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Chapters Clinical Cases

1 An Introduction to Anatomy and Physiology 1 Using A&P to Save a Life 2

2 The Chemical Level of Organization 26 What is Wrong with my Baby? 27

3 The Cellular Level of Organization 64 When Your Heart is in the Wrong Place 65

4 The Tissue Level of Organization 113 The Rubber Girl 114

5 The Integumentary System 150 Skin Cells in Overdrive 151

6 Osseous Tissue and Bone Structure 178 A Case of Child Abuse? 179

7 The Axial Skeleton 206 Knocked Out 207

8 The Appendicular Skeleton 241 The Orthopedic Surgeon’s Nightmare 242

9 Joints 263 What’s Ailing the Birthday Girl? 264

10 Muscle Tissue 289 A Real Eye Opener 290

11 The Muscular System 332 The Weekend Warrior 333

12 Neural Tissue 385 Did Franklin D. Roosevelt Really Have Polio? 386

13 The Spinal Cord, Spinal Nerves, and Spinal Reflexes 429 Prom Night 430

14 The Brain and Cranial Nerves 461 The Neuroanatomist’s Stroke 462

15 Sensory Pathways and the Somatic Nervous System 508 Living with Cerebral Palsy 509

16 The Autonomic Nervous System and The First Day in Anatomy Lab 532
Higher-Order Functions 531

17 The Special Senses 563 A Chance to See 564

18 The Endocrine System 608 Stones, Bones, and Groans 609

19 Blood 652 A Mysterious Blood Disorder 653

20 The Heart 684 A Needle to the Chest 685

21 Blood Vessels and Circulation 723 Did Ancient Mummies Have Atherosclerosis? 724

22 The Lymphatic System and Immunity 781 Isn’t There a Vaccine for That? 782

23 The Respiratory System 830 How Long Should a Cough Last? 831

24 The Digestive System 880 An Unusual Transplant 881

25 Metabolism and Energetics 935 The Miracle Supplement 936

26 The Urinary System 972 A Case of "Hidden" Bleeding 973

27 Fluid, Electrolyte, and Acid–Base Balance 1015 When Treatment Makes You Worse 1016

28 The Reproductive System 1050 A Post-Game Mystery 1051

29 Development and Inheritance 1095 The Twins That Looked Nothing Alike 1096
Spotlight Figures

1–1 Levels of Organization 1–10 Diagnostic Imaging Techniques

2–3 Chemical Notation

3–1 Anatomy of a Model Cell 3–7 Protein Synthesis, Processing, and Packaging 3–22 Overview of Membrane Transport
3–23 DNA replication 3–24 Stages of a Cell’s Life Cycle
4–20 Inflammation and Regeneration
5–3 The Epidermis

6–11 Endochondral Ossification 6–16 Types of Fractures and Steps in Repair

7–4 Sectional Anatomy of the Skull
8–10 Sex Differences in the Human Skeleton
9–2 Joint Movement
10–9 Events at the Neuromuscular Junction 10–10 Excitation-Contraction Coupling
10–11 The Contraction Cycle and Cross-Bridge Formation
11–3 Muscle Action
12–9 Resting Membrane Potential 12–14 Generation of an Action Potential 12–15 Propagation of an Action Potential
13–8 Peripheral Distribution of Spinal Nerves 13–14 Spinal Reflexes
14–4 Formation and Circulation of Cerebrospinal Fluid
15–6 Somatic Sensory Pathways
16–2 Overview of the Autonomic Nervous System

17–2 Olfaction and Gustation 17–13 Refractive Problems 17–16 Photoreception

18–2 Structural Classification of Hormones 18–3 G Proteins and Second Messengers 18–18 Diabetes Mellitus
18–20 The General Adaptation Syndrome
19–1 The Composition of Whole Blood 19–8 Hemolytic Disease of the Newborn
20–10 Heart Disease and Heart Attacks 20–14 Cardiac Arrhythmias
21–33 Congenital Heart Problems
22–28 Cytokines of the Immune System
23–15 Respiratory Muscles and Pulmonary Ventilation 23–25 Control of Respiration
24–15 Regulation of Gastric Activity 24–27 Chemical Events of Digestion
25–11 Absorptive and Postabsorptive States
26–16 Summary of Renal Function
27–18 The Diagnosis of Acid-Base Disorders
28–12 Regulation of Male Reproduction 28–24 Regulation of Female Reproduction
29–5 Extraembryonic Membranes and Placenta Formation
F U N D A M E N TA L S O F

Anatomy&Physiology
Tenth Edition

Frederic H. Martini, Ph.D.

University of Hawaii at Manoa

Judi L. Nath, Ph.D.

Lourdes University

Edwin F. Bartholomew, M.S.

William C. Ober, M.D. Claire E. Ober, R.N. Kathleen Welch, M.D. Ralph T. Hutchings
Art Coordinator and Illustrator Illustrator Clinical Consultant Biomedical Photographer

Clinical Cases by:

Ruth Anne O’Keefe

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Content Producer: Joe Mochnick Senior Anatomy & Physiology Specialist: Derek Perrigo
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Notice: Our knowledge in clinical sciences is constantly changing. The authors and the publisher of
this volume have taken care that the information contained herein is accurate and compatible with
the standards generally accepted at the time of the publication. Nevertheless, it is difficult to ensure
that all information given is entirely accurate for all circumstances. The authors and the publisher
disclaim any liability, loss, or damage incurred as a consequence, directly or indirectly, of the use
and application of any of the contents of this volume.

Copyright © 2015, 2012 by Frederic H. Martini, Inc., Judi L. Nath, LLC, and Edwin F. Bartholomew,
Inc. Published by Pearson Education, Inc., publishing as Pearson Benjamin Cummings, 1301
Sansome St., San Francisco, CA 94111. All rights reserved. Manufactured in the United States of
America. This publication is protected by Copyright and permission should be obtained from the
publisher prior to any prohibited reproduction, storage in a retrieval system, or transmission in
any form or by any means, electronic, mechanical, photocopying, recording, or likewise. To obtain
permission(s) to use material from this work, please submit a written request to Pearson Educa-
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ing permissions, call (847) 486-2635.

Many of the designations used by manufacturers and sellers to distinguish their products are
claimed as trademarks. Where those designations appear in this book, and the publisher was aware
of a trademark claim, the designations have been printed in initial caps or all caps.

MasteringA&P®, A&P Flix™, Practice Anatomy Lab™ (PAL™), and Interactive Physiology® are trade-
marks, in the U.S. and/or other countries, of Pearson Education, Inc. or its affiliates.

Library of Congress Cataloging-in-Publication Data

Martini, Frederic, author.
Fundamentals of anatomy & physiology/Frederic H. Martini, Judi L. Nath, Edwin F. Bartholomew;
William C. Ober, art coordinator and illustrator; Claire E. Ober, illustrator; Kathleen Welch, clinical
consultant; Ralph T. Hutchings, biomedical photographer. — Tenth edition.
p.; cm.
Fundamentals of anatomy and physiology
Includes bibliographical references and index.
ISBN-13: 978-0-321-90907-7
ISBN-10: 0-321-90907-0
I. Nath, Judi Lindsley, author. II. Bartholomew, Edwin F., author. III. Title.
IV. Title: Fundamentals of anatomy and physiology.
[DNLM: 1. Anatomy. 2. Physiology. QS 4]
QP34.5
612—dc23 2013037105
1 2 3 4 5 6 7 8 9 10—DOW—17 16 15 14 13
0-321-90907-0 (Student edition)
978-0321-90907-7 (Student edition)
0-321-93968-9 (Exam Copy)
978-0321-93968-5 (Exam Copy)
Text and Illustration Team
Frederic (Ric) H. Martini, Ph.D.
Author
Dr. Martini received his Ph.D. from
Cornell University in comparative and
functional anatomy for work on the
pathophysiology of stress. In addition to
professional publications that include
journal articles and contributed chapters, technical reports,
and magazine articles, he is the lead author of ten undergradu-
ate texts on anatomy and physiology or anatomy. Dr. Martini is
currently affiliated with the University of Hawaii at Manoa and
has a long-standing bond with the Shoals Marine Laboratory,
a joint venture between Cornell University and the University
of New Hampshire. He has been active in the Human Anatomy
and Physiology Society (HAPS) for over 20 years and was a
member of the committee that established the course curricu-
lum guidelines for A&P. He is now a President Emeritus of HAPS
after serving as President-Elect, President, and Past-President
over 2005–2007. Dr. Martini is also a member of the American
Physiological Society, the American Association of Anato-
mists, the Society for Integrative and Comparative Biology, the
Australia/New Zealand Association of Clinical Anatomists,
the Hawaii Academy of Science, the American Association for
the Advancement of Science, and the International Society of
Vertebrate Morphologists.
Edwin F. Bartholomew, M.S.
Author
Edwin F. Bartholomew received his
undergraduate degree from Bowling
Green State University in Ohio and his
M.S. from the University of Hawaii.
Mr. Bartholomew has taught human
anatomy and physiology at both the secondary and undergrad-
uate levels and a wide variety of other science courses (from
botany to zoology) at Maui Community College and at his-
toric Lahainaluna High School, the oldest high school west of
the Rockies. He is a coauthor of Visual Anatomy & Physiology,
Essentials of Anatomy & Physiology, Visual Essentials of Anatomy
& Physiology, Structure and Function of the Human Body, and The
Human Body in Health and Disease (all published by Pearson).
Mr. Bartholomew is a member of the Human Anatomy and
Physiology Society (HAPS), the National Association of Biol-
ogy Teachers, the National Science Teachers Association, the
Hawaii Science Teachers Association, and the American Asso-
ciation for the Advancement of Science.
Judi L. Nath, Ph.D.
Author
Dr. Judi Nath is a biology professor at
Lourdes University, where she teaches
anatomy and physiology, pathophysi-
ology, and medical terminology. She
received her Bachelor’s and Master’s
degrees from Bowling Green State University and her Ph.D.
from the University of Toledo. Dr. Nath is devoted to her stu-
dents and strives to convey the intricacies of science in captivat-
ing ways that are meaningful, interactive, and exciting. She has
won the Faculty Excellence Award—an accolade recognizing
effective teaching, scholarship, and community service—multiple
times. She is active in many professional organizations, no-
tably the Human Anatomy and Physiology Society (HAPS),
where she has served several terms on the board of direc-
tors. Dr. Nath is a coauthor of Visual Anatomy & Physiology,
Visual Essentials of Anatomy & Physiology, and Anatomy & Physi-
ology (all published by Pearson), and she is the sole author
of Using Medical Terminology. Her favorite charities are those
that have significantly affected her life, including the local
Humane Society, the Cystic Fibrosis Foundation, and the
ALS Association. On a personal note, Dr. Nath enjoys family
life with her husband and their dogs.
William C. Ober, M.D.
Art Coordinator and Illustrator
Dr. Ober received his undergraduate
degree from Washington and Lee
University and his M.D. from the
University of Virginia. He also studied
in the Department of Art as Applied
to Medicine at Johns Hopkins Univer-
sity. After graduation, Dr. Ober completed a residency in Fam-
ily Practice and later was on the faculty at the University of
Virginia in the Department of Family Medicine and in the
Department of Sports Medicine. He also served as Chief of
Medicine of Martha Jefferson Hospital in Charlottesville, VA.
He is currently a Visiting Professor of Biology at Washington
and Lee University, where he has taught several courses and
led student trips to the Galapagos Islands. He was on the
Core Faculty at Shoals Marine Laboratory for 24 years, where
he taught Biological Illustration every summer. Dr. Ober
has collaborated with Dr. Martini on all of his textbooks in
every edition.
iii
iv Text and Illustration Team
Claire E. Ober, R.N.
Illustrator
Claire E. Ober, R.N., B.A., practiced fam-
ily, pediatric, and obstetric nursing be-
fore turning to medical illustration as a
full-time career. She returned to school
at Mary Baldwin College, where she re-
ceived her degree with distinction in studio art. Following a
five-year apprenticeship, she has worked as Dr. Ober’s partner
in Medical & Scientific Illustration since 1986. She was on the
Core Faculty at Shoals Marine Laboratory and co-taught the
Biological Illustration course with Dr. Ober for 24 years. The
textbooks illustrated by Medical & Scientific Illustration have
won numerous design and illustration awards.
Kathleen Welch, M.D.
Clinical Consultant
Dr. Welch received her B.A. from the
University of Wisconsin–Madison, her
M.D. from the University of Washington
in Seattle, and did her residency in Fam-
ily Practice at the University of North
Carolina in Chapel Hill. Participating in the Seattle WWAMI
rural medical education program, she studied in Fairbanks,
Anchorage, and Juneau, Alaska, with time in Boise, Idaho, and
Anacortes, Washington, as well. For two years, she served as
Director of Maternal and Child Health at the LBJ Tropical
Medical Center in American Samoa and subsequently was a
member of the Department of Family Practice at the Kaiser
Permanente Clinic in Lahaina, Hawaii, and on the staff at Maui
Memorial Hospital. She has been in private practice since 1987
and is licensed to practice in Hawaii and Washington State.
Dr. Welch is a Fellow of the American Academy of Family
Practice and a member of the Maui County Medical Society
and the Human Anatomy and Physiology Society (HAPS).
With Dr. Martini, she has coauthored both a textbook on anat-
omy and physiology and the A&P Applications Manual. She and
Dr. Martini were married in 1979, and they have one son.
Ralph T. Hutchings
Biomedical Photographer
Mr. Hutchings was associated with the
Royal College of Surgeons for 20 years.
An engineer by training, he has focused
for years on photographing the struc-
ture of the human body. The result
has been a series of color atlases, including the Color Atlas of
Human Anatomy, the Color Atlas of Surface Anatomy, and The
Human Skeleton (all published by Mosby-Yearbook Publishing).
For his anatomical portrayal of the human body, the Interna-
tional Photographers Association has chosen Mr. Hutchings as
the best photographer of humans in the twentieth century. He
lives in North London, where he tries to balance the demands
of his photographic assignments with his hobbies of early
motor cars and airplanes.
Ruth Anne O’Keefe, M.D.
Clinical Contributor
Dr. O’Keefe did her undergraduate stud-
ies at Marquette University, attended
graduate school at the University of
Wisconsin, and received her M.D. from
George Washington University. She
was the first woman to study orthopedics at The Ohio State
University during her residency. She did fellowship training in
trauma surgery at Loma Linda University in California. In ad-
dition to her private orthopedic practice, she has done ortho-
pedic surgery around the world, taking her own surgical teams
to places such as the Dominican Republic, Honduras, Peru,
New Zealand, and Burkina Faso. She serves on the board of
Global Health Partnerships, a group that partners with a clinic
serving 35,000 people in remote Kenya. Dr. O’Keefe has al-
ways enjoyed teaching and now supervises medical students
from the University of New Mexico doing ongoing research
in Kenya. She lives in Albuquerque with her Sweet Ed. She
is mother of four, grandmother of nine, and foster mother
to many.
Preface
The Tenth Edition of Fundamentals of Anatomy & Physiology is a
comprehensive textbook that fulfills the needs of today’s stu-
dents while addressing the concerns of their professors. We fo-
cused our attention on the question “How can we make this
information meaningful, manageable, and comprehensible?”
During the revision process, we drew upon our content knowl-
edge, research skills, artistic talents, and years of classroom ex-
perience to make this edition the best yet.
The broad changes to this edition are presented in the New
to the Tenth Edition section below, and the specific changes
are presented in the Chapter-by-Chapter Changes in the
Tenth Edition section that follows.
New to the Tenth Edition
In addition to the many technical changes in this edition, such
as updated statistics and anatomy and physiology descriptions,
we have made the following key changes:
NEW 50 Spotlight Figures provide highly visual one- and
two-page presentations of tough topics in the book, with
a particular focus on physiology. In the Tenth Edition, 18
new Spotlight Figures have been added for a total of 50
across the chapters. There is now at least one Spotlight
Figure in every chapter, as well as one Spotlight Figure cor-
responding to every A&P Flix.
NEW 29 Clinical Cases get students motivated for their
future careers. Each chapter opens with a story-based Clini-
cal Case related to the chapter content and ends with a
Clinical Case Wrap-Up that incorporates the deeper con-
tent knowledge students will have gained from the chapter.
NEW The repetition of the chapter-opening Learning
Outcomes below the coordinated section headings
within the chapters underscores the connection between
the HAPS-based Learning Outcomes and the associated
teaching points. Author Judi Nath sat on the Human
Anatomy and Physiology Society (HAPS) committee that
developed the HAPS Learning Outcomes, recommended
to A&P instructors, and the Learning Outcomes in this
book are based on them. Additionally, the assessments in
MasteringA&P are organized by these Learning Outcomes.
As in the previous edition, full-sentence section headings,
correlated with the Learning Outcomes, state a core fact or
concept to help students readily see and learn the chapter
content; and Checkpoints, located at the close of each sec-
tion, ask students to pause and check their understanding
of facts and concepts. If students cannot answer these ques-
tions within a matter of minutes, then they should reread
the section before moving on. The Checkpoints reinforce
the Learning Outcomes, resulting in a systematic integra-
tion of the Learning Outcomes over the course of the
chapter. Answers to the Checkpoints are located in the blue
Answers tab at the back of the book.
Easier narrative uses simpler, shorter, more active sen-
tences and a reading level that makes reading and studying
easier for students.
Improved text-art integration throughout the illustration
program enhances the readability of figures. Several tables
have been integrated directly into figures to help students
make direct connections between tables and art.
Eponyms are now included within the narrative, along
with the anatomical terms used in Terminologia Anatomica.
NEW Assignable MasteringA&P activities include the
following:
NEW Spotlight Figure Coaching Activities are highly
visual, assignable activities designed to bring interac-
tivity to the Spotlight Figures in the book. Multi-part
activities include the ranking and sorting types that ask
students to manipulate the visuals.
NEW Book-specific Clinical Case Activities stem from
the story-based Clinical Cases that appear at the begin-
ning and end of each chapter in the book.
NEW Adaptive Follow-up Assignments allow instruc-
tors to easily assign personalized content for each in-
dividual student based on strengths and weaknesses
identified by his or her performance on MasteringA&P
parent assignments.
NEW Dynamic Study Modules help students acquire,
retain, and recall information quickly and efficiently.
The modules are available as a self-study tool or can be
assigned by the instructor. They can be easily accessed
with smartphones.
Chapter-by-Chapter Changes in the
Tenth Edition
This annotated Table of Contents provides select examples of
revision highlights in each chapter of the Tenth Edition. For
a more complete list of changes, please contact the publisher.
v
vi Preface
Chapter 1: An Introduction to Anatomy and Physiology
• New Clinical Case: Using A&P to Save a Life
• New Spotlight Figure 1–10 Diagnostic Imaging Techniques
• New Clinical Note: Autopsies and Cadaver Dissection
• New Clinical Note: Auscultation
• Figure 1–7 Directional References revised
• Figure 1–8 Sectional Planes revised
• Figure 1–9 Relationships among the Subdivisions of the Body
Cavities of the Trunk revised
Chapter 2: The Chemical Level of Organization
• New Clinical Case: What Is Wrong with My Baby?
• New Clinical Note: Radiation Sickness
• Clinical Note: Fatty Acids and Health revised
• Section 2-2 includes revised Molecular weight discussion
• Figure 2–4 The Formation of Ionic Bonds revised
• Figure 2–5 Covalent Bonds in Five Common Molecules revised
• Table 2–3 Important Functional Groups of Organic Compounds
revised (to clarify structural group and R group)
• Protein Structure subsection includes new discussion of amino
acids as zwitterions
• Figure 2–21 Protein Structure revised
Chapter 3: The Cellular Level of Organization
• New Clinical Case: When Your Heart Is in the Wrong Place
• New information added about cholesterol and other lipids
• New overview added about roles of microtubules
• Figure 3–5 The Endoplasmic Reticulum revised
• Clinical Note on DNA Fingerprinting revised
• Figure 3–13 The Process of Translation revised
• Figure 3–14 Diffusion revised
• Figure 3–17 Osmotic Flow across a Plasma Membrane revised
• New Spotlight Figure 3–22 Overview of Membrane Transport
incorporates old Figures 3–18, 3–19, and 3–21 and old
Table 3–2
• New Spotlight Figure 3–23 DNA Replication incorporates old
Figure 3–23
• Spotlight Figure 3–24 Stages in a Cell’s Life Cycle revised
Chapter 4: The Tissue Level of Organization
• New Clinical Case: The Rubber Girl
• Intercellular Connections subsection updated
• Figure 4–2 Cell Junctions revised
• Figure 4–8 The Cells and Fibers of Connective Tissue Proper
revised
• Adipose Tissue subsection includes updated discussion
of brown fat
• Figure 4–10 Loose Connective Tissues revised
• Spotlight Figure 4–20 Inflammation and Regeneration revised
Chapter 5: The Integumentary System
• New Clinical Case: Skin Cells in Overdrive
• Figure 5–1 The Components of the Integumentary System revised
• New Figure 5–2 The Cutaneous Membrane and Accessory
Structures
• New Spotlight Figure 5–3 The Epidermis incorporates old
Figures 5–2 and 5–3
• New Figure 5–5 Vitiligo
• New Figure 5–6 Sources of Vitamin D3
• Clinical Note: Decubitus Ulcers revised with new photo
• New Figure 5–8 Reticular Layer of Dermis
• Figure 5–10 Dermal Circulation revised
• Figure 5–12 Hair Follicles and Hairs revised
• New Figure 5–11 Hypodermis
Chapter 6: Osseous Tissue and Bone Structure
• New Clinical Case: A Case of Child Abuse?
• Figure 6–1 A Classification of Bones by Shape revised
• New Figure 6–2 An Introduction to Bone Markings incorporates
old Table 6–1
• New Spotlight Figure 6–11 Endochondral Ossification incor-
porates old Figure 6–10
• New Figure 6–12 Intramembranous Ossification
• Spotlight Figure 6–16 Types of Fractures and Steps in Repair
revised
• Clinical Note: Abnormal Bone Development revised
Chapter 7: The Axial Skeleton
• New Clinical Case: Knocked Out
• New Clinical Note: Sinusitis
• Figure 7–2 Cranial and Facial Subdivisions of the Skull revised
• Figure 7–3 The Adult Skull revised to incorporate old Table 7–1
• New Spotlight Figure 7–4 Sectional Anatomy of the Skull
incorporates old Figure 7–4 and parts of old Table 7–1
• Figure 7–6 The Frontal Bone revised
• Figure 7–14 The Nasal Complex revised
• Figure 7–22 The Thoracic Cage revised
Chapter 8: The Appendicular Skeleton
• New Clinical Case: The Orthopedic Surgeon’s Nightmare
• New Clinical Note: Hip Fracture
• New Clinical Note: Runner’s Knee
• New Clinical Note: Stress Fractures
• Carpal Bones subsection now lists the 8 carpal bones in two
groups of 4 (proximal and distal carpal bones)
• Figure 8–6 Bones of the Right Wrist and Hand revised
• New Spotlight Figure 8–10 Sex Differences in the Human
Skeleton incorporates old Figure 8–10, old Table 8–1, and
old bulleted list in text
• Clinical Note: Carpal Tunnel Syndrome includes new illustration
• Figure 8–14 Bones of the Ankle and Foot revised
• Clinical Note: Congenital Talipes Equinovarus includes
new photo
Chapter 9: Joints
• Chapter title changed from Articulations to Joints
• New Clinical Case: What’s Ailing the Birthday Girl?
• New Clinical Note: Dislocation and Subluxation
• New Clinical Note: Damage to Intervertebral Discs
• Table 9–1 Functional and Structural Classifications of Articula-
tions redesigned
• Spotlight Figure 9–2 Joint Movement incorporates old Figures
9–2 and 9–6 and subsection on Types of Synovial Joints
• Revised discussion of synovial fluid function in shock absorption
• Figure 9–6 Intervertebral Articulations expanded
• Figure 9–7 The Shoulder Joint revised
• Figure 9–10 The Right Knee Joint rearranged and revised
• Clinical Note: Knee Injuries revised

Chapter 10: Muscle Tissue
• New Clinical Case: A Real Eye Opener
• New subsection Electrical Impulses and Excitable Membranes
added in Section 10-4
• New Spotlight Figure 10–10 Excitation–Contraction Coupling
incorporates old Figures 10–9 and 10–10
• New Figure 10–13 Steps Involved in Skeletal Muscle Contraction
and Relaxation incorporates old Table 10–1
• Treppe subsection includes new discussion of treppe in cardiac
muscle
• Motor Units and Tension Production subsection includes new
discussion of fasciculation
• Figure 10–20 Muscle Metabolism revised
• Table 10–2 Properties of Skeletal Muscle Fiber Types revised to
make column sequences better parallel text discussion
Chapter 11: The Muscular System
• New Clinical Case: The Weekend Warrior
• Figure 11–1 Muscle Types Based on Pattern of Fascicle Organiza-
tion revised
• Figure 11–2 The Three Classes of Levers revised
• New Spotlight Figure 11–3 Muscle Action
• Figure 11–14 An Overview of the Appendicular Muscles of the
Trunk revised
• Figure 11–18 Muscles That Move the Hand and Fingers revised
• Figure 11–22 Extrinsic Muscles That Move the Foot and Toes
revised
Chapter 12: Neural Tissue
• New Clinical Case: Did President Franklin D. Roosevelt Really
Have Polio?
• New Figure 12–1 A Functional Overview of the Nervous System
• Figure 12–7 Schwann Cells, Peripheral Axons, and Formation of
the Myelin Sheath revised and new part c step art added
• New Spotlight Figure 12–9 Resting Membrane Potential incor-
porates old Figure 12–9
• Figure 12–10 Electrochemical Gradients for Potassium and
Sodium Ions revised
• Added ligand-gated channels as an alternative term for chemi-
cally gated channels
• New Spotlight Figure 12–15 Propagation of an Action
Potential incorporates old Figures 12–6 and 12–15
• New Figure 12–16 Events in the Functioning of a Cholinergic
Synapse incorporates old Figure 12–17 and old Table 12–4
Chapter 13: The Spinal Cord, Spinal Nerves, and Spinal Reflexes
• New Clinical Case: Prom Night
• New “Tips & Tricks” added to Cervical Plexus subsection
• Figure 13–7 Dermatomes revised
• New information on the Jendrassik maneuver added to Section 13-8
• New Figure 13–10 The Cervical Plexus incorporates old Table 13–1
and old Figure 13–11
• New Figure 13–11 The Brachial Plexus incorporates old Table 13–2
and old Figure 13–12
• New in-art Clinical Note: Sensory Innervation in the Hand added
to Figure 13–11
• New Figure 13–12 The Lumbar and Sacral Plexuses incorporates
old Table 13–3 and old Figure 13–13
• New in-art Clinical Note: Sensory Innervation in the Ankle and
Foot added to Figure 13–12
Preface vii
• New Spotlight Figure 13–14 Spinal Reflexes incorporates old
Figures 13–15, 13–17, 13–19, and 13–20
Chapter 14: The Brain and Cranial Nerves
• New Clinical Case: The Neuroanatomist’s Stroke
• New Spotlight Figure 14–4 Formation and Circulation of
Cerebrospinal Fluid incorporates old Figure 14–4
• Figure 14–5 The Diencephalon and Brain Stem revised
• New Figures 14–6 The Medulla Oblongata and 14–7 The Pons
incorporate old Figure 14–6 and old Table 14–2
• New Figure 14–8 The Cerebellum incorporates old Figure 14–7
and old Table 14–3
• New Figure 14–9 The Midbrain incorporates old Figure 14–8, old
Table 14–4, and a new cadaver photograph
• New Figure 14–11 The Hypothalamus in Sagittal Section incorpo-
rates old Figure 14–10 and old Table 14–6
• New Figure 14–12 The Limbic System incorporates old
Figure 14–11 and old Table 14–7
• Figure 14–14 Fibers of the White Matter of the Cerebrum revised
• Figure 14–15 The Basal Nuclei revised
• Figure 14–16 Motor and Sensory Regions of the Cerebral Cortex
revised
• New information on circumventricular organs added to Section 14-2
Chapter 15: Sensory Pathways and the Somatic Nervous System
• New Clinical Case: Living with Cerebral Palsy
• New Figure 15–1 An Overview of Events Occurring along the
Sensory and Motor Pathways
• New Figure 15–3 Tonic and Phasic Sensory Receptors
• Spotlight Figure 15–6 Somatic Sensory Pathways revised
• Figure 15–8 Descending (Motor) Tracts in the Spinal Cord
reorganized
Chapter 16: The Autonomic Nervous System and Higher-Order
Functions
• New Clinical Case: The First Day in Anatomy Lab
• New Spotlight Figure 16–2 Overview of the Autonomic
Nervous System incorporates old Figures 16–3 and 16–7
• Figure 16–3 Sites of Ganglia in Sympathetic Pathways revised
• Figure 16–4 The Distribution of Sympathetic Innervation revised
Chapter 17: The Special Senses
• New Clinical Case: A Chance to See
• Figure 17–1 The Olfactory Organs revised
• Spotlight Figure 17–2 Olfaction and Gustation revised
• Figure 17–3 Gustatory Receptors revised
• Figure 17–22 The Middle Ear revised
• Figures 17–23, 17–24, and 17–25 revised to indicate different
orientations of maculae in the utricle and saccule
• Figure 17–32 Pathways for Auditory Sensations revised
Chapter 18: The Endocrine System
• New Clinical Case: Stones, Bones, and Groans
• New Spotlight Figure 18–3 G Proteins and Second Messengers
incorporates old Figure 18–3
• Figure 18–7 The Hypophyseal Portal System and the Blood
Supply to the Pituitary Gland revised
• Figure 18–11 The Thyroid Follicles revised
• New Figure 18–14 The Adrenal Gland incorporates old
Figure 18–14 and old Table 18–5
viii Preface
Chapter 19: Blood
• New Clinical Case: A Mysterious Blood Disorder
• Figure 19–3 The Structure of Hemoglobin revised
• Table 19–4 includes revised names for Factors IX and XI and
source of Factor X
Chapter 20: The Heart
• New Clinical Case: A Needle to the Chest
• Figure 20–3 The Superficial Anatomy of the Heart revised
• Figure 20–6 The Sectional Anatomy of the Heart revised
• Figure 20–12 Impulse Conduction through the Heart revised
• Figure 20–16 Phases of the Cardiac Cycle revised
• Figure 20–21 Autonomic Innervation of the Heart revised
• Figure 20–24 A Summary of the Factors Affecting Cardiac Output
revised
Chapter 21: Blood Vessels and Circulation
• New Clinical Case: Did Ancient Mummies Have
Atherosclerosis?
• Figure 21–2 Histological Structures of Blood Vessels revised
• Figure 21–8 Relationships among Vessel Diameter, Cross-
Sectional Area, Blood Pressure, and Blood Velocity within the
Systemic Circuit revised
• Figure 21–9 Pressures within the Systemic Circuit revised
• Figure 21–11 Forces Acting across Capillary Walls revised
• Figure 21–20 Arteries of the Chest and Upper Limb revised
• Figure 21–25 Arteries of the Lower Limb revised
• Figure 21–29 Flowcharts of Circulation to the Superior and Infe-
rior Venae Cavae revised
• Figure 21–30 Venous Drainage from the Lower Limb revised
Chapter 22: The Lymphatic System and Immunity
• New Clinical Case: Isn’t There a Vaccine for That?
• Figure 22–6 The Origin and Distribution of Lymphocytes revised
• Figure 22–11 Innate Defenses revised
• Complement System subsection – includes revised number of
complement proteins in plasma (from 11 to more than 30)
• Figure 22–18 Antigens and MHC Proteins revised
Chapter 23: The Respiratory System
• New Clinical Case: How Long Should a Cough Last?
• Figure 23–1 The Structure of the Respiratory System reorganized
• Figure 23–3 The Structures of the Upper Respiratory System revised
• Figure 23–5 The Glottis and Surrounding Structures revised
• Figure 23–7 The Gross Anatomy of the Lungs revised
• Figure 23–9 The Bronchi, Lobules, and Alveoli of the Lung revised
• Figure 23–10 Alveolar Organization revised
• Figure 23–13 Mechanisms of Pulmonary Ventilation revised
• New Spotlight Figure 23–15 Respiratory Muscles and Pulmonary
Ventilation incorporates old Figure 23–16
• Figure 23–16 Pulmonary Volumes and Capacities revised
• Spotlight Figure 23–25 Control of Respiration revised
Chapter 24: The Digestive System
• New Clinical Case: An Unusual Transplant
• Figure 24–10 The Esophagus revised
• Figure 24–12 The Stomach revised
• Figure 24–16 Segments of the Intestine revised
• Figure 24–21 The Anatomy and Physiology of the Gallbladder
and Bile Ducts revised
Chapter 25: Metabolism and Energetics
• New Clinical Case: The Miracle Supplement
• Figure 25–9 Lipid Transport and Utilization revised
• Figure 25–12 MyPlate Plan revised
• Figure 25–14 Mechanisms of Heat Transfer revised
Chapter 26: The Urinary System
• New Clinical Case: A Case of “Hidden” Bleeding
• Revised all relevant figure labels by replacing “Renal lobe” with
“Kidney lobe”
• Figure 26–6 The Functional Anatomy of a Representative Neph-
ron and the Collecting System revised
• Spotlight Figure 26–16 Summary of Renal Function revised
Chapter 27: Fluid, Electrolyte, and Acid–Base Balance
• New Clinical Case: When Treatment Makes You Worse
• Figure 27–2 Cations and Anions in Body Fluids revised
• Figure 27–3 Fluid Gains and Losses revised
• Figure 27–11 The Role of Amino Acids in Protein Buffer Systems
revised (to emphasize amino acids as zwitterions)
• Figure 27–13 Kidney Tubules and pH Regulation revised
• New Spotlight Figure 27–18 The Diagnosis of Acid–Base
Disorders incorporates old Figure 27–18
Chapter 28: The Reproductive System
• New Clinical Case: A Post-Game Mystery
• Figure 28–1 The Male Reproductive System revised
• Figure 28–3 The Male Reproductive System in Anterior View
revised and reorganized
• Figure 28–4 The Structure of the Testes revised
• Figure 28–7 Spermatogenesis revised
• Figure 28–13 The Female Reproductive System revised
• Figure 28–15 Oogenesis revised
• Figure 28–18 The Uterus revised
Chapter 29: Development and Inheritance
• New Clinical Case: The Twins That Looked Nothing Alike
• Revised all relevant chapter text by replacing “embryological”
with “embryonic” for simplification
• New Spotlight Figure 29–5 Extraembryonic Membranes and
Placenta Formation incorporates old Figure 29–5
• Table 29–2 An Overview of Prenatal Development includes
revised sizes and weights at different gestational ages
• Figure 29–8 The Second and Third Trimesters revised
• Figure 29–9 Growth of the Uterus and Fetus revised
• Figure 29–13 Growth and Changes in Body Form and Proportion
revised
Appendix
• New periodic table
• New codon chart
Acknowledgments
This textbook represents a group effort, and we would like to
acknowledge the people who worked together with us to create
this Tenth Edition.
Foremost on our thank-you list are the instructors who
offered invaluable suggestions throughout the revision process.
We thank them for their participation and list their names and
affiliations below.
Lisa Conley, Milwaukee Area Technical College
Theresa G. D’Aversa, Iona College
Danielle Desroches, William Paterson University
Debra Galba-Machuca, Portland Community College–Cascade
Lauren Gollahon, Texas Tech University
Gigi Goochey, Hawaii Community College
Mark Haefele, Community College of Denver
Anthony Jones, Tallahassee Community College
William L’ Amoreaux, College of Staten Island
J. Mitchell Lockhart, Valdosta State University
Scott Murdoch, Moraine Valley Community College
Louise Petroka, Gateway Community College
Cynthia Prentice-Craver, Chemeketa Community College
S. Michele Robichaux, Nicholls State University
Susan Rohde, Triton College
Yung Su, Florida State University
Bonnie Taylor, Schoolcraft College
Carol Veil, Anne Arundel Community College
Patricia Visser, Jackson College
Theresia Whelan, State College of Florida – Manatee-Sarasota
Samia Williams, Santa Fe College
The accuracy and currency of the clinical material in this
edition and in the A&P Applications Manual in large part reflect
the work of Kathleen Welch, M.D. Her professionalism and
concern for practicality and common sense make the clinical
information especially relevant for today’s students. Addition-
ally, our content expert on the Clinical Cases, Ruth Anne O’Keefe,
M.D., provided constant, useful feedback on each chapter.
Virtually without exception, reviewers stressed the impor-
tance of accurate, integrated, and visually attractive illustra-
tions in helping readers understand essential material. The
revision of the art program was directed by Bill Ober, M.D.
and Claire E. Ober, R.N. Their suggestions about presentation
sequence, topics of clinical importance, and revisions to the
proposed art were of incalculable value to us and to the project.
The illustration program for this edition was further enhanced
by the efforts of several other talented individuals. Jim Gibson
designed most of the new Spotlight Figures in the art program
and consulted on the design and layout of the individual fig-
ures. His talents have helped produce an illustration program
that is dynamic, cohesive, and easy to understand. Anita Im-
pagliazzo helped create the new photo/art combinations that
have resulted in clearer presentations and a greater sense of re-
alism in important anatomical figures. We are also grateful to
the talented team at Imagineering (imagineeringart.com) for
their dedicated and detailed illustrative work on key figures for
this edition. The new color micrographs in this edition were
provided by Dr. Robert Tallitsch, and his assistance is much ap-
preciated. Many of the striking anatomy photos in the text and
in Martini’s Atlas of the Human Body are the work of biomedical
photographer Ralph Hutchings; his images played a key role in
the illustration program.
We also express our appreciation to the editors and sup-
port staff at Pearson Science.
We owe special thanks to Executive Editor, Leslie Berriman,
for her creativity and dedication. Her vision helped shape
this book in countless ways. Leslie’s enthusiasm for publish-
ing the highest quality material spills over onto the author/
illustrator team. She is our biggest advocate and is always
willing to champion our cause—despite the challenges of
working with authors. We are appreciative of all her efforts
on our behalf.
Assistant Editor, Cady Owens, and Associate Project Editor,
Lisa Damerel, are unquestionably the very finest at what they
do. While it is expected that editors pay attention to details and
keep projects moving forward, Cady and Lisa are true profes-
sionals and extremely skilled at not only preparing our ma-
terial for publication, but making sure it is the best it could
possibly be. This past year could not have happened without
them.
Annie Reid, our Development Editor, played a vital role in
revising the Tenth Edition. Her unfailing attention to readabil-
ity, consistency, and quality was invaluable to the authors in
meeting our goal of delivering complex A&P content in a more
student-friendly way.
We are grateful to Mike Rossa for his careful attention to
detail and consistency in his copyedit of the text and art.
This book would not exist without the extraordinary
dedication of the Production team, including Caroline Ayres,
who solved many problems under pressure with unfailing
good cheer. Norine Strang skillfully led her excellent team at
S4Carlisle to move the book smoothly through composition.
ix
x Acknowledgments
The striking cover and clear, navigable interior design were
created by tani hasegawa. Thanks also to Mark Ong, Design
Manager, and Marilyn Perry, who devised innovative solutions
for several complex design challenges.
Thanks to our photo researcher, Maureen Spuhler, and
photo editor, Donna Kalal, for finding, obtaining, and coordi-
nating all the photos in the photo program.
Thanks are also due to Sharon Kim, Editorial Assistant,
who served as project editor for the print supplements for
instructors and students and coordinated the administrative
details of the entire textbook program. Dorothy Cox and Shan-
non Kong worked tirelessly to shepherd the print and media
supplements through production. Thanks also to Stacey Wein-
berger for handling the physical manufacturing of the book.
We are also grateful to Joe Mochnick, Content Producer,
and Liz Winer, Executive Content Producer, for their creative
efforts on the media package, most especially MasteringA&P.
We would also like to express our gratitude to the fol-
lowing people at Pearson Science: Paul Corey, President, who
continues to support all our texts; Barbara Yien, Director of De-
velopment, who kindly kept all phases moving forward under
all circumstances; Allison Rona, Senior Marketing Manager;
and the dedicated Pearson Science sales representatives for
their continuing support of this project. Special thanks go to
Frank Ruggirello, Vice President and Editorial Director, for
working closely with Leslie in ensuring we have the resources
necessary to publish what students need to succeed. And, a
round of applause goes to Derek Perrigo, Senior A&P Special-
ist, our biggest cheerleader.
To help improve future editions, we encourage you to send
any pertinent information, suggestions, or comments about
the organization or content of this textbook to us directly,
using the e-mail addresses below. We warmly welcome com-
ments and suggestions and will carefully consider them in the
preparation of the Eleventh Edition.
Frederic (Ric) H. Martini
Haiku, Hawaii
martini@pearson.com
Judi L. Nath
Sandusky, Ohio
nath@pearson.com
Edwin F. Bartholomew
Lahaina, Hawaii
bartholomew@pearson.com
Contents

Preface v
2 The Chemical Level of
Organization 26
UNIT 1 LEVELS OF ORGANIZATION
An Introduction to the Chemical Level of Organization 27
1 An Introduction to Anatomy 2-1 Atoms are the basic particles of matter 27
and Physiology 1 Atomic Structure 27
Elements and Isotopes 28
An Introduction to Studying the Human Body 2 Atomic Weights 29
Electrons and Energy Levels 30
1-1 Anatomy and physiology directly affect
your life 2 2-2 Chemical bonds are forces formed by atom
interactions 31
1-2 Anatomy is structure, and physiology is function 3
Ionic Bonds 31
1-3 Anatomy and physiology are closely integrated 4 Covalent Bonds 34
Anatomy 4 Hydrogen Bonds 35
Physiology 5 States of Matter 35
1-4 Levels of organization progress from molecules 2-3 Decomposition, synthesis, and exchange reactions are
to a complete organism 6 important chemical reactions in physiology 36
1-5 Homeostasis is the state of internal balance 7 Basic Energy Concepts 36
1-6 Negative feedback opposes variations from normal, Types of Chemical Reactions 37
whereas positive feedback exaggerates them 10 2-4 Enzymes catalyze specific biochemical reactions by
The Role of Negative Feedback in Homeostasis 10 lowering the energy needed to start them 38
The Role of Positive Feedback in Homeostasis 12 2-5 Inorganic compounds lack carbon, and organic
Systems Integration, Equilibrium, and Homeostasis 13 compounds contain carbon 39
1-7 Anatomical terms describe body regions, anatomical 2-6 Physiological systems depend on water 39
positions and directions, and body sections 14 The Properties of Aqueous Solutions 40
Superficial Anatomy 14 Colloids and Suspensions 41
Sectional Anatomy 16
2-7 Body fluid pH is vital for homeostasis 41
1-8 Body cavities of the trunk protect internal organs
and allow them to change shape 18 2-8 Acids, bases, and salts are inorganic compounds with
important physiological roles 42
The Thoracic Cavity 22
Salts 43
The Abdominopelvic Cavity 22
Buffers and pH Control 43
Chapter Review 23
Spotlights 2-9 Carbohydrates contain carbon, hydrogen, and oxygen
Levels of Organization 8
in a 1:2:1 ratio 43
Diagnostic Imaging Techniques 20 Monosaccharides 44
Clinical Case Disaccharides and Polysaccharides 45
Using A&P to Save a Life 2 2-10 Lipids often contain a carbon-to-hydrogen ratio
Clinical Notes of 1:2 46
Autopsies and Cadaver Dissection 5 Fatty Acids 46
Auscultation 14 Eicosanoids 47
Glycerides 48
Steroids 48
Phospholipids and Glycolipids 49

xi
xii Contents

2-11 Proteins contain carbon, hydrogen, oxygen, and 3-6 Carrier-mediated and vesicular transport assist
nitrogen and are formed from amino acids 51 membrane passage 94
Protein Structure 51 Carrier-Mediated Transport 94
Protein Shape 52 Vesicular Transport 96
Enzyme Function 54 3-7 The membrane potential results from the unequal
Glycoproteins and Proteoglycans 56 distribution of positive and negative charges across
2-12 DNA and RNA are nucleic acids 56 the plasma membrane 100
Structure of Nucleic Acids 56 3-8 Stages of a cell’s life cycle include interphase, mitosis,
RNA and DNA 56 and cytokinesis 101
2-13 ATP is a high-energy compound used by cells 58 DNA Replication 101
Interphase, Mitosis, and Cytokinesis 101
2-14 Chemicals and their interactions form functional units
The Mitotic Rate and Energy Use 103
called cells 59
Chapter Review 60 3-9 Several growth factors affect the cell life cycle 103
Spotlights 3-10 Tumors and cancers are characterized by abnormal cell
Chemical Notation 32 growth and division 106
Clinical Case 3-11 Differentiation is cellular specialization as a result of
What Is Wrong with My Baby? 27 gene activation or repression 108
Clinical Notes Chapter Review 109
Radiation Sickness 29
Spotlights
Fatty Acids and Health 48
Anatomy of a Model Cell 66
Protein Synthesis, Processing, and Packaging 78
Overview of Membrane Transport 98

3 The Cellular Level

DNA Replication 102
Stages of a Cell’s Life Cycle 104
of Organization 64 Clinical Case
When Your Heart Is in the Wrong Place 65
An Introduction to Cells 65 Clinical Notes
3-1 The plasma membrane separates the cell from its Inheritable Mitochondrial Disorders 80
surrounding environment and performs various DNA Fingerprinting 84
functions 65 Mutations 86
Membrane Lipids 68 Drugs and the Plasma Membrane 90
Telomerase, Aging, and Cancer 107
Membrane Proteins 69
Parkinson’s Disease 108
Membrane Carbohydrates 70
3-2 Organelles within the cytoplasm perform particular
functions 70
The Cytosol 70 4 The Tissue Level
The Organelles 71 of Organization 113
3-3 The nucleus contains DNA and enzymes essential for
controlling cellular activities 82 An Introduction to the Tissue Level of Organization 114
Contents of the Nucleus 83 4-1 The four tissue types are epithelial, connective,
Information Storage in the Nucleus 83 muscle, and neural 114
3-4 DNA controls protein synthesis, cell structure, and cell 4-2 Epithelial tissue covers body surfaces, lines cavities
function 84 and tubular structures, and serves essential
The Role of Gene Activation in Protein Synthesis 84 functions 114
The Transcription of mRNA 84 Functions of Epithelial Tissue 115
Translation and Protein Synthesis 86 Specializations of Epithelial Cells 115
How the Nucleus Controls Cell Structure and Function 87 Maintaining the Integrity of Epithelia 116
3-5 Diffusion is a passive transport mechanism that assists 4-3 Cell shape and number of layers determine the
membrane passage 87 classification of epithelia 118
Diffusion 89 Classification of Epithelia 119
Diffusion across Plasma Membranes 91 Glandular Epithelia 123
 Contents xiii

4-4 Connective tissue provides a protective structural Stratum Spinosum 153

framework for other tissue types 126 Stratum Granulosum 155
Classification of Connective Tissues 126 Stratum Lucidum 155
Connective Tissue Proper 126 Stratum Corneum 155
4-5 Cartilage and bone provide a strong supporting 5-2 Factors influencing skin color are epidermal
framework 133 pigmentation and dermal circulation 155
Cartilage 133 The Role of Epidermal Pigmentation 156
Bone 136 The Role of Dermal Circulation 157
4-6 Tissue membranes are physical barriers of four types: 5-3 Sunlight causes epidermal cells to convert a steroid
mucous, serous, cutaneous, and synovial 137 into vitamin D3 158
Mucous Membranes 137 5-4 Epidermal growth factor has several effects on the
Serous Membranes 137 epidermis and epithelia 159
The Cutaneous Membrane 139 5-5 The dermis is the tissue layer that supports the
Synovial Membranes 139 epidermis 160
4-7 Connective tissue creates the internal framework Dermal Strength and Elasticity 160
of the body 139 Cleavage Lines 161
4-8 The three types of muscle tissue are skeletal, cardiac, The Dermal Blood Supply 161
and smooth 140 Innervation of the Skin 161
Skeletal Muscle Tissue 140 5-6 The hypodermis connects the dermis to underlying
Cardiac Muscle Tissue 142 tissues 162
Smooth Muscle Tissue 142 5-7 Hair is composed of keratinized dead cells that have
4-9 Neural tissue responds to stimuli and propagates been pushed to the surface 163
electrical impulses throughout the body 142 Hair Production 165
4-10 The response to tissue injury involves inflammation The Hair Growth Cycle 165
and regeneration 144 Types of Hairs 165
Inflammation 144 Hair Color 165
Regeneration 144 5-8 Sebaceous glands and sweat glands are exocrine
4-11 With advancing age, tissue repair declines and cancer glands found in the skin 166
rates increase 144 Sebaceous Glands 166
Aging and Tissue Structure 144 Sweat Glands 167
Aging and Cancer Incidence 146 Other Integumentary Glands 168
Chapter Review 146 Control of Glandular Secretions and the Homeostatic
Spotlights Role of the Integument 168
Inflammation and Regeneration 145 5-9 Nails are keratinized epidermal cells that protect the
Clinical Case tips of fingers and toes 169
The Rubber Girl 114 5-10 Several phases are involved in repairing the
Clinical Notes integument following an injury 169
Exfoliative Cytology 120 5-11 Effects of aging include skin thinning, wrinkling,
Marfan’s Syndrome 129 and reduced melanocyte activity 172
Chapter Review 175
Spotlights
UNIT 2 SUPPORT AND MOVEMENT The Epidermis 154
Clinical Case
Skin Cells in Overdrive 151
5 The Integumentary Clinical Notes
Skin Cancer 158
System 150 Decubitus Ulcers 161
Liposuction 163
An Introduction to the Integumentary System 151 Burns and Grafts 171
5-1 The epidermis is composed of layers with various Skin Abnormalities 172
functions 153
Stratum Basale 153
xiv Contents

6 Osseous Tissue and Bone 7 The Axial Skeleton 206

Structure 178
An Introduction to the Axial Skeleton 207
An Introduction to the Skeletal System 179 7-1 The 80 bones of the head and trunk
6-1 The skeletal system has five make up the axial skeleton 207
primary functions 179 7-2 The skull is composed of 8 cranial bones and
6-2 Bones are classified according to shape and structure, 14 facial bones 207
and they have a variety of surface markings 180 7-3 Each orbital complex contains an eye, and the nasal
Bone Shapes 180 complex encloses the nasal cavities 223
Bone Markings 181 The Orbital Complexes 223
Bone Structure 182 The Nasal Complex 223
6-3 Bone is composed of matrix and several types of 7-4 Fontanelles are non-ossified areas between cranial
cells: osteocytes, osteoblasts, osteogenic cells, bones that allow for brain growth in infants and small
and osteoclasts 182 children 224
Bone Matrix 183 7-5 The vertebral column has four spinal curves 226
Bone Cells 183 Spinal Curvature 226
6-4 Compact bone contains parallel osteons, and spongy Vertebral Anatomy 227
bone contains trabeculae 184 7-6 The five vertebral regions are the cervical, thoracic,
Compact Bone Structure 185 lumbar, sacral, and coccygeal regions 228
Spongy Bone Structure 186 Cervical Vertebrae 229
The Periosteum and Endosteum 187 Thoracic Vertebrae 232
6-5 Bones form through ossification and enlarge through Lumbar Vertebrae 232
appositional growth and remodeling 189 The Sacrum 232
Endochondral Ossification 189 The Coccyx 235
Intramembranous Ossification 192 7-7 The thoracic cage protects organs in the chest and
The Blood and Nerve Supplies to provides sites for muscle attachment 235
Bone 192 The Ribs 235
6-6 Bone growth and development depend on a balance The Sternum 236
between bone formation and bone resorption 192 Chapter Review 238
6-7 Exercise, hormones, and nutrition affect bone Spotlights
development and the skeletal system 194 Sectional Anatomy of the Skull 212
The Effects of Exercise on Bone 194 Clinical Case
Nutritional and Hormonal Effects on Bone 194 Knocked Out 207
6-8 Calcium plays a critical role in bone physiology 196 Clinical Notes
The Skeleton as a Calcium Reserve 196 Temporomandibular Joint Syndrome 222
Sinusitis 225
Hormones and Calcium Balance 196
Craniostenosis 226
6-9 A fracture is a crack or break in a bone 198 Kyphosis, Lordosis, and Scoliosis 229
6-10 Osteopenia has a widespread effect on aging skeletal
tissue 199
Chapter Review 203
Spotlights
8 The Appendicular
Endochondral Ossification 190
Skeleton 241
Types of Fractures and Steps in Repair 200
Clinical Case An Introduction to the Appendicular Skeleton 242
A Case of Child Abuse? 179 8-1 The pectoral girdles—the clavicles and scapulae—
Clinical Notes attach the upper limbs to the axial skeleton 242
Heterotopic Bone Formation 188 The Clavicles 244
Abnormal Bone Development 196 The Scapulae 244
 Contents xv

8-2 The upper limbs are adapted for free movement 245 9-5 The shoulder is a ball-and-socket joint, and the elbow
The Humerus 245 is a hinge joint 276
The Ulna 247 The Shoulder Joint 276
The Radius 247 The Elbow Joint 278
The Carpal Bones 247 9-6 The hip is a ball-and-socket joint, and the knee is a
The Metacarpal Bones and Phalanges 248 hinge joint 279
8-3 The pelvic girdle—two hip bones—attaches the lower The Hip Joint 279
limbs to the axial skeleton 250 The Knee Joint 280
The Pelvic Girdle 250 9-7 With advancing age, arthritis and other degenerative
The Pelvis 250 changes impair joint mobility 283
8-4 The lower limbs are adapted for movement and 9-8 The skeletal system supports and stores energy and
support 254 minerals for other body systems 284
The Femur 254 Chapter Review 286
The Patella 254 Spotlights
The Tibia 256 Joint Movement 270
The Fibula 256 Clinical Case
The Tarsal Bones 257 What’s Ailing the Birthday Girl? 264
The Metatarsal Bones and Phalanges 258
Clinical Notes
8-5 Sex differences and age account for individual skeletal Bursitis and Bunions 268
variation 258 Dislocation and Subluxation 268
Chapter Review 260 Damage to Intervertebral Discs 275
Knee Injuries 283
Spotlights
Sex Differences in the Human Skeleton 253
Clinical Case
The Orthopedic Surgeon’s Nightmare 242 10 Muscle Tissue 289
Clinical Notes
Carpal Tunnel Syndrome 249 An Introduction to Muscle Tissue 290
Hip Fracture 254
Runner’s Knee 254 10-1 Skeletal muscle performs six major functions 290
Stress Fractures 258
Congenital Talipes Equinovarus 258
10-2 A skeletal muscle contains muscle tissue, connective
tissues, blood vessels, and nerves 291
Organization of Connective Tissues 292
Blood Vessels and Nerves 292
9 Joints 263 10-3 Skeletal muscle fibers have distinctive features 292
The Sarcolemma and Transverse Tubules 292
An Introduction to Joints 264 Myofibrils 293
9-1 Joints are categorized according to their range The Sarcoplasmic Reticulum 294
of motion or structure 264 Sarcomeres 295
9-2 Synovial joints are freely movable joints containing Sliding Filaments and Muscle Contraction 298
synovial fluid 266
Articular Cartilage 266
10-4 The nervous system communicates with skeletal
muscles at the neuromuscular junction 299
Synovial Fluid 267
Electrical Impulses and Excitable
Accessory Structures 267 Membranes 302
Factors That Stabilize Synovial Joints 267 The Control of Skeletal Muscle Activity 302
9-3 The structure and function of synovial joints enable Excitation–Contraction Coupling 302
various skeletal movements 268 Relaxation 308
Types of Movements at Synovial Joints 269
10-5 Sarcomere shortening and muscle fiber stimulation
9-4 Intervertebral discs and ligaments are structural produce tension 308
components of intervertebral joints 274 Tension Production by Muscle Fibers 308
Intervertebral Discs 274 Tension Production by Skeletal Muscles 312
Intervertebral Ligaments 275 Motor Units and Tension Production 312
Vertebral Movements 275
xvi Contents

10-6 ATP provides energy for muscle contraction 316 11-4 Descriptive terms are used to name skeletal
ATP and CP Reserves 316 muscles 339
ATP Generation 317 Location in the Body 339
Energy Use and the Level of Muscular Activity 318 Origin and Insertion 339
Muscle Fatigue 318 Fascicle Organization 339
The Recovery Period 318 Position 339
Hormones and Muscle Metabolism 320 Structural Characteristics 339
Action 340
10-7 Muscle performance capabilities depend on muscle
fiber type and physical conditioning 320 Axial and Appendicular Muscles 341
Types of Skeletal Muscle Fibers 320 11-5 Axial muscles are muscles of the head and neck,
Muscle Performance and the Distribution of Muscle vertebral column, trunk, and pelvic floor 341
Fibers 321 Muscles of the Head and Neck 341
Muscle Hypertrophy and Atrophy 321 Muscles of the Vertebral Column 351
Physical Conditioning 322 Oblique and Rectus Muscles 354
10-8 Cardiac muscle tissue differs structurally and Muscles of the Pelvic Floor 356
functionally from skeletal muscle tissue 324 11-6 Appendicular muscles are muscles of the shoulders,
Structural Characteristics of Cardiac Muscle Tissue 324 upper limbs, pelvis, and lower limbs 358
Functional Characteristics of Cardiac Muscle Tissue 325 Muscles of the Shoulders and Upper Limbs 358
10-9 Smooth muscle tissue differs structurally and Muscles of the Pelvis and Lower Limbs 369
functionally from skeletal and cardiac muscle 11-7 With advancing age, the size and power of muscle
tissue 325 tissue decrease 379
Structural Characteristics of Smooth Muscle Tissue 326
11-8 Exercise produces responses in multiple body
Functional Characteristics of Smooth Muscle Tissue 327 systems 379
Chapter Review 328 Chapter Review 381
Spotlights Spotlights
Events at the Neuromuscular Junction 300 Muscle Action 338
Excitation–Contraction Coupling 303
Clinical Case
The Contraction Cycle and Cross-Bridge Formation 304
The Weekend Warrior 333
Clinical Case
Clinical Notes
A Real Eye Opener 290
Intramuscular Injections 344
Clinical Notes Hernia 378
Tetanus 306
Rigor Mortis 308
Delayed-Onset Muscle Soreness 323
UNIT 3 CONTROL AND REGULATION

11 The Muscular System 332

12 Neural Tissue 385
An Introduction to the Muscular System 333
An Introduction to Neural Tissue 386
11-1 Fascicle arrangement is correlated with muscle power
and range of motion 333 12-1 The nervous system has anatomical and functional
Parallel Muscles 333 divisions 386
Convergent Muscles 333 The Anatomical Divisions of the Nervous System 386
Pennate Muscles 334 The Functional Divisions of the Nervous System 387
Circular Muscles 335 12-2 Neurons are nerve cells specialized for intercellular
communication 388
11-2 The three classes of levers increase muscle
efficiency 335 The Structure of Neurons 388
The Classification of Neurons 390
11-3 Muscle origins are at the fixed end of muscles, and
insertions are at the movable end of muscles 336 12-3 CNS and PNS neuroglia support and protect neurons 392
Origins and Insertions 336 Neuroglia of the Central Nervous System 392
Actions 337 Neuroglia of the Peripheral Nervous System 397
Neural Responses to Injuries 398
 Contents xvii

12-4 The membrane potential is the electrical potential of
the cell’s interior relative to its surroundings 398
The Membrane Potential 398
Changes in the Membrane Potential 402
Graded Potentials 404
13-3 Gray matter integrates information and initiates
commands, and white matter carries information from
place to place 435
Organization of Gray Matter 437
Organization of White Matter 437

12-5 An action potential is an electrical event 406 13-4 Spinal nerves form plexuses that are named according
The All-or-None Principle 406 to their level of emergence from the vertebral
canal 437
Generation of Action Potentials 406
Anatomy of Spinal Nerves 437
Propagation of Action Potentials 407
Peripheral Distribution of Spinal Nerves 438
12-6 Axon diameter, in addition to myelin, affects Nerve Plexuses 438
propagation speed 412
13-5 Interneurons are organized into functional groups
12-7 At synapses, communication occurs among neurons called neuronal pools 447
or between neurons and other cells 413
Synaptic Activity 413 13-6 Reflexes are rapid, automatic responses to
stimuli 449
General Properties of Synapses 413
The Reflex Arc 449
Cholinergic Synapses 414
Classification of Reflexes 452
12-8 Neurotransmitters and neuromodulators have various
functions 416 13-7 Spinal reflexes vary in complexity 453
The Activities of Other Neurotransmitters 416 Monosynaptic Reflexes 453
Neuromodulators 417 Polysynaptic Reflexes 454
How Neurotransmitters and Neuromodulators 13-8 The brain can affect spinal cord–based reflexes 455
Work 420 Voluntary Movements and Reflex Motor Patterns 456
12-9 Individual neurons process information by integrating Reinforcement and Inhibition 456
excitatory and inhibitory stimuli 421 Chapter Review 457
Postsynaptic Potentials 421 Spotlights
Presynaptic Inhibition and Presynaptic Facilitation 423 Peripheral Distribution of Spinal Nerves 440
The Rate of Generation of Action Potentials 423 Spinal Reflexes 450
Chapter Review 425 Clinical Case
Spotlights Prom Night 430
Resting Membrane Potential 400 Clinical Notes
Generation of an Action Potential 408 Anesthesia 435
Propagation of an Action Potential 410 Shingles 439
Clinical Case Sensory Innervation in the Hand 444
Did Franklin D. Roosevelt Really Have Polio? 386 Sensory Innervation in the Ankle and Foot 447

Clinical Notes
Rabies 390
Tumors 392
Demyelination 395
14 The Brain and Cranial
Nerves 461

An Introduction to the Brain and Cranial Nerves 462

13 The Spinal Cord, Spinal Nerves, 14-1 The brain has several principal structures, each with
and Spinal Reflexes 429 specific functions 462
Major Brain Regions and Landmarks 462
An Introduction to the Spinal Cord, Spinal Nerves, Embryology of the Brain 464
and Spinal Reflexes 430 Ventricles of the Brain 464
13-1 The brain and spinal cord make up the central nervous 14-2 The brain is protected and supported by the cranial
system (CNS), and the cranial nerves and spinal nerves meninges, cerebrospinal fluid, and the blood–brain
make up the peripheral nervous system (PNS) 430 barrier 465
13-2 The spinal cord is surrounded by three meninges and The Cranial Meninges 465
carries sensory and motor information 431 Cerebrospinal Fluid 467
Gross Anatomy of the Spinal Cord 431 The Blood Supply to the Brain 469
Spinal Meninges 433
xviii Contents

14-3 The medulla oblongata is continuous with the spinal 15-4 Separate pathways carry somatic sensory and visceral
cord and contains vital centers 470 sensory information 518
14-4 The pons contains nuclei and tracts that carry or relay Somatic Sensory Pathways 518
sensory and motor information 472 Visceral Sensory Pathways 523
14-5 The cerebellum coordinates learned and reflexive patterns 15-5 The somatic nervous system is an efferent division that
of muscular activity at the subconscious level 473 controls skeletal muscles 523
14-6 The midbrain regulates auditory and visual reflexes The Corticospinal Pathway 524
and controls alertness 475 The Medial and Lateral Pathways 525
The Basal Nuclei and Cerebellum 526
14-7 The diencephalon integrates sensory information with
motor output at the subconscious level 477 Levels of Processing and Motor Control 527
The Thalamus 477 Chapter Review 528
The Hypothalamus 478 Spotlights
Somatic Sensory Pathways 520
14-8 The limbic system is a group of tracts and nuclei that
function in emotion, motivation, and memory 480 Clinical Case
Living with Cerebral Palsy 509
14-9 The cerebrum, the largest region of the brain, contains
motor, sensory, and association areas 482 Clinical Notes
Assessment of Tactile Sensitivities 517
The Cerebral Cortex 482
Amyotrophic Lateral Sclerosis 526
The White Matter of the Cerebrum 482 Cerebral Palsy 527
The Basal Nuclei 482
Motor and Sensory Areas of the Cortex 486
14-10 Cranial reflexes involve sensory and motor fibers
of cranial nerves 503 16 The Autonomic Nervous
Chapter Review 504 System and Higher-Order
Spotlights Functions 531
Formation and Circulation of Cerebrospinal Fluid 468
Clinical Case An Introduction to the Autonomic Nervous System and
The Neuroanatomist’s Stroke 507 Higher-Order Functions 532
Clinical Notes 16-1 The autonomic nervous system is involved in the
Epidural and Subdural Hemorrhages 467 unconscious regulation of visceral functions and has
Disconnection Syndrome 488 sympathetic and parasympathetic divisions 532
Aphasia and Dyslexia 489 Organization of the ANS 532
Divisions of the ANS 533
16-2 The sympathetic division consists of preganglionic
15 Sensory Pathways and neurons and ganglionic neurons involved in using
energy and increasing metabolic rate 536
the Somatic Nervous Organization and Anatomy of the Sympathetic
System 508 Division 537
Sympathetic Activation 540
An Introduction to Sensory Pathways and the Somatic Nervous 16-3 Stimulation of sympathetic neurons leads to the
System 509 release of various neurotransmitters 540
15-1 Sensory information from all parts of the body is Sympathetic Stimulation and the Release of
routed to the somatosensory cortex 509 NE and E 541
15-2 Sensory receptors connect our internal and external Sympathetic Stimulation and the Release of
environments with the nervous system 510 ACh and NO 541
The Detection of Stimuli 510 Summary: The Sympathetic Division 542
The Interpretation of Sensory Information 511 16-4 The parasympathetic division consists of preganglionic
Adaptation 512 neurons and ganglionic neurons involved in
conserving energy and lowering metabolic rate 542
15-3 General sensory receptors are classified by the type of
stimulus that excites them 513 Organization and Anatomy of the Parasympathetic
Division 542
Nociceptors 513
Parasympathetic Activation 542
Thermoreceptors 514
Mechanoreceptors 514
Chemoreceptors 517
 Contents xix

16-5 Stimulation of parasympathetic neurons leads to the 17-4 Photoreceptors respond to light and change it into
release of the neurotransmitter ACh 544 electrical signals essential to visual physiology 581
Neurotransmitter Release 544 Visual Physiology 581
Membrane Receptors and Responses 544 The Visual Pathways 587
Summary: The Parasympathetic Division 544 17-5 Equilibrium sensations originate within the internal
16-6 The sympathetic and parasympathetic divisions ear, while hearing involves the detection and
interact, creating dual innervation 545 interpretation of sound waves 590
Anatomy of Dual Innervation 545 Anatomy of the Ear 590
Autonomic Tone 546 Equilibrium 593
Hearing 596
16-7 Visceral reflexes play a role in the integration and
control of autonomic functions 549 Chapter Review 604
Visceral Reflexes 549 Spotlights
Higher Levels of Autonomic Control 550 Olfaction and Gustation 566
Refractive Problems 582
The Integration of SNS and ANS Activities 551
Photoreception 584
16-8 Higher-order functions include memory and states of Clinical Case
consciousness 552
A Chance to See 564
Memory 552
Clinical Notes
States of Consciousness 554
Diabetic Retinopathy 574
16-9 Neurotransmitters influence brain chemistry and Detached Retina 574
behavior 556 Glaucoma 577
Motion Sickness 593
16-10 Aging produces various structural and functional
changes in the nervous system 557
Chapter Review 559
Spotlight
Overview of the Autonomic Nervous System 534
18 The Endocrine System 608
Clinical Case An Introduction to the Endocrine System 609
The First Day in Anatomy Lab 532
18-1 Homeostasis is preserved through intercellular
Clinical Notes communication 609
Amnesia 553
Categorizing Nervous System Disorders 555 18-2 The endocrine system regulates physiological
Alzheimer’s Disease 557 processes through the binding of hormones to
receptors 611
Classes of Hormones 611
Secretion and Distribution of Hormones 612
17 The Special Senses 563 Mechanisms of Hormone Action 614
Control of Endocrine Activity by Endocrine Reflexes 616
An Introduction to the Special Senses 564 18-3 The bilobed pituitary gland is an endocrine organ that
17-1 Olfaction, the sense of smell, involves olfactory releases nine peptide hormones 619
receptors responding to chemical stimuli 564 The Anterior Lobe of the Pituitary Gland 619
Olfactory Receptors 564 The Posterior Lobe of the Pituitary Gland 623
Olfactory Pathways 565 Summary: The Hormones of the Pituitary Gland 625
Olfactory Discrimination 565 18-4 The thyroid gland lies inferior to the larynx and
17-2 Gustation, the sense of taste, involves taste receptors requires iodine for hormone synthesis 626
responding to chemical stimuli 568 Thyroid Follicles and Thyroid Hormones 626
Taste Receptors 568 Functions of Thyroid Hormones 628
Gustatory Pathways 568 The C Cells of the Thyroid Gland and Calcitonin 629
Gustatory Discrimination 569 18-5 The four parathyroid glands, embedded in the
17-3 Internal eye structures contribute to vision, while posterior surface of the thyroid gland, secrete
accessory eye structures provide protection 570 parathyroid hormone to elevate blood Ca2 630
Accessory Structures of the Eye 570 18-6 The adrenal glands, consisting of a cortex and medulla,
The Eye 573 cap the kidneys and secrete several hormones 631
The Adrenal Cortex 631
The Adrenal Medulla 634
xx Contents

18-7 The pineal gland, attached to the roof of the third 19-4 The ABO blood types and Rh system are based on
ventricle, secretes melatonin 634 antigen–antibody responses 664
18-8 The pancreas is both an exocrine organ and endocrine Cross-Reactions in Transfusions 666
gland 635 Testing for Transfusion Compatibility 666
The Pancreatic Islets 636 19-5 The various types of white blood cells contribute to the
Insulin 637 body’s defenses 667
Glucagon 637 WBC Circulation and Movement 667
18-9 Many organs have secondary endocrine Types of WBCs 670
functions 639 The Differential Count and Changes in WBC
The Intestines 639 Profiles 671
The Kidneys 639 WBC Production 672
The Heart 640 19-6 Platelets, disc-shaped structures formed from
The Thymus 640 megakaryocytes, function in the clotting process 674
The Gonads 641 Platelet Functions 675
Adipose Tissue 643 Platelet Production 675

18-10 Hormones interact to produce coordinated 19-7 Hemostasis involves vascular spasm, platelet plug
physiological responses 643 formation, and blood coagulation 675
Role of Hormones in Growth 644 The Vascular Phase 675
Aging and Hormone Production 644 The Platelet Phase 676
Chapter Review 648 The Coagulation Phase 677
Spotlights Fibrinolysis 679
Structural Classification of Hormones 613 Chapter Review 680
G Proteins and Second Messengers 615 Spotlights
Diabetes Mellitus 638 The Composition of Whole Blood 654
The General Adaptation Syndrome 645 Hemolytic Disease of the Newborn 668
Clinical Case Clinical Case
Stones, Bones, and Groans 609 A Mysterious Blood Disorder 653
Clinical Notes Clinical Notes
Diabetes Insipidus 623 Collecting Blood for Analysis 656
Endocrine Disorders 642 Plasma Expanders 657
Hormones and Athletic Performance 646 Abnormal Hemoglobin 660

UNIT 4 FLUIDS AND TRANSPORT

20 The Heart 684

An Introduction to the Cardiovascular System 685

19 Blood 652 20-1 The heart is a four-chambered organ, supplied by the
coronary circulation, that pumps oxygen-poor blood
An Introduction to Blood and the Cardiovascular to the lungs and oxygen-rich blood to the rest of the
System 653 body 686
19-1 Blood has several important functions and unique The Pericardium 686
physical characteristics 653 Superficial Anatomy of the Heart 686
19-2 Plasma, the fluid portion of blood, contains significant The Heart Wall 686
quantities of plasma proteins 656 Cardiac Muscle Tissue 689
Plasma Proteins 656 Internal Anatomy and Organization 689
19-3 Red blood cells, formed by erythropoiesis, contain Connective Tissues and the Cardiac Skeleton 695
hemoglobin that can be recycled 657 The Blood Supply to the Heart 695
Abundance of RBCs 657 20-2 The conducting system distributes electrical impulses
Structure of RBCs 658 through the heart, and an electrocardiogram records
Hemoglobin 659 the associated electrical events 697
RBC Formation and Turnover 660 Cardiac Physiology 697
RBC Production 661 The Conducting System 697
 Contents xxi

The Electrocardiogram 702 The Cardiovascular Response to Hemorrhaging 751

Contractile Cells 703 Vascular Supply to Special Regions 752
20-3 Events during a complete heartbeat make up a cardiac 21-5 The pulmonary and systemic circuits of the
cycle 706 cardiovascular system exhibit three general functional
Phases of the Cardiac Cycle 707 patterns 753
Pressure and Volume Changes in the Cardiac Cycle 708 21-6 In the pulmonary circuit, deoxygenated blood enters
Heart Sounds 710 the lungs in arteries, and oxygenated blood leaves the
lungs by veins 754
20-4 Cardiodynamics examines the factors that affect
cardiac output 711 21-7 The systemic circuit carries oxygenated blood from
Overview: Factors Affecting Cardiac Output 711 the left ventricle to tissues and organs other than
the pulmonary exchange surfaces, and returns
Factors Affecting the Heart Rate 712
deoxygenated blood to the right atrium 755
Factors Affecting the Stroke Volume 715
Systemic Arteries 755
Summary: The Control of Cardiac Output 717
Systemic Veins 763
The Heart and the Cardiovascular System 718
Chapter Review 719 21-8 Modifications of fetal and maternal cardiovascular
systems promote the exchange of materials, and
Spotlights independence occurs at birth 772
Heart Disease and Heart Attacks 698
Placental Blood Supply 772
Cardiac Arrhythmias 704
Fetal Circulation in the Heart and Great Vessels 772
Clinical Case
Cardiovascular Changes at Birth 773
A Needle to the Chest 685
Clinical Note 21-9 Aging affects the blood, heart, and blood vessels 775
Abnormal Conditions Affecting Cardiac Output 708 Chapter Review 777
Spotlight
Congenital Heart Problems 774
Clinical Case
21 Blood Vessels Did Ancient Mummies Have Atherosclerosis? 724
and Circulation 723 Clinical Notes
Arteriosclerosis 728
An Introduction to Blood Vessels and Circulation 724 Edema 741
21-1 Arteries, arterioles, capillaries, venules, and veins differ
in size, structure, and functional properties 724
The Structure of Vessel Walls 725
Differences between Arteries and Veins 726
22 The Lymphatic System
Capillaries 729
and Immunity 781
Veins 732
An Introduction to the Lymphatic System
The Distribution of Blood 733
and Immunity 782
21-2 Pressure and resistance determine blood flow and
22-1 Surface barriers and internal defenses make up
affect rates of capillary exchange 734
innate defenses, and lymphocytes provide adaptive
Pressure 734 defenses 782
Total Peripheral Resistance 734
22-2 Lymphatic vessels, lymphocytes, lymphoid tissues, and
An Overview of Cardiovascular Pressures 736 lymphoid organs function in body defenses 783
Capillary Pressures and Capillary Exchange 739 Functions of the Lymphatic System 784
21-3 Cardiovascular regulatory mechanisms involve Lymphatic Vessels 784
autoregulation, neural mechanisms, and endocrine Lymphocytes 787
responses 742
Lymphoid Tissues 790
Autoregulation of Blood Flow within Tissues 742
Lymphoid Organs 790
Neural Mechanisms 743
The Lymphatic System and Body Defenses 794
Hormones and Cardiovascular Regulation 746
22-3 Innate (nonspecific) defenses do not discriminate
21-4 The cardiovascular system adapts to physiological between potential threats and respond the same
stress and maintains a special vascular supply to the regardless of the invader 796
brain, heart, and lungs 749
Physical Barriers 796
The Cardiovascular Response to Exercise 749
Phagocytes 796
xxii Contents

Immune Surveillance 798

Interferons 799 UNIT 5 ENVIRONMENTAL EXCHANGE
Complement System 799
Inflammation 801
Fever 802 23 The Respiratory System 830
22-4 Adaptive (specific) defenses respond to individual
threats and are either cell-mediated or antibody- An Introduction to the Respiratory System 831
mediated 802
23-1 The respiratory system, organized into an upper
Forms of Immunity 803
respiratory system and a lower respiratory system, has
Properties of Adaptive Immunity 804 several basic functions 831
An Introduction to the Immune Response 804 Functions of the Respiratory System 831
22-5 T cells play a role in initiating, maintaining, and Organization of the Respiratory System 832
controlling the immune response 805
23-2 Located outside the thoracic cavity, the upper
Antigen Presentation 805 respiratory system consists of the nose, nasal cavity,
Antigen Recognition 806 paranasal sinuses, and pharynx 835
Activation of CD8 T Cells 808 The Nose, Nasal Cavity, and Paranasal Sinuses 835
Activation of CD4 T Cells 809 The Pharynx 837
22-6 B cells respond to antigens by producing specific 23-3 Composed of cartilages, ligaments, and muscles, the
antibodies 810 larynx produces sound 837
B Cell Sensitization and Activation 810 Cartilages and Ligaments of the Larynx 837
Antibody Structure 811 Sound Production 838
Primary and Secondary Responses to Antigen The Laryngeal Musculature 839
Exposure 814
23-4 The trachea and primary bronchi convey air to and
Summary of the Immune Response 815 from the lungs 839
22-7 Immunocompetence enables a normal immune The Trachea 839
response; abnormal responses result in immune The Primary Bronchi 840
disorders 818
The Development of Immunocompetence 818
23-5 Enclosed by pleural cavities, the lungs are paired
organs containing alveoli, which permit gaseous
Cytokines of the Immune System 818 exchange 841
Immune Disorders 818 Lobes and Surfaces of the Lungs 841
Stress and the Immune Response 823 The Bronchi 841
22-8 The immune response diminishes as we age 825 The Bronchioles 841
22-9 The nervous and endocrine systems influence the Alveolar Ducts and Alveoli 843
immune response 825 The Blood Supply to the Lungs 846
Chapter Review 826 The Pleural Cavities and Pleural Membranes 846
Spotlight 23-6 External respiration and internal respiration allow
Cytokines of the Immune System 820 gaseous exchange within the body 847
Clinical Case 23-7 Pulmonary ventilation—the exchange of air between
Isn’t There a Vaccine for That? 782 the atmosphere and the lungs—involves pressure
Clinical Notes changes, muscle movement, and respiratory rates and
Cancer and the Lymphatic System 788 volumes 848
Graft Rejection and Immunosuppression 806 The Movement of Air 848
AIDS 819 Pressure Changes during Inhalation and Exhalation 849
The Mechanics of Breathing 852
Respiratory Rates and Volumes 854
23-8 Gas exchange depends on the partial pressures of
gases and the diffusion of molecules 856
The Gas Laws 856
Diffusion and Respiratory Function 858
 Contents xxiii

23-9 Most oxygen is transported bound to hemoglobin; 24-4 The esophagus is a muscular tube that transports
and carbon dioxide is transported in three ways: as solids and liquids from the pharynx to the
carbonic acid, bound to hemoglobin, or dissolved in stomach 895
plasma 860 Histology of the Esophagus 895
Oxygen Transport 860 Swallowing 896
Carbon Dioxide Transport 863
24-5 The stomach is a J-shaped organ that receives the
Summary: Gas Transport 864 bolus from the esophagus and aids in chemical and
23-10 Neurons in the medulla oblongata and pons, along mechanical digestion 897
with respiratory reflexes, control respiration 864 Anatomy of the Stomach 897
Local Regulation of Gas Transport and Alveolar Regulation of Gastric Activity 901
Function 865 Digestion and Absorption in the Stomach 901
The Respiratory Centers of the Brain 866
24-6 The small intestine digests and absorbs nutrients,
Respiratory Reflexes 870 and associated glandular organs assist with digestive
Voluntary Control of Respiration 872 processes 901
Changes in the Respiratory System at Birth 872 The Small Intestine 901
23-11 Respiratory performance declines with age 873 Histology of the Small Intestine 904
Intestinal Secretions 906
23-12 The respiratory system provides oxygen to, and
eliminates carbon dioxide from, other organ Intestinal Movements 907
systems 873 The Pancreas 907
Chapter Review 876 The Liver 909
Spotlights The Gallbladder 914
Respiratory Muscles and Pulmonary Ventilation 853 The Coordination of Secretion and Absorption 914
Control of Respiration 868 24-7 The large intestine is divided into three parts with
Clinical Case regional specialization 916
How Long Should a Cough Last? 831 The Cecum 917
Clinical Notes The Colon 917
Breakdown of the Respiratory Defense System 834 The Rectum 919
Pneumothorax 852 Histology of the Large Intestine 919
Decompression Sickness 858
Physiology of the Large Intestine 920
Blood Gas Analysis 860
Carbon Monoxide Poisoning 863 24-8 Digestion is the chemical alteration of food that allows
Emphysema and Lung Cancer 875 the absorption and use of nutrients 922
The Processing and Absorbing of Nutrients 922
Carbohydrate Digestion and Absorption 922

24 The Digestive System 880 Lipid Digestion and Absorption 925

Protein Digestion and Absorption 925
Water Absorption 926
An Introduction to the Digestive System 881
Ion Absorption 926
24-1 The digestive system, consisting of the digestive tract
and accessory organs, has overlapping food utilization 24-9 Many age-related changes affect digestion and
functions 881 absorption 928
Functions of the Digestive System 882 24-10 The digestive system is extensively integrated with
The Digestive Organs and the Peritoneum 883 other body systems 928
Histology of the Digestive Tract 885 Chapter Review 930
The Movement of Digestive Materials 886 Spotlights
Control of Digestive Functions 887 Regulation of Gastric Activity 902
Chemical Events of Digestion 923
24-2 The oral cavity contains the tongue, salivary glands,
Clinical Case
and teeth, each with specific functions 889
An Unusual Transplant 881
The Tongue 890
Clinical Notes
Salivary Glands 890
Peritonitis 883
The Teeth 892
Epithelial Renewal and Repair 886
24-3 The pharynx is a passageway between the oral cavity Mumps 890
and esophagus 894 Gastritis and Peptic Ulcers 897
xxiv Contents

Pancreatitis 907 Dietary Fats and Cholesterol 951

Cirrhosis 909 Vitamins 960
Colorectal Cancer 917 Alcohol 962
Inflammatory and Infectious Disorders of the Digestive System 920 Induced Hypothermia 965
Thermoregulatory Disorders 967

25 Metabolism and
Energetics 935 26 The Urinary System 972

An Introduction to Metabolism and Energetics 936 An Introduction to the Urinary System 973

25-1 Metabolism refers to all the chemical reactions 26-1 The kidneys, ureters, urinary bladder, and urethra
in the body, and energetics refers to the flow and make up the urinary system, which has three primary
transformation of energy 936 functions 973

25-2 Carbohydrate metabolism involves glycolysis, ATP 26-2 Kidneys are highly vascular organs containing
production, and gluconeogenesis 939 functional units called nephrons, which filter, reabsorb,
and secrete 974
Glycolysis 939
Sectional Anatomy of the Kidneys 975
Mitochondrial ATP Production 939
Blood Supply and Innervation of the Kidneys 976
Energy Yield of Glycolysis and Cellular Respiration 945
The Nephron 978
Gluconeogenesis 946
26-3 Different segments of the nephron form urine by
25-3 Lipid metabolism involves lipolysis, beta-oxidation,
filtration, reabsorption, and secretion 983
and the transport and distribution of lipids as free fatty
acids and lipoproteins 947 Basic Processes of Urine Formation 983
Lipid Catabolism 947 26-4 Hydrostatic and colloid osmotic pressures influence
Lipid Synthesis 949 glomerular filtration pressure, which in turn affects the
glomerular filtration rate 987
Lipid Transport and Distribution 949
Filtration Pressures 988
25-4 Protein catabolism involves transamination and
The Glomerular Filtration Rate 989
deamination, whereas protein synthesis involves
amination and transamination 952 Control of the GFR 989
Amino Acid Catabolism 952 26-5 Countercurrent multiplication, antidiuretic
Protein Synthesis 952 hormone, and aldosterone affect reabsorption and
secretion 992
25-5 The body experiences two patterns of metabolic
Reabsorption and Secretion at the PCT 992
activity: the absorptive and postabsorptive
states 956 The Nephron Loop and Countercurrent
Multiplication 993
25-6 Adequate nutrition is necessary to prevent deficiency Reabsorption and Secretion at the DCT 996
disorders and ensure physiological functioning 957
Reabsorption and Secretion along the Collecting
Food Groups and a Balanced Diet 957 System 997
Nitrogen Balance 957 The Control of Urine Volume and Osmotic
Minerals 959 Concentration 997
Vitamins 960 The Function of the Vasa Recta 1001
Diet and Disease 961 The Composition of Normal Urine 1001
25-7 Metabolic rate is the average caloric expenditure, and 26-6 Urine is transported by the ureters, stored in the
thermoregulation involves balancing heat-producing bladder, and eliminated through the urethra, aided by
and heat-losing mechanisms 962 the micturition reflex 1004
Energy Gains and Losses 962 The Ureters 1005
Thermoregulation 964 The Urethra 1006
Chapter Review 969 The Micturition Reflex and Urination 1007
Spotlight 26-7 Age-related changes affect kidney function and the
Absorptive and Postabsorptive States 954 micturition reflex 1009
Clinical Case 26-8 The urinary system is one of several body systems
The Miracle Supplement 936 involved in waste excretion 1011
Clinical Notes
Carbohydrate Loading 947
 Contents xxv

Chapter Review 1011 Metabolic Acidosis 1041

Spotlight Metabolic Alkalosis 1043
Summary of Renal Function 1002 The Detection of Acidosis and Alkalosis 1043
Clinical Case 27-7 Aging affects several aspects of fluid, electrolyte, and
A Case of “Hidden” Bleeding 973 acid–base balance 1045
Clinical Notes Chapter Review 1046
Analysis of Renal Blood Flow 977 Spotlight
Glomerulonephritis 982 The Diagnosis of Acid–Base Disorders 1044
Diuretics 997
Urinary Obstruction 1008
Clinical Case
Renal Failure and Kidney Transplant 1009 When Treatment Makes You Worse 1016
Clinical Notes
Water and Weight Loss 1023
Athletes and Salt Loss 1027
27 Fluid, Electrolyte, and
Acid–Base Balance 1015
UNIT 6 CONTINUITY OF LIFE
An Introduction to Fluid, Electrolyte, and Acid–Base
Balance 1016
27-1 Fluid balance, electrolyte balance, and acid–
base balance are interrelated and essential to
28 The Reproductive
homeostasis 1016 System 1050
27-2 The ECF and ICF make up the fluid compartments,
which also contain cations and anions 1017 An Introduction to the Reproductive System 1051
The ECF and the ICF 1017 28-1 Basic reproductive system structures are gonads,
Basic Concepts in the Regulation of Fluids and ducts, accessory glands and organs, and external
Electrolytes 1019 genitalia 1051
An Overview of the Primary Regulatory Hormones 1020 28-2 Spermatogenesis occurs in the testes, and hormones
The Interplay between Fluid Balance and Electrolyte from the hypothalamus, anterior lobe of the
Balance 1021 pituitary gland, and testes control male reproductive
functions 1052
27-3 Hydrostatic and osmotic pressures regulate the
The Testes 1052
movement of water and electrolytes to maintain fluid
balance 1021 Spermatogenesis 1056
Fluid Movement within the ECF 1021 Mitosis and Meiosis 1056
Fluid Gains and Losses 1022 The Anatomy of a Spermatozoon 1060
Fluid Shifts 1022 The Male Reproductive Tract 1061
The Accessory Glands 1062
27-4 Sodium, potassium, calcium, magnesium, phosphate,
and chloride balance is essential for maintaining Semen 1064
homeostasis 1024 The External Genitalia 1064
Sodium Balance 1025 Hormones and Male Reproductive Function 1066
Potassium Balance 1027 28-3 Oogenesis occurs in the ovaries, and hormones
Balance of Other Electrolytes 1028 from the pituitary gland and gonads control female
reproductive functions 1068
27-5 In acid–base balance, regulation of hydrogen ions in
body fluids involves buffer systems and respiratory The Ovaries 1069
and renal compensatory mechanisms 1030 The Uterine Tubes 1074
The Importance of pH Control 1030 The Uterus 1075
Types of Acids in the Body 1030 The Vagina 1079
Mechanisms of pH Control 1032 The External Genitalia 1080
Maintenance of Acid–Base Balance 1035 The Mammary Glands 1081
Hormones and Female Reproductive Function 1081
27-6 Respiratory acidosis/alkalosis and metabolic
acidosis/alkalosis are classes of acid–base balance 28-4 The autonomic nervous system influences male and
disturbances 1038 female sexual function 1087
Respiratory Acidosis 1038 Male Sexual Function 1087
Respiratory Alkalosis 1041 Female Sexual Function 1088
xxvi Contents

28-5 With age, decreasing levels of reproductive hormones the uterus undergoes structural and functional
cause functional changes 1088 changes 1112
Menopause 1088 Pregnancy and Maternal Systems 1112
The Male Climacteric 1089 Structural and Functional Changes in the Uterus 1114
28-6 The reproductive system secretes hormones affecting 29-6 Labor consists of the dilation, expulsion, and placental
growth and metabolism of all body systems 1089 stages 1115
Chapter Review 1092 Stages of Labor 1115
Spotlights Premature Labor 1117
Regulation of Male Reproduction 1067 Difficult Deliveries 1117
Regulation of Female Reproduction 1084 Multiple Births 1117
Clinical Case 29-7 Postnatal stages are the neonatal period, infancy,
A Post-Game Mystery 1051 childhood, adolescence, and maturity, followed by
Clinical Notes senescence 1118
Dehydroepiandrosterone (DHEA) 1066 The Neonatal Period, Infancy, and Childhood 1118
Prostatic Hypertrophy and Prostate Cancer 1068 Adolescence and Maturity 1120
Ovarian Cancer 1074 Senescence 1122
Cervical Cancer 1075
Breast Cancer 1083 29-8 Genes and chromosomes determine patterns of
inheritance 1122
Patterns of Inheritance 1123
Sources of Individual Variation 1126
29 Development and Sex-Linked Inheritance 1128
Inheritance 1095 The Human Genome Project and Beyond 1129
Chapter Review 1131
An Introduction to Development and Inheritance 1096 Spotlight
29-1 Development, marked by various stages, is a Extraembryonic Membranes and Placenta Formation 1104
continuous process that occurs from fertilization to Clinical Case
maturity 1096 The Twins That Looked Nothing Alike 1096
29-2 Fertilization—the fusion of a secondary oocyte and a Clinical Notes
spermatozoon—forms a zygote 1097 Abortion 1114
The Oocyte at Ovulation 1097 Chromosomal Abnormalities and Genetic Analysis 1130
Oocyte Activation 1099
29-3 Gestation consists of three stages of prenatal Appendix
development: the first, second, and third The Composition of Minor Body Fluids A-1
trimesters 1099 The Chemistry of Blood, Cerebrospinal Fluid, and Urine A-2
The Periodic Table A-3
29-4 Cleavage, implantation, placentation, and
Codon Chart A-4
embryogenesis are critical events of the first
trimester 1100 Answers to Checkpoints, End-of-Chapter Questions,
Cleavage and Blastocyst Formation 1101 and Clinical Case Wrap-Ups AN-1
Implantation 1101
Glossary G-1
Placentation 1106
Embryogenesis 1107 Credits C-1
29-5 During the second and third trimesters, maternal Index I-1
organ systems support the developing fetus, and
Another random document with
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 print, and yet we had to send to England for paper to do the
job. Also all the pronunciation marks for Webster’s dictionary
were to be put in, and we did not have the type or the
matrices. I had to have the letters cut on wood, and matrices
made; this was a world of trouble. Some of the letters were
cut over half-a-dozen times or more, and after all they were
far from perfect. I also had a set of shaped music types cut,
and this took a deal of time and pains to get them all properly
cut, as also to get the matrices made. I finally succeeded
quite well in both respects.... I also experimented not a little in
stereotyping, and succeeded in doing fair work. I trained one
boy who stereotyped Matthew before I left. In order to carry it
on effectually and rapidly I had a furnace and press made and
fitted up, which after sundry changes worked very well.... I
also had a new style of case for Chinese type made, which I
think will be an improvement on the old. I also had a complete
and thorough overhauling of the matrices, reassorted them
all, and had new cases made. This was a serious job, but it
will I am sure prove a very great help to the efficient working
of the establishment.

He consented to manage the press only until a competent man

could be secured to take it off his hands. When casting about for
such a person, his mind had been directed to his brother John,
nearly a year before he was himself forced into this position. John
had hoped to go to college, and to prepare for the ministry, and to go
out as a missionary, but, on account of certain tendencies developed
as to his health, he was compelled to abandon his purpose. As to his
mechanical gifts and his ability to turn them into use in a great
variety of ways, he resembled Calvin; and the latter was so confident
that John could soon fit himself to be a competent superintendent of
the press at Shanghai that he advised the Board of Missions to make
inquiry in regard to him. The result was that eventually he was
selected for the place, and he arrived in China early in August, 1871.
Before he could satisfactorily enter on his duties it was necessary for
him to acquire some knowledge of the language and to acquaint
himself with the business committed to his charge. This detained
Calvin until late in that year; and after a period of some three months
spent at Tengchow, he returned to Shanghai to assist John in moving
the press to new and much better premises that had been
purchased. The moving proper was a heavy job, requiring a week of
hard, dirty labor. The distance was about a mile, mostly by water, but
by land a hundred or more yards at either end. While thus engaged,
although he was no longer officially at the head of the business, he
took the main charge, so as to allow his brother to give his time
chiefly to the acquisition of the language and to other things that he
needed to learn.
The new place is the same now occupied by the press in Peking
Road. Under the superintendency of Rev. G. F. Fitch, it has become
the center not only of the Presbyterian missions, but of the general
missionary activity all over China. In writing to his brother as early as
November, 1869, he said of this plant: “It is a very important place,
and would give you an extensive field for doing good. The
establishment is not very large, it is true, as compared with similar
establishments in such cities as New York or Philadelphia; yet it is
the largest and best of the kind in China. It not only does all the
printing for all our missionaries, but a great deal of job work for
others; besides making and selling a large amount of type.” After he
had completed his term of the management, and while helping John
to get into the traces, he wrote to one of the secretaries of the Board:

I am not in favor of enlargement, but I would be very sorry

to see the present efficiency of the press curtailed. It is doing
a great and a good work not only for our missions, but for all
China. It has exerted a prodigious collateral influence both in
China and in Japan, affording facilities for the production of all
kinds of scientific books, dictionaries, and so forth. Aside from
any general interest in the missionary work, having at no
small sacrifice left my proper work and given more than a
year to the press, and also having a brother here in charge of
it, I feel a lively interest in its future.
 The last record that has come down to us concerning his work
there is: “We have just sold to the Chinese government a large font
of Chinese type. They are going to use movable metal type. This is a
large step for them to take, and it will do good. China yields slowly,
but she is bound to yield to Christianity and Christian civilization.”
At no subsequent period of his life had he any part in the
management of a printing establishment, but indirectly he continued
to have much to do with the press. He was a member of a joint
committee of the Shantung and the Peking mission, in charge of
publications, and as such he had to acquaint himself with what was
needed, and with what was offered, so as to pass intelligent
judgment. Unofficially and as a friend whose aid was solicited, he
revised one or more of the books which his associates submitted to
him for criticism. At the General Conference of Missionaries, held at
Shanghai in 1877, a committee, of which he was a member, was
appointed to take steps to secure the preparation of a series of
schoolbooks for use in mission schools. Not long afterward he
published an elaborate paper on the subject, discussing in it the
character which such publications should have, and especially
calling attention to the need of peculiar care as to the Chinese words
which ought to be employed in the treatises on the sciences. That
committee diligently set itself to work, and initiated measures for a
rather comprehensive set of books by various missionaries to meet
the want recognized in this general field. He was himself called upon
to prepare several books, some of which he was willing to undertake;
others he put aside as not properly falling to him. In one or two
instances he claimed for himself precedence as to treatises
suggested for others to write. Some friction occurred, and when the
Conference met again in 1890 that committee was discharged, and
an Educational Association, composed of missionaries familiar with
the needs of schools, and confining its functions more exclusively to
the publication of books for teaching—largely under his leadership—
was formed. He was its first chairman. This change he had warmly
favored, and he was an active member of the Association. In it he
was chairman of a committee on scientific terms in Chinese, a
subject of great difficulty, and of prime importance in the preparation
of text-books. In the subsequent years he was so much occupied
with the revision of the Mandarin Bible, and with other duties, that he
could give to the technical terms only a secondary place in his
activities. Still, six years after he accepted this chairmanship he
says: “I have collected a large number of lists of subjects for terms in
chemistry, physics, mathematics, astronomy, geology, metallurgy,
photography, watch-making, machinery, printing, music, mental and
moral philosophy, political economy, theology, and so forth.”
Subsequently he continued this work.
The first literary production of his own pen in Chinese was a tract
on infant baptism; this was called forth by local conditions at
Tengchow. A small sheet tract, entitled “A Prayer in Mandarin,” also
followed early. As chairman of the committee appointed by the
Educational Association, he made a report on chemical terms, and
recommended a new and distinctively Chinese method for the
symbols in that science. This was printed.
In a preliminary report of the Shanghai press, made in September,
1871, he, in a list of books in course of preparation, mentions under
his own name as author the following: “1. Catechism on Genesis,
with answers to the more difficult questions,—finished, needing only
a slight revision. 2. An explanation of the moral law as contained in
the ten commandments,—half-finished. 3. Scripture Text-Book and
Treasury, being Scripture references by subjects, supplying in great
part the place of a concordance,—one-third finished.” All of these
had been under way for several years, but had been frequently
shunted off the track by other imperative work. Very soon after that
date the catechism was published. He had a good deal to do with
Julia’s “Music Book,” especially in coining appropriate terminology,
though he never claimed joint authorship in it. Along with Dr. Nevius,
he published a hymn book for use in Chinese services; and down to
the close of his life, especially on a Sabbath when he did not preach,
he now and then made an additional Chinese version of a hymn. In
fact, whenever he heard a new hymn that especially moved him he
wished to enrich the native collection by a translation of it into their
speech. One which the Chinese came greatly to like was his
rendering of the Huguenot song, “My Lord and I.” A subject that was
always dominant in his mind and heart was the call to the ministry,
and it was significant that one of the last things on which he worked
was a translation of the hymn which has the refrain, “Here am I, send
me.” It was not quite finished when his illness compelled him to lay
down his pen; but recently at a meeting of the Chinese student
volunteers, constituting a company rising well toward one hundred
and fifty, that hymn was printed on cards, and a copy was given to
each of these candidates for the ministry. In 1907 he had carried a
theological class through the Westminster Shorter Catechism, and
as an outcome his translation was published. This is the last
religious book he made in Chinese. During his long service as a
missionary he taught a number of theological classes in various
studies, and his lectures were regarded as very superior, but he
published none of them.
His schoolbooks all originated in the necessities of his own work
as a teacher. The first thus to force itself upon his attention was an
arithmetic. He was already at work on it in 1868, and it went to press
while his brother John was superintending the plant at Shanghai.
The preparation of such a book, to one unacquainted with the
conditions under which this one was made, may seem to have been
a rather easy undertaking, and to have required little more than a
sufficient mastery of the Chinese language and of English; yet there
were some perplexing questions that arose in connection with it. For
instance, the method of writing numbers horizontally was wholly
unknown to the Chinese. Should the new arithmetic use the western,
or should it retain the Chinese method? To retain the Chinese would
be to train the pupils in a usage that would be confusing in
subsequent reading of western mathematics; to abandon it would be
equally confusing in printing the text of the book, which, according to
Chinese usage, must be arranged perpendicularly. The difficulty was
gotten over by duplicating each pattern example, giving it once
horizontally and once perpendicularly. Pupils using the book were
permitted to take their choice in performing their work, but in the text
proper all numbers appeared vertically. Such lines as those dividing
the numerator and denominator of a fraction stood perpendicularly,
with the figures to the right and the left. Until he published his
arithmetic, the Chinese numerals had been employed; he introduced
the Arabic. At the dawn of the new era subsequent to the Boxer
outbreak, almost the first book in demand by Chinese teachers and
pupils outside the mission schools was a western arithmetic; and
among others put upon the market were many “pirated” editions of
Mateer’s book, printed on cheap paper and with wooden blocks. The
publishers had not yet learned the significance of “copyright.” The
circulation of the book, however brought about, had at least the
effect of immediately increasing the reputation of its author among
the scholarly classes outside the church. Of the editions issued by
the press at Shanghai tens of thousands of copies have been sold.
Dr. Fitch writes that “it is impossible to state the total number,” and
that “the book has gone into all parts of the empire.”
In October, 1884, he submitted to the schoolbook committee of the
Educational Association the manuscript of his geometry, and in doing
so he said of it:

It is the result of much pains and labor.... The book is

written in plain Wen-li, and much pains has been taken to
make it smooth in style and accurate in meaning. In the few
equations used I have introduced the mathematical signs
employed in the West, of which I have given a full explanation
in the beginning of the book.... Mathematical signs and
symbols are a species of universal language, used alike by all
civilized nations, and it is unwise to change them until it is
absolutely necessary. The young men who have given most
effective assistance in the preparation of this geometry are
decided in their opinion that we should not change or garble
the mathematical symbolism of the West, but give it to them in
its integrity. The only change made is in writing equations
perpendicularly instead of horizontally,—a change which is
necessitated by the form of Chinese writing.

The book was published the following year. To the same

committee he reports in March, 1882, that his algebra was then all in
manuscript, and only needing revision and some rearrangement
before printing. The geometry was followed by his algebra, first part.
These have had a large sale, though, because fewer studied this
branch, not the equal of the arithmetic.
On January 14, 1908, he sent to the manager of the press the
preface to the second volume of his algebra, which covers the same
ground as the “University” edition in the United States. Of this Dr.
Hayes says: “Over twenty years ago he began the preparation of
Part II of his algebra, and the draft then made was used in
manuscript for many years. Other duties pressed upon him, and he
was compelled to lay it away unfinished. Yet he had not forgotten it,
but from time to time he would make a step in advance. It was only a
few months before his death that the work was completed and
published.”
There were a number of other books which he planned, on some
of which he did considerable work, but none of which he completed.
One of these was so colossal in its projected scope and scholarship
that it deserves special notice because indicative of the large things
to which early in his missionary career he was already eager to give
his time and abilities. This was a Mandarin dictionary. In its
preparation he sought to associate with himself Rev. Chauncey
Goodrich, of Peking; and in writing to him under date of June 6,
1874, he thus stated his conception of the work:

My idea of the book is a dictionary of the spoken language

of north China, in all its length and breadth, including on the
one hand all the colloquialisms that the people use in
everyday life,—all they use in Chi-li and in Shantung, and in
all the Mandarin-speaking provinces, so far as we can get it,
noting, of course, as such, the words and phrases we know to
be local. Further, let it include as a prominent feature all sorts
of ready-made idiomatic phrases, and in general all
combinations of two or more characters in which the meaning
coalesces, or varies from the simple rendering of the separate
characters.

Considerable preliminary work had already been done, when the

death of Mrs. Goodrich compelled her husband to withdraw from the
partnership; and the project was abandoned by Mateer, though with
a hope that it might be resumed. In 1900, however, as the fruit of this
and kindred studies he published an analysis of two thousand one
hundred and eighteen Chinese characters. This little book was
designed to help children in dictation exercises to write characters,
and is still largely used for this purpose by mission schools. The
huge dictionary, though never completed, had three direct
descendants. With Dr. Goodrich it produced first a Chinese phrase
book, and then a pocket Chinese-English dictionary, which for brevity
and comprehensiveness is a marvel, and which is regarded by
almost every student of Chinese as a necessity. In marked contrast
with these two volumes is an immense dictionary left behind in
manuscript by Dr. Mateer. It is wholly in Chinese; and as it lies
unfinished it occupies more than a cubic foot of space, and consists
of a set of volumes. No comprehensive dictionary of the Chinese
language has been published for two hundred and fifty years, and
the last issued had been mainly classical. The object of this was to
supply the evident need of a great new work of that sort. One
insurmountable difficulty encountered was a phonetic arrangement
commanding common usage. None had the requisite approval.
Fortunately, on this undertaking Dr. Mateer did not spend his own
time, except so far as that was necessary to direct the preparation of
it by his scribes when they were not otherwise employed.
In his letter to his college classmates in 1897 he says that he has
“well in hand a work on electricity, and one on homiletics prepared
when teaching theology.” Neither of these was finished and
published. To his college classmate, S. C. T. Dodd, Esq., he wrote in
1898 that he was trying also to finish a work on moral philosophy. In
March, 1878, he wrote to Dr. W. A. P. Martin, of Peking: “You will
remember probably that when you were here I spoke of my intention
to make a natural philosophy by and by. You said, ‘Go ahead,’ and
that you would retire in my favor by the time mine was ready, say, ten
years hence. If I am spared I hope to have the book ready within the
time, if not sooner. As you know, natural philosophy is my hobby, and
I have taught it more thoroughly probably than has been done in any
other school in China. I intend when I visit America to prepare myself
with the material and the facilities for such work.” He was not able to
find time for this work; and when later Dr. Martin invited him to write
for the revised edition of his treatise the chapter on electricity, this
privilege had for the same reason to be put aside. He had also
advanced far toward the completion of a translation of “Pilgrim’s
Progress” into Mandarin.
His “Mandarin Lessons” was published early in 1892, and
immediately commanded a success even larger than its author may
have anticipated. Ever since, it has gone on toward a more general
use by foreigners wishing to master the language, and has now far
outstripped every other work of its kind. He was a quarter of a
century in making the book. June 28, 1873, he made the following
entry in his Journal concerning it:

Most of last week and this I have spent in making lessons

and planning a much larger number than I have made. Mr.
Mills urged me to work at them for Dr. ⸺’s benefit, as he did
not seem to take hold of Wade. I did not think of what a job I
was sliding into when I made three lessons for Maggie a few
years ago. I have now laid out quite an extensive plan, and if I
am spared I trust I shall be able to finish it, though it will take
a deal of work. I believe that I can produce a far better book
than any that has yet been brought forth. I was not intending
to do this work now, and cannot work much more at it, as
other matters imperatively demand attention.

Guided by the hint in this quotation, we are able to trace the book
still farther back to its very beginning. June 20, 1867, he said in his
Journal: “Maggie Brown [Julia’s sister] has been pushing on pretty
lively with the Chinese. I made her lessons for a good while, which
she studies, and now she is reading ‘The Peep of Day.’ I tried to
make her lessons with a view to bringing out the peculiarities of
Chinese idiom. It led me to a good deal of thinking and investigating.
I have a mind to review and complete the work, and may some day
give it to the world. My great difficulty is in classifying the results
attained.”
 As the years went by his ideas of the plan for the work took
definite shape. In one of his letters concerning it he wrote:

Each lesson illustrates an idiom, the word idiom being

taken with some latitude. The sentences, as you will see, are
gathered from all quarters, and introduce every variety of
subjects. I have also introduced every variety of style that can
be called Mandarin, the higher style being found chiefly in the
second hundred lessons. The prevailing object, however, is to
help people to learn Mandarin as it is spoken. I have tried to
avoid distinct localisms, but not colloquialisms. A large
acquaintance with these is important, not to say essential, to
every really good speaker of Mandarin. It is, of course,
possible to avoid the most of them, and to learn to use a
narrow range of general Mandarin which never leaves the
dead level of commonplace expressions, except to introduce
some stilted book phrase. This, however, is not what the
Chinese themselves do, nor is it what foreigners should seek
to acquire. Many colloquialisms are very widely used, and
they serve to give force and variety to the language,
expressing in many instances what cannot be expressed in
any other way. I have tried to represent all quarters, and in
order to do so I have in many cases given two or more forms.

In the pursuit of his plan he sought the aid of competent scholars

in the north and in central China, so as to learn the colloquialisms
and the usage of words; also in the preparation of a syllabary of the
sounds of characters as heard in each of the large centers where
foreigners are resident. To accomplish this he also traveled widely.
Late in 1889, after a summer spent in studying the dialects of China,
he, in company with Julia, made a three months’ trip to the region of
the Yangtse, going down on the Grand Canal, spending a month on
the great river, and remaining a month at Nanking; always with the
main purpose of informing himself as to the current Mandarin, so as
to perfect his book. This tour enabled him to give it the final revision;
and in his opinion it “more than doubled the value” of the “Lessons.”
As finished, they were a huge quarto of six hundred pages, which
with the help of Mrs. Julia Mateer he saw through the press down at
Shanghai. In 1901, assisted by Mrs. Ada Mateer, he issued a more
elementary work of the same general nature.
The protracted study and care which he put upon the “Lessons”
were characteristic of him in all his literary productions. Upon this
subject no one is better qualified to bear testimony than is Dr.
George F. Fitch, Superintendent of the Presbyterian Mission Press,
at Shanghai, who speaks from direct personal observation. He says:

One very marked characteristic of Dr. Mateer was the

almost extreme painstaking with which he went over any work
which he was getting ready for publication; revising and re-
revising, seeking the judgment of others, and then waiting to
see if possibly new light might dawn upon the subject. I
remember reading shortly after I came to China the
manuscript of a paper which he had prepared with great labor,
upon the much-mooted “term question”; and in which he had
collected, with infinite pains, seemingly a great number of
quotations from the Chinese classics and other native works,
bearing on the use of Shen as the proper word for God in
Chinese. I urged him to publish at once, as I thought it might
be useful in helping settle that question. But he stoutly
refused, saying that it was not yet complete. Nor did it finally
see the light, in print, until nearly twenty years afterward.

None of his books at all reveal the protracted and toilsome

process of the preparation. We see only the result of years of
research. For instance, in his library there was a long row of Chinese
books each one of which showed a large number of little white slips
at the top. Each one of this multitude of marks had been placed
there by some student whom he had employed respectively to read
works in Chinese likely to use the word Shen, in order to indicate the
passages at which he needed to look. All these were canvassed,
and the different shades of meaning were classified.
 From the “Mandarin Lessons,” and recently from the arithmetic, he
received substantial pecuniary returns, though not at all sufficient to
entitle him to be regarded as wealthy. In his manner of living he
would have been untrue to his training and impulses if he had not
practiced frugality, economy, and simplicity. As the means came into
his possession he used them generously both for personal friends
and for the promotion of the cause to which he had consecrated his
life. Of his outlays for the school and college we shall presently need
to speak. The expenses of the Yangtse trip came out of his own
pocket. March 9, 1895, he wrote to one of the secretaries of the
Board:

The mission minutes spoke, if you remember, of my

intention to erect a building for a museum and public lecture
room, and present it to the Board. This I intend to do at once.
It will cost about twelve hundred dollars, possibly more. I may
say in the same connection also that my “Mandarin Lessons”
has fully paid all the cost of printing, and so forth, and I expect
during the next year to pay into the treasury of the Board one
thousand dollars, Mexican. This I do in view of the liberality of
the Board in giving me my time while editing and printing the
book. When the second edition is printed I expect to pay over
a larger amount. I need not say that I feel very much gratified
that the book has proved such a success: especially do I feel
that it has been, and is going to be, very widely useful in
assisting missionaries to acquire the Chinese language. My
scientific books are also paying for themselves, but as yet
have left no margin of profits.

May 20, 1905, he wrote to a secretary: “I may say, however, that in

view of the great importance of the school both to the Tengchow
station and as a feeder to the college at Wei Hsien, I have set apart
from the profit of my ‘Mandarin Lessons’ enough to support the
school for the present year.” December 13, 1906, he wrote to a
friend in the United States: “My brother is now holding a large
meeting of elders and leading men from all the stations in this field.
There are about three hundred of them. It is no small expense to
board and lodge so many for ten days. I am paying the bill.” In one of
his latest letters to me he mentions this ability pecuniarily to help as
affording him satisfaction.
 X
THE CARE OF THE NATIVE CHRISTIANS

“The need of the hour in China is not more new stations with expensive
buildings and wide itinerating. It is rather teaching and training what
we have, and giving it a proper development. Most of all we should
raise up and prepare pastors and preachers and teachers, who are
well grounded in the truth, so that the Chinese Church may have wise
and safe leaders.... There are already enough mission stations, or
centers, in the province, if they were properly worked. The need of the
hour is to consolidate and develop what we have, and by all means in
our power develop native agency, and teach and locate native
pastors,—men who are well grounded in the faith.”—letter to
secretary fox, of the American Bible Society, January 6, 1906.

Dr. Mateer believed that sooner than most missionaries

anticipated the Chinese Christians will join together and set up an
independent church. He meant by this not merely a union of the
ministers and churches of the various Presbyterian denominations at
work in the country, such as has already been effected, but an
organization that would include in its membership all the Protestant
Christians, and that would leave little or no place for the service of
foreign missionaries. He regarded this as inevitable; and for that
reason he considered it to be of prime importance that such an
effective preliminary work should promptly be done, that this coming
ecclesiastical independence might not be attended by unsoundness
as to creed or laxity in life. At the same time, in holding up the care
and the training of the native Christians as so important a part of the
work of the foreign missionary in China, in anticipation of what is
ahead, he was only for an additional reason urging what he had in all
his long career recognized as second to no other in importance. Of
course, at the beginning of the effort to give the gospel to a people it
is indispensable to do “the work of an evangelist”; that is, to seek by
the spoken word and by the printed book to acquaint them with
elementary Christian truth, and to endeavor to win them to Christ;
and we have already seen how diligent Dr. Mateer was in this
service, especially in his earlier missionary years. But he was just as
diligent in caring for the converts when gained; and in the school and
college it was the preparation of men for pastors and teachers and
evangelists that was constantly his chief aim.
The first body of native Christians with whose oversight he had
anything to do was that very small band that had been gathered into
the church at Tengchow. Mills was the senior missionary, and as
such he presided over that little flock until his death. In 1867 he was
installed as the pastor, and he continued in this office nearly twenty
years. During this long period Dr. Mateer at times supplied the pulpit
and cared for the church in Mills’s absence or illness, but for most of
the time it was only as a sort of adviser that he could render help in
that field. We have no reason to think specially unfavorably of
Chinese converts because some of those with whom he then had to
do at Tengchow, or elsewhere, proved themselves, to him, to be a
discouraging set of professing Christians. Were not a good many of
Paul’s converts very much of the same grade when he traveled
among the churches, and wrote his letters? Did it not take much
patience, and fidelity, and persistence on the part of Christ to make
anything worth while out of his select disciples? Yet these constituted
the membership of the primitive church from which even the
missionaries of our day have originated. At any rate some of the
earliest experiences of Dr. Mateer with the native Christians were of
a very depressing sort. In his Journal, under date of March 17, 1864,
he made this record:

Since coming to Tengchow there have been great

difficulties in the native church. Several of the members were
accused by common fame of various immoral practices,—one
of smoking opium, another of lying and conforming to
idolatrous practices, and another of breaking the Sabbath.
The second of these confessed his fault, and was publicly
reproved; the third also confessed, and on his profession of
penitence was restored to the confidence of the church. But
 though the first confessed to the use of the ashes of opium,
he gave no certain assurance of amendment; and he was
suspended, and so remains. These matters gave us all a
great deal of anxiety and sorrow of heart. It is sad thus to find
that even those who profess the name of Christ are so much
under the power of sin. It is one of the great discouragements
of the missionary work. Yet God is able to keep even such
weak ones as these unto eternal life.

Under date of September 15, 1866, he told of a worse case of

discipline:

We had a hearing with the accused, and gave him notice

that he would be tried, and of the charges and witnesses. We
wrote to Mr. Corbett at Chefoo, to get depositions for us. He
did so, and we met, and tried him. The evidence was
sufficient to convict him of lying, and of forging an account,
and of adultery; notwithstanding, he denied it all, endeavoring
to explain away such evidence as he was forced to admit. We
decided to excommunicate him, and it was done two weeks
ago.

It must not be supposed that there was a great deal of such

discouraging work; as a rule, the native Christians tried to live correct
lives; and the worst that could be said of most of them at those early
dates was that they were “babes” in Christ. But we cannot appreciate
what the missionary needs to do as to the professed converts unless
we look at this depressing phase. Besides, incidentally we are thus
shown one of the methods by which the native Christians were
trained in the conduct of their own churches. Each case is dealt with
just as is required by the regulations of the denomination with which
the church is associated. The same formalities and processes are
employed as if in the United States; the same fairness and fullness
of investigation, with witnesses and hearing of the accused; and the
same effort neither to fall below nor to exceed what justice and
charity combined demand for the good of the individual and of the
organization as a whole. As to this, in these particular cases no
exceptional credit can be claimed for Dr. Mateer; but we can be
perfectly sure that it commanded his hearty approbation. This was a
practical school also in which was called into exercise a quality of
which a young missionary, and especially a man of his type, seldom
has enough,—that of mingling a firm adherence to truth and
righteousness with a forbearing kindness that will not break a
bruised reed or quench the smoking flax. Gradually this became so
characteristic of him that the boys in his school and the Christians in
the churches were accustomed to come to him and unburden
themselves not only of sorrows, but of faults, with no expectation that
he would condone wrong or shield them from its just consequences,
but confident that he would feel for them, and help them if he could.
Nor was it to these classes alone that his heart and hands opened.
As they came to know him better, the professor in the imperial
university sought his advice and the coolie turned to him in his need;
and never in vain.
But there was a brighter side to the experience of those early
days. Several of the boys in the school were converted. What joy this
afforded, we who live in Christian lands cannot appreciate. The little
church at Tengchow also steadily moved forward in those early days
of its history. In 1869 it had risen to about fifty members, and the
attendance was such that a building solely for its services became
indispensable; and in due time an appropriation was made by the
Board of Missions, first for a lot, and soon after for a house of
worship. Pastor Mills was then absent, and by appointment of
presbytery Dr. Mateer acted as stated supply. As such, having first
bought the lot, he made an appeal to the Board for the new edifice,
saying:

We hold our services in the boys’ schoolroom, which has

been kept inconveniently large, for this very purpose. It is the
only room that will seat all, and it will not do it sometimes. The
desks have to be carried out every Sabbath; and all the
benches, chairs, and so forth, about the establishment carried
in, making a decidedly nondescript collection. Aside from the
 inconvenience, two serious drawbacks are felt. One is the
want of sacred associations about the place. All heathen are
wanting in reverence, and no small part of what they need is
to have this idea instilled into their minds. We greatly need in
this work a house especially devoted to the worship of God.
The other drawback is the disorganizing effect the Sabbath
and week-day services have on the school. The room being in
the midst of the premises, it is impossible to prevent a large
amount of lounging, gossiping, and so forth, in the boys’ room
before the service begins. The superintendent feels that it is a
very serious drawback to the school, as well as an injury to
the native Christians.

Any American who is familiar with students and their habits will
perceive that in this matter Chinese young men and boys are very
much like those of our own land.
In that appeal there is another paragraph that deserves
transcription here:

It has been said that the Christians in heathen lands ought

to build their own churches, but this is impossible in the early
stages of the work, especially at the center of operations,
where the foreigner preaches and teaches in person, and
where a large part of his hearers are often from a distance.
The church at this place gives character to the whole work in
the eyes of the people at large, and must of necessity differ in
many respects from churches in small places presided over
by native pastors. Concerning these last we have already
taken a decided stand, requiring the natives to help
themselves to a great extent.

Dr. Mateer was appointed by the presbytery to serve a second

year as stated supply of the Tengchow church; and had it not been
that he was called in 1870 to Shanghai to take charge of the mission
press, he no doubt would have given his personal supervision to the
erection of the new house of worship. It was built during his absence,
and when he came back he rejoiced in its completion. At the death of
Mills in 1895, Dr. Mateer was chosen pastor, and was installed as
such,—a position he was able to assume because he had found in
Mr. Hayes a substitute for himself in the presidency of the college.
He remained pastor until he went with the college to Wei Hsien. Dr.
Hayes had already for years worked quietly and efficiently in the
school, under the presidency of Dr. Mateer, and had shown himself
to be a man of exceptional ability and energy—a man after Dr.
Mateer’s own heart. After he assumed the presidency Dr. Mateer
was still to assist in the college, but he was so often absent or
otherwise engaged that both the college and the preaching were
largely in the hands of Dr. Hayes.
According to the “Form of Government” of the Presbyterian
Church in the United States of America, when a “call” is made out for
a pastor it must be certified to have been voted by a majority of the
people entitled to exercise this right; and it must fill the blank in the
following clause: “And that you may be free from worldly cares and
avocations, we hereby promise and oblige ourselves to pay to you
the sum of ... in regular quarterly (or half-yearly, or yearly) payments
during the time of your being and continuing the regular pastor of this
church.” In the settling of native pastors over the Chinese churches
scattered through the country, the filling of that blank, and the actual
subscription of the funds needed for this and other expenses of the
organization, usually require the presence of a missionary and of his
earnest stimulation and guidance. Sometimes the pledges are very
liberal, if estimated by ability of the members; and sometimes it is
with great difficulty that they are brought up to the measure of their
duty. The salaries, however, are almost incredibly small, and even
according to Chinese standards are scarcely sufficient for a
livelihood. We need to keep this state of things in mind in order to
appreciate the amount that was inserted in the blank in Dr. Mateer’s
call to the pastorate of the Tengchow church. In reporting the entire
procedure to the Board of Missions, he said: “The church in
Tengchow in calling me for their pastor promised a salary of cash
amounting to fifty dollars, which is to be used to employ an
evangelist whom I am to select and direct.” Of course, he continued
to receive his own pay as a missionary from the funds of the Board.
The fifty dollars was probably a creditable amount, as contributed by
the native members out of their narrow means; and as a salary for a
native evangelist it was at least a fair average.
When reporting this pastorate to the Board of Missions, Dr. Mateer
said, “This is work that I love to do, especially the preaching.” When
doing the work of an evangelist among the people at large,
sermonizing could have no place. Even formal addresses of any sort
were rarely practicable. The best that the missionary can do when
itinerating is to get attention by any legitimate means, and then to
talk, and hear and answer questions, and bear with all sorts of
irrelevancies and interruptions. But when a church is organized, a
sermon, consisting of a passage of Scripture and a discourse built
upon it, is just as much in place as it is in one of our home houses of
worship on the Sabbath. It was to the opportunity for that form of
service that he refers when he expressed his pleasure in the
pastorate. In this also he greatly excelled. Some who knew him most
intimately, and who appreciated fully his great worth and efficiency,
did not regard him as a very eloquent preacher in an English pulpit.
He commanded the attention of his audience by his strong, clear,
earnest presentation of the great religious truths which he believed
with all his soul. The personality and consecration of the man were a
tremendous force when he stood in a pulpit in his own land; what he
lacked was the ability which some speakers possess of carrying his
audience with him, almost irrespective of the thoughts to which they
give utterance. But in preaching to the Chinese he took on an
extraordinary effectiveness. There was in the man, in the movement
of his thought, in his mastery of the language, in the intense
earnestness of his delivery, in the substance of his sermons and
addresses, much that captivated the native Christians, and made
others bow before his power. Mr. Baller, who had heard him
frequently, says: “His sermons were logical, direct, a unit in thought
and enriched with a copious vocabulary and illustrations. His points
were usually put from the Chinese point of view, so that a foreign air
was conspicuously absent.” To this day some of his addresses are
recalled as triumphs of real eloquence of speech; perhaps the most
notable of these being an address which he delivered at the opening
of the English Baptist Institution at Tsinan fu, in 1907. It was an