Senior Acquisitions Editor: John Goucher Senior Development Editor: Dana Knighten Senior Project Editor: Senior Marketing Manager: Aimee Sirmon Cover and Interior Designer: Armen Kojoyian Compositor: Maryland Composition, Inc. Printer: R.R. Donnelley & Sons-Willard Copyright © 2005 Lippincott Williams & Wilkins 351 West Camden Street Baltimore, MD 21201 530 Walnut Street Philadelphia, PA 19106 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means, including photocopying, or utilized by any information storage and retrieval system without written permission from the copyright owner. The publisher is not responsible (as a matter of product liability, negligence, or otherwise) for any injury resulting from any material contained herein. This publication contains information relating to general principles of medical care that should not be construed as specific instructions for individual patients. Manufacturers’ product information and package inserts should be reviewed for current information, including contraindications, dosages, and precautions. Printed in the United States of America Library of Congress Cataloging-in-Publication Data Cohen, Barbara J. Memmler’s The human body in health & disease / Barbara Janson Cohen. 10th ed. p. cm. Includes index. ISBN 1. Human physiology. 2. Physiology, Pathological. 3. Human anatomy. [numbers, etc.] The publishers have made every effort to trace the copyright holders for borrowed material. If they have inadvertently overlooked any, they will be pleased to make the necessary arrangements at the first opportunity. To purchase additional copies of this book, call our customer service department at (800) 638-3030 or fax orders to (301) 824-7390. International customers should call (301) 714-2324. Visit Lippincott Williams & Wilkins on the Internet: http://www.LWW.com. Lippincott Williams & Wilkins customer service representatives are available from 8:30 am to 6:00 pm, EST. [numbers] Reviewers We gratefully acknowledge the generous contributions of the reviewers whose names appear in the list that follows. These instructors were kind enough to read the text thoroughly and make suggestions for improvement. Their comments determined many of the changes in content and direction for this revision, such as the increased number and types of learning aids, addition of new art and revisions to existing art, a stronger focus on teaching and learning anatomic and medical terminology, and an increased emphasis on physiology and the interrelatedness of structure and function. We hope they will be pleased with the results of their hard work in this 10th edition of Memmler’s The Human Body in Health and Disease. LaVon Barrett, RN, BSN Amarillo College Amarillo, TX Michelle Cleary, PhD Florida International University Miami, FL Nina Beaman, MS, CMA, RNC Allied Health Program Area Coordinator Bryant and Stratton College Richmond, VA Stephen M. Colarusso, BS, NCTMB, ACST Director of Education Charles of Italy School of Massage Therapy Lake Havasu City, AZ Mark Andrew Bloom, BS, MS Instructor of Biology Texas Christian University Fort Worth, TX Zoe Hanson Cujak, BSN, MEd Associate Dean, Service Occupations Fox Valley Technical College Appleton, WI Kathleen Bode, RN, MS Chair, Division of Health Flint Hills Technical College Emporia, KS Katherine Fukuyama, BSN, MEd Vancouver Community College Vancouver, British Columbia, Canada William J. Burke, BA Madison Area Technical College Madison, WI Blackhawk Area Technical College Monroe, WI Glenn Grady, MEd, BSMT (ASCP), CMA Allied Health Department Chair Miller-Motte Technical College Wilmington, NC Patti Calk, MEd, LOTR University of Louisiana at Monroe Monroe, LA Kerry Hull, PhD Associate Professor Department of Biology Bishop’s University Lennoxville, Quebec, Canada Kathy Carson, RPH The Cleveland Institute of DentalMedical Assistants, Inc. Mentor, OH Tammee Neuhaus, MLT Minnesota School of Health Sciences Apple Valley, MN Debra J. Paul, BAM, CMA Medical Assisting Program Instructor IVY Tech State College South Bend, IN Lisa S. Reed, RN, MS, CNOR Department Chairperson for Surgical Technology New England Institute of Technology Warwick, RI Dyal N. P. Singh, BSc (Honors), MSc, PhD Professor of Anatomy Director of Neuroscience Ross University School of Medicine Dominica, West Indies Rox Ann Sparks, RN, BSN, MICN Vocational Nursing Instructor Merced College Merced, CA Alan H. Stephenson, BS, MS, PhD Chair, Science Department Edgecombe Community College Tarboro, NC Jean A. Zorko, MS, BSMT (ASCP) Assistant Professor, Science Stark State College of Technology Canton, OH Preface Memmler’s The Human Body in Health and Disease is a textbook for introductory-level health professions and nursing students who need a basic understanding of anatomy and physiology, the interrelationships between structure and function, and the effects of disease on body systems. Like preceding editions, the tenth edition remains true to Ruth Memmler’s original vision. Designed for health professions and nursing students, the features and content specifically meet the needs of those who may be starting their health career preparation with little or no science background. This book’s primary goals are: To provide the essential knowledge of human anatomy, physiology, and the effects of disease, at an ideal level of detail, and in language that is clear and understandable. ◗ To illustrate the concepts discussed with anatomic art that depicts the appropriate level of detail with accuracy, simplicity, and elegance, and that is integrated seamlessly with the narrative. ◗ To incorporate the most recent scientific findings into the fundamental material on which Ruth Memmler’s classic text is based. ◗ To include pedagogy designed to enhance interest in and understanding of the concepts presented. ◗ To teach the basic anatomic and medical terminology used in healthcare settings, preparing students to function efficiently in their chosen health career. ◗ To present an integrated teaching-learning package that includes all of the elements necessary for a successful learning experience. ◗ This revision is the direct result of in-depth market feedback solicited to tell us what instructors and students at this level most need. We listened carefully to the feedback, and the results we obtained are integrated into every feature of this book. The text itself has been thoroughly revised and updated to reflect the latest accepted scientific thought in each area of the book. Because visual learning devices are so important to students at this level, this edition also features a completely revamped and expanded art program that includes revised versions of many of the figures from previous editions as well as numerous all-new, full-color anatomic line drawings and photographs. Last but not least, these features appear in an all-new design that makes the content more user-friendly and accessible than ever. ◗ Organization and Structure Like previous editions, the tenth edition uses a body systems approach to the study of the normal human body and how disease affects it. The book is divided into seven units, grouping related information and body systems together as follows: ◗ Unit I, The Body as a Whole (Chapters 1–4), focuses on the body’s organization; basic chemistry needed to understand body functions; cells and their functions; and tissues, glands, and membranes. ◗ Unit II, Disease and the First Line of Defense (Chapters 5 and 6), presents information on disease, organisms that produce disease, and the integumentary system, which is the body’s first line of defense against injury and disease. ◗ Unit III, Movement and Support (Chapters 7 and 8), includes the skeletal and muscular systems. ◗ Unit IV, Coordination and Control (Chapters 9–12), focuses on the nervous system, the sensory system, and the endocrine system. ◗ Unit V, Circulation and Body Defense (Chapters 13–17), includes the blood, the heart and heart disease, blood vessels and circulation, the lymphatic system, and the immune system. ◗ Unit VI, Energy: Supply and Use (Chapters 18–22), includes the respiratory system, the digestive system, metabolism, nutrition, temperature control, body fluids, and the urinary system. ◗ Unit VII, Perpetuation of Life (Chapters 23–25), covers the male and female reproductive systems, development and birth, and heredity and hereditary diseases. The main Glossary defines the chapters’ boldfaced terms, and a Glossary of Word Parts is a reference tool that not only teaches basic medical and anatomic terminology but also helps students learn to recognize unfamiliar terms. Appendixes include a variety of supplementary information that students will find useful as they work with the text, including answers to the Chapter Checkpoint questions and Zooming In illustration questions (Appendix 6) that are found in every chapter. ◗ Pedagogic Features Every chapter contains pedagogy that has been designed with the health professions and nursing student in mind (the User’s Guide that follows the Preface provides a “guided tour” of these features and their pedagogic benefits). Features marked with an asterisk (*) appear in every chapter: ◗ *Learning Outcomes: Chapter objectives on the first page of every chapter help the student organize and prioritize learning. ix x ✦ CHAPTER SEVEN *Selected Key Terms: List that accompanies the Learning Outcomes presents the most important terms covered in the chapter. ◗ *Chapter Checkpoints: Brief questions at the end of main sections test and reinforce the student’s recall of key information in that section. ◗ *“Zooming In” questions “(NEW to this edition): Questions with the figure legends test and reinforce the student’s understanding of concepts depicted in the illustration. They are set in a second color to increase their visibility. ◗ Phonetic pronunciations: Easy-to-learn phonetic pronunciations are spelled out in the narrative, appearing in parentheses directly following many terms—no need for students to understand dictionary-style diacritical marks. (See the “Guide to Pronunciation” below.) ◗ *Special interest boxes: Each chapter contains three special interest boxes focusing on topics that augment chapter content. The book includes five kinds of boxes altogether: ◗ A Closer Look: Provide additional in-depth scientific detail on topics in or related to the chapter. ◗ Clinical Perspective: Focus on diseases and disorders relevant to the chapter, providing detailed content for students training in different fields. ◗ Health Professions (NEW to this edition): Describe various careers in the health professions, highlighting the reasons why students need a thorough grounding in anatomy and physiology. ◗ Hot Topic (NEW to this edition): Focus on current trends and research, reinforcing the link between anatomy and physiology and related news coverage that students may have seen. ◗ Health Maintenances: Offer supplementary information on health and wellness issues. ◗ *Figures: The greatly expanded and revised art program includes full-color anatomic line art, both new and revised, with a level of detail that matches that of the narrative. Also NEW to this edition are photomicrographs, radiographs, and other scans, included to give students a “preview” of what they might see in real-world healthcare settings. ◗ Tables: The numerous new and revised tables in this edition summarize key concepts and information in an easy-to-review form. ◗ Color figure and table numbers (NEW to this edition): Figure and table numbers appear in color in the narrative, helping students quickly find their place after stopping to look at an illustration or table. Figure callouts appear in blue type, and table callouts, in red. ◗ *Word Anatomy: Organized by chapter headings, this chart groups various word parts used in terms found in the chapter. This learning tool helps students build vocabulary and promotes recognition of even unfamiliar terms based on a knowledge of common word parts. ◗ *Summary: Outline-format summary provides a concise overview of chapter content, aiding in study and test preparation. ◗ *Questions for Study and Review: Study questions have been thoroughly revised and organized hierarchically into three NEW levels in this edition (answers appear in the Instructor’s Manual): ◗ Building Understanding: Includes fill-in-the-blank, matching, and multiple choice questions that test factual recall. ◗ Understanding Concepts: Includes short-answer questions (define, describe, compare/contrast) that test and reinforce understanding of concepts. ◗ Conceptual Thinking: Includes short-essay questions that promote critical thinking skills. ◗ ◗ Summary In short, the tenth edition of Memmler’s The Human Body in Health and Disease builds on the successes of the previous nine editions by offering clear, concise narrative into which accurate, aesthetically pleasing anatomic art has been woven. We have made every effort to respond thoughtfully and thoroughly to reviewers’ and instructors’ comments, offering the ideal level of detail for students preparing for a career in the health professions and nursing, and the pedagogic features that best support it. We hope you will agree that the tenth edition of Memmler’s is the best ever. User’s Guide In today’s health careers, a thorough understanding of human anatomy and physiology is more important than ever. Memmler’s The Human Body in Health and Disease not only provides the conceptual knowledge you’ll need but also teaches you how to apply it. This User’s Guide introduces you to the features and tools that will enhance your learning experience. A unifying theme of this text is the relationship between structure and function, and how they differ in health and disease. We’ve woven that theme into the book’s design and approach. Take a few minutes to look through the text and get acquainted with its organization. The two tables of contents provide a framework for your learning: the Brief Contents gives a wide-angle view of the book’s “skeleton”—the units and chapters—while the detailed Contents focuses in on the individual “bones,” the topics themselves. As with the different body systems, specific topics build on each other from chapter to chapter, with each supporting the ones that follow. Next, take a look at the chapters themselves. We’ve included some important tools to help you learn about anatomy and physiology and apply your new knowledge: Objectives and key terms highlight important concepts—helping you organize and prioritize learning. ◗ “Health Professions” boxes focus on a variety of health careers—showing how the knowledge of anatomy and physiology is applied in real-world jobs. ◗ “Hot Topic” boxes provide cutting-edge content on trends and research—giving a view to what is happening in the larger scientific community. ◗ “Clinical Perspective” boxes focus on physical disorders and related body processes as well as techniques used in clinical settings—providing additional content on diseases and their treatments. ◗ “A Closer Look” boxes provide additional detail on selected topics from the text—focusing in on the details of structure and function. ◗ “Health Maintenance” boxes cover common health issues—offering useful information about how to keep the body healthy. ◗ “Checkpoint” questions test your understanding of the chapter’s key points—helping you review as you proceed through the chapter. ◗ “Zooming In” questions ask you to focus in on the illustration’s details and answer questions based on what you see—reviewing important concepts and honing your conceptual thinking. ◗ Phonetic pronunciations follow selected terms—helping you say the term correctly without having to stop and look up complicated pronunciation symbols. ◗ The “Word Anatomy” chart helps you learn to recognize new terms based on your knowledge of word parts—building vocabulary. ◗ Chapter summaries provide a quick review of key points in outline form—helping you prepare for exams. ◗ Questions for Study and Review cover chapter content thoroughly—testing your recall of facts, reinforcing understanding of concepts, and teaching critical thinking. ◗ The bonus CD contains a glossary of pronunciations from Stedman’s Medical Dictionary and an electronic image atlas. The pronunciation glossary allows you to hear the correct pronunciation of key terms from the text and practice them yourself, helping to prepare you to communicate effectively in the healthcare setting. The electronic image atlas, which contains the most important illustrations from the text, is a convenient study tool that lets you review and test your understanding of key body structures. xi Box 1-3 • Health Professions Health Information Technicians E very time a patient receives medical treatment, information is added to the patient’s medical record, which includes data about symptoms, medical history, test results, diagnoses, and treatment. Health information technicians organize and manage these records, working closely with physicians, nurses, and other health professionals to ensure that medical records provide a complete, accurate basis for quality patient care. Accurate medical records are also essential for administrative purposes. Health information technicians assign a code to each diagnosis and procedure a patient receives, and this information is used for accurate patient billing. In addition, health information technicians analyze medical records to discover trends in health and disease. This research can be used to improve patient care, manage costs, and help establish new medical treatments. Health information technicians need a strong clinical knowledge base. A thorough background in medical terminology is essential when reading and interpreting medical records. Anatomy and physiology are definitely required! Most health information technologists work in hospitals and long-term care facilities. Others work in medical clinics, government agencies, insurance companies, and consulting firms. Job prospects are promising because of the growing need for healthcare. In fact, health information technology is projected to be one of the fastest growing careers in the United States. For more information about this profession, contact Box 8-2 Management Hot Topics the American Health Information Association. Anabolic Steroids: Winning at All Costs? A nabolic steroids mimic the effects of the male sex hormone testosterone by promoting metabolism and stimulating growth. These drugs are legally prescribed to promote muscle regeneration and prevent atrophy from disuse after surgery. However, athletes also purchase them illegally, using them to increase muscle size and strength and improve endurance. When steroids are used illegally to enhance athletic performance, the doses needed are large enough to cause serious side effects. They increase blood cholesterol levels, which may lead to atherosclerosis, heart disease, kidney failure, and Box 7-1 stroke. Steroids damage the liver, making it more susceptible to disease and cancer, and suppress the immune system, increasing the risk of infection and cancer. In men, steroids cause impotence, testicular atrophy, low sperm count, infertility, and the development of female sex characteristics such as breasts (gynecomastia). In women, steroids disrupt ovulation and menstruation and produce male sex characteristics such as breast atrophy, enlargement of the clitoris, increased body hair, and deepening of the voice. In both sexes steroids increase the risk for baldness and, especially in men, cause mood swings, depression and violence. Clinical Perspectives Landmarking: Seeing With Your Fingers M ost body structures lie beneath the skin, hidden from view except in dissection. A technique called landmarking allows health care providers to visualize hidden structures without cutting into the patient. Bony prominences, or landmarks, can be palpated (felt) beneath the skin to serve as reference points for locating other structures. Landmarking is used during physical examinations and surgeries, when giving injections, and for many other clinical procedures. The lower tip of the sternum, the xiphoid process, is a reference point in the administration of cardiopulmonary resuscitation (CPR). Practice landmarking by feeling for some of the other bony prominences. You can feel the joint between the mandible and the temporal bone of the skull (the temporomandibular joint, or TMJ) anterior to the ear canal as you move your lower jaw up and down. Feel for the notch in the sternum (breast bone) between the clavicles (collar bones). Approximately 4 cm below this notch you will feel a bump called the sternal angle. This prominence is an important landmark because its location marks where the trachea splits to deliver air to both lungs. Move your fingers lateral to the sternal angle to palpate the second ribs, important landmarks for locating the heart and lungs. Feel for the most lateral bony prominence of the shoulder, the acromion process of the scapula (shoulder blade). Two to three fingerbreadths down from this point is the correct injection site into the deltoid muscle of the shoulder. Place your hands on your hips and palpate the iliac crest of the hip bone. Move your hands forward until you reach the anterior end of the crest, the anterior superior iliac spine (ASIS). Feel for the part of the bony pelvis that you sit on. This is the ischial tuberosity. It and the ASIS are important landmarks for locating safe injection sites in the gluteal region. Box 13-1 A Closer Look Hemoglobin: Door to Door Oxygen Delivery T he hemoglobin molecule is a protein made of four chains of amino acids (the globin part of the molecule), each of which holds an iron-containing heme group. Each of the four hemes can bind one molecule of oxygen. Heme group Globin chains Hemoglobin. This protein in red blood cells consists of four amino acid chains (globins), each with an oxygen-binding heme group. Box 5-2 • Health M aintenance The The Cold Cold Facts Facts about about the the Common Common Cold Cold E very year, an estimated one billion Americans suffer from the symptoms of the common cold—runny nose, sneezing, coughing, and headache. Although most cases are mild and usually last about a week, colds are the leading cause of doctor visits and missed days at work and school. Colds are caused by a viral infection of the mucous membranes of the upper respiratory tract. More than 200 different viruses are known to cause cold symptoms. While most colds occur in winter, scientists have found that cold weather does not increase the risk of “catching” a cold; the incidence is probably higher in winter because people spend more time indoors, increasing the chances that the virus will spread from person to person. Colds spread primarily from contact with a contaminated surface. When an infected person coughs or sneezes, small droplets of water filled with viral particles are propelled through the air. One unshielded sneeze may spread hundreds of thousands of viral particles several feet. Depending upon xii temperature and humidity, these particles may live as long as 3 to 6 hours, and others who touch the contaminated surface may pick up the particles on their hands. To help prevent the transmission of cold viruses: ◗ ◗ ◗ ◗ Avoid close contact with someone who is sneezing or coughing. Wash hands frequently to remove any viral particles you may have picked up. Avoid touching or rubbing your eyes, nose, or mouth with contaminated hands. Clean contaminated surfaces with disinfectant. There are currently no medically proven cures for the common cold, and treatments only ease the symptoms. Because viruses cause the common cold, antibiotics are of no benefit. Getting plenty of rest and drinking lots of fluids are the best ways to speed recovery. Hemoglobin allows the blood to carry much more oxygen than it could were the oxygen simply dissolved in the plasma. A red blood cell contains about 250 million hemoglobins, each capable of binding four molecules of oxygen. So, a single red blood cell can carry about one billion oxygen molecules! Hemoglobin reversibly binds oxygen, picking it up in the lungs and releasing it in the body tissues. Active cells need more oxygen and also generate heat and acidity. These changing conditions promote the release of oxygen from hemoglobin into metabolically active tissues. Immature red blood cells (erythroblasts) produce hemoglobin as they mature into erythrocytes in the red bone marrow. When the liver and spleen destroy old erythrocytes they break down the released hemoglobin. Some of its components are recycled, and the remainder leaves the body as a brown fecal pigment called stercobilin. In spite of some conservation, dietary protein and iron are still essential to maintain supplies. with their sels, and wn as osne, which s up the of other d in rings ER-shan) one cells xtend out can be in h its cenwn as an channel The second type of bone tissue, called spongy, or cancellous, bone has more spaces than compact bone. It is made of a meshwork of small, bony plates filled with red marrow. Spongy bone is found at the epiphyses (ends) of the long bones and at the center of other bones. Figure 74 shows a photograph of both compact and spongy tissue in a bone section. Checkpoint 7-1 A long bone has a long narrow shaft and two irregular ends. What are the scientific names for the shaft and the ends of a long bone? 7 Checkpoint 7-2 What are the two types of osseus (bone) tissue Figure 8-1 Structure of a skeletal muscle. Connective tissue coverings are shown. (B, Reprinted with permission from Gartner LP, Hiatt JL. Color Atlas of Histology. 3rd ed. Philadelphia: Lippincott Williams & Wilkins, 2000.) ZOOMING IN ✦ What is the innermost layer of connective tissue in a muscle? What layer of connective tissue surrounds a fascicle of muscle fibers? Figure 7-21 The pelvic bones. (A) Anterior view. (B) Lateral view; shows jo lum. ZOOMING IN ✦ What bone is nicknamed the “sit bone”? head of the femur is the greater trochanter (troKAN-ter), used as a surface landmark. The lesser trochanter, a smaller elevation, is located on the medial side. On the posterior surface there is a long central ridge, the linea aspera, which is a point for attachment of hip muscles. ◗ can be f der fibu thus, it olus (m lower en inner as lower en outer as projecti th The patella (pah-TEL-lah), or kneecap (see Fig. 7-1), is embedded in the tendon of the large anterior thigh muscle, the quadriceps femoris, where it crosses the k j i t It i l f id (SES h Medical terms are built from standardized word parts (prefixes, roots and suffixes). Learning the meanings of these parts can help you remember words and interpret unfamiliar terms. WORD PART MEANING EXAMPLE Bones diaoss, osse/o oste/o -clast through, between bone, bone tissue bone, bone tissue break The diaphysis, or shaft, of a long bone is between the two ends, or epiphyses. Osseous tissue is another name for bone tissue. The periosteum is the fibrous membrane around a bone. An osteoclast breaks down bone in the process of resorption. Divisions of the Skeleton paranear pariet/o wall cost/o rib supraabove, superior infrabelow, inferior metanear, beyond I. Types of muscle A. Smooth muscle 1. In walls of hollow organs, vessels, and respiratory passageways 2. Cells tapered, single nucleus, nonstriated 3. Involuntary; produces peristalsis; contracts and relaxes slowly B. Cardiac muscle 1. Muscle of heart wall 2. Cells branch; single nucleus; lightly striated 3. Involuntary; self-excitatory C. Skeletal muscle 1. Most attached to bones and move skeleton 2. Cells long, cylindrical; multiple nuclei; heavily striated 3. Voluntary; contracts and relaxes rapidly II. Muscular system 1. Functions a. Movement of skeleton b. Maintenance of posture c. Generation of heat The paranasal sinuses are near the nose. The parietal bones form the side walls of the skull. Intercostal spaces are located between the ribs. The supraspinous fossa is a depression superior to the spine of the scapula The infraspinous fossa is a depression inferior to the spine of the scapula. The metacarpal 3. Isometric contractions—tension increases, but muscle does not shorten III. Mechanics of muscle movement 1. Attachments of skeletal muscles a. Tendon—cord of connective tissue that attaches muscle to bone (1) Origin—attached to more fixed part (2) Insertion—attached to moving part b. Aponeurosis—broad band of connective tissue that attaches muscle to bone or other muscle A. Muscles work together 1. Prime mover—performs movement 2. Antagonist—produces opposite movement 3. Synergists—steady body parts and assist prime mover B. Levers and body mechanics—muscles function with skeleton as lever systems 1. Components a. Lever—bone b. Fulcrum—joint c Force—muscle contraction Questions for Study and Review Building Understanding Fill in the blanks. 1. The shaft of a long bone is called the ______. 2. The structural unit of compact bone is the ______. 3. Red bone marrow manufactures ______. 4. Bones are covered by a connective tissue membrane called ______. 5. Bone matrix is produced by ______. Matching Match each numbered item with the most closely related lettered item. a. condyle ___ 6. A rounded bony projection b. foramen ___ 7. A sharp bony prominence c. fossa ___ 8. A hole through bone d. sinus ___ 9. A bony depression e. spine ___ 10. An air-filled bony cavity teoarthritis, rheumatoid arthritis, and gout? Multiple-choice b. hinge ___ 11. On which of the following bones would the c. pivot mastoid process be found? d. ball-and-socket a. occipital bone b femur U d t di C t Ancillaries A complete teaching and learning package is available for both faculty and students. For more information, please visit the text’s companion website at http://connection.LWW.com/ memmler, or contact your local LWW representative. Free Instructor’s Manual packaged with Instructor’s Resource CD, which includes a test generator, image bank, PowerPoint™ slides, and the Instructor’s Manual files (0-7817-5392-9). ◗ Free transparency set (0-7817-6167-0). ◗ Free course preparation assistance for instructors and ◗ tutoring for students, powered by Smarthinking™ , an online support service featuring access to live e-structors. To demo this service, please visit the website listed above. ◗ Online course materials and management powered by WebCT and Blackboard. To demo the online course, please visit the website listed above. ◗ Student Study Guide available for purchase either alone (0-7817-5172-1) or packaged with the text (0-7817-6207-3). xv Acknowledgments To prepare a textbook, an author needs the assistance of many skilled people. This is my opportunity to thank those who have helped with revisions for the 10th edition of Memmler’s The Human Body in Health and Disease. My editor, John Goucher, has guided this project through from start to finish and showed great skills in putting out fires. Senior Development Editor Dana Knighten kept her eye on the big picture as well as the tiniest details—and everything in between. Jason Taylor gave advice on the entire manuscript and also wrote the special interest boxes and chapter summary questions. Kerry Hull’s contribution as a reviewer landed her the job of writing all of the ancillary materials, assisted by Ancillary Editor Molly Ward. Elizabeth Connolly and Jennifer Clements kept the art program on track, managing all of the electronic art files. My thanks to all the many reviewers, listed separately, who made such valuable and detailed comments on the text. Their insights and advice truly guided every aspect of this new edition. Enormous thanks to Craig Durant and Dragonfly Media Group for their brilliant work on the art program. They understood our needs, often better than we did, and rendered art astonishing in its clarity, instructional value, and beauty of design. And as always, thanks to my husband Matthew, currently an instructor in anatomy and physiology, for his advice on and contributions to the text. Brief Contents Unit 1 ◗ The Body as a Whole 1 1. Organization of the Human Body 000 2. Chemistry, Matter, and Life 000 3. Cells and Their Functions 000 4. Tissues, Glands, and Membranes 000 Unit II ◗ Disease and the First Line of Defense 000 5. Disease and Disease-Producing Organisms 000 6. The Skin in Health and Disease 000 Unit III ◗ Movement and Support 000 7. The Skeleton: Bones and Joints 000 8. The Muscular System 000 Unit IV ◗ Coordination and Control 000 9. The Nervous System: The Spinal Cord and Spinal Nerves 000 10. The Nervous System: The Brain and Cranial Nerves 000 11. The Sensory System 000 12. The Endocrine System: Glands and Hormones 000 Unit V ◗ Circulation and Body Defense 000 13. The Blood 000 14. The Heart and Heart Disease 000 15. Blood Vessels and Blood Circulation 000 16. The Lymphatic System and Lymphoid Tissue 000 17. Body Defenses, Immunity, and Vaccines 000 Unit VI ◗ Energy: Supply and Use 000 18. Respiration 000 19. Digestion 000 20. Metabolism, Nutrition, and Body Temperature 000 21. Body Fluids 000 22. The Urinary System 000 Unit VII ◗ Perpetuation of Life 000 23. The Male and Female Reproductive Systems 000 24. Development and Birth 000 25. Heredity and Hereditary Diseases 000 Glossary 000 Glossary of Word Parts 000 Appendices 000 Index 000 xix Contents Unit I ◗ Movement That Requires Cellular Energy How Osmosis Affects Cells THE BODY AS A WHOLE 000 1 Cell Aging 000 Cells and Cancer 000 Organization of the Human Body 000 Studies of the Human Body 000 Cancer Risk Factors 000 Levels of Organization 000 Body Systems 000 Metabolism and Its Regulation 000 4 Homeostasis 000 The Effects of Aging 000 Structure of Epithelial Tissue 000 Special Functions of Epithelial Tissue 000 Glands 000 Directions in the Body 000 Directional Terms 000 Planes of Division 000 Connective Tissue 000 Body Cavities 000 Soft Connective Tissue 000 Fibrous Connective Tissue 000 Hard Connective Tissue 000 Dorsal Cavity 000 Ventral Cavity 000 The Metric System 000 Muscle Tissue 000 Nervous Tissue 000 Units of Length 000 Units of Weight 000 Units of Volume 000 Temperature 000 2 Tissues, Glands, and Membranes 000 Tissue Classification 000 Epithelial Tissue 000 The Neuron 000 Neuroglia 000 Membranes 000 Epithelial Membranes 000 Connective Tissue Membranes 000 Membranes and Disease 000 Chemistry, Matter, and Life 000 Elements 000 Benign and Malignant Tumors 000 Atoms 000 Benign Tumors 000 Malignant Tumors 000 Symptoms of Cancer 000 Diagnosis of Cancer 000 Molecules and Compounds 000 The Importance of Water 000 Mixtures: Solutions and Suspensions Chemical Bonds 000 Tissues and Aging 000 Ionic Bonds 000 Covalent Bonds 000 Compounds: Acids, Bases and Salts 000 The pH Scale 000 Unit II Buffers 000 Isotopes and Radioactivity 000 Use of Radioactive Isotopes 000 Chemistry of Living Matter 000 Organic Compounds 000 ◗ DISEASE AND THE FIRST LINE OF DEFENSE 000 5 Disease and Disease-Producing Organisms 000 Categories of Disease 000 3 Cells and Their Functions 000 The Role of Cells 000 Microscopes 000 Cell Structure 000 Plasma Membrane 000 The Nucleus 000 The Cytoplasm 000 Surface Organelles 000 Cellular Diversity 000 Protein Synthesis 000 Nucleic acids- DNA and RNA Cell Division 000 Stages of Mitosis 000 Movement of Substances Across the Plasma Membrane 000 Movement That Does Not Require Cellular Energy 000 Predisposing Causes of Disease 000 The Study of Disease 000 Disease Terminology 000 Treatment and Prevention of Disease 000 Complementary and Alternative Medicine 000 Prevention of Disease 000 Infectious Disease 000 Modes of Transmission 000 Microbiology- The Study of Microorganisms 000 Normal Flora 000 Bacteria 000 Viruses 000 Fungi 000 Protozoa 000 Parasitic Worms 000 Roundworms 000 Flatworms 000 xxi xxii ✦ CONTENTS Tumors 000 Infection 000 Structural Disorders 000 Fractures 000 Skeletal Changes in the Aging 000 Microbial Control 000 Microbes and Public Health 000 Aseptic Methods 000 Infection Control Techniques 000 Antimicrobial Agents 000 The Joints 000 Laboratory Identification of Pathogens 000 More About Synovial Joints 000 Disorders of Joints 000 Bacterial Isolations and Tests 000 Staining Techniques 000 Other Methods of Identification 000 8 6 The Skin in Health and Disease 000 Smooth Muscle 000 Cardiac Muscle 000 Skeletal Muscle 000 Structure of the Skin 000 Epidermis 000 Dermis 000 Subcutaneous Layer 000 The Muscular System 000 Structure of a Muscle 000 Muscle Cells in Action 000 Energy Sources 000 Effects of Exercise 000 Types of Muscle Contractions 000 Accessory Structures of the Skin 000 Sebaceous (Oil) Glands 000 Sudoriferous (Sweat) Glands 000 Hair 000 Nails 000 The Mechanics of Muscle Movement 000 Functions of the Skin 000 Muscles Work Together 000 Levers and Body Mechanics 000 Protection Against Infection 000 Protection Against Dehydration 000 Regulation of Body Temperature 000 Collection of Sensory Information 000 Other Activities of the Skin 000 Skeletal Muscle Groups 000 Muscles of the Head 000 Muscles of the Neck 000 Muscles of the Upper Extremities 000 Muscles of the Trunk 000 Muscles of the Lower Extremities 000 Observation of the Skin 000 Color 000 Lesions 000 Burns 000 Effects of Aging on Muscles 000 Muscular Disorders 000 Tissue Repair 000 Effects of Aging on the Integumentary System 000 Care of the Skin 000 Skin Disorders 000 Dermatitis 000 Psoriasis 000 Cancer 000 Acne and Other Skin Infections 000 Alopecia (Baldness) 000 Allergy and Other Immune Disorders 000 Pressure Ulcers 000 The Muscular System 000 Types of Muscle 000 Diseases of Muscles 000 Disorders of Associated Structures 000 Unit IV ◗ COORDINATION AND CONTROL 000 9 The Nervous System: The Spinal Cord and Spinal Nerves 000 Role of the Nervous System 000 Unit III ◗ MOVEMENT AND SUPPORT 000 7 The Skeleton: Bones and Joints 000 Bones 000 Bone Structure 000 Bone Growth and Repair 000 Bone Markings 000 Bones of the Axial Skeleton 000 Framework of the Skull 000 Framework of the Trunk 000 Bones of the Appendicular Skeleton 000 The Upper Division of the Appendicular Skeleton 000 The Lower Division of the Appendicular Skeleton 000 Disorders of Bone 000 Metabolic Disorders 000 Structural Divisions 000 Functional Divisions 000 Neurons and Their Functions 000 Structure of a Neuron 000 Types of Neurons 000 Nerves and Tracts 000 Neuroglia 000 The Nervous System at Work 000 The Nerve Impulse 000 The Synapse 000 The Spinal Cord 000 Structure of the Spinal Cord 000 The Reflex Arc 000 Medical Procedures Involving the Spinal Cord 000 Diseases and Other Disorders of the Spinal Cord 000 The Spinal Nerves 000 Branches of the Spinal Nerves 000 Disorders of the Spinal Nerves 000 CONTENTS ✦ xxiii The Autonomic Nervous System (ANS) 000 Divisions of the Autonomic Nervous System 000 Functions of the Autonomic Nervous System 000 10 The Nervous System: The Brain and Cranial Nerves 000 The Brain 000 Protective Structures of the Brain and Spinal Cord 000 Cerebrospinal Fluid 000 The Cerebral Hemispheres 000 Functions of the Cerebral Cortex 000 Communication Areas 000 Memory and the Learning Process 000 The Diencephalon 000 The Limbic System 000 The Brain Stem 000 The Midbrain 000 The Pons 000 The Medulla Oblongata 000 12 The Endocrine System: Glands and Hormones 000 Hormones 000 Hormone Chemistry 000 Hormone Regulation 000 The Endocrine Glands and Their Hormones 000 The Pituitary 000 The Thyroid Gland 000 The Parathyroid Glands 000 The Adrenal Glands 000 The Pancreas and Its Hormones 000 The Sex Glands 000 The Thymus Gland 000 The Pineal Gland 000 Other Hormone-Producing Tissues 000 Prostaglandins 000 Hormones and Treatment 000 Hormones and Stress 000 Aging and the Endocrine System 000 The Cerebellum 000 Brain Studies 000 The Electroencephalograph 000 Disorders of the Brain and Associated Structures 000 Hydrocephalus 000 Stroke and Other Brain Disorders 000 Injury 000 Degenerative Diseases 000 Cranial Nerves 000 Names and Functions of the Cranial Nerves 000 Disorders Involving the Cranial Nerves 000 Aging of the Nervous System 000 11 The Sensory System 000 The Senses 000 Sensory Receptors 000 Special and General Senses 000 The Eye and Vision 000 Coats of the Eyeball 000 Pathway of Light Rays and Refraction 000 Function of the Retina 000 Muscles of the Eye 000 Nerve Supply to the Eye 000 Errors of Refraction and other Eye Disorders 000 The Ear 000 The Outer Ear 000 The Middle Ear and Ossicles 000 The Inner Ear 000 Otitis and Other Disorders of the Ear 000 Other Special Sense Organs 000 Sense of Taste 000 Sense of Smell 000 Unit V ◗ CIRCULATION AND BODY DEFENSE 000 13 The Blood 000 Functions of the Blood 000 Transportation 000 Regulation 000 Protection 000 Blood Constituents 000 Blood Plasma 000 The Formed Elements 000 Hemostasis 000 Blood Clotting 000 Blood Types 000 The ABO Blood Type Group 000 The Rh Factor 000 Uses of Blood and Blood Components 000 Whole Blood Transfusions 000 Use of Blood Components 000 Blood Disorders 000 Anemia 000 Leukemia 000 Clotting Disorders 000 Blood Studies 000 The Hematocrit 000 Hemoglobin Tests 000 Blood Cell Counts 000 The Blood Slide (Smear) 000 Blood Chemistry Tests 000 Coagulation Studies 000 Bone Marrow Biopsy 000 The General Senses 000 Sense of Touch 000 Sense of Pressure 000 Sense of Temperature 000 Sense of Position 000 Sense of Pain 000 Sensory Adaptation 000 14 The Heart and Heart Disease 000 Circulation and the Heart 000 Location of the heart 000 Structure of the Heart 000 The Pericardium 000 Special Features of the Myocardium 000 xxiv ✦ CONTENTS Divisions of the Heart 000 Blood Supply to the Myocardium 000 Function of the Heart 000 Cardiac Output 000 The Heart’s Conduction System 000 Control of the Heart Rate 000 Heart Sounds 000 The Reticuloendothelial System 000 Disorders of the Lymphatic System and Lymphoid Tissue 000 Lymphedema 000 Lymphadenopathy 000 Splenomegaly 000 Lymphoma 000 Heart Disease 000 Classifications of Heart Disease 000 Congenital Heart Disease 000 Rheumatic Heart Disease 000 Coronary Artery Disease 000 Heart Failure 000 The Heart in the Elderly 000 Prevention of Heart Disease 000 Heart Studies 000 Treatment of Heart Disease 000 Medications 000 Correction of Arrhythmias 000 Heart Surgery 000 15 Blood Vessels and Blood Circulation 000 Blood Vessels 000 Blood Circuits 000 Vessel Structure 000 Systemic Arteries 000 The Aorta and Its Parts 000 The Iliac Arteries and Their Subdivisions 000 Arteries That Branch to the Arm and Head 000 Anastomoses 000 17 Body Defenses, Immunity, and Vaccines 000 Why Do Infections Occur? 000 Nonspecific Defenses 000 Chemical and Mechanical Barriers 000 Phagocytosis 000 Natural Killer Cells 000 Inflammation 000 Fever 000 Interferon 000 Immunity 000 Inborn Immunity 000 Acquired Immunity 000 The Antigen—Antibody Reaction 000 Naturally Acquired Immunity 000 Artificially Acquired Immunity 000 Disorders of the Immune System 000 Allergy 000 Autoimmunity 000 Immune Deficiency Diseases 000 Multiple Myeloma 000 The Immune System and Cancer 000 Transplantation and the Rejection Syndrome 000 Systemic Veins 000 The Venae Cavae and Their Tributaries 000 Venous Sinuses 000 The Hepatic Portal System 000 The Physiology of Circulation 000 Capillary Exchange 000 The Dynamics of Blood Flow 000 The Pulse 000 Blood Pressure 000 Arterial Degeneration and Other Blood Vessels Disorders 000 Hemorrhage 000 Shock 000 Thrombosis 000 Varicose Veins 000 16 The Lymphatic System and Lymphoid Tissue 000 The Lymphatic System 000 Functions of the Lymphatic System 000 Lymphatic Circulation 000 Lymphatic Capillaries 000 Lymphatic Vessels 000 Movement of Lymph 000 Lymphoid Tissue 000 Lymph Nodes 000 The Spleen 000 The Thymus 000 The Tonsils 000 Other Lymphoid Tissue 000 Unit VI ◗ ENERGY: SUPPLY AND USE 000 18 Respiration 000 Phases of Respiration 000 The Nasal Cavities 000 The Pharynx 000 The Larynx 000 The Trachea 000 The Bronchi 000 The Lungs 000 The Process of Respiration 000 Pulmonary Ventilation 000 Gas Exchange 000 Transport of Oxygen 000 Transport of Carbon Dioxide 000 Regulation of Respiration 000 Abnormal Ventilation 000 Breathing Patterns 000 Disorders of the Respiratory System 000 Disorders of the Nasal Cavities and Related Structures 000 Infection 000 Hay Fever and Asthma 000 Chronic Obstructive Pulmonary Disease (COPD) 000 Sudden Infant Death Syndrome (SIDS) 000 Respiratory Distress Syndrome (RDS) 000 Cancer 000 Disorders Involving the Pleura 000 CONTENTS ✦ xxv Age and the Respiratory Tract 000 Special Equipment for Respiratory Treatment 000 19 Digestion 000 Function and Design of the Digestive System 000 The Wall of the Digestive Tract 000 The Peritoneum 000 Body Temperature 000 Heat Production 000 Heat Loss 000 Temperature Regulation 000 Fever 000 Responses to Excessive Heat 000 Responses to Excessive Cold 000 Organs of the Digestive Tract 000 The Mouth 000 The Teeth 000 The Pharynx 000 The Esophagus 000 The Stomach 000 The Small Intestine 000 The Large Intestine 000 The Accessory Organs 000 The Salivary Glands 000 The Liver 000 The Gallbladder 000 The Pancreas 000 Enzymes and the Digestive Process 000 The Role of Water 000 Digestion, Step-by-Step 000 Absorption 000 Absorption of Fats 000 Absorption of Vitamins and Minerals 000 Control of Digestion 000 Hunger and Appetite 000 Eating Disorders 000 Disorders of the Digestive System 000 Peritonitis 000 Diseases of the Mouth and Teeth 000 Disorders of the Esophagus and Stomach 000 Intestinal Disorders 000 Infection of the Salivary Glands 000 Cirrhosis and Other Liver Diseases 000 Gallstones 000 Pancreatitis 000 Aging and the Digestive System 000 20 Metabolism, Nutrition, and Body Temperature 000 Metabolism 000 Cellular Respiration 000 The Use of Nutrients for Energy 000 Anabolism 000 Minerals and Vitamins 000 Nutritional Guidelines 000 Carbohydrates 000 Fats 000 Proteins 000 Vitamin and Mineral Supplements 000 The Food Guide Pyramid 000 Alcohol 000 Nutritional Disorders 000 Food Allergies 000 Malnutrition 000 Overweight and Obesity 000 Underweight 000 Nutrition and Aging 000 21 Body Fluids 000 The Importance of Water 000 Fluid Compartments 000 Water Balance 000 Sense of Thirst 000 Electrolytes and Their Functions 000 Electrolyte Balance 000 Acid—Base Balance 000 Regulation of pH 000 Abnormal pH 000 Disorders of Body Fluids 000 Fluid Therapy 000 Excretion 000 Organs of the Urinary System 000 The Kidneys 000 Blood Supply to the Kidney 000 Structure of the Kidney 000 Functions of the Kidney 000 Formation of Urine 000 The Ureters 000 The Urinary Bladder 000 The Urethra 000 Urination 000 The Urine 000 Normal Constituents 000 Abnormal Constituents 000 Disorders of the Urinary System 000 Kidney Disorders 000 Disorders of the Ureters 000 Disorders of the Urethra 000 The Effects of Aging 000 22 The Urinary System Excretion 000 Organs of the Urinary System 000 The Kidneys 000 Blood Supply to the Kidney 000 Structure of the Kidney 000 Functions of the Kidney 000 Formation of Urine 000 The Ureters 000 The Urinary Bladder 000 The Urethra 000 Urination 000 The Urine 000 Normal Constituents 000 Abnormal Constituents 000 Disorders of the Urinary System 000 Kidney Disorders 000 Disorders of the Ureters 000 Disorders Of the Bladder 000 Disorders of the Urethra 000 The Effects of Aging 000 xxvi ✦ CONTENTS The Mammary Glands and Lactation 000 Disorders of Pregnancy, Childbirth, and Lactation 000 Unit VII ◗ PERPETUATING LIFE 000 23 The Male and Female Reproductive Systems 000 Reproduction 000 Meiosis 000 The Male Reproductive System 000 The Testes 000 Accessory Organs 000 Semen 000 The Urethra and Penis 000 Hormonal Control of Male Reproduction 000 The Effects of Aging on Male Reproduction 000 Disorders of the Male Reproductive System 000 Structural Disorders 000 Infections 000 Tumors 000 The Female Reproductive System 000 The Ovaries 000 The Ova and Ovulation 000 Accessory Organs 000 The Menstrual Cycle 000 Beginning of the Cycle 000 Ovulation 000 The Menstrual Phase 000 Menopause 000 Hormone Replacement Therapy 000 Birth Control 000 Disorders of the Female Reproductive System 000 Menstrual Disorders 000 Benign and Malignant Tumors 000 Infections 000 Infertility 000 24 Development and Birth 000 Pregnancy 000 Fertilization and the Start of Pregnancy 000 The Placenta 000 Development of the Embryo 000 The Fetus 000 The Mother 000 Childbirth 000 The Four Stages of Labor 000 Cesarean Section 000 Multiple Births 000 Termination of Pregnancy 000 Pregnancy-Induced Hypertension 000 Postpartum Disorders 000 Lactation Disturbances 000 25 Heredity and Hereditary Diseases 000 Genes and Chromosomes 000 Dominant and Recessive Genes 000 Distribution of Chromosomes to Offspring 000 Sex Determination 000 Sex-Linked Traits 000 Hereditary Traits 000 Gene Expression 000 Genetic Mutation 000 Genetic Diseases 000 Congenital Versus Hereditary Diseases 000 Examples of Genetic Diseases 000 Treatment and Prevention of Genetic Diseases 000 Genetic Counseling 000 Progress in Medical Treatment 000 Glossary 000 Glossary of Word Parts 000 Appendixes 000 Appendix 1 Metric measurements 000 Appendix 2 Celsius-Fahrenheit temperature conversion scale 000 Appendix 3 Periodic table of the elements 000 Appendix 4 Laboratory tests 000 Table 1, Routine urinalysis 000 Table 2, Complete blood count 000 Table 3, Blood chemistry tests 000 Appendix 5 Infectious diseases and their causative conditions 000 Table 1, Bacterial diseases 000 Table 2, Viral diseases 000 Table 3, Prion diseases 000 Table 4, Fungal diseases 000 Table 5, Protozoal diseases 000 Appendix 6 Answers to Chapter Checkpoint and Zooming In questions 000 Index 000