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 Contributor
DANIEL J. MATUSIAK, BS, MA, EdD
Life Science Instructor
St. Dominic High School, O’Fallon, Missouri
Adjunct Professor
St. Charles Community College, Cottleville, Missouri

Reviewers
The Department of Physiology and The Geralyn M. Caplan Cammie Emory
Department of Anatomy & Structural Owensboro Community and Technical Bossier Parish Community College
Biology College
Julie Fiez
Otago School of Medical Sciences University
Roger Carroll Washington University School of Medicine
of Otago
University of Tennessee School of Medicine
Dunedin, New Zealand Beth A. Forshee
Melvin Chambliss Lake Erie College of Osteopathic Medicine
Mohammed Abbas
Alfred State College
Wayne County Community College Laura Frost
SUNY College of Technology
Florida Gulf Coast University
Laura Anderson
Pattie Clark
Elk County Catholic High School Debbie Gantz
Abraham Baldwin College
Mississippi Delta Community College
Bert Atsma
Richard Cohen
Union County College Christy Gee
Union County College
South College–Asheville
John Bagdade
Barbara A. Coles
Northwestern University Becky Gesler
Wake Technical Community College
Spalding University
Mary K. Beals
Harry W. Colvin, Jr.
Southern University and A&M College Norman Goldstein
University of California–Davis
California State University–Hayward
Rachel Venn Beecham
Teresa Cowan
Mississippi Valley State University Zully Villanueva Gonzalez
Baker College of Auburn Hills
Dona Ana Branch Community College
Brenda Blackwelder
Dorwin Coy
Central Piedmont Community College John Goudie
University of North Florida
Kalamazoo Area Mathematics & Science
Richard Blonna
Douglas M. Dearden Center
William Paterson College
General College of University of Minnesota
Charles J. Grossman
Claude Bouchei
Cheryl Donlon Xavier University
INSERM
Northeast Iowa Community College
Monica L. Hall-Woods
Charles T. Brown
J. Paul Ellis St. Charles Community College
Barton County Community College
St. Louis Community College
Rebecca Halyard
Laurence Campbell
Frank G. Emanuele Clayton State College
Florida Southern College
Mercyhurst University
Ann T. Harmer
Patricia W. Campbell
Orange Coast College
Carolinas College of Health Sciences
 Reviewers vii

Linden C. Haynes Susan Marshall Henry M. Seidel

Hinds Community College St. Louis University School of Medicine The Johns Hopkins University School of
Medicine
Lois Jane Heller Gary Massaglia
University of Minnesota School of Medicine Elk County Christian High School Gerry Silverstein
University of Vermont–Burlington
Lee E. Henderson Bruce S. McEwan
Prairie View A&M University The Rockefeller University Charles Singhas
East Carolina University
Angela R. Hess Jeff Mellenthin
Bloomsburg University The Methodist Debakey Heart Center Marci Slusser
Reading Area Community College
Paula Holloway Lanette Meyer
Ohio University Regis University/Denver Children’s Hospital Paul Keith Small
Eureka College
Julie Hotz-Siville Donald Misumi
Mt. San Jacinto College Los Angeles Trade–Technical Center William G. Sproat, Jr.
Walters State Community College
Gayle Dranch Insler Susan Moore
Adelphi University New Hampshire Community Technical Snez Stolic
College Griffith University
Patrick Jackson
Canadian Memorial Chiropractic College Rose Morgan Aleta Sullivan
Minot State University Pearl River Community College
Carolyn Jaslow
Rhodes College Jeremiah Morrissey Kathleen Tatum
Washington University School of Medicine Iowa State University
Gloria El Kammash
Wake Technical Community College Greg Mullen Reid Tatum
South Louisiana Community College/ St. Martin’s Episcopal School
Murray Kaplan
National EMS Academy
Iowa State University Kent R. Thomas
Robert Earl Olsen Wichita State University
Kathy Kath
Briar Cliff College
Henry Ford Hospital School of Radiologic Todd Thuma
Technology Susan M. Caley Opsal Macon College
Illinois Valley Community College
Brian H. Kipp Stuart Tsubota
Grand Valley State University Juanelle Pearson St. Louis University
Spalding University
Johanna Krontiris-Litowitz Judith B. Van Liew
Youngstown State University Nicole Pinaire State University of New York College at
St. Charles Community College Buffalo
William Langley
Butler County Community College Wanda Ragland Karin VanMeter
Macomb Community College Iowa State University/Des Moines Area
Michael Levitzky
Community College
Louisiana State University School of Saeed Rahmanian
Medicine Roane State Community College Gordon Wardlaw
Ohio State University
Clifton Lewis Robert S. Rawding
Wayne County Community College Gannon University Amy L. Way
Lock Haven University of Pennsylvania
Jerri Lindsey Carolyn Jean Rivard
Tarrant County Junior College Fanshawe College of Applied Arts and Anthony J Weinhaus
Technology University of Minnesota
Eddie Lunsford
Southwestern Community College Mary F. Ruh Cheryl Wiley
St. Louis University School of Medicine Andrews University
Bruce Luon
University of Texas Medical Branch Jenny Sarver Clarence C. Wolfe
Sarver Chiropractic Northern Virginia Community College
Melanie S. MacNeil
Brock University
 Preface
T
his textbook relates the story of the human body’s structure and function. More
than simply a collection of facts, it is both a teaching tool and a learning tool. It
was written to help students unify information, stimulate critical thinking, and
acquire a taste for knowledge about the wonders of the human body. The story
related in this textbook will help students avoid becoming lost in a maze of facts while
navigating a complex learning environment. It will encourage them to explore, to ques-
tion, and to look for relationships, not only between related facts in a single discipline, but
also between fields of academic inquiry and personal experience.
This new edition of the text has been extensively revised to better tell the
story of the human body. Because pictures are important in telling our story, we have
significantly upgraded our art program. Many of the longer chapters were split into
smaller chapters to improve comprehension and better organize study. We also improved
our execution of a page design and layout that maximizes learning effectiveness. As with
each new edition, we added carefully selected new information on both anatomy and
physiology to provide an accurate and up-to-date presentation. We have retained the basic
philosophy of personal and interactive teaching that characterized previous editions. Es-
sential, accurate, and current information continues to be presented in a com-
fortable storytelling style. Emphasis is placed on concepts rather than descriptions,
and the “connectedness” of human structure and function is repeatedly reinforced by
unifying themes.
UNIFYING THEMES
Anatomy and physiology encompasses a
body of knowledge that is large and com-
plex. Students are faced with the need to
know and understand a multitude of indi-
vidual structures and functions that con-
stitute a bewildering array of seemingly
disjointed information. Ultimately, the
student of anatomy and physiology must
be able to “pull together” this information
to view the body as a whole—to see the
“Big Picture.” If a textbook is to be
successful as a teaching tool in such
a complex learning environment, it
must help unify information, stimulate
critical thinking, and motivate students
to master a new vocabulary.
To accomplish this synthesis of information,
unifying themes are required to tell the story of
the human body effectively. In addition, a mech-
anism to position and implement these themes
must be an integral part of each chapter. Unit 1
begins with “Seeing the Big Picture,” an over-
view that encourages students to place individ-
ual structures or functions into an integrated
framework. Then, a special “The Big Picture”
section wraps up the story of each chapter so
that its significance in the overall function of
the body can easily be seen. Anatomy & Physiol-
ogy is dominated by two major unifying themes:
(1) the complementarity of normal structure
and function and (2) homeostasis. The student
is shown, as our story unfolds, how organized
anatomical structures of a particular size, shape,
form, or placement serve unique and special-
ized functions. The integrating principle of
homeostasis is used to show how the “normal”
interaction of structure and function is achieved
and maintained by counterbalancing forces
within the body. Repeated emphasis of these
principles encourages students to integrate oth-
erwise isolated factual information into a cohe-
sive and understandable whole. “The Big Pic-
ture” summarizes the larger interaction between
structures and functions of the different body
systems. As a result, the story of anatomy
and physiology emerges as a living and
dynamic topic of personal interest and
importance to students.
AIMS OF THE REVISION
As in past editions, our revision efforts focused
on identifying the need for new or revised infor-
mation and for additional visual presentations
that clarify important, yet sometimes difficult,
content areas.
In this ninth edition, we have included infor-
mation on new concepts in many areas of
anatomy and physiology. For example, new
data on the role of the human microbiome and
updates in terminology have been included.
Most of these changes are subtle adjustments to
our current understanding of human science.
 0°
Preface ix
Hyp
xion ere
However, the accumulation of all of these subtle changes makes this edition the most Fle xte
Extension ns
up-to-date textbook available. ion
We have also added information on calculating mean arterial pressure, the
45°
role of autonomic receptors in pharmacology, the nature of head trauma, assess-
ing acid-base balance using arterial blood gases, and other clinically relevant 55°
topics. This material, scattered throughout the book, better prepares students for
their clinical courses.
One of the most apparent changes that you will notice in this new edition is a con-
tinuation of the reorganization of chapters begun in the previous edition. A hallmark of
our textbook has been its effective “chunking” of material into manageable bite-size
pieces. These changes reflect our continuing commitment to that approach. Most notice-
able is the splitting of eleven of the longest chapters into smaller, more compact narratives
that students can read easily in one sitting. This reorganization offers an opportunity to pro-
vide more clarity and emphasis to topics such as homeostasis, which is now covered in its own
chapter (Chapter 2). Likewise, nerve signaling (Chapter 19), ventilation (Chapter 36), gas ex-
change and transport (Chapter 37), and other topics benefit by being the focus of their own
easily digestable chapters.
As we chunked the chapters, we also carefully clarified and added subheadings to improve
S
the telling of our story. Besides providing graphic scaffolding to help students construct a clear
understanding of concepts as the story unfolds, these subheadings also help students find A P

relevant material as they later “raid” their textbook for specific help in clarifying difficult I
concepts—or concepts they missed or forgot after their first reading.
Another aim of this revision has been the expansion of our use of online A&P Connect articles.
More than two dozen new articles have been added in this edition, some of them expanded versions
180°
of boxed sidebars that previously appeared in the textbook proper. Besides providing interesting
asides that help spark interest in a topic and motivate deeper learning, these articles provide an op-
portunity to integrate diverse topics scattered throughout the book. For example, the new article The
Human Microbiome is called out in many different chapters, helping readers see the numerous
connections that characterize human structure and function. Such “integrative” use of the articles
has been expanded and improved in this edition.
Previous editions have featured what is now our signature page design that makes the textbook
easier to use by putting the illustrations, graphs, and tables closer to the related text. In this edi-
tion, we have worked hard to make the page layout even more effective for telling our story.

Abd ion
Our extensive set of summary tables helps students visually organize important concepts

uct
and complements the improved design to provide a multisensory learning tool. We have
improved the art program by adopting a new style for graphs, which not only clarify con-
cepts but also provide the practice in graph interpretation needed for professional courses
in health careers. Many photographs featuring live anatomical models were replaced with
a coordinated set of new photographs (some of which appear on this page). Several new

Ad
du
illustrations maintain the use of a consistent Color Key (pp. xxx-xxxi) for certain cell parts, 50° c ti
on
tissue types, and biomolecules to help make learning easier for beginning students.
In this edition, we continue our effort to make this text accessible to students whose first
language is not English. After consulting with ESL specialists and ESL learners, we have
continued to enhance our word lists and improve our readability to make the 0°

concepts of human structure and function more understandable for all

students.
As teachers of anatomy and physiology, we know that to be effective a text must be clear
and readable, and it must challenge and excite the student. This text remains one that
students will read—one designed to help the teacher teach and the student
learn. To accomplish this end, we facilitated the comprehension of difficult material for
students with thorough, consistent, and nonintimidating explanations that are free of unnec-
essary terminology and extraneous information. This easy access to complex ideas remains the
single most striking hallmark of our textbook.
x Preface

ILLUSTRATIONS AND DESIGN

A major strength of this text has always been the exceptional quality, accuracy, and
beauty of the illustration program. It is the original “visual” anatomy and physiology
textbook. We have worked very closely with scientific illustrators to provide attractive and colorful
images that clearly and accurately portray the major
concepts of anatomy and physiology.
The truest test of any illustration is how effec-
tively it can complement and strengthen the written
information in the text and how successfully it can
be used by the student as a learning tool. Each il-
lustration is explicitly referred to in the text in bold
type and is designed to support the text discussion.
Careful attention has been paid to placement and
sizing of the illustrations to maximize usefulness and
clarity. Each figure and all labels are relevant to—and
consistent with—the text discussion. Each illustration has a boldface title for easy identification.
Most illustrations also include a concise explanation that guides the student through the
image as a complement to the nearby text narrative.
The artistically drawn, full-color artwork is both aesthetically pleasing and func-
tional. Color is used to highlight specific structures in drawings to help orga-
nize or highlight complex material in illustrated tables or conceptual
flow charts. The text is also filled with dissection photographs, excep-
tional light micrographs, and scanning (SEM) and transmission
(TEM) electron micrographs, some of which are new to this edition.
In addition, examples of medical imagery, including CT
scans, PET scans, MRIs, and x-ray photographs, are used
throughout the text to show structural detail, explain
medical procedures, and enhance the understanding of
differences that distinguish pathological conditions
from normal structure and function. All illustrations
used in the text are an integral part of the learning pro-
cess and should be carefully studied by the student.

LEARNING AIDS
Anatomy & Physiology is a student-oriented text. Written in a readable style
that tells a coherent story, the text is designed with many different pedagogi-
cal aids to motivate and maintain interest. The special features and learning
aids listed below are intended to facilitate learning and retention of informa-
tion in the most effective and efficient manner.
No textbook can replace the direction and stimulation provided by an en-
thusiastic teacher to a curious and involved student. However, a full comple-
ment of innovative pedagogical aids that are carefully planned and implemented
can contribute a great deal to the success of a text as a learning tool. An excellent
textbook can and should be enjoyable to read and should be helpful to both
 Preface xi

student and teacher. We hope you agree that the learning aids in Anatomy & Physiology appreciate the “Big Picture” of human structure
meet the high expectations we have set. and function each time they see a familiar
structure in a new illustration. For an explana-
U nit i ntrodUctions tion of the color scheme, see the Color Key on
Each of the six major units of the text begins with a brief overview statement. The general pp. xxx-xxxi.
content of the unit is discussed, and the chapters and their topics are listed. Before begin- Directional rosettes help stu- S
ning the study of material in a new unit, students are encouraged to scan the introduction dents learn the orientation of ana- R L
and each of the chapter outlines in the unit to understand the relationship and “connect- tomical structures. Where appro-
I
edness” of the material to be studied. Each unit has a color-coded tab at the outside edge priate, small orientation diagrams
of every page to help you quickly find the information you need. and directional rosettes are in-
cluded as part of an illustration to help students
c hapter L earning a ids locate a structure with reference to the body as
Study Hints give specific suggestions for using many of the learning aids found in each a whole or orient a small structure in a larger
chapter. Because many readers have never learned the special skills needed to make ef- view.
fective use of pedagogical resources found in science textbooks, helpful Quick Check questions test your knowledge

Hint tips are embedded within each Chapter Outline, Language of Science
& Medicine list, Case Study, Chapter Summary, Review Questions set,
and Critical Thinking section. Answers for the Quick Check and Case
of material you’ve just read. Short objective-type
questions are located immediately following
major topic discussions throughout the body of
Study questions are available for students on the Evolve website (evolve.elsevier.com/ the text. These questions cover important infor-
Patton/AP/), and answers for these plus the Review and Critical Thinking Exercises are mation presented in the preceding section.
available for instructors in the TEACH Instructor’s Resource. Students unable to answer the questions should
Chapter Outline summarizes the contents of a chapter at a glance. An overview outline reread that section before proceeding. This
introduces each chapter and enables the student to preview the content and direction of feature therefore enhances reading comprehen-
the chapter at the major concept level before beginning a detailed reading. Page refer- sion. Quick Check items are numbered by
ences enable students to quickly locate topics in the chapter. chapter, and a numerical listing of their answers
Language of Science introduces you to new scientific terms in the chapter. A comprehen- can be found on the Evolve website (evolve.
sive list of new terms is presented at the beginning of the chapter. Each term in the list has elsevier.com/Patton/AP/).
an easy-to-use pronunciation guide to help the learner easily “own” the word by
being able to say it. Literal translations of each term’s word parts are included to
help students learn how to deduce the meaning of new terms on their own. The
listed terms are defined in the text body, where they appear in boldface type, and
are also in the Glossary at the back of the book. The boldface type feature en-
ables students to scan the text for new words before beginning their first detailed
reading of the material, so they may read without having to disrupt the flow to
grapple with new words or phrases. The Language of Science word list includes
terms related to the essential anatomy and physiology presented in the chapter.
Another word list near the end of
the chapter, a feature described on BIOCHEMISTRY CELLULAR STRUCTURES OTHER STRUCTURES

the next page as the Language of

Cytosol Artery
Medicine, is an inventory of all the
C Carbon D Aspartic Acid Y Tyrosine

Extracellular

new clinical terms introduced in Cl Chloride Cysteine Valine Vein

C V Fluid

the chapter.
Plasma
Energy Energy G Glycine H2O Water Membrane Capillary

Color-coded illustrations help ATP ATP E Glutamic Acid Hormone Nucleus Bone

beginning students appreciate the H Hydrogen Q Glutamine Enzyme

Golgi
Apparatus
Muscle

“Big Picture” of human structure N Nitrogen H Histidine Protein

Mitochondrion Nerve

and function. A special feature of O Oxygen I Isoleucine Carbohydrate

Endoplasmic
Reticulum
Schwann Cell

the illustrations in this text is the K Potassium L Leucine Fatty acid Ribosome Fat

careful and consistent use of color Na Sodium K Lysine

DNA, Centrioles Gland

to identify important structures Nucleic Acid

Microtubule
Afferent (Sensory)
C

A
G

and substances that recur through-

Methionine
C

S Sulfur M RNA Pathway

Intermediate Efferent (Motor)

out the book. Consistent use of a

Ca Calcium F Phenylalanine C Cytosine Filament Pathway

color key helps beginning students P Organic P Proline A Adenine Microfilament Sympathetic
Phosphate

Inorganic Actin / Thin

Pi U Selenocysteine G Guanine Filament Parasympathetic
Phosphate

Myosin / Thick
Alanine Serine Thymine / Process Arrow
A S T Filament
Uracil

Chromosome Na+ Channel

R Arginine T Threonine

N Asparagine W Tryptophan
xii Preface
A&P Connect features call the reader’s attention to online articles that illustrate,
clarify, and apply concepts encountered in the text. Embedded within the text narrative,
these boxes connect you with interesting, brief online articles that stimulate thinking,
satisfy your curiosity, and help you apply important concepts. A&P Connect articles also
help you understand connections among structures and functions throughout the body,
integrating concepts into a “Big Picture” of human function. They are often illustrated
with micrographs, medical images, and medical illustrations.
Cycle of Life describes major changes that occur over a person’s lifetime.
In many body systems, changes in structure and function are frequently re-
lated to a person’s age or state of development. In appropriate chapters of the
text, these changes are highlighted in this special section.
The Big Picture explains the interactions of the system discussed in a
particular chapter with the body as a whole. This helps students relate infor-
mation about body structures or functions that are discussed in the chapter
to the body as a whole. The Big Picture feature helps you improve critical
thinking by focusing on how structures and functions relate to one another
on a bodywide basis.
Mechanisms of Disease helps you understand the basic principles of human structure
and function by showing what happens when things go wrong. Examples of pathology, or
disease, are included in many chapters of the book to stimulate student interest and to help
students understand that the disease process is a disruption in homeostasis, a breakdown of
normal integration of form and function. The
intent of the Mechanisms of Disease section
is to reinforce the normal structures and
mechanisms of the body while highlighting
the general causes of disorders for a particular
body system. These sections are heavily illus-
trated with diagrams and medical photographs
that bring pathology concepts to life.
Language of Medicine introduces you to
new clinical terms in the chapter. A brief list of
clinical terms is presented near the end of
each chapter. As in the Language of Science
list at the beginning of the chapter, each term
has a phonetic pronunciation guide and
translations of word parts. The listed terms
are defined in the text body, where they ap-
pear in boldface type.
Case Study challenges you with
“real-life” clinical or other practical
situations so you can creatively ap-
ply what you have learned. Case
studies precede the chapter summaries. The
case study consists of a description of a real-life
situation and a series of questions that require
the student to use critical thinking skills to de-
termine the answers.
Chapter Summary outlines essential infor-
mation in a way that helps you organize your
study. Detailed end-of-chapter summaries pro-
vide excellent guides for students as they review
the text materials before examinations. Many
students also find the summaries to be useful as
a chapter preview in conjunction with the
chapter outline.
Audio Chapter Summaries al-
low you to listen and learn wherever
you may be. These summaries are
available in MP3 format for down-
load at the Evolve website (evolve.elsevier.com/
Patton/AP/).
Review Questions help you determine
whether you have mastered the important con-
cepts of each chapter. Review questions at the
end of each chapter give students practice in
using a narrative format to discuss the concepts
presented in the chapter.
Critical Thinking Questions actively en-
gage and challenge you to evaluate and synthe-
size the chapter content. Critical thinking ques-
tions require students to use their higher level
reasoning skills and demonstrate their under-
standing of, not just their repetition of, complex
concepts.
B oxed s ideBars
As always, we made every effort to update fac-
tual information and incorporate the most cur-
rent anatomy and physiology research findings
in this edition. Although there continues to be
an incredible explosion of knowledge in the life
sciences, not all new information is appropriate
for inclusion in a fundamental-level textbook.
Therefore we were selective in choosing new
clinical, pathological, or special-interest mate-
rial to include in this edition. This text remains
focused on normal anatomy and physiology.
The addition of new boxed content is intended
to stimulate student interest and provide exam-
ples that reinforce the immediate personal rel-
evance of anatomy and physiology as important
disciplines for study.
 Preface xiii

General Interest Boxes provide an expanded explanation of specific chapter content.

Many chapters contain boxed essays, occasionally clinical in nature, that expand on or g Lossary
relate to material covered in the text. Examples of subjects include the Brainbow visual- A comprehensive glossary of terms is located at
ization of neural networks and the enteric nervous system. the end of the text. An expanded list of accu-
rate, concise definitions and phonetic pronun-
ciation guides is provided, along with word
parts and their literal translations. An audio
glossary is also available on the expanded
Evolve website (evolve.elsevier.com/Patton/AP/)
with definitions and audio pronunciations for
most of the key terms in the text.

LEARNING SUPPLEMENTS
Health Matters presents current information on diseases, disorders, clinical
applications, and other health issues related to normal structure and function.
FOR STUDENTS
In some instances, examples of structural anomalies or pathophysiology are B rief a tLas and Q Uick g Uide
presented. Information of this type is often useful in helping students under- This comprehensive supplement is packaged
stand the mechanisms involved in maintaining the “normal” interaction of structure and with every new copy of this edition of Anatomy
function. & Physiology. One section features a full-color
Diagnostic Study keeps you abreast of developments in diagnosing dis- Brief Atlas of Human Anatomy containing ca-
eases and disorders. These boxes deal with specific diagnostic tests used in daver dissections, osteology, organ casts, histol-
clinical medicine or research. Lumbar puncture, angiography, and ante- ogy specimens, and surface anatomy photo-
natal diagnosis and treatment are examples. graphs. This helpful supplement serves as a
FYI gives you more in-depth information on interesting topics mentioned handy reference for students as they study the
in the text. Topics of current interest, such as new advances in anatomy and human body in class and in the laboratory—
physiology research, are covered in these “for your information” boxes. and even later on in clinical and career con-
Sports and Fitness highlights sports-related topics. Exercise texts. Also included is the Quick Guide to the
physiology, sports injury, and physical education applications are high- Language of Science & Medicine, which pro-
lighted in these boxes. vides the foundation for learning the terminol-
Career Choices highlights individuals in health-related careers. A Career ogy of A&P. This quick guide features basic
Choices box appears at the end of each unit (and also below). These completely updated principles of terminology and lists of common
boxes feature a new set of health professionals describing a few of the diverse opportuni- roots, prefixes, suffixes, acronyms, Roman nu-
ties currently available in health-related occupations. They also demonstrate the impor- merals, and the Greek alphabet.
tance of how an understanding of anatomy and physiology will be useful to students in
their futures.
xiv Preface
Upper Arm - Transverse Section

Anterior View B
113 114

c Lear V iew of the h Uman B ody

119 120 113. Parietal bone 2 C
115 1
114. Frontal sinus D
116
115. Sphenoidal sinus 1 4
117 E
116. Occipital bone D
117. Palatine process 153 A
118 154 L R
118. Cervical vertebrae
118 119. Corpus callosum 154 P

This edition again features a student favorite—a full-color,

122 121 155
120. Thalamus
155
A. Biceps brachii m.
121 121. Trapezius m. 121
B. Brachialis m.
123 122. Acromion process 156
31
126 156 C. Humerus
125 123. Coracoid process 31 121
125 126 157 D. Triceps brachii m., medial
124 124. Humerus

semitransparent model of the body called the Clear View of

157 E. Triceps brachii m., lateral
152 124 125. Subscapularis m. 158
127 30 126. Deltoid m. (cut) 158
151 127. Triceps m. 160
127 127 162a
128. Brachialis m. 162a 160
133 Posterior View
132 129. Brachioradialis m. 127 161 127
162 162

the Human Body. Found after the end of Chapter 13, this
130. Radius 161
128 128 1. Epicranius m.
134 132 131. Ulna
15 15 2. Temporalis m.
132. Diaphragm
135 136 133. Thoracic duct 4. Masseter m.
129 134 129 159
134. Quadratus lumborum m. 15. Abdominal oblique m., external
135 166 159 166 167 31. Deltoid m.

feature permits the virtual dissection of male and female hu-

137 136 135. Psoas m. 167
130 130 163 168 121. Trapezius m.
141 136. Lumbar vertebrae 168 163 164
140 137. Iliacus m. 164 171 163 127. Triceps m.
131 138 137 141 131 163
138. Gluteus medius m. 171 172 153. Platysma m.
139 138 140
142 172 164 164 173 154. Splenius capitis m.
139. Iliofemoral ligament
142 173 174 155. Levator scapulae m.
139

man bodies along several different planes of the body. Devel-

140. Sacral nerves 169 175
174 169 156. Rhomboideus m.
141. Sacrum 170 176
175 170
145 142. Coccyx 176 157. Infraspinatis m.
143
145 143. Femur 158. Teres major m.
143 165 165
144. Vastus lateralis m. 165 165 159. Lumbodorsal fascia
146 145. Femoral artery and vein 160. Erector spinae m.

oped by Kevin Patton and Paul Krieger, this tool helps learn-
144
146 146. Adductor magnus m. 161. Serratus post. inf. m.
144
S 147. Patella 162. Latissimus dorsi m.
S 162a. Latissimus dorsi m. (cut)
R L 148. Fibula
149. Tibia 177 177 L R 163. Gluteus medius m.
I
150. Fibularis longus m. 177 177 I 164. Gluteus maximus m.

ers assimilate their knowledge of the complex structure of the

151. Spinal cord 165. Iliotibial tract
152. Nerve root 166. Flexor carpi ulnaris m.
147 167. Extensor carpi ulnaris m.
147 168. Extensor digitorum m.
148 169. Carpal ligament, dorsal

human body. It also provides a unique learning resource that

170. Interosseus m.
149 148
150 149 171. Gluteus minimus m.
172. Piriformis m.
178 178
150 178 178 173. Gemellus sup. m.
174. Obturator internus m.

helps students visualize human anatomy in the manner of

175. Gemellus inf. m.
176. Quadratus femoris m.
177. Biceps femoris m.
178. Gastrocnemius m.
179 179 179. Calcaneal (Achilles) tendon
179 179

today’s clinical body imaging technology.

180 180. Calcaneus bone
180

evolve . elsevier . com / patton / ap /

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This new edition of Anatomy & Physiology is supported by an ex- students who purchase a new textbook, this online course includes
panded multimedia Evolve website, featuring: instructionally sound learning modules with animations, interactive
• Audio Summaries for each chapter available for streaming or exercises, and assessments.
download in convenient MP3 form.
• Answers to all of the Quick Check and Case Study questions
S urvival G uide for A natomy
found in the textbook. & P hysiology
The Survival Guide for Anatomy & Physiology (2nd edition), writ-
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ten by Kevin Patton, is an easy-to-read and easy-to-understand brief
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oring Book, which offers analogies, and diagrams that convey all of the important facts and
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tant sites simply by clicking on a subject in the book’s table of A natomy & P hysiology
contents. L aboratory M anual
You can visit the Evolve site by pointing your browser to evolve. The Anatomy & Physiology Laboratory Manual, authored by Kevin
elsevier.com/Patton/AP/. Patton with new contributions from Steven Wood, continues to be
an invaluable resource for students. This extensively illustrated, full-
a natomy and p hysioLogy o nLine color manual features an extensively revised illustration program.
This 24-module online course brings A&P to life and helps you un- This popular lab manual contains more than 50 well-integrated ex-
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features are boxed hints on handling specimens and managing labo-
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The new edition of the lab manual includes eLabs for Anatomy &
Physiology, an online lab program designed to complement tradi-
tional lab exercises. The lab exercises, both anatomy and physiology
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TEACHING SUPPLEMENTS
FOR INSTRUCTORS
i nstrUctor r esoUrces on e VoLVe
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on Evolve, it provides critical thinking questions, learning objectives
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Preface xv
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 Acknowledgments
Over the years, many people have contributed to the development
and success of Anatomy & Physiology. We extend our thanks and
deep appreciation to all of the students and classroom instructors
who have provided us with helpful suggestions. We also thank the
many contributors and reviewers who have, over the last several edi-
tions, provided us with extraordinary insights and useful features that
we have added to our textbook.
Paul Krieger helped us design the Clear View of the Human Body,
for which we are grateful. Thanks to Betsy Brantley, who contributed
many of the case studies found in this edition. Thanks also to those
who provided their insights in the Career Choices boxes.
A special thanks goes to Dan Matusiak, who has contributed in
many ways to the last few editions.
Also, a very special thanks to Dr. Joanne Wagner, PT, PhD, Rich-
ard Hawkins of MMS Medical, and Jeff Wilsman of Southampton
Medical for help securing medical supplies for our photo shoot, and
to the crew and staff at Meoli Digital for a great shoot!
To those at Elsevier who put their best efforts into producing this
edition, we are indebted. This new edition, and its ever-expanding
library of ancillary resources, would not have been possible without
the efforts of Kellie White, Executive Content Strategist, and Joe
Gramlich, Senior Content Development Specialist. And where the
rubber meets the road, we were fortunate to have a wonderful team
of professionals working with us to keep it all on track and moving
along: Nathan Wurm-Cutter, Content Coordinator; Deborah Vogel
and Jeff Patterson, Publishing Services Managers; and John Gabbert
and Clay Broeker, Project Managers. We are also grateful to our
friends at Graphic World, who helped us improve and execute our
integrated design, layout, and art program.
Kevin T. Patton
Gary A. Thibodeau
 Contents
UNIT 1 The Body as a Whole, 1
CHAPTER 1 Organization of the Body, 3
Science and Society, 4
Anatomy and Physiology, 5
Anatomy, 5
Physiology, 5
Language of Science and Medicine, 5
Characteristics of Life, 6
Levels of Organization, 7
Chemical Level—Basis for Life, 7
Organelle Level, 7
Cellular Level, 8
Tissue Level, 8
Organ Level, 8
System Level, 8
Organism Level, 9
Anatomical Position, 9
Body Cavities, 10
Ventral Body Cavities, 10
Dorsal Body Cavities, 11
Other Cavities, 12
Body Regions, 12
Abdominopelvic Regions, 13
Abdominal Quadrants, 14
Terms Used in Describing Body Structure, 14
Directional Terms, 14
Terms Related to Organs, 15
Anatomical Rosette, 15
Body Planes and Sections, 16
Sagittal Planes, 16
Coronal Planes, 16
Transverse Planes, 16
Other Planes and Sections, 17
Interaction of Structure and Function, 17
Cycle of Life: Life Span Considerations, 17
The Big Picture: Organization of the Body, 18
Case Study, 19
CHAPTER 2 Homeostasis, 23
Homeostasis, 24
The Internal Environment, 24
Relative Stability, 24
Set Point, 24
Models of Homeostasis, 25
Homeostatic Control Mechanisms, 26
Feedback Loops, 26
Basic Components of Control Systems, 26
Negative Feedback in Control Systems, 27
Positive Feedback in Control Systems, 28
Changing the Set Point, 29
Feed-Forward in Control Systems, 30
Levels of Homeostatic Control, 30
Summary of Homeostasis, 31
Cycle of Life: Life Span Considerations, 31
The Big Picture: Homeostasis, 31
Mechanisms of Disease, 31
Case Study, 35
CHAPTER 3 Chemical Basis of Life, 38
Units of Matter, 39
Elements and Compounds, 39
Atoms, 40
Atomic Structure, 41
Cloud Model, 41
Atomic Number and Mass Number, 41
Energy Levels, 41
Isotopes, 42
Attractions Between Atoms, 43
Chemical Bonds, 43
Attractions Between Molecules, 44
Hydrogen Bonds, 44
Chemical Reactions, 45
Metabolism, 46
Body Chemistry, 46
Catabolism, 46
Anabolism, 47
 Organic and Inorganic Compounds, 47 Cytoskeleton, 88
Inorganic Molecules, 47 Cell Fibers, 88
Water, 47 Centrosome, 88
Oxygen and Carbon Dioxide, 48 Molecular Motors, 89
Electrolytes, 48 Cell Extensions, 90
The Big Picture: Chemical Basis of Life, 50 Cell Connections, 92
Mechanisms of Disease, 51 Desmosomes, 92
Case Study, 52 Gap Junctions, 92
Tight Junctions, 92
CHAPTER 4 Biomolecules, 55 The Big Picture: Cell Anatomy and the Whole Body, 93
Organic Molecules, 56 Mechanisms of Disease, 93
Carbohydrates, 56 Case Study, 94
Monosaccharides, 57
Disaccharides and Polysaccharides, 57 CHAPTER 6 Cell Function, 98
Lipids, 58 Movement of Substances through Cell Membranes, 99
Triglycerides or Fats, 58 Passive Transport Processes, 99
Phospholipids, 59 Active Transport Processes, 104
Steroids, 60 Cell Metabolism, 109
Prostaglandins, 60 Metabolism, 109
Proteins, 61 Role of Enzymes, 109
Amino Acids, 63 Catabolism, 111
Levels of Protein Structure, 64 Anabolism, 114
Importance of Protein Shape, 65 The Big Picture: Cell Physiology and the Whole
Nucleic Acids and Related Molecules, 67 Body, 115
DNA and RNA, 67 Mechanisms of Disease, 116
Nucleotides and Related Molecules, 68 Case Study, 117
Combined Forms, 69
The Big Picture: Biomolecules, 71 CHAPTER 7 Cell Growth and Development, 120
Mechanisms of Disease, 71 Protein Synthesis, 121
Case Study, 72 Deoxyribonucleic Acid (DNA), 121
Ribonucleic Acid (RNA), 122
CHAPTER 5 Cell Structure, 75 Transcription, 122
Functional Anatomy of Cells, 76 Editing the Transcript, 123
The Typical Cell, 76 Translation, 123
Cell Structures, 77 Post-Translation Processing, 126
Cell Membranes, 79 Cell Growth, 126
Membrane Structure, 79 Production of Cytoplasm, 126
Membrane Function, 80 DNA Replication, 127
Cytoplasm and Organelles, 82 Cell Reproduction, 128
Endoplasmic Reticulum (ER), 82 Mitosis, 129
Ribosomes, 83 Meiosis, 131
Golgi Apparatus, 83 Regulating the Cell Life Cycle, 131
Lysosomes, 85 Cycle of Life: Cells, 131
Proteasomes, 85 The Big Picture: Cell Growth, Reproduction, and the
Peroxisomes, 85 Whole Body, 133
Mitochondria, 86 Mechanisms of Disease, 133
Nucleus, 86 Case Study, 134
CHAPTER 8 Introduction to Tissues, 137 Skin Color, 188
Introduction to Tissues, 138 Melanin, 188
Principal Types of Tissue, 138 Other Pigments, 189
Development of Tissues, 139 Functions of the Skin, 190
Extracellular Matrix, 139 Protection, 191
Fluid Environment of the Body, 139 Sensation, 191
Components of the ECM, 140 Flexibility, 191
Holding Tissues Together, 144 Excretion, 191
Tissue Repair, 144 Hormone (Vitamin D) Production, 191
Body Membranes, 145 Immunity, 191
Epithelial Membranes, 145 Homeostasis of Body Temperature, 191
Connective Tissue Membranes, 147 Appendages of the Skin, 194
The Big Picture: Tissues, Membranes, and the Whole Hair, 195
Body, 149 Nails, 196
Mechanisms of Disease, 149 Skin Glands, 197
Case Study, 152 Cycle of Life: Skin, 198
The Big Picture: Skin and the Whole Body, 199
CHAPTER 9 Tissue Types, 155 Mechanisms of Disease, 199
Epithelial Tissue, 156 Case Study, 204
Types and Locations of Epithelial Tissue, 156
Functions of Epithelial Tissue, 156
CHAPTER 11 Skeletal Tissues, 209
Generalizations about Epithelial Tissue, 156 Functions of Bone, 210
Classification of Epithelial Tissue, 156 Types of Bones, 210
Connective Tissue, 162 Parts of a Long Bone, 211
Functions of Connective Tissue, 162 Parts of Flat Bones and Other Bones, 212
Characteristics of Connective Tissue, 162 Bone Tissue, 213
Classification of Connective Tissue, 163 Composition of Bone Matrix, 213
Fibrous Connective Tissue, 163 Microscopic Structure of Bone, 214
Bone Tissue, 167 Compact Bone, 214
Cartilage Tissue, 169 Cancellous Bone, 214
Blood Tissue, 169 Types of Bone Cells, 216
Muscle Tissue, 170 Bone Marrow, 217
Nervous Tissue, 172 Regulation of Blood Calcium Levels, 218
The Big Picture: Tissue Types and the Whole Body, 172 Mechanisms of Calcium Homeostasis, 218
Case Study, 174 Development of Bone, 218
Career Choices, 174 Intramembranous Ossification, 219
Endochondral Ossification, 220
Bone Remodeling, 222
Repair of Bone Fractures, 224
UNIT 2 Support and Movement, 179 Cartilage, 225
Types of Cartilage, 225
CHAPTER 10 Skin, 180 Function of Cartilage, 226
Structure of the Skin, 181 Growth of Cartilage, 226
Thin and Thick Skin, 181 Cycle of Life: Skeletal Tissues, 226
Epidermis, 181 The Big Picture: Skeletal Tissues, 226
Dermoepidermal Junction, 185 Mechanisms of Disease, 227
Dermis, 186 Case Study, 229
Hypodermis, 187
CHAPTER 12 Axial Skeleton, 233 Circular Movements, 299
Divisions of the Skeleton, 234 Gliding Movements, 299
Skull, 236 Special Movements, 299
Cranial Bones, 248 Examples of Joint Movements, 299
Facial Bones, 250 Cycle of Life: Articulations, 305
Eye Orbits, 250 The Big Picture: Articulations, 305
Fetal Skull, 252 Mechanisms of Disease, 306
Hyoid Bone, 253 Case Study, 309
Vertebral Column, 255
Thorax, 258 CHAPTER 15 Axial Muscles, 313
Sternum, 258 Skeletal Muscle Structure, 314
Ribs, 258 Connective Tissue Components, 314
Mechanisms of Disease, 260 Size, Shape, and Fiber Arrangement, 316
Case Study, 261 Attachment of Muscles, 317
Muscle Actions, 318
CHAPTER 13 Appendicular Skeleton, 264 Lever Systems, 318
Upper Extremity, 265 How Muscles Are Named, 321
Shoulder Girdle, 265 Hints on How to Deduce Muscle Actions, 323
Arm, 266 Axial Muscles, 323
Forearm, 266 Muscles of the Head and Neck, 324
Hand, 269 Muscles of Facial Expression, 324
Lower Extremity, 270 Muscles of Mastication, 325
Pelvic Girdle, 270 Muscles That Move the Head, 326
Thigh, 272 Trunk Muscles, 327
Leg, 274 Muscles of the Thorax, 327
Foot, 275 Muscles of the Abdominal Wall, 328
Skeletal Differences Between Men and Women, 276 Muscles of the Back, 330
Cycle of Life: Skeletal System, 278 Muscles of the Pelvic Floor, 332
The Big Picture: Skeletal System, 278 The Big Picture: Axial Muscles and the Whole
Mechanisms of Disease, 279 Body, 333
Case Study, 280 Case Study, 334

CHAPTER 14 Articulations, 283 CHAPTER 16 Appendicular Muscles, 337

Classification of Joints, 284
Fibrous Joints (Synarthroses), 284
Cartilaginous Joints (Amphiarthroses), 284
Synovial Joints (Diarthroses), 286
Representative Synovial Joints, 289
Humeroscapular Joint, 289
Elbow Joint, 290
Forearm, Wrist, Hand, and Finger Joints, 291
Hip Joint, 293
Knee Joint, 293
Ankle Joint, 295
Vertebral Joints, 297
Movement at Synovial Joints, 298
Range of Motion, 298
Angular Movements, 299
Appendicular Muscles, 338
Upper Extremity Muscles, 338
Muscles Acting on the Shoulder Girdle, 338
Muscles That Move the Arm, 341
Muscles That Move the Forearm, 342
Muscles That Move the Wrist, Hand, and
Fingers, 345
Lower Extremity Muscles, 349
Muscles That Move the Thigh and Leg, 349
Muscles That Move the Ankle and Foot, 356
Posture, 357
How Posture Is Maintained, 357
Cycle of Life: Muscular System, 358
The Big Picture: Appendicular Muscles and the Whole
Body, 358
Case Study, 359
CHAPTER 17 Muscle Contraction, 361 Repair of Nerve Fibers, 404
General Functions, 362 Cycle of Life: Nervous System Cells, 406
Function of Skeletal Muscle Tissue, 362 The Big Picture: Nervous System Cells and the Whole
Functional Characteristics of Muscle, 362 Body, 406
Overview of the Muscle Cell, 362 Mechanisms of Disease, 407
Myofilaments, 364 Case Study, 408
Mechanism of Contraction, 366
Energy Sources for Muscle Contraction, 370 CHAPTER 19 Nerve Signaling, 412
Function of Skeletal Muscle Organs, 373 Electrical Nature of Neurons, 413
Motor Unit, 374 Membrane Potentials, 413
Myography, 374 Resting Membrane Potentials, 413
The Twitch Contraction, 375 Local Potentials, 414
Treppe: The Staircase Phenomenon, 375 Action Potentials, 415
Tetanus, 375 Mechanism of the Action Potential, 415
Muscle Tone, 377 Refractory Period, 417
Graded Strength Principle, 377 Conduction of the Action Potential, 418
Grades of Muscle Strength, 377 Synaptic Transmission, 418
Mobilizing and Stabilizing Contractions, 379 Structure of the Synapse, 418
Function of Cardiac and Smooth Muscle Tissue, 381 Types of Synapses, 418
Cardiac Muscle, 381 Mechanisms of Synaptic Transmission, 420
Smooth Muscle, 382 Summation, 422
The Big Picture: Muscle Tissue and the Whole Synapses and Memory, 423
Body, 384 Neurotransmitters, 424
Mechanisms of Disease: Major Muscular Disorders, 384 Functional Classification of Neurotransmitters, 424
Case Study, 386 Structural Classification of Neurotransmitters, 425
Career Choices, 387 Neural Networks, 429
The Network Model, 429
Development of Neural Networks, 429
UNIT 3 Communication, Control, Complexity in Neural Networks, 430
The Big Picture: Nerve Signaling and the Whole
and Integration, 391 Body, 431
Mechanisms of Disease, 431
CHAPTER 18 Nervous System Cells, 392 Case Study, 432
Organization of the Nervous System, 393
Central and Peripheral Nervous Systems, 393 CHAPTER 20 Central Nervous System, 436
Afferent and Efferent Divisions, 394 Coverings of the Brain and Spinal Cord, 437
Somatic and Autonomic Nervous Systems, 394 Cerebrospinal Fluid, 439
Glia, 395 Fluid Spaces, 439
Overview of Glia, 395 Formation and Circulation of Cerebrospinal
Central Glia, 395 Fluid, 439
Peripheral Glia, 397 Spinal Cord, 442
Neurons, 399 Structure of the Spinal Cord, 442
Structure and Function of Neurons, 399 Functions of the Spinal Cord, 443
Classification of Neurons, 400 Brain, 445
Reflex Arc, 402 Regions of the Brain, 445
Nerves and Tracts, 403 Brain Development, 445
Nerves, 403 Structure of the Brainstem, 446
Tracts, 404 Functions of the Brainstem, 447
White and Gray Matter, 404 Structure of the Cerebellum, 449
 Functions of the Cerebellum, 450 Autonomic Neurotransmitters and Receptors, 509
Diencephalon, 452 Norepinephrine and Its Receptors, 509
Structure of the Cerebrum, 454 Acetylcholine and Its Receptors, 510
Functions of the Cerebral Cortex, 457 Nonadrenergic-Noncholinergic Transmission, 511
Somatic Sensory Pathways in the Central Nervous Synaptic Complexity, 511
System, 464 Pharmacology, 511
Somatic Motor Pathways in the Central Nervous Functions of the Autonomic Nervous System, 512
System, 466 Overview of Autonomic Function, 512
Pyramidal Tracts, 467 Functions of the Sympathetic Division, 512
Extrapyramidal Tracts, 467 Functions of the Parasympathetic Division, 516
Cycle of Life: Central Nervous System, 468 The Big Picture: Autonomic Nervous System and the
The Big Picture: The Central Nervous System and the Whole Body, 516
Whole Body, 469 Case Study, 517
Mechanisms of Disease, 469
Case Study, 472 CHAPTER 23 General Senses, 520
Sensory Receptors, 521
CHAPTER 21 Peripheral Nervous System, 479 Receptor Response, 521
Spinal Nerves, 480 Distribution of Receptors, 521
Structure of Spinal Nerves, 481 Classification of Receptors, 522
Nerve Plexuses, 482 Classification by Location, 522
Dermatomes and Myotomes, 487 Classification by Stimulus Detected, 522
Cranial Nerves, 489 Classification by Structure, 522
Olfactory Nerve (CN I), 490 Sense of Pain, 523
Optic Nerve (CN II), 490 Sense of Temperature, 525
Oculomotor Nerve (CN III), 491 Sense of Touch, 525
Trochlear Nerve (CN IV), 491 Skin Movement, 525
Trigeminal Nerve (CN V), 491 Itch, 525
Abducens Nerve (CN VI), 491 Tickle, 525
Facial Nerve (CN VII), 492 Light Touch, 526
Vestibulocochlear Nerve (CN VIII), 492 Deep Touch, 526
Glossopharyngeal Nerve (CN IX), 492 Sense of Proprioception, 526
Vagus Nerve (CN X), 494 The Big Picture: General Senses, 528
Accessory Nerve (CN XI), 494 Case Study, 529
Hypoglossal Nerve (CN XII), 494
Somatic Motor Nervous System, 495 CHAPTER 24 Special Senses, 532
Divisions of the Peripheral Nervous Systems, 495 Sense of Smell, 533
The Big Picture: Peripheral Nervous System and the Olfactory Receptors, 533
Whole Body, 498 Olfactory Pathway, 534
Case Study, 499 Sense of Taste, 534
Taste Buds, 534
CHAPTER 22 Autonomic Nervous System, 503 Neural Pathway for Taste, 536
Overview of the Autonomic Nervous System, 504 Senses of Hearing and Balance, 536
Role of the Autonomic Nervous System, 504 Structure of the Ear, 536
Divisions of the Autonomic Nervous System, 504 The Process of Hearing, 538
Structure of the Autonomic Nervous System, 505 Balance, 540
Basic Plan of Autonomic Pathways, 505 Sense of Vision, 541
Structure of the Sympathetic Pathways, 505 Structure of the Eye, 542
Structure of the Parasympathetic Pathways, 507 The Process of Seeing, 547
 Cycle of Life: Special Senses, 553 Thymus, 598
The Big Picture: Special Senses, 553 Gastric and Intestinal Mucosa, 599
Mechanisms of Disease, 553 Heart, 600
Case Study, 557 Adipose Tissue, 600
Other Endocrine Glands and Hormones, 600
CHAPTER 25 Endocrine Regulation, 562 Cycle of Life: Endocrine System, 600
Organization of the Endocrine System, 563 The Big Picture: The Endocrine System and the Whole
Classification of Hormones, 564 Body, 601
Steroid Hormones, 564 Mechanisms of Disease, 601
Nonsteroid Hormones, 564 Case Study, 604
How Hormones Work, 567 Career Choices, 604
General Principles of Hormone Action, 567
Mechanism of Steroid Hormone Action, 567
Mechanisms of Nonsteroid Hormone Action, 568 UNIT 4 Transportation and
Regulation of Hormone Secretion, 569
Regulation of Target Cell Sensitivity, 571
Defense, 609
Eicosanoids, 572
Tissue Hormones, 572 CHAPTER 27 Blood, 610
Prostaglandins, 573 Composition of Blood, 611
Thromboxanes and Leukotrienes, 574 Structure and Function of Blood, 611
The Big Picture: Endocrine Regulation and the Whole Blood Volume, 612
Body, 574 Hematocrit, 613
Mechanisms of Disease, 574 Blood Plasma, 613
Red Blood Cells, 614
CHAPTER 26 Endocrine Glands, 579 Structure of Red Blood Cells, 614
Pituitary Gland, 580 Function of Red Blood Cells, 614
Structure of the Pituitary Gland, 580 Hemoglobin, 615
Adenohypophysis (Anterior Lobe of Pituitary), 580 Formation of Red Blood Cells, 615
Neurohypophysis (Posterior Lobe of Pituitary), 585 Life Cycle of Red Blood Cells, 617
Pineal Gland, 586 Blood Types, 617
Thyroid Gland, 587 White Blood Cells, 621
Structure of the Thyroid Gland, 587 Granulocytes, 622
Thyroid Hormone, 587 Agranulocytes, 622
Calcitonin, 589 White Blood Cell Numbers, 622
Parathyroid Glands, 589 Formation of White Blood Cells, 623
Structure of the Parathyroid Glands, 589 Platelets, 624
Parathyroid Hormone, 589 Structure and Function of Platelets, 624
Adrenal Glands, 592 Formation and Life Span of Platelets, 624
Structure of the Adrenal Glands, 592 Hemostasis, 624
Adrenal Cortex, 592 Vasoconstriction, 624
Adrenal Medulla, 595 Platelet Plug Formation, 624
Pancreatic Islets, 595 Blood Clotting (Coagulation), 625
Structure of the Pancreatic Islets, 595 Conditions That Oppose Clotting, 628
Pancreatic Hormones, 596 Conditions That Hasten Clotting, 628
Gonads, 598 Clot Dissolution, 629
Testes, 598 The Big Picture: Blood and the Whole Body, 629
Ovaries, 598 Mechanisms of Disease, 629
Placenta, 598 Case Study, 633
CHAPTER 28 Heart, 637
Heart Structure, 638
Location of the Heart, 638
Size and Shape of the Heart, 638
Coverings of the Heart, 642
Structure of the Heart, 642
The Heart as a Pump, 649
Conduction System of the Heart, 649
Electrocardiogram (ECG), 651
Cardiac Cycle, 654
Heart Sounds, 656
Cycle of Life: Heart, 656
The Big Picture: Heart, 656
Mechanisms of Disease, 656
Case Study, 661
CHAPTER 29 Blood Vessels, 665
Blood Vessel Types, 666
Arteries, 666
Capillaries, 666
Veins, 667
Structure of Blood Vessels, 669
Circulatory Routes, 670
Systemic Circulation, 671
Systemic Arteries, 671
Systemic Veins, 681
Fetal Circulation, 688
The Basic Plan of Fetal Circulation, 688
Changes in Circulation at Birth, 691
Cycle of Life: Blood Vessels, 692
The Big Picture: Blood Vessels and the Whole
Body, 692
Mechanisms of Disease, 692
Case Study, 696
CHAPTER 30 Circulation of Blood, 699
Hemodynamics, 700
Primary Principle of Circulation, 700
Arterial Blood Pressure, 701
Cardiac Output, 701
Peripheral Resistance, 706
Venous Return to the Heart, 711
Venous Pumps, 711
Total Blood Volume, 712
Measuring Blood Pressure, 714
Arterial Blood Pressure, 714
Blood Pressure and Bleeding, 717
Minute Volume of Blood, 717
Velocity of Blood Flow, 718
Pulse, 718
Mechanism, 718
Pulse Wave, 719
Where the Pulse Can Be Felt, 719
Venous Pulse, 720
Cycle of Life: Cardiovascular Physiology, 721
The Big Picture: Blood Flow and the Whole Body, 721
Mechanisms of Disease, 721
Case Study, 723
CHAPTER 31 Lymphatic System, 728
Overview of the Lymphatic System, 729
Lymph and Interstitial Fluid, 730
Lymphatic Vessels, 730
Distribution of Lymphatic Vessels, 730
Structure of Lymphatic Vessels, 731
Functions of Lymphatic Vessels, 731
Circulation of Lymph, 732
The Lymphatic Pump, 733
Lymph Nodes, 734
Structure of Lymph Nodes, 734
Locations of Lymph Nodes, 734
Functions of Lymph Nodes, 735
Lymphatic Drainage of the Breast, 737
Distribution of Lymphatics in the Breast, 738
Lymph Nodes Associated with the Breast, 739
Tonsils, 739
Thymus, 739
Location and Appearance of the Thymus, 739
Structure of the Thymus, 740
Function of the Thymus, 740
Spleen, 740
Location of the Spleen, 740
Structure of the Spleen, 740
Functions of the Spleen, 742
Cycle of Life: Lymphatic System, 743
The Big Picture: Lymphatic System and the Whole
Body, 743
Mechanisms of Disease, 743
Case Study, 745
CHAPTER 32 Innate Immunity, 749
Organization of the Immune System, 750
Defense of the Body, 750
Innate Immunity, 751
Species Resistance, 752
Mechanical and Chemical Barriers, 752
 Inflammation and Fever, 753
The Inflammatory Response, 753
Fever, 753
Phagocytosis, 754
Natural Killer Cells, 757
Interferon, 757
Complement, 758
Toll-Like Receptors, 759
The Big Picture: Innate Immunity and the Whole
Body, 759
CHAPTER 33 Adaptive Immunity, 762
Overview of Adaptive Immunity, 763
B Cells and Antibody-Mediated Immunity, 765
Development and Activation of B Cells, 765
Antibodies (Immunoglobulins), 766
Clonal Selection Theory, 769
T Cells and Cell-Mediated Immunity, 771
Development of T Cells, 771
Activation and Functions of T Cells, 771
Types of Adaptive Immunity, 775
Summary of Adaptive Immunity, 776
The Big Picture: Immune System and the Whole
Body, 778
Mechanisms of Disease, 778
Case Study, 782
CHAPTER 34 Stress, 785
Selye’s Concept of Stress, 786
Development of the Stress Concept, 786
Definitions, 786
Stressors, 786
General Adaptation Syndrome, 788
Mechanism of Stress, 790
Some Current Concepts about Stress, 790
Definitions, 790
Stress Syndrome, 791
Stress and Disease, 792
Indicators of Stress, 792
Corticoids and Resistance to Stress, 793
Psychological Stress, 793
Effects of Intrauterine Stress, 795
The Big Picture: Stress and the Whole Body, 796
Case Study, 796
Career Choices, 797
UNIT 5 Respiration, Nutrition,
and Excretion, 799
CHAPTER 35 Respiratory Tract, 800
Structural Plan of the Respiratory Tract, 801
Upper Respiratory Tract, 802
Nose, 802
Pharynx, 805
Larynx, 805
Lower Respiratory Tract, 807
Trachea, 807
Bronchi and Alveoli, 807
Lungs, 812
Thorax, 816
Cycle of Life: Respiratory Tract, 817
The Big Picture: Respiratory Tract, 817
Mechanisms of Disease, 817
Case Study, 821
CHAPTER 36 Ventilation, 824
Respiratory Physiology, 825
Mechanism of Ventilation, 825
Primary Principle of Ventilation, 825
Inspiration, 828
Expiration, 829
Pulmonary Volumes and Capacities, 831
Pulmonary Volumes, 831
Pulmonary Capacities, 834
Pulmonary Airflow, 835
Ventilation and Perfusion, 837
Regulation of Ventilation, 837
Homeostasis of Blood Gases and pH, 837
Respiratory Control Centers, 838
Feedback and Responses, 838
Other Influences on Ventilation, 841
The Big Picture: Ventilation and the Whole Body, 842
Mechanisms of Disease, 842
Case Study, 845
CHAPTER 37 Gas Exchange and Transport, 848
Pulmonary Gas Exchange, 849
Partial Pressure, 849
Exchange of Gases in the Lungs, 850
How Blood Transports Gases, 852
Hemoglobin, 852
Transport of Oxygen, 853
Transport of Carbon Dioxide, 854
 Systemic Gas Exchange, 856
The Big Picture: Gas Exchange and Transport and the
Whole Body, 858
Case Study, 858
CHAPTER 38 Upper Digestive Tract, 860
Organization of the Digestive System, 861
The Digestive Tract, 861
Wall of the GI Tract, 862
Mouth, 863
Structure of the Oral Cavity, 863
Salivary Glands, 866
Teeth, 867
Pharynx, 869
Esophagus, 869
Stomach, 871
Size and Position of the Stomach, 871
Divisions of the Stomach, 872
Curves of the Stomach, 872
Sphincter Muscles, 872
Stomach Wall, 872
Functions of the Stomach, 873
Cycle of Life: Upper Digestive Tract, 873
Mechanisms of Disease, 874
Case Study, 878
CHAPTER 39 Lower Digestive Tract, 882
Small Intestine, 883
Size and Position of the Small Intestine, 883
Divisions of the Small Intestine, 883
Wall of the Small Intestine, 883
Large Intestine, 885
Size of the Large Intestine, 885
Divisions of the Large Intestine, 885
Wall of the Large Intestine, 887
Vermiform Appendix, 887
Peritoneum, 888
Liver, 888
Location and Size of the Liver, 888
Liver Lobes and Lobules, 888
Bile Ducts, 891
Functions of the Liver, 891
Gallbladder, 893
Size and Location of the Gallbladder, 893
Structure of the Gallbladder, 893
Functions of the Gallbladder, 893
Pancreas, 893
Size and Location of the Pancreas, 893
Structure of the Pancreas, 893
Functions of the Pancreas, 893
Cycle of Life: Lower Digestive Tract, 894
The Big Picture: The Digestive Tract, 894
Mechanisms of Disease, 895
Case Study, 898
CHAPTER 40 Digestion and Absorption, 901
Overview of Digestive Function, 902
Digestion, 902
Mechanical Digestion, 904
Chemical Digestion, 908
Secretion, 913
Saliva, 914
Gastric Juice, 914
Pancreatic Juice, 915
Bile, 916
Intestinal Juice, 917
Control of Digestive Gland Secretion, 918
Control of Salivary Secretion, 918
Control of Gastric Secretion, 918
Control of Pancreatic Secretion, 918
Control of Bile Secretion, 920
Control of Intestinal Secretion, 920
Absorption, 920
Process of Absorption, 920
Mechanisms of Absorption, 920
Elimination, 923
The Big Picture: Digestion and the Whole Body, 924
Case Study, 925
CHAPTER 41 Nutrition and Metabolism, 930
Overview of Nutrition and Metabolism, 931
Carbohydrates, 933
Dietary Sources of Carbohydrates, 933
Carbohydrate Metabolism, 933
Lipids, 944
Dietary Sources of Lipids, 944
Transport of Lipids, 944
Lipid Metabolism, 945
Proteins, 946
Sources of Proteins, 946
Protein Metabolism, 947
Vitamins and Minerals, 948
Vitamins, 948
Minerals, 951
Metabolic Rates, 952
Basal Metabolic Rate, 952
Total Metabolic Rate, 955
Energy Balance and Body Weight, 955
Mechanisms for Regulating Food Intake, 956
Cycle of Life: Nutrition and Metabolism, 957
 The Big Picture: Nutrition, Metabolism, and the Whole CHAPTER 44 Acid-Base Balance, 1019
Body, 957 Mechanisms That Control pH of Body Fluids, 1020
Mechanisms of Disease, 957 Review of the pH Concept, 1020
Case Study, 961 Sources of pH-Influencing Chemicals, 1021
Types of pH Control Mechanisms, 1021
CHAPTER 42 Urinary System, 966 Effectiveness of pH Control Mechanisms—Range of
Anatomy of the Urinary System, 967 pH, 1022
Gross Structure, 967 Buffer Mechanisms for Controlling pH of Body
Microscopic Structure, 971 Fluids, 1022
Physiology of the Urinary System, 976 Buffers Defined, 1022
Overview of Kidney Function, 976 Buffer Pairs Present in Body Fluids, 1022
Filtration, 978 Buffer Actions That Prevent Marked Changes in pH
Reabsorption, 980 of Body Fluids, 1022
Tubular Secretion, 984 Evaluation of the Role of Buffers in pH
Regulation of Urine Volume, 985 Control, 1025
Urine Composition, 986 Respiratory Mechanisms of pH Control, 1025
Cycle of Life: Urinary System, 989 Explanation of Respiratory Mechanisms, 1025
The Big Picture: Urinary System and the Whole Respiratory Adjustment to Counter pH Imbalance
Body, 989 of Arterial Blood, 1026
Mechanisms of Disease, 989 Principles That Relate Respirations to pH
Case Study, 994 Value, 1026
Arterial Blood Gas Analysis, 1027
CHAPTER 43 Fluid and Electrolyte Balance, 999 Urinary Mechanisms That Control pH, 1027
Interrelationship of Fluid and Electrolyte Balance, 1000 General Principles Concerning Urinary
Total Body Water, 1000 Mechanisms, 1027
Body Fluid Compartments, 1001 Mechanisms That Control Urine pH, 1027
Chemical Content, Distribution, and Measurement of The Big Picture: Acid-Base Balance, 1030
Electrolytes in Body Fluids, 1001 Mechanisms of Disease, 1030
Extracellular vs. Intracellular Fluids, 1001 Case Study, 1033
Measuring Electrolyte Reactivity, 1003 Career Choices, 1033
Avenues by Which Water Enters and Leaves the
Body, 1003
Some General Principles about Fluid Balance, 1003 UNIT 6 Reproduction and
Mechanisms That Maintain Homeostasis of Total Fluid
Volume, 1004
Development, 1037
Regulation of Fluid Intake, 1005
Regulation of Urine Volume, 1005 CHAPTER 45 Male Reproductive System, 1038
Factors That Alter Fluid Loss Under Abnormal Sexual Reproduction, 1039
Conditions, 1006 Male Reproductive Organs, 1039
Regulation of Water and Electrolyte Levels in Plasma Perineum, 1039
and Interstitial Fluid, 1007 Testes, 1039
Edema, 1009 Structure and Location, 1039
Regulation of Water and Electrolyte Levels in ICF, 1010 Microscopic Anatomy of the Testis, 1040
Regulation of Sodium and Potassium Levels in Body Testes Functions, 1043
Fluids, 1011 Spermatozoa, 1044
Cycle of Life: Fluid and Electrolyte Balance, 1013 Reproductive Ducts, 1045
The Big Picture: Fluid and Electrolyte Balance, 1013 Epididymis, 1045
Mechanisms of Disease, 1014 Vas Deferens, 1045
Case Study, 1016 Ejaculatory Duct, 1047
Urethra, 1047
 Accessory Reproductive Glands, 1047 Cycle of Life: Female Reproductive System, 1079
Seminal Vesicles, 1047 The Big Picture: Female Reproductive System and the
Prostate Gland, 1047 Whole Body, 1079
Bulbourethral Glands, 1048 Mechanisms of Disease, 1080
Supporting Structures, 1048 Case Study, 1085
Scrotum, 1048
Penis, 1049 CHAPTER 47 Growth and Development, 1090
Spermatic Cords, 1049 A New Human Life, 1091
Composition and Course of Seminal Fluid, 1049 Production of Sex Cells, 1091
Male Fertility, 1050 Ovulation and Insemination, 1096
Cycle of Life: Male Reproductive System, 1050 Fertilization, 1096
The Big Picture: Male Reproductive System, 1051 Prenatal Period, 1097
Mechanisms of Disease, 1051 Cleavage and Implantation, 1097
Case Study, 1053 Placenta, 1098
Periods of Development, 1102
CHAPTER 46 Female Reproductive System, 1057 Stem Cells, 1102
Overview of the Female Reproductive System, 1058 Formation of the Primary Germ Layers, 1103
Function of the Female Reproductive System, 1058 Histogenesis and Organogenesis, 1106
Structural Plan of the Female Reproductive Birth, or Parturition, 1108
System, 1058 Stages of Labor, 1108
Perineum, 1059 Multiple Births, 1110
Ovaries, 1060 Postnatal Period, 1110
Location of the Ovaries, 1060 Infancy, 1111
Microscopic Structure of the Ovaries, 1061 Childhood, 1112
Functions of the Ovaries, 1062 Adolescence and Adulthood, 1112
Uterus, 1062 Older Adulthood and Senescence, 1113
Structure of the Uterus, 1062 Effects of Aging, 1115
Functions of the Uterus, 1064 Skeletal System, 1115
Uterine Tubes, 1064 Muscular System, 1115
Location of the Uterine Tubes, 1064 Integumentary System (Skin), 1116
Structure of the Uterine Tubes, 1064 Urinary System, 1116
Function of the Uterine Tubes, 1065 Respiratory System, 1116
Vagina, 1065 Cardiovascular System, 1116
Location of the Vagina, 1065 Special Senses, 1117
Structure of the Vagina, 1066 Reproductive Systems, 1117
Functions of the Vagina, 1066 Benefits of Aging, 1117
Vulva, 1066 Causes of Death, 1117
Structure of the Vulva, 1066 The Big Picture: Growth, Development, and the Whole
Functions of the Vulva, 1068 Body, 1118
Female Reproductive Cycles, 1069 Mechanisms of Disease, 1119
Recurring Cycles, 1069 Case Study, 1121
Control of Female Reproductive Cycles, 1071
Importance of Female Reproductive Cycles, 1072 CHAPTER 48 Genetics and Heredity, 1126
Infertility and Use of Fertility Drugs, 1072 The Science of Genetics, 1127
Menarche and Menopause, 1075 Chromosomes and Genes, 1127
Breasts, 1076 Mechanism of Gene Function, 1127
Location and Size of the Breasts, 1076 The Human Genome, 1128
Structure of the Breasts, 1077 Distribution of Chromosomes to Offspring, 1130
Function of the Breasts, 1078
Gene Expression, 1131
Hereditary Traits, 1131
Sex-Linked Traits, 1133
Genetic Mutations, 1135
Medical Genetics, 1136
Mechanisms of Genetic Diseases, 1136
Single-Gene Diseases, 1137
Epigenetic Conditions, 1139
Chromosomal Diseases, 1139
Genetic Basis of Cancer, 1141
Prevention and Treatment of Genetic Diseases, 1141
Genetic Counseling, 1141
Treating Genetic Diseases, 1143
The Big Picture: Genetics, Heredity, and the Whole
Body, 1144
Case Study, 1145
Career Choices, 1146
Glossary of Anatomy & Physiology, 1151
Index, 1197
Contents
 Color Key
BIOCHEMISTRY

C Carbon D Aspartic Acid Y Tyrosine

Cl Chloride C Cysteine V Valine

Energy Energy G Glycine H2O Water

ATP ATP E Glutamic Acid Hormone

H Hydrogen Q Glutamine Enzyme

N Nitrogen H Histidine Protein

O Oxygen I Isoleucine Carbohydrate

K Potassium L Leucine Fatty acid

DNA,
Na Sodium K Lysine
Nucleic Acid
C

A
G

Methionine
C
S Sulfur M RNA

Ca Calcium F Phenylalanine C Cytosine

P Organic P Proline A Adenine

Phosphate

Inorganic
Pi
Phosphate U Selenocysteine G Guanine

A Alanine S Serine T
Thymine /
Uracil

R Arginine T Threonine Chromosome

N Asparagine W Tryptophan
 Color Key xxxi

CELLULAR STRUCTURES OTHER STRUCTURES

Cytosol Artery

Extracellular
Vein
Fluid

Plasma
Membrane Capillary

Nucleus Bone

Golgi
Muscle
Apparatus

Mitochondrion Nerve

Endoplasmic
Schwann Cell
Reticulum

Ribosome Fat

Centrioles Gland

Afferent (Sensory)
Microtubule
Pathway

Intermediate Efferent (Motor)

Filament Pathway

Microfilament Sympathetic

Actin / Thin
Filament Parasympathetic

Myosin / Thick
Process Arrow
Filament

Na+ Channel
 Illustration and
Photograph Credits
COVER AND FRONT MATTER
Courtesy of the Laboratory of Neuro Imaging and Martinos Center
for Biomedical Imaging, Consortium of the Human Connectome
Project, www.humanconnectomeroject.org. Career Choices box:
Courtesy of Spencer Derenzy.
UNIT 1
Seeing the Big Picture box: Copyright Kevin Patton, Lion Den Inc,
Weldon Spring, MO.
Chapter 1
1-2: De Humani Corporis Fabrica (On the Structure of the Human
Body), in 1543. 1-3, 1-8, 1-9: Courtesy Barbara Cousins. 1-10: Re-
drawn from Muscolino JE: Know the body: muscle, bone, and palpa-
tion essentials, St. Louis, 2012, Mosby. 1-11, A: Courtesy Vidic B,
Suarez RF: Photographic atlas of the human body, St. Louis, 1984,
Mosby. 1-11, B: Suarez RF: Photographic atlas of the human body,
St. Louis, 1984, Mosby. A&P Connect box: From Goldman L, Ausi-
ello D: Cecil textbook of medicine, ed 22, Philadelphia, 2004,
Saunders.
Chapter 2
2-6: Data from Schwartz WJ: A clinician’s primer on the circadian
clock: its localization, function, and resetting. Adv Intern Med, 38:81-
106, 1993. In (redrawn from) Koeppen B, Stanton B: Berne & Levy
physiology, ed 6, Mosby, 2010. 2-8, 2-9, B: From Patton KT,
Thibodeau G: Human body in health & disease, ed 6, St. Louis,
2014, Mosby. 2-9, A: From Donne DG, Viles JH, Groth D, Melhorn
I: Structure of the recombinant full-length hamster prion protein
PRp (29-231): the N terminus is highly flexible, Proc Natl Acad Sci
USA, 94:13452-13457, 1997. Copyright National Academy of Sci-
ences, USA.
Chapter 3
3-1: From Patton KT, Thibodeau G: Human body in health & dis-
ease, ed 6, St. Louis, 2014, Mosby. 3-4: From Sugimoto Y, Pou P, Abe
M et al: Chemical identification of individual surface atoms by
atomic force microscopy, Nature, 466:64-67, 2007. 3-8, C: Michael
Godomski/Tom Stack & Associates. Case Study box: From Potter P,
Perry A: Basic nursing: essentials for practice, ed 6, St. Louis, 2006,
Mosby.
Chapter 4
4-13: From Patton KT, Thibodeau GA: Mosby’s handbook of anat-
omy & physiology, ed 2, St. Louis, 2014, Elsevier. 4-14: From Patton
K, Thibodeau G, Douglas M: Essentials of anatomy and physiology,
Mosby, 2012. 4-15, Box 4-4 (photo): From National Institute of
General Medical Sciences, The structures of life, July 2007, retrieved
November 2008 from http://www.nigms.nih.gov/news/science_ed/
structlife/. Box 4-2 (photo): Copyright Kevin Patton, Lion Den Inc,
Weldon Spring, MO.
Chapter 5
5-1, B: Courtesy A. Arlan Hinchee. 5-2, 5-9, 5-10, 5-13, 5-15 (elec-
tron micrographs), 5-17: From Pollard T, Earnshaw W: Cell biology,
revised reprint, international edition, ed 1, Philadelphia, 2004, Saun-
ders. 5-7, B, 5-12, B, 5-18, B: Courtesy Charles Flickinger, Univer-
sity of Virginia. 5-11, B: Courtesy Brenda Russell. 5-14: From Patton
KT, Thibodeau GA: Mosby’s handbook of anatomy & physiology, ed
2, St. Louis, 2014, Elsevier. 5-15 (fluorescence light micrographs
[right panel]), 5-15, A: Courtesy I. Herman, Tufts University. 5-15,
B: Courtesy E. Smith and E. Fuchs, University of Chicago. 5-15, C:
Courtesy G. Borisy, University of Wisconsin, Madison. 5-16, B:
Courtesy Conly Rieder, Wadsworth Center, Albany, NY. 5-18, A: Su-
sumu Ito. Table 5-4 (figures): From Patton KT, Thibodeau GA:
Mosby’s handbook of anatomy & physiology, ed 2, St. Louis, 2014,
Elsevier. A&P Connect box (figure): From Kong LB et al: Structure
of the vault, a ubiquitous cellular component, Structure, 7:371-379,
1999.
Chapter 6
6-9: Adapted from McCance K, Huether S: Pathophysiology, ed 4,
St. Louis, 2002, Mosby. 6-11 (electron micrographs): Courtesy
M.M. Perry and A.B. Gilbert, Edinburgh Research Center. Box 6-1,
B: From Goldman L, Ausiello D: Cecil textbook of medicine, ed 22,
Philadelphia, 2004, Saunders.
Chapter 7
7-1 (photo): Cold Spring Harbor Laboratory. 7-4: Adapted from Pol-
lard T, Earnshaw W: Cell biology, revised reprint, international edi-
tion, ed 1, Philadelphia, 2004, Saunders. 7-10, A-F: Dennis Strete.
7-12: Wikimedia Commons.
Chapter 8
8-1: From Patton KT, Thibodeau GA: Mosby’s handbook of anatomy
& physiology, ed 2, St. Louis, 2014, Elsevier. 8-4 (bottom image):
Modified from Pollard TD, Earnshaw W: Cell biology, ed 2, Philadel-
phia, 2007, W.B. Saunders Company. 8-5: From Gartner LP, Hiatt
JL: Color textbook of histology, ed 3, Philadelphia, 2007, Saunders.
8-7: From Callen J, Greer K, Hood A et al: Color atlas of dermatol-
ogy, Philadelphia, 1993, Saunders. 8-10, A, B: From Samuelson DA:
Textbook of veterinary histology, W.B. Saunders Company, 2007.
8-10, C: Will Murray (Willscrit), http://wilmurraymedia.com. 8-12:
Reprinted with permission from Gregor Reid, PhD, Lawson Health

Research Institute. 8-13: From Gartner L, Hiatt J: Color textbook of
histology, ed 3, Philadelphia, 2007, Saunders.
Chapter 9
9-2, 9-4, 9-6, 9-7, 9-8, 9-9, 9-14, 9-16, 9-17, 9-18, 9-23, 9-25, 9-26,
9-27, 9-29, 9-30, 9-31, 9-32, 9-33: Dennis Strete. 9-3 (drawing): Bar-
bara Cousins. 9-3 (electron micrograph), 9-10, 9-15, B: From Er-
landsen SL, Magney J: Color atlas of histology, St. Louis, 1992,
Mosby. 9-5: Ed Reschke 9-20, 9-28: From Gartner L, Hiatt J: Color
textbook of histology, ed 3, Philadelphia, 2007, Saunders. 9-21, 9-24:
From Kerr J: Atlas of functional histology, London, 1999, Mosby.
9-22: Courtesy Gary Thibodeau. Box 9-1: From Zitelli B, Davis H:
Atlas of pediatric physical diagnosis, ed 3, Philadelphia, 1997, Mosby.
Career Choices box: Courtesy of Joanna McGaughey
UNIT 2
Chapter 10
10-1 (photo): Ed Reschke. 10-1 (drawing), 10-6, 10-29: Barbara
Cousins. 10-3: Copyright Kevin Patton, Lion Den Inc, Weldon
Spring, MO. 10-10: From Rouzaud F, Kadekaro A, Abdel-Malek Za,
Hearing VJ: MC1R and the response of melanocytes to ultraviolet
radiation, Mutat Res, 571:136, 2005. 10-11: From Regezi J, Sciubba
JJ, Jordan RCK: Oral pathology: clinical pathologic correlations, ed 5,
St. Louis, 2008, Saunders. 10-12: From Epstein O, Perkin GD,
Cookson J, de Bono D: Clinical examination, ed 3, St. Louis, 2003,
Mosby. 10-13 (gradient): From McCance K, Huether S: Pathophysi-
ology, ed 5, St. Louis, 2005, Mosby. 10-17, C: Copyright © by David
Scharf, 1986, 1993. 10-18: Copyright Kevin Patton, Lion Den Inc,
Weldon Spring, MO. 10-20: Courtesy Christine Olekyk. 10-21, 10-
24, 10-25: From Habif TP: Clinical dermatology, ed 4, St. Louis,
Mosby, 2004. 10-22: From Habif TP: Clinical dermatology, ed 2, St.
Louis, 1990, Mosby. 10-26: From Potter P, Perry A: Basic nursing:
essentials for practice, ed 5, St. Louis, 2003, Mosby. 10-27: From
James WD, Berger TG, Elston DM: Andrew’s diseases of the skin:
clinical dermatology, ed 10, London, 2000, Saunders. 10-28, A: From
Goldman L, Ausiello D: Cecil textbook of medicine, ed 23, Philadel-
phia, 2003, Saunders. 10-28, B: From Noble J: Textbook of primary
care medicine, ed 3, Philadelphia, 2001, Mosby. 10-28, C: From
Townsend C, Beauchamp RD, Evers BM, Mattox K: Sabiston text-
book of surgery, ed 18, Philadelphia, 2008, Saunders. 10-28, D: From
Rakel R: Textbook of family medicine, ed 7, Philadelphia, 2007, Saun-
ders. Box 10-1: Courtesy James A. Ischen, MD, Baylor College of
Medicine. Box 10-4: From Emond R: Color atlas of infectious dis-
eases, ed 4, Philadelphia, 2003, Mosby. Box 10-5 (figure): Courtesy
Photo Researchers, Inc. http://images.sciencesource.com/search/
SB1498. Box 10-7 (figure): From Callen JP et al: Color atlas of der-
matology, ed 2, Philadelphia, 2000, Saunders. Case Study (figure):
Copyright Kevin Patton, Lion Den Inc.
Chapter 11
11-3, B: From White T: Human osteology, ed 2, Philadelphia, 2000,
Academic Press. 11-4, B: From Moses K, Nava P, Banks J, Petersen
D: Moses atlas of clinical gross anatomy, Philadelphia, 2005, Mosby.
11-6, B, 11-24, A, B: Dennis Strete. 11-8, 11-16: From Williams P:
Gray’s anatomy, ed 38, Philadelphia, 1996, Churchill Livingstone.
11-9, A: From Muscolino J: Kinesiology, St. Louis, 2006, Mosby.
11-9, B: From Erlandsen SL, Magney J: Color atlas of histology, St.
Illustration and Photograph Credits xxxiii
Louis, 1992, Mosby. 11-10: Wikimedia Common. 11-13: From Pat-
ton K, Thibodeau G, Doublas M: Essentials of anatomy and physiol-
ogy, St. Louis, 2012, Mosby. 11-14: From Pollard TD, Earnshaw W:
Cell biology, ed 2, Philadelphia, 2007, Saunders. 11-17: From Zitelli
B, Davis H: Atlas of pediatric physical diagnosis, ed 4, Philadelphia,
Mosby, 2002. 11-18: Ed Reschke. 11-20: From Booher JM,
Thibodeau Ga: Athletic injury assessment, St. Louis, 1985, Mosby.
11-24, 11-25: From Kumar V, Abbas A, Fausto N: Robbins and Co-
tran pathologic basis of disease, ed 7, Philadelphia, 2005, Saunders.
Chapter 12
12-2 (photo), 12-3 (photo), 12-4 (photo), 12-5 (photo), Courtesy
Vidic B, Suarez FR: Photographic atlas of the human body, St. Louis,
1984, Mosby. 12-6 (photo), 12-11, 12-16, 12-13 (inset): From Wil-
liams P: Gray’s anatomy, ed 38, Philadelphia, Churchill Livingstone,
1996. 12-14, A-H: From Gosling J, Harris P, Whitmore I, Willan P:
Human anatomy, ed 4, Philadelphia, 2002, Mosby. 12-17: Courtesy
Dr. N. Blevins, New England Medical Center, Boston.
Chapter 13
13-2, D, 13-3, C, 13-4, C, 13-5, 13-6, 13-7, 13-8, D, E, 13-9, B (pho-
tos): Courtesy Vidic B, Suarez FR: Photographic atlas of the human
body, St. Louis, 1984, Mosby. 13-7, 13-11, B, D: From Abrahams P,
Marks S, Hutchings R: McMinn’s color atlas of human anatomy,
ed 5, Philadelphia, 2003, Mosby. 13-10 (drawings): From Yvonne
Wylie Walston. 13-10 (photo inset): From Seidel HM, Ball JW,
Dains JE, Benedict GW: Mosby’s guide to physical examination,
ed 5, St. Louis, 2003, Mosby. Case Study box: From Browner B,
Jupiter J, Trafton P: Skeletal trauma: basic science, management, and
reconstruction, ed 3, Philadelphia, 2003, Saunders.
Chapter 14
14-3, B, 14-6, 14-7, A, B, 14-8, 14-11: From Gosling J, Harris P,
Whitmore I, Willan PI: Human anatomy, ed 4, Philadelphia, 2002,
Mosby. 14-5, B, D, 14-7, C, 14-9, B, D, 14-10, B, D: Courtesy Vidic
B, Suarez FR: Photographic atlas of the human body, St. Louis, 1984,
Mosby. 14-26: From Seidel HM, Ball JW, Dains JE, Benedict GW:
Mosby’s guide to physical examination, ed 5, St. Louis, 2003, Mosby.
14-27: From Swartz MH: Textbook of physical diagnosis, ed 4, Phila-
delphia, 2002, Saunders. 14-28: Courtesy Lanny L. Johnson, MD,
East Lansing, MI. Box 14-1 (photo): From Cummings N, Stanley-
Green S, Higgs P: Perspectives in athletic training, St. Louis, 2009,
Mosby. Box 14-3: From Canale ST: Campbell’s operative orthopae-
dics, ed 9, St Louis, 1998, Mosby. Case Study box: From Goldman
L, Ausiello D: Cecil textbook of medicine, ed 23, Philadelphia, 2007,
Saunders.
Chapter 15
15-4: Adapted from Muscolino J: Kinesiology, St. Louis, 2006, Mosby.
15-14: From Gosling J, Harris P, Whitmore I, Willan P: Human
anatomy, ed 4, Philadelphia, 2002, Mosby. Box 15-1 (photo): From
Harkreader H: Fundamentals of nursing: caring and clinical judg-
ment, ed 3, St. Louis, 2007, Saunders.
Chapter 16
Box 16-1: Courtesy Aren Cummings, Ben Munson, and St. Charles
Community College, Cottleville, MO.
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 DANCE ON STILTS AT THE GIRLS’ UNYAGO, NIUCHI

Newala, too, suffers from the distance of its water-supply—at least

the Newala of to-day does; there was once another Newala in a lovely
valley at the foot of the plateau. I visited it and found scarcely a trace
of houses, only a Christian cemetery, with the graves of several
missionaries and their converts, remaining as a monument of its
former glories. But the surroundings are wonderfully beautiful. A
thick grove of splendid mango-trees closes in the weather-worn
crosses and headstones; behind them, combining the useful and the
agreeable, is a whole plantation of lemon-trees covered with ripe
fruit; not the small African kind, but a much larger and also juicier
imported variety, which drops into the hands of the passing traveller,
without calling for any exertion on his part. Old Newala is now under
the jurisdiction of the native pastor, Daudi, at Chingulungulu, who,
as I am on very friendly terms with him, allows me, as a matter of
course, the use of this lemon-grove during my stay at Newala.
 FEET MUTILATED BY THE RAVAGES OF THE “JIGGER”
(Sarcopsylla penetrans)

The water-supply of New Newala is in the bottom of the valley,

some 1,600 feet lower down. The way is not only long and fatiguing,
but the water, when we get it, is thoroughly bad. We are suffering not
only from this, but from the fact that the arrangements at Newala are
nothing short of luxurious. We have a separate kitchen—a hut built
against the boma palisade on the right of the baraza, the interior of
which is not visible from our usual position. Our two cooks were not
long in finding this out, and they consequently do—or rather neglect
to do—what they please. In any case they do not seem to be very
particular about the boiling of our drinking-water—at least I can
attribute to no other cause certain attacks of a dysenteric nature,
from which both Knudsen and I have suffered for some time. If a
man like Omari has to be left unwatched for a moment, he is capable
of anything. Besides this complaint, we are inconvenienced by the
state of our nails, which have become as hard as glass, and crack on
the slightest provocation, and I have the additional infliction of
pimples all over me. As if all this were not enough, we have also, for
the last week been waging war against the jigger, who has found his
Eldorado in the hot sand of the Makonde plateau. Our men are seen
all day long—whenever their chronic colds and the dysentery likewise
raging among them permit—occupied in removing this scourge of
Africa from their feet and trying to prevent the disastrous
consequences of its presence. It is quite common to see natives of
this place with one or two toes missing; many have lost all their toes,
or even the whole front part of the foot, so that a well-formed leg
ends in a shapeless stump. These ravages are caused by the female of
Sarcopsylla penetrans, which bores its way under the skin and there
develops an egg-sac the size of a pea. In all books on the subject, it is
stated that one’s attention is called to the presence of this parasite by
an intolerable itching. This agrees very well with my experience, so
far as the softer parts of the sole, the spaces between and under the
toes, and the side of the foot are concerned, but if the creature
penetrates through the harder parts of the heel or ball of the foot, it
may escape even the most careful search till it has reached maturity.
Then there is no time to be lost, if the horrible ulceration, of which
we see cases by the dozen every day, is to be prevented. It is much
easier, by the way, to discover the insect on the white skin of a
European than on that of a native, on which the dark speck scarcely
shows. The four or five jiggers which, in spite of the fact that I
constantly wore high laced boots, chose my feet to settle in, were
taken out for me by the all-accomplished Knudsen, after which I
thought it advisable to wash out the cavities with corrosive
sublimate. The natives have a different sort of disinfectant—they fill
the hole with scraped roots. In a tiny Makua village on the slope of
the plateau south of Newala, we saw an old woman who had filled all
the spaces under her toe-nails with powdered roots by way of
prophylactic treatment. What will be the result, if any, who can say?
The rest of the many trifling ills which trouble our existence are
really more comic than serious. In the absence of anything else to
smoke, Knudsen and I at last opened a box of cigars procured from
the Indian store-keeper at Lindi, and tried them, with the most
distressing results. Whether they contain opium or some other
narcotic, neither of us can say, but after the tenth puff we were both
“off,” three-quarters stupefied and unspeakably wretched. Slowly we
recovered—and what happened next? Half-an-hour later we were
once more smoking these poisonous concoctions—so insatiable is the
craving for tobacco in the tropics.
Even my present attacks of fever scarcely deserve to be taken
seriously. I have had no less than three here at Newala, all of which
have run their course in an incredibly short time. In the early
afternoon, I am busy with my old natives, asking questions and
making notes. The strong midday coffee has stimulated my spirits to
an extraordinary degree, the brain is active and vigorous, and work
progresses rapidly, while a pleasant warmth pervades the whole
body. Suddenly this gives place to a violent chill, forcing me to put on
my overcoat, though it is only half-past three and the afternoon sun
is at its hottest. Now the brain no longer works with such acuteness
and logical precision; more especially does it fail me in trying to
establish the syntax of the difficult Makua language on which I have
ventured, as if I had not enough to do without it. Under the
circumstances it seems advisable to take my temperature, and I do
so, to save trouble, without leaving my seat, and while going on with
my work. On examination, I find it to be 101·48°. My tutors are
abruptly dismissed and my bed set up in the baraza; a few minutes
later I am in it and treating myself internally with hot water and
lemon-juice.
Three hours later, the thermometer marks nearly 104°, and I make
them carry me back into the tent, bed and all, as I am now perspiring
heavily, and exposure to the cold wind just beginning to blow might
mean a fatal chill. I lie still for a little while, and then find, to my
great relief, that the temperature is not rising, but rather falling. This
is about 7.30 p.m. At 8 p.m. I find, to my unbounded astonishment,
that it has fallen below 98·6°, and I feel perfectly well. I read for an
hour or two, and could very well enjoy a smoke, if I had the
wherewithal—Indian cigars being out of the question.
Having no medical training, I am at a loss to account for this state
of things. It is impossible that these transitory attacks of high fever
should be malarial; it seems more probable that they are due to a
kind of sunstroke. On consulting my note-book, I become more and
more inclined to think this is the case, for these attacks regularly
follow extreme fatigue and long exposure to strong sunshine. They at
least have the advantage of being only short interruptions to my
work, as on the following morning I am always quite fresh and fit.
My treasure of a cook is suffering from an enormous hydrocele which
makes it difficult for him to get up, and Moritz is obliged to keep in
the dark on account of his inflamed eyes. Knudsen’s cook, a raw boy
from somewhere in the bush, knows still less of cooking than Omari;
consequently Nils Knudsen himself has been promoted to the vacant
post. Finding that we had come to the end of our supplies, he began
by sending to Chingulungulu for the four sucking-pigs which we had
bought from Matola and temporarily left in his charge; and when
they came up, neatly packed in a large crate, he callously slaughtered
the biggest of them. The first joint we were thoughtless enough to
entrust for roasting to Knudsen’s mshenzi cook, and it was
consequently uneatable; but we made the rest of the animal into a
jelly which we ate with great relish after weeks of underfeeding,
consuming incredible helpings of it at both midday and evening
meals. The only drawback is a certain want of variety in the tinned
vegetables. Dr. Jäger, to whom the Geographical Commission
entrusted the provisioning of the expeditions—mine as well as his
own—because he had more time on his hands than the rest of us,
seems to have laid in a huge stock of Teltow turnips,[46] an article of
food which is all very well for occasional use, but which quickly palls
when set before one every day; and we seem to have no other tins
left. There is no help for it—we must put up with the turnips; but I
am certain that, once I am home again, I shall not touch them for ten
years to come.
Amid all these minor evils, which, after all, go to make up the
genuine flavour of Africa, there is at least one cheering touch:
Knudsen has, with the dexterity of a skilled mechanic, repaired my 9
× 12 cm. camera, at least so far that I can use it with a little care.
How, in the absence of finger-nails, he was able to accomplish such a
ticklish piece of work, having no tool but a clumsy screw-driver for
taking to pieces and putting together again the complicated
mechanism of the instantaneous shutter, is still a mystery to me; but
he did it successfully. The loss of his finger-nails shows him in a light
contrasting curiously enough with the intelligence evinced by the
above operation; though, after all, it is scarcely surprising after his
ten years’ residence in the bush. One day, at Lindi, he had occasion
to wash a dog, which must have been in need of very thorough
cleansing, for the bottle handed to our friend for the purpose had an
extremely strong smell. Having performed his task in the most
conscientious manner, he perceived with some surprise that the dog
did not appear much the better for it, and was further surprised by
finding his own nails ulcerating away in the course of the next few
days. “How was I to know that carbolic acid has to be diluted?” he
mutters indignantly, from time to time, with a troubled gaze at his
mutilated finger-tips.
 Since we came to Newala we have been making excursions in all
directions through the surrounding country, in accordance with old
habit, and also because the akida Sefu did not get together the tribal
elders from whom I wanted information so speedily as he had
promised. There is, however, no harm done, as, even if seen only
from the outside, the country and people are interesting enough.
The Makonde plateau is like a large rectangular table rounded off
at the corners. Measured from the Indian Ocean to Newala, it is
about seventy-five miles long, and between the Rovuma and the
Lukuledi it averages fifty miles in breadth, so that its superficial area
is about two-thirds of that of the kingdom of Saxony. The surface,
however, is not level, but uniformly inclined from its south-western
edge to the ocean. From the upper edge, on which Newala lies, the
eye ranges for many miles east and north-east, without encountering
any obstacle, over the Makonde bush. It is a green sea, from which
here and there thick clouds of smoke rise, to show that it, too, is
inhabited by men who carry on their tillage like so many other
primitive peoples, by cutting down and burning the bush, and
manuring with the ashes. Even in the radiant light of a tropical day
such a fire is a grand sight.
Much less effective is the impression produced just now by the
great western plain as seen from the edge of the plateau. As often as
time permits, I stroll along this edge, sometimes in one direction,
sometimes in another, in the hope of finding the air clear enough to
let me enjoy the view; but I have always been disappointed.
Wherever one looks, clouds of smoke rise from the burning bush,
and the air is full of smoke and vapour. It is a pity, for under more
favourable circumstances the panorama of the whole country up to
the distant Majeje hills must be truly magnificent. It is of little use
taking photographs now, and an outline sketch gives a very poor idea
of the scenery. In one of these excursions I went out of my way to
make a personal attempt on the Makonde bush. The present edge of
the plateau is the result of a far-reaching process of destruction
through erosion and denudation. The Makonde strata are
everywhere cut into by ravines, which, though short, are hundreds of
yards in depth. In consequence of the loose stratification of these
beds, not only are the walls of these ravines nearly vertical, but their
upper end is closed by an equally steep escarpment, so that the
western edge of the Makonde plateau is hemmed in by a series of
deep, basin-like valleys. In order to get from one side of such a ravine
to the other, I cut my way through the bush with a dozen of my men.
It was a very open part, with more grass than scrub, but even so the
short stretch of less than two hundred yards was very hard work; at
the end of it the men’s calicoes were in rags and they themselves
bleeding from hundreds of scratches, while even our strong khaki
suits had not escaped scatheless.

NATIVE PATH THROUGH THE MAKONDE BUSH, NEAR

MAHUTA

I see increasing reason to believe that the view formed some time
back as to the origin of the Makonde bush is the correct one. I have
no doubt that it is not a natural product, but the result of human
occupation. Those parts of the high country where man—as a very
slight amount of practice enables the eye to perceive at once—has not
yet penetrated with axe and hoe, are still occupied by a splendid
timber forest quite able to sustain a comparison with our mixed
forests in Germany. But wherever man has once built his hut or tilled
his field, this horrible bush springs up. Every phase of this process
may be seen in the course of a couple of hours’ walk along the main
road. From the bush to right or left, one hears the sound of the axe—
not from one spot only, but from several directions at once. A few
steps further on, we can see what is taking place. The brush has been
cut down and piled up in heaps to the height of a yard or more,
between which the trunks of the large trees stand up like the last
pillars of a magnificent ruined building. These, too, present a
melancholy spectacle: the destructive Makonde have ringed them—
cut a broad strip of bark all round to ensure their dying off—and also
piled up pyramids of brush round them. Father and son, mother and
son-in-law, are chopping away perseveringly in the background—too
busy, almost, to look round at the white stranger, who usually excites
so much interest. If you pass by the same place a week later, the piles
of brushwood have disappeared and a thick layer of ashes has taken
the place of the green forest. The large trees stretch their
smouldering trunks and branches in dumb accusation to heaven—if
they have not already fallen and been more or less reduced to ashes,
perhaps only showing as a white stripe on the dark ground.
This work of destruction is carried out by the Makonde alike on the
virgin forest and on the bush which has sprung up on sites already
cultivated and deserted. In the second case they are saved the trouble
of burning the large trees, these being entirely absent in the
secondary bush.
After burning this piece of forest ground and loosening it with the
hoe, the native sows his corn and plants his vegetables. All over the
country, he goes in for bed-culture, which requires, and, in fact,
receives, the most careful attention. Weeds are nowhere tolerated in
the south of German East Africa. The crops may fail on the plains,
where droughts are frequent, but never on the plateau with its
abundant rains and heavy dews. Its fortunate inhabitants even have
the satisfaction of seeing the proud Wayao and Wamakua working
for them as labourers, driven by hunger to serve where they were
accustomed to rule.
But the light, sandy soil is soon exhausted, and would yield no
harvest the second year if cultivated twice running. This fact has
been familiar to the native for ages; consequently he provides in
time, and, while his crop is growing, prepares the next plot with axe
and firebrand. Next year he plants this with his various crops and
lets the first piece lie fallow. For a short time it remains waste and
desolate; then nature steps in to repair the destruction wrought by
man; a thousand new growths spring out of the exhausted soil, and
even the old stumps put forth fresh shoots. Next year the new growth
is up to one’s knees, and in a few years more it is that terrible,
impenetrable bush, which maintains its position till the black
occupier of the land has made the round of all the available sites and
come back to his starting point.
The Makonde are, body and soul, so to speak, one with this bush.
According to my Yao informants, indeed, their name means nothing
else but “bush people.” Their own tradition says that they have been
settled up here for a very long time, but to my surprise they laid great
stress on an original immigration. Their old homes were in the
south-east, near Mikindani and the mouth of the Rovuma, whence
their peaceful forefathers were driven by the continual raids of the
Sakalavas from Madagascar and the warlike Shirazis[47] of the coast,
to take refuge on the almost inaccessible plateau. I have studied
African ethnology for twenty years, but the fact that changes of
population in this apparently quiet and peaceable corner of the earth
could have been occasioned by outside enterprises taking place on
the high seas, was completely new to me. It is, no doubt, however,
correct.
The charming tribal legend of the Makonde—besides informing us
of other interesting matters—explains why they have to live in the
thickest of the bush and a long way from the edge of the plateau,
instead of making their permanent homes beside the purling brooks
and springs of the low country.
“The place where the tribe originated is Mahuta, on the southern
side of the plateau towards the Rovuma, where of old time there was
nothing but thick bush. Out of this bush came a man who never
washed himself or shaved his head, and who ate and drank but little.
He went out and made a human figure from the wood of a tree
growing in the open country, which he took home to his abode in the
bush and there set it upright. In the night this image came to life and
was a woman. The man and woman went down together to the
Rovuma to wash themselves. Here the woman gave birth to a still-
born child. They left that place and passed over the high land into the
valley of the Mbemkuru, where the woman had another child, which
was also born dead. Then they returned to the high bush country of
Mahuta, where the third child was born, which lived and grew up. In
course of time, the couple had many more children, and called
themselves Wamatanda. These were the ancestral stock of the
Makonde, also called Wamakonde,[48] i.e., aborigines. Their
forefather, the man from the bush, gave his children the command to
bury their dead upright, in memory of the mother of their race who
was cut out of wood and awoke to life when standing upright. He also
warned them against settling in the valleys and near large streams,
for sickness and death dwelt there. They were to make it a rule to
have their huts at least an hour’s walk from the nearest watering-
place; then their children would thrive and escape illness.”
The explanation of the name Makonde given by my informants is
somewhat different from that contained in the above legend, which I
extract from a little book (small, but packed with information), by
Pater Adams, entitled Lindi und sein Hinterland. Otherwise, my
results agree exactly with the statements of the legend. Washing?
Hapana—there is no such thing. Why should they do so? As it is, the
supply of water scarcely suffices for cooking and drinking; other
people do not wash, so why should the Makonde distinguish himself
by such needless eccentricity? As for shaving the head, the short,
woolly crop scarcely needs it,[49] so the second ancestral precept is
likewise easy enough to follow. Beyond this, however, there is
nothing ridiculous in the ancestor’s advice. I have obtained from
various local artists a fairly large number of figures carved in wood,
ranging from fifteen to twenty-three inches in height, and
representing women belonging to the great group of the Mavia,
Makonde, and Matambwe tribes. The carving is remarkably well
done and renders the female type with great accuracy, especially the
keloid ornamentation, to be described later on. As to the object and
meaning of their works the sculptors either could or (more probably)
would tell me nothing, and I was forced to content myself with the
scanty information vouchsafed by one man, who said that the figures
were merely intended to represent the nembo—the artificial
deformations of pelele, ear-discs, and keloids. The legend recorded
by Pater Adams places these figures in a new light. They must surely
be more than mere dolls; and we may even venture to assume that
they are—though the majority of present-day Makonde are probably
unaware of the fact—representations of the tribal ancestress.
 The references in the legend to the descent from Mahuta to the
Rovuma, and to a journey across the highlands into the Mbekuru
valley, undoubtedly indicate the previous history of the tribe, the
travels of the ancestral pair typifying the migrations of their
descendants. The descent to the neighbouring Rovuma valley, with
its extraordinary fertility and great abundance of game, is intelligible
at a glance—but the crossing of the Lukuledi depression, the ascent
to the Rondo Plateau and the descent to the Mbemkuru, also lie
within the bounds of probability, for all these districts have exactly
the same character as the extreme south. Now, however, comes a
point of especial interest for our bacteriological age. The primitive
Makonde did not enjoy their lives in the marshy river-valleys.
Disease raged among them, and many died. It was only after they
had returned to their original home near Mahuta, that the health
conditions of these people improved. We are very apt to think of the
African as a stupid person whose ignorance of nature is only equalled
by his fear of it, and who looks on all mishaps as caused by evil
spirits and malignant natural powers. It is much more correct to
assume in this case that the people very early learnt to distinguish
districts infested with malaria from those where it is absent.
This knowledge is crystallized in the
ancestral warning against settling in the
valleys and near the great waters, the
dwelling-places of disease and death. At the
same time, for security against the hostile
Mavia south of the Rovuma, it was enacted
that every settlement must be not less than a
certain distance from the southern edge of the
plateau. Such in fact is their mode of life at the
present day. It is not such a bad one, and
certainly they are both safer and more
comfortable than the Makua, the recent
intruders from the south, who have made USUAL METHOD OF
good their footing on the western edge of the CLOSING HUT-DOOR
plateau, extending over a fairly wide belt of
country. Neither Makua nor Makonde show in their dwellings
anything of the size and comeliness of the Yao houses in the plain,
especially at Masasi, Chingulungulu and Zuza’s. Jumbe Chauro, a
Makonde hamlet not far from Newala, on the road to Mahuta, is the
most important settlement of the tribe I have yet seen, and has fairly
spacious huts. But how slovenly is their construction compared with
the palatial residences of the elephant-hunters living in the plain.
The roofs are still more untidy than in the general run of huts during
the dry season, the walls show here and there the scanty beginnings
or the lamentable remains of the mud plastering, and the interior is a
veritable dog-kennel; dirt, dust and disorder everywhere. A few huts
only show any attempt at division into rooms, and this consists
merely of very roughly-made bamboo partitions. In one point alone
have I noticed any indication of progress—in the method of fastening
the door. Houses all over the south are secured in a simple but
ingenious manner. The door consists of a set of stout pieces of wood
or bamboo, tied with bark-string to two cross-pieces, and moving in
two grooves round one of the door-posts, so as to open inwards. If
the owner wishes to leave home, he takes two logs as thick as a man’s
upper arm and about a yard long. One of these is placed obliquely
against the middle of the door from the inside, so as to form an angle
of from 60° to 75° with the ground. He then places the second piece
horizontally across the first, pressing it downward with all his might.
It is kept in place by two strong posts planted in the ground a few
inches inside the door. This fastening is absolutely safe, but of course
cannot be applied to both doors at once, otherwise how could the
owner leave or enter his house? I have not yet succeeded in finding
out how the back door is fastened.

MAKONDE LOCK AND KEY AT JUMBE CHAURO

 This is the general way of closing a house. The Makonde at Jumbe
Chauro, however, have a much more complicated, solid and original
one. Here, too, the door is as already described, except that there is
only one post on the inside, standing by itself about six inches from
one side of the doorway. Opposite this post is a hole in the wall just
large enough to admit a man’s arm. The door is closed inside by a
large wooden bolt passing through a hole in this post and pressing
with its free end against the door. The other end has three holes into
which fit three pegs running in vertical grooves inside the post. The
door is opened with a wooden key about a foot long, somewhat
curved and sloped off at the butt; the other end has three pegs
corresponding to the holes, in the bolt, so that, when it is thrust
through the hole in the wall and inserted into the rectangular
opening in the post, the pegs can be lifted and the bolt drawn out.[50]

MODE OF INSERTING THE KEY

With no small pride first one householder and then a second

showed me on the spot the action of this greatest invention of the
Makonde Highlands. To both with an admiring exclamation of
“Vizuri sana!” (“Very fine!”). I expressed the wish to take back these
marvels with me to Ulaya, to show the Wazungu what clever fellows
the Makonde are. Scarcely five minutes after my return to camp at
Newala, the two men came up sweating under the weight of two
heavy logs which they laid down at my feet, handing over at the same
time the keys of the fallen fortress. Arguing, logically enough, that if
the key was wanted, the lock would be wanted with it, they had taken
their axes and chopped down the posts—as it never occurred to them
to dig them out of the ground and so bring them intact. Thus I have
two badly damaged specimens, and the owners, instead of praise,
come in for a blowing-up.
The Makua huts in the environs of Newala are especially
miserable; their more than slovenly construction reminds one of the
temporary erections of the Makua at Hatia’s, though the people here
have not been concerned in a war. It must therefore be due to
congenital idleness, or else to the absence of a powerful chief. Even
the baraza at Mlipa’s, a short hour’s walk south-east of Newala,
shares in this general neglect. While public buildings in this country
are usually looked after more or less carefully, this is in evident
danger of being blown over by the first strong easterly gale. The only
attractive object in this whole district is the grave of the late chief
Mlipa. I visited it in the morning, while the sun was still trying with
partial success to break through the rolling mists, and the circular
grove of tall euphorbias, which, with a broken pot, is all that marks
the old king’s resting-place, impressed one with a touch of pathos.
Even my very materially-minded carriers seemed to feel something
of the sort, for instead of their usual ribald songs, they chanted
solemnly, as we marched on through the dense green of the Makonde
bush:—
 “We shall arrive with the great master; we stand in a row and have
no fear about getting our food and our money from the Serkali (the
Government). We are not afraid; we are going along with the great
master, the lion; we are going down to the coast and back.”
With regard to the characteristic features of the various tribes here
on the western edge of the plateau, I can arrive at no other
conclusion than the one already come to in the plain, viz., that it is
impossible for anyone but a trained anthropologist to assign any
given individual at once to his proper tribe. In fact, I think that even
an anthropological specialist, after the most careful examination,
might find it a difficult task to decide. The whole congeries of peoples
collected in the region bounded on the west by the great Central
African rift, Tanganyika and Nyasa, and on the east by the Indian
Ocean, are closely related to each other—some of their languages are
only distinguished from one another as dialects of the same speech,
and no doubt all the tribes present the same shape of skull and
structure of skeleton. Thus, surely, there can be no very striking
differences in outward appearance.
 Even did such exist, I should have no time
to concern myself with them, for day after day,
I have to see or hear, as the case may be—in
any case to grasp and record—an
extraordinary number of ethnographic
phenomena. I am almost disposed to think it
fortunate that some departments of inquiry, at
least, are barred by external circumstances.
Chief among these is the subject of iron-
working. We are apt to think of Africa as a
country where iron ore is everywhere, so to
speak, to be picked up by the roadside, and
where it would be quite surprising if the
inhabitants had not learnt to smelt the
material ready to their hand. In fact, the
knowledge of this art ranges all over the
continent, from the Kabyles in the north to the
Kafirs in the south. Here between the Rovuma
and the Lukuledi the conditions are not so
favourable. According to the statements of the
Makonde, neither ironstone nor any other
form of iron ore is known to them. They have
not therefore advanced to the art of smelting
the metal, but have hitherto bought all their
THE ANCESTRESS OF
THE MAKONDE
iron implements from neighbouring tribes.
Even in the plain the inhabitants are not much
better off. Only one man now living is said to
understand the art of smelting iron. This old fundi lives close to
Huwe, that isolated, steep-sided block of granite which rises out of
the green solitude between Masasi and Chingulungulu, and whose
jagged and splintered top meets the traveller’s eye everywhere. While
still at Masasi I wished to see this man at work, but was told that,
frightened by the rising, he had retired across the Rovuma, though
he would soon return. All subsequent inquiries as to whether the
fundi had come back met with the genuine African answer, “Bado”
(“Not yet”).
 BRAZIER

Some consolation was afforded me by a brassfounder, whom I

came across in the bush near Akundonde’s. This man is the favourite
of women, and therefore no doubt of the gods; he welds the glittering
brass rods purchased at the coast into those massive, heavy rings
which, on the wrists and ankles of the local fair ones, continually give
me fresh food for admiration. Like every decent master-craftsman he
had all his tools with him, consisting of a pair of bellows, three
crucibles and a hammer—nothing more, apparently. He was quite
willing to show his skill, and in a twinkling had fixed his bellows on
the ground. They are simply two goat-skins, taken off whole, the four
legs being closed by knots, while the upper opening, intended to
admit the air, is kept stretched by two pieces of wood. At the lower
end of the skin a smaller opening is left into which a wooden tube is
stuck. The fundi has quickly borrowed a heap of wood-embers from
the nearest hut; he then fixes the free ends of the two tubes into an
earthen pipe, and clamps them to the ground by means of a bent
piece of wood. Now he fills one of his small clay crucibles, the dross
on which shows that they have been long in use, with the yellow
material, places it in the midst of the embers, which, at present are
only faintly glimmering, and begins his work. In quick alternation
the smith’s two hands move up and down with the open ends of the
bellows; as he raises his hand he holds the slit wide open, so as to let
the air enter the skin bag unhindered. In pressing it down he closes
the bag, and the air puffs through the bamboo tube and clay pipe into
the fire, which quickly burns up. The smith, however, does not keep
on with this work, but beckons to another man, who relieves him at
the bellows, while he takes some more tools out of a large skin pouch
carried on his back. I look on in wonder as, with a smooth round
stick about the thickness of a finger, he bores a few vertical holes into
the clean sand of the soil. This should not be difficult, yet the man
seems to be taking great pains over it. Then he fastens down to the
ground, with a couple of wooden clamps, a neat little trough made by
splitting a joint of bamboo in half, so that the ends are closed by the
two knots. At last the yellow metal has attained the right consistency,
and the fundi lifts the crucible from the fire by means of two sticks
split at the end to serve as tongs. A short swift turn to the left—a
tilting of the crucible—and the molten brass, hissing and giving forth
clouds of smoke, flows first into the bamboo mould and then into the
holes in the ground.
The technique of this backwoods craftsman may not be very far
advanced, but it cannot be denied that he knows how to obtain an
adequate result by the simplest means. The ladies of highest rank in
this country—that is to say, those who can afford it, wear two kinds
of these massive brass rings, one cylindrical, the other semicircular
in section. The latter are cast in the most ingenious way in the
bamboo mould, the former in the circular hole in the sand. It is quite
a simple matter for the fundi to fit these bars to the limbs of his fair
customers; with a few light strokes of his hammer he bends the
pliable brass round arm or ankle without further inconvenience to
the wearer.
SHAPING THE POT

SMOOTHING WITH MAIZE-COB

CUTTING THE EDGE

 FINISHING THE BOTTOM

LAST SMOOTHING BEFORE

BURNING

FIRING THE BRUSH-PILE

 LIGHTING THE FARTHER SIDE OF
THE PILE

TURNING THE RED-HOT VESSEL

NYASA WOMAN MAKING POTS AT MASASI

Pottery is an art which must always and everywhere excite the
interest of the student, just because it is so intimately connected with
the development of human culture, and because its relics are one of
the principal factors in the reconstruction of our own condition in
prehistoric times. I shall always remember with pleasure the two or
three afternoons at Masasi when Salim Matola’s mother, a slightly-
built, graceful, pleasant-looking woman, explained to me with
touching patience, by means of concrete illustrations, the ceramic art
of her people. The only implements for this primitive process were a
lump of clay in her left hand, and in the right a calabash containing
the following valuables: the fragment of a maize-cob stripped of all
its grains, a smooth, oval pebble, about the size of a pigeon’s egg, a
few chips of gourd-shell, a bamboo splinter about the length of one’s
hand, a small shell, and a bunch of some herb resembling spinach.
 Nothing more. The woman scraped with the
shell a round, shallow hole in the soft, fine
sand of the soil, and, when an active young
girl had filled the calabash with water for her,
she began to knead the clay. As if by magic it
gradually assumed the shape of a rough but
already well-shaped vessel, which only wanted
a little touching up with the instruments
before mentioned. I looked out with the
MAKUA WOMAN closest attention for any indication of the use
MAKING A POT. of the potter’s wheel, in however rudimentary
SHOWS THE a form, but no—hapana (there is none). The
BEGINNINGS OF THE embryo pot stood firmly in its little
POTTER’S WHEEL
depression, and the woman walked round it in
a stooping posture, whether she was removing
small stones or similar foreign bodies with the maize-cob, smoothing
the inner or outer surface with the splinter of bamboo, or later, after
letting it dry for a day, pricking in the ornamentation with a pointed
bit of gourd-shell, or working out the bottom, or cutting the edge
with a sharp bamboo knife, or giving the last touches to the finished
vessel. This occupation of the women is infinitely toilsome, but it is
without doubt an accurate reproduction of the process in use among
our ancestors of the Neolithic and Bronze ages.
There is no doubt that the invention of pottery, an item in human
progress whose importance cannot be over-estimated, is due to
women. Rough, coarse and unfeeling, the men of the horde range
over the countryside. When the united cunning of the hunters has
succeeded in killing the game; not one of them thinks of carrying
home the spoil. A bright fire, kindled by a vigorous wielding of the
drill, is crackling beside them; the animal has been cleaned and cut
up secundum artem, and, after a slight singeing, will soon disappear
under their sharp teeth; no one all this time giving a single thought
to wife or child.
To what shifts, on the other hand, the primitive wife, and still more
the primitive mother, was put! Not even prehistoric stomachs could
endure an unvarying diet of raw food. Something or other suggested
the beneficial effect of hot water on the majority of approved but
indigestible dishes. Perhaps a neighbour had tried holding the hard
roots or tubers over the fire in a calabash filled with water—or maybe
an ostrich-egg-shell, or a hastily improvised vessel of bark. They
became much softer and more palatable than they had previously
been; but, unfortunately, the vessel could not stand the fire and got
charred on the outside. That can be remedied, thought our
ancestress, and plastered a layer of wet clay round a similar vessel.
This is an improvement; the cooking utensil remains uninjured, but
the heat of the fire has shrunk it, so that it is loose in its shell. The
next step is to detach it, so, with a firm grip and a jerk, shell and
kernel are separated, and pottery is invented. Perhaps, however, the
discovery which led to an intelligent use of the burnt-clay shell, was
made in a slightly different way. Ostrich-eggs and calabashes are not
to be found in every part of the world, but everywhere mankind has
arrived at the art of making baskets out of pliant materials, such as
bark, bast, strips of palm-leaf, supple twigs, etc. Our inventor has no
water-tight vessel provided by nature. “Never mind, let us line the
basket with clay.” This answers the purpose, but alas! the basket gets
burnt over the blazing fire, the woman watches the process of
cooking with increasing uneasiness, fearing a leak, but no leak
appears. The food, done to a turn, is eaten with peculiar relish; and
the cooking-vessel is examined, half in curiosity, half in satisfaction
at the result. The plastic clay is now hard as stone, and at the same
time looks exceedingly well, for the neat plaiting of the burnt basket
is traced all over it in a pretty pattern. Thus, simultaneously with
pottery, its ornamentation was invented.
Primitive woman has another claim to respect. It was the man,
roving abroad, who invented the art of producing fire at will, but the
woman, unable to imitate him in this, has been a Vestal from the
earliest times. Nothing gives so much trouble as the keeping alight of
the smouldering brand, and, above all, when all the men are absent
from the camp. Heavy rain-clouds gather, already the first large
drops are falling, the first gusts of the storm rage over the plain. The
little flame, a greater anxiety to the woman than her own children,
flickers unsteadily in the blast. What is to be done? A sudden thought
occurs to her, and in an instant she has constructed a primitive hut
out of strips of bark, to protect the flame against rain and wind.
This, or something very like it, was the way in which the principle
of the house was discovered; and even the most hardened misogynist
cannot fairly refuse a woman the credit of it. The protection of the
hearth-fire from the weather is the germ from which the human
dwelling was evolved. Men had little, if any share, in this forward
step, and that only at a late stage. Even at the present day, the
plastering of the housewall with clay and the manufacture of pottery
are exclusively the women’s business. These are two very significant
survivals. Our European kitchen-garden, too, is originally a woman’s
invention, and the hoe, the primitive instrument of agriculture, is,
characteristically enough, still used in this department. But the
noblest achievement which we owe to the other sex is unquestionably
the art of cookery. Roasting alone—the oldest process—is one for
which men took the hint (a very obvious one) from nature. It must
have been suggested by the scorched carcase of some animal
overtaken by the destructive forest-fires. But boiling—the process of
improving organic substances by the help of water heated to boiling-
point—is a much later discovery. It is so recent that it has not even
yet penetrated to all parts of the world. The Polynesians understand
how to steam food, that is, to cook it, neatly wrapped in leaves, in a
hole in the earth between hot stones, the air being excluded, and
(sometimes) a few drops of water sprinkled on the stones; but they
do not understand boiling.
To come back from this digression, we find that the slender Nyasa
woman has, after once more carefully examining the finished pot,
put it aside in the shade to dry. On the following day she sends me
word by her son, Salim Matola, who is always on hand, that she is
going to do the burning, and, on coming out of my house, I find her
already hard at work. She has spread on the ground a layer of very
dry sticks, about as thick as one’s thumb, has laid the pot (now of a
yellowish-grey colour) on them, and is piling brushwood round it.
My faithful Pesa mbili, the mnyampara, who has been standing by,
most obligingly, with a lighted stick, now hands it to her. Both of
them, blowing steadily, light the pile on the lee side, and, when the
flame begins to catch, on the weather side also. Soon the whole is in a
blaze, but the dry fuel is quickly consumed and the fire dies down, so
that we see the red-hot vessel rising from the ashes. The woman
turns it continually with a long stick, sometimes one way and
sometimes another, so that it may be evenly heated all over. In
twenty minutes she rolls it out of the ash-heap, takes up the bundle
of spinach, which has been lying for two days in a jar of water, and
sprinkles the red-hot clay with it. The places where the drops fall are
marked by black spots on the uniform reddish-brown surface. With a
sigh of relief, and with visible satisfaction, the woman rises to an
erect position; she is standing just in a line between me and the fire,
from which a cloud of smoke is just rising: I press the ball of my
camera, the shutter clicks—the apotheosis is achieved! Like a
priestess, representative of her inventive sex, the graceful woman
stands: at her feet the hearth-fire she has given us beside her the
invention she has devised for us, in the background the home she has
built for us.
At Newala, also, I have had the manufacture of pottery carried on
in my presence. Technically the process is better than that already
described, for here we find the beginnings of the potter’s wheel,
which does not seem to exist in the plains; at least I have seen
nothing of the sort. The artist, a frightfully stupid Makua woman, did
not make a depression in the ground to receive the pot she was about
to shape, but used instead a large potsherd. Otherwise, she went to
work in much the same way as Salim’s mother, except that she saved
herself the trouble of walking round and round her work by squatting
at her ease and letting the pot and potsherd rotate round her; this is
surely the first step towards a machine. But it does not follow that
the pot was improved by the process. It is true that it was beautifully
rounded and presented a very creditable appearance when finished,
but the numerous large and small vessels which I have seen, and, in
part, collected, in the “less advanced” districts, are no less so. We
moderns imagine that instruments of precision are necessary to
produce excellent results. Go to the prehistoric collections of our
museums and look at the pots, urns and bowls of our ancestors in the
dim ages of the past, and you will at once perceive your error.
MAKING LONGITUDINAL CUT IN
BARK

DRAWING THE BARK OFF THE LOG

REMOVING THE OUTER BARK

 BEATING THE BARK

WORKING THE BARK-CLOTH AFTER BEATING, TO MAKE IT

SOFT

MANUFACTURE OF BARK-CLOTH AT NEWALA

To-day, nearly the whole population of German East Africa is
clothed in imported calico. This was not always the case; even now in
some parts of the north dressed skins are still the prevailing wear,
and in the north-western districts—east and north of Lake
Tanganyika—lies a zone where bark-cloth has not yet been
superseded. Probably not many generations have passed since such
bark fabrics and kilts of skins were the only clothing even in the
south. Even to-day, large quantities of this bright-red or drab
material are still to be found; but if we wish to see it, we must look in
the granaries and on the drying stages inside the native huts, where
it serves less ambitious uses as wrappings for those seeds and fruits
which require to be packed with special care. The salt produced at
Masasi, too, is packed for transport to a distance in large sheets of
bark-cloth. Wherever I found it in any degree possible, I studied the
process of making this cloth. The native requisitioned for the
purpose arrived, carrying a log between two and three yards long and
as thick as his thigh, and nothing else except a curiously-shaped
mallet and the usual long, sharp and pointed knife which all men and
boys wear in a belt at their backs without a sheath—horribile dictu!
[51]
Silently he squats down before me, and with two rapid cuts has
drawn a couple of circles round the log some two yards apart, and
slits the bark lengthwise between them with the point of his knife.
With evident care, he then scrapes off the outer rind all round the
log, so that in a quarter of an hour the inner red layer of the bark
shows up brightly-coloured between the two untouched ends. With
some trouble and much caution, he now loosens the bark at one end,
and opens the cylinder. He then stands up, takes hold of the free
edge with both hands, and turning it inside out, slowly but steadily
pulls it off in one piece. Now comes the troublesome work of
scraping all superfluous particles of outer bark from the outside of
the long, narrow piece of material, while the inner side is carefully
scrutinised for defective spots. At last it is ready for beating. Having
signalled to a friend, who immediately places a bowl of water beside
him, the artificer damps his sheet of bark all over, seizes his mallet,
lays one end of the stuff on the smoothest spot of the log, and
hammers away slowly but continuously. “Very simple!” I think to
myself. “Why, I could do that, too!”—but I am forced to change my
opinions a little later on; for the beating is quite an art, if the fabric is
not to be beaten to pieces. To prevent the breaking of the fibres, the
stuff is several times folded across, so as to interpose several
thicknesses between the mallet and the block. At last the required
state is reached, and the fundi seizes the sheet, still folded, by both
ends, and wrings it out, or calls an assistant to take one end while he
holds the other. The cloth produced in this way is not nearly so fine
and uniform in texture as the famous Uganda bark-cloth, but it is
quite soft, and, above all, cheap.
Now, too, I examine the mallet. My craftsman has been using the
simpler but better form of this implement, a conical block of some
hard wood, its base—the striking surface—being scored across and
across with more or less deeply-cut grooves, and the handle stuck
into a hole in the middle. The other and earlier form of mallet is
shaped in the same way, but the head is fastened by an ingenious
network of bark strips into the split bamboo serving as a handle. The
observation so often made, that ancient customs persist longest in
connection with religious ceremonies and in the life of children, here
finds confirmation. As we shall soon see, bark-cloth is still worn
during the unyago,[52] having been prepared with special solemn
ceremonies; and many a mother, if she has no other garment handy,
will still put her little one into a kilt of bark-cloth, which, after all,
looks better, besides being more in keeping with its African
surroundings, than the ridiculous bit of print from Ulaya.
MAKUA WOMEN