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sixth edition
Human
Anatomy
Michael P. McKinley
Glendale Community College (Emeritus)
Valerie Dean O’Loughlin

Indiana University
Elizabeth E. Pennefather-O’Brien
Medicine Hat College
mck51357_fm_i-xxx.indd 1 12/3/19 6:36 PM

14.2 Cytology of Nervous Tissue 410 16.4c Intercostal Nerves 487
14.2a Neurons 410 16.4d Cervical Plexuses 487
14.2b Glial Cells 413 16.4e Brachial Plexuses 488
14.3 Myelination of Axons 417 16.4f Lumbar Plexuses 493
14.3a Myelination 417 16.4g Sacral Plexuses 496
14.3b Nerve Impulse Conduction 418 16.5 Reflexes 497
14.4 Axon Regeneration 420 16.5a Components of a Reflex Arc 500
14.5 Nerves 420 16.5b Examples of Spinal Reflexes 502
14.6 Synapses 422 16.5c Reflex Testing in a Clinical Setting 502
14.6a Synaptic Communication 423 16.6 Development of the Spinal Cord 503
14.7 Neural Integration and Neural Circuits 425
14.8 Development of the Nervous System 426
Chapter 17
Pathways and Integrative Functions 508
Chapter 15 17.1 General Characteristics of Nervous System
Brain and Cranial Nerves 431 Pathways 509
15.1 Brain Development and Tissue 17.2 Sensory Pathways 509
Organization 432 17.2a Functional Anatomy of Sensory
15.1a Embryonic Development of the Pathways 510
Brain 433 17.3 Motor Pathways 513
15.1b Organization of Neural Tissue Areas in the Brain 436 17.3a Functional Anatomy of Motor Pathways 513
15.2 Support and Protection of the Brain 438 17.3b Levels of Processing and Motor Control 518
15.2a Cranial Meninges 440 17.4 Higher-Order Processing and Integrative
15.2b Brain Ventricles 442 Functions 518
15.2c Cerebrospinal Fluid 442 17.4a Development and Maturation of Higher-Order
15.2d Blood-Brain Barrier 444 Processing 519
15.3 Cerebrum 446 17.4b Hemispheric Lateralization 519
15.3a Cerebral Hemispheres 446 17.4c Language 519
15.3b Functional Areas of the Cerebrum 448 17.4d Cognition 520
15.3c Central White Matter 451 17.4e Memory 521
15.3d Cerebral Nuclei 453 17.4f Consciousness 522
15.4 Diencephalon 454 17.4g Electroencephalogram 523
15.4a Epithalamus 455 17.4h Sleep 524
15.4b Thalamus 455 17.5 Aging and the Nervous System 525
15.4c Hypothalamus 456
15.5 Brainstem 457
15.5a Midbrain 457 Chapter 18
15.5b Pons 459 Autonomic Nervous System 530
15.5c Medulla Oblongata 460 18.1 Comparison of the Somatic and
15.6 Cerebellum 461 Autonomic Nervous Systems 531
15.6a Cerebellar Peduncles 462 18.1a Motor Neurons of the Somatic
15.7 Limbic System 462 Versus Autonomic Nervous
15.8 Cranial Nerves 465 System 532
18.2 Divisions of the Autonomic
Chapter 16 Nervous System 533
18.2a Functional Differences 533
Spinal Cord and Spinal Nerves 477 18.2b Anatomic Differences in Lower Motor Neurons 534
16.1 Gross Anatomy of the Spinal Cord 478 18.3 Parasympathetic Division 535
16.2 Spinal Cord Meninges 480 18.3a Cranial Components 535
16.3 Sectional Anatomy of the Spinal Cord 482 18.3b Pelvic Splanchnic Nerves 537
16.3a Distribution of Gray Matter 482 18.3c Effects and General Functions of the Parasympathetic
16.3b Distribution of White Matter 483 Division 537
16.4 Spinal Nerves 484 18.4 Sympathetic Division 537
16.4a Spinal Nerve Distribution 484 18.4a Organization and Anatomy of the Sympathetic
16.4b Nerve Plexuses 486 Division 537
viii

18.4b Sympathetic Pathways 540 20.4 Thyroid Gland 605
18.4c Effects and General Functions of the Sympathetic 20.4a Synthesis of Thyroid Hormone by Thyroid Follicles 605
Division 540 20.4b Thyroid Gland–Pituitary Gland Negative Feedback 607
18.5 Other Features of the Autonomic Nervous System 542 20.4c Parafollicular Cells 608
18.5a Autonomic Plexuses 542 20.5 Parathyroid Glands 610
18.5b Enteric Nervous System 543 20.6 Adrenal Glands 611
18.5c Overview of ANS Neurotransmitters 544 20.6a Adrenal Cortex 611
18.5d Autonomic Tone 545 20.6b Adrenal Medulla 613
18.5e Dual Innervation 545 20.7 Pancreas 615
18.5f Systems Controlled Only by the Sympathetic 20.8 Pineal Gland and Thymus 618
Division 546
20.9 Endocrine Functions of the Kidneys, Heart,
18.5g Autonomic Reflexes 546
Gastrointestinal Tract, and Gonads 618
18.6 CNS Control of Autonomic Function 548
20.9a Kidneys 618
18.7 Development of the Autonomic Nervous System 548 20.9b Heart 619
20.9c Gastrointestinal Tract 619
Chapter 19 20.9d Gonads 619
Senses: General and Special 552 20.10 Aging and the Endocrine System 619
19.1 Introduction to Sensory 20.11 Development of the Endocrine System 619
Receptors 553 20.11a Adrenal Glands 619
19.1a Properties of Sensory 20.11b Pituitary Gland 619
Receptors 553 20.11c Thyroid Gland 621
19.1b Classification of Sensory Receptors 554
19.2 Tactile Receptors 557
19.2a Unencapsulated Tactile Receptors 557
Chapter 21
19.2b Encapsulated Tactile Receptors 559 Blood 625
19.3 Olfaction 559 21.1 General Composition and
19.3a Olfactory Receptor Cells 559 Functions of Blood 626
19.3b Olfactory Discrimination 560 21.1a Components of Blood 626
19.3c Olfactory Pathways 560 21.1b Functions of Blood 627
19.4 Gustation 561 21.2 Blood Plasma 627
19.4a Papillae and Taste Buds of the Tongue 561 21.2a Plasma Proteins 627
19.4b Gustatory Discrimination 562 21.2b Other Solutes in Plasma 627
19.4c Gustatory Pathways 562 21.2c Differences Between Plasma and Interstitial Fluid 628
19.5 Vision 562 21.3 Formed Elements in the Blood 628
19.5a Accessory Structures of the Eye 563 21.3a Erythrocytes 629
19.5b Eye Structure 564 21.3b Leukocytes 636
19.5c Visual Pathways 572 21.3c Platelets 638
19.5d Development of the Eye 573 21.4 Hematopoiesis: Production of Formed Elements 639
19.6 Equilibrium and Hearing 576 21.4a Erythropoiesis 640
19.6a External Ear 576 21.4b Thrombopoiesis 642
19.6b Middle Ear 577 21.4c Leukopoiesis 642
19.6c Inner Ear 578
19.6d Development of the Ear 589 Chapter 22
Chapter 20 Heart 645
22.1 Overview of the Cardiovascular
Endocrine System 595 System 646
20.1 Endocrine Glands and Hormones 596 22.1a Pulmonary and Systemic
20.1a Overview of Hormones 596 Circulations 646
20.1b Negative and Positive 22.1b Position of the Heart 647
Feedback 598 22.1c Characteristics of the Pericardium 647
20.2 Hypothalamic Control of the Endocrine System 598 22.2 Anatomy of the Heart 648
20.3 Pituitary Gland 601 22.2a Heart Wall Structure 649
20.3a Anterior Pituitary 601 22.2b External Heart Anatomy 649
20.3b Posterior Pituitary 604 22.2c Internal Heart Anatomy: Chambers and Valves 649
ix

22.3 Coronary Circulation 656 24.3 Lymphoid Cells 717
22.4 How the Heart Beats: Electrical Properties of Cardiac 24.3a Types and Functions of Lymphocytes 719
Tissue 658 24.3b Lymphopoiesis 723
22.4a Characteristics of Cardiac Muscle Tissue 658 24.4 Lymphoid Structures 725
22.4b Contraction of Heart Muscle 658 24.4a Lymphoid Nodules 725
22.4c The Heart’s Conducting System 658 24.4b Lymphoid Organs 725
22.5 Innervation of the Heart 661 24.5 Aging and the Lymphatic System 731
22.6 Tying It All Together: The Cardiac Cycle 663 24.6 Development of the Lymphatic
22.6a Steps in the Cardiac Cycle 663 System 731
22.6b Summary of Blood Flow During the Cardiac Cycle 663
22.7 Aging and the Heart 666
22.8 Development of the Heart 667
Chapter 25
Respiratory System 737
25.1 General Organization and Functions
Chapter 23 of the Respiratory System 738
Vessels and Circulation 673 25.1a Respiratory System Functions 738
23.1 Anatomy of Blood 25.2 Upper Respiratory Tract 740
Vessels 674 25.2a Nose and Nasal Cavity 740
23.1a Blood Vessel Tunics 674 25.2b Paranasal Sinuses 740
23.1b Arteries 674 25.2c Pharynx 740
23.1c Capillaries 676 25.2d Larynx 743
23.1d Veins 678 25.3 Lower Respiratory Tract 745
23.2 Blood Pressure 681 25.3a Trachea 747
23.3 Systemic Circulation 683 25.3b Bronchial Tree 748
23.3a General Arterial Flow Out of the Heart 683 25.3c Respiratory Bronchioles, Alveolar Ducts,
23.3b General Venous Return to the Heart 683 and Alveoli 750
23.3c Blood Flow Through the Head and Neck 683 25.4 Lungs 752
23.3d Blood Flow Through the Thoracic and Abdominal 25.4a Pleura and Pleural Cavities 752
Walls 689 25.4b Gross Anatomy of the Lungs 752
23.3e Blood Flow Through the Thoracic Organs and Spinal 25.4c Blood Supply to and from the Lungs 753
Cord 690 25.4d Lymphatic Drainage 753
23.3f Blood Flow Through the Gastrointestinal Tract 692 25.5 Pulmonary Ventilation 756
23.3g Blood Flow Through the Posterior Abdominal Organs, 25.6 Mechanics of Breathing 757
Pelvis, and Perineum 695 25.6a Skeletal Muscles of Breathing 757
23.3h Blood Flow Through the Upper Limb 696 25.6b Volume Changes in the Thoracic Cavity 757
23.3i Blood Flow Through the Lower Limb 699 25.7 Innervation of the Respiratory System 758
23.4 Pulmonary Circulation 703 25.7a Ventilation Control by Respiratory Centers
23.5 Review of Heart, Systemic, and Pulmonary of the Brain 758
Circulation 703 25.8 Aging and the Respiratory System 761
23.6 Aging and the Cardiovascular System 704 25.9 Development of the
23.7 Blood Vessel Development 705 Respiratory System 764
23.7a Artery Development 705
23.7b Vein Development 705
23.7c Comparison of Fetal and Postnatal Circulation 706
Chapter 26
Digestive System 769
Chapter 24 26.1 General Structure and Functions
of the Digestive System 770
Lymphatic System 714 26.1a Digestive System
24.1 Functions of the Lymphatic Functions 770
System 715 26.2 Oral Cavity 771
24.2 Lymph and Lymphatic Vessels 716 26.2a Cheeks, Lips, and Palate 771
24.2a Lymphatic Capillaries 716 26.2b Tongue 772
24.2b Lymphatic Vessels 716 26.2c Salivary Glands 772
24.2c Lymphatic Trunks 717 26.2d Teeth 774
24.2d Lymphatic Ducts 717 26.3 Pharynx 776

26.4 General Arrangement of Abdominal GI Organs 776 27.3 Urinary Tract 817
26.4a Peritoneum, Peritoneal Cavity, and Mesentery 777 27.3a Ureters 817
26.4b General Histology of GI Organs 27.3b Urinary Bladder 819
(Esophagus to Large Intestine) 777 27.3c Urethra 821
26.4c Blood Vessels, Lymphoid Structures, and Nerve 27.3d Micturition 822
Supply 779 27.4 Aging and the Urinary System 823
26.5 Esophagus 780 27.5 Development of the Urinary System 824
26.5a Gross Anatomy 780 27.5a Kidney and Ureter Development 824
26.5b Histology 780 27.5b Urinary Bladder and Urethra Development 824
26.6 The Swallowing Process 781
26.7 Stomach 783
26.7a Gross Anatomy 783
Chapter 28
26.7b Histology 783 Reproductive System 830
26.7c Gastric Secretions 784 28.1 Comparison of the Female
26.8 Small Intestine 787 and Male Reproductive
26.8a Gross Anatomy and Regions 787 Systems 831
26.8b Histology 787 28.1a Perineum 831
26.9 Large Intestine 789 28.2 Anatomy of the Female Reproductive System 832
26.9a Gross Anatomy and Regions 789 28.2a Ovaries 832
26.9b Histology 790 28.2b Uterine Tubes 839
26.9c Control of Large Intestine Activity 793 28.2c Uterus 841
26.10 Accessory Digestive Organs 793 28.2d Vagina 843
26.10a Liver 793 28.2e External Genitalia 844
26.10b Gallbladder 796 28.2f Mammary Glands 845
26.10c Biliary Apparatus 796 28.3 Anatomy of the Male Reproductive System 849
26.10d Pancreas 797 28.3a Scrotum 849
26.11 Aging and the Digestive System 799 28.3b Spermatic Cord 851
26.12 Development of the Digestive System 799 28.3c Testes 851
26.12a Stomach, Duodenum, and Omenta Development 799 28.3d Ducts in the Male Reproductive System  854
26.12b Liver, Gallbladder, and Pancreas Development 799 28.3e Accessory Glands 855
26.12c Intestine Development 801 28.3f Semen 856
28.3g Penis 857
Chapter 27 28.4 Aging and the Reproductive Systems 858

28.5 Development of the Reproductive Systems 860
Urinary System 806 28.5a Genetic Versus Phenotypic Sex 860
27.1 General Structure and Functions 28.5b Formation of Indifferent Gonads
of the Urinary System 807 and Genital Ducts 860
27.2 Kidneys 809 28.5c Internal Genitalia Development 862
27.2a Gross and Sectional Anatomy 28.5d External Genitalia Development 862
of the Kidney 809
27.2b Blood Supply to the Kidney 810 Appendix A: Answers A-1
27.2c Innervation of the Kidney 812
27.2d Nephrons 812 Glossary G-1
27.2e Collecting Tubules and Collecting Ducts: How Tubular
Fluid Becomes Urine 816 Index I-1
27.2f Juxtaglomerular Apparatus 817
xi

Preface
What Makes
This Book Special?
H uman anatomy is a fascinating field with many layers of complexity.
The subject is difficult to teach, and students can often be over-
whelmed by its massive amount of material. Our goal in writing Human
Chapter 1 A First Look at Anatomy
■
■
New Clinical View 1.1: Clinicians’ Use of Scientific Method
New Clinical View 1.2: Etiology (Causes) and Pathogenesis
Anatomy was to create a textbook that guides students on a clearly written (Development) of Disease
and expertly illustrated beginner’s path through the human body. For all ■ Modified section 1.4e to clarify discussion of pelvic brim
six editions it has been of paramount importance to make this book enjoy- ■ Edited Clinical View 1.3: Medical Imaging Procedures
able to read, easy to understand, pedagogically efficient, and visually ■ Revised figures: 1.1a, 1.1b, 1.4, 1.5
engaging. The following pages highlight the enhancements we’ve made ■ Revised tables: 1.1, 1.4
to the sixth edition, as well as the hallmark features that define this book.
Chapter 2 The Cell: Basic Unit of Structure and Function
■ New Learning Strategy 2.2 on receptors and ligands
New to the Sixth Edition ■ Modified section 2.1b to clarify discussion of the general cell
New research findings, shifting terminology, technological advance- function of reproduction
ments, and the evolving needs of students and instructors in the class- ■ Edited Clinical View 2.3: Adrenoleukodystrophy (ALD) to
room require textbook authors to continually monitor and revise their include more recent treatment
content. Throughout the sixth edition, changes have been made to ■ Adapted Clinical View 2.5: Characteristics of Cancer Cells to
incorporate the latest information, update terminology, and improve include an image of a dividing cervical cancer cell
wording to make discussions easier for students to read and under- ■ Revised figures: 2.1, 2.5, 2.9–2.13, 2.15, 2.19, 2.20
stand. Highlights of these revisions are as follows. ■ Revised table 2.2
Chapter 3 Embryology
Global Changes ■ New Clinical View 3.7: Preterm (Premature) Birth
The Sixth Edition received some global changes to increase stu- ■ Revised Clinical View 3.6 to include information on both
dent understanding and success. Amniocentesis and Chorionic Villus Sampling
■ Additional Learning Strategies are added to each chapter, and ■ Edited Clinical View 3.5: Congenital Malformations
are consecutively numbered, for easier reference ■ Edited text in sections 3.2 (discussion of fertilization),
■ All major concepts are addressed by a measurable Learning 3.3 (clarified concept of capacitation), 3.4g (clarified peak
Objective development period)
■ Data from McGraw-Hill’s LearnSmart program was used to ■ Revised figures: 3.1, 3.3, 3.5, 3.6, 3.7
clarify and edit text in areas where students most need support ■ Revised tables: 3.2, 3.3, 3.4
■ What Did You Learn? questions are revised to be more Chapter 4 Tissue Level of Organization
challenging and provide more active learning experiences such ■ Revised Clinical View 4.1: Stem Cells
as drawing, preparing flowcharts, or making tables of concepts ■ Edited Clinical View 4.2: What Are You Planning to Do with
■ When possible, images or photos are added to most Clinical Your Baby’s Umbilical Cord?
Views and Learning Strategies ■ Modified Clinical View 4.4: Gangrene
■ Each End of Chapter section is extensively revised, including: ■ Edited Clinical View 4.5: Tissue Transplantation
• Challenge Yourself section now includes a prompt for students ■ Modified section 4.1a discussion on polarity to include apical
to actively write or type their answers in a separate document surface modifications
to reinforce learning before checking their answers ■ Adapted section 4.1f to change the discussion order of secretion
• Challenge Yourself questions are aligned to cover all chapter types
Learning Objectives ■ Edited section 4.4a to clarify use of terms involuntary and
• Multiple Choice and Content Review questions are edited to
autorhythmic
be more challenging and to review more global aspects ■ Revised figures: 4.1b, 4.2, 4.4, 4.7, 4.8
• All chapters now have three Developing Critical Reasoning ■ Revised tables: 4.1, 4.11, 4.13
questions
Chapter 5 Integumentary System
In addition to these changes, all chapters were thoroughly edited to
■ New Learning Strategy 5.2 and accompanying photo comparing
respond to reviewers’ comments and suggestions. Chapter-specific
dermal papillae and epidermal ridges to egg crate foam
changes are as follows:
xii

■ Edited section 5.1b on metabolic regulation ■ Edited tables 9.3–9.5 to ensure consistent discussion of
■ Revised section 5.2a description of stratum spinosum movement
■ Modified section 5.5 to clarify discussion of epidermal
derivatives Chapter 10 Muscle Tissue and Organization
■ Removed Clinical View 5.3 on dermatoglyphics, and ■ New Learning Strategy 10.1 on the connective tissue
incorporated selected information into the text components of muscle
■ Added new photos for selected Clinical View boxes ■ Expanded Learning Strategy 10.3 to include a figure
■ Clinical View 5.6: Treatments for Aging Skin is updated to ■ New Learning Strategy 10.4 on motor unit recruitment
include information about dermal fillers, with a new photo of a ■ Updated Clinical View 10.1: Tendonitis
Botox treatment ■ Enhanced Clinical View 10.3: Muscular Paralysis and
■ Revised figures: 5.3, 5.4, 5.9, 5.10 Neurotoxins with a figure
■ Revised tables: 5.3, 5.4 ■ Revised Clinical View 10.5: Anabolic Steroids and Other
Performance-Enhancing Compounds
Chapter 6 Cartilage and Bone ■ Updated Clinical View 10.6: Neuromuscular Diseases
■ Enhanced Clinical View 6.3: Achondroplastic Dwarfism with ■ Enhanced our discussion of levers in section 10.7 by adding
the inclusion of a photo text and a figure
■ Revised Clinical View 6.5: Bone Scans
■ Edited Clinical View 6.6: Osteoporosis Chapter 11 Axial Muscles
■ Revised figures: 6.4, 6.8, 6.9, 6.12, 6.13, 6.16 ■ Modified Learning Strategy 11.1
■ Extensively edited Clinical View 11.2: Strabismus, including
Chapter 7 Axial Skeleton new photos
■ Section 7.1 discussion of basal view of the skull edited ■ Edited section 11.15, figure 11.15, and table 11.12 to replace the
■ Clinical View 7.3: Spinal Curvature Abnormalities was adapted outdated reference to “urogenital diaphragm” with the names
to incorporate the terms hyperkyphosis and hyperlordosis to of the muscles composing this structure
describe abnormal curvatures ■ Revised figure 11.15
■ Modified Clinical View 7.4: Herniated Discs ■ Revised tables: 11.8, 11.10, 11.12
■ Revised figures: 7.7, 7.9, 7.15, 7.23
Chapter 12 Appendicular Muscles
Chapter 8 Appendicular Skeleton ■ Added photo to Clinical View 12.1: Paralysis of the Serratus
■ Adapted Clinical View 8.1: Fracture of the Clavicle to add an Anterior Muscle (“Winged Scapula”)
illustration ■ Removed Clinical View 12.5: Anatomic Snuffbox
■ Modified Clinical View 8.2: Colles Fracture to add an ■ Modified Clinical View 12.5: Thigh Muscle Injuries to include
illustration figure
■ Expanded Clinical View 8.4: Pott Fracture to include an ■ Expanded Clinical View 12.6: Plantar Fasciitis to include figure
illustration ■ Updated Clinical View 12.7: Shin Splints and Compartment
■ Revised figures: 8.2, 8.4, 8.9, 8.10, 8.11 Syndrome
■ Enhanced Learning Strategy 12.5 with a new figure
Chapter 9 Articulations ■ Edited section 12.1b to include discussion of short head of
■ New Learning Strategy 9.2 on gomphosis biceps brachii
■ New Learning Strategy 9.3 relating to the movements at ■ Updated terminology: actions versus functions of muscles;
selected joints intermuscular septum; radial and ulnar deviation
■ Edited Clinical Views 9.1–9.9 to be more concise; Clinical ■ Edited section 12.2c to note the variability of presence of
View 9.9: Arthritis contains updated treatment information; fibularis tertius
new photos are added to Clinical Views 9.1 and 9.6; several ■ Revised figures: 12.1, 12.2, 12.4, 12.5, 12.16
photos in other Clinical Views were replaced ■ Revised tables: 12.1, 12.2, 12.4, 12.6, 12.8
■ Removed previous Clinical View on Joint Replacement;
pertinent text is now included in section 9.6 (disease and aging Chapter 13 Surface Anatomy
of the joints) ■ New What Did You Learn? section at the end of section 13.1
■ Revised discussions in section 9.4a (general anatomy of ■ New Learning Strategy 13.2 to help distinguish the anterior
synovial joints) on cartilage, bursae throughout the body, and and lateral cervical regions of the neck
Hilton’s law with regard to innervation of joints ■ New Learning Strategy 13.3 to help students remember which
■ Edited discussion of glenohumeral joint in section 9.5b to side of the lower limb originates the small and great saphenous
emphasize that it is the muscles, not the ligaments, that provide veins
support to the joint ■ Modified section 13.2 to discuss six regions of the face
■ Expanded discussion of the elbow joint in section 9.5b to ■ Clinical View 13.1: Lip Color as a Diagnostic Tool includes a
include discussion on Tommy John surgery to emphasize the new photo
importance of the ulnar collateral ligament in this joint ■ Updated section 13.3 and figure 13.2 the discussion on the
■ Revised figures: 9.7, 9.11 regions of the neck, using the Terminologia Anatomica-
■ Edited table 9.2, figure 9.7, and the text to emphasize that approved terms anterior, lateral, and posterior cervical
hyperextension is a movement beyond the normal range of regions of the neck; the terms anterior triangle and posterior
motion triangle are replaced
xiii

■ Revised section 13.6d (foot) to clarify discussion on where to Chapter 16 Spinal Cord and Spinal Nerves
take the pulse of the dorsalis pedis artery ■ Significantly updated Clinical View 16.1: Lumbar Puncture
and Epidural Injection to include the similarities and
Chapter 14 Nervous Tissue differences between the two
■ New Learning Strategy 14.1 on functions of dendrites and ■ Updated terminology in Clinical View 16.2: Shingles (Herpes
axons Zoster)
■ New Learning Strategy 14.3 on myelin ■ Revised Clinical View 16.3: Brachial Plexus Injuries text, with
■ Significantly revised Clinical View 14.1: Neuroplasticity and an added figure
Neurogenesis, including differentiation between the CNS and ■ Enhanced Clinical View 16.4: Sacral Plexus Nerve Injuries
the PNS with a new figure
■ Enhanced Clinical View 14.2: Tumors of the Central Nervous ■ New Learning Strategy 16.3 distinguishes vertebral foramina
System with a new image from intervertebral foramina
■ Added new Clinical View 14.3: Nervous System Disorders ■ Expanded section 16.4g to include a paragraph on sural
Affecting Myelin nerves
■ Revised Clinical View 14.4: Treating Spinal Cord Injuries ■ Modified section 16.5b to change terminology from Golgi
■ Modified Clinical View 14.5: Amyotrophic Lateral Sclerosis tendon reflex to tendon reflex
■ Updated Clinical View 14.6: Neural Tube Defects ■ Revised figures: 16.2, 16.3; removed figure 16.4
■ Edited section 14.2a to update discussion on anaxonic neurons ■ Revised tables: 16.3, 16.4
■ Edited section 14.2b to include current information on
astrocyte function, and neuron-to-glial-cell ratios Chapter 17 Pathways and Integrative Functions
■ Edited section 14.6a ■ New Learning Strategy 17.1 distinguishes between a tract and a
■ Edited section 14.7 to use the term neuronal circuits instead of pathway
neuronal pools, and to clarify examples ■ Revised section 17.1 based on recent research on the sensory
■ Revised figures: 14.10, 4.12 homunculus
■ Revised tables: 14.1, 14.4 ■ New Learning Strategy 17.3 on location of sensory pathways
and their common primary neuron—posterior root ganglion
Chapter 15 Brain and Cranial Nerves
■ Clarified section 17.2a discussion of sensory pathways
■ Modified all Clinical Views, with new photos added when
■ New Learning Strategy 17.4 distinguishes medial pathway
appropriate from lateral pathway
■ Clarified section 15.2 regarding the meninges and the falx
■ Updated Clinical View 17.1: Cerebrovascular Accident to
cerebri include information about transient ischemic attacks
■ Retitled Clinical View 15.1 Meningitis and Encephalitis, and
■ Retitled Clinical View 17.2 as Epilepsy, Lobectomy, and
included information on both for comparison, as some people Hemispherectomies, with updated text
confuse the two ailments
■ Updated Clinical View 17.6: Alzheimer Disease: The “Long
■ New Learning Strategy 15.2 notes the cerebral lobes share the Goodbye”
same name as the skull bone that overlies each lobe
■ Revised figures: 17.9, 17.10, 17.12
■ Edited and updated Section 15.3b discussion of sensory
homunculus per medical neuroscience research to state there is Chapter 18 Autonomic Nervous System
extensive overlap of body regions in this structure (and thus it ■ New Learning Strategy 18.2 on functions of parasympathetic
is not as precise as the motor homunculus) versus sympathetic nervous system
■ Extensively updated Clinical View 15.5 to discuss functional ■ New Learning Strategy 18.3 on remembering splanchnic
brain regions and provide up-to-date information from the nerves
Human Connectome Project about updated brain maps. It ■ Added new Clinical View 18.1: Autonomic Nervous System
includes new photos from the Human Connectome Project. and Cardiovascular Disease
■ Removed section 15.3b and figure 15.11: discussion and ■ Enhanced Clinical View 18.2: Raynaud Syndrome with a new
portrayal of gnostic area, due to debate by neuroscientists figure
about this region’s borders and functions ■ Expanded Clinical View 8.4: Autonomic Dysreflexia expanded
■ Edited, clarified, and updated section 15.3d and table 15.5: to include bladder/bowel care in spinal cord injuries and a new
discussion on cerebral nuclei per latest neuroscience figure
research ■ Edited section 18.3 reference to the PNS decreasing force of
■ New Learning Strategy 15.3 to help the reader remember the contraction in the heart
functions of the superior and inferior colliculi ■ Revised section 18.5c on lack of ANS influence on skeletal
■ Revised section 15.5 (brainstem) muscle blood vessels, and to discuss the receptors for the ANS
■ Updated section 15.6 (cerebellum) to discuss additional non- ■ Revised figures: 18.1, 18.3, 18.4, 18.5, 18.7, 18.8, 18.9
motor functions of the cerebellum ■ Revised tables: 18.1, 18.2, 18.3, 18.4, 18.5
■ New Learning Strategy 15.4 on the cerebellar peduncle and
how it connects to the brainstem Chapter 19 Senses: General and Special
■ Revised section 15.7 (limbic system) to include information ■ Reordered and edited sections 19.3 and 19.4 to discuss olfaction
about neurogenesis in the hippocampus prior to gustation
■ Revised figures: 15.11, 15.13, 15.19, 15.20, 15.22 ■ Added photos to selected Learning Strategies
xiv

■ Clarified discussion in section 19.1a is edited on tonic vs. ■ Revised section 22.4b’s discussion on gap junctions and
phasic receptors desmosomes
■ Clarified text in section 19.2 contains clarified text on ■ Edited terminology from isovolumetric to isovolumic in section
encapsulated tactile receptors 22.6a and figure 22.14
■ New Learning Strategy 19.2 highlights similarities between ■ Revised figures: 22.1, 22.2, 22.5, 22.9, 22.14
olfactory and gustation receptors ■ Revised table 22.2
■ New Learning Strategy 19.3 helps to recall the differences
between rods and cones Chapter 23 Vessels and Circulation
■ New Learning Strategy 19.4 details that semicircular ducts ■ Modified and repositioned Learning Strategy 23.3 to before
detect angular movements of the head section 23.3a, where the named vessels are first discussed
■ New Clinical View 19.9: Are Earbuds Bad for Your Health? ■ Added examples to section 23.1 (anatomy of blood vessels)
■ Revised figures: 19.2, 19.5, 19.6 (previously 19.8), 19.11, 19.12, to illuminate the difference between arterial and venous
19.13, 19.14, 19.17, 19.26 anastomoses
■ Revised table 19.4 ■ Revised section 23.1a to explain the difference between arteries
and veins
Chapter 20 Endocrine System ■ Clarified section 23.1b regarding vasoconstriction of all artery
■ Enhanced Learning Strategy 20.1 with a new figure types to varying degrees
■ Updated Clinical View 20.1: Disorders of Growth Hormone ■ Edited the discussion of section 23.1c (capillaries) about
Secretion precapillary sphincters and capillary beds
■ Modified Clinical View 20.2: Hypophysectomy to include ■ Revised section 23.3 to include a new section on blood flow
figure through the spinal cord
■ Clinical View 20.3: Disorders of Thyroid Hormone Secretion ■ New Learning Strategy 23.5 helps recall where the great
includes updated photos saphenous vein is located
■ Edited section 20.3a to clarify the portal system and what it is ■ Rewrote and expanded section 23.6
in general before discussing the specific portal system ■ Revised figures: 23.4, 23.8
■ Reordered and edited section 20.3a discussion of mammotropic Chapter 24 Lymphatic System
cells and prolactin ■ Terminology is modified throughout the chapter: lymphoid
■ Edited section 20.9a to clarify renin secretion is used to reference organs, structures, and cells; lymphatic
■ Revised figures: 20.1, 20.6, 20.10, 20.12, 20.13, 20.14, 20.15; is used when referring to the system, vessels, ducts, trunks,
removed figure 20.13 capillaries, and movement of lymph
■ Revised tables: 20.1, 20.2, 20.3, 20.4, 20.6, 20.7, 20.8 ■ New Learning Strategy 24.1 on movement of lymph into
capillaries
Chapter 21 Blood ■ New Learning Strategy 24.3 on functions of different types of
■ Edited section 21.1b (functions of blood) to clarify discussion lymphocytes
on pH, and movement of fluid and nutrients ■ Edited section 24.2c and section 24.3a
■ Added new section 21.2b (other solutes in plasma) and ■ Replaced photos in several Clinical View boxes
expanded complement information in table 21.1 ■ Revised figures: 24.1, 24.5, 24.6, 24.7, 24.8, 24.10
■ Added new photos to selected Clinical Views
■ Modified Clinical View 21.2 to focus on anemia; includes a Chapter 25 Respiratory System
new photo ■ Edited/corrected the discussion in sections 25.1, 25.2 and 25.3,
■ New Clinical View 21.4: Whole Blood versus Plasma in table 25.2, and in selected figures to clarify the division
Donations between the upper and lower respiratory tracts, so the larynx is
■ Edited section 21.3b (leukocytes) and section 21.3c (platelets) included with discussion of the upper respiratory tract
■ Included the embryonic period in section 21.4 ■ Larynx (previously section 25.3a) moved to section 25.2d (so it
(hematopoiesis) is grouped with other upper respiratory tract structures)
■ Added discussion in section 21.4 about alternative models for ■ New photos added to Learning Strategies and Clinical Views,
hematopoiesis when appropriate
■ Revised figures: 21.7, 21.10 ■ In section 25.2b, more detail added regarding the function of
■ Revised table 21.1 the paranasal sinuses
■ Revised Clinical View 25.3 to focus on aspirated bodies
Chapter 22 Heart and the Heimlich maneuver; includes new photo of how to
■ New Learning Strategy 22.2 on coronary circulation perform the Heimlich maneuver; discussion of bronchoscopy
■ New Learning Strategy 22.4 on pressure and blood flow removed as this clinical procedure is no longer commonly
■ Enhanced Clinical View 22.1: Pericarditis with a new used
figure ■ Expanded section 25.3c (bronchial tree) to explain why less
■ Revised Clinical View 22.4: Angina Pectoris and Myocardial cartilage is needed in the bronchial tree compared to the
Infarction to include a figure trachea, and that bronchoconstriction and bronchodilation are
■ Edited section 22.1c to clarify the role of serous fluid in the controlled by the ANS
pericardial cavity ■ Modified sections 25.6a and 25.7a
■ Modified sections 22.2b and 22.2c for clarity ■ Revised figures: 25.1, 25.4, 25.7, 25.8, 25.9, 25.10
xv

Chapter 26 Digestive System ■ Updated terminology in section 27.2f (juxtaglomerular
■ New Learning Strategy 26.1 on mixing/segmentation apparatus) using granular cells to replace juxtaglomerular
■ Revised section 26.1a to employ the term segmentation cells
■ Edited section 26.2c to update secretion types in salivary ■ New Learning Strategy 27.6 on how to ID transitional
glands epithelium
■ Edited sections 26.4a and 26.4b ■ Edited section 27.3c discussion of external urethral sphincter to
■ Replaced photos in Clinical Views 26.2, 26.3, 26.4, 26.5, 26.6 remove reference to the outdated term urogenital diaphragm
■ Edited text in Clinical View 26.5: Gallstones (Cholelithiases) to ■ Revised figures: 27.7, 27.8, 27.10, 27.11
distinguish between cholelithiasis and choledocholithiasis
■ Enhanced Clinical View 26.8: Intestinal Disorders with a new Chapter 28 Reproductive System
figure ■ Added subheads to better organize ovarian cycle phase
■ Revised figures: 26.6, 26.11, 26.21 discussion
■ Updated section 28.2a for more current discussion of the
Chapter 27 Urinary System follicular phase
■ New Learning Strategy 27.1 on the main function of the ■ Edited section 28.2c for easier readability
kidneys ■ Updated Clinical View 28.1 to add a figure
■ New Learning Strategy 27.2 to help visualize the ■ Replaced photos in Clinical Views 28.2, 28.5
retroperitoneal nature of the kidneys ■ Updated Clinical View 28.2: Cervical Cancer with current
■ Edited section 27.2d (nephrons) and table 27.2 to clarify that information
nutrients normally are reabsorbed at the proximal convoluted ■ Added figures to Clinical View 28.3: Endometriosis, Clinical
tubule View 28.6: Benign Prostatic Hyperplasia and Prostate Cancer,
■ New Learning Strategy 27.4 uses the analogy of a conveyor and Clinical View 28.8: Sexually Transmitted Infections
belt to explain filtration, secretion, and reabsorption ■ Updated Clinical View 28.4: Contraception Methods
■ New Learning Strategy 27.5 to help recall that aldosterone ■ Modified Clinical View 28.5: Breast Cancer
helps us retain sodium ■ Revised figures: 28.4, 28.6, 28.11, 28.13, 28.16
xvi

Themes and Distinctive
Topic Approaches
T hrough our teaching experience, we have developed a few approach-
es that really seem to help students grasp certain topics or spark
their interest. Thus, we have tried to incorporate these successful ideas
contains beautiful photographs and clear, concise text as well
as numerous Clinical Views that illustrate the importance of
surface anatomy landmarks and how they are used daily in
from our own courses into our book. health care.
■ Nervous System. In order to understand the workings of the
■ Embryology. Learning about embryologic events can
nervous system, it is best to learn how the brain controls all
increase understanding of the adult anatomy. For this reason,
aspects of the nervous system. Thus, in this text we examine
chapter 3, Embryology, appears early in the book. In addition,
the brain first, followed by a chapter comparing its similarities,
“systems embryology” sections in each systems chapter (e.g.,
differences, and relationships to the spinal cord. It seemed
integumentary system, digestive system) provide a brief but
appropriate to use central nervous system terminology to
thorough overview of the developmental processes for that
describe the brain first and then the spinal cord. Additionally,
particular system.
because the nuclei of the cranial nerves are housed within the
■ Forensic Anthropology. Forensic examples are a great way
brain, we felt it made more sense to present the cranial nerves
to reinforce learning, and students enjoy the “real-life”
along with the brain.
application of anatomic knowledge in forensic analysis. The ■ Arteries and Veins. Arteries and veins are covered in unison
skeletal system chapters (6–9) feature discussions on topics
by region. For example, we present the arteries and veins of the
such as determining age of death by evaluating epiphyseal
upper limb together. This approach emphasizes to students that
plates and the pubic symphysis, and determining sex by
the arteries often have corresponding veins and that both are
noting differences in the skull and pelvis.
responsible for the blood flow in a general region.
■ Surface Anatomy. To best serve our audience, we have
dedicated a full chapter (13) to surface anatomy. This chapter
Veins of neck and superficial

head structures
Branches of common Branches of external Occipital vein
carotid artery carotid artery Superficial temporal vein
Superficial temporal artery Maxillary vein
Internal carotid artery Maxillary artery Major veins draining Posterior auricular vein
External carotid artery Posterior auricular artery head and neck Retromandibular vein
Occipital artery Vertebral vein Facial vein
Paired arteries to head and neck Facial artery External jugular vein Lingual vein
Thyrocervical trunk Lingual artery
Internal jugular
Ascending pharyngeal artery vein
Costocervical trunk Superior thyroid vein
Superior thyroid artery
Thyroid cartilage Right subclavian
Vertebral artery vein
Brachiocephalic artery
Common carotid artery Right brachiocephalic
Subclavian artery
vein
(a) Arteries, right lateral view (b) Veins, right lateral view
xvii

Accurate and Engaging
Illustrations
B ecause anatomy is a visual subject, quality illustrations are crucial
to understanding and retention. The brilliant illustrations in
Human Anatomy bring the study of anatomy to life! Drawn by a team of
coordinate with the text discussions. Human Anatomy also features a
beautiful collection of cadaver dissection images, bone photographs,
surface anatomy shots, and histology micrographs. These detailed
medical illustrators, all figures have been carefully rendered to convey images capture the intangible characteristics of human anatomy that
realistic, three-dimensional detail. Each drawing has been meticulously can only be conveyed in human specimens, and help familiarize
reviewed for accuracy and consistency, and precisely labeled to students with the appearance of structures they will encounter in lab.
View Orientation Anterior rami Color Coding

Reference diagrams Posterior divisions Many illustrations use color coding to organize
Anterior divisions
clarify the view or information and clarify concepts for visual learners.
plane an illustration
represents.
L1
Iliohypogastric nerve
L2 Ilioinguinal nerve
Ilioinguinal nerve Genitofemoral nerve

L3
Genitofemoral nerve Femoral nerve
L4
Lateral femoral Lateral femoral
cutaneous nerve cutaneous nerve
L5
Femoral nerve
Obturator nerve
Obturator nerve
Lumbosacral trunk
(a) Anterior view
Saphenous nerve
(continuation of
Subcostal nerve femoral nerve)
Multilevel
Ilioinguinal nerve Perspective
Illustrations
Lateral femoral depicting complex
cutaneous nerve
Genitofemoral nerve
structures connect
Obturator nerve macroscopic
and microscopic
views to show
the relationships
between
Femoral nerve
increasingly
detailed drawings.
(b) Right pelvic region, anterior view (c) Right lower limb, anterior view
(b) ©McGraw-Hill Education/Christine Eckel, photographer

xviii

Complementary Views
Drawings paired with photographs enhance
visualization of structures. Labels on art and photos
mirror each other whenever possible, making it easy to
correlate structures between views.
Pancreatic islet cells

Inferior Abdominal
vena cava aorta Spleen Alpha cell
Body of Beta cell

pancreas
Blood
Delta cell
capillary
Bile
duct F cell
Pancreatic
ducts
Tail of
pancreas Pancreatic
acinus
Alpha cell
Major Beta cell

duodenal
papilla Delta cell
F cell
Duodenum
of small
intestine
Head of
pancreas
Pancreatic islet
Diaphragm
Celiac trunk
Inferior
Spleen
vena cava
Liver (cut)
Pancreatic
Body of acini
Gallbladder pancreas
Head of
pancreas
LM 150x
Duodenum Abdominal Left Tail of

aorta kidney pancreas
(a) Anterior gross view (b) Microscopic view
(a) ©McGraw-Hill Education/Christina Eckel, photographer;

(b) ©McGraw-Hill Education/Alvin Telser, photographer
Cadaver Dissections Histology Micrographs

Expertly dissected specimens are preserved Light micrographs, as well as scanning and transmission
in richly colored photos that reveal electron micrographs, are used in conjunction with
incredible detail. Many unique views show illustrations to present a true picture of microscopic
relationships between anatomic structures anatomy. Magnifications provide a reference point for
from a new perspective. the sizes of the structures shown in the micrographs.
xix

Helpful Pedagogical Tools
H uman Anatomy is built around a pedagogical framework designed to
foster retention of facts and encourage the application of knowledge
that leads to understanding. The learning aids in this book help organize
studying, reinforce learning, and promote critical-thinking skills.
Learning Objectives
Numbered learning objectives at the
beginning of each section help focus attention
on critical information. Online question
banks are correlated with these objectives.
Chapter Outline 22.1 Overview of the Cardiovascular

Each chapter begins with an outline that provides
a quick snapshot of the chapter contents and
System
organization. Headings are numbered throughout ✓ Learning Objectives
the chapter for easy reference. 1. Identify and describe the basic features of the cardiovascular
system.
2. Describe and trace the general patterns of the pulmonary and
CARDIOVASCULAR SYSTEM systemic circulations.
3. Identify and describe the position and location of the heart.
Heart
22 4. Discuss the structure and function of the pericardium.
Outline
22.1 Overview of the Cardiovascular System
22.1a Pulmonary and Systemic Circulations
22.1b Position of the Heart
22.1c Characteristics of the Pericardium
22.2 Anatomy of the Heart
22.2a Heart Wall Structure
22.2b External Heart Anatomy
22.2c Internal Heart Anatomy: Chambers and Valves
22.3 Coronary Circulation
22.4 How the Heart Beats: Electrical Properties
of Cardiac Tissue
What Do You Think?
22.4a Characteristics of Cardiac Muscle Tissue
22.4b Contraction of Heart Muscle These critical thinking questions actively engage
22.4c The Heart’s Conducting System
22.5 Innervation of the Heart students in application or analysis of the chapter
22.6 Tying It All Together: The Cardiac Cycle
22.6a Steps in the Cardiac Cycle
22.6b Summary of Blood Flow During the Cardiac Cycle
material and encourage students to think more
22.7 Aging and the Heart globally about the content. Answers to What Do
22.8 Development of the Heart
You Think? questions are given at the end of
each chapter, allowing students to evaluate the
logic used to solve the problem.
W H AT D O YO U TH I N K ?
●
2 Have you ever noticed that most of the salt you buy in the
grocery store is labeled as “iodized”? Why is iodine added to
our salt?
MODULE 9: CARDIOVASCULAR SYSTEM
xx

blood only when an Rh negative individual is exposed to Rh positive
blood. This exposure to Rh positive blood most often occurs as a re- W H AT D I D YO U LE A R N ?
sult of an inappropriate blood transfusion. Therefore, individuals who
are Rh positive never exhibit anti-D antibodies, because they possess ●
5 Why does an erythrocyte lack cellular organelles, and how is
the Rh antigen on their erythrocytes. Only individuals who are Rh this related to its life span?
negative can exhibit anti-D antibodies, and that can occur only after ●
6 How do transferrin and ferritin participate in recycling
exposure to Rh antigens. erythrocyte components after the cells break down?
The ABO and Rh blood types are usually reported together. For ●
7 Should a person with blood type A donate blood to a person
example, types AB and Rh+ together are reported as AB+. However, with blood type AB? Why or why not?
Clinical View 21.3

Medical Stethoscope
Clinical View
Sometimes an example of what
Rh Incompatibility and Rh– Mother
can go wrong in the body helps
Pregnancy crystallize understanding of
1st pregnancy: Between pregnancies: 2nd pregnancy:
The potential presence of anti-D
antibodies is especially important in
Antigen D introduced to
mother’s blood
Anti-D antibodies produced
in the mother
Anti-D antibodies attack
+
Rh fetal erythrocytes the “norm.” Clinical Views
pregnant women who are Rh negative provide insights into health or
and have an Rh positive fetus. An Rh disease processes. These essays
incompatibility may result during Antigen D
the pregnancy if the mother has
Anti-D expand upon topics covered in
antibody
previously been exposed to Rh posi- the text and provide relevant
tive blood (such as can occur with a background information for
previously carried Rh positive fetus, Placenta students pursuing health-related
typically at the time of childbirth). As
a result of the prior exposure, the careers.
mother has anti-D antibodies that
may cross the placenta and destroy
the fetal erythrocytes, resulting in 1st Rh+ 2nd Rh+
severe illness or death. The illness fetus fetus
that occurs in the newborn is called

hemolytic disease of the newborn
(HDN), or erythroblastosis fetalis. Mother Rh Blood Types Fetus Rh Blood Types
The newborn typically presents

Pregnancy #1 Pregnancy #2 Pregnancy #1 Pregnancy #2
with anemia and hyperbilirubinemia
(increased bilirubin in the blood)
due to erythrocyte destruction. In Blood type Rh negative Rh negative Rh positive Rh positive
severe cases, the infant may devel-
op heart failure and must be given a No antigen D No antigen D Antigen D Antigen D
blood transfusion to survive.
Giving a pregnant Rh negative
Erythrocytes
woman special immunoglobulins
(e.g., RhoGAM) between weeks
28–32 of her pregnancy and at birth
prevents the mother from develop- No anti-D antibodies Anti-D antibodies No anti-D antibodies No anti-D antibodies
(due to prior
ing anti-D anitbodies. Specifically, exposure) Anti-D antibodies
from mother cross
these immunoglobulins bind to fetal Plasma placenta and attack
erythrocyte surface antigens—and fetal erythrocytes
causing hemolytic
in so doing, prevent the mother’s disease of the newborn
immune system from recognizing
Rh antigens and being stimulated to
produce anti-D antibodies. Hemolytic disease of the newborn.
Chapter Twenty-One Blood 635
In contrast to the ABO blood group, where antibodies may be remember that ABO and Rh blood types are independent of each What Did You Learn?
found in the blood even without prior exposure to a foreign antigen, other, and neither of them interacts with or influences the presence Review questions at the end of
antibodies to the Rh factor termed anti-D antibodies appear in the or activities of the other group.
blood only when an Rh negative individual is exposed to Rh positive
each section prompt students
blood. This exposure to Rh positive blood most often occurs as a re- W H AT D I D YO U LE A R N ?
to test their comprehension of
sult of an inappropriate blood transfusion. Therefore, individuals who key concepts. These mini self-
are Rh positive never exhibit anti-D antibodies, because they possess ●
5 Why does an erythrocyte lack cellular organelles, and how is
the Rh antigen on their erythrocytes. Only individuals who are Rh this related to its life span? tests help students determine
negative can exhibit anti-D antibodies, and that can occur only after ●
6 How do transferrin and ferritin participate in recycling whether they have a sufficient
exposure to Rh antigens. erythrocyte components after the cells break down?
grasp of the information
The ABO and Rh blood types are usually reported together. For ●
7 Should a person with blood type A donate blood to a person
example, types AB and Rh+ together are reported as AB+. However, with blood type AB? Why or why not? before moving on to the next
section of the chapter.
Clinical View 21.3

Medical Stethoscope
Learning
Rh Incompatibility andStrategy 14.3 Rh Mother –
PregnancyRecall from Section 2.3a: “Composition and Structure of Membranes” that the
1st pregnancy: Between pregnancies: 2nd pregnancy:
The potential plasma
presence
antibodies is especially
membrane
of anti-Dis composed ofDlipids
Antigen and proteins.
introduced
mother’s blood
to Similar
Anti-Dto flattening
antibodies and
produced
in the mother
Learning Strategy
Anti-D antibodies attack
Rh+ fetal erythrocytes
rolling upimportant
a tube of in toothpaste to get the toothpaste out, the myelinating cell
pregnant women who are Rh negative Many anatomy instructors provide students
(neurolemmocyte or oligodendrocyte) is flattened and rolled up, leaving only
and have an Rh positive fetus. An Rh with everyday analogies, mnemonics, and
incompatibilitythe lipid
may bilayers
result of plasma membrane,
during which
Antigen D make the myelin.
other useful tips to help them understand and
Anti-D
the pregnancy if the mother has
previously been exposed to Rh posi-
antibody
remember the information. Learning Strategy
tive blood (such as can occur with a boxes throughout each chapter offer tried-
previously carried Rh positive fetus, Placenta and-tested practical learning strategies that
typically at the time of childbirth). As
a result of the prior exposure, the
students can apply as they read. These tips are
mother has anti-D antibodies that not just useful—they can also be fun!
may cross the placenta and destroy
the fetal erythrocytes, resulting in 1st Rh+ 2nd Rh+
Lawrence Manning/Getty Imagesfetus fetus
severe illness or death. The illness
that occurs in the newborn is called
xxi
hemolytic disease of the newborn
(HDN), or erythroblastosis fetalis. Mother Rh Blood Types Fetus Rh Blood Types
The newborn typically presents

Pregnancy #1 Pregnancy #2 Pregnancy #1 Pregnancy #2
with anemia and hyperbilirubinemia
(increased bilirubin in the blood)
mck51357_fm_i-xxx.indd 21 due to erythrocyte destruction. In Blood type Rh negative Rh negative Rh positive Rh positive 12/3/19 6:37 PM
End-of-Chapter Tools
710 Chapter Twenty-Three Vessels and Circulation
A carefully devised set of learning aids at the end of each chapter
helps students review the chapter content, evaluate their grasp of
key concepts, and utilize what they have learned. Reading the chapter
Clinical Terms
edema Noticeable swelling from fluid accumulation in body tissues. heard when the cuff pressure equals the systolic pressure and summary and completing the Challenge Yourself exercises is a great
Edema most commonly occurs in the feet and legs, where it is cease to be heard once the cuff has deflated past the diastolic
referred to as peripheral edema.
Korotkoff (kŏ-rot′kŏf) sounds Distinctive sounds heard through a
pressure.
vasculitis (vas-kyū-lī′tis) Inflammation of any type of blood vessel. If
way to assess learning.
stethoscope when taking a blood pressure reading, resulting only arteries are inflamed, the condition is called arteritis; if
from blood turbulence in the artery. The sounds are first only veins are inflamed, it is called phlebitis.
Chapter Summary Chapter Summary Tables

■ Blood vessels form a closed supply system to transport oxygen and nutrients to body tissues, and remove waste products from these
tissues.
Chapter summaries are presented in
23.1 Anatomy of
Blood Vessels
■ Arteries conduct blood away from the heart; capillaries exchange gases, nutrients, and wastes with body tissues; and veins conduct
blood to the heart.
a concise, bulleted table format that
23.1a Blood Vessel Tunics
■ The tunica intima (innermost layer) is composed of an endothelium, a basement membrane, and a layer of areolar connective
provides a basic overview of each
■
tissue. It also may contain an internal elastic lamina.
The tunica media (middle layer) is composed of smooth muscle and also may have an external elastic lamina. This is the largest chapter. Section and page references
tunic in an artery.
■ The tunica externa (outermost layer) is composed of areolar connective tissue and adipose connective tissue. This is the largest
tunic in a vein.
make it easy to look up topics for review.
■ Capillaries have a tunica intima, composed of an endothelial layer and a basement membrane only.
23.1b Arteries
■ Elastic arteries have the largest diameter and the greatest proportion of elastic fibers in their walls.
■ Muscular arteries are medium-sized arteries with more smooth muscle and fewer elastic fibers to ensure vasodilation and
vasoconstriction.
■ Arterioles are the smallest arteries.
23.1c Capillaries
■ Capillaries, the smallest blood vessels, connect arterioles with venules. Gas and nutrient exchange occurs in the capillaries.
■ The three types of capillaries are continuous capillaries, fenestrated capillaries, and sinusoids.
23.1d Veins
■ Venules are small veins that merge into larger veins. Blood pressure is low in the veins, which act as reservoirs and hold about 60%
of the body’s blood at rest.
■ One-way valves prevent blood backflow in veins. 712 Chapter Twenty-Three Vessels and Circulation
23.2 Blood Pressure ■ Blood pressure is the force exerted by the blood on the vessel wall. Systolic blood pressure is a measure of pressure during
Challenge Yourself
ventricular contraction, and diastolic pressure is a measure of pressure during ventricular relaxation.
23.3 Systemic
Circulation
■
23.3a General Arterial Flow Out of the Heart

Challenge Yourself
The systemic circulation conducts oxygenated blood to and deoxygenated blood from peripheral capillary beds.
■ Actively
The ascending aorta gives off the left and right coronary write
arteries or type
to supply the your
heart. answers in a separate document to reinforce your learning, before checking your answers. This battery of matching, multiple-
■ The aortic arch has three branches: the brachiocephalic trunk, the left common carotid artery, and the left subclavian artery.
■ Multiple
The descending thoracic aorta extends several branches Choice
to supply the thoracic wall. 9. The left fourth aortic arch vessel in an embryo becomes which
structure?
choice, short answer, and critical-
■ Select the
The descending abdominal aorta bifurcates into common best
iliac answer
arteries; from
these the four
vessels choices
divide provided.
into internal and external iliac
arteries.
1. Which vessel type consists of a tunica intima with large gaps
a. left common carotid artery
b. left subclavian artery
thinking questions is designed to test
23.3b General Venous Return to the Heart between the endothelial cells, and a discontinuous basement c. aortic arch
■ Deoxygenated blood returns to the heart via the superior membrane?
and inferior venae cavae.
a. continuous
d. left pulmonary artery students on all levels of learning,
10. Vasa vasorum are found in which tunic of a large blood vessel?
b. arteriole
c. sinusoid a. intima from basic comprehension to
b. media
2.
d. fenestrated
Some venous blood from the lower limb drains through which
c. externa
d. intermedia
synthesis of concepts.
of the following veins?
a. great saphenous vein Content Review
b. basilic vein
c. external jugular vein 1. What are the respiratory and skeletal muscular pumps,
d. median cubital vein and how do they assist in the return of venous blood to
the heart?
3. Which of the following vessels supplies the stomach wall and is
not a direct branch of the celiac trunk? 2. Compare and contrast arteries and veins with respect to
a. splenic artery function, tunic size, and lumen size.
b. right gastric artery 3. Trace the path of blood flow from the left ventricle of the heart to
c. left gastric artery the right atrium of the heart. List the types of vessels (e.g., elastic
d. common hepatic artery arteries, arterioles) the blood travels through, and identify the type
4. Which type of vessel has a large number of smooth muscle cell of blood vessel in which gas and nutrient exchange occur.
layers in its tunica media as well as elastic tissue confined to an 4. What is the main function of capillaries? What are the three
internal elastic lamina and external elastic lamina? kinds of capillaries?
a. elastic artery 5. Is blood pressure higher in arteries or veins? What are the
b. muscular artery consequences of hypertension?
c. arteriole 6. Identify the three main branches of the aortic arch that receive
d. venule oxygenated blood, and identify the areas of the body they supply.
5. Which statement is true about veins? 7. How is blood flow through the upper and lower limbs similar?
a. Veins always transport deoxygenated blood.
b. Veins drain into smaller vessels called venules. 8. Compare the systemic and pulmonary circulations. Discuss the
c. The largest tunic in a vein is the tunica externa. function of arteries and veins in each system.
9. How does aging affect blood vessel anatomy and function?
Answers to What
d. The lumen of a vein tends to be smaller than that of a
comparably sized artery. 10. What postnatal changes occur in the heart and blood vessels?
6. Which of the following is the pathway that blood follows Why do these occur?
through the upper limb arteries?
a. subclavian → axillary → ulnar → radial Developing Critical Reasoning Do You Think?
→ brachial
b. subclavian → axillary → brachial → cephalic
1. Two 50-year-old men are trying to determine their risk
for developing atherosclerosis. John jogs three times a The What Do You Think?
→ basilic week, maintains a healthy weight, and eats a diet low in
c. subclavian → ulnar → brachial → radial
d. subclavian → axillary → brachial → radial and ulnar
saturated fats. Thomas rarely exercises, is overweight, questions are answered at
and only occasionally eats healthy meals. Based on your
7. Which of the following veins typically does not drain directly
into the inferior vena cava?
knowledge of the cardiovascular system and atherosclerosis,
which man do you think is more at risk for developing the
the end of each chapter.
a. renal disease? What other factors could put a person at risk for
b. hepatic portal atherosclerosis?
c. common iliac 2. Arteries tend to have a lot of vascular anastomoses around body
d. right gonadal joints (such as the elbow and knee). Propose a reason why this
8. After birth, the umbilical vein becomes which structure? would be beneficial.
a. medial umbilical ligament 3. The internal thoracic artery is frequently used as a coronary
b. ligamentum venosum bypass vessel (a replacement artery for a blocked coronary
c. ligamentum arteriosum artery). What makes this vessel a good choice for this Chapter Twenty-Three Vessels and Circulation 713
d. round ligament of the liver surgery? Will blood flow to the thoracic wall be compromised
as a result? Why or why not?
Answers to “What Do You Think?”

1. A smoker would have elevated blood pressure, because nicotine 3. If the left ulnar artery were cut, the left hand and fingers could
increases cardiac output and causes vasoconstriction. still receive blood via the left radial artery.
2. Blood could still reach the brain through the vertebral arteries. 4. If the right femoral artery were blocked, blood flow to the right
However, it is unlikely that these arteries could provide leg would be cut off; in other words, the popliteal artery and
sufficient blood to the entire brain and head. the branches to the leg would not receive any blood.
xxii

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xxiii

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xxv

Another random document with
no related content on Scribd:
The Project Gutenberg eBook of Elmer Gantry
This ebook is for the use of anyone anywhere in the United
States and most other parts of the world at no cost and with
almost no restrictions whatsoever. You may copy it, give it away
or re-use it under the terms of the Project Gutenberg License
included with this ebook or online at www.gutenberg.org. If you
are not located in the United States, you will have to check the
laws of the country where you are located before using this
eBook.
Title: Elmer Gantry
Author: Sinclair Lewis
Release date: January 3, 2024 [eBook #72609]
Language: English
Original publication: New York: Harcourt, Brace and Company,

1927
Credits: Al Haines, Mark Akrigg, Cindy Beyer & the online

Distributed Proofreaders Canada team at
http://www.pgdpcanada.net
*** START OF THE PROJECT GUTENBERG EBOOK ELMER

GANTRY ***
ELMER GANTRY
BY
SINCLAIR LEWIS
NEW YORK
H A R C O U R T, B R A C E A N D C O M P A N Y
C O P Y R I G H T, 1 9 2 7 , B Y
H A R C O U R T, B R A C E A N D C O M P A N Y, I N C .
Fourteenth printing, September, 1928

PRINTED IN THE U. S. A. BY
QUINN & BODEN COMPANY, INC,
RAHWAY, N. J.
To
H. L. MENCKEN
with profound admiration
No character in this book
is the portrait of any actual
person.
S. L.
E L M E R G A N T R Y
CHAPTER I
I
elmer gantry was drunk. He was eloquently drunk, lovingly and
pugnaciously drunk. He leaned against the bar of the Old Home
Sample Room, the most gilded and urbane saloon in Cato, Missouri,
and requested the bartender to join him in “The Good Old Summer
Time,” the waltz of the day.
Blowing on a glass, polishing it and glancing at Elmer through its
flashing rotundity, the bartender remarked that he wasn’t much of a
hand at this here singing business. But he smiled. No bartender
could have done other than smile on Elmer, so inspired and full of
gallantry and hell-raising was he, and so dominating was his beefy
grin.
“All right, old socks,” agreed Elmer. “Me and my roommate’ll
show you some singing as is singing! Meet roommate. Jim Lefferts.
Bes’ roommate in world. Wouldn’t live with him if wasn’t! Bes’
quarterback in Milwest. Meet roommate.”
The bartender again met Mr. Lefferts, with protestations of
distinguished pleasure.
Elmer and Jim Lefferts retired to a table to nourish the long, rich,
chocolate strains suitable to drunken melody. Actually, they sang
very well. Jim had a resolute tenor, and as to Elmer Gantry, even
more than his bulk, his thick black hair, his venturesome black eyes,
you remembered that arousing barytone. He was born to be a
senator. He never said anything important, and he always said it
sonorously. He could make “Good morning” seem profound as Kant,
welcoming as a brass band, and uplifting as a cathedral organ. It
was a ’cello, his voice, and in the enchantment of it you did not hear
his slang, his boasting, his smut, and the dreadful violence which (at
this period) he performed on singulars and plurals.
Luxuriously as a wayfarer drinking cool beer they caressed the
phrases in linked sweetness long drawn out:
Strolling through the shaaaaady lanes, with your baby-mine,
You hold her hand and she holds yours, and that’s a very good
sign
That she’s your tootsey-wootsey in the good old summer time.
Elmer wept a little, and blubbered, “Lez go out and start a scrap.
You’re lil squirt, Jim. You get somebody to pick on you, and I’ll come
along and knock his block off. I’ll show ’em!” His voice flared up. He
was furious at the wrong about to be suffered. He arched his paws
with longing to grasp the non-existent scoundrel. “By God, I’ll knock
the tar out of um! Nobody can touch my roommate! Know who I am?
Elmer Gantry! Thash me! I’ll show um!”
The bartender was shuffling toward them, amiably ready for
homicide.
“Shut up, Hell-cat. What you need is ’nother drink. I’ll get ’nother
drink,” soothed Jim, and Elmer slid into tears, weeping over the
ancient tragic sorrows of one whom he remembered as Jim Lefferts.
Instantly, by some tricky sort of magic, there were two glasses in
front of him. He tasted one, and murmured foolishly, “ ’Scuse me.” It
was the chaser, the water. But they couldn’t fool him! The whisky
would certainly be in that other lil sawed-off glass. And it was. He
was right, as always. With a smirk of self-admiration he sucked in the
raw Bourbon. It tickled his throat and made him feel powerful, and at
peace with every one save that fellow—he could not recall who, but
it was some one whom he would shortly chastise, and after that float
into an Elysium of benevolence.
The barroom was deliriously calming. The sour invigorating
stench of beer made him feel healthy. The bar was one long
shimmer of beauty—glowing mahogany, exquisite marble rail,
dazzling glasses, curiously shaped bottles of unknown liqueurs, piled
with a craftiness which made him very happy. The light was dim,
completely soothing, coming through fantastic windows such as are
found only in churches, saloons, jewelry shops, and other retreats
from reality. On the brown plaster walls were sleek naked girls.
He turned from them. He was empty now of desire for women.
“That damn’ Juanita. Jus’ wants to get all she can out of you.
That’s all,” he grumbled.
But there was an interesting affair beside him. A piece of
newspaper sprang up, apparently by itself, and slid along the floor.
That was a very funny incident, and he laughed greatly.
He was conscious of a voice which he had been hearing for
centuries, echoing from a distant point of light and flashing through
ever-widening corridors of a dream.
“We’ll get kicked out of here, Hell-cat. Come on!”
He floated up. It was exquisite. His legs moved by themselves,
without effort. They did a comic thing once—they got twisted and the
right leg leaped in front of the left when, so far as he could make out,
it should have been behind. He laughed, and rested against some
one’s arm, an arm with no body attached to it, which had come out of
the Ewigkeit to assist him.
Then unknown invisible blocks, miles of them, his head clearing,
and he made grave announcement to a Jim Lefferts who suddenly
seemed to be with him:
“I gotta lick that fellow.”
“All right, all right. You might as well go find a nice little fight and
get it out of your system!”
Elmer was astonished; he was grieved. His mouth hung open
and he drooled with sorrow. But still, he was to be allowed one
charming fight, and he revived as he staggered industriously in
search of it.
Oh, he exulted, it was a great party. For the first time in weeks he
was relieved from the boredom of Terwillinger College.
II
Elmer Gantry, best known to classmates as Hell-cat, had, this
autumn of 1902, been football captain and led the best team
Terwillinger College had known in ten years. They had won the
championship of the East-middle Kansas Conference, which
consisted of ten denominational colleges, all of them with buildings
and presidents and chapel services and yells and colors and a
standard of scholarship equal to the best high-schools. But since the
last night of the football season, with the glorious bonfire in which the
young gentlemen had burned up nine tar barrels, the sign of the Jew
tailor, and the president’s tabby-cat, Elmer had been tortured by
boredom.
He regarded basket-ball and gymnasium antics as light-minded
for a football gladiator. When he had come to college, he had
supposed he would pick up learnings of cash-value to a lawyer or
doctor or insurance man—he had not known which he would
become, and in his senior year, aged twenty-two this November, he
still was doubtful. But this belief he found fallacious. What good
would it be in the courtroom, or at the operating table, to understand
trigonometry, or to know (as last spring, up to the examination on
European History, he remembered having known) the date of
Charlemagne? How much cash would it bring in to quote all that stuff
—what the dickens was it now?—all that rot about “The world is too
much around us, early and soon” from that old fool Wordsworth?
Punk, that’s what it was. Better be out in business. But still, if his
mother claimed she was doing so well with her millinery business
and wanted him to be a college graduate, he’d stick by it. Lot easier
than pitching hay or carrying two-by-fours anyway.
Despite his invaluable voice, Elmer had not gone out for
debating, because of the irritating library-grinding, nor had he taken
to prayer and moral eloquence in the Y. M. C. A., for with all the force
of his simple and valiant nature he detested piety and admired
drunkenness and profanity.
Once or twice in the class in Public Speaking, when he had
repeated the splendors of other great thinkers, Dan’l Webster and
Henry Ward Beecher and Chauncey M. Depew, he had known the
intoxication of holding an audience with his voice as with his closed
hand, holding it, shaking it, lifting it. The debating set urged him to
join them, but they were rabbit-faced and spectacled young men,
and he viewed as obscene the notion of digging statistics about
immigration and the products of San Domingo out of dusty spotted
books in the dusty spotted library.
He kept from flunking only because Jim Lefferts drove him to his
books.
Jim was less bored by college. He had a relish for the flavor of
scholarship. He liked to know things about people dead these
thousand years, and he liked doing canned miracles in chemistry.
Elmer was astounded that so capable a drinker, a man so deft at
“handing a girl a swell spiel and getting her going” should find
entertainment in Roman chariots and the unenterprising amours of
sweet-peas. But himself—no. Not on your life. He’d get out and finish
law school and never open another book—kid the juries along and
hire some old coot to do the briefs.
To keep him from absolutely breaking under the burden of
hearing the professors squeak, he did have the joy of loafing with
Jim, illegally smoking the while; he did have researches into the
lovability of co-eds and the baker’s daughter; he did revere
becoming drunk and world-striding. But he could not afford liquor
very often and the co-eds were mostly ugly and earnest.
It was lamentable to see this broad young man, who would have
been so happy in the prize-ring, the fish-market, or the stock
exchange, poking through the cobwebbed corridors of Terwillinger.
III
Terwillinger College, founded and preserved by the more zealous
Baptists, is on the outskirts of Gritzmacher Springs, Kansas. (The
springs have dried up and the Gritzmachers have gone to Los
Angeles, to sell bungalows and delicatessen.) It huddles on the
prairie, which is storm-racked in winter, frying and dusty in summer,
lovely only in the grass-rustling spring or drowsy autumn.
You would not be likely to mistake Terwillinger College for an Old
Folks’ Home, because on the campus is a large rock painted with
class numerals.
Most of the faculty are ex-ministers.
There is a men’s dormitory, but Elmer Gantry and Jim Lefferts
lived together in the town, in a mansion once the pride of the
Gritzmachers themselves: a square brick bulk with a white cupola.
Their room was unchanged from the days of the original August
Gritzmacher; a room heavy with a vast bed of carved black walnut,
thick and perpetually dusty brocade curtains, and black walnut chairs
hung with scarves that dangled gilt balls. The windows were hard to
open. There was about the place the anxious propriety and all the
dead hopes of a secondhand furniture shop.
In this museum, Jim had a surprising and vigorous youthfulness.
There was a hint of future flabbiness in Elmer’s bulk, but there would
never be anything flabby about Jim Lefferts. He was slim, six inches
shorter than Elmer, but hard as ivory and as sleek. Though he came
from a prairie village, Jim had fastidiousness, a natural elegance. All
the items of his wardrobe, the “ordinary suit,” distinctly glossy at the
elbows, and the dark-brown “best suit,” were ready-made, with
faltering buttons, and seams that betrayed rough ends of thread, but
on him they were graceful. You felt that he would belong to any set in
the world which he sufficiently admired. There was a romantic flare
to his upturned overcoat collar; the darned bottoms of his trousers
did not suggest poverty but a careless and amused ease; and his
thoroughly commonplace ties hinted of clubs and regiments.
His thin face was resolute. You saw only its youthful freshness
first, then behind the brightness a taut determination, and his brown
eyes were amiably scornful.
Jim Lefferts was Elmer’s only friend; the only authentic friend he
had ever had.
Though Elmer was the athletic idol of the college, though his
occult passion, his heavy good looks, caused the college girls to
breathe quickly, though his manly laughter was as fetching as his
resonant speech, Elmer was never really liked. He was supposed to
be the most popular man in college; every one believed that every
one else adored him; and none of them wanted to be with him. They
were all a bit afraid, a bit uncomfortable, and more than a bit
resentful.
It was not merely that he was a shouter, a pounder on backs, an
overwhelming force, so that there was never any refuge of intimacy
with him. It was because he was always demanding. Except with his
widow mother, whom he vaguely worshiped, and with Jim Lefferts,
Elmer assumed that he was the center of the universe and that the
rest of the system was valuable only as it afforded him help and
pleasure.
He wanted everything.
His first year, as the only Freshman who was playing on the
college football team, as a large and smiling man who was expected
to become a favorite, he was elected president. In that office, he was
not much beloved. At class-meetings he cut speakers short, gave
the floor only to pretty girls and lads who toadied to him, and roared
in the midst of the weightiest debates, “Aw, come on, cut out this
chewing the rag and let’s get down to business!” He collected the
class-fund by demanding subscriptions as arbitrarily as a Catholic
priest assessing his parishioners for a new church.
“He’ll never hold any office again, not if I can help it!” muttered
one Eddie Fislinger, who, though he was a meager and rusty-haired
youth with protruding teeth and an uneasy titter, had attained power
in the class by always being present at everything, and by the piety
and impressive intimacy of his prayers in the Y. M. C. A.
There was a custom that the manager of the Athletic Association
should not be a member of any team. Elmer forced himself into the
managership in Junior year by threatening not to play football if he
were not elected. He appointed Jim Lefferts chairman of the ticket
committee, and between them, by only the very slightest doctoring of
the books, they turned forty dollars to the best of all possible uses.
At the beginning of Senior year, Elmer announced that he desired
to be president again. To elect any one as class-president twice was
taboo. The ardent Eddie Fislinger, now president of the Y. M. C. A.
and ready to bring his rare talents to the Baptist ministry, asserted
after an enjoyable private prayer-meeting in his room that he was
going to face Elmer and forbid him to run.
“Gwan! You don’t dare!” observed a Judas who three minutes
before had been wrestling with God under Eddie’s coaching.
“I don’t, eh? Watch me! Why, everybody hates him, the darn’
hog!” squeaked Eddie.
By scurrying behind trees he managed to come face to face with
Elmer on the campus. He halted, and spoke of football, quantitative
chemistry, and the Arkansas spinster who taught German.
Elmer grunted.
Desperately, his voice shrill with desire to change the world,
Eddie stammered:
“Say—say, Hell-cat, you hadn’t ought to run for president again.
Nobody’s ever president twice!”
“Somebody’s going to be.”
“Ah, gee, Elmer, don’t run for it. Ah, come on. Course all the
fellows are crazy about you but— Nobody’s ever been president
twice. They’ll vote against you.”
“Let me catch ’em at it!”
“How can you stop it? Honest, Elm—Hell-cat—I’m just speaking
for your own good. The voting’s secret. You can’t tell—”
“Huh! The nominations ain’t secret! Now you go roll your hoop,
Fissy, and let all the yellow coyotes know that anybody that
nominates anybody except Uncle Hell-cat will catch it right where the
chicken caught the ax. See? And if they tell me they didn’t know
about this, you’ll get merry Hail Columbia for not telling ’em. Get me?
If there’s anything but an unanimous vote, you won’t do any praying
the rest of this year!”
Eddie remembered how Elmer and Jim had shown a Freshman
his place in society by removing all his clothes and leaving him five
miles in the country.
Elmer was elected president of the senior class—unanimously.
He did not know that he was unpopular. He reasoned that men
who seemed chilly to him were envious and afraid, and that gave
him a feeling of greatness.
Thus it happened that he had no friend save Jim Lefferts.
Only Jim had enough will to bully him into obedient admiration.
Elmer swallowed ideas whole; he was a maelstrom of prejudices; but
Jim accurately examined every notion that came to him. Jim was
selfish enough, but it was with the selfishness of a man who thinks
and who is coldly unafraid of any destination to which his thoughts
may lead him. The little man treated Elmer like a large damp dog,
and Elmer licked his shoes and followed.
He also knew that Jim, as quarter, was far more the soul of the
team than himself as tackle and captain.
A huge young man, Elmer Gantry; six foot one, thick, broad, big
handed; a large face, handsome as a Great Dane is handsome, and
a swirl of black hair, worn rather long. His eyes were friendly, his
smile was friendly—oh, he was always friendly enough; he was
merely astonished when he found that you did not understand his
importance and did not want to hand over anything he might desire.
He was a barytone solo turned into portly flesh; he was a gladiator
laughing at the comic distortion of his wounded opponent.
He could not understand men who shrank from blood, who liked
poetry or roses, who did not casually endeavor to seduce every
possibly seducible girl. In sonorous arguments with Jim he asserted
that “these fellows that study all the time are just letting on like
they’re so doggone high and mighty, to show off to these doggone
profs that haven’t got anything but lemonade in their veins.”
IV
Chief adornment of their room was the escritoire of the first
Gritzmacher, which held their library. Elmer owned two volumes of
Conan Doyle, one of E. P. Roe, and a priceless copy of “Only a Boy.”
Jim had invested in an encyclopedia which explained any known
subject in ten lines, in a “Pickwick Papers,” and from some unknown
source he had obtained a complete Swinburne, into which he was
never known to have looked.
But his pride was in the possession of Ingersoll’s “Some Mistakes
of Moses,” and Paine’s “The Age of Reason.” For Jim Lefferts was
the college freethinker, the only man in Terwillinger who doubted that
Lot’s wife had been changed into salt for once looking back at the
town where, among the young married set, she had had so good a
time; who doubted that Methuselah lived to nine hundred and sixty-
nine.
They whispered of Jim all through the pious dens of Terwillinger.
Elmer himself was frightened, for after giving minutes and minutes to
theological profundities Elmer had concluded that “there must be
something to all this religious guff if all these wise old birds believe it,
and some time a fellow had ought to settle down and cut out the hell-
raising.” Probably Jim would have been kicked out of college by the
ministerial professors if he had not had so reverent a way of asking
questions when they wrestled with his infidelity that they let go of him
in nervous confusion.
Even the President, the Rev. Dr. Willoughby Quarles, formerly
pastor of the Rock of Ages Baptist Church of Moline, Ill., than whom
no man had written more about the necessity of baptism by
immersion, in fact in every way a thoroughly than-whom figure—
even when Dr. Quarles tackled Jim and demanded, “Are you getting
the best out of our instruction, young man? Do you believe with us
not only in the plenary inspiration of the Bible but also in its verbal
inspiration, and that it is the only divine rule of faith and practise?”
then Jim looked docile and said mildly:
“Oh, yes, Doctor. There’s just one or two little things that have
been worrying me, Doctor. I’ve taken them to the Lord in prayer, but
he doesn’t seem to help me much. I’m sure you can. Now why did
Joshua need to have the sun stand still? Of course it happened—it
says so right in Scripture. But why did he need to, when the Lord
always helped those Jews, anyway, and when Joshua could knock
down big walls just by having his people yell and blow trumpets?
And if devils cause a lot of the diseases, and they had to cast ’em
out, why is it that good Baptist doctors today don’t go on diagnosing
devil-possession instead of T. B. and things like that? Do people
have devils?”
“Young man, I will give you an infallible rule. Never question the
ways of the Lord!”
“But why don’t the doctors talk about having devils now?”
“I have no time for vain arguments that lead nowhere! If you
would think a little less of your wonderful powers of reasoning, if
you’d go humbly to God in prayer and give him a chance, you’d
understand the true spiritual significances of all these things.”
“But how about where Cain got his wife—”
Most respectfully Jim said it, but Dr. Quarles (he had a chin-
whisker and a boiled shirt) turned from him and snapped, “I have no
further time to give you, young man! I’ve told you what to do. Good
morning!”
That evening Mrs. Quarles breathed, “Oh, Willoughby, did you
’tend to that awful senior—that Lefferts—that’s trying to spread
doubt? Did you fire him?”
“No,” blossomed President Quarles. “Certainly not. There was no
need. I showed him how to look for spiritual guidance and— Did that
freshman come and mow the lawn? The idea of him wanting fifteen
cents an hour!”
Jim was hair-hung and breeze-shaken over the abyss of hell, and
apparently enjoying it very much indeed, while his wickedness
fascinated Elmer Gantry and terrified him.
V
That November day of 1902, November of their Senior year, was
greasy of sky, and slush blotted the wooden sidewalks of
Gritzmacher Springs. There was nothing to do in town, and their
room was dizzying with the stench of the stove, first lighted now
since spring.
Jim was studying German, tilted back in an elegant position of
ease, with his legs cocked up on the desk tablet of the escritoire.
Elmer lay across the bed, ascertaining whether the blood would run
to his head if he lowered it over the side. It did, always.
“Oh, God, let’s get out and do something!” he groaned.
“Nothing to do, Useless,” said Jim.
“Let’s go over to Cato and see the girls and get drunk.”
As Kansas was dry, by state prohibition, the nearest haven was
at Cato, Missouri, seventeen miles away.
Jim scratched his head with a corner of his book, and approved:
“Well, that’s a worthy idea. Got any money?”
“On the twenty-eighth? Where the hell would I get any money
before the first?”
“Hell-cat, you’ve got one of the deepest intellects I know. You’ll be
a knock-out at the law. Aside from neither of us having any money,
and me with a Dutch quiz tomorrow, it’s a great project.”
“Oh, well—” sighed the ponderous Elmer, feebly as a sick kitten,
and lay revolving the tremendous inquiry.
It was Jim who saved them from the lard-like weariness into
which they were slipping. He had gone back to his book, but he
placed it, precisely and evenly, on the desk, and rose.
“I would like to see Nellie,” he sighed. “Oh, man, I could give her
a good time! Little devil! Damn these co-eds here. The few that’ll let
you love ’em up, they hang around trying to catch you on the
campus and make you propose to ’em.”
“Oh, gee! And I got to see Juanita,” groaned Elmer. “Hey, cut out
talking about ’em, will you! I’ve got a palpitating heart right now, just
thinking about Juanny!”
“Hell-cat! I’ve got it. Go and borrow ten off this new instructor in
chemistry and physics. I’ve got a dollar sixty-four left, and that’ll
make it.”
“But I don’t know him.”
“Sure, you poor fish. That’s why I suggested him! Do the check-
failed-to-come. I’ll get another hour of this Dutch while you’re
stealing the ten from him—”
“Now,” lugubriously, “you oughtn’t to talk like that!”
“If you’re as good a thief as I think you are, we’ll catch the five-
sixteen to Cato.”
They were on the five-sixteen for Cato.
The train consisted of a day-coach, a combined smoker and
baggage car, and a rusty old engine and tender. The train swayed so
on the rough tracks as it bumped through the drooping light that
Elmer and Jim were thrown against each other and gripped the arm
of their seat. The car staggered like a freighter in a gale. And tall raw
farmers, perpetually shuffling forward for a drink at the water-cooler,
stumbled against them or seized Jim’s shoulder to steady
themselves.
To every surface of the old smoking-car, to streaked windows and
rusty ironwork and mud-smeared cocoanut matting, clung a
sickening bitterness of cheap tobacco fumes, and whenever they
touched the red plush of the seat, dust whisked up and the prints of
their hands remained on the plush. The car was jammed.
Passengers came to sit on the arm of their seat to shout at friends
across the aisle.
But Elmer and Jim were unconscious of filth and smell and
crowding. They sat silent, nervously intent, panting a little, their lips
open, their eyes veiled, as they thought of Juanita and Nellie.
The two girls, Juanita Klauzel and Nellie Benton, were by no
means professional daughters of joy. Juanita was cashier of the Cato
Lunch—Quick Eats; Nellie was assistant to a dressmaker. They were
good girls but excitable, and they found a little extra money useful for
red slippers and nut-center chocolates.
“Juanita—what a lil darling—she understands a fellow’s troubles,”
said Elmer, as they balanced down the slushy steps at the grimy
stone station of Cato.
When Elmer, as a Freshman just arrived from the pool-halls and
frame high school of Paris, Kansas, had begun to learn the decorum
of amour, he had been a boisterous lout who looked shamefaced in
the presence of gay ladies, who blundered against tables, who
shouted and desired to let the world know how valiantly vicious he
was being. He was still rather noisy and proud of wickedness when
he was in a state of liquor, but in three and a quarter years of college
he had learned how to approach girls. He was confident, he was
easy, he was almost quiet; he could look them in the eye with
fondness and amusement.
Juanita and Nellie lived with Nellie’s widow aunt—she was a
moral lady, but she knew how to keep out of the way—in three
rooms over a corner grocery. They had just returned from work when
Elmer and Jim stamped up the rickety outside wooden steps. Juanita
was lounging on a divan which even a noble Oriental red and yellow
cover (displaying a bearded Wazir, three dancing ladies in chiffon

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Chapter 27 28.4 Aging and the Reproductive Systems 858

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Veins of neck and superficial

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View Orientation Anterior rami Color Coding

Ilioinguinal nerve Genitofemoral nerve

(a) Anterior view

(b) ©McGraw-Hill Education/Christine Eckel, photographer

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Pancreatic islet cells

Body of Beta cell

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Duodenum Abdominal Left Tail of

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Chapter Outline 22.1 Overview of the Cardiovascular

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Clinical View 21.3

that occurs in the newborn is called

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Clinical View 21.3

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Title: Elmer Gantry

Author: Sinclair Lewis