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A LANGE medical book

Ganong’s Review of
Medical Physiology
TWENTY-FIFTH EDITION

Kim E. Barrett, PhD Scott Boitano, PhD


Distinguished Professor, Department of Medicine Professor, Physiology and Cellular and Molecular
Dean of the Graduate Division Medicine
University of California, San Diego Arizona Respiratory Center
La Jolla, California Bio5 Collaborative Research Institute
University of Arizona
Tucson, Arizona
Susan M. Barman, PhD
Professor, Department of Pharmacology/
Toxicology Heddwen L. Brooks, PhD
Michigan State University Professor, Physiology and Pharmacology
East Lansing, Michigan College of Medicine
University of Arizona
Tucson, Arizona

New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto

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Copyright © 2016 by McGraw-Hill Education. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be
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ISBN: 978-0-07-184897-8

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whether such claim or cause arises in contract, tort or otherwise.
Dedication to
William Francis Ganong

W
illiam Francis (“Fran”) Ganong was an outstanding remarked on and admired whenever the book came up for dis-
scientist, educator, and writer. He was completely cussion among physiologists. He was an excellent writer and
dedicated to the field of physiology and medical ed- far ahead of his time with his objective of distilling a complex
ucation in general. Chairman of the Department of Physiology subject into a concise presentation. Like his good friend, Dr.
at the University of California, San Francisco, for many years, Jack Lange, founder of the Lange series of books, Fran took
he received numerous teaching awards and loved working with great pride in the many different translations of the Review of
medical students. Medical Physiology and was always delighted to receive a copy
Over the course of 40 years and some 22 editions, he was of the new edition in any language.
the sole author of the best selling Review of Medical Physiology, He was a model author, organized, dedicated, and enthusi-
and a co-author of 5 editions of Pathophysiology of Disease: An astic. His book was his pride and joy and like other best-selling
Introduction to Clinical Medicine. He was one of the “deans” authors, he would work on the next edition seemingly every
of the Lange group of authors who produced concise medical day, updating references, rewriting as needed, and always ready
text and review books that to this day remain extraordinarily and on time when the next edition was due to the publisher. He
popular in print and now in digital formats. Dr. Ganong made did the same with his other book, Pathophysiology of Disease:
a gigantic impact on the education of countless medical stu- An Introduction to Clinical Medicine, a book that he worked on
dents and clinicians. meticulously in the years following his formal retirement and
A general physiologist par excellence and a neuroendo- appointment as an emeritus professor at UCSF.
crine physiologist by subspecialty, Fran developed and main- Fran Ganong will always have a seat at the head table of
tained a rare understanding of the entire field of physiology. the greats of the art of medical science education and commu-
This allowed him to write each new edition (every 2 years!) nication. He died on December 23, 2007. All of us who knew
of the Review of Medical Physiology as a sole author, a feat him and worked with him miss him greatly.

Barrett_FM_i-xii_P1.indd 3 6/30/15 1:20 PM


Key Features of the Twenty-Fifth Edition of
Ganong’s Review of Medical Physiology
A concise, up-to-date and clinically relevant review
of human physiology
• Provides succinct coverage of every important topic without sacrificing
comprehensiveness or readability
• Reflects the latest research and developments in the areas of chronic pain,
reproductive physiology, and acid-base homeostasis
• Incorporates examples from clinical medicine to illustrate important
physiologic concepts
• Section introductions help you build a solid foundation on the given topic
• Includes both end-of-chapter and board-style review questions
• Chapter summaries ensure
retention of key concepts
CHAPTER 37 Renal Function & Micturition 673

• More clinical cases and flow charts Podocyte


A Proximal tubule B

than ever, along with modern Capsule


Red blood cells
Glomerular basal
approaches to therapy Mesangial
cell
lamina
Bowman’s space Capillary
Capillary

• Expanded legends for each Granular cells

illustration—so you don’t have to Podocyte


processes Nerve fibers
Podocyte
process

refer back to the text Efferent


arteriole
Afferent
arteriole
Capillary Capillary
Basal
lamina

Distal tubule Smooth muscle

• Introductory materials cover key Macula densa Mesangial cell Cytoplasm of


endothelial
cell

principles of endocrine regulation C Basal lamina Endothelium D

in physiology Basal lamina


Endothelium Foot processes
of podocytes
Podocyte Filtration slit

Bowman’s
Fenestrations
space

Capillary lumen
Basal lamina

FIGURE 37–2 Structural details of glomerulus. A) Section through vascular pole, showing capillary loops. B) Relation of mesangial cells
and podocytes to glomerular capillaries. C) Detail of the way podocytes form filtration slits on the basal lamina, and the relation of the lamina
to the capillary endothelium. D) Enlargement of the rectangle in C to show the podocyte processes. The fuzzy material on their surfaces is
glomerular polyanion.

about 12 m2. The volume of blood in the renal capillaries at any glomerular filtration rate (GFR) and is claimed to enhance and
given time is 30–40 mL. prolong anuria in acute kidney injury (AKI).
More than LYMPHATICS INNERVATION OF
600 full-color The kidneys have an abundant lymphatic supply that drains
via the thoracic duct into the venous circulation in the thorax.
THE RENAL VESSELS
The renal nerves travel along the renal blood vessels as they
illustrations CAPSULE enter the kidney. They contain many postganglionic sym-
pathetic efferent fibers and a few afferent fibers. There also
The renal capsule is thin but tough. If the kidney becomes appears to be a cholinergic innervation via the vagus nerve,
edematous, the capsule limits the swelling, and the tissue but its function is uncertain. The sympathetic pregangli-
pressure (renal interstitial pressure) rises. This decreases the onic innervation comes primarily from the lower thoracic

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CHAPTER 11 Smell & Taste 225

Taste exhibits after reactions and contrast phenomena 2. A 37-year-old female was diagnosed with multiple sclerosis.
that are similar in some ways to visual after images and con- One of the potential consequences of this disorder is
trasts. Some of these are chemical “tricks,” but others may be diminished taste sensitivity. Taste receptors
true central phenomena. A taste-modifier protein, miraculin, A. for sweet, sour, bitter, salt, and umami are spatially separated
has been discovered in a plant. When applied to the tongue, on the surface of the tongue.
this protein makes acids taste sweet. B. are synonymous with taste buds.
C. are a type of chemoreceptor.
Animals, including humans, form particularly strong
D. are innervated by afferents in the facial, trigeminal, and
aversions to novel foods if eating the food is followed by ill-
glossopharyngeal nerves.
ness. The survival value of such aversions is apparent in terms E. All of the above.
of avoiding poisons.
3. Which of the following does not increase the ability to
discriminate many different odors?
CHAPTER SUMMARY A. Many different receptors


B. Pattern of olfactory receptors activated by a given
Olfactory sensory neurons, supporting (sustentacular) cells, odorant
and basal stem cells are located in the olfactory epithelium C. Projection of different mitral cell axons to different parts of


within the upper portion of the nasal cavity.
The cilia located on the dendritic knob of the olfactory
sensory neuron contain odorant receptors that are coupled to
the brain
D. High β-arrestin content in olfactory neurons
E. Sniffing
End-of-chapter review
G-proteins. Axons of olfactory sensory neurons contact the
dendrites of mitral and tufted cells in the olfactory bulbs to
form olfactory glomeruli.
4. As a result of an automobile accident, a 10-year-old boy suffered
damage to the brain including the periamygdaloid, piriform, questions help you assess

and entorhinal cortices. Which of the following sensory deficits
Information from the olfactory bulb travels via the lateral
olfactory stria directly to the olfactory cortex, including
the anterior olfactory nucleus, olfactory tubercle, piriform
is he most likely to experience?
A. Visual disturbance
B. Hyperosmia
your comprehension
cortex, amygdala, and entorhinal cortex.

C. Auditory problems
Taste buds are the specialized sense organs for taste and are D. Taste and odor abnormalities
composed of basal stem cells and three types of taste cells (dark, E. No major sensory deficits
light, and intermediate). The three types of taste cells may
5. Which of the following are incorrectly paired?
represent various stages of differentiation of developing taste
cells, with the light cells being the most mature. Taste buds are A. ENaC : Sour taste
located in the mucosa of the epiglottis, palate, and pharynx and B. Gustducin : Bitter taste
in the walls of papillae of the tongue. C. T1R3 family of GPCRs : Sweet taste


D. Heschel sulcus : Smell
There are taste receptors for sweet, sour, bitter, salt, and
E. Ebner glands : Taste acuity
umami. Signal transduction mechanisms include passage
through ion channels, binding to and blocking ion channels, 6. A 9-year-old boy had frequent episodes of uncontrollable nose
and GPCRs requiring second messenger systems. bleeds. At the advice of his clinician, he underwent surgery

to correct a problem in his nasal septum. A few days after the
The afferents from taste buds in the tongue travel via
surgery, he told his mother he could not smell the cinnamon
the seventh, ninth, and tenth cranial nerves to synapse
rolls she was baking in the oven. Which of the following is true
in the NTS. From there, axons ascend via the ipsilateral
about olfactory transmission?
medial lemniscus to the ventral posteromedial nucleus
of the thalamus, and onto the anterior insula and frontal A. An olfactory sensory neuron expresses a wide range of
operculum in the ipsilateral cerebral cortex. odorant receptors.
B. Lateral inhibition within the olfactory glomeruli reduces
the ability to distinguish between different types of odorant
MULTIPLE-CHOICE QUESTIONS receptors.
C. Conscious discrimination of odors is dependent on the
For all questions, select the single best answer unless otherwise pathway to the orbitofrontal cortex.
directed. D. Olfaction is closely related to gustation because odorant and
1. A young boy was diagnosed with congenital anosmia, a rare gustatory receptors use the same central pathways.
disorder in which an individual is born without the ability to E. All of the above.
smell. Odorant receptors are 7. A 31-year-old female is a smoker who has had poor oral
A. located in the olfactory bulb. hygiene for most of her life. In the past few years she has
B. located on dendrites of mitral and tufted cells. noticed a reduced sensitivity to the flavors in various foods
C. located on neurons that project directly to the olfactory which she used to enjoy eating. Which of the following is not
cortex. true about gustatory sensation?
D. located on neurons in the olfactory epithelium that project A. The sensory nerve fibers from the taste buds on the anterior
to mitral cells and from there directly to the olfactory cortex. two-thirds of the tongue travel in the chorda tympani
E. located on sustentacular cells that project to the olfactory bulb. branch of the facial nerve.

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132 SECTION I Cellular and Molecular Basis for Medical Physiology

CLINICAL BOX 6–2

Myasthenia Gravis arthritis, systemic lupus erythematosus, and polymyositis.


Myasthenia gravis is a serious and sometimes fatal disease in About 30% of patients with myasthenia gravis have a mater-
which skeletal muscles are weak and tire easily. It occurs in 25 nal relative with an autoimmune disorder. These associations
to 125 of every 1 million people worldwide and can occur at suggest that individuals with myasthenia gravis share a genetic
any age but seems to have a bimodal distribution, with peak predisposition to autoimmune disease. The thymus may play
occurrences in individuals in their 20s (mainly women) and a role in the pathogenesis of the disease by supplying helper
60s (mainly men). It is caused by the formation of circulating T cells sensitized against thymic proteins that cross-react with
antibodies to the muscle type of nicotinic cholinergic recep- acetylcholine receptors. In most patients, the thymus is hyper-
tors. These antibodies destroy some of the receptors and bind plastic; and 10–15% have a thymoma.
others to neighboring receptors, triggering their removal by
endocytosis. Normally, the number of quanta released from THERAPEUTIC HIGHLIGHTS
the motor nerve terminal declines with successive repetitive
Muscle weakness due to myasthenia gravis improves
stimuli. In myasthenia gravis, neuromuscular transmission fails
after a period of rest or after administration of an ace-
at these low levels of quantal release. This leads to the major
tylcholinesterase inhibitor such as neostigmine or
clinical feature of the disease, muscle fatigue with sustained
pyridostigmine. Cholinesterase inhibitors prevent
or repeated activity. There are two major forms of the disease.
metabolism of acetylcholine and can thus compensate
In one form, the extraocular muscles are primarily affected. In
for the normal decline in released neurotransmitters dur-
the second form, there is a generalized skeletal muscle weak-
ing repeated stimulation. Immunosuppressive drugs
ness. In severe cases, all muscles, including the diaphragm,
(eg, prednisone, azathioprine, or cyclosporine) can
can become weak and respiratory failure and death can ensue.
suppress antibody production and have been shown to
The major structural abnormality in myasthenia gravis is the
improve muscle strength in some patients with myas-
appearance of sparse, shallow, and abnormally wide or absent
thenia gravis. Thymectomy is indicated especially if a
synaptic clefts in the motor endplate. Studies show that the
thymoma is suspected in the development of myasthe-
postsynaptic membrane has a reduced response to acetylcho-
nia gravis. Even in those without thymoma, thymectomy
line and a 70–90% decrease in the number of receptors per
induces remission in 35% and improves symptoms in
endplate in affected muscles. Patients with mysathenia gravis
another 45% of patients.
have a greater than normal tendency to also have rheumatoid

CLINICAL BOX 6–3


Clinical cases add Lambert–Eaton Syndrome prostate, bladder, kidney, or gallbladder. Clinical signs usually

real-world relevance In a relatively rare condition called Lambert–Eaton myas-


thenic syndrome (LEMS), muscle weakness is caused by an
precede the diagnosis of cancer. A syndrome similar to LEMS
can occur after the use of aminoglycoside antibiotics, which
also impair Ca2+ channel function.
autoimmune attack against one of the voltage-gated Ca2+

to the text channels in the nerve endings at the neuromuscular junc-


tion. This decreases the normal Ca2+ influx that causes acetyl- THERAPEUTIC HIGHLIGHTS
choline release. The incidence of LEMS in the United States is Since there is a high comorbidity with small cell lung can-
about 1 case per 100,000 people; it is usually an adult-onset cer, the first treatment strategy is to determine whether
disease that appears to have a similar occurrence in men and the individual also has cancer and, if so, to treat that
women. Proximal muscles of the lower extremities are primar- appropriately. In patients without cancer, immunother-
ily affected, producing a waddling gait and difficulty raising apy is initiated. Prednisone administration, plasma-
the arms. Repetitive stimulation of the motor nerve facilitates pheresis, and intravenous immunoglobulin are some
accumulation of Ca2+ in the nerve terminal and increases ace- examples of effective therapies for LEMS. Also, the use of
tylcholine release, leading to an increase in muscle strength. aminopyridines facilitates the release of acetylcholine
This is in contrast to myasthenia gravis in which symptoms are in the neuromuscular junction and can improve muscle
exacerbated by repetitive stimulation. About 40% of patients strength in LEMS patients. This class of drugs causes
with LEMS also have cancer, especially small cell cancer of the blockade of presynaptic K+ channels and promote activa-
lung. One theory is that antibodies that have been produced to tion of voltage-gated Ca2+ channels. Acetylcholinesterase
attack the cancer cells may also attack Ca2+ channels, leading inhibitors can be used but often do not ameliorate the
to LEMS. LEMS has also been associated with lymphosarcoma; symptoms of LEMS.
malignant thymoma; and cancer of the breast, stomach, colon,

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About the Authors
KIM E. BARRETT and an MSU College of Human Medicine Distinguished Faculty
Award. She has been very active in the American Physiologi-
Kim Barrett received her PhD in biological cal Society (APS) and served as its 85th President. She has also
chemistry from University College London served as a Councillor as well as Chair of the Central Nervous
in 1982. Following postdoctoral training at System Section of APS, Women in Physiology Committee and
the National Institutes of Health, she joined Section Advisory Committee of APS. She is also active in the
the faculty at the University of California, San Michigan Physiological Society, a chapter of the APS.
Diego, School of Medicine in 1985, rising to
the rank of Professor of Medicine in 1996, SCOTT BOITANO
and was named Distinguished Professor of
Scott Boitano received his PhD in
Medicine in 2015. Since 2006, she has also
genetics and cell biology from Washing-
served the University as Dean of the Graduate Division. Her
ton State University in Pullman, Wash-
research interests focus on the physiology and pathophysiology
ington, where he acquired an interest
of the intestinal epithelium, and how its function is altered by
in cellular signaling. He fostered this
commensal, probiotic, and pathogenic bacteria as well as in
interest at University of California, Los
specific disease states, such as inflammatory bowel diseases. She
Angeles, where he focused his research
has published more than 200 articles, chapters, and reviews, and
on second messengers and cellular
has received several honors for her research accomplishments
physiology of the lung epithelium. How
including the Bowditch and Davenport Lectureships from the
the airway epithelium contributes to lung health has remained a
American Physiological Society and the degree of Doctor of
central focus of his research at the University of Wyoming and
Medical Sciences, honoris causa, from Queens University, Belfast.
in his current positions with the Departments of Physiology and
She has been very active in scholarly editing, serving currently
Cellular and Molecular Medicine, the Arizona Respiratory Center
as the Deputy Editor-in-Chief of the Journal of Physiology. She
and the Bio5 Collaborative Research Institute at the University of
is also a dedicated and award-winning instructor of medical,
Arizona. Dr. Boitano remains an active member of the American
pharmacy, and graduate students, and has taught various topics
Physiological Society and served as the Arizona Chapter’s Presi-
in medical and systems physiology to these groups for more than
dent from 2010–2012.
20 years. Her efforts as a teacher and mentor were recognized
with the Bodil M. Schmidt-Nielson Distinguished Mentor and
Scientist Award from the American Physiological Society (APS)
HEDDWEN L. BROOKS
in 2012, and she also served as the 86th APS President from Heddwen Brooks received her PhD from
2013–14. Her teaching experiences led her to author a prior Imperial College, University of London and
volume (Gastrointestinal Physiology, McGraw-Hill, 2005; second is a Professor in the Departments of Physi-
edition published in 2014) and she was honored to have been ology and Pharmacology at the University
invited to take over the helm of Ganong in 2007 for the 23rd and of Arizona (UA). Dr Brooks is a renal phys-
subsequent editions, including this one. iologist and is best known for her develop-
ment of microarray technology to address
SUSAN M. BARMAN in vivo signaling pathways involved in the
hormonal regulation of renal function. Dr
Susan Barman received her PhD in physiol-
Brooks’ many awards include the American Physiological Society
ogy from Loyola University School of Med-
(APS) Lazaro J. Mandel Young Investigator Award, which is for
icine in Maywood, Illinois. Afterward she
an individual demonstrating outstanding promise in epithelial
went to Michigan State University (MSU)
or renal physiology. In 2009, Dr Brooks received the APS Renal
where she is currently a Professor in the
Young Investigator Award at the annual meeting of the Federation
Department of Pharmacology/Toxicology
of American Societies for Experimental Biology. Dr Brooks served
and the Neuroscience Program. Dr Barman
as Chair of the APS Renal Section (2011–2014) and currently
has had a career-long interest in neural con-
serves as Associate Editor for the American Journal of Physiology-
trol of cardiorespiratory function with an
Regulatory, Integrative and Comparative Physiology and on the
emphasis on the characterization and origin
Editorial Board for the American Journal of Physiology-Renal
of the naturally occurring discharges of sympathetic and phrenic
Physiology (since 2001). Dr Brooks has served on study sections
nerves. She was a recipient of a prestigious National Institutes of
of the National Institutes of Health, the American Heart Associa-
Health MERIT (Method to Extend Research in Time) Award. She
tion and recently was a member of the Nephrology Merit Review
is also a recipient of an Outstanding University Woman Faculty
Board for the Department of Veterans’ Affairs.
Award from the MSU Faculty Professional Women’s Association
vii

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Contents
Preface xi

S E C T I O N
13 Autonomic Nervous System 255
Cellular & Molecular

I Basis for Medical


Physiology 1
14 Electrical Activity of the Brain, Sleep–
Wake States, & Circadian Rhythms 269

15 Learning, Memory, Language,


1 General Principles & Energy Production & Speech 283
in Medical Physiology 3

2 Overview of Cellular Physiology in Medical


Physiology 33 S E C T I O N
Endocrine & Reproductive
3 Immunity, Infection, & Inflammation 67

4 Excitable Tissue: Nerve 85


III Physiology 297

16 Basic Concepts of Endocrine


5 Excitable Tissue: Muscle 99 Regulation 299
6 Synaptic & Junctional Transmission 121 17 Hypothalamic Regulation of Hormonal
Functions 307
7 Neurotransmitters & Neuromodulators 137
18 The Pituitary Gland 321

S E C T I O N 19 The Thyroid Gland 337


Central & Peripheral
II Neurophysiology 157 20 The Adrenal Medulla & Adrenal Cortex 351

21 Hormonal Control of Calcium, & Phosphate


8 Somatosensory Neurotransmission: Metabolism & the Physiology of Bone 375
Touch, Pain, & Temperature 159
22 Reproductive Development & Function of the
9 Vision 177 Female Reproductive System 389

10 Hearing & Equilibrium 199 23 Function of the Male Reproductive


System 417
11 Smell & Taste 217
24 Endocrine Functions of the Pancreas
12 Reflex & Voluntary Control of & Regulation of Carbohydrate
Posture & Movement 227 Metabolism 429

ix

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x CONTENTS

S E C T I O N S E C T I O N
Gastrointestinal
IV Physiology 451
VI Respiratory Physiology 619

25 Overview of Gastrointestinal Function 34 Introduction to Pulmonary Structure


& Regulation 453 & Mechanics 621

26 Digestion, Absorption, & Nutritional 35 Gas Transport & pH 639


Principles 475
36 Regulation of Respiration 655
27 Gastrointestinal Motility 495

28 Transport & Metabolic Functions


of the Liver 507 S E C T I O N

S E C T I O N
VII Renal Physiology 669

Cardiovascular
V Physiology 517 37 Renal Function & Micturition 671

38 Regulation of Extracellular Fluid Composition


29 Origin of the Heartbeat & the Electrical & Volume 695
Activity of the Heart 519
39 Acidification of the Urine & Bicarbonate
30 The Heart as a Pump 537 Excretion 709

31 Blood as a Circulatory Fluid & the Dynamics Answers to Multiple Choice Questions 719
of Blood & Lymph Flow 553
Index 721
32 Cardiovascular Regulatory Mechanisms 585

33 Circulation Through Special Regions 601

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Preface
FROM THE AUTHORS of cartoons and conceptual diagrams, as well as flow charts, to
promote learning of the integrated material that defines physi-
Once again, we are delighted to launch a new edition of ology. Overall, we hope that the updates to the volume engage
Ganong’s Review of Medical Physiology—the 25th. The authors the student and make understanding and assimilation of the
have attempted to maintain the highest standards of excel- material a more pleasurable task.
lence, accuracy, and pedagogy developed by Fran Ganong We remain grateful to the many colleagues and students
over the 46 years during which he educated countless students who contacted us with suggestions for clarifications and new
worldwide with this textbook. material upon reviewing the 24th edition. This input helps us
Recognizing the pivotal, and increasing, role for graphical to ensure that the text is as useful as possible, although the
material in effective medical education, our goal for this new responsibility for any errors, which are almost inevitable in a
edition was to undertake a thorough overhaul of the art pro- project of this scope, remains with the author team. Neverthe-
gram while also making important and timely updates to the less, we hope that you enjoy the fruits of our labors, and the
text. The vast majority of the figures in this edition have been new material in the 25th Edition.
revised or are wholly new. To aid in understanding across con-
tent areas, we have used consistent coloring and diagrammatic This edition is a revision of the original works of Dr. Francis
schemes, wherever possible, to depict comparable structures, Ganong.
cells and organs. We have also included an increased number

xi

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SECTION I
Cellular & Molecular Basis
for Medical Physiology

The detailed study of physiologic system structure and In the second part of this introductory section, we take a
function has its foundations in physical and chemical laws cellular approach to lay a groundwork of understanding
and the molecular and cellular makeup of each tissue and groups of cells that interact with many of the systems dis­
organ system. This first section provides an overview of the cussed in future chapters. The first group of cells presented
basic building blocks that provide the important frame­ contribute to inflammatory reactions in the body. These
work for human physiology. It is important to note here that individual players, their coordinated behavior, and the net
these initial sections are not meant to provide an exhaustive effects of the “open system” of inflammation in the body are
understanding of biophysics, biochemistry, or cellular and discussed in detail. The second group of cells discussed are
molecular physiology, rather they are to serve as a reminder responsible for the excitatory responses in human physiol­
of how the basic principles from these disciplines contrib­ ogy and include both neuronal and muscle cells. A funda­
ute to medical physiology discussed in later sections. mental understanding of the inner workings of these cells,
and how they are controlled by their neighboring cells
In the first part of this section, the following basic building helps the student to understand their eventual integration
blocks are introduced and discussed: electrolytes; carbohy­ into individual systems discussed in later sections.
drates, lipids, and fatty acids; amino acids and proteins; and
nucleic acids. Students are reminded of some of the basic In the end, this first section serves as an introduction,
principles and building blocks of biophysics and biochemi­ refresher, and quick source of material to best understand
stry and how they fit into the physiologic environment. systems physiology presented in the later sections. For
Examples of direct clinical applications are provided in detailed understanding of any of the chapters within this
the Clinical Boxes to help bridge the gap between build­ section, several excellent and current textbooks that pro­
ing blocks, basic principles, and human physiology. These vide more in depth reviews of principles of biochemistry,
basic principles are followed up with a discussion of the biophysics, cell physiology, muscle and neuronal physiol­
generic cell and its components. It is important to realize ogy are provided as resources at the end of each individ­
the cell is the basic unit within the body, and it is the collec­ ual chapter. Students who are intrigued by the overview
tion and fine-tuned interactions among and between these provided in this first section are encouraged to visit these
fundamental units that allow for proper tissue, organ, and texts for a more thorough understanding of these basic
organism function. principles.

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1
General Principles & C H A P T E R

Energy Production in
Medical Physiology

O B J EC T IVES ■■ Define units used in measuring physiologic properties.


■■ Define pH and buffering.
■■
After studying this chapter, Understand electrolytes and define diffusion, osmosis, and tonicity.
■■
you should be able to:
Define and explain the significance of resting membrane potential.
■■ Understand in general terms the basic building blocks of the cell: nucleotides,
amino acids, carbohydrates, and fatty acids.
■■ Understand higher-order structures of the basic building blocks: DNA, RNA,
proteins, and lipids.
■■ Understand the basic contributions of the basic building blocks to cell
structure, function, and energy balance.

INTRODUCTION
In unicellular organisms, all vital processes occur in a single products of metabolism; a reproductive system to perpetuate
cell. As the evolution of multicellular organisms progressed, the species; and nervous and endocrine systems to coordinate
various cell groups organized into tissues and organs have and integrate the functions of the other systems. This book is
taken over particular functions. In humans and other vertebrate concerned with the way these systems function and the way each
animals, the specialized cell groups include a gastrointestinal contributes to the functions of the body as a whole. This first
system to digest and absorb food; a respiratory system to take chapter focuses on a review of basic biophysical and biochemical
up O2 and eliminate CO2; a urinary system to remove wastes; principles and the introduction of the molecular building blocks
a cardiovascular system to distribute nutrients, O2, and the that contribute to cellular physiology.

GENERAL PRINCIPLES In animals with a closed vascular system, the ECF is


divided into the interstitial fluid, the circulating blood
plasma, and the lymph fluid that bridges these two domains.
THE BODY AS ORGANIZED The plasma and the cellular elements of the blood, principally
“SOLUTIONS” red blood cells, fill the vascular system, and together they
constitute the total blood volume. The interstitial fluid is
The cells that make up the bodies of all but the simplest mul-
that part of the ECF that is outside the vascular and lymph
ticellular animals, both aquatic and terrestrial, exist in an
systems, bathing the cells. About one-third of the total body
“internal sea” of extracellular fluid (ECF) enclosed within the
water is extracellular; the remaining two-thirds is intracellu-
integument of the animal. From this fluid, the cells take up
lar (intracellular fluid). Inappropriate compartmentalization
O2 and nutrients; into it, they discharge metabolic waste prod-
of the body fluids can result in edema (Clinical Box 1–1).
ucts. The ECF is more dilute than present-day seawater, but its
In the average young adult male, 18% of the body weight is
composition closely resembles that of the primordial oceans in
protein and related substances, 7% is mineral, and 15% is fat.
which, presumably, all life originated.

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4 SECTION I Cellular and Molecular Basis for Medical Physiology

weight is a ratio, it is dimensionless. The dalton (Da) is a unit


CLINICAL BOX 1–1 of mass equal to one-twelfth the mass of an atom of carbon-12.
The kilodalton (kDa = 1000 Da) is a useful unit for express-
Edema ing the molecular mass of proteins. Thus, for example, one can
Edema is the build up of body fluids within tissues. The speak of a 64-kDa protein or state that the molecular mass of
increased fluid is related to an increased leak from the blood the protein is 64,000 Da. However, because molecular weight
and/or reduced removal by the lymph system. Edema is is a dimensionless ratio, it is incorrect to say that the molecular
often observed in the feet, ankles, and legs, but can happen weight of the protein is 64 kDa.
in many areas of the body in response to disease, including
those of the heart, lung, liver, kidney, or thyroid. Equivalents
The concept of electrical equivalence is important in physiol-
THERAPEUTIC HIGHLIGHTS ogy because many of the solutes in the body are in the form of
The best treatment for edema includes reversing the charged particles. One equivalent (Eq) is 1 mol of an ionized
underlying disorder. Thus, proper diagnosis of the substance divided by its valence. One mole of NaCl dissociates
cause of edema is the primary first step in therapy. into 1 Eq of Na+ and 1 Eq of Cl–. One equivalent of Na+ = 23 g,
More general treatments include restricting dietary but 1 Eq of Ca2+ = 40 g/2 = 20 g. The milliequivalent (mEq) is
sodium to minimize fluid retention and using appro­ 1/1000 of 1 Eq.
priate diuretic therapy. Electrical equivalence is not necessarily the same as chem-
ical equivalence. A gram equivalent is the weight of a substance
that is chemically equivalent to 8.0 g of oxygen. The normality
(N) of a solution is the number of gram equivalents in 1 L. A
1 N solution of hydrochloric acid contains both H+ (1.0 g) and
The remaining 60% is water. The distribution of this water is Cl– (35.5 g) equivalents, = (1.0 g + 35.5 g)/L = 36.5 g/L.
shown in Figure 1–1A.
The intracellular component of the body water accounts
for about 40% of body weight and the extracellular component
WATER, ELECTROLYTES, &
for about 20%. Approximately 25% of the extracellular compo- ACID/BASE
nent is in the vascular system (plasma = 5% of body weight) The water molecule (H2O) is an ideal solvent for physiologic
and 75% outside the blood vessels (interstitial fluid = 15% of reactions. H2O has a dipole moment where oxygen slightly
body weight). The total blood volume is about 8% of body pulls away electrons from the hydrogen atoms and creates a
weight. Flow between these compartments is tightly regulated. charge separation that makes the molecule polar. This allows
water to dissolve a variety of charged atoms and molecules. It
also allows the H2O molecule to interact with other H2O mol-
UNITS FOR MEASURING ecules via hydrogen bonding. The resulting hydrogen bond
CONCENTRATION OF SOLUTES network in water allows for several key properties relevant to
In considering the effects of various physiologically important physiology: (1) water has a high surface tension, (2) water has
substances and the interactions between them, the number a high heat of vaporization and heat capacity, and (3) water has
of molecules, electrical charges, or particles of a substance a high dielectric constant. In layman’s terms, H2O is an excel-
per unit volume of a particular body fluid are often more lent biologic fluid that serves as a solute; it provides optimal
meaningful than simply the weight of the substance per unit heat transfer and conduction of current.
volume. For this reason, physiologic concentrations are fre- Electrolytes (eg, NaCl) are molecules that dissociate
quently expressed in moles, equivalents, or osmoles. in water to their cation (Na+) and anion (Cl–) equivalents.
Because of the net charge on water molecules, these electro-
lytes tend not to reassociate in water. There are many impor-
Moles tant electrolytes in physiology, notably Na+, K+, Ca2+, Mg2+, Cl–,
A mole is the gram-molecular weight of a substance, that is, and HCO3–. It is important to note that electrolytes and other
the molecular weight of the substance in grams. Each mole charged compounds (eg, proteins) are unevenly distributed
(mol) consists of 6 × 1023 molecules. The millimole (mmol) is in the body fluids (Figure 1–1B). These separations play an
1/1000 of a mole, and the micromole (μmol) is 1/1,000,000 of a important role in physiology.
mole. Thus, 1 mol of NaCl = 23 g + 35.5 g = 58.5 g and 1 mmol
= 58.5 mg. The mole is the standard unit for expressing the
amount of substances in the SI unit system. pH & BUFFERING
The molecular weight of a substance is the ratio of the The maintenance of a stable hydrogen ion concentration
mass of one molecule of the substance to the mass of one- ([H+]) in body fluids is essential to life. The pH of a solution
twelfth the mass of an atom of carbon-12. Because molecular is defined as the logarithm to the base 10 of the reciprocal of

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CHAPTER 1 General Principles & Energy Production in Medical Physiology 5

Stomach Intestines Extracellular fluid Intracellular fluid


200
Skin
Blood plasma:
Lungs Kidneys
5% body weight
Plasma
Extra- Interstitial fluid Misc.
cellular 150 phosphates
Interstitial fluid:

Cell membrane
fluid: K+
20% body 15% body weight

mEq/L H2O

Capillaries
weight Na+ Cl−
100 Cl−
Na+

Na+
Intracellular fluid:
50 HCO3− Prot−
40% body weight
K+ K+ HCO3− HCO3−
Prot−

0
A B Cl−

FIGURE 1–1 Organization of body fluids and electrolytes into compartments. A) Body fluids can be divided into intracellular and
extracellular fluid compartments (ICF and ECF, respectively). Their contribution to percentage body weight (based on a healthy young adult
male; slight variations exist with age and gender) emphasizes the dominance of fluid makeup of the body. Transcellular fluids, which constitute
a very small percentage of total body fluids, are not shown. Arrows represent fluid movement between compartments. B) Electrolytes and
proteins are unequally distributed among the body fluids. This uneven distribution is crucial to physiology. Prot–, protein, which tends to have a
negative charge at physiologic pH.

the H+, that is, the negative logarithm of the [H+]. The pH of
water at 25°C, in which H+ and OH– ions are present in equal
CLINICAL BOX 1–2
numbers, is 7.0 (Figure 1–2). For each pH unit less than 7.0,
the [H+] is increased 10-fold; for each pH unit above 7.0, it is Acid–Base Disorders
decreased 10-fold. In the plasma of healthy individuals, pH Excesses of acid (acidosis) or base (alkalosis) exist when
is slightly alkaline, maintained in the narrow range of 7.35– the blood is outside the normal pH range (7.35–7.45). Such
7.45 (Clinical Box 1–2). Conversely, gastric fluid pH can be changes impair the delivery of O2 to and removal of CO2 from
quite acidic (on the order of 3.0) and pancreatic secretions tissues. There are a variety of conditions and diseases that can
can be quite alkaline (on the order of 8.0). Enzymatic activ- interfere with pH control in the body and cause blood pH to fall
ity and protein structure are frequently sensitive to pH; in outside of healthy limits. Acid–base disorders that result from
any given body or cellular compartment, pH is maintained respiration to alter CO2 concentration are called respiratory aci­
to allow for maximal enzyme/protein efficiency. dosis and respiratory alkalosis. Nonrespiratory disorders that
Molecules that act as H+ donors in solution are consid- affect HCO3– concentration are referred to as metabolic acido­
ered acids, while those that tend to remove H+ from solu- sis and metabolic alkalosis. Metabolic acidosis or alkalosis can
tions are considered bases. Strong acids (eg, HCl) or bases be caused by electrolyte disturbances, severe vomiting or diar­
(eg, NaOH) dissociate completely in water and thus can most rhea, ingestion of certain drugs and toxins, kidney disease, and
diseases that affect normal metabolism (eg, diabetes).

H+ concentration THERAPEUTIC HIGHLIGHTS


(mol/L) pH
Proper treatments for acid–base disorders are depen­
10−1 1
dent on correctly identifying the underlying causal
10−2 2
process(es). This is especially true when mixed disor­
ACIDIC

10−3 3
10−4 4 ders are encountered. Treatment of respiratory acido­
10−5 5 sis should be initially targeted at restoring ventilation,
10−6 6 whereas treatment for respiratory alkalosis is focused
For pure water,
10−7 7
[H+] = 10−7 mol/L on the reversal of the root cause. Bicarbonate is typi­
10−8 8
10−9 9 cally used as a treatment for acute metabolic acido­
ALKALINE

10−10 10 sis. An adequate amount of a chloride salt can restore


10−11 11 acid–base balance to normal over a matter of days for
10−12 12 patients with a chloride-responsive metabolic alka­
10−13 13
losis whereas chloride-resistant metabolic alkalosis
10−14 14
requires treatment of the underlying disease.
FIGURE 1–2 Proton concentration and pH. Relative proton
(H+) concentrations for solutions on a pH scale are shown.

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6 SECTION I Cellular and Molecular Basis for Medical Physiology

change the [H+] in solution. In physiologic compounds, most If H+ is added to a solution of carbonic acid, the equilib-
acids or bases are considered “weak,” that is, they contribute rium shifts to the left and most of the added H+ is removed
or remove relatively few H+ from solution. Body pH is stabi- from solution. If OH– is added, H+ and OH– combine, tak-
lized by the buffering capacity of the body fluids. A buffer ing H+ out of solution. However, the decrease is countered by
is a substance that has the ability to bind or release H+ in more dissociation of H2CO3, and the decline in H+ concentra-
solution, thus keeping the pH of the solution relatively con- tion is minimized. A unique feature of HCO3– is the linkage
stant despite the addition of considerable quantities of acid between its buffering ability and the ability for the lungs to
or base. Of course there are a number of buffers at work in remove CO2 from the body. Other important biologic buffers
biologic fluids at any given time. All buffer pairs in a homog- include phosphates and proteins.
enous solution are in equilibrium with the same [H+]; this
is known as the isohydric principle. One outcome of this
principle is that by assaying a single buffer system, we can DIFFUSION
understand a great deal about all of the biologic buffers in
Diffusion is the process by which a gas or a substance in a
that system.
solution expands, because of the motion of its particles, to fill
When acids are placed into solution, there is dissociation
all the available volume. The particles (molecules or atoms)
of some of the component acid (HA) into its proton (H+) and
of a substance dissolved in a solvent are in continuous ran-
free acid (A–). This is frequently written as an equation:
dom movement. A given particle is equally likely to move into
or out of an area in which it is present in high concentration.
HA H+ + A−
|

However, because there are more particles in the area of high


concentration, the total number of particles moving to areas
According to the laws of mass action, a relationship for
of lower concentration is greater; that is, there is a net flux of
the dissociation can be defined mathematically as:
solute particles from areas of high concentration to areas of
Ka = [H+][A–]/[HA] low concentration. The time required for equilibrium by dif-
fusion is proportional to the square of the diffusion distance.
where Ka is a constant, and the brackets represent concentra- The magnitude of the diffusing tendency from one region to
tions of the individual species. In layman’s terms, the product another is directly proportional to the cross-sectional area
of the proton concentration ([H+]) times the free acid concen- across which diffusion is taking place and the concentration
tration ([A–]) divided by the bound acid concentration ([HA]) gradient, or chemical gradient, which is the difference in
is a defined constant (K). This can be rearranged to read: concentration of the diffusing substance divided by the thick-
ness of the boundary (Fick’s law of diffusion). Thus,
[H+] = Ka [HA]/[A–]
J = –DA Δc
If the logarithm of each side is taken: Δx
where J is the net rate of diffusion, D is the diffusion coeffi-
log[H+] = logKa + log[HA]/[A−] cient, A is the area, and Δc/Δx is the concentration gradient.
The minus sign indicates the direction of diffusion. When
Both sides can be multiplied by –1 to yield:
considering movement of molecules from a higher to a lower
−log[H+] = −logKa + log[A−]/[HA] concentration, Δc/Δx is negative, so multiplying by –DA gives
a positive value. The permeabilities of the boundaries across
This can be written in a more conventional form known which diffusion occurs in the body vary, but diffusion is still
as the Henderson-Hasselbalch equation: a major force affecting the distribution of water and solutes.

pH = pKa + log[A−]/[HA]

This relatively simple equation is quite powerful. One


OSMOSIS
thing that can be discerned right away is that the buffering When a substance is dissolved in water, the concentration of
capacity of a particular weak acid is best when the pKa of that water molecules in the solution is less than that in pure water,
acid is equal to the pH of the solution, or when: because the addition of solute to water results in a solution
that occupies a greater volume than does the water alone. If the
[A−] = [HA], pH = pKa solution is placed on one side of a membrane that is permeable
to water but not to the solute, and an equal volume of water is
Similar equations can be set up for weak bases. An impor- placed on the other, water molecules diffuse down their con-
tant buffer in the body is carbonic acid. Carbonic acid is a weak centration (chemical) gradient into the solution (Figure 1–3).
acid, and thus is only partly dissociated into H+ and HCO3–: This process—the diffusion of solvent molecules into a
region in which there is a higher concentration of a solute
H2CO3 H+ + HCO3–
|

to which the membrane is impermeable—is called osmosis.

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CHAPTER 1 General Principles & Energy Production in Medical Physiology 7

Semipermeable concentration (activity) in the body fluids rather than the


membrane Pressure number of equivalents of an electrolyte in solution that deter-
mines its osmotic capacity. This is why, for example, 1 mmol
of NaCl per liter in the body fluids contributes somewhat less
than 2 mOsm of osmotically active particles per liter. The
more concentrated the solution, the greater the deviation from
an ideal solution.
The osmolal concentration of a substance in a fluid is mea-
sured by the degree to which it depresses the freezing point,
FIGURE 1–3 Diagrammatic representation of osmosis. with 1 mol of an ideal solution depressing the freezing point
Water molecules are represented by small open circles, and solute by 1.86°C. The number of milliosmoles per liter in a solution
molecules by large solid circles. In the diagram on the left, water equals the freezing point depression divided by 0.00186. The
is placed on one side of a membrane permeable to water but not osmolarity is the number of osmoles per liter of solution (eg,
to solute, and an equal volume of a solution of the solute is placed
on the other. Water molecules move down their concentration
plasma), whereas the osmolality is the number of osmoles per
(chemical) gradient into the solution, and, as shown in the diagram kilogram of solvent. Therefore, osmolarity is affected by the
on the right, the volume of the solution increases. As indicated by the volume of the various solutes in the solution and the tempera-
arrow on the right, the osmotic pressure is the pressure that would ture, while the osmolality is not. Osmotically active substances
have to be applied to prevent the movement of the water molecules. in the body are dissolved in water, and the density of water
is 1, so osmolal concentrations can be expressed as osmoles
per liter (Osm/L) of water. In this book, osmolal (rather than
It is an important factor in physiologic processes. The ten- osmolar) concentrations are considered, and osmolality is
dency for movement of solvent molecules to a region of expressed in milliosmoles per liter (of water).
greater solute concentration can be prevented by applying Note that although a homogeneous solution contains
pressure to the more concentrated solution. The pressure nec- osmotically active particles and can be said to have an osmotic
essary to prevent solvent migration is the osmotic pressure of pressure, it can exert an osmotic pressure only when it is in
the solution. contact with another solution across a membrane permeable
Osmotic pressure—like vapor pressure lowering, freezing- to the solvent but not to the solute.
point depression, and boiling-point elevation—depends on
the number rather than the type of particles in a solution; that
is, it is a fundamental colligative property of solutions. In an
ideal solution, osmotic pressure (P) is related to temperature OSMOLAL CONCENTRATION OF
and volume in the same way as the pressure of a gas: PLASMA: TONICITY
nRT The freezing point of normal human plasma averages –0.54°C,
P= which corresponds to an osmolal concentration in plasma of
V
290 mOsm/L. This is equivalent to an osmotic pressure against
where n is the number of particles, R is the gas constant, T is pure water of 7.3 atmospheres (atm). The osmolality might be
the absolute temperature, and V is the volume. If T is held con- expected to be higher than this, because the sum of all the cat-
stant, it is clear that the osmotic pressure is proportional to ion and anion equivalents in plasma is over 300 mOsm/L. It
the number of particles in solution per unit volume of solu- is not this high because plasma is not an ideal solution and
tion. For this reason, the concentration of osmotically active ionic interactions reduce the number of particles free to exert
particles is usually expressed in osmoles. One osmole (Osm) an osmotic effect. Except when there has been insufficient
equals the gram-molecular weight of a substance divided by time after a sudden change in composition for equilibrium to
the number of freely moving particles that each molecule occur, all fluid compartments of the body are in (or nearly in)
liberates in solution. For biologic solutions, the milliosmole osmotic equilibrium. The term tonicity is used to describe the
(mOsm; 1/1000 of 1 Osm) is more commonly used. osmolality of a solution relative to plasma. Solutions that have
If a solute is a nonionizing compound such as glucose, the the same osmolality as plasma are said to be isotonic; those
osmotic pressure is a function of the number of glucose mol- with greater osmolality are hypertonic; and those with lesser
ecules present. If the solute ionizes and forms an ideal solu- osmolality are hypotonic. All solutions that are initially isos-
tion, each ion is an osmotically active particle. For example, motic with plasma (ie, that have the same actual osmotic pres-
NaCl would dissociate into Na+ and Cl– ions, so that each mole sure or freezing-point depression as plasma) would remain
in solution would supply 2 Osm. One mole of Na2SO4 would isotonic if it were not for the fact that some solutes diffuse
dissociate into Na+, Na+, and SO42– supplying 3 Osm. How- into cells and others are metabolized. Thus, a 0.9% saline solu-
ever, the body fluids are not ideal solutions, and although the tion remains isotonic because there is no net movement of the
dissociation of strong electrolytes is complete, the number of osmotically active particles in the solution into cells and the
particles free to exert an osmotic effect is reduced owing to particles are not metabolized. On the other hand, a 5% glucose
interactions between the ions. Thus, it is actually the effective solution is isotonic when initially infused intravenously, but

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L e n g u a ’s, verminking der ooren bij de —, II 334.

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L e v e n s v o o r w a a r d e n , werking van veranderde — op den mensch, 57;


invloed van de — op het gevederte der vogels, II 186.

Libellula depressa, kleur van de mannelijke —, 550.


Libellulidae, betrekkelijke grootte der seksen van —, 536;
verschil der seksen van —, 549.

L i c h a a m s g r o o t t e , afhankelijk van plaatselijke invloeden, 58.

L i c h a a m s k r a c h t , zie S p i e r k r a c h t .

L i c h t , mogelijke invloed van het [447]—, 59;


invloed van het — op de kleuren van schelpen, 515.

L i c h t e n s t e i n , over Chera progne, II 115.

L i c h t g e v e n d vermogen van sommige insekten, 535.

L i e f d e , moederlijke —, 117;
bij dieren, 117;
ouderlijke en kinderlijke — gedeeltelijk het gevolg van natuurlijke teeltkeus, 190.

L i e f d e - V e r t o o n i n g e n en dansen der vogels, II 63.

L i e r v o g e l , bijeenkomsten van den —, II 98.

L i l f o r d , Lord, de Kemphaan aangelokt door schitterende voorwerpen, II 108.

Limosa lapponica, II 193.

L i n n a e u s , beschouwingswijze van — over de plaats van den mensch, 268.

Linaria, II 171.

Linaria montana, 484.

Linyphia, 525.

L i p p e n , doorboren der — door de wilden, II 334.

L i p v i s c h , Pauw-, zie Labrus pavo.

L i p v i s s c h e n , zie Labrus.

Lithobius, grijpwerktuigen der wijfjes van —, 528.

Lithosia, kleuren van —, 584.


L i t t e e k e n van een brandwond veroorzaakt wijziging der
aangezichtsbeenderen, 88.

Littorina littorea, 514.

L i v i n g s t o n e , Dr., over den invloed van vochtigheid en droogte op de kleur van


de huid, 363;
over de vatbaarheid der negers voor tropische koortsen, na eenigen tijd in een
kouder klimaat te hebben doorgebracht, 364;
over de spoorvleugelige gans, II 45;
over wevervogels, II 59;
over een Afrikaansche nachtzwaluw, II 70, 93;
over de litteekens der mannelijke zoogdieren in Zuid-Afrika, II 225;
over het wegnemen der bovensnijtanden bij de Batoka’s, II 333;
over het doorboren der bovenlip door de Makalolo, II 334;
over de Banyai, II 339;
over den gorilla, 271.

L l o y d , L., over de veelwijvigheid van den auerhaan en de trapgans, 448;


over de getalsverhouding der seksen bij het auerhoen en korhoen, 484;
over den zalm, II 4;
over de kleuren van den zeedonderpad, II 8;
over de strijdlustigheid van boschhoenders, II 47;
over den auerhaan en korhaan, II 43, 47, 52;
over het roepen van den auerhaan, II 57;
over de bijeenkomsten van boschhoenders en snippen, II 98;
over het paren van een mannelijke schildeend en een gewone eend, II 110;
over de gevechten van zeehonden, II 226;
over den eland, II 235.

Lobivanellus, vleugelsporen van —, II 45.

L o c k w o o d , de heer, over de ontwikkeling van Hippocampus, 285.

Locustidae, gesjirp der —, 541;


afstamming der —, 544.

L o f , invloed van het haken naar —, 194, 202, 242, 243.

L o n g e n , vergrooting der — bij de Quechua en Aymara Indianen, 62;


de — een gewijzigde zwemblaas, 283;
verschillende grootte der — bij de menschenrassen, 331.

Longicornia, verschil in kleur der seksen van —, 555;


gesjirp der —, 565.

L o n g s l a k k e n , zie Pulmonata.

L o n s d a l e , de heer, over een voorbeeld van onderlinge genegenheid van Helix


pomatia, 514.

L o o p k e v e r s , zie Carabidae.

L o o p v o g e l s , zie Cursores.

Lophobranchii, broedzakken van de mannetjes der —, II 19.

Lophophorus, gewoonten van —, II 116.

Lophorina atrata, seksueel kleurverschil bij —, II 211.

Lophornis ornatus, II 74.

L o r d , J. K., over Salmo lycaodon, II 4.

L o s b a n d i g h e i d , 220;
groote — der wilden, 205;
de — een beletsel van den aanwas der bevolking, 77.

L o w n e , B. T., over Musca vomitoria, 86. [448]

Loxia, kenmerken van de jongen van —, II 176.

L u b b o c k , Sir J., over de oudheid van den mensch, 8;


over den oorsprong van den mensch, 9;
over de verstandelijke vermogens van wilden, 111;
over den oorsprong der werktuigen, 143;
over de vereenvoudiging der talen, 143;
over het gemis van het denkbeeld van God bij sommige menschenrassen, 145;
over den oorsprong van het geloof aan geesten, 146;
over bijgeloof, 148;
over het gevoel van plicht, 181;
over de gewoonten der Fidsji-eilanders om hun ouders en om zieken levend te
begraven, 186;
de zelfmoord zeldzaam bij de laagst ontwikkelde wilden, 203;
over de zedeloosheid der wilden, 206;
over de aanspraak van den heer Wallace op het vaderschap van het denkbeeld
van natuurlijke teeltkeus, 80;
over het ontbreken van het gevoel van berouw bij de wilden, 242;
over de zekerheid, dat alle beschaafde natiën eens in wilden staat verkeerden,
257;
over den vooruitgang der wilden in sommige kunsten, 259;
over de gelijksoortigheid der verstandelijke vermogens bij verschillende
menschenrassen, 345;
over het tellen onzer vroegste voorouders, 346;
over de kunsten door de wilden beoefend, 346;
over de grijporganen van het mannetje van Labidocera Darwinii, 518;
over Chloëon, 531;
over Smynthurus luteus, 537;
over het worstelen om de vrouwen bij de Noord-Amerikaansche Indianen, II 318;
over muziek, II 327;
over de gewoonten der wilden om zich te versieren, 331;
over de waarde van den baard bij de Angelsaksers, II 341;
over kunstmatige misvorming van den schedel, II 343;
over „communale huwelijken”, II 352;
over exogamie, II 354, 359;
over de Veddah’s, II 357;
over polyandrie, II 359.

L u c a n i d e n , veranderlijkheid van de bovenkaken der —, 562.

Lucanus, grootte der mannetjes van —, 536.

Lucanus cervus, getalsverhouding der seksen van —, 492.

Lucanus elaphus, gebruik der bovenkaken door —, 563;


groote kaken der mannetjes van —, 532.

L u c a s , Prosper, over seksueele voorkeur bij paarden en stieren, II 256.

L u c h t p i j p , bij sommige vogels gewonden en diep in het borstbeen ingesloten,


II 56;
vorm van de — bij Rhynchaea, 192.

L u i a a r d s , seksueele verschillen van —, II 276.


L u i p a a r d e n , zwarte —, II 283.

L u i z e n , van huisdieren en menschen, 334.

L u n d , Dr., over schedels in de holen van Brazilië gevonden, 332.

L u s c h k a , Prof., over een samengerold lichaam aan het uiteinde van de


koekoeksbeenderen, 30.

Lycaena, seksueel kleurverschil bij soorten van —, 579.

L i j d e n van vreemdelingen, ongevoeligheid der wilden voor het —, 204.

L y e l l , Sir C., over den ouderdom van het menschelijk geslacht, 8;


over den oorsprong van den mensch, 9;
over de overeenkomst in de ontwikkeling van soorten en talen, 141;
over het uitsterven van talen, 141;
over de inquisitie, 255;
over de fossiele overblijfsels van Gewervelde Dieren, 278;
over de vruchtbaarheid van mulatten, 335.

L i j f l a n d , getalsverhouding van mannelijke en vrouwelijke geboorten in —, 477.

L y n x , Canadaschen, kraag om hals en kin van den —, II, 251.

L i j s t e r s , parende met een merel, II 109;


kleuren en nestbouw van de —, II 162.

L i j s t e r , Bef—, zie Turdus torquatus.

L i j s t e r , gewone of zang—, zie Turdus musicus.

L i j s t e r , Spot—, zie Turdus polyglottus.

L i j s t e r , Trek—, zie Turdus migratorius. [449]

L i j s t e r , Woud—, II 206.

L i j s t e r , zwarte, zie M e r e l .

L i j s t e r s , Aard—, zie Pittidae.

L i j s t e r s , kenmerken van jonge —, II 176.


M.

M a a k s e l , nuttelooze wijzigingen van —, 94.

M a a k s e l , verschil van — bij verschillende menschenrassen, 331.

M a a n , verband tusschen de levensfuncties en de schijngestalten der —, 287.

Macacus, ooren van —, 22;


samengerold lichaam aan het einde van den staart van —, 30;
veranderlijkheid van den staart bij de soorten van het geslacht —, 91;
bakkebaarden bij sommige soorten van het geslacht —, II 275.

Macacus brunneus, 92.

Macacus ecaudatus, 93.

Macacus cynomolgus, vooruitsteken der wenkbrauwbogen bij —, II 314;


grijs worden van den baard en de bakkebaarden van —, II 315.

Macacus lasiotus, vlekken in het gelaat van —, II 296.

Macacus radiatus, 270.

Macacus rhesus, seksueel verschil in kleur van —, II 283, 298.

M a c a l i s t e r , Prof., over verscheidenheden van den Palmaris accessorius, 53;


over afwijkingen in het spierstelsel, 71, 72;
wijzigingen der spieren meer algemeen bij den man dan bij de vrouw, 453.

M a c c u l l o c h , Dr., over de derdendaagsche koorts bij een hond, 14.

M a c c u l l o c h , Kol., over een Indisch dorp zonder een enkel vrouwelijk kind, II
344.

M a c g i l l i v r a y , W., over de stemorganen der vogels, 141;


over de Egyptische gans, II 45;
over de gewoonten der spechten, II 59;
over de gewoonten van snippen, II 60;
over de grasmusch, II 65;
over het ruien van snippen, II 79;
over het ruien der Eendachtige Vogels, II 81;
over het vinden van nieuwe gezellen door eksters, II 100;
over het paren van een merel en een lijster, II 109;
over gevlekte raven, II 122;
over den zeekoet, II 122;
over de kleuren der meezen, II 166;
over het onvolwassen gevederte der vogels, II 178 v.v.

Machetes, seksen en jongen van —, II 203.

Machetes pugnax, getalsverhouding der seksen, 484;


waarschijnlijk veelwijvig, 448;
vurigheid van het mannetje, II 41;
dubbele ruiing van —, 78.

M a c I n t o s h , Dr., over de kleuren der Snoerwormen (Nemertina), 516.

M a c k i n t o s h , over het zedelijk gevoel, 180.

M a c l a c h l a n , R., over Apatania muliebris en Boreus hyemalis, 494;


over de aanhangsels aan het achterlijf der mannelijke insekten, 532;
over het paren der Waternimfen, 536;
over Waternimfen, 550;
over dimorphisme bij Agrion, 550;
over de weinige strijdlustigheid der mannelijke Waternimfen, 551;
over nachtvlinders op de Shetlandsche eilanden, 591.

M a c L e n n a n , over de huwelijken der Korakken, II 366;


over den oorsprong van het geloof aan geesten, 146;
over de losbandigheid der wilden, 205, II 352;
over kindermoord, 77, II 358;
over de vroegere barbaarschheid der beschaafde volken, 257;
over sporen van de gewoonte om vrouwen te rooven, 258, II 358;
over polyandrie, II 359.

M a c n a m a r a , over de Andaman-eilanders, de bewoners van Nepaul en de


bergstammen van Engelsch-Indië, 356.

Macrorhinus proboscideus, vorm van den neus van —, II 269.

M a i l l a r d , M., over de verhouding der seksen in een soort van Papilio van
Bourbon, 488.
M a i n e , de heer, over het samensmelten [450]van den eenen stam met den
anderen, 238;
over het gebrek aan begeerte naar verbetering, 244.

M a k a l o l o , doorboren van de bovenlip bij de —, II 334.

M a l e i e r s , contrast tusschen de Papoea’s en de —, 331;


scheidingslijn tusschen de Papoea’s en de —, 333;
de — over het algemeen baardeloos, II 316;
over het verven van de tanden door de —, II 332;
afkeer van sommige — van haren in het gelaat, II 340.

M a l h e r b e , over de spechten, II 166.

M a l l e , Dureau de la, over een hond, door een kat grootgebracht, 121;
over valken, 121.

Mallotus, borstelachtige schubben bij —, II 2.

M a l t h u s , S., over den aanwas der bevolking, 74, 75, 76.

Maluridae, nestbouw van —, II 162.

Maluri, jongen van —, II 204.

M a n d a n e n , correlatie tusschen de kleur en den aard van het haar bij de —,


368.

M a n d a r i j n e e n d e n , aan haar mannetjes zeer gehecht, II 104.

M a n d r i l , aantal staartwervels bij den —, 91;


kleuren van den mannelijken —, II 281, 285, 298.

M a n e n s c h a a p , zie Ammotragus.

M a n n e l i j k e dieren, gevechten der — om het bezit der wijfjes, 438, 439;


vurigheid van de — in den paartijd, II 318;
de — over het algemeen meer gewijzigd dan de wijfjes, 450, 452;
de — verschillen op de zelfde wijze van de wijfjes en de jongen, 461.

M a n n e l i j k e kenmerken, bij de wijfjes ontwikkeld, 458;


het overbrengen van — op vrouwelijke vogels, II 184.
M a n n e t j e s , aanwezigheid van rudimentaire vrouwelijke organen bij de —, 283.

M a n n e t j e s en wijfjes, getalsverhouding tusschen —, 440, 441.

M a n t c h o e r i j s c h h e r t , zie Cervus Mantchuricus.

M a n t e g a z z a , Prof., over de versieringen der wilden, II 331 v.v.;


over de baardeloosheid der Nieuw-Zeelanders, II 340;
over de overdrijving van natuurlijke kenmerken bij den mensch, II 342;
over de achterste kies bij den mensch, 27.

M a n t e l l , W., over het wegnemen der mooie meisjes door de opperhoofden van
Nieuw-Zeeland, 362.

Mantis, strijdlustigheid van de — soorten, 548.

M a o r i ’s, hun uitsterven, 352;


kindermoord bij de —, 497.

M a r c u s A u r e l i u s , over den oorsprong van het zedelijk gevoel, 181;


over den invloed van voortdurende gedachten, 211.

Mareca penelope, II 110.

M a r s h a l l , de heer, over de hersenen van een vrouwelijke Bosjesman, 331.

M a r s h a l l , Dr. W., over de hersenen van den chimpanzee, 391;


over de uitwassen op den kop van vogels, 467, II 69.

M a r s h a l l , Kolonel, over de Toda’s, 357;


over de oorzaken waardoor het aantal mannen onder de Toda’s dat der vrouwen
aanzienlijk overtreft, 496.

Marsupialia, 279;
tepels der —,285;
hun afstamming van de Monotremata, 288;
baarmoeder der —,67;
ontwikkeling van het membrana nictitans bij de —, 24;
buidels der —, 435;
betrekkelijke grootte der seksen bij de —, II 244;
kleuren der —, II 277.
M a r t e l i n g e n , ongevoeligheid der Amerikaansche wilden voor —, 205.

M a r t i n , over de baarden van de bewoners van St. Kilda, II 316.

M a r t i n , W. C. L., over den schrik van een orang op het gezicht van een
schildpad, 120;
over het haar bij Hylobates, 271;
over het wijfje van een Amerikaansch hert, II 243;
over de stem van Hylobates agilis, II 268;
over Semnopithecus nemaeus, II 300. [451]

M a r t i n s , C., over den dood ten gevolge der ontsteking van het wormvormig
aanhangsel, 28.

M a t e n , muzikale, waarneming van — door dieren, II 326.

M a t r o z e n , belemmering van den groei der — door hun levenswijze, 58.

M a t r o z e n en soldaten, verschil in lichaamsverhoudingen tusschen —, 60.

M a u d s l e y , Dr., over den invloed van den reuk bij den mensch, 25;
over Laura Bridgman, 138;
over de ontwikkeling der stemorganen, 140;
over de behaardheid van idioten, 64.

M a y e r , Prof., over muggen, 538.

M a y e r s , F. W., over het fokken van den goudvisch in China, II 15.

M a y h e w , E., over de genegenheid tusschen individu’s van verschillende seksen


bij den hond, II 254.

M a y n a r d , C. J., over de seksen van Chrysemys picta, II 25.

M ’ C a n n , J., over zelfbewustheid, 134.

M ’ C l e l l a n d , J., over de Indische Cyprinidae, II 16.

M c N e i l l , de heer, over het gebruik van het gewei der herten, II 239;
over den Schotschen hertenhond, II 246;
over de lange haren aan de keel van het hert, II 252;
over het loeien der herten, II 267.
M e c k e l , over correlatie tusschen de spieren van den arm en het been, 73;
over polydactylisme, 66.

M e d e g e v o e l , waarom sterker opgewekt door een bemind, dan door een


onverschillig persoon, 191.

Medusae, schitterende kleuren van sommige —, 512.

M e e k r a p v l i n d e r , 587.

M e e r k o l , jongen van den —, II 198;


jongen van den Canadaschen —, II 198;
zie V l a a m s c h e g a a i e n .

M e e r k o l , Canadasche —, zie Perisorius Canadensis.

M e e u w e n , kleine —, zie Gavia.

M e e z e n , zie Parinae.

M e e z e n , seksueel kleurverschil bij de —, II 161.

M e g a l i t h i s c h e gedenkteekenen, begraving onder —, 345.

Megalophrys montana, seksueele verschillen bij —, II 23.

Megapicus validus, seksueel verschil in kleur bij —, II 166.

Megasoma, grootte der mannetjes van —, 536.

M e i g s , Dr. A., over wijziging in de schedelvormen der inboorlingen van Amerika,


53.

M e i n e c k e , over de getalsverhouding der seksen bij de Kapellen, 488.

M e i s j e s en jongens, zie J o n g e n s en meisjes.

M e l a n e s i ë r s , groote sterfte onder de —, 353.

M e l d o l a , over de kleuren van Thecla en Hipparchis, 590.

Meliphagidae, nestbouw van de Australische —, II 162.

Melito, secundaire seksueele kenmerken van —, 520.


M e l k a f s c h e i d i n g bij een man, 286.

M e l k k l i e r e n , 435, 284.

Meloë, verschil in kleur bij de seksen van een soort van —, 555.

Membrana nictitans, 24, 283.

M e m n o n , de jonge —, 332.

M e n s c h , veranderlijkheid van den —, 42;


dwaling om den — in grootere mate getemd te noemen dan andere dieren, 55;
geen bepaald punt aanwijsbaar in den stamboom van den — waarop hij dien
naam ’t eerst verdiende, 347;
verhuizingen van den —, 77;
verspreiding van den —, 78;
oorzaken van de onbehaardheid van den —, 89;
geringe spierkracht van den —, 97;
getalsverhouding der seksen bij den —, 443, 476;
de — een lid van den stam der Catarrhinen, 276;
vroege voorouders van den —, 282;
secundaire seksueele kenmerken bij den —, II 312;
oorspronkelijke toestand van den —, II 360;
vadsigheid [452]van den — bij gemakkelijke levensvoorwaarden, 256;
overeenkomst en verschil in het maaksel en de ontwikkeling zijner hersenen en
die der apen, 389.

M e n s c h e l i j k h e i d , bij sommige wilden onbekend, 203;


gebrek aan — bij de wilden, 210.

M e n s c h e n o f f e r s , 148, 258.

M e n s c h e n r i j k , 265.

Menura Alberti, II 98;


zang van —, II 53.

Menura superba, II 98;


lange staarten der beide seksen van —, II 158.

M e r e l , seksueele kenmerken bij de —, 447;


verhouding der seksen bij de —, 484;
hoe een — leert zingen, II 52;
kleur van den snavel bij de —, II 69, 212;
paring van een — met een lijster, II 109;
kleuren en nestbouw van de —, II 162;
jongen van de —, II 206;
seksueel kleurverschil bij de —, II 211.

M e r g a n s e r , luchtpijp van den mannelijken —, II 56.

Merganser serrator, mannelijk gevederte van —, II 81.

M e r g h e u v e l s , 393.

Mergus cucullatus, spiegelvlek van —, 468.

Mergus merganser, jongen van —, II 180.

M e r i n o s c h a a p , verlies der horens door het vrouwelijk —, 462;


horens van het —, 467.

M e s t t o r r e n , zie Copris.

Metallura, glanzende staartvederen van —, II 146.

Methoca ichneumonides, groot mannetje van —, 537.

M e v e s , M., over het trommelend geraas van de snip, II 60.

M e x i c a n e n , de beschaving der —, niet uit vreemde bron voortgevloeid, 259.

M e y e r , Dr. L., over het verschil tusschen de ooren van den man en die van de
vrouw, 453;
over het Darwinsche spitsoor, 22.

M e y e r , over een samengerold lichaam aan het einde van den staart bij een
Macacus en een kat, 30.

M e y e r , Dr. A., over het paren van Phryganidae van verschillende soorten, 532.

M i c r o c e p h a l e idioten, 137, 64.

M i d d e l , afmetingen van het — bij soldaten en matrozen, 60.


M i e r e n , 265; spelen der —, 116;
geheugen der —, 122;
hoe de — elkander hun gedachten mededeelen door middel van hun sprieten,
140;
grootte van de hersengangliën der —, 86;
soldaten bij de —, groote kaken van de —, 96;
verschil der seksen bij de —, 551;
hoe de — elkander na lange scheiding herkennen, 551.

M i e r e n , witte, gewoonten der —, 551.

M i l l , J. S., over den oorsprong van het zedelijk gevoel, 181;


over beweegredenen van het gedrag, 207;
over het „beginsel van het grootste geluk”, 207;
over het verschil in de geestvermogens der seksen bij den mensch, II 322.

M i l l i o e n p o o t e n , 528.

M i l n e E d w a r d s , H., over het gebruik der vergroote knijpers van het mannetje
van Gelasimus, 520.

Milvago leucurus, seksen en jongen van —, II 194.

„M i m i c k r y ”, 597;
bij vlinders, 597.

Mimus polyglottus, II 105.

M i n n e d r a n k e n der vrouwen van Noord-West-Amerika, II 336.

M i o c e n e zwijnen, afwezigheid van slagtanden bij mannelijke —, II 250.

M i s d a d i g e r s , 249.

M i s k r a a m , het heerschen van de gewoonte om — te verwekken, 76.

M i t f o r d , over teeltkeus te Sparta, 56.

M i t c h e l l (Dr.), over de bewoners der eilanden bewesten Schotland, 357.

M i v a r t , St. George, over de verkleining van organen, 19;


over de ooren der Lemuroidea, 22;
over de variabiliteit der spieren bij Lemuroidea, [453]71, 78;
over de staartwervels van apen, 91;
over de klassificatie der Primaten, 274;
over den orang en den mensch, 274;
over verschillen bij de Lemuroidea, 275;
over den kam bij den mannelijken Watersalamander, II 21.
M ö b i u s , Prof., over de geestvermogens van een snoek, 124.

M o d e , bestendigheid der zelfde — bij de wilden, II 336, 343.

M o e d , verschil in — bij individu’s van de zelfde soorten, 116;


hooge waardeering van den —, 205;
belangrijkheid van den —, 240;
een kenmerk van den mensch, II 321.

M o e r a s v o g e l s , jongen der —, II 204.

M o l l e n , getalsverhouding der seksen, 483.

Mollienesia petenensis, seksueel verschil bij —, II 9.

M o l l u s c a , schoone kleuren en vorm der —, 515;


gemis der secundaire seksueele kenmerken bij de —, 513.

Molluscoïda, 281, 513.

Monacanthus, borstelorgaan van —, II 2.

Monacanthus scopas en M. Peronii, seksueele verschillen bij —, II 9, 10.

M o n b u t t o e ’s, verschil in kleur tusschen de seksen bij de —, II 312.

M o n g o l e n , scherpe zinnen der —, 62.

M o n o g a m i e , geen natie die oorspronkelijk in — leefde, 258.

M o n o g e n i s t e n , 341.

Mononychus pseudacori, gesjirp van —, 568.

Monotremata, 279;
ontwikkeling van de membrana nictitans bij de —, 24;
melkafscheidende klieren der —, 284;
verbinding der zoogdieren met de reptielen door de —, 288.
M o n s t r u o s i t e i t e n , overeenkomstig den mensch en de lagere dieren, 57;
veroorzaakt door stilstand in ontwikkeling, 65;
correlatie van —, 73;
overplanting van —, 337.

M o n t a g u , G., over de gewoonten van den korhaan en den rooden Schotschen


boschhaan, 448;
over de strijdlustigheid van den kemphaan, II 41;
over het zingen van vogels, II 49;
over de dubbele ruiing van de mannelijke pijlstaarteend, II 81.

M o n t e i r o , de heer, over Bucorax abyssinicus, II 68.

M o n t e s d e O c a , M., over de strijdlustigheid van mannelijke Kolibri’s, II 39.

Monticola cyanea, II 164.

M o n u m e n t e n , als sporen van uitgestorven stammen, 384.

M o r i n e l , — Plevier, II 192.

M o r g a n , L. H., over den bever, 114;


over het redeneerend vermogen van den bever, 123;
over het met geweld rooven der vrouwen, 258; over het castoreum der bevers, II
270;
het huwelijk in de vroegste tijden onbekend, II 352;
polyandrie, II 359.

M o r r i s , F. O., over een verlaten havik die door andere haviken gevoed werd, II
103.

M o r s e , Dr., over beschermende kleuren bij weekdieren, 515.

M o r s e l l i , E., over het jukbeen, 68.

M o r t o n , over het aantal menschenrassen, 339.

Moschus moschiferus, riekende stoffen en afscheidende organen van —, II 271.

M o s d i e r e n , zie Polyzoa.

M o s s e l e n , door apen geopend, 81.


M o s s e l k r e e f t e n , zie Cirrhipedia.

Motacillae, jongen van Indische —, II 181.

M o t m o t , raketvormige vederen in den staart van een —, II 70.

M o t m o t s , over den staart der —, II 372.

M u i l e z e l , met rede begaafd, 127;


onvruchtbaarheid en lang leven van den —, 335.

M u g g e n , langbeenige, 538.

M u l a t t e n , blijvende vruchtbaarheid van —, 335;


vrij van gele koorts, 363. [454]

M ü l l e r , Ferd., over de Mexicanen en Peruanen, 259.

M ü l l e r , Fritz, over de mannetjes van Tanais, 435;


over het verdwijnen van vlekken en strepen bij volwassen Zoogdieren, II 293;
over de verhouding der seksen bij sommige Schaaldieren, 495;
over secundaire seksueele kenmerken bij verschillende Schaaldieren, 517 v.v.;
muzikale strijd tusschen twee mannelijke cicaden, 540;
over de seksueele rijpheid van jonge tot de vlookreeften behoorende
Schaaldieren, II 202;
over het pronken van Gastnia, 584.

M ü l l e r , H., over Eristalis, 538.

M ü l l e r , Dr. Hermann en Fritz, over de verhouding der seksen bij de bijen, 493,
494.

M ü l l e r , Hermann, over seksueele kleurverschillen bij de bijen, 553.

M ü l l e r , J., over de membrana nictitans en de plica semilunaris, 24.

M ü l l e r , Max, over den oorsprong der spraak, 137;


strijd om het bestaan bij de woorden, enz. der taal, 142;
over Darwin’s verklaring van den oorsprong der taal, 139.

M ü l l e r , S., over den Bantengstier, II 280;


over de kleuren van Semnopithecus chrysomelas, II 281.

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