ANATOMY & PHYSIOLOGY OF

THE DIGESTIVE SYSTEM

Prepared by:-

MR. SAIHOU SANNEH

RN, RM, BSN&RH, FWACN.
LECTURER- SONM
BANJUL, THE GAMBIA.
 INTRODUCTION
• The Digestive system is also known as the GASTRO
INTESTINAL TRACT or THE ALIMENTARY
CANAL.
• It is a continuous, coiled, hollow, muscular tube of
about 23 to 30 feet (9 meters) long, extending from
the mouth and running through the body to the anus.
• Generally, the entire G.I.T is composed of 4 common
layers, taking from outside in:-
(i) SEROSA:- the outer most layer (ii) MUSCLE:-
middle layer (iii) SUBMUCOSA:- sub-middle layer
(iv) MUCOUS MEMBRANE:- innermost layer.
 INTRODUCTION

• Around the esophagus, the outer coat is of

fibrous tissue rather than serosa.
• The muscle layer consist of two layers:-
• The outer longitudinal in nature
• The inner circular in nature.
• The G.I.T is also surrounded by sympathetic
and parasympathetic branches of the
autonomic nervous system.
• The sympathetic branch controls the
inhibitory actions while the parasympathetic
branch controls the excitatory effects.
 STRUCTURE OF THE G.I.T
• The G.I.T. is composed of the following organs
and accessories:-
• THE MOUTH
• THE PHARYNX
• THE ESOPHAGUS
• THE STOMACH
• THE SMALL INTESTINE
• THE LARGE INTESTINE
• The Accessory Glands include:-
• The Salivary glands
• The Liver . The pancreas.
• The Gall Bladder & . The Spleen.
 THE MOUTH
• The mouth is the first part of the digestive
system also called the oral cavity.
GENERAL FUNCTIONS OF THE MOUTH

• Generally, the mouth has 3 digestive

functions.
1. To receive food called ingestion.
2. To prepare food for digestion
3. To begin the digestion of starch
STRUCTURE OF THE MOUTH
• The mouth is a mucous membrane-lined
cavity and can be divided into 3 parts (outer,
middle & inner)
• The outer section is composed of the LIPS.
• The middle section called sub-oral cavity is
composed of the TEETH.
• The inner section called oral cavity is
composed of the TONGUE, SALIVA and
SALIVARY GLANDS.
 THE MOUTH
THE LIPS
• These are two flaps that are visible outside
and they surround the orifice of the mouth.
• They are made up of squamous epithelium.
• They assist in collecting the food to get into
the mouth.
• They also assist in speech control.
THE LIPS
 THE MOUTH
THE TEETH
• These are small bones contained in the sub-
oral cavity.
• They aid in the chewing of food into smaller
particles that can be mixed with the secreted
juices.
• There are two types of teeth:-
• DECIDUOUS TEETH or MILK or BABY TEETH
• PERMANENT TEETH.
 THE MOUTH
THE MILK TEETH
• These groups of teeth constitute at completion of 20
(10 up and 10 down).
• The first 8 to appear through the gums are called
INCISORS.
• The next to appear are the CANINES.
• The last to appear are the MOLARS.
• At 2 to 2yrs, 6months of age the baby teeth will
complete their development.
• However, during the first 2yrs, the permanent teeth
will begin to develop within the jaw.
• At 6ys, the first permanent tooth appear before the
baby teeth fall off.
 THE MOUTH
THE PERMANENT TEETH
• As the child grows, the jawbone also grows, making
space for additional teeth to grow.
• After the 6th year, the molars will appear, the baby
incisors will loosen and are replaced by permanent
teeth.
• Next, the baby Canines are replaced by Permanent
Canines.
• Finally, the baby molars are replaced by the
Bicuspids or Premolars of the permanent teeth.
• At 12 yrs, the 2nd permanent molars begin to appear.
• At teenage yrs, the 3rd molars called WISDOM
TEETH will begin to appear.
 THE MOUTH
• At adult age, there is a complete set of 32
permanent teeth (16 up & 16 down).
• The first 8 are incisors (4 up & 4 down).
• They are used in biting and mild cutting.
• The next 4 are Canines (2 up & 2 down).
• They are also used in biting & cutting hard food.
• The next 8 are Premolars (4 up & 4 down).
• They are used in chewing.
• The last 12 are Molars (6 up & 6 down).
• They compliment premolars in chewing.
THE TEETH
STRUCTURE OF THE TOOTH
• A Tooth consist of 3 parts:-
• A CROWN:- Is the exposed part of the tooth
appearing white & visible outside.
• THE NECK:- Is the constricted portion that is
around the surface of the gums.
• THE ROOT:- Is embedded into the jaw.
• However, two main parts are usually described.
• The Crown contain the ENAMEL which is the
hardest substance heavily mineralized with calcium
salts.
• The outer surface of the root is covered by a
substance called CEMENTUM which attaches the
tooth to the PERIODONTAL MEMBRANE.
STRUCTURE OF THE TOOTH
Cont’d…..
• This membrane holds the tooth in place in the
bony jaw.
• Underneath the root is the DENTIN, a bone-like
structure that forms the bulk of the tooth.
• It surrounds a central PULP CAVITY which
contains several structures such as connective
tissue, blood vessels & nerve fibers.
• The pulp supplies nutrients to the tooth tissue
and provides for tooth sensations.
 THE MOUTH
THE TONGUE
• The Tongue is a muscular tissue located in the oral
cavity. It almost occupies the floor of mouth.
• It aids in chewing by rolling the food into a bolus
between the teeth.
• It also aid in swallowing and is the principal organ of
speech control.
• On the surface of the tongue, it consist of a number
of special organs called TASTE BUDS.
• The taste buds determine taste sensations of
different nature such as Sweet, Salt, Sour and Bitter.
 THE MOUTH
SWEET TASTES are acutely experienced at the
tip of the tongue.
SOUR TASTES are most effectively detected by
the taste buds located at the sides of the tongue.
SALTY TASTES are most acute at the anterior
sides of the tongue.
BITTER TASTES are detected at the back of the
tongue.
The nerves for taste are derived from the Facial
and Glossopharyngeal cranial nerves (vii & xi).
THE TONGUE
 THE MOUTH
THE SALIVARY GLANDS
These are accessory organs in the mouth.
They manufacture and secret saliva.
There are 3 major types of salivary glands found in
the mouth.
1. PAROTID GLAND:- This is the largest group
and are located below and in front of the ears.
2. THE SUB-MANDIBULAR or SUB-MAXILLARY
GLAND:- They are located near the body of the
lower jaw.
3. THE SUB-LINGUAL GLANDS:- They are found
under the tongue.
 THE MOUTH
THE SALIVA
• This is a liquid mixture that contains
mainly water, protein, mucus, inorganic
salts and salivary amylase secreted by the
salivary glands.
• It helps in lubricating food and facilitate
chewing.
• Approximately, 1.5liters of saliva can be
secreted by an average adult.
 THE PHARYNX
• The Pharynx is a musculo-membranous tube
which is divided into three parts:-
a) NASO PHARYNX:- Connects to the nose.
b) ORO PHARYNX:- Connects to the mouth
C) LARYNGO-PHARYNX:- Connects to the
larynx.
• The mucus membrane of the pharynx is
continuous with that of the nasal cavity,
mouth, auditory tube and larynx.
 THE PHARYNX
GENERAL FUNCTIONS OF THE PHARYNX.
• It plays a part in swallowing by directing the
flow of food.
• It secrets mucus that assist in lubricating
food to aid in chewing and swallowing.
• It provides the right direction for the food
from the mouth to the esophagus.
 THE PROCESS OF SWALLOWING
Swallowing is a voluntary act that is regulated by
the swallowing center in the medulla oblongata
in the CNS.
As food is swallowed, the epiglottis moves to cover
the tracheal opening to prevent aspiration of
food into the lungs.
With the swallowing reflex, the smooth muscles in
the walls of the esophagus propels the food
down to the stomach.
As food passes, the lower esophageal sphincter
constricts tightly to prevent reflux.
 THE ESOPHAGUS
• The esophagus also called GULLET is a muscular
tube located in the mediastinum in the thoracic
cavity.
• It lies anterior to the spine and posterior to the
trachea and heart.
• It measures 23 to 25cm (9 – 10inches) long and 2cm
in diameter.
• It is made up of 4 layers from outside in:- Serosa,
Muscularis, Sub-mucosa & Mucosa.
• It passes through the diaphragm at an angle called
DIAPHRAGMATIC HIATUS.
• The esophagus propels food into the stomach.
 THE STOMACH
• The Stomach is a C-shaped distensible pouch
situated in the upper abdomen towards the left of the
midline.
• It lies obliquely in the epigastric, umbilical and left
hypochondriac region of the abdomen.
• The shape of the stomach and its position varies
based on the contents, digestion and muscular walls.
• However, the stomach of an average adult has a
capacity of 1500mls.
• The inlet to the stomach is called esophagastric
junction.
• This junction is surrounded by a ring sphincter called
cardiac sphincter.
 THE STOMACH
• The cardiac sphincter closes up the stomach
from the esophagus.
• The stomach can be divided into 5 anatomic
divisions:-
• THE CARDIAC SPHINCTER (entrance)
• THE FUNDUS
• THE BODY
• THE ANTRUM
• THE PYLORUS SPHINCTER(outlet)
• The stomach is also made up of 3 main layers
from outside in:-
 THE STOMACH
i) PERIMETRIUM:- The outer layer of serous
epithelium.
ii) THE MYOMETRIUM:- Middle layer of circular
smooth muscles.
iii) ENDOMETRIUM:- Inner layer of oblique
smooth epithelium.
• The mucus layer of the stomach forms and folds
in a rough nature called RUGGEA.
• This reggae contains many small glands that
secrets.
 FUNCTIONS OF THE STOMACH
• It serve as a recevoir for food and other
contents.
• In the fundus of the stomach are parietal cells
which secrets hydrochloric acid, water & intrinsic
factors
• The intrinsic factors promotes the absorption of
vitamin B12.
• The hydrochloric acid helps in the breakdown of
food into more absorbable components.
• It also helps in the destruction of ingested
bacteria.
 THE STOMACH
FUNCTIONS OF THE STOMACH
The stomach secrets Pepsin which helps in the
breakdown of proteins to polypeptides and
amino acids.
It secrets streapsin which converts triglycerides
to fatty acids, to diglycerides and then to
monoglycerides.
The stomach helps in propelling food contents into
the small intestine.
Most digestive activity occur in the pyloric region of
the stomach.
THE STOMACH
 THE SMALL INTESTINE
• The small intestine is a coiled tube of about 23feet
(7m) long and 2.5 to 2.8 cm in diameter.
• It extends from the pylorus to the ilio-cecal valve.
• This valve controls the exit of food contents into the
large intestine and prevents it reflux.
• The small intestine is divided into 3 parts:-
DUODENUM:- upper part
JEJUNUM:- middle part
ILEUM:- lower part.
• The small intestine connects with the large intestine.
• At the junction where they meet forms a tail-like
structure called VERMIFORM APPENDIX.
 THE SMALL INTESTINE
• The small intestine is made up of 3 layers:-
i) Perimetrium:- outer layer of serous
epithelium
ii) Myometrium:- middle layer of smooth
muscles.
iii) Endometrium:- inner layer of thick,
vascular and glandular mucosa.
• The inner layer is also made up of circular
folds that provide a surface for secretion of
digestive juices and absorption.
 THE SMALL INTESTINE
FUNCTIONS OF THE SMALL INTESTINE
The functional unit of the small intestine is the VILLI.
- Villi are small finger-like projections in the mucosa
membrane that helps in absorption.
- The small intestine contain goblet cells that secret
mucus and absorption cells that absorbs digestive
foodstuffs.
- The small intestine contain Brunner’s Glands in
the sub-mucosa of the duodenum that also secets
mucus.
- It contains the Vagus Nerve that stimulates
motility and secretion of juices.
 THE SMALL INTESTINE
FUNCTIONS OF THE SMALL INTESTINE
• The small intestine secrets lipase that helps in fat
metabolism.
• It also secrets the following substances:-
• Amylase – helps in carbohydrate digestion
• Peptidase – help in protein digestion
• Lactase - converts Lactose to Glucose and
Fructose.
• Sucrase – converts Glucose to Galactose
• Maltase – converts Maltose to Glucose.
• The small intestine also secrets mucus, hormones
and neuro-regulators.
 THE SMALL INTESTINE
FUNCTIONS OF THE SMALL INTESTINE
• The mucus secreted protects the mucosal lining
from injury by the HCl.
• The hormones and neuro-regulators secreted
control the secretion the glands.
• The small intestine absorbs most of the end
products of digestion across the walls to the
circulation for use by the cells.
• During peristalsis movements, 2 types of contractions
occur regularly in the S/intestine.
i) SEGMANTETION CONTRACTION:- Mixing waves of back
and forth.
ii) INTESTINAL PERISTALSIS:- Contents propelled
towards the large intestine.
SMALL INTESTINE
 THE LARGE INTESTINE
The Large intestine is a hollow muscular tube of
about 1.5m to 2m long and about 5cm in
diameter.
It is divided into 4 parts;-
THE CECUM with the appendix.
THE COLON which is also sub-divided into 4 parts.
- Ascending colon on the right.
- Transverse Colon on across the abd.
- Descending colon on the left.
- Sigmoid colon on the bottom.
THE RECTUM
THE ANUS – Terminal portion.
 THE LARGE INTESTINE
FUNCTIONS OF THE LARGE INTESTINE
• Helps in the absorption of water and
electrolytes.
• Serves as a recevoir for the fecal mass
until defecation.
• Secrets mucus which acts as lubricant to
prevent the anus from bruising during
defecation.
 THE VERMIFORM APPENDIX
• The appendix is a small, finger-like
structure that hangs out of the large
intestine.
• It is actually part of the large intestine.
• It appears like a blind pouch and is
attached to the cecum of the ascending
colon of the large intestine.
• It is located in the right iliac fossa just
below the ilio-cecal valve.
• It measures about 10cm (4inches) long.
 THE VERMIFORM APPENDIX
FUNCTIONS OF THE APPENDIX
• The appendix has no known function.
• It is actually part of the large intestine.
• It do fill with food contents and empties
regularly into the cecum.
• The lumen of the appendix is very small
and is therefore susceptible to empty its
contents inefficiently.
• The makes it prone to obstruction and
eventually infection called APPENDICITIS.
THE LARGE INTESTINE
 THE ACCESSORY ORGANS OF THE
DIGESTIVE SYSTEM
THE LIVER
• The Liver is the largest gland in the body and
weighs about 1.5kg in an average adult.
• It is situated in the upper part of the abdominal
cavity occupying a greater part of the right
hypochondriac region, part of the epigastric
region and extending into the left hypochondriac
region.
• The upper anterior surface of the liver is smooth
and curved to fit the under surface of the
diaphragm.
• Its posterior surface is irregular.
 THE ACCESSORY ORGANS OF THE
DIGESTIVE SYSTEM
THE LIVER Cont’d..
• The Liver is enclosed in a thin capsule and
incompletely covered by a layer of peritoneum.
• Posteriorly, the liver is divided into two by the
falciform ligament, which connects it to the
diaphragm.
ORGANS ASSOCIATED WITH THE LIVER
• SUPERIORLY - is the diaphragm
• ANTERIORLY – is the abdominal wall
• INFERIORLY – the stomach, bile ducts, duodenum,
hepatic flexure of the colon, right kidney and adrenals.
• POSTERIORLY – esophagus, inferior vena cava, aorta,
gall bladder, vertebral column & diaphragm.
 THE LIVER
DIVISIONS OF THE LIVER
• The liver is said to have 4 lobes.
• When viewed interiorly, only two lobes can
be seen (right & left lobe).
• Posteriorly, and additional two lobes can be
seen called Caudate & Quadrate.
BLOOD SUPPLY TO THE LIVER
• The liver receives blood from two sources.
• Portal Veins (70%)
• Hepatic artery (30%)
 THE LIVER
BLOOD SUPPLY
• The Hepatic artery carries well-oxygenated blood
from the aorta.
• The Portal vein carry poorly oxygenated blood but
nutrient-riched blood from the gastro-intestinal
tract (except from the inferior part of the anal
canal) to the sinusoids of the liver.
VENOUS RETURN:- Venous blood drains from the
liver sinusoids into the central veins which join
with the veins from other lobes until it eventually
become hepatic vein, which leaves the liver and
empty blood into the inferior vena cava.
 THE LIVER
NERVE SUPPLY:- The liver receives its nerve
supply from the hepatic nerve plexus (vagus
nerve)
LYMPHATIC DRAINAGE:- From the thoracic lymph
nodes.
FUNCTIONS OF THE LIVER
• The liver performs a wide range of functions
which includes the following:-
METABOLISM & STORAGE OF GLUCOSE in the
form of Glycogen.
• When blood sugar level falls below normal, the liver
cells converts glycogen to glucose and release it into
the bloodstream, which serve to restore the normal
concentration of blood sugar.
 FUNCTIONS OF THE LIVER
• The liver assist in the formation of blood
plasma proteins such as albumin, globulin and
clotting factor of prothrombin.
• The liver synthesizes urea which is a waste
product of protein metabolism. This urea is
released into the blood and transported to the
kidneys for elimination.
• It modifies fats so that they can be used more
efficiently by the cells all over the body.
• The liver is the main manufacturer of bile.
• It assist in the destruction of old RBCs and the
pigments released from the cells in both liver &
the spleen is eliminated in the bile.
 THE LIVER
FUNCTIONS OF THE LIVER
• The liver detoxifies(remove poisonous
properties) of harmful substances such as
alcohol and certain drugs.
• It stores some fat-soluble vitamins such as
Vit. A, D, E and K which are necessary eye
sight, ultra violet rays, skin texture and blood
clotting respectively.
• The liver also stores some water-soluble
vitamins such as vitamin B2, B6, B12 and folic
acid for neuralgic pains & HB level.
• Storage of iron, copper and zinc. (Minerals)
 THE PANCREAS
• The pancreas is a pale grey gland composed of
many small sacs.
• It is similar in structure to the salivary glands.
• The liver weighs about 60-100gms and is about 12
– 15cm long.
• It extends from the duodenum to the spleen.
• It is situated in the epigastrium towards the left
hypochondric region of the abdominal cavity.
• The pancreas consist of 3 parts:-
i) THE HEAD:- This forms the largest part. It is circled
in the greater curvature of the duodenum and the
right of abdominal cavity.
 THE PANCEAS
ii) THE BODY:- lies behind the stomach and
some parts of the 1st lumbar vertebra.
iii) THE TAIL:- This reaches to the spleen
and lies in front of the left kidney.
 STRUCTURE OF THE PANCREAS
• The pancreas consist of a large number of lobules of
small sacs called ALVEOLI.
• The walls of the alveoli consist of secretory cells
which secret pancreatic juice.
• Each lobule drains into a tiny duct and these unite to
form larger and larger ducts called Pancreatic
Ducts.
• The pancreatic duct to the whole length of the gland
and opens into the duodenum at mid-point.
• Just before entering the duodenum, the pancreatic
ducts join the bile duct.
• The pancreatic juice is strongly alkaline and consist
mainly of water, mineral salts, enzymes, amylase,
trypsinogen & lipase
 THE PANCREATIC CELLS
• The Pancreatic cells are called Islets of
Langerhans.
• These cells are found in clusters irregularly
distributed throughout the pancreas.
• There are no ducts from these clusters of islet
cells.
• Their secretions passes directly into the
pancreatic veins and circulates throughout the
body.
• There are three main types of cells in the
pancreatic islets. These are:-
 THE PANCREATIC CELLS
i) ALPHA CELLS:- Contributes about 20% of
pancreatic secretions. It secrets GLUCAGON
which increases blood glucose level.
ii) BETA CELLS:- Contributes about 70% of
pancreatic secretions. It secrets INSULIN which
reduces blood sugar level.
iii) DELTA CELLS:- Contributes about 5% of
pancreatic secretions. It secrets SOMATOSTATIN
which inhibits or regulates the production of
insulin and glycogen.
NORMAL FASTING BLOOD GLUCOSE LEVEL
(FBS) = 2.5 – 7.0mm/mol.
 IMPORTANCE OF PANCREATIC HORMONES

1. THE HORMONE GLUCAGON

• The effects of Glucagon increases blood
glucose levels by stimulating the
following:-
• Conversion of glycogen to glucose in the
liver and skeletal muscles.
• Glycogenesis( production of glucose from
aminoacids)
 IMPORTANCE OF PANCREATIC HORMONES
2. THE HORMONE INSULIN
• Insulin participates in maintaining homeostatis of
blood glucose and promotes other metabolic
activities.
• It mainly targets the liver, adipose tissue,
muscles and satiety center in the hypothalamus
of the brain.
• When glucose is in excess of immediate body
needs, insulin promotes storage and reduces
high glucose level by:-
• Acting on cell membranes and stimulate uptake
and utilization of glucose by muscles and
connective tissue.
 IMPORTANCE OF PANCREATIC HORMONES
INSULIN Cont’d..
• Increase the conversion of glucose to glycogen
especially in the liver and skeletal muscles.
• Accelerate uptake of amino acids by cells and
synthesis of proteins.
• Promotes synthesis of fatty acids and storage of
fats in adipose tissue.
• Prevent breakdown of protein and fat and
glucogenesis (formation of new sugars from
proteins).
• Secretion of insulin is stimulated by increase
glucose and amino acids and G.I.T. hormones such
as gastrin, secretin. Etc.
 IMPORTANCE OF PANCREATIC HORMONES
THE HORMONE SOMATOSTATIN
• This hormone is produced by the hypothalamus.
• It is secreted mainly when there is high level of
insulin and glycogen.
• It inhibits their secretion to ensure a balance
between Insulin & Glycogen.
BLOOD SUPPLY TO THE PANCREAS
• The blood supply to the pancreas is from the
spleenic and mesenteric arteries and venous
return is from the corresponding veins.
NERVE SUPPLY:- From the sympathetic &
parasympathetic nerves.
THE PANCREAS
 GALL BLADDER
• The gall bladder is a small thin-walled, green,
muscular sac on the inferior surface of the liver.
• It serves as a strong pouch for bile that is
manufactured and secreted by the liver.
• When food digestion is not occurring, bile flows
back along the hepatic ducts and then up through
the cystic ducts that is connected with the gall
bladder where it is stored.
• When bile is stored too long in the gall bladder,
the cholesterol it contains may crystallize, forming
gallstones.
• The gall bladder is also susceptible to disease
called CHOLELITHIASIS.
 GALL BLADDER
• Blockage of the common bile duct,
prevents bile from entering the small
intestine, and it begins to back up into the
liver.
• This exerts pressure on the liver cells, and
bile salts and bile begin to enter the blood
stream causing yellow discoloration on the
body called Jaundice.
 THE SPLEEN
• The Spleen is located in the upper left quadrant of
the abdomen.
FUNCTIONS OF THE SPLEEN
• The functions of the spleen can be classified into 4
general groups:-
1. HEMATOPOIETIC FUNCTION:- This involves the
production of RBCs during fetal development.
2. FILTRATION FUNCTION:- The spleen provides
an ideal filter mechanism for old and defaecative
RBCs for the circulation by mononuclear &
phagocytic system.
• The spleen also filters iron for reuse by
catabolizing HB released by hemolysis.
 SPLEEN FUNCTION
3. IMMUNE FUNCTION:- The spleen
contains rich supply of lymphocytes and
monocytes.
4. STORAGE FUNCTION:- Approximately,
305 of platelets mass are stored in the
spleen.
 THE PHYSIOLOGY OF DIGESTION &
ABSORPTION
• DIGESTION is the physical and chemical
breakdown of food into absorbable substances.
• The process of digestion begins in the mouth where
food is chewed, mechanically broken down and
mixed with saliva.
• The saliva lubricates and starts starch digestion.
• Salivation is stimulated by chewing movements and
the sight, smell or taste of food.
• The food is swallowed and passes into the
esophagus where peristaltic waves propels it to the
stomach.
• In the stomach, the digestion of proteins begins with
minimal digestion of starches and fats.
 THE PHYSIOLOGY OF DIGESTION &
ABSORPTION
• The food is then mixed with gastric juice
secretions where they undergo nervous and
hormonal control.
• Digestion is completed in the small intestine
where carbohydrates are hydrolyzed to
monosaccharides; fats to glycogen and fatty
acids; and proteins to amino acids.
• These hormones stimulate the pancreas and
duodenum to secret into the contents.
• These actions allow bile to flow into the
duodenum for hydrolysis of carbohydrates, fats
and proteins.
 THE PHYSIOLOGY OF DIGESTION &
ABSORPTION
• ABSORPTION is the transfer of the end
products of digestion across the intestinal
wall to the circulation for use by the cells.
• Most of the absorption takes place in the
small intestine with the aid of it’s villi.
 REFERENCE
• Marieb E.N. (2006)- Essentials of Anatomy
& physiology, 8th edition, New York, USA.
 THE END

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