UNIT 3

I. VOCABULARY

1. Fill in with the correct derivative or root word:

Histology is the ................ (SPECIALISE) of anatomy that involves study of the microscopic
structure of tissues. Tissues are ....................(ASSIGNEMENT) to four basic categories on the
basis of their cellular........................(COMPOSE) and histological.................. (APPEAR).
Although cells are the structural and functional units of the body, the cells of a
complex ................... (CELL) organism are so specialized that they do not function
..................... (INDEPENDENCE). Tissues are .................... (AGGREGATE) of similar cells
and cell products that perform specific functions. The various types of tissues are
.......................... (ESTABLISHMENT) during early embryonic development. As the embryo
grows, organs form from specific arrangements of tissues. Many adult organs, ...................
(INCLUSION) the heart, brain and muscles, contain the ................ (ORIGIN) cells and tissues
that were formed ................. (NATAL), although some functional changes occur in the tissues
as they are acted upon by hormones or as their .................. (EFFECTIVE) diminishes with age.
The study of tissues is referred to as histology. Many diseases profoundly ..............
(ALTERATION) the tissues within an affected organ; therefore, by knowing the normal tissue
structure, a physician can recognize the ................ (NORMAL). Although histologists
......................... (EMPLOYMENT) many different techniques for preparing, staining, and
....................... (SECTION) tissues, only two basic kinds of microscopes are used to view the
...................... (PREPARATION) tissues. The light microscope is used to .........................
(OBSERVATION) overall tissue structure, and the electron microscope to observe the fine
details of tissue and cellular structure.
Many tissue cells are surrounded and bound together by a ............... (LIVE)
................(CELL) matrix (ma′triks) that the cells secrete. Matrix varies in composition from
one tissue to another and may take the form of a liquid, semisolid, or solid. Blood, for
example, has a liquid matrix, permitting this tissue to flow through vessels. By contrast, bone
cells are ................. (SEPARATION) by a solid matrix, permitting this tissue to support the
body.
The tissues of the body are assigned to four principal types on the basis of structure
and function: (1) epithelial (ep″ı˘-the′le-al) tissue covers body surfaces, lines body cavities
and ducts, and forms glands; (2) connective tissue binds, supports, and protects body parts;
(3) muscle tissue contracts to produce movement; and (4) nervous tissue initiates and
......................... (TRANSMISSION) nerve impulses from one body part to another.

Knowledge Check
1. Define tissue and explain why histology is important to the study of anatomy, physiology,
and medicine.
2. Cells are the functional units of the body. Explain how the matrix permits specific kinds of
cells to be even more effective and functional as tissues.
3. What are the four principal kinds of body tissues? What are the basic functions of each
type?

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EPITHELIAL TISSUE
There are two major categories of epithelia: ....................... (MEMBRANE) and glandular.
Membranous epithelia are ................ (LOCATION) throughout the body and form such
structures as the outer ............ (LAY) of the skin; the inner ............ (LINE) of body cavities,
tubes, and ducts; and the covering of visceral organs. Glandular epithelia are specialized
tissues that form the .................. (SECRETE) portion of glands.
Characteristics of Membranous Epithelia
Membranous epithelia always have one free surface exposed to a body cavity, a lumen
(hollow portion of a body tube), or to the skin surface. Some membranous epithelia are
derived from ectoderm, such as the outer layer of the skin; some from mesoderm, such as the
inside lining of blood vessels; and others from endoderm, such as the inside lining of the
digestive tract (gastrointestinal, or GI, tract).
....................... (MEMBRANE) epithelia may be one or several cell layers thick. The
................. (UP) surface may be exposed to gases, as in the case of epithelium in the
..................... (TEGUMENT) and respiratory systems; to liquids, as in the circulatory and
urinary systems; or to semisolids, as in the GI tract. The deep surface of most membranous
epithelia is bound to underlying .................... (SUPPORT) tissue by a basement membrane,
that consists of glycoprotein from the epithelial cells and a meshwork of collagenous and
reticular fibres from the underlying ...................... (CONNECT) tissue. With few (EXCEPT),
membranous epithelia are ..................... (VASCULAR) (without blood vessels) and must be
nourished by ....................... (DIFFUSE) from underlying connective tissues. Cells that make
up membranous epithelia are tightly packed together, with little intercellular matrix between
them. Some of the functions of membranous epithelia are quite specific, but certain
........................ (GENERAL) can be made. Epithelia that cover or line surfaces provide
.................. (PROTECT) from pathogens, physical injury, toxins, and desiccation. Epithelia
lining the GI tract function in .................. (ABSORB). The epithelium of the kidneys provides
filtration, whereas that within the pulmonary alveoli (air sacs) of the lungs allows for
diffusion. Highly specialized neuroepithelium in the taste buds and in the nasal region has a
chemoreceptor function.

(a) Simple squamous epithelium lines the lumina of vessels, where it permits diffusion. (b) A
photomicrograph of this tissue and (c) a labelled diagram. Simple squamous epithelia that
line the lumina of vessels are referred to as endothelia, and that which cover visceral organs
are referred to as mesothelia.

Many membranous epithelia are exposed to friction or ...............(HARM) substances from the
outside environment. For this reason, epithelial tissues have .................(REMARK)
.......................(REGENERATE) abilities. The mitotic ...................(PLACE) of the outer layer
of skin and the lining of the GI tract, for example, is a ..................... (CONTINUE) process.
Membranous epithelia are .......................... (HISTOLOGY) classified by the number of
layers of cells and the shape of the cells along the exposed surface. Epithelial tissues that are
composed of a single layer of cells are called simple; those that are layered are said to be

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stratified. Squamous cells are ............... (FLAT); cuboidal cells are cubeshaped; and columnar
cells are taller than they are wide.
Body Membranes – are composed of thin layers of epithelial tissue and, in certain
..................... (LOCATE), epithelial tissue coupled with ................ (SUPPORT) connective
tissue. Body membranes cover, separate, and support visceral organs and line body cavities.
Glandular Epithelia
As tissues develop in the embryo, tiny invaginations (infoldings) or evaginations
(outfoldings) of membranous epithelia give rise to specialized secretory structures called
exocrine (ek′so˘-krin) glands. These glands remain connected to the epithelium by ducts, and
their secretions pass through the ducts onto body surfaces or into body cavities. Exocrine
glands should not be ...................... (CONFUSION) with endocrine glands, which are ductless,
and which secrete their products (hormones) into the blood or ................. (SURROUND)
extracellular fluid.
Exocrine glands within the skin include oil (sebaceous) glands, sweat glands, and mammary
glands. Exocrine glands within the ..................... (DIGEST) system include the ...................
(SALIVA) and ................... (PANCREAS) glands. Exocrine glands are ......................
(CLASSIFICATION) according to their structure and how they discharge their products.
Classified according to structure, there are two types of exocrine glands, unicellular and
multicellular glands.
1. Unicellular glands are single-celled glands, such as goblet cells. They are modified
columnar cells that ................. (OCURRENCE) within most epithelial tissues. Goblet cells are
found in the epithelial linings of the respiratory and digestive systems. The mucus ................
(SECRETE) of these cells lubricates and protects the surface linings.
2. Multicellular glands, as their name .................. (IMPLICATION), are composed of both
secretory cells and cells that form the walls of the ducts. Multicellular glands are classified as
simple or compound glands. The ducts of the simple glands do not branch, whereas those of
the compound type do. Multicellular glands are also classified according to the shape of their
secretory portion. They are identified as tubular glands if the secretory portion .....................
(RESEMBLANCE) a tube and as acinar glands if the secretory portion resembles a flask.
Multicellular glands with a secretory portion that resembles both a tube and a flask are
termed tubuloacinar glands. Multicellular glands are also classified according to the means
by which they release their product.
1. Merocrine (mer′o˘-krin) glands are those that secrete a ..................... (WATER) substance
through the cell membrane of the secretory cells. Salivary glands, pancreatic glands, and
certain sweat glands are of this type.
2. Apocrine (ap′o˘-krin) glands are those in which the secretion ......................
(ACCUMULATION) on the surface of the ......................... (SECRETE) cell; then, a portion of
the cell, along with the secretion, is pinched off to be discharged. Mammary glands are of this
type.

2. Fill in the blanks with one suitable word:

CONNECTIVE TISSUE
Connective tissue is divided .............. subtypes according to the matrix that binds the cells.
Connective tissue .............. structural and metabolic support for ............ tissues and organs of
the body.
Characteristics and Classification of Connective Tissue
Connective tissue is the most ................ tissue in the body. It supports other tissues or binds
them ................ and provides ............ the metabolic needs of all body organs. Certain types of
connective tissue ............ nutritional substances; ........... types manufacture protective and

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regulatory materials. With the exception .............. mature cartilage, connective tissue is
highly vascular and ............ nourished. It is able to replicate and, by ........... doing, is
responsible ........... the repair of body organs. ............. epithelial tissue, which is composed
........... tightly fitted ..............., connective tissue contains considerably ............ matrix
(intercellular material) ........... cells. Connective tissue does not occur ........ free surfaces of
body cavities or on the surface of the body, as does epithelial tissue. ..............., connective
tissue is embryonically derived ............. mesoderm, whereas epithelial tissue derives from
ectoderm, mesoderm, and endoderm.
The classification of connective tissue is not exact, and several schemes have been devised.
In general, ..............., the various types are named ............ to the kind and arrangement of the
matrix. The following are the ............. kinds of connective tissues:
A. Embryonic connective tissue
B. Connective tissue proper
1. Loose (areolar) connective tissue
2. Dense regular connective tissue
3. Dense irregular connective tissue
4. Elastic connective tissue
5. Reticular connective tissue
6. Adipose tissue
C. Cartilage
1. Hyaline cartilage
2. Fibrocartilage
3. Elastic cartilage
D. Bone tissue
E. Blood (vascular tissue)

Embryonic Connective Tissue

The embryonic period .......... development, which ............ 6 weeks (from the start of the third
........... the end of the eighth week), is characterised .............. extensive tissue differentiation
and organ formation. .............. the beginning of the embryonic period, all connective tissue
looks ............. and is referred to as mesenchyme (mez′en-kı￣m). Mesenchyme is
undifferentiated embryonic connective tissue that is ............. from mesoderm. It consists
........... irregularly shaped cells surrounded by large amounts of a homogeneous, jellylike
matrix. In certain periods of development, mesenchyme migrates ........... predisposed sites
............. it interacts ............ other tissues to form organs. Once mesenchyme has completed its
embryonic migration ............ a predetermined destination, it differentiates ............ all other
kinds of connective tissue. Some mesenchymal-like tissue persists past the embryonic period
in certain sites ............. the body. Good examples are the undifferentiated cells ...........
surround blood vessels and form fibroblasts .......... the vessels are traumatized. Fibroblasts
assist ......... healing wounds. Another kind of prenatal connective tissue exists ............. in the
foetus (the foetal period is from 9 weeks to birth) and is .................. mucous connective tissue
or Wharton’s jelly. It gives a turgid consistency .............. the umbilical cord.
Connective Tissue Proper
Connective tissue proper has a loose, flexible ................, frequently called ground substance.
The most common cell .................. connective tissue proper is called a fibroblast (fi′bro-
blast). Fibroblasts are large, star-shaped ............. that produce collagenous (ko˘-laj′e˘- nus),
elastic, and reticular (re˘-tik′yoo-lar) fibres.
Collagenous fibres are composed ............... a protein called collagen (kol′a˘-jen); they are
flexible, .............. they have tremendous strength. Elastic fibres are composed of a protein

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called elastin, .............. provides certain tissues with .................. Collagenous and elastic
fibres may be .................. sparse and irregularly arranged, .............. in loose connective tissue,
or ................ packed, as in dense connective tissue. Tissues with loosely arranged fibres
generally ............. packing material that cushions and protects various organs, .............. those
that are tightly arranged form the binding and ......................... connective tissues of the body.
Resilience .............. tissues that contain elastic fibres is extremely .................... for several
physical ................... of the body. Consider, for example, that elastic fibres are ............... in
the walls of large arteries and in the walls of the lower respiratory ................. As these walls
are expanded .................. blood moving through vessels or by inspired air, the elastic fibres
must ................ stretch and then recoil. This maintains the pressures of the fluid or air moving
........................ the lumina, thus ensuring adequate flow rates and rates of diffusion
.................... capillary and lung surfaces.
Reticular fibres reinforce ................ branching and joining to form a delicate lattice or
reticulum. Reticular fibres are common ................. lymphatic glands, where they form a
meshlike centre called the stroma.
Six basic ................ of connective tissue proper are generally recognized. These tissues are
distinguished ............... the consistency of the ground substance and the type and arrangement
................. the reinforcement fibres.
Loose Connective (Areolar) Tissue
Loose connective tissue is distributed ..................... the body as a binding and packing
material. It binds the skin ............. the underlying muscles and is highly vascular, ................
nutrients to the skin. Loose connective tissue that binds skin ........... underlying muscles is
known ............ fascia (fash′e-a˘). It also surrounds blood vessels and nerves, ............... it
provides both protection and nourishment. Specialized cells ................ mast cells are
dispersed ................ the loose connective tissue surrounding blood vessels. Mast cells
................. heparin (hep′a˘-rin), an anticoagulant that ................... blood from clotting within
the vessels. They also .................... histamine, which is released .............. inflammation.
Histamine acts ........... a powerful vasodilator. The cells of loose connective tissue are
predominantly fibroblasts, ............... collagenous and elastic fibres dispersed throughout the
ground substance. The irregular arrangement .............. this tissue ............... flexibility, yet
strength, in any direction. It is this tissue layer, for example, that permits the skin to
................... when a part of the body is rubbed. Much of the fluid of the body is found
............. loose connective tissue and is called interstitial fluid (tissue fluid). Sometimes
excessive tissue fluid ...................., causing a swollen condition ................... edema (e˘-
de′ma˘). Edema is a symptom of .................. dysfunctions or disease processes.
Dense Regular Connective Tissue
Dense regular connective tissue is ........................ by large amounts .............. densely packed
collagenous fibres that run parallel ................. the direction of force placed on the tissue
during body movement. Because this tissue is silvery ............... in appearance, it is sometimes
called white fibrous connective tissue. Dense regular connective tissue occurs ............. strong,
flexible support is needed. Tendons, which attach muscles to bones and transfer the forces of
muscle contractions, and ligaments, which ..................... bone to bone across articulations,
are composed ............. this type of tissue. Trauma ........... ligaments, tendons, and muscles are
common sports-related injuries. A strain is an ................. stretch of the tissue composing the
tendon or muscle, with no serious damage. A sprain is a tearing of the ................. of a
ligament and may be ......................, moderate, or complete. A complete tear of a .................
ligament is especially painful and disabling. Ligamentous tissue does not .................. well
because it has a poor blood supply. Surgical reconstruction is generally .................... for the
treatment of a severed ligament.

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Dense Irregular Connective Tissue – characterized by .................. amounts of densely packed
collagenous fibres that are interwoven to ..................... tensile strength in any direction. This
tissue is found ............. the dermis of the skin and the submucosa of the GI tract. It also
............... the fibrous capsules of organs and joints.
Elastic Connective Tissue – is ............ primarily of elastic fibres that are irregularly arranged
and yellowish in...............They can be stretched to one and a half times their original
.............. and will snap back to their former size. Elastic connective tissue is ............. in the
walls of large arteries, in portions of the larynx, and in the trachea and bronchial tubes of the
............It is also present between the arches of the vertebrae that make up the vertebral
column.
Reticular Connective Tissue
Reticular connective tissue is characterized by a ............................. of reticular fibres woven
...................... a jellylike matrix. Certain specialized cells .............. reticular tissue are
phagocytic (fag″o˘-sit′ik) (macrophages) and therefore can ingest foreign materials. The liver,
spleen, lymph nodes, and bone marrow .......................................... reticular connective tissue.
Adipose Tissue
Adipose tissue is a specialized .................... of loose fibrous connective tissue that contains
large ...................... of adipose cells, or adipocytes (ad′ı˘-po-sı￣ts). Adipose cells form from
mesenchyme and, for the .................. part, are formed prenatally and during the first year of
.................. Adipose cells store droplets of fat ...................... their cytoplasm, causing them to
.................... and forcing their nuclei to one side. Adipose tissue is found ....................... the
body but is concentrated around the kidneys, in the hypodermis of the .............., on the
surface of the heart, surrounding joints, and in the ................. of sexually mature females. Fat
functions not only ................. a food reserve, but also supports and protects various ...............
It is a good insulator against .......................................... because it is a poor conductor of heat.
Excessive fat can be .......................... by placing a strain on the heart and perhaps causing
.................... death. For these reasons, good exercise programs and sensible ............... are
extremely important. Adipose tissue can also ....................... lipid-soluble, environmental
pollutants that are ingested or absorbed ..................... the skin. Dieting eliminates the fat
stored ................. adipose tissue but not the tissue itself. The surgical procedure of suction
lipectomy may be ................... to remove small amounts of adipose tissue from ......................
body areas such as the breasts, abdomen, buttocks, and ........................ Suction .....................
is used for cosmetic purposes ...................... than as a treatment for obesity, and the risks
.............. potentially detrimental side effects need to be ................. considered. Potential
candidates ................... be between 30 and 40 years old and only about 15 to 20 pounds
............................ They should also have good skin ..................................................................

Reticular connective tissue forms the stroma, or framework, of such organs as the spleen (a),
liver, thymus, and lymph nodes. (b) A photomicrograph of this tissue and (c) a labeled
diagram.

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Cartilage
Cartilage (kar′tı˘-lij) consists .................... cartilage cells, or chondrocytes (kon′dro-sı￣ts),
and a semisolid matrix that imparts marked elastic properties to the tissue. It is a supportive
and .......................... connective tissue that is frequently associated ................. bone. Cartilage
forms a precursor ............. one type of bone and persists at the articular surfaces ........... the
bones of all movable ................. The chondrocytes ................. cartilage may occur singly but
are .................. clustered. Chondrocytes occupy cavities, called lacunae (la˘-kyoo′ne—
singular lacuna), ................ the matrix. Most cartilage is surrounded by a dense irregular
................. tissue called perichondrium (per″ı￣-kon′dre-um). Cartilage at the articular
surfaces of bones (articular cartilage) lacks a perichondrium. Because mature cartilage is
.........................., it must receive nutrients ........................ diffusion from the perichondrium
and the surrounding ...................... For this reason, cartilaginous tissue has a slow ...............
of mitotic activity; if damaged, it heals with ..........................
There are three ...................... of cartilage: hyaline (hi′a˘-l￣ın) cartilage, fibrocartilage, and
elastic cartilage. They are distinguished ............... the type and amount of fibres embedded
within the matrix.
Hyaline Cartilage. Hyaline cartilage, .................. called ―gristle,‖ has a homogeneous, bluish-
staining matrix in .................. the collagenous fibres are so fine that they can be observed
only ..................... an electron microscope. When viewed through a light microscope, hyaline
cartilage has a clear, glassy ................. Hyaline cartilage is the most ....................... cartilage
within the body. It covers the articular surfaces of ..............., supports the tubular trachea and
bronchi of the respiratory system, reinforces the .................., and forms the flexible bridge,
called costal cartilage, between the anterior .................... of each of the first 10 ribs and the
sternum. Most of the bones of the body form .................... as hyaline cartilage and later
become bone in a process called endochondral ossification.
Fibrocartilage. Fibrocartilage has a matrix that is reinforced ............. numerous collagenous
fibres. It is a durable tissue ................. to withstand tension and compression. It is found
.............. the symphysis pubis, where the two pelvic bones ................., and between the
vertebrae as intervertebral discs. It also ...................... the cartilaginous wedges ................ the
knee ................., called menisci. By the .............. of the day, the intervertebral discs of the
vertebral column are .................... compacted. So a person is actually ...................... shorter in
the evening .............. in the morning, following a recuperative rest. Aging, ................, brings
with it a .................................................. compression of the intervertebral discs that is
irreversible.
Elastic Cartilage. Elastic cartilage is ...................... to hyaline cartilage except .................. the
presence of abundant elastic fibres that ................. elastic cartilage very flexible
........................ compromising its strength. The numerous elastic fibres also give it a
yellowish ................ This tissue is found in the outer ..................., portions of the larynx, and
in the auditory canal.
Bone Tissue
Bone tissue is the most .................... of all the connective tissues. Unlike cartilage, bone
tissue has a rich vascular ........................ and is the ...................... of considerable metabolic
activity. The hardness of bone is largely ................... to the calcium phosphate (calcium
hydroxyapatite) deposited ..................... the intercellular matrix. Numerous collagenous
fibres, also embedded .................................................... the matrix, give bone some flexibility.

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Fibrocartilage is located at the symphysis pubis, within the knee joints, and between the
vertebrae as the intervertebral discs (a). A photomicrograph of the tissue is shown in (b) and
a labeled diagram in (c).

Blood (Vascular Tissue) – is a highly specialized fluid ...................... tissue that plays a
................ role ................ maintaining homeostasis. The cells, or formed elements, of blood
are suspended .................... a liquid matrix called blood plasma. The three ...................... of
formed elements are erythrocytes (red blood cells), leukocytes (white blood cells), and
thrombocytes (platelets). An injury .................. a portion of the body may stimulate tissue
repair .................., usually involving connective tissue. A minor scrape or cut ................... in
platelet and plasma activity of the exposed blood and the formation ............ a scab. The
epidermis of the skin regenerates .............. the scab. A severe open wound heals ..............
connective tissue granulation. In this process, collagenous fibres form ............. surrounding
fibroblasts to strengthen the traumatized .......................... The healed area is known as a scar.

Knowledge Check
9. List the basic types of connective tissue and describe the structure, function, and location
of each.
10. Which of the previously discussed connective tissues function to protect body organs?
Which type is phagocytic? Which types bind and support various structures? Which types are
associated in some way with the skin?
11. What is the developmental significance of mesenchyme and how does it differ
functionally from adult connective tissue?
12. Briefly describe reticular fibres, fibroblasts, collagenous fibres, elastic fibres, and mast
cells.

3. Choose the word from the box that best fills in each blank:
MUSCLE TISSUE

materials replicate positioned unique occurring contractile

arteries contract spindle-shaped part striations heart
accomplished locomotion adjacent multinucleated tract
contraction bifurcating involuntary mesoderm attaches
voluntary responsible fasciculi fresh completed peristaltic
thus stimulus
Muscle tissue is.......................... for the movement of .................through the body, the
movement of one............ of the body with respect to another, and for................. Fibres in the
three kinds of muscle tissue are adapted to...................... in response to stimuli.
Muscle tissue is.................... in its ability to contract, and ....................make movement
possible. The muscle cells, or fibres, are elongated in the direction of contraction, and
movement is .......................through the shortening of the fibres in response to a...................

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Muscle tissue is derived from.................. There are three types of muscle tissue in the body:
smooth, cardiac, and skeletal muscle tissue.
Smooth Muscle . Smooth muscle tissue is common throughout the body, ....................in many
of the systems. For example, in the wall of the GI................... it provides the ...................force
for the ................movements involved in the mechanical digestion of food. Smooth muscle is
also found in the walls of................., the walls of respiratory passages, and in the urinary and
reproductive ducts. Smooth muscle fibres are long, ....................cells. They contain a single
nucleus and lack............................ These cells are usually grouped together in
........................sheets, forming the muscular portion of a wall around a lumen.
Cardiac Muscle. Cardiac muscle tissue makes up most of the wall of the.................. This
tissue is characterized by................................. (branching) fibres, each with a single,
centrally..................... nucleus, and by transversely positioned intercalated (in-ter′ka˘-la￣t-
ed) discs. Intercalated discs help to hold .....................cells together and transmit the force of
..................from cell to cell. Like skeletal muscle, cardiac muscle is striated, but unlike
skeletal muscle it experiences rhythmic ............................contractions.
Skeletal Muscle
Skeletal muscle tissue ........................to the skeleton and is responsible for ..................body
movements. Each elongated, ................... has distinct transverse striations. Fibres of this
muscle tissue are grouped into parallel ...............................(bundles) that can be seen without
a microscope in ..........................muscle. Both cardiac and skeletal muscle fibres cannot
..................................once tissue formation has been ....................................shortly after birth.

Knowledge Check
13. Describe the general characteristics of muscle tissue. What is meant by voluntary and
involuntary as applied to muscle tissue?
14. Distinguish between smooth, cardiac, and skeletal muscle tissue on the bases of structure,
location, and function.

NERVOUS TISSUE
contains specialized surrounds fibres bind receive transmit
severed respond under abundant prenatally units extending
sometimes assist ability microtubules into derive neurons
extension impulses
Nervous tissue is composed of........................, which respond to stimuli and conduct..............
to and from all body organs, and neuroglia, which functionally support and physically bind
neurons.
Neurons Although there are several kinds of neurons (noor′onz) in nervous tissue, they all
have three principal components: (1) a cell body, or perikaryon; (2) dendrites; and (3) an
axon. Dendrites are branched processes that ..................stimuli and conduct nerve impulses
toward the cell body. The cell body, or perikaryon (per″ı˘-kar′e-on), contains the nucleus
and specialized organelles and.................. The axon is a cytoplasmic................... that
conducts nerve impulses away from the cell body. The term nerve fibre refers to any process
........................from the cell body of a neuron and the myelin sheath that .............................it.
Neurons ..............from ectoderm and are the basic structural and functional ...............of the
nervous system. They are specialized to .................to physical and chemical stimuli, convert
stimuli ..............nerve impulses, and conduct these impulses to other neurons,
muscle..............., or glands. Of all the body‘s cells, neurons are probably the
most...................... As with muscle cells, the number of neurons is established...............

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(before birth); thereafter, they lack the.......................... to undergo mitosis, although
................certain circumstances a .....................portion can regenerate.
Neuroglia. In addition to neurons, nervous tissue................ neuroglia (noorog′ le-a˘).
Neuroglial cells, ......................called glial cells, are about 5 times as .......................as neurons
and have limited mitotic abilities. They do not...................... impulses but support and
........................neurons together. Certain neuroglial cells are phagocytic; others .............in
providing sustenance to the neurons.

Changes in Tissue Composition

occur nutrition decaying strength injury clotting inactivity impaired
rates caused massive aging estimating death alter diminished trauma
histologically nourishment particular
Most diseases ...............tissue structure locally, where the disease is prevalent. Some diseases,
however, called general conditions, cause changes that are far removed from the locus of the
disease.
Atrophy (wasting of body tissue), for example, may be limited to a ..................organ where
the disease interferes with the metabolism of that organ, but it may also involve an entire
limb if ........................or nerve impulses are................. Muscle atrophy can be ....................by
a disease of the nervous system like polio, or it can be the result of a ....................blood
supply to a muscle. Senescence (se˘-ne˘ ′sens) atrophy, or simply senescence, is the natural
.............of tissues and organs within the body. Disuse atrophy is a local atrophy that results
from the .........................of a tissue or organ. Muscular dystrophy causes a disuse atrophy that
decreases muscle size and .................because of the loss of sarcoplasm within the muscle.
Necrosis (ne˘-kro′sis) is ................of cells or tissues within the living body. It can be
recognized by physical changes in the dead tissues. Necrosis can be caused by
severe.................; physical agents (.............., heat, radiant energy, chemical poisons); or poor
...............of tissues. When .......................examined, the necrotic tissue usually appears
opaque, with a whitish or yellowish cast. Gangrene is a ..............necrosis of tissue
accompanied by an invasion of microorganisms that live on ................flesh. Somatic death is
the death of the body as a whole. Following somatic death, tissues undergo irreversible
changes, such as rigor mortis (muscular rigidity), ..............of the blood, and cooling of the
body. Post-mortem changes ...............under varying conditions at predictable.............., which
is useful in ......................the approximate time of death.

Tissue Analysis

intricacy routinely thin observation unaided structures multistep

withdrawn pathologist removal operation specimen magnification
scraping fundamental

In diagnosing a disease, it is frequently important to examine tissues from a living person

histologically. When this is necessary, a biopsy (bi′op-se) (...................of a section of living
tissue) is performed. There are several techniques for biopsies. Surgical removal is usually
done on large masses or tumors. Curettage (kyoo″re˘-tazh′) involves cutting and
.....................tissue, as may be done in examining for uterine cancer. In a percutaneous needle
biopsy, a biopsy needle is inserted through a small skin incision and tissue samples
are................. Both normal and diseased tissues are removed for purposes of comparison.
Preparing tissues for examination is a................. process.

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Fixation is ..................... for all histological preparation. It is the rapid killing, hardening, and
preservation of tissue to maintain its existing structure. Embedding the tissue in a supporting
medium such as paraffin wax usually follows fixation. The next step, sectioning the tissue
into extremely .....................slices, is followed by mounting the ....................on a slide. Some
tissues are fixed by rapid freezing and then sectioned while frozen, making embedding
unnecessary. Frozen sections enable the ...................to make a quick diagnosis during a
surgical................ These are done frequently, for example, in cases of suspected breast
cancer. Staining is the next step. Haematoxylin and eosin (H & E) stains are
........................used on all tissue specimens. They give a differential blue and red colour to
the basic and acidic ....................within the tissue. Other dyes may be needed to stain for
specific structures.
Examination is first done with the .....................eye and then with a microscope. Practically
all histological conditions can be diagnosed with low................. (40). Higher magnification
is used to clarify specific details. Further examination may be performed with an electron
microscope, which reveals the ...........of cellular structure. Histological ......................provides
the foundation for subsequent diagnosis, prognosis, treatment, and re-evaluation.

Tissue Transplantation

clinical healthy foetuses transfusions maturation mechanisms

immunosuppressive recipient breakthroughs ethical twins foreign thigh termed
reaction non-functional genotype advancements genetically

In the last two ............, medical science has made tremendous .................. in tissue
transplants. Tissue transplants are necessary for replacing.............., damaged, or lost body
parts. The most successful transplant is one where tissue is taken from one place on a
person‘s body and moved to another place, such as a skin graft from the ................to replace
burned tissue of the hand. Transfer of one‘s own tissue is ...................an autograft. Isografts
are transplants between ...................identical individuals, the only example being
identical.......... These transplants also have a high success rate. Allografts, or
homotransplants, are grafts between individuals of the same species but of different.............,
and xenografts, or heterografts, are grafts between individuals of different species. An
example of a xenograft is the transplant of a pig valve to replace a dysfunctional or diseased
human heart valve. Both allografts and xenografts present the problem of a possible tissue-
rejection............. When this occurs, the recipient‘s immune ............are triggered, and the
donor‘s tissue is identified as ......................and is destroyed. The reaction can be minimized
by ―matching‖ recipient and ................ tissue. Immunosuppressive drugs also may lessen the
rejection rate. These drugs act by interfering .............. the recipient‘s immune mechanisms.
Unfortunately, ....................drugs may also lower the recipient‘s resistance to infections. New
techniques involving blood ....................from donor to recipient before a transplant are
proving successful. In any event, tissue transplants are an important aspect of medical
research, and significant .................are on the horizon. The use of foetal ............
transplantation to grow new tissues in adult patients has shown promise for the treatment of
many .................problems of tissues or organs. Desired cells are harvested from as many
............ 15 human................. and are then quickly implanted into the transplant................ The
foetal cells are allowed to follow a normal course of ...................within the adult patient, with
the hope that a..............., fully functional body structure will ......................... Because the
typical source for foetal tissues is aborted foetuses, this procedure has become a
medical.................... dilemma.

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II. GRAMMAR

FUTURE TENSES

Prediction • Will
Will is used to make predictions. It is often preceded by I think or by
opinion words like perhaps. A time expression is also necessary.
I think it'll rain tomorrow. Perhaps she'll be
late.
In speech, will is contracted to 'll.
• Going to
Going to is also used for predictions. It is especially common when we
can see the cause of the event.
Look out! There's a bus coming! It's going to hit us!
I can see you're going to have a baby. When is it due?
You're going to fall!
Going to is also common in impersonal
statements.
Liverpool are going to win the Cup.
But will can also be used for most examples like this, with no
change of meaning.
• Future continuous
The future continuous is used to describe a situation in
progress at a particular time in the future.
This time next week I expect I'll be living in London. And I'll
probably be cycling to work.
• Future perfect
The future perfect looks back from a point in the future.
By the time we get there, the film will have started.
It refers to indefinite time up to that point. This means that when we
get to the future point we can say:
The film has started.
Intention • Going to
Going to is used to describe a present intention or plan. This is
something we have already decided to do.
I'm going to fix the television tomorrow.
• Will
Will is used for instant decisions made at the time of speaking.
I know, I'll get him a wallet for his birthday.

Fixed • Present continuous

arrangements and The present continuous is used to describe definite, fixed
timetables arrangements.
Sorry, I can't help you, I'm leaving in the morning.
The arrangements are often social arrangements or appointments and
may be written in a diary.
• Present simple
The present simple is used to describe future events which are
based on a timetable, programme or calendar.
My train leaves at 11.30 tomorrow morning.

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When, until, as After the time expressions when, until and as soon as a present tense
soon as form is used, although this refers to future time.
I'll wait for you here until you get back.
The present perfect is often used in cases like this to emphasize the
completion of an event.
I'll wait here until you have finished.

Practice
1. Underline the most suitable future form in each sentence.
a) Why are you going to buy/will you buy a new mountain bike?
b) Don't phone between 8.00 and 9.00. I'll study/I'll be studying then.
c) Look out! That tree will/is going to fall!
d) Let me know as soon as Louise will get/gets there.
e) Great news! Jean and Chris will come/are coming to stay with us.
f) According to this timetable, the bus is going to arrive/arrives at 6.00.
g) Can you call me at 7.00, because I'll leave/I'm leaving tomorrow.
h) If you arrive late at the sale, the best things will go/will have gone.

2. Put each verb in brackets into a suitable future form.

Have you ever wondered what exactly (1) ..you will be doing... (you do) in ten years time?
Well, according to computer expert Tom Vincent, computers (2)......................................
(soon be able) to make accurate predictions about the future. Professor Vincent, from
Cambridge, (3)......................................................... (hold) a press conference next week to
describe the computer which he calls 'Computafuture'. 'This computer can tell us what life
(4)................................................. (be) like, based on data describing past events,' explains
Professor Vincent. For example, Computafuture can predict how many people
(5)................................................. (live) in a particular area, or whether there
(6)............................................... (be) a lot of rain during a particular period. Professor
Vincent also believes that by the year 2050, computers (7)...............................................
(replace) teachers, and (8)........................................................ (also do) most of the jobs now
being done by the police. 'Computers are becoming more intelligent all the time,' says
Professor Vincent. 'Soon they (9).............................................. (direct) traffic and
(10)....................................................... (teach) our children. And telling us about the future.‘

3. Put each verb in brackets into a suitable verb form. All sentences refer to future time.
a) When I (see) ....see.....you tomorrow, I (tell)............................................. you my news.
b) As soon as we (get)............................there, we (phone).................................. for a taxi.
c) I (go)............................... to the library before I (do)..................................the shopping.
d) We (wait)................................... here until the rain (stop)...............................................
e) I (get)........................................... £50 from the bank when it (open) ..............................
f) After you (take)................................ the medicine, you (feel)............................... better.
g) You have to stay until you (finish)................................................................. your work.
h) I (let).................................. you know the minute I (hear)............................. the results.
i) Before we (paint)................................... the wall, we (have)........................ a cup of tea,
j) We (climb)................................... over the wall as soon as it (get).......................... dark.

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III. READING COMPREHENSION

Evolution of Psychosomatic Diagnosis in DSM

Although recognition of the interaction of ―psyche‖ and ―soma‖ dates from antiquity, only in
modern times have we developed the vocabulary and concepts to elucidate and then to
systematically study its manifestations. With these developments came the notion of
―psychosomatic disorders‖ (or ―diseases‖); however, the precise definition of these terms
remained vague and holds true for all the ―mental disorders.‖ Before the mid-20th century,
psychiatric diagnoses were unstandardised, varying in part from hospital to hospital, although
with fair agreement on the major categories, which were predominantly psychoses.
―Hospital‖ is used deliberately, for it was in these primarily public mental hospitals that early
psychiatry largely had existed.
The first Diagnostic and Statistical Manual of Mental Disorders (DSM) was
developed between 1946 and 1951, just after World War II. From that conflict had come a
cadre of American medical officers who observed a host of nonpsychotic disorders arising in
response to military service and combat. Many medical officers subsequently became
psychiatrists, but not within state hospitals; instead they devoted themselves to treating
nonpsychotic patients in ambulatory settings. Moreover, they came to understand the
conditions they saw as largely psychological reactions to life experience requiring
psychological treatment: psychotherapy. Most were influenced by psychoanalysis and a
number became analysts, joining a group of European analysts who had fled to the United
States.
Those trends were abundantly reflected in DSM. With the exception of the organic
brain disorders and mental ―deficiency‖ (retardation), all mental disorders were denoted as
―reactions.‖ Thus, the psychoses included affective and schizophrenic ―reactions‖; it was
noted that these reactions could occur ―with or without defined physical causes or structural
change in the brain,‖ a statement consistent with the psychologism of the time.
Immediately after the psychoses was the new rubric: ―psycho-physiological
autonomic and visceral disorders,‖ with an explanation that ―This term is used in preference
to ‗psychosomatic disorders‘ since the latter refers to a point of view on the discipline of
medicine as a whole rather than to certain specified conditions.‖ The explanation went on to
state that ―these reactions represent the visceral expression of affect, which may be thereby
largely prevented from being conscious.
The symptoms are due to a chronic and exaggerated state of the normal physiological
expression of emotion, with the feeling, or subjective part, repressed. Such long continued
visceral states may eventually lead to structural changes.‖ This is not the place to dissect
these interesting ideas. What is relevant is that this conceptualization is psychodynamic,
psychoanalytic, and most specifically, the formulation of Franz Alexander. Alexander, Co-
Director of the Chicago Psychoanalytic Institute and probably the most prominent figure in
the psychosomatic field at that time, was for 3 years (1947–1950) a member of the committee
that developed DSM; a combination of roles that makes full sense in the context of the
history just elucidated.

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 The psychophysiological disorders were subcategorized into ―reactions‖ of various
organ systems: musculoskeletal, cardiovascular, gastrointestinal, genitourinary, endocrine,
etc. In each, examples of the conditions included ranged over a span from symptoms through
demonstrable pathology such as backache, tension headache, asthma, constipation, colitis,
hypertension, and dyspareunia. Of further note is the prominent locus of this category in the
centre of the overall schema between the psychotic and neurotic reactions.
DSM-II was published 16 years later. By then, psychoanalysis had become
established in American psychiatry, with an emphasis on clinical observation and the
idiographic approach (idiographic: pertaining to or involving the study of cases or events as
individual units, with a view to understanding each one separately). Analysts had assumed
many chairs of medical school psychiatry departments. Even so, doubts had begun to
increase, as had heightened awareness of the value of controlled scientific research in those
academic departments. (An examination of the content of Psychosomatic Medicine and
programs of the meetings of The American Psychosomatic Society during this period
indicated that our field was at the cutting edge of this shift.)
These doubts and increased emphasis on empirical research were reflected in the new
DSM-II. Although its general features and categories were very similar to the original
edition, the ubiquitous term ―reactions‖ was dropped; conditions were now being referred to
as neuroses, psychoses, or ―disorders.‖ Psychosomatic conditions became
―psychophysiological disorders,‖ with ―autonomic and visceral‖ dropped, likely reflecting
discomfort with being bound specifically to the concepts of Alexander. Subsequently,
questions about psychoanalysis continued to increase, accompanied by advances in the basic
and applied neurosciences relevant to mental disorders.
American psychiatry became more scientific, with an emphasis on evidence-based
diagnosis and treatment resting on data derived from appropriately designed research, and it
became more neurobiological. Psychology was not entirely eschewed but was given less
prominence, with psychoanalysis augmented or supplanted by behaviorism and cognitive
science. Unfortunately, this new knowledge was applied within the tired old biomedical
model rather than a ―biopsycho- social‖ model. Even when psychological factors were
deemed important, they were seen to operate in a concrete, linear way. All this was embodied
in the vastly changed nature of DSM-III, which appeared 12 years later. Its major features
included 1) the naming of conditions as ―disorders,‖ a term chosen deliberately as
etiologically neutral (although many subtle clues of biogenic bias were evident elsewhere); 2)
the listing of sets of specific, defined criteria to be used as the basis for diagnosis; and 3) the
organization of diagnostic categories in a hierarchy, with diagnoses of later categories often
requiring the absence of earlier ones.
Within the hierarchy of disorders, ―psychophysiological disorders‖ was removed.
Instead, there was a new category designated as ―psychological factors affecting physical
condition.‖ The nature of this category speaks for itself: Psychological processes can
influence primarily physical, i.e., biological, conditions, but are modifiers operating in a
lesser, secondary role. Nor is there any hint of their transactional relationship with the
biological. This category was placed at the very end of the hierarchy, to many conveying its
less important status.

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A new feature of DSM-III provided for diagnoses to be placed within a ―multiaxial‖ format
in which pre-existing personality disorders or mental retardation, concomitant medical
conditions, stressors, and functional capacity were included. With this incorporation of
psychological, biological, and social factors into a dynamic framework, this system had the
capacity to portray nonlinear psychosomatic causal adaptive processes. Unfortunately,
perhaps because of its complexities, most psychiatrists paid lip service to the use of this
novel, creative system.
Fourteen years later, DSM-IV, with the same overall design as its predecessor,
continued the same trends. Additional empirical data collected over the interval allowed for
the refinement of diagnostic criteria, and a few disorders were added, dropped, relabelled, or
reorganized, but the changes were minor. One subtle, but telling, shift was the dropping of
the term ―neurosis‖—which implies psychogenesis— which had been left optional for a few
disorders in DSM-III.
Two changes were made in the disorders of our current interest. ―Psychological
factors affecting medical condition‖ was substituted for ―…physical condition,‖ a further
narrowing. More significant, this rubric no longer had the status of a category in itself but
became one of a series of subsections within the category ―other conditions that may be a
focus of attention,‖ grouped with medication-induced problems, relationship problems,
abuse, etc: a step further down—or out. The subcategory also was broken down into several
types: mental disorders…, psychological symptoms…, personality disorders or traits…, and
stress responses…affecting medical conditions; and maladaptive health behaviors. All are
reasonable, useful distinctions, but the overall effect was to further downgrade the role of
psychological factors and thus dilute the concept of psychosomatic processes.
As we look ahead toward the next DSM, we need to confront a fundamental and
important question: Should there be a category for ―psychosomatic disorders‖ at all?
Psychological and biological factors are involved in all aspects of human function, healthy
and disordered. All diseases, and health, are psychosomatic; there are no ―psychosomatic
disorders‖ because there are no non-psychosomatic ones.
To be practical, there are situations in which biological factors play a more major role
or are more pressing or amenable to treatment and thus must be the focus of diagnostic
attention (noting that the same is true for psychological factors).
Traumatic injuries must be treated on a gurney, not a couch. Such issues assume
genuine importance when we shift our focus away from abstractions about the nature of
disease to the concrete actualities of sick persons. In this sense, there is justification for
having a rubric: ―psychological factors affecting physical condition‖— although an equal
case can be made for adding a corresponding category of ―physical disorders affecting a
psychological condition.‖ But neither of these—nor any single diagnostic label—can
adequately reflect the complex nature of human disease as an adaptive psychosomatic
process. It may be that a better solution to the problem will be a broadened application of a
multiaxial system, which can allow us to portray more accurately the array of specific
psychological and somatic (biological) processes operating transactionally in a patient,
reflecting the true psychosomatic nature of human disease.
Joel E. Dimsdale (ed), Somatic Presentations of Mental Disorders
(Arlington: American Psychiatric Association, 2009) pp. ix-xii

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Answer the following questions:

1. How were psychiatric diagnoses before the mid-20th century? What do you know about the
state of psychiatry up to that point?
2. Why do you think the first DSM developed after WW II?
3. In the 1950s and 1960s, why were mental disorders denoted as ―reactions‖?
4. What is an ―Idiographic approach‖?
5. Why do you think the term ―reactions‖ was dropped from the second DSM? What are the
implications of its replacement with ―neuroses,‖ ―psychoses,‖ or ―disorders‖?
6. Describe DSM-III and the changes included in it. How would you explain them?
7. As Regards DSM-IV, how do you explain the substitution of ―psychological factors
affecting medical condition‖ with ―physical condition‖?
8. Given the tendency towards narrowing down this problem, what is your opinion on the
question formulated in the text: ―Should there be a category for ‗psychosomatic disorders‘ at
all?
9. What does the author mean by the following statement: ―Traumatic injuries must be treated
on a gurney, not a couch‖?
10. Can you provide examples of psychosomatic disorders from your own experience?

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