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Anatomy & Physiology: The Unity of Form and Function
10th International Student Edition Edition Kenneth S.
Saladin - eBook PDF
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Human
Anatomy Sixth Edition
Saladin’s Human Anatomy goes beyond descriptions of body struc- nerve, the pediatric auditory tube, lumbar puncture, epidermal
ture to read as a story that weaves together basic science, clinical histology, flat bone structure, gastric and colonic histology, the
applications, the history of medicine, and the evolutionary basis mechanical advantage of levers, and the spermatic cord. Always
of human structure. Saladin combines this humanistic perspective watching for opportunities to enhance topics with photos or to
with vibrant photos and art to convey the beauty and excitement of replace old photos with better ones, this edition has new photos
the subject to beginning students. of diabetic gangrene, rickets, shingles, endemic goiter, muscle his-
tochemistry, rod and cone cell SEMs, an intravenous pyelogram,
and ovulation.
Changes to the Sixth Edition
Attending scientific conferences, subscribing to several scien- Detailed List of Changes
tific and medical journals, and engaging in online forums and Chapter by chapter, the sixth edition’s most significant changes
answering public questions on anatomy, physiology, and health are as follows:
help Ken Saladin stay abreast of advances in the field. In this
Chapter 1, The Study of Human Anatomy, has added descrip-
edition, he introduces newly discovered functions of osteocytes,
tions of dynamic spatial reconstruction, open MRI, and Doppler
astrocytes, dendritic cells, the greater omentum, the corneal epi-
ultrasound.
thelium, and even eyelashes. He reports new research insights on
peroxisome production, tracing white matter tracts of the brain, Chapter 2, Cytology—The Study of Cells, has new clinical topics
and endocrine disruptors; new discoveries of cerebral lymphat- including mitochondrial diseases and birth defects arising from pri-
ics, and pulmonary production of blood platelets; and clinical mary cilium dysfunctions. It has updates on mitochondrial DNA,
advances in asthma and cancer mortality and survival, cord blood the role of gap junctions in the lens and cornea, and peroxisome
transplants, stem-cell harvesting, and regenerative medicine. production. It describes the vascular corrosion cast technique seen
These and more examples are listed chapter by chapter later in in many of the book’s SEM photos.
this section. Chapter 3, Histology—The Study of Tissues, has new Clinical
In response to users and reviewers, the sixth edition has Applications on biopsy and regenerative medicine, and functional
more concise treatments of gametogenesis, sperm capacitation, updates on urothelium (transitional epithelium) and epithelial base-
fertilization, aneuploidy, and embryology of the sense organs, car- ment membranes.
diovascular system, and digestive tract. The muscle chapters are Chapter 4, Human Development, has reduced the level of detail, at
reorganized for better flow, with chapter 10 focusing on the cellular reviewer and user suggestions, on gametogenesis, sperm capacita-
level; chapter 11 on whole-muscle organization, accessory connec- tion, fertilization, and aneuploidy.
tive tissues, musculoskeletal biomechanics, and the axial muscu-
Chapter 5, The Integumentary System, has a new Clinical Applica-
lature; and chapter 12 on the appendicular musculature. Ken has
tion on sunscreens, sunburn, and skin cancer.
also upgraded some of the book’s pedagogical features. There are
new, challenging thought questions, and the Study Guide section Chapter 6, The Skeletal System I: Bone Tissue, has new clinical
presents “What’s Wrong with These Statements?”—10 statements coverage of osteomalacia, rickets, and osteosarcoma, and updates
that all have subtle errors, prompting students to identify what is on osteoporosis, the endocrine role of osteocytes, and limitation of
wrong with them. microfractures by osteon structure. It includes enhanced art on flat
bone structure.
Chapter 7, The Skeletal System II: Axial Skeleton, has a new sec-
New and Enhanced Perspectives
tional view of the head and its cavities, and new clinical coverage of
This sixth edition details enhancements to topics already in the pre-
cleft palate and lip.
vious edition, including new anatomical imaging techniques, ethnic
variations in anatomy, osteon structure and microfractures, vascu- Chapter 8, The Skeletal System III: Appendicular Skeleton, had little
lar aging and hypertension, the scope of the immune system, T cell need for change but has an upgraded illustration of the clavicle for
selection, clinical importance of the cricothyroid ligament, colonic improvement in its surface features.
histology, photosensory effects on the pineal gland, musculoskel- Chapter 9, The Skeletal System IV: Joints, updates the material
etal biomechanics, and more. science of joint prostheses.
Chapter 10, The Muscular System I: Muscle Cells, has improved
New Art and Photography illustrations of the neuromuscular junction, motor units, and
This edition includes new drawings of motor units, sectional the histochemistry of muscle fiber types, and new clinical cover-
anatomy of the head, hand innervation, the course of the vagus age of rigor mortis and fibromyalgia. Chapters 10 to 12 on the
viii
muscular system are reorganized so that chapter 10 focuses on the Chapter 21, The Circulatory System III: Blood Vessels, gives an
cellular level; chapter 11 discusses the accessory connective tissues updated multicultural perspective on vascular aging and hyperten-
of muscle, whole-muscle structure and organization, musculoskel- sion; adds new challenge questions on identifying arteries in a mag-
etal biomechanics, and the axial muscles; and chapter 12 discusses netic resonance angiogram and identifying blood vessels used for
the appendicular muscles. routine clinical purposes; and treats blood vessel embryology more
Chapter 11, The Muscular System II: Axial Musculature, now incor- concisely.
porates material moved from chapters 10 and 12 and has enhanced Chapter 22, The Lymphoid System and Immunity, now takes an
coverage of accessory connective tissues, muscle compartments, expanded, more contemporary view of the meaning of immune
muscle–bone attachments, musculoskeletal biomechanics, a new system. It reports the recent discovery of cerebral lymphatics and
illustration of lever biomechanics, and a clinical update on types has enhanced discussions of lymphatic vessel peristalsis and lymph
and treatment of inguinal hernias. flow, the maturation and selection of T cells, and the antigen-
Chapter 12, The Muscular System III: Appendicular Musculature, presenting role of dendritic cells.
updates the treatment of carpal tunnel syndrome. Chapter 23, The Respiratory System, has improved descriptions
Chapter 13, The Nervous System I: Nervous Tissue, updates astro- of the nasal and tracheal mucosae, the bronchial tree, and the cri-
cyte functions and the role of electrical synapses in neuronal cothyroid ligament in relation to tracheostomy. It updates asthma
synchrony. mortality rates and lung cancer survival, and reports the newly dis-
covered role of the lungs in producing blood platelets.
Chapter 14, The Nervous System II: Spinal Cord and Spinal
Nerves, now covers lumbar puncture and adds new illustrations Chapter 24, The Digestive System, has new clinical coverage of
of shingles and the distribution of hand innervation from the diverticulosis, diverticulitis, hepatitis, cirrhosis, gastroesophageal
brachial plexus. reflux disease, and gallstones. It has enhanced discussions of mes-
entery structure and omentum function; dental anatomy and pro-
Chapter 15, The Nervous System III: Brain and Cranial Nerves,
prioception; salivary gland innervation; anatomy of the ileocecal
has new drawings of regional functions of the cerebral cortex and
junction; and ethnic variation in colonic anatomy. It has new illus-
distribution of the vagus nerve; new clinical coverage of stroke
trations of histology of the stomach and colon, and a more concise
and trigeminal neuralgia; and scientific updates on brain senes-
treatment of GI embryology.
cence, functions of the red nucleus and insula, and mapping of
the brain with diffusion tensor imaging. Chapter 25, The Urinary System, adds new coverage of intravenous
pyelography and kidney stone treatment, and corrects a common
Chapter 16, The Nervous System IV: Autonomic Nervous System
misconception about female urethral sphincters.
and Visceral Reflexes, has a redrawn figure 16.2 to better compare
sympathetic, parasympathetic, and somatic efferent pathways, Chapter 26, The Reproductive System, has added substantial new
and it expands slightly on pre- and postganglionic fibers and their clinical content, with Clinical Applications and other discussions of
neurotransmitters. varicocele, uterine fibroids, uterine cancer, endometriosis, sexually
transmitted diseases, contraception, testicular cancer, male breast
Chapter 17, The Nervous System V: Sense Organs, has scientific
cancer, and male reproductive tract disorders. It has a new endo-
updates on the roles of the eyelashes, corneal epithelium, and vitre-
scopic photo of ovulation, a revision of penile anatomy to focus
ous body; new clinical coverage of phantom pain, macular degen-
more on the uncircumcised state, and an update on environmental
eration, and diabetic retinopathy; new SEM photos of rod and cone
endocrine disruptors and their effect on fertility.
cells; a new drawing of the pediatric and adult auditory tubes as
related to middle-ear infection; and a more concise treatment of ear
and eye embryology. A Storytelling Writing Style
Chapter 18, The Endocrine System, has enhanced discussions of
Students and instructors alike cite Saladin’s prose style as the
pineal gland innervation and function, melatonin, the endocrine
number one attraction of this book. Students doing blind compari-
pancreas, and endemic goiter (with a new photo), and a new inter-
sons of Ken Saladin’s chapters and those of other anatomy books
pretation of anterior pituitary chromophobes. It has new clinical
routinely find Saladin clearly written, easy to understand, and a
coverage of congenital absence of the pituitary gland (panhypopi-
stimulating, interesting read. Saladin’s analogy-rich writing enables
tuitarism) and hypo- and hyperthyroidism, and has added a basic
students to easily visualize abstract concepts in terms of everyday
pathophysiology of diabetes mellitus.
experience. Consider, for example, from chapter 13:
Chapter 19, The Circulatory System I: Blood, updates the status The dimensions of human neurons are more impressive when
of cord blood transfusions and the harvesting of stem cells from we scale them up to the size of familiar objects. If the soma of a
circulating blood; enhances coverage of the role of blood circula- spinal motor neuron was the size of a tennis ball, its dendrites would
tion in thermoregulation and of the role of erythroblasts; and form a huge bushy mass that could fill a 30-seat classroom from
reports a startling new finding on where most blood platelets are floor to ceiling. Its axon would be up to a mile long but a little nar-
produced. rower than a garden hose. This is quite a point to ponder. The neuron
Chapter 20, The Circulatory System II: The Heart, updates the treat- must assemble molecules and organelles in its “tennis ball” soma
ment options for patent ductus arteriosis and has a more concise and deliver them through its “mile-long garden hose” to the end of
treatment of cardiac embryology. the axon.
Ken Saladin’s penchant for writing began early. For his tenth-grade
biology class, he wrote a 318-page monograph on hydras with
53 original India ink drawings and 10 original photomicrographs. We
at McGraw-Hill think of this as Ken’s “first book.” At a young age, Ken
Ken served as an A&P textbook reviewer and testbank writer for several
years and then embarked on his first book for McGraw-Hill in 1993. He
published the first edition of Anatomy & Physiology: The Unity of Form and
Function in 1997 and his first edition of Human Anatomy in 2004. The story
continues with Human Anatomy, sixth edition.
Human
ABOUT THE COVER
The front cover shows a human iris against a background of retinal cells. The tall gray columns are the light-absorbing
segments of the rods; the two light green cells are cones; and the basal cell bodies are in violet. The iris is so intricate,
unique to the individual, and forgery-proof that iris recognition technology is rapidly supplementing or replacing other
forms of identity confirmation such as fingerprints, PINs, national identification cards, and even passports. Saladin
Anatomy
Human Anatomy
NOW INCLUDES:
Sixth Edition
Fueled by McGraw-Hill LearnSmart® —the most SmartBook® is the first and only adaptive reading
widely used and intelligent adaptive learning experience designed to create personalized
resource—LearnSmart Prep® is designed to get learning for students. SmartBook highlights the
students ready for an upcoming course by quickly most impactful concepts a student needs to learn
and effectively addressing prerequisite knowledge at that moment in time.
gaps that may cause problems down the road.
Practice Atlas for A&P is an interactive tool that APR is an interactive cadaver dissection tool to
pairs images of common anatomical models with enhance lecture and lab. Make use of the custom
stunning cadaver photography, allowing students structure list to focus learning! Now, APR is
to practice naming structures on both models mobile—get the experience anywhere, anytime!
and human bodies, anytime and anywhere.
Sixth
ISBN 978-1-260-21026-2
Edition
MHID 1-260-21026-X
9 0000
9 7 8 1 2 6 0 2 1 02 6 2
Saladin
meal in response to rising levels of blood-borne nutrients surrounded by a capsule, the theca. The theca and granulosa cells col-
Central
canal Osteon corresponding numbered text descriptions.
such as glucose and amino acids. It stimulates most body laborate to produce estrogen. Midway through the monthly ovarian
Lacuna tissues to absorb these nutrients and store or metabolize cycle, the follicle ovulates (releases the egg) and begins to secrete an
Collagen them. Amylin enhances the effects of insulin and influences abundance of progesterone. Estrogen and progesterone contribute
fibers gastric emptying and bile secretion. to the development of the reproductive system and feminine phy-
Lacunae
Concentric
3. Delta (δ) cells, or somatostatin cells, which secrete somatostatin sique, regulate the menstrual cycle, sustain pregnancy, and prepare
lamellae (growth hormone–inhibiting hormone). Somatostatin is the mammary glands for lactation. Inhibin, which is also secreted
Circumferential
lamellae
Canaliculi secreted under the same conditions as insulin. It helps to by the follicle, is a signal from the ovaries to the anterior pituitary.
Central It inhibits the secretion of follicle-stimulating hormone (FSH). The
(b) canal 22
Paul Langerhans (1847–88), German anatomist effects of these hormones are further considered in chapter 26.
Lamella
Sinuatrial node
(pacemaker) Left 3 AV node fires.
atrium
2
Subendocardial
Atrioventricular 3
conducting network 4 Excitation spreads down AV
node bundle.
Bundle
Atrioventricular branches 5 Subendocardial conducting
bundle 4 network distributes excitation
5
through ventricular
myocardium.
Subendocardial
conducting network
Figure 20.13 The Cardiac Conduction System. Electrical signals travel along the pathways indicated by the arrows.
• Which atrium is the first to receive the signal that induces atrial contraction?
4 The atrioventricular (AV) bundle, a cord of modified branches, each cardiomyocyte contacts several other cells, so collec-
cardiomyocytes by which signals leave the AV node. The bundle tively they form a network throughout a heart chamber. A cardiomyo-
soon forks into right and left bundle branches, which enter the cyte usually has only one, centrally placed nucleus, often surrounded
interventricular septum and descend toward the apex of the heart. by a mass of the energy-storage carbohydrate, glycogen; one-quarter
to one-third of the cells, however, have two or more nuclei. The sar-
5 The bundle branches give rise to conducting cardiac myofibers coplasmic reticulum is less developed than in skeletal muscle; it lacks
(formerly called Purkinje cells), which turn upward at the terminal cisterns, although it does have footlike sacs associated with
apex of the heart and spread throughout the ventricular the T tubules. The T tubules are much larger than in skeletal muscle.
myocardium. These myofibers distribute electrical excitation During excitation of the cell, they admit calcium ions from the extra-
to the cardiomyocytes of the ventricles. Collectively, they cellular fluid to activate muscle contraction. Cardiomyocytes have
form the subendocardial conducting network. The network is especially large mitochondria, which make up about 25% of the cell
more elaborate in the left ventricle than in the right. volume, compared to skeletal muscle mitochondria, which are much
smaller and comprise only 2% of the cell volume.
After we examine the structure of cardiac muscle, we will see how
this conduction system relates to the heart’s cycle of contraction
and relaxation. C L I N I C A L A P P L I C AT I O N 20.2
sal1026X_fm_i-xx.indd 11 12/11/18 9:43 AM
xii P R E FAC E
C LOrientation
I N I C A L A P P L ITools, such 12.2
C AT I O N as dissection planes and a compass The Psychology of Learning
on the anatomical art, clarify the perspective from which a
Carpal Tunnel Syndrome
Prolonged, repetitive motions of the wrist and fingers can cause pianists, meat cutters, and others who spend long hours making Having taught human anatomy and histology for 40 years,
structure
tissues in the carpal tunnel tois viewed.
become inflamed, swollen, or repetitive wrist motions. It can also be caused by other factors
fibrotic. Since the carpal tunnel cannot expand, swelling puts that reduce the size of the carpal tunnel, including tumors, infec- Saladin knows what works in the classroom and incorporates
pressure on the median nerve, which passes through the carpal tions, and bone fractures. Carpal tunnel syndrome is treated
tunnel with the flexor tendons (fig. 12.9). This pressure causes
tingling and muscular weakness in the palm and lateral side of
with aspirin and other anti-inflammatory drugs, immobilization of
the wrist, and sometimes surgical division (splitting) of the flexor
those approaches into the pedagogy of Human Anatomy.
the hand and pain that may radiate to the arm and shoulder. This retinaculum to relieve pressure on the nerve.
condition, called carpal tunnel syndrome, is common among
Ulnar bursa
which area of this interactive cadaver dissection
Radial artery
Anterior
Trapezoid
Hamate program corresponds to the chapter topic.
Capitate
Lateral Medial
Scaphoid Extensor tendons
Posterior
(b) Cross section
Figure 12.9 The Carpal Tunnel. (a) Dissection of the wrist (anterior aspect) showing the tendons, nerve, and bursae that pass under the flexor
retinaculum. (b) Cross section of the wrist, viewed as if from the distal end of a person’s right forearm extended toward you with the palm up. Note
how the flexor tendons and median nerve are confined in the tight space between the carpal bones and flexor retinaculum. That tight packing and
repetitive sliding movements of the flexor tendons through the tunnel contribute to carpal tunnel syndrome.
Study Guide
Syndesmoses
f . describe the two types of cartilaginous joints and give
an example of each.
Expected Learning
of short, Outcomes
easily digestible sections manageable in
Sutures
A syndesmosis6 (SIN-dez-MO-sis) is a fibrous joint at which two
bones are bound by relatively long collagenous fibers. The separa-
Sutures are immobile or only slightly mobile fibrous joints that short bits of reading time.
When you have completed this section, you should be able to
closely bind the bones of the skull to each other; they occur nowhere 9.1b Fibrou
tion between the bones and lengthAny of the fibers
point givetwo
where these meet isBefore
joints
bones You
called a joint Go On
(articulation), else. In chapter 7, we did not take much notice of the differences
more mobility than a suture or gomphosis. An especially mov-
whether or not the bones are movable at that interface. The science a. explain
between one suture and another, but some differences might have what joints
Expected are, howOutcomes
Learning they are named, and
give the what
student A fibrous joint is
able syndesmosis exists between the Answer the following questions 1 to test your understanding of the
of shafts of the radius
joint structure, and ulna,
function, and dysfunction is called arthrology. functions they serve;
caught your attention as you studied the diagrams in that chapter or
which are joined by a broad fibrous Theinterosseousmembrane.
study of musculoskeletal This preceding section:
movement is kinesiology2 (kih-NEE- examined laboratory specimens. Sutures can be classified as serrate, a preview of key points to be learned within the is a point at whic
syndesmosis permits such movements as pronation and supina- 1. What is the difference between arthrology and kinesiology?
see-OL-oh-jee). This is a branch of biomechanics, which deals with b. name and describe the four major classes of joints;
lap, and planesutures. Readers with some knowledge of woodwork- that emerge from
tion of the forearm. A less mobile
binds the distal ends of the tibia and
syndesmosis
a broad
fibula
variety isofthe
together,
movements 2. Explainprocesses
one that and mechanical the distinction
in the
sis, and synarthrosis.
between
ingamaysynostosis,
recognizeamphiarthro-
that the structures and functional properties of
c. name some nextjoints
few pages.
that become solidly fused by bone as them, and penetra
body, including the side by side
physics of blood circulation, respiration, and these sutures have something in common with basic types of car-
(fig. 9.1c). hearing. 3. Give some examples of joints that become synostoses
pentry joints (fig. 9.2). they age; three kinds of fibr
4.
with age.
Define suture, gomphosis, and syndesmosis, and explain
Before
d. describe You Go
the three Onofprompts
types the student
fibrous joints to pause
and give an In sutures and gom
9.1c Cartilaginous Joints 1 3
syn = together; ost = bone; osis = condition
example and spot-check his or her mastery of the
arthro = joint; logy = study of what these three joints have in common.
2
kinesio = movement; logy = study of
A cartilaginous joint is also called an amphiarthrosis7 (AM-fee-ar- 5.
4
syn = together; arthr = joined; osis = condition
Name the three types of sutures and describe how they
of each; little or no movem
THRO-sis). In these joints, two bones are linked by cartilage differ. e. distinguish between
previous fewthe three
pages typesprogressing
before of sutures; to
andnew attached bones are
(fig. 9.3). The two types of cartilaginous joints are synchondroses 6. Name two synchondroses and two symphyses.
and symphyses. f . describe material.
the two types of cartilaginous joints and give
an example of each. Sutures
Sutures are immo
4. Chorionic villi develop from 8. The feature that distinguishes a fetus from 13. The brain and spinal cord develop from a
5
gomph = nail, bolt; osis = condition
closely bind the bo
6 8
syn = together; desm = band; osis = condition syn = together; chondr = cartilage; osis = condition
7 9
amphi = on all sides; arthr = joined; osis = condition
a. the zona
Vocabulary pellucida. sym = together; physis = growth
Building an embryo is that the fetus has longitudinal ectodermal channel called the
Any point where two bones meet is called a joint (articulation), else. In chapter 7,
a. all of the organ systems. _____.
Severalb. features
the endometrium.
help build a student’s level of comfort with medical whether or not the bones are movable at that interface. The science between one sutur
c. the syncytiotrophoblast. b. three germ layers. 14. Attachment of the conceptus to the uterine
vocabulary.
d. the embryoblast. c. a placenta.
of joint structure, function, and dysfunction is called arthrology.1
wall is called _____.
caught your attent
2
e. the epiblast. d. an amnion. The study of musculoskeletal 15. Fetalmovement
blood flowsis kinesiology (kih-NEE-
through growths called examined laborato
Pronunciation Guides Knowing proper pronunciation is key see-OL-oh-jee). This is a branch lap, and planesutu
5. Which of these results from aneuploidy? e. arm and leg buds. _____, which project into thedeals
of biomechanics, which with
placental
to remembering and spelling terms. Saladin gives simple, a broad variety of movements sinus. and mechanical processes in the ing may recognize
a. Down syndrome 9. The first blood and future egg and sperm
intuitive body, including the physics of enzymes
blood circulation, respiration,
a sperm and these sutures have
b. fetal“pro-NUN-see-AY-shun”
alcohol syndrome guides to helpcells students over
come from 16. The with which pen-
this hearing. etrates an egg are contained in an organelle pentry joints (fig.
c. hurdle and widen the student’s comfort zone
nondisjunction a. for
themedical
mesoderm.
d. mutation b. the hypoblast. called the _____.
vocabulary.
e. polyspermy c. the syncytiotrophoblast.
1 17.
arthro = joint; logy = study of
Fertilization occurs in a part of the female 3
syn = together; ost =
2 reproductive tract called the _____. 4
syn = together; arthr
Word Origins Accurate spelling
6. Fetal urine accumulates in the _____ and and insight into d.
medical the placenta.
terms kinesio = movement; logy = study of
e. the used
yolk sac. 18. Bone, muscle, and dermis arise from
arecontributes
greatly enhanced
to the fluidbythere.
a familiarity with commonly word segments of mesoderm called _____.
a. placental
roots, prefixes,sinus
and suffixes. 10. For the first 8 weeks of gestation, a concep-
19. The egg cell has fast and slow blocks to
b. yolk sac tus is nourished mainly by
_____, or fertilization by more than one
c. allantois
Footnotes throughout the chapters help build the student’s a. the placenta.
sperm.
d. chorion b. amniotic fluid.
working lexicon of word elements. An end-of-book Glossary 20. A developing individual is first classified as
e. amnion c. colostrum.
provides clear definitions of the most important a/an _____ when the three primary germ
7. A preembryo has d.ordecidual
frequently
cells.
layers have formed.
used
a. aterms.
neural tube. e. yolk cytoplasm.
b. a heart bulge. 11. Viruses and chemicals that cause congenital
Answers in appendix A
Building Your Medical
c. a cytotrophoblast. Vocabulary An exercise atanatomical
the end deformities
of are called _____.
each
d. achapter
coelom.helps students creatively use their 12. Aneuploidy
knowledgeisofcaused by _____, the failure
e. decidual cells. of a pair of chromosomes to separate in
new medical word elements. meiosis.
14. Why is a baby more likely to be born with anatomical Testing Your Recall
howing the Effect of Thalidomide defects stemming from teratogen exposure at 30 days
1. Below L2, the vertebral canal is occupied 5. A patient has a gunshot wound that caused d. the arachnoid mater.
than from exposure at 10 days? by a bundle of spinal nerve roots called a bone fragment to nick the spinal cord. e. the dura mater.
a. the terminal filum. The patient now feels no pain or tempera- 9. The intercostal nerves between the ribs
b. the descending tracts. ture sensations from that level of the body arise from which spinal nerve plexus?
c. the gracile fasciculus. down. Most likely, the _____ was damaged. a. cervical
d. the medullary cone. a. gracile fasciculus b. brachial
e. the cauda equina. b. medial lemniscus c. lumbar
2. The brachial plexus gives rise to all of the c. tectospinal tract d. sacral
following nerves except d. lateral corticospinal tract e. none of them
a. the axillary nerve. e. spinothalamic tract
10. All somatic reflexes share all of the follow-
b. the radial nerve. 6. Which of these is not a region of the spinal ing properties except
c. the obturator nerve. cord? a. they are quick.
d. the median nerve. a. cervical b. they are monosynaptic.
e. the ulnar nerve. b. thoracic
Testing Your Recall sections at the end of each chapter
c. they require stimulation.
3. Between the dura mater and vertebral bone, c. pelvic d. they are involuntary.
one is most likely to find d. lumbar e. they are stereotyped.
e. sacral
offer 20 simple recall questions to test retention of a. arachnoid mater.
b. denticulate ligaments.
c. cartilage.
7. In the spinal cord, the neurosomas of the
lower motor neurons are found in
11. Outside the CNS, the neurosomas of neu-
rons are clustered in swellings called _____.
12. Distal to the intervertebral foramen, a spi-
students to concisely explain why the false statements e. the tectospinal tract b. the perineurium.
c. the endoneurium.
cord produce the rhythmic muscular con-
tractions of walking.
are untrue.
What’s Wrong with These Statements?
application and other interpretive essay questions that 1. More people get rheumatoid arthritis than
osteoarthritis.
2. A doctor who treats arthritis is called a
6. The lateral and medial malleoli are protru-
sions of the two sides of the tibia in the
lubricating fluid between them.
9. Synovial fluid is secreted by the bursae.
tarsal region. 10. Several sutures can be found in the long
require the student to apply the chapter’s basic science kinesiologist.
3. Synovial joints are also known as synarthroses.
7. To stand on tiptoes to reach something on
a high shelf, you would use dorsiflexion of
bones of the upper and lower limbs.
C L I N I C A L A P P L I C AT I O N 14.2
to more than a
r and resemble
aller branches.
Purely sensory nerves, composed only of afferent fibers, are rare;
ches are called Apply What You Know they include the olfactory and optic nerves described in table 15.3.
ly called periph-
How does the structure of a nerve compare to that of a skeletal Motor nerves carry only efferent fibers. Most nerves, however, are
are ensheathed Making it Relevant
muscle? Which of the descriptive terms for nerves have similar mixed. A mixed nerve consists of both afferent and efferent fibers
counterparts in muscle histology? and therefore conducts signals in two directions, although any one
often a myelin
he neurilemma, Clinical Application essays cover the clinical relevance of fiber within the nerve carries signals in one direction only. Many
nerves often described as motor are actually mixed because they
en a thin sleeve basic science. carry sensory signals of proprioception from the muscles back to
In most nerves, Peripheral nerve fibers are of two kinds: sensory (afferent) fibers, the CNS.
fascicles, each which carry signals from sensory receptors to the CNS, and motor If a nerve resembles a thread, a ganglion18 resembles a knot in
perineurium is (efferent) fibers, which carry signals from the CNS to muscles and the thread. A ganglion is a cluster of neurosomas outside the CNS.
ous, epithelium- glands. Both sensory and motor fibers can also be described as It is enveloped in an epineurium continuous with that of the nerve.
er and wrapped somatic or visceral and as general or special depending on the organs Among the neurosomas are bundles of nerve fibers leading into
hole. The tough they innervate (table 14.2). and out of the ganglion. Figure 14.9 shows a type of ganglion asso-
nnective tissue
ciated with the spinal nerves.
Nerves have a
upply, which is 15
polio = gray matter; myel = spinal cord; itis = inflammation
onnective tissue 16
a = without; myo = muscle; troph = nourishment
17 18
Lou Gehrig (1903–41), American baseball player gangli = knot
For Instructors
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I wish to thank the hundreds of colleagues who have reviewed my writing over the years and tremendously contributed to the factual
accuracy, scientific currency, and presentation style of the book before you. Much of this has come about through revising my flagship
book, Anatomy & Physiology: The Unity of Form and Function, through eight editions. Human Anatomy and my book coauthored with Robin
McFarland, Essentials of Anatomy & Physiology, have derived their own content improvements as they follow in the wake of the heavily
reviewed two-semester textbook.
I wish to thank specifically all of the reviewers of the fifth edition text (listed below). Their feedback has been instrumental to the revi-
sion process for this sixth edition. In addition to these commissioned reviews of my chapters, spontaneous feedback from other instructors
and from students all over the world has been enormously stimulating and helpful in the incessant effort to approach that elusive asymptote
called textbook perfection. I’m deeply appreciative of all the encouragement, information, corrections, and suggestions these readers have
sent, and I look forward to many more years of such productive correspondence.
Christina Gan updated the question bank and test bank to closely correlate with the intricate changes made in this sixth edition, and
greatly increased the educational value of these books through her work to create self-assessment tools and align McGraw-Hill’s Connect
resources with the textbook. This has contributed greatly to student and instructor satisfaction with our overall package of learning media,
and to the students’ success as they master A&P en route to their career aspirations. I am delighted to have Christina on my team.
I would also like to extend appreciation to members of the Life Sciences Book Team at McGraw-Hill Education who have worked with
me on this project, including Matthew Garcia, Portfolio Manager; Donna Nemmers, Senior Product Developer; Vicki Krug, Senior Content
Project Manager; Lori Hancock, Lead Content Licensing Specialist; Brent dela Cruz, Senior Content Project Manager; David Hash, Lead
Designer; and Jeanne Patterson, freelance copy editor. Their efforts have yielded another great edition of the text and its companion media
suite of Connect products.
Ken Saladin
Georgia College & State University
Reviewers
Fazal K. Aasi Tamara Davault David S. McLeod
Compton Community College University of Texas of the Permian Basin James Madison University
Yael Avissar Bryan Essien Ronald D. Norris
Rhode Island College Ball State University Azusa Pacific University
Guoying Bing Michael T. Griffin Jacqueline Pal
University of Kentucky Angelo State University East Los Angeles College
Erika Brockmann April Richardson Hatcher Behnaz Parhami-Seren
Los Angeles Valley College University of Kentucky Moorpark College
Becky Brown Candi K. Heimgartner Lula Smith
College of Marin University of Idaho Alabama State University
Pamela Byrd-Williams Deborah C. Henry Robert Stow
Los Angeles Valley College Coastline Community College University of Wisconsin—Eau Claire
Jennifer Carr Nicole Houston Curt Walker
Tufts University Indiana University Kokomo Dixie State University
Julie K. Collins Wilfredo López-Ojeda Colonel (Ret.) Michael Yard
Eastern Oklahoma State College UCF-COM Indiana University Purdue University
Kathleen Coughlan Chris T. McAllister Indianapolis (IUPUI)
Redlands Community College Eastern Oklahoma State College—Idabel
xviii
Dear Students,
When I was a young boy, I became interested in what I then called “nature study” for two reasons. One was the sheer beauty of nature.
I reveled in children’s books with abundant, colorful drawings and photographs of animals, plants, minerals, and gems. It was this esthetic
appreciation of nature that made me want to learn more about it and made me happily surprised to discover I could make a career of it.
At a slightly later age, another thing that drew me still deeper into biology was to discover writers who had a way with words—who could
captivate my imagination and curiosity with their elegant prose. Once I was old enough to hold part-time jobs, I began buying zoology and
anatomy books that mesmerized me with their gracefulness of writing and fascinating art and photography. I wanted to write and draw like
that myself, and I began learning from “the masters.” I spent many late nights in my room peering into my microscope and jars of pond
water, typing page after page of manuscript, and trying pen and India ink as an art medium. My “first book” was a 318-page paper on some
little pond animals called hydras, with 53 illustrations, that I wrote for my tenth-grade biology class when I was 16.
Fast forward about 30 years to when I became a textbook writer, and I found myself bringing that same enjoyment of writing and illus-
trating to my own anatomy and physiology textbooks. Why? Not only for its intrinsic creative satisfaction, but because I’m guessing that
you’re like I was—you can appreciate a book that does more than simply give you the information you need. You appreciate, I trust, a writer
who makes it enjoyable for you through scientific, storytelling prose and a conceptualized way of illustrating things to spark interest and
facilitate understanding. Some of you probably think of yourselves as “visual learners” and others as “verbal learners.” Either way, I hope
this book will serve your learning style.
I know from my own students, however, that you need more than captivating illustrations and enjoyable reading. Let’s face it—A&P is
a complex subject and it may seem a formidable task to acquire even a basic knowledge of the human body. It was difficult even for me to
learn (and the learning never ends). So in addition to simply writing this book, I’ve given a lot of thought to pedagogy—the art of teaching.
I’ve designed my chapters to make them easier for you to study and to give you abundant opportunity to check whether you’ve understood
what you read—to test yourself (as I advise my own students) before the instructor tests you. Christina Gan, digital author, also produces rich
Connect interactive questions that test your understanding as you progress through each chapter. Students have commended these online
questions as extremely helpful in learning human anatomy.
Each chapter is broken down into short, digestible bits with a set of learning goals (Expected Learning Outcomes) at the beginning of
each section, and self-testing questions (Before You Go On) just a few pages later. Even if you have just 30 minutes to read during a lunch
break or a bus ride, you can easily read or review one of these brief sections. There are also numerous self-testing questions at the end of each
chapter, in some of the figure legends, and the occasional Apply What You Know questions dispersed through each chapter. The questions
cover a broad range of cognitive skills, from simple recall of a term to your ability to evaluate, analyze, and apply what you’ve learned to new
clinical situations or other problems.
The Guided Tour takes you through the learning aids we’ve created for you within the book itself and additional study aids available
within Connect. I hope you will take a little time to look at the Guided Tour to see what we have to offer you.
I hope you enjoy your study of this book, but I know there are always ways to make it even better. Indeed, what quality you may find in
this edition owes a great deal to feedback I’ve received from students all over the world. If you find any typos or other errors, if you have any
suggestions for improvement, if I can clarify a concept for you, or even if you just want to comment on something you really like about the
book, I hope you’ll feel free to write to me. I correspond quite often with students and would enjoy hearing from you.
Ken Saladin
Georgia College & State University
TwainStation@gmail.com
xix
THE STUDY OF
HUMAN ANATOMY 1
C HA P TER OU TLI N E CLI NI CAL AP P LI CAT I ONS
1.1 The Scope of Human Anatomy 1.1 Situs Inversus and Other Unusual Anatomy
1.1a The Anatomical Sciences 1.2 Cardiac Tamponade
1.1b Methods of Study
1.1c Variation in Human Structure
Study Guide
T
his book is an introduction to the structure of the human the Persian physician Avicenna (Ibn Sina, 980–1037 ce). For nearly
body. It is meant primarily to provide a foundation for 1,500 years, medical professors in Europe idolized these “ancient
advanced study in fields related to health and fitness. masters” and considered their works above reproach. Modern
Beyond that purpose, however, the study of anatomy can also human anatomy, however, dates to the sixteenth century, when
provide a satisfying sense of self-understanding. Even as chil- Flemish physician and professor Andreas Vesalius (1514–64) ques-
dren, we’re curious about what’s inside the body. Dried skele- tioned the accuracy of the earlier authorities and commissioned the
tons, museum exhibits, and beautifully illustrated atlases of the first accurate anatomical illustrations for his book, De Humani Cor-
body have long elicited widespread public fascination. poris Fabrica (On the Structure of the Human Body, 1543) (fig. 1.1).
This chapter lays a foundation for our study of anatomy by The tradition begun by Vesalius has been handed down to us
considering some broad, unifying themes. We will consider what through such famous contemporary works as Gray’s Anatomy, Frank
this science encompasses and what methods are used for the Netter’s Atlas of Human Anatomy, and many others, to the richly
study of anatomy. We will lay out a general “road map” of the illustrated textbooks used by college students today.
human body to provide a context for the chapters that follow. For all its attention to the deceased body, or cadaver,2 human anat-
We will also get some insights into how a beginning anatomy omy is hardly a “dead science.” New techniques of study continually
student can become comfortable with medical terminology. produce exciting new insights into human structure and its functional
relevance; anatomists have discovered far more about the human body in
the last century than in the 2,500 years before. Anatomy now embraces
several subdisciplines that study human structure from different per-
1.1 The Scope of Human Anatomy spectives. Gross anatomy is the study of structure visible to the naked
eye, using methods such as surface observation, dissection, X-rays, and
Expected Learning Outcomes MRI scans. Surface anatomy is the external structure of the body, and is
especially important in conducting a physical examination of a patient.
When you have completed this section, you should be able to
Radiologic anatomy is the study of internal structure, using X-rays and
a. define anatomy and some of its subdisciplines; other medical imaging techniques described in the next section.
b. name and describe some approaches to studying Systemic anatomy is the study of one organ system at a time and is
anatomy; the approach taken by most introductory textbooks such as this one.
c. describe some methods of medical imaging; and Regional anatomy is the study of multiple organ systems at once in a
d. discuss the variability of human anatomy. given region of the body, such as the head or chest. (See the Atlas of
Regional and Surface Anatomy following chapter 12.) Medical schools
and anatomy atlases typically teach anatomy from a regional perspec-
Human anatomy is the study of the structural basis of body function. tive, because it is more practical to dissect all structures of the head
It provides an essential foundation for understanding p hysiology, and neck, the chest, or a limb, than it would be to try to dissect the
the functional relevance of that structure; anatomy and physiol- entire digestive system, then the cardiovascular system, and so forth.
ogy together are the bedrock of the health sciences. You can study Dissecting one system almost invariably destroys organs of other sys-
human anatomy from an atlas; yet as beautiful, fascinating, and tems that stand in the way. Furthermore, as surgeons operate on a
valuable as atlases are, they teach almost nothing but the locations, particular area of the body, they must think from a regional perspective
shapes, and names of things. This book is different; it deals with and attend to the interrelationships of all structures in that area.
what biologists call functional morphology1—not just the structure Ultimately, the structure and function of the body result from its
of organs, but the functional reasons behind it. individual cells. To see those, we usually take tissue specimens, thinly
Anatomy and physiology complement each other; each makes slice and stain them, and observe them under the microscope. This
sense of the other, and each molds the other in the course of human approach is called histology (microscopic anatomy). Histopathology3
development and evolution. Thus, we can say that the human body is the microscopic examination of tissues for signs of disease. Cytol-
exhibits a unity of form and function. We can’t delve into the details ogy4 is the study of the structure and function of individual cells.
of physiology in this book, but enough will be said of function to Many important aspects of human structure are so small we can see
help you make sense of human structure and to more deeply appre- them only with the electron microscope (see chapter 2, section 2.1).
ciate the beauty of human form. Structure at the subcellular to molecular level is called ultrastructure.
1.1a The Anatomical Sciences
1.1b Methods of Study
Anatomy is an ancient human interest, undoubtedly older than any
written language we know. We can only guess when people began There are several ways to examine the structure of the human body.
deliberately cutting into human bodies out of curiosity, simply to The simplest is inspection—simply looking at the body’s appearance
know what was inside. Some of the earliest and most influential in careful detail, as in performing a physical examination or making
books of anatomy were written by the Greek philosopher Aristotle a clinical diagnosis from surface appearance. Observations of the
(384–322 bce), the Greek physician Galen (129–c. 200 ce), and
2
from cadere = to fall down or die
3
histo = tissue; patho = disease; logy = study of
1 4
morpho = form, structure; logy = study of cyto = cell; logy = study of
(a) (b)
Figure 1.1 Evolution of Medical Art. Two illustrations of the skeletal system made about 500 years apart. (a) From an eleventh-century work
attributed to Persian physician Avicenna. (b) From De Humani Corporis Fabrica (1543) by Andreas Vesalius.
©NLM/Science Source
skin and nails, for example, can provide clues to such underlying tissues and can be used to produce images on X-ray film or through
problems as vitamin deficiencies, anemia, heart disease, and liver electronic detectors. The benefits of ionizing radiation must always
disease. Physical examinations involve not only looking at the body be weighed against its risks. It is called ionizing because it ejects
for signs of normalcy or disease, but also touching and listening to it. electrons from the atoms and molecules it strikes. This effect can
Palpation5 means feeling a structure with the hands, such as palpat- cause mutation and trigger cancer, so ionizing radiation cannot be
ing a swollen lymph node or taking a pulse. Auscultation6 (AWS-cul- used indiscriminately. Used judiciously, however, the benefits of a
TAY-shun) is listening to the natural sounds made by the body, such mammogram or dental X-ray substantially outweigh the small risk.
as heart and lung sounds. In percussion, the examiner taps on the Some of the imaging methods to follow are considered
body, feels for abnormal resistance, and listens to the emitted sound noninvasive because they do not involve any penetration of the skin
for signs of abnormalities such as pockets of fluid, air, or scar tissue. or body orifices. Invasive imaging techniques may entail inserting
A deeper understanding of the body depends on dissection ultrasound probes into the esophagus, vagina, or rectum to get
(dis-SEC-shun)—the careful cutting and separation of tissues to closer to the organ to be imaged, or injecting substances into the
reveal their relationships. The very words anatomy7 and dissection8 bloodstream or body passages to enhance image formation.
both mean “cutting apart”; until the nineteenth century, dissection Any anatomy student today must be acquainted with the basic
was called “anatomizing.” In many schools of health science, cadaver techniques of radiology and their respective advantages and limita-
dissection is one of the first steps in the training of students. tions. Many of the images printed in this book have been produced
Dissection, of course, is not the method of choice when study- by the following techniques.
ing a living person! Not long ago, it was common to diagnose
disorders through exploratory surgery—opening the body and tak- Radiography
ing a look inside to see what was wrong and what could be done Radiography, first performed in 1895, is the process of photograph-
about it. Any breach of the body cavities is risky, however, and ing internal structures with X-rays. Until the 1960s, this was the only
most exploratory surgery has now been replaced by medical imag- widely available imaging method; even today, it accounts for more than
ing techniques—methods of viewing the inside of the body without 50% of all clinical imaging. X-rays pass through the soft tissues of the
surgery. The branch of medicine concerned with imaging is called body to a photographic film or detector on the other side, where they
radiology. Anatomy learned in this way is called radiologic anat- produce relatively dark images. They are absorbed, however, by dense
omy, and those who use radiologic methods for clinical purposes matter such as bones, teeth, tumors, and tuberculosis nodules, which
include radiologists and radiologic technicians. leave the image lighter in these areas (fig. 1.2a). The term X-ray also
Some radiologic methods involve high-energy ionizing radiation applies to a photograph (radiograph) made by this method. Radiogra-
such as X-rays or particles called positrons. These penetrate the phy is commonly used in dentistry, mammography, diagnosis of frac-
tures, and examination of the chest. Hollow organs can be visualized
5
palp = touch, feel; ation = process by filling them with a contrast medium that absorbs X-rays. Barium
6
auscult = listen; ation = process
7
ana = apart; tom = cut sulfate, for example, is given orally for examination of the esophagus,
8
dis = apart; sect = cut stomach, and small intestine, or by enema for examination of the large
(a) X-ray (radiograph) (b) Cerebral angiogram (c) Computed tomographic (CT) scan
intestine. Other substances are given by injection for a ngiography, the these images to construct a three-dimensional image of the body.
examination of blood vessels (fig. 1.2b). Some disadvantages of radi- CT scanning has the advantage of imaging thin sections of the
ography are that images of overlapping organs can be confusing and body, so there is little organ overlap and the image is much sharper
slight differences in tissue density are not easily detected. than a conventional X-ray. It requires extensive knowledge of cross-
Blood vessels can be seen much more sharply, however, with sectional anatomy to interpret the images. CT scanning is useful
a new radiographic method called digital subtraction angiography for identifying tumors, aneurysms, cerebral hemorrhages, kidney
(DSA). This entails taking X-rays before and after injecting a con- stones, and other abnormalities.
trast medium into a vessel. A computer then “erases” the first image The dynamic spatial reconstructor (DSR) is a modified CT
from the second, leaving a clear, dark image of just the injected ves- scanner that produces dynamic, three-dimensional video images
sels without the overlying and surrounding tissues. This is useful for rather than two-dimensional static ones. It shows organ motion and
showing vascular blockages and anatomical malformations, abnor- volume changes, and is valuable for visualizing heart movements
malities of cerebral blood flow, and narrowing (stenosis) of renal and blood flow.
arteries, and as an aid in threading catheters into blood vessels.
Magnetic Resonance Imaging
Computed Tomography Magnetic resonance imaging (MRI) (fig. 1.2d) is better than CT for
Computed tomography (a CT scan) is a more sophisticated applica- visualizing soft tissues. The patient lies in either a tube or an open-
tion of X-rays. The patient is moved through a ring-shaped machine sided scanner surrounded by a powerful electromagnet. Hydrogen
that emits low-intensity X-rays on one side and receives them with atoms in the patient’s tissues alternately align themselves with this
a detector on the opposite side. A computer analyzes signals from magnetic field and with a radio-frequency field turned on and off
the detector and produces an image of a “slice” of the body about by the technologist. These changes in hydrogen alignment generate
as thin as a coin (fig. 1.2c). The computer can “stack” a series of signals that are analyzed by computer to produce an anatomical
image. MRI can “see” clearly through the skull and spine to produce
images of the nervous tissue within, and it is better than CT for dis-
tinguishing between soft tissues such as the white and gray matter of
the brain. It has some disadvantages, however, such as the claustro-
phobic feeling some patients experience in the scanner, loud noises
generated by the machine, and long exposure times that prevent
sharp images being made of the constantly moving stomach and
intestines. Open-sided MRI machines are favored by some claustro-
phobic or obese patients, but have weaker magnetic fields, produce
poorer images, and may miss important tissue abnormalities.
Functional MRI (fMRI) is a form of MRI that visualizes moment-
to-moment changes in tissue physiology; fMRI scans of the brain,
for example, show shifting patterns of activity as the brain applies (a)
itself to a specific task. This method has been very useful in clari-
fying which parts of the brain are involved in emotions, thought,
language, sensation, and movement. Figure 1.3 Fetal Sonography.
(a) A patient getting a fetal
sonogram. (b) A three-dimensional
Positron Emission Tomography fetal image made at 32 weeks of
Positron emission tomography (the PET scan) is used to assess the meta- gestation.
bolic state of a tissue and to distinguish which tissues are most active at • Why is sonography safer for
a given moment (fig. 1.2e). The procedure begins with an injection of the fetus than radiography or
computed tomography?
radioactively labeled glucose, which emits positrons (electron-like par- (a) ©Keith Brofsky/Getty Images; (b) ©Kenneth Saladin
(b)
ticles with a positive charge). When a positron and electron meet, they
annihilate each other and give off gamma rays that can be detected by
sensors and processed by computer. The result is a color image that shows Apply What You Know
which tissues were using the most glucose. In cardiology, PET scans can The concept of MRI was conceived in 1948 but could not
show the extent of tissue death from a heart attack. Since damaged tissue be put into clinical practice until the 1970s. Speculate on a
consumes little or no glucose, it appears dark. In neuroscience, PET scans possible reason for this delay.
can similarly reveal the extent of brain damage from stroke or trauma.
PET scans are also used to diagnose cancer and evaluate tumor status;
they can often reveal small tumors earlier than they would be detected by 1.1c Variation in Human Structure
CT or MRI. The PET scan is an example of nuclear medicine—the use of A quick look around any classroom is enough to show that no two humans
radioisotopes to treat disease or to form diagnostic images of the body. look exactly alike; on close inspection, even identical twins exhibit differ-
ences. Anatomy atlases and textbooks can easily give you the impression
Sonography that everyone’s internal anatomy is the same, but this simply is not true.
Sonography9 is the second oldest and second most widely used Books such as this one can teach you only the most common structure—
method of imaging. A handheld device pressed against the skin the anatomy seen in approximately 70% or more of people. Someone who
emits high-frequency ultrasound waves and receives the signals thinks that all human bodies are the same internally would make a con-
reflected back from internal organs. Sonography avoids the harm- fused medical student or an incompetent surgeon.
ful effects of X-rays, and the equipment is relatively inexpensive Some people completely lack certain organs. For example, most
and portable. Its primary disadvantages are that it cannot penetrate of us have a palmaris longus muscle in the forearm and a plantaris
bone and it usually does not produce a very sharp image. Although muscle in the leg, but not everyone. Most of us have five lumbar ver-
sonography was first used medically in the 1950s, images of sig- tebrae (bones of the lower spine), but some have four and some have
nificant clinical value had to wait until computer technology had six. Most of us have one spleen, but some people have two. Most have
developed enough to analyze differences in the way tissues reflect two kidneys, but some have only one. Most kidneys are supplied by
ultrasound. Sonography is not very useful for examining bones or a single renal artery and drained by one ureter, but in some people, a
lungs, but it is the method of choice in obstetrics, where the image single kidney has two renal arteries or ureters. Figure 1.4 shows some
(sonogram) can be used to locate the placenta and evaluate fetal common variations in human anatomy, and Clinical Application 1.1
age, position, and development (fig. 1.3). Sonography can also be describes a particularly dramatic variation.
used to view tissues in motion, such as fetal movements, a beating
heart, and blood ejection from the heart. Sonographic imaging of
the beating heart is called echocardiography. A Doppler ultrasound Apply What You Know
scan is a sonographic method for visualizing heart actions and the People who are allergic to penicillin or aspirin often wear
flow of blood through the vessels. bracelets or necklaces that note this fact in case they need
emergency medical treatment and cannot communicate. Why
would it be important for a person with situs inversus (see
9
Clinical Application 1.1) to have this noted on a bracelet?
sono = sound; graphy = recording process
Engineer checks design information for first computer built from complete
information furnished by another computer. Shown is a subassembly of the
computer, which will be used in the Army’s Nike-Zeus antimissile defense system.
After a rather hard to explain slow start, then, the computer is now
well established as a scientific and engineering tool. Blue-sky
schemes describe systems in which the engineer simply discusses
his problem with the machine, giving specifications and the desired
piece of equipment. The machine talks back, rejecting certain
proposed inputs and suggesting alternatives, and finally comes up
with the finished design for the engineer’s approval. If he laughs
overly loud at this possibility, the engineer may be trying to cover up
his real feelings. At any rate the computer has added a thinking cap
to its wardrobe of eyeshade and work gloves.
Digital Doctor
Medical electronics is a fairly well-known new field of science, but
the part being played in medicine by the computer is surprising to
those of us not close to this work. Indicative of the use of the
computer by medical scientists is a study of infant death rates being
conducted by the American Medical Research Foundation. Under
the direction of Dr. Sydney Kane, this research uses a UNIVAC
computer and in 1961 had already processed information on 50,000
births in ninety participating hospitals. Punched-card data include the
mother’s age, maternal complications, type of delivery, anesthetics
used, and other pertinent information. Dr. Kane believes that
analysis by the computer of this information may determine causes
of deaths, after-birth pathological conditions, and incapacity of
babies to reach viability. A reduction in infant mortality of perhaps
12,000 to 14,000 annually is believed possible as a result of the
studies.
Another killer of mankind, cancer, is being battled by the computer.
Researchers at the University of Philadelphia, supported in part by
the American Cancer Society, are programming electronic
computers to act as cancer cells! The complexity of the problem is
seen in the fact that several man-years of work and 500 hours of
computer programming have barely scratched the surface of the
problem. A third of a million molecules make up the genes in a
human cell, and the actions of these tiny components take place
many times faster than even the high-speed computer can operate.
Despite the problems, some answers to tough chemical questions
about the cancer cells are being found by using the computer, which
is of course thousands of times faster than manual computation.
If you were discharged from a hospital in 1962, there is a chance
that your records are being analyzed by a computer at Ann Arbor,
Michigan as part of the work of the Commission on Professional and
Hospital Activity. Information on 2-1/2 million patients from thirty-four
states will be processed by a Honeywell 400 computer to evaluate
diagnostic and hospital care and to compare the performance of the
various institutions.
In the first phase of a computerized medical literature analysis and
retrieval system for the National Library of Medicine, the U.S. Public
Health Service contracted with General Electric for a system called
MEDLARS, MEDical Literature Analysis and Retrieval System.
MEDLARS will process several hundred thousand pieces of medical
information each year. New York University’s College of Engineering
has formed a biomedical computing section to provide computer
service for medical researchers. Using an IBM 650 and a Control
Data Corporation 1604, the computer section has already done
important work, including prediction of coronary diseases in men
under forty.
The success of computers in these small-scale applications to the
problems of medicine has prompted the urging of a national
biomedical computer system. It is estimated that as yet only about 5
per cent of medical research projects are using computer
techniques, but that within ten years the figure will jump to between
50 and 75 per cent.
An intriguing possibility is the use of the computer as a diagnostic
tool. Small office machines, costing perhaps only $50, have been
suggested, not by quacks or science-fiction writers, but by scientists
like Vladimir Zworykin of the Rockefeller Institute of Medical
Research. Zworykin is the man who fathered the iconoscope and
kinescope that made television possible. The simple diagnostic
computer he proposes would use information compiled by a large
electronic computer which might eventually catalog the symptoms of
as many as 10,000 diseases. Using an RCA 501 computer, a pilot
project of this technique has already gathered symptoms of 100
hematological diseases.
Another use of the computer is in the HIPO system. Despite its
frightening acronymic name, this is merely a plan for the automated
dispensing of the right medicine at the right time to the right patient,
thus speeding recoveries and preventing the occasional tragic
results of wrong dosage. More exotic is a computer called the
Heikolator which is designed to substitute for the human brain in
transmitting messages to paralyzed limbs that could otherwise not
function.
The simulation of body parts by the computer for study is already
taking place. Some researchers treat the flow of blood through
arteries as similar to the flow of water through a rubber tube, analyze
these physical actions, and use them in computer simulation of the
human system. The Air Force uses a computer to simulate the
physical chemistry of the entire respiratory and circulatory systems,
a task that keeps track of no less than fifty-three interdependent
variables.
Dr. Kinsey of the Kresge Eye Institute in Detroit is directing
computer work concerning the physiology of the eye. According to
Kinsey it was impossible previously to approximate the actual
composition of cell substances secreted from the blood into the eye.
Even those whose eyes no longer serve them are being benefited by
computer research. The Battelle Memorial Institute in Columbus,
Ohio, uses an IBM computer to develop reading devices for the
blind. These complicated readers use a digital computer to convert
patterns of printed letters into musical tones. Further sophistication
could lead to an output of verbalized words. Interestingly, it is
thought that the research will also yield applications of use in
banking, postal service, and other commercial fields.
Russia is also aware of the importance of the computer in the
medical field. A neurophysiologist reported after a trip to Russia that
the Soviet Union is training its brightest medical students in the use
of the computer. Such a philosophy is agreed to by medical
spokesmen in this country who state that no other field can make
better use of the computer’s abilities. Among advanced Russian
work with computers in the biomedical field is a study of the effects
on human perception of changes in sound and color.
Visionary ideas like those of radio transmitters implanted in
patients to beam messages to a central computer for continuous
monitoring and diagnosis are beginning to take on the appearance of
distinct possibilities. Some are beginning to wonder if after it has
learned a good bedside manner, the computer may even ask for a
scalpel and a TV series.
Music
The computer has proved itself qualified in a number of fields and
professions, but what of the more artistic ones? Not long ago RCA
demonstrated an electronic computer as an aid to the musical
composer. Based on random probability, this machine is no tongue-
in-cheek gadget but has already produced its own compositions
based on the style of Stephen Foster. Instead of throwing up their
hands in shocked horror, modern composers like Aaron Copland
welcome the music “synthesizer” with open arms. Bemoaning only
the price of such a computer—about $150,000—Copland looks to
the day when the composer will feed in a few rough ideas and have
the machine produce a fully orchestrated piece. The orchestration,
incidentally, will include sounds no present instruments can produce.
“Imagine what will happen when every combination of eighty-eight
keys is played,” Copland suggests. Many traditionalists profess to
shudder at the thought of a machine producing music, but
mathematical compositions are no novelty. Even random music was
“composed” by Mozart, whose “A Musical Dice Game” is chance
music with a particularly descriptive title, and Dr. John Pierce of Bell
Laboratories has extended such work.
Taken from “Illiac Suite,” by L. A. Hiller
and L. M. Isaacson, copyrighted 1957, by
Theodore Presser Co. Used by permission.
Listen: [MP3]
“Our new ‘brain’ recognizes the human factor, doctor!... After feeding it the
symptoms, it gives the diagnosis and treatment.... But YOU set the fee!”
“Men have become the tools of their tools.”
—Thoreau
9: The Computer and Automation
In his movie, City Lights, Charlie Chaplin long ago portrayed the
terrible plight of the workman in the modern factory. Now that the
machine is about to take over completely and relieve man of this
machinelike existence, it is perhaps time for Charlie to make another
movie pointing up this new injustice of civilization or machine’s
inhumanity to man. It seems to be damned if it does and damned if it
doesn’t.
For some strange reason, few of us become alarmed at the news
of a computer solving complex mathematics, translating a book, or
processing millions of checks daily, but the idea of a computer
controlling a factory stimulates union reprisals, editorials in the press
against automation, and much general breast-beating and soul-
searching. Perversely we do not seem to mind the computer’s
thinking as much as we do its overt action.
It is well to keep sight of the fact that automation is no new
revolution, but the latest development in the garden variety of
industrial revolution that began a couple of centuries ago in England:
Mechanization was the first step in that revolution, mechanization being the
application of power to supplement the muscles of men. Mass production came
along as the second step at the turn of this century. It was simply an organization
of mechanized production for faster, more efficient output.
Automation is the latest logical extension of the two earlier steps, made possible
by rapid information handling and control. Recent layoffs in industry triggered
demonstrations, including television programs, that would indicate we suspect
automation of having a rather cold heart. The computer is the heart of automation.
Remington Rand UNIVAC