struggle with despair, which engrossed his soul, and how at last he was
prompted by an inward influence to the use of the means of grace once
more; and how, when at length he dared to open his Bible again, a text of
comfort and of hopefulness looked him in the face; that he had said to
himself, over and over again, “It is impossible!” till hope had died in his
heart: but here this true word contradicted at once the terrible utterance of
his self-abandonment. “All things,” it was written, “are possible with God;”
and Halbert told her, how the first tears that had moistened his eyes since
his great fall sprang up in them that very day. He told her of the scene so
fair, where this mighty utterance of the Almighty went to his soul, and
where he found peace; in the words of the gifted American—

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(eBook PDF) Anatomy & Physiology: The Unity of Form and

Anatomy & Physiology: The Unity of Form and Function

Anatomy & Physiology. The Unity of Form and Function

Anatomy & Physiology: The Unity of Form and Function

(eBook PDF) Seeley's Essentials of Anatomy and

(eBook PDF) Vander's Human Physiology: The Mechanisms

(eBook PDF) Laboratory Manual for Anatomy & Physiology

(eBook PDF) Mader's Understanding Human Anatomy &

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Ken’s “first book,” Hydra One of Ken’s drawings

Ken began working on his first

The first edition (1997)

The story continues (2020)

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Writing Style and Level

CHANGES TO THE NINTH EDITION

New Art and Photography

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INNOVATIVE CHAPTER SEQUENCING

Early Presentation of Heredity Urinary System Presented Close to Circulatory

About the Authors iv

terms for the joint movements. APPENDIX A: Answer Keys A-1

membrane electrophysiology. iii

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Chapter Outlines provide quick previews

CHA P T ER O U T L IN E 7.4 Physiology of Osseous Tissue D E E P E R I NS I G H TS

A ll organisms, from the simplest to the most complex, are

Tiered Assessments Based on

3 .1 Concepts of Cellular Structure

Each major section begins with Expected Learning Outcomes to help

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296 PART TWO Support and Movement

for assessment that are useful to both students and

adjacent bone levers, of each tion of the foot

▶ Testing Your Recall

▶ What’s Wrong with These Statements? Answers in Appendix A

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ARTWORK THAT INSPIRES Stroma:

Vivid Illustrations Afferent lymphatic

Rich textures and shading and bold,

Francis Leroy, Biocosmos/Science Source

Palatine tonsil Vomer

Vestibular fold Laryngopharynx

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Trapezium Superficial palmar

(a) Anterior view

Aorta 2 Blood in right atrium flows through right

9 4 Blood flows through pulmonary valve

Inferior 10 Blood in aorta is distributed to every organ in

11 Blood returns to right atrium via venae cavae.

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You’re in the driver’s seat.

They’ll thank you for it.

Make it simple, Solutions for your

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