FESTINA LENTE 
SYNOPSIS OF LECTURES 
IN 
ANATOM! AND PHYSIOLOGY 
Arranged for the Boston Normal School of Gymnastics 
BY 
EMMA L. CALL, M-D. FESTINA LENTE 
SYNOPSIS OF LECTURES 
IN 
ANATOM! AND PHYSIOLOGY 
Arranged for the Boston Normal School of Gymnastics 
EMMA L. M.D. 
BY 
BOSTON 
Press of Geo. 11. Ellis, 141 Franklin Street 
1892 COPYRIGHTED 
1892 
BY EMMA L. CALL, M.D. Section I.—SKELETON 
SKELETON, solid framework of body. 
Uses: 
To sustain weight. 
To form points of leverage for muscles. 
To protect vital organs. 
In full grown animals composed of bone. 
In higher animals covered with skin, muscles, fat, etc. 
BONE : 
Structure of 
animal substance (gelatine). 
mineral substance (of which 50% is calcium 
phosphate, 11 % calcium carbonate). 
Mineral substance may be dissolved out by HCI. Shape re- 
mains perfect, but soft and flexible. 
Animal substance removed by burning. Bone becomes light 
and brittle. 
compact 
cancellated 
Teeth, very hard form of bone. Hardness due to enamel. 
Shape, long, short, flat, irregular. 
Formation of; 
difference in density- 
Definitions employed in reference to bone : 
Articulation, union of two bones. 
Articular surface, parts of bone between which union takes 
place. 
Process, projection from main part of a bone. 
Tuberosity, a rough, broad prominence. 
Tubercle, a small, rough prominence. 
Spine, a sharp, slender projection. 
Fossa, a shallow depression. 
Foramen, a passage into or through a bone. 
General rule in examining a bone : a smooth eminence or de- 
pression marks an articular surface; a rough surface marks 
attachment of muscles, ligaments, or tendons. 
Difference in appearance between fresh and dried bone. 
PERIOSTEUM, fibrous membrane containing cells and blood- 
vessels which covers outside of fresh bone except at articular 
surfaces. 
Bone derives nourishment through the blood-vessels. 
Cells help to form new bone. 
IE destroyed to any extent, bone dies. 
MARROW, soft, fatty substance (red or yellow) which fills spaces 
in cancellous tissue, and in shaft of long bones. 2 
Red chiefly in young bones (many blood-vessels). 
Yellow has more fat cells. 
SKELETON of a vertebrate distinguished by the vertebral or 
spinal column, a flexible column of bones extending lengthwise 
through the body, whose office is : 
Contributes to growth of bone from within. 
i st. To support, directly or indirectly, all the other parts of 
skeleton. 
VERTEBRAL COLUMN, possessed by mammals, birds, rep- 
tiles, and fishes. 
2d. To protect spinal cord 
In man, extends from base of skull to tip of coccyx. 
Skull is modification of vertebral column to receive the brain. 
Composed of twenty-four true or separate vertebras, and nine 
false or united vertebrae. 
True vertebrae, characteristics of: 
Ist. Body, solid anterior portion. 
2d. Two pedicles projecting backward from body. 
3d. Two lamina which curve toward each other and unite 
in median line behind. 
4th. Seven processes for attachment of muscles, ligaments, 
and bones. These include two transverse projecting 
laterally from some part of pedicle, four articular from 
union of pedicles and laminae, one spinous projecting 
from union of laminae. 
sth. Spinal foramen, space enclosed by body, pedicles, and 
laminae. 
True vertebrae divided into: 
Cervical (Ist to 7th vertebrae inclusive). 
Dorsal (Bth to 19th vertebras inclusive). 
Lumbar (20th to 24th vertebras inclusive). 
Cervical vertebras. Flexibility needed more than strength. 
Distinguishing mark in mammals and birds, a foramen in 
transverse process for vertebral artery. 
Other characteristics : body small, light, broad transversely, 
inferior border prolonged to lap over next vertebra. 
Laminae long and thin. Spinal foramen large. Spinous 
process bifid for muscles. Articular surfaces look ob- 
liquely upward and downward. 
Dorsal vertebras. Each attached to a rib. Many muscles at- 
tached. Mobility less than in other regions. Distinguished 
by facet on body of vertebra for articulating with head of a rib. 
In most cases each rib is attached between two vertebrae, 3 
the articular surface being partly on each. In animals, 
ribs are often prolongations of the transverse processes 
of vertebrae. Nearly all dorsal vertebrae have a second 
facet, on transverse process, for articulating with tu- 
berosity of rib. 
Further characteristics of dorsal vertebrae : body, diameter 
greatest antero-posteriorly, larger than cervical, smaller 
than lumbar. Laminae broad and thick. Spinal foramen 
small, nearly circular. Spinous processes long and ob- 
lique. Articular surfaces look backward and forward. 
Lumbar vertebrae. Chief characteristic, its massiveness. 
Strength needed to bear the weight of body. Distinguished 
from other vertebrae by exclusion, having neither foramen in 
transverse process nor facet for rib. 
Other characteristics; body large and heavy, pedicles and 
laminae short, broad, and thick. Spinal foramen smaller 
than cervical region, larger than dorsal. Spinous process 
short, broad, thick, nearly horizontal. Articular surfaces 
look inward and outward. 
PECULIAR VERTEBRAE : 
First cervical: At/as, supports head. No body nor spinous 
process. In front only ring of bone. Pedicles present ear- 
shaped fossae for condyles of occiput. Spinal foramen very 
large to accommodate enlargement of cord, and also to pre- 
vent pressure. Anterior portion encroached upon by tubercles 
for transverse ligaments, which hold axis in place. 
Second cervical: Axis, pivot on which head turns. Distin- 
guished by a tooth-like (odontoid) process, projecting upward 
from the body and taking the place of body of Atlas. On the 
front of odontoid process is a smooth facet, which lies against 
ring of Atlas. Process held in place by transverse ligament. 
Tip rough for check ligament, which binds it to occiput. Spi- 
nous process large and strong, for muscles that rotate head. 
Seventh cervical: Vertebra prominens, very long spinous 
process. 
Vertebras fastened together directly by articular processes; 
indirectly by intervertebral disks of cartilage interposed 
between bodies. These disks increase mobility, and 
serve as cushions to lessen the jar. Articular processes 
interlock and form very firm union. Space between the 
body and interlocking processes called intervertebral 
foramina. 4 
FALSE VERTEBRAE nine. Five unite to make sacrum, four 
the coccyx. 
Sacrum, pyramidal bone, concave anteriorly, convex posteriorly, 
consisting of five vertebras welded together. 
Anterior surface smooth; shows lines of division between 
bodies of vertebrae. 
Foramina correspond to intervertebral foramina. 
Lateral portion represents transverse processes. 
Posterior surface rough, rudimentary spinous processes. 
Articular surface laterally ear-shaped for articulation with 
hip bones. Foramina posteriorly, continuation of those 
anteriorly. 
Spinal canal continued through bone. 
Base articulates with last lumbar vertebra, apex with coccyx. 
Coccyx, four rudimentary vertebras, tapering off nearly to a 
point. No spinal canal, and only very imperfect bodies and 
processes. 
Section IL—THORAX. 
Thorax, or chest, formed by union of dorsal vertebras, ribs, and 
sternum. 
STERNUM, or breast-bone,— narrow, flat bone, sword-shaped,— 
consists of three pieces ; 
Superior portion, manubrium, or handle. 
Middle portion, gladiolus, or blade. 
Inferior portion, siphoid, or ensiform appendage. 
To manubrium are attached clavicle, first rib, part of second 
rib. To gladiolus, part of second rib, and all of third, 
fourth, fifth, sixth, part of seventh. To end of appendage, 
lower part of seventh. All ribs are attached to sternum 
indirectly by intercostal cartilage. 
RIBS, twelve pairs : 
Seven pairs true, attached to sternum by intercostal cartilages. 
Five pairs false, attached to cartilages of other ribs. 
Three pairs floati?ig, no attachment anteriorly. 
RIBS as a whole vary : 
In direction, obliquity increases from first to ninth, decreases 
to twelfth. 
In length, increases first to seventh, decreases seventh to twelfth. 
INTERCOSTAL CARTILAGES: 
Join true ribs to sternum. 5 
Join false ribs to cartilages of other ribs. 
Tip floating ribs. 
Vary in direction : first three follow direction of ribs; fourth 
cartilage forms slight angle with rib ; angle increases in acute- 
ness to tenth rib. 
INTERCOSTAL spaces follow direction of ribs and cartilages : 
Breadth greater in front and in upper spaces. 
RIBS are divided into vertebral extremity, sternal extremity, and 
shaft: 
Vertebral extremity consists of: 
Head, expanded extremity, with kidney-shaped, articular 
surface divided into two facets for articulation with dorsal 
vertebra. 
Neck, constriction next the head rests on transverse process, 
has tuberosity which has articular facet for articulation 
with transverse process of dorsal vertebra. 
Sternal extremity, oval, surface slightly depressed and rough 
for fitting of intercostal cartilage. 
Shaft, thin, flat; convex externally, concave internally. 
External surface shows angle where shaft changes its plane 
of direction. Distance from angle to tuberosity increases 
from second to tenth rib. 
Internal surface shows groove near lower border for inter- 
costal vessels and nerves. 
Superior border, thick and round. 
Inferior border, thin and sharp. 
PECULIAR RIBS. 
First, short, flat from above downward, nearly horizontal; no 
angle; prominent tuberosity. 
Second rib resembles first, but has slight angle and curve. 
Tenth, eleventh, and twelfth, single facet. 
Eleventh and twelfth, no neck, tuberosity, or angle. 
Section lII.—SHOULDER. 
Shoulder, bones which connect the arm with the body, scapula and 
clavicle. 
SCAPULA, triangular, flat bone lying on posterior aspect of 
thorax, posterior border being parallel to and about two inches 
from vertebral spines. 
Anterior surface, or venter, presents large concave surface, 6 
subscapular fossa, crossed by ridges. This fossa lodges 
Subscapularis muscle. 
Posterior surface, or dorsum, is divided into two unequal parts 
by a transverse ridge, the spine. The smaller part lying 
above spine is supra-spinous fossa, and lodges Supra-spinatus 
muscle. Part below spine is infra-spinous fossa, and lodges 
Infraspinatus muscle. 
Spine begins at upper third of internal border, and above 
external border rises to terminate in acromion process. Sur- 
face rough for attachment of muscles. 
Acromion process, rough projection, protects shoulder joint and 
articulates with clavicle. 
Borders of scapula : 
Vertebral, longest. 
Axillary, thick, and rough. 
t> xu r. i 
Both attach many muscles 
J 
Superior, terminates in coracoid process, at base of which is 
supra-scapular notch. 
Angles : 
Superior, highest, gives attachment to Lev. Ang, scapula. 
Inferior, thick and rough. 
Anterior, irregular, occupied by : 
Glenoid cavity, a shallow, oblong depression for head of 
humerus. 
Neck of scapula, constriction below cavity, to which is 
attached capsular ligament. 
Coracoid process, above and anterior to glenoid fossa, which 
affords attachment for short head of Biceps. 
CLAVICLE (a key), resembles letter S. A very elastic, curved 
bone, extending from top of sternum to acromion process. It acts 
as a brace to keep the shoulder back and prevent the heavy end of 
scapula from tilting forward and downward. 
Sternal end articulates with sternum and first rib, triangular. 
Acromial end, rough for muscles, facet for acromion process. 
Shaft, double curve, convex at sternal end and concave at 
acromial end. 
Female clavicle less curved, more slender and shorter than male. 
Right clavicle larger than left. May be very prominent in those 
who perform much muscular labor. 
Clavicle often broken, usually by fall on arm or shoulder. 7 
Section IV.—UPPER EXTREMITY. 
Upper extremity consists of arm, forearm, and hand. 
HUMERUS, bone of the arm : shaft and two extremities. 
Upper extremity, largest part, consists of: 
Head, rounded eminence for articulation with glenoid cavity 
of scapula. 
Neck (anatomical), constriction uniting head and shaft. 
Great tuberosity, protuberance opposite head for shoulder 
muscles. 
Lesser tuberosity, in front of and below head. 
Shaft of humerus cylindrical above, flattened below. 
Anterior surface, upper part shows bicipital groove. 
External surface, middle part, deltoid eminence. 
Posterior surface, musculo-spiral groove, separating attach- 
ments of two heads of Triceps. 
Lower extremity, flat, curved forward, presents two articular 
surfaces separated by ridge. 
Inner surface (trochlear), broad and grooved, articulating 
with ulna. 
Outer surface, rounded, articulating with radius. 
Above articular surfaces anteriorly, two depressions, coronoid 
and radial. Posterior articular surface extends into a 
deep depression, olecranon fossa. 
To upper edges of these depressions are attached anterior 
and posterior ligaments of elbow. 
Condyles (internal and external), projections beyond articu- 
lar surfaces ; internal condyle more prominent. 
Internal condyle gives attachment to internal lateral 
ligament of elbow, and to most of flexor and pronator 
muscles of forearm. 
External condyle gives attachments to external lateral 
ligament, and extensors and supinators of forearm. 
FOREARM consists of ulna and radius. 
Ulna (little finger side), largest bone, forms chief part of elbow 
joint,— shaft and two extremities. 
Upper extremity, the larger, presents two processes: the 
large one posteriorly, the olecranon; small one anteriorly, 
the coronoid. 
Olecranon: 
Posterior surface subcutaneous, upper border gives 
attachment to Triceps and posterior ligament. 
Anterior surface, with posterior surface of ooronoid, 8 
forms a concave articular surface, the greater sigmoid 
cavity, for trochlear surface of humerus in flexion 
of forearm. 
Small depression in outer side of great sigmoid cavity, 
the lesser sigmoid cavity, receives the head of ra- 
dius ; outer edge rough for orbicular ligament. 
Shaft of ulna prismoid, slightly bent forward and outward. 
Anterior surface covered largely by Flexor profundus digi- 
torum. 
Posterior surface shows oblique ridge, below which impor- 
tant extensors arise. 
Lower extremity small, does not enter directly into wrist 
joint, being separated from carpus by fibro-cartilage ; pre- 
sents rounded surface, the head articulating with fibro- 
cartilage and projecting from inner and lower part, the 
styloid process, to which is attached internal ligament of 
wrist joint. 
Radius (spoke of a wheel), outer side of forearm, rolls around 
the ulna; chief bone of wrist joint. 
Upper extremity small, and forms only very small part of 
elbow joint. 
Head rounded, with shallow depression above, articu- 
lating with radial surface of humerus. Internally 
smooth, rotating in lesser sigmoid cavity of ulna. 
Neck, constriction below head. 
Tuberosity, rough eminence inner side for Biceps. 
Shaft prismoid, narrow above, slightly curved outward. 
Anterior surface gives origin to Flexor longus pollicis 
above, Pronator quadratus below. 
Posterior surface, to extensor muscles. 
Lower extremity large, quadrilateral. 
Inferior surface articulates with carpal bones. 
Internally small depression, sigmoid cavity of radius, for 
articulation with ulna. 
HAND consists of carpus, metacarpus, and phalanges. 
Carpus, bones of wrist, two rows (enumerated from radial side). 
Upper row, scaphoid', semilunar, cuneiform, pisiform. 
Scaphoid and semilunar articulate with radius above. All 
except pisiform, with second row of carpus below. 
Lower row, trapezium, trapezoid, os 7nagnum, unciform. 
Articulate by their upper surfaces with first row of carpus ; 
by their lower surfaces with the five metacarpals. 
Metacarpus, five bones (metacarpal), nearly parallel. Articu- 9 
late above with second row of carpus; below with first pha- 
lanx of each finger. 
Carpal extremity, or base, cuboid, articulating on its infe- 
rior surface with carpus, and laterally with adjacent meta- 
carpals (except metacarpal of thumb). 
Digital extremity rounded for articulation with phalanges. 
First metacarpal (thumb) shorter and wider than others; 
does not articulate with adjacent metacarpal; palmar 
surface faces the others; digital extremely less rounded • 
has facet for sesamoid bones. 
Phalanges fourteen in number,— three to each finger, two to 
thumb. Decrease regularly in size to tip. 
Shaft convex posteriorly, concave anteriorly, rough at sides 
for sheaths of flexor tendons. 
Metacarpal extremity of phalanges slightly concave. 
Digital extremity of first two, small condyles. 
Ungual phalanx pointed and rough. 
Section V.—PELVIS. 
Pelvis, lowest cavity of trunk; upper flaring portion supports, par- 
tially, contents of abdomen, and is called “ false pelvis ” ; lower por- 
tion protects organs of reproduction, and is called “ true pelvis 
FALSE PELVIS formed by upper part of ossa innominata, and 
union of sacrum with last lumbar vertebra. 
TRUE PELVIS includes all below the line which separates flar- 
ing portion from enclosed portion. Opening from false into true 
pelvis called pelvic inlet, lower opening of pelvis the pelvic outlet. 
Pelvic inlet, bounded by union of last lumbar vertebra with 
sacrum posteriorly, a prominent line on the hip bones, the 
linea ilio-pectinea, laterally, and the union of the hip bones an- 
teriorly. 
Pelvic outlet, bounded by coccyx behind, lowest part of ossa 
innominata laterally, and union of the two bones (lower bor- 
der) anteriorly. 
It will be noted that in the upright position, owing to the 
curve of the sacrum, the true pelvis does not lie directly 
under the false pelvis, but behind it. 
OSSA INNOMINATA, two very irregular bones, the hip bones 
which form the sides and front of the pelvic cavity. Homologous 
to scapula; connect lower extremity with vertebral column. Each 
consists of ilium, ischium, pubes,— separate in youth. Ilium, broad, expanded upper portion. 
Superior border, or crest, rough ridge extending from ante- 
rior superior spinous process, to posterior superior spinous 
process. 
To it attached abdominal muscles and Latissimus dorsi. 
Anterior border extends from anterior superior spinous 
process to anterior inferior spinous process. 
Posterior border from posterior superior spinous process to 
posterior inferior spinous process. 
Lower border of ilium, externally, forms upper part of 
acetabulum. 
External surface, or dorsum, is irregularly curved, and 
shows three lines,— superior, middle, inferior. Spaces 
between these give origin to Glutei muscles. 
Internal surface shows smooth concavity anteriorly, the 
venter, or iliac fossa, which lodges the lliacus muscle. Be- 
hind this a rough surface, the lower portion of which 
presents an auricular surface for articulation with sacrum. 
Upper part filled by muscles and ligaments. Inferior 
border of iliac fossa is the ilio-pectineal line. 
Below posterior inferior spinous process, ilium shows a deep 
curve, the great sacrosciatic notch. 
Ischium forms lower and back part of the bone, divided into 
body, ramus, and tuberosity. 
Body, upper portion; externally forms a large part of con- 
cavity of acetabulum; internally forms part of lateral 
wall of true pelvis. Below, bounded by a large opening, 
the obturator foramen. 
Posterior border marked by a prominent spine, below 
which is lesser sacrosciatic notch. 
Tuberosity rough strong projection, forming lower part; is 
the part on which body rests in sitting. 
Ramus (a branch), extending upward and inward from 
tuberosity, to meet descending branch of pubes; forms 
lower boundary of obturator foramen. 
Inner surface forms part of anterior wall of pelvis. 
Lower border rough, everted; forms part of pelvic 
outlet. 
Pubes, anterior part of ossa innominata, consists of body, hori- 
zontal and perpendicular rami. 
Body, anterior and inner po. on, from which two rami 
spring. 
Upper border marked by prominent spine, the termina- 
tion of ilio-pectineal line. Between spine and median line prominent ridge, the 
crest. 
Inner border, the union of two pubic bones symphysis 
pubes, presents series of nipple-like projections, into 
which the fibro-cartilage fits. 
From inferior portion descends perpendicular ramus. 
Horizontal ramus unites pubes with ilium and ischium. 
From external portion springs horizontal ramus. 
Lower border forms upper border of obturator foramen ; 
outer extremity forms pubic portion of acetabulum. 
Perpendicular ramus runs downward and outward from 
body to meet ascending ramus of ischium. 
Upper or external border forms internal part of obtu- 
rator foramen ; internal border forms part of pelvic 
outlet. 
Acetabulum, cup-shaped cavity at union of the three bones, 
for articulation with head of femur. Ilium forms about two- 
fifths ; ischium, two-fifths; pubes, one-fifth. 
Bounded by a strong, uneven rim, which serves for attach- 
ment of fibro-cartilage. 
Inner side cotyloid notch. 
Depression for ligamentum teres. 
Obturator foramen, large, oval opening below acetabulum. 
Object, to make bone lighter,— in life nearly filled by obtu- 
rator membrane. 
Margin formed by pubes above, rami of pubes and ischium 
internally and below, ischium (body of) externally. 
Differences between male and female pelvis : 
Male Pelvis. 
Rones large and massive. 
Iliac fossa more nearly 
perpendicular. 
Pelvic inlet heart-shaped. 
Sacrum sharply curved. 
Pubic arch narrow. 
Female Pelvis. 
Bones light and delicate. 
Iliac fossa more nearly hori- 
zontal. 
Pelvic inlet more nearly cir- 
cular. 
Sacrum less curved. 
Pubic arch wider and edges 
everted. 
Section VI.—LOWER EXTREMITY 
Lower extremity consists of thigh, leg, and foot. 
FEMUR, or thigh, longest, largest, strongest long bone in body; 
homologous to humerus. Superior extremity forms, with acetabu- 12 
lum, the hip joint. Inferior extremity forms, with bones of leg, 
knee joint. It consists of shaft and two extremities. 
Upper extremity consists of 
Head, globular, directed upward, inward, and slightly for- 
ward. Smooth, with depression for ligamentum teres. 
Neck connects head with shaft. Obliquity varies with 
age and sex : in woman, nearly right angle; in man, ob- 
tuse angle ; in childhood, curve upward ; in old age, curve 
downward. 
Great trochanter, a large, rough prominence on outer 
side of upper end of shaft, a little below level of head, 
and beginning at outer end of superior border of neck. 
External surface rough for attachment of muscles. 
Internal surface deep depression, the digital fossa. 
Lesser trochanter lies on inner side of upper extremity 
of femur, at root of neck. 
Inter-trochanteric lines, rough line connecting the two 
trochanters, anterior and posterior; is the line of attach- 
ment of capsular ligament. 
Important muscles attached around and upon great tro- 
chanter. 
Six external rotators; namely, two Gemelli, two Obturators, 
Quadratus femoris and Pyriformis. 
Three Glutei; namely, Gluteus medius to top, Gluteus mini- 
mus to anterior surface, Gluteus maximus posterior just 
below base. 
To lesser trochanter attached flexors of thigh; namely, 
Proas and Iliaus. 
Shaft of femur cylindrical, slightly convex anteriorly. 
Anterior surface smooth for Crureus. 
Posterior surface marked by “ linea aspera,” of which we 
distinguish, in the middle of shaft, external lip, internal 
lip, intervening space. In upper part, it divides into 
three lines, below into two diverging lines, which enclose 
between them popliteal space. 
Muscles attached to linea aspera: 
Outer lip, Vastus externus. 
Inner lip, Vastus internus. 
Between the lips, three Adductors. 
Upper end outer lip, Gluteus maximus. 
Upper end inner lip, Pectineus. 
Lower end outer lip, Biceps (short head). 
Lower extremity flattened antero-posteriorly, and presents two large articular eminences, outer and inner condyles, sepa- 
rated by depression, which posteriorly becomes inter-condyloid 
notch. 
External condyle most prominent and broadest. 
Internal condyle longest, narrowest. 
Articular surface extends high in front, behind divided 
into two parts by inter-condyloid notch, to which are 
attached crucial ligaments. 
Tuberosities, two rough projections from condyles. 
Outer on outer side external condyle; inner on inner 
side internal condyle. To them attached internal and 
external lateral ligaments of knee joint. 
Above condyles attached two heads of Gastrocnemius. 
LEG consists of tibia, fibula, and patella. 
Tibia (a flute), front and inner side of leg. 
Upper extremity greatly expanded forms part of knee joint. 
Consists of two lateral eminences, external and internal 
tuberosities. 
Tuberosities: 
Upper surfaces, two shallow concavities for articulation 
with condyles of femur. Between these surfaces a 
prominence, the spine, surmounted by two tubercles, 
to which are attached the semilunar cartilages. In 
front and behind spine, rough depression for carti- 
lages and crucial ligament. 
Anterior surface continuous; at base projection the 
tubercle for ligamentum patellae. 
Posteriorly tuberosity separated by popliteal notch. 
Internal tuberosity long and oval for internal condyle, 
has attached internal lateral ligament. 
External tuberosity broad and circular for external 
condyle, marked by articular surface for fibula. 
Shaft prismoid, broad above, narrow in lower fourth, ex- 
panding again at lower end. 
Anterior border thin and sharp,— subcutaneous, form- 
ing crest, or shin. 
External border has attached above interosseous mem- 
brane, at lower part interosseous ligament. 
Internal border rounded, smooth. 
Internal surface upper third attachment of muscles; 
lower part subcutaneous. 
External surface covered by tendons of muscles to 
dorsum of foot (mainly extensors). Posterior surface upper end, oblique line marks limit of 
Popliteus. Below are attached muscles of plantar 
surface of foot (chiefly flexors). 
Lower extremity small, quadrilateral, prolonged down on 
inner side. 
Anterior surface covered by extensor tendons. 
Posterior surface rough, deep groove for tendon of 
Flexor longus pollicis. 
Inferior surface smooth for articulation with astragalus. 
Exterior surface articular for fibula. 
Internal surface prolonged into internal malleolus forms 
inner prominence of ankle. External surface of 
malleolus deepens articular surface of ankle joint. 
To its edge attached internal lateral ligament. 
Fibula, outer side of leg, small and slender; upper extremity 
lies below head of tibia. Does not enter into formation of 
knee joint. Lower extremity inclined forward,— forms outer 
prominence of ankle joint. 
Upper extremity, or head, irregular. 
Inner side above, facet for articulation with tibia. 
Outer side prominence, to which attached Biceps and 
long external lateral ligament of knee. 
Upper end prolonged above articular surface into styloid 
process, to which attached short external lateral liga- 
ment of knee. 
Shaft prismoid. 
Anterior surface gives origin to principal extensors. 
Internal surface gives origin to principal flexors and 
interosseous ligament. 
External surface gives origin to Peronei. 
Lower extremity forms external malleolus, the outer promi- 
nence of ankle. 
External surface rough for external lateral ligament of 
ankle. 
Internal surface articular above for tibia, below for 
astragalus. 
Posterior border marked by grooves for Peroneus longus 
and Brevis. 
Patella, or knee-pan, small triangular bone, which slides over 
anterior articular surface of femur in movements of knee,— 
protects knee joint. By some regarded as sesamoid bone. 
Anterior surface rough, covered by tendon of Quadriceps 
extensor. Posterior surface smooth, articular, divided by slight ridge 
for two condyles of femur, 
Superior bolder thick and rough for Rectus and Crureus. 
Lateral border thin for the Yasti; apex gives origin to liga- 
mentum patellae. 
FOOT consists of tarsus, metatarsus, and phalanges. 
Tarsus, seven bones placed below and in front of leg, forming 
heel and posterior part of foot. 
First row, astragalus, os calcis, scaphoid, connected with 
tibia and fibula with astragalus posteriorly; articulates 
with second row anteriorly. 
Second row, cuboid, external middle, and internal cuneiform, 
connected posteriorly with first rowr of tarsus, anteriorly 
with five metatarsals. 
Astragalus forms, with tibia and fibula, ankle joint. 
Articular surface above, which is prolonged over 
each side to fit concavity formed by malleoli. 
Below rests on os calcis. 
Os calcis, largest tarsal bone, forms prominence of heel. 
Rough projection posteriorly, to which attached 
Tendo Achilles. 
Inner surface shows deep concavity for plantar ves- 
sels, nerves, and flexor tendons. 
Scaphoid lies in front of astragalus. 
Metatarsus consists of five metatarsal bones strongly resem- 
bling metacarpals; distinguished from them by deep groove 
on plantar surface at tarsal extremity for tendon of Peroneus 
longus. 
First metatarsal (great toe) very large, short, broad, does 
not face others as thumb. Plantar surface has grooved 
facets for sesamoid bones. 
Fifth metatarsal (little toe) has a large prominence at 
base externally. 
Phalanges same in number as in hand,— fourteen. 
First row strongly resembles hand. Articulates with 
second row of tarsus posteriorly and with second row of 
phalanges anteriorly. 
Second row very small and short, but broad. Ungual 
phalanges very short and small, but otherwise like hand. 16 
Section VIL—SKULL 
SKULL, upper cavity of skeleton. May be regarded as modified 
vertebrae to receive the brain. Body and processes of vertebrae 
are represented by base of skull; the intervertebral foramina by 
the opening for the cranial nerves ; while the spinal canal is greatly 
expanded to receive the brain. 
Composed of four vertebrae: occipital, parietal, frontal, nasal 
(last rudimentary in man); bones all welded together, as mo- 
tion is not desirable. 
Divided into cranium and face. 
Cranium (eight bones) forms cavity for brain. 
Face (fourteen bones) forms anterior portion. 
Bones all immovably united except lower jaw. Such 
union called a suture. 
Bones of external surface of cranium composed of two 
layers of compact substance, enclosing a varied 
amount of cancellated tissue. Compact layers 
known as “ tables of skull ” (outer and inner). 
Divided into five regions : 
First, vertex; second and third, lateral; fourth, base; 
fifth, face. 
Vertex, superior portion of cranium, includes all above a line 
drawn from nasal eminence to occipital protuberance. 
Principal parts named: 
Superciliary ridge,— external angular process, temporal 
ridge, superior curved li7ie of occiput. 
External surface smooth, includes greater part of 
forehead, whole of top of head, and superior por- 
tion of occiput. 
Sagittal suture runs longitudinally across its highest 
part. 
Coronal suture runs at right angles to the sagittal, over 
the crown. 
Lambdoidal suture posteriorly marks the superior limit 
of occiput. 
Superior curved line of occiput gives attachment to 
Occipito-frontalis above, and Trapezius below. 
Occipital protuberance gives attachment to ligamen- 
tum nuchae. 
Lateral regions occupy side of skull. 
Anterior limit, external angular process. 
Superior limit, temporal ridge. Posterior limit, superior curved line of occiput. 
Inferior limit, the zygoma, outer surface of mastoid process. 
This includes part known as temples. 
Zygoma, an arched ridge, extending from just anterior to 
ear to meet a similar ridge extending backward from 
cheek bone. First part known as “ zygomatic process 
of temporal bone ” ; second part, as “ zygomatic process 
of malar bone.” 
Posterior end of zygoma, two roots, enclosing be- 
tween them glenoid fossa for lower jaw (inferior 
maxillary). 
In front of anterior root, the eminentia articularis, 
which prevents jaw slipping from socket. 
Behind glenoid fossa is external auditory 7neatus, sur- 
rounded by auricular process, to which is attached 
cartilage of external ear. 
Behind auditory meatus, a rough, round projection, 
the mastoid process, to which is attached the Sterno- 
cleido-mastoid muscle. 
Space between zygoma and main part of skull filled 
largely with Temporal muscle. 
Base of skull. 
External surface. 
Anterior limit, front, or incisor teeth of upper jaw. 
Lateral limit, alveolar process, lower edge of zygoma, and 
a line drawn from zygoma over tip of mastoid process 
to superior curved line. 
Posterior limit, superior curved line. 
On this surface, which is very irregular, we note alveolar 
process, projection for teeth of upper jaw. 
Behind this, two oval openings, the posterior nares, limited 
on each side by a long process with two sharp edges 
bounding a fossa, the pterygoid processes and fossce. 
Plate of bone dividing the nasal cavity, the vomer. 
Behind posterior nares, a quadrilateral surface, the basilar 
process; just behind this, two oval projections, the con- 
dyles for Atlas. 
External to condyles, just in front of mastoid process, 
projects sharp, slender styloid process. Under surface 
mastoid process grooved for Digastric muscle. 
Inward from condyles the foramen magnum, through 
which the spinal cord enters the skull. Surface poste- 
rior to foramen magnum rough and grooved for attach- ment of muscles, chiefly those which hold the head 
erect. 
About an inch anterior to superior curved line is seen an 
inferior curved line, to which attached several muscles. 
Line from occipital protuberance to posterior edge of fora- 
men magnum, occipital crest. 
Anterior region, or face. 
Superior limit, superciliary ridges, nasal eminence 
Inferior limit, chin. 
Laterally, malar bone and ramus of lower jaw. 
Contains two cavities for eyes,— the orbits. 
Upper limit of orbit supra-orbital ridge, toward the inner 
edge of which is supra-orbital foramen, or notch, which 
transmits supraorbital vessels and nerves. Cone- 
shaped, apex being deepest part. 
Between the orbits, prominence of nose, ending below is an 
oval opening, anterior nares. 
Anterior nares divided into two parts by the vomer, and 
they communicate directly with posterior nares. Floor 
of anterior nares is roof of upper jaw. 
External to nares and just below lower edge of orbit is 
infra-orbital foramen, transmitting infra-orbital nerve and 
blood vessels. Depression below, canine fossa. 
Outward prominence of cheeks formed by malar bones. 
Below nares and cheeks, opening of mouth, bounded 
above by alveolar process of upper jaw (superior maxil- 
lary bone), with sockets for teeth. 
Space between two sides of alveolar process, a hard ridged 
surface, the palatine arch, or hard palate, the slope of 
which varies much in individuals. 
Lower jaw (inferior maxilla) is lower boundary of mouth 
and also of face; consists of body and ramus. 
Body, horizontal portion, horseshoe form; in median 
line the symphysis, which ends in projection of chin, 
mental process. From it runs oblique ridge for attach- 
ment of muscles of lower jaw. Internal surface con- 
cave, and divided by mylohyoid ridge for Mylohyoid 
muscle. In median line two projections, genial tuber- 
cles. Superior, or alveolar, border contains sockets 
for lower teeth. 
Bamus, or perpendicular portion, joins body at nearly 
right ang!es. Angle of jaw is the point where infe- rior border of horizontal portion unites with posterior 
border of perpendicular. 
Exterior surface nearly covered by Masseter. 
Interior surface presents a foramen, through which in- 
ferior dental nerve and vessels enter jaw. 
Inner surface of cranium divided into vertex and base. 
Horizontal section shows thickness of cranial bones to differ 
greatly in different parts, being usually thickest in occipital 
and frontal regions and thinnest over temples and around 
foramen magnum. 
Vertex marked by irregularities for convolutions of brain. 
On each side grooves for middle meningeal artery. Me- 
dian line shows groove for longitudinal sinus. 
Base of skull divided into anterior, middle, and posterior 
fossae. 
Anterior fossa extends from inner side of frontal 
bones to a sharp semicircular ridge which extends 
from the side inward terminating near the median 
line in prominent process. 
In median line is seen Crista Galli, on sides of 
which is thin plate of bone pierced with holes, 
the cribriform plate of ethmoid. 
Forms roof of orbit, and lodges anterior lobes of 
cerebrum. 
Middle fossa lower level than anterior, deeply con- 
cave. Terminates behind in a ridge that runs ob- 
liquely forward and inward from base of mastoid 
process. 
Central portion irregular, sides deeply grooved 
for cerebral convolutions. 
Lodges middle lobes of cerebrum. 
Posterior fossa largest of three and on the lowest 
plane. 
Anterior wall nearly perpendicular, formed by pe- 
trous portion of temporal bone, which contains 
mechanism of internal ear. 
In median line anterior wall formed by basilar 
process. 
Upper border corresponds to superior curved line 
of occiput, and gives attachment to membrane 
which separates cerebrum from cerebellum, the 
tentorium cerebelli. 
Median line prominent ridge, to which is attached 
membrane separating the halves of cerebellum. 20 
Lodges Cerebellum, Pons Varolii, and Medulla Ob- 
longata. 
Behind basilar process, the large oval opening of 
foramen magnum, through which spinal cord 
enters cranium. Opening encroached on slightly 
anteriorly by tubercles for odontoid ligaments. 
Most important openings in base of skull named from before back- 
ward : 
OPENINGS. 
CONTENTS. 
1. Cribriform plate of ethmoid, 
2. Foramen opticum, 
3. Foramen lacerum anterius. 
4. Foramen rotundum. 
5. Foramen ovale. 
6. Foramen spinosum. 
7. Foramen lacerum medium. 
8. Meatus auditorius internus. 
9. Foramen lacerum posterius. 
10. Foramen magnum. 
11. Anterior condyloid foramen. 
12. Posterior condyloid foramen. 
ist, or olfactory nerve. 
2cl, or optic nerve. 
3d, 4th, sth (ist division;, 6th, 
nerves. 
sth (2d division). 
sth (3d division). 
Middle meningeal artery. 
Carotid artery. 
7th (facial), Bth (auditory), 
nerves. 
9th, 10th, nth, nerves. Jugu- 
lar vein. 
Spinal cord. 
12th nerve. 
Veins. 
Section VIII.—DEVELOPMENT OF BONE. 
METHODS OF DEVELOPMENT. 
All bones of skeleton, except a pottion of skull, are formed in the 
embryo in cartilage, which later is changed into bone. The bones 
of the skull, except the base and lower jaw, are developed from a 
membrane which later becomes periosteum. Endochondral growth, 
development from cartilage. Periosteal growth, development from 
periosteal membrane. 
Process of ossification, the process by which bone is devel- 
oped in either of the above ways. 
Bones grow in length by endochondral process. 
Bones grow in thickness by periosteal process. 
Centres of ossification, portion of bone at which the process of 
ossification starts. 
Most bones have several such centres. 
Long bones have usually one centre for shaft and one or more 
for each extremity. 
At birth all the shafts of long bones are ossified, but the ex- 21 
tremities are nearly all still cartilaginous, as are also carpus, 
five bones of tarsus, and coccyx. 
Centres of ossification in each extremity of long bone first coa- 
lesce and form one mass, which later is united to shaft. Such 
an extremity is an epiphysis. 
Laws of epiphyses. 
Do not usually join shaft till adult life, generally twentieth 
to twenty-fifth year. Usually join shaft in inverse order 
of development. This order is regulated by direction of 
nutrient artery of bone. 
Section IX —CARTILAGE, Etc. 
CARTILAGE, tough, glutinous tissue which resembles gelatine. 
Three kinds, known as : 
ist, Hyaline, glistening and semi-transparent, forms surface of 
joints, costal cartilages, cartilage of nose, larynx, trachea, and 
bronchi. 
2d, Fibro cartilage, which is very tough and not transparent. 
Found in intervertebral disks, interarticular cartilage, sesa- 
moid bones, sacro-iliac, and pubic symphyses. 
3d, Fibro elastic cartilage, very firm in structure, but con- 
tains also many elastic fibres, so that it is capable of stretch- 
ing. Found in epiglottis, cartilage of ear, parts of larynx. 
LIGAMENTS, strong bands of fibres which connect bones with 
each other, and usually hold the articular surface of a joint in more 
or less complete apposition. Some ligaments, like the ligamentum 
nuchoe, have a good many elastic fibres, but usually ligaments are 
not elastic. 
SYNOVIAL MEMBRANE, delicate membrane which encloses 
the two extremities of an articulation, like a tube, usually lining the 
ligaments. It secretes a clear fluid, like white of egg, synovia, 
which acts like oil in keeping the surface of joint moist, and pre- 
vents injury from friction. 
MUSCULAR TISSUE consists of bands of fibres which have 
the property of shortening or contracting on the application of a 
stimulus. Two forms, involuntary, or unstriped, and voluntary, or 
striped. 
Involuntary, or unstriped, found in all parts of body not 
under control of the will, as in the walls of the stomach, in- 
testines, bladder, uterus, blood vessels, etc. 22 
Pale in color, smooth in appearance, and contractions are 
generally slow and often long continued. 
Voluntary, or striped, found in all parts of the body con- 
trolled by the will, as the skeletal muscles, and also in the 
heart. 
Color red; fibres bound in bundles of various shapes and 
sizes; contraction.powerful, sudden, and short. 
Each fibre presents a striped appearance, owing to the mus- 
cular substance being arranged in alternate light and 
dark bands. 
Each muscular fibre has a delicate covering, the sarcolemma. 
Bundles bound together by a delicate tissue, the perimesium. 
Sheath, form of covering which encloses muscles. 
Muscles usually have two attachments, origin and insertion. 
Origin, the part toward which the motion is made. 
Insertion, the part which moves toward the origin. 
Many muscles act from both ends, but for convenience the 
word “ origin ” is usually given to the end nearest the 
trunk. 
TENDONS, white, shining bands, or cords, which connect muscles 
with bones or other muscles. They increase the strength of the 
union of muscles to the bone, while decreasing its bulk. Tendons, 
when broad and flat, are often called aponeuroses. 
AREOLAR, OR CONNECTIVE TISSUE, a delicate, web- 
like structure which connects the different tissues with each other 
or different parts of same tissue; found in all parts of body. 
Serves as connection between skin and muscles, and is then often 
called superficialfascia. The same structure, when thick and firm, 
forms sheaths for the muscles, and is then known as deep fascia. 
Section X.—HEART AND BLOOD VESSELS. 
HEART, organ by means of which the blood is propelled through- 
out the body. Size, shape, weight, base, apex. 
Double organ, having a double office : 
First, to propel blood throughout body (systemic circuit). 
Second, to carry it to lungs to be purified (pulmonic circuit). 
Heart is double, its two sides (right and left) having no com- 
munication with each other. 
Each side divided into smaller upper cavity, the auricles, (right 
and left), lower and larger the ventricles, (right and left). 23 
Auricles receive blood : right auricle from body by vena cava; 
left auricle from lungs by pulmonary veins. 
Ventricles pump out the blood: right ventricle into lungs by 
pulmonary artery; left ventricle by Aorta all over the body. 
Auricles open into ventricles by auricular ventricular open- 
ing. 
Valves of heart, delicate folds of membrane which guard the 
various openings, and direct the passage of blood. 
Tricuspid valve guards right auricular ventricular opening. 
Bicuspid, or mitral, valve guards left auricular ventricular 
opening. 
Semilunar valves guard aortic and pulmonary openings. 
Mitral and tricuspid valves kept from swinging in 
wrong direction by chordae tendinias. 
Course of blood through heart: 
i. Enters right auricle by venae cavae (superior and inferior) ; 
2. From right auricle poured in right ventricle (tricuspid valve 
open); 
3. From right ventricle forced into pulmonary artery (tricuspid 
valve closes, pulmonary semilunar valve open); 
4, By pulmonary artery carried to lungs, and from there re- 
turned to left auricle by pulmonary veins (semilunar valve 
closes and prevents return of blood to ventricle); 
5. From left auricle flows into left ventricle (mitral valve 
open); 
6. From left ventricle into aorta (mitral valve closed, aortic 
semilunar valve open). 
Structure of heart: 
Muscular substance. 
Chief mass of heart muscular fibre arranged in different layers, 
forming the walls of the cavities : on inner surface of auric- 
ular appendages called “ musculi pectinati ” ; on inner sur- 
face of ventricles called “ column® carni ” and “ papillary 
muscles.” 
Muscular walls vary in thickness. Right auricle thinnest, left 
auricle twice as thick. Right ventricle at least twice as thick 
as left auricle. Left ventricle three or four times as thick as 
right ventricle. 
All cavities contain about same amount of blood,— namely, 
three or four ounces. 
External covering, pericardium, a double membrane, one layer 
being firmly attached to muscular substance of heart, 
(visceral layer). This membrane is reflected back from 24 
base, and forms loose bag in which heart is suspended 
(parietal layer). Serous or sero-fibrous membrane. 
Inner lining of heart, ejidocardium, smooth ; serous membrane 
attached to muscular wall of cavities, and forming, by re- 
duplication, the valves of heart. 
Action of heart consists in alternate contraction and relaxation 
of muscular walls. 
Mechanism of circulation, or cardiac cycle : 
ist. Auricles fill with blood, right from venae cavae, left 
from pulmonary veins, 
2d. Contraction of auricles by which blood is forced 
through auricular ventricular openings into ventricles. 
3d. Tricuspid and bicuspid valves close, and prevent 
return into auricles. 
4th. Ventricles contract, and force blood through aorta 
and pulmonary semilunar valves into aorta and pul- 
monary artery. 
sth. Semilunar valves close, and after a slight pause the 
contraction of auricles begins again. 
Contraction of cardiac cavities called systole. 
Dilation of cardiac cavities called diastole. 
Cardiac cycle takes place about 72 times per minute. 
Time occupied for contraction of auricles, T\j- second; 
contraction of ventricles, second; pause, second. 
BLOOD VESSELS, series of tubes by means of which blood is 
distributed throughout body. 
Arteries carry blood from heart. 
Have firm, elastic walls; remain open when cut across; 
blood spirts from them in jets. 
Composed of three coats : 
First, intima, smooth; composed chiefly of longitudinal 
elastic fibres. 
Second, media, elastic ; involuntary muscular fibres in 
varied proportions (chiefly circular). 
Third, adventitia, fibrous connective tissue. 
Veins carry blood to the heart. 
Walls thin, but strong; distensible, but not elastic; fall 
together when cut; blood flows in steady stream. 
Composed of three coats similar to artery, but much thinner 
and very few elastic fibres ; furnished with valves. 
Capillaries, tiny vessels which connect arteries and veins. 
Walls thin ; single layer of transparent cells. From to 
ttoVo inches in diameter. When cut, blood oozes in drops. 
Walls so thin that fluid parts of blood transude through 
them. Section XL—PRINCIPAL ARTERIES OF BODY. 
NAME. 
DISTRIBUTION, 
ARCH OF AORTA.— from upper right-hand corner of right 
ventricle to left side of body of fourth dorsal vertebra : 
1. Coronary, 
2. Innominata. 
1. Right common carotid. 
1. Internal carotid. 
2. External carotid. 
2. Right subclavian. 
3. Left common carotid. 
1. Internal carotid. 
2. External carotid. 
4. Left subclavian. 
Walls of heart. 
Anterior and middle lobes of 
brain. 
Face ; surface of cranium ; mem- 
branes of brain; upper part 
neck. 
Lower part neck; anterior wall 
thorax (by internal mammary) ; 
posterior part brain (by verte- 
bral) ; shoulder ; first two ribs 
(superior intercostal). 
As on right side. 
As on right side. 
As on right side. 
As on right side. 
THORACIC AORTA,— from fourth dorsal vertebra to dia- 
phragm ; 
1. Bronchial. To lungs. 
2. Intercostals (10). To chest walls. 
3. Pericardial. To pericardium. 
ABDOMINAL AORTA,— from diaphragm to fourth lumbar ver- 
tebra : 
1. Phrenic. To diaphragm. 
2. Coeliac axis. 
Gastric. 
Hepatic. 
Splenic. 
To stomach, liver, spleen, pan- 
creas, and gall bladder. 
3. Superior mesenteric. To pancreas, small intestines, 
large intestine, upper part. 
4. Renal. To kidneys. 
5. Spermatic or ovarian. To testes or ovaries. 
6. Inferior mesenteric. To large intestine. 
ARTERIES OF UPPER EXTREMITY. Subclavian be- 
comes axillary after passing first rib : 
Axillary, from first rib to lower 
border Teres Major. 
Brachial, from Teres Major to 
one-half inch below elbow. 
1. Ulnar, from bend of elbow 
to palm (ulnar side), ter- 
minates in superficial 
arch. 
To axilla, lateral wall of thorax, 
shoulder joint and scapula. 
To arm (posterior surface sup- 
plied by Superior Profunda). 
To elbow joint; ulnar side fore- 
arm and hand ; posterior side 
(by posterior interosseous); 
fingers (except first and sec- 
ond). 26 
2. Radial, from bend of 
elbow to palm of hand 
(radial side); forms 
deep palmar arch. 
To elbow joint, forearm, and 
hand (radial side), thumb, and 
radial side index finger. 
PRIMARY DIVISIONS OF AORTA —at fourth lumbar 
vertebra: 
Right Common Iliac. 
1. Internal Iliac (right). 
2. External Iliac (right). 
Left Common Iliac. 
Pelvic organs, posterior part hip 
and thigh. 
Muscles of abdomen and pelvis. 
Same as right. 
ARTERIES OF LOWER EXTREMITY. External Iliac 
becomes Femoral on leaving pelvis : 
Femoral, from edge of pelvis to 
opening in Adductor magnus. 
Profunda Femoris, 
Popliteal, from Adductor magnus 
to lower border Popliteal. 
1. Anterior Tibial to annular 
ligament. 
Dorsalis Pedis. 
2. Posterior Tibial to behind 
inner malleolus. 
Peroneal. 
Posterior Tibial divides into 
1. Internal plantar. 
2. External plantar, forms 
with Dorsalis Pedis 
plantar arch. 
Superficial fascia of thigh ab- 
dominal and external genitals ; 
anterior surface of thigh; knee 
joint. 
Hip joint; posterior muscles of 
thigh. 
Knee joint, muscles of calf, and 
lower extremities of thigh. 
Anterior surface of leg, ankle 
joint. 
Dorsum of foot; plantar surface 
first and second toe. 
Posterior surface of leg, tibial 
side. 
Fibular side of leg. 
Internal side of foot. 
Plantar surface of foot and toes 
except as above. 
Section XII.—VEINS. 
Veins begin at periphery, and converge towards heart. Deep veins 
follow arteries, and usually have same name. Often two accompany 
an artery, communicating at intervals by cross branches. These are 
known as “venae comites.” Superficial veins lie directly under skin, 
and have no accompanying arteries. They empty into deep veins. 
VEINS OF CRANIUM, NECK, AND FACE form Internal 
and External Jugular, which unite with veins of upper extremity to 
make Venae Innominata. 
VEINS OF UPPER EXTREMITY. 
Deep veins accompany Radial, Ulnar, Brachial, Axillary, and 
Subclavian arteries, Subclavian vein joins Interior Jugular to 
make Innominata. 27 
Superficial veins of upper extremity form Cephalic (radial 
side) and Basilic (ulnar side). Basilic enters brachial or 
axillary; Cephalic joins axillary. 
Union of right and left Innominata make Vena Cava Superior. 
VEINS OF LOWER EXTREMITY. 
Deep veins accompany Plantar, Tibial, Popliteal, and Femoral 
arteries. 
Superficial veins of anterior and inner side of foot, leg, and 
thigh form Long or Internal Saphenous. Those of posterior 
and outer side of foot and leg form External or Short Saphe- 
nous. 
Internal Saphenous joins Femoral; External Saphenous 
joins Popliteal. 
VEINS OF TRUNK BELOW HEART. 
Veins of same name accompany External Iliac, Internal Iliac, 
and Common Iliac arteries. 
Right and left Iliac veins unite to form Vena Cava Superior. 
Vena Cava Inferior receives also blood from abdominal organs 
through liver by hepatic veins. 
Venae Azygi connect Vena Cava Superior with Vena Cava Infe- 
rior. Empty into former. 
Receive intercostal and bronchial veins. 
Relation of arteries and veins to capillaries : 
Capillaries everywhere make connection between arteries, 
and veins. (Exceptions,— tips of fingers and toes, bed of 
nails, tip of ears and nose.) 
Form a network which penetrates nearly every part of the 
body, forming the link between arteries and veins. 
Smallest capillaries, in nervous system ; largest, in marrow 
of bone. None in transparent parts of eye, cartilage, nor 
in some parts of bone. 
Walls of capillaries, layer of transparent, flat,' polygonal 
cells, cemented together by their edges. 
Section XIII.—PHYSIOLOGY OF CIRCULATION. 
FORCES THAT MOVE BLOOD. 
First, Contraction of muscular walls of heart, sufficient in 
itself to drive the blood throughout the body. 
Repeated on an average 72 times per minute. 
Action involuntary, but may be greatly modified by external 
circumstances. 28 
Modified by (a) age ; (b) sex; (c) position ; (d) exercise; 
(e) mental emotion. 
Causes of contraction, nerve stimulation from nerve cen- 
tres in cardiac walls; inhibited by pneumogastric; accel- 
erated by sympathetic (cardiac plexus). 
Second, Contraction of walls of blood vessels; acts chiefly 
in arteries. 
Third, Aspiratory force of thorax. 
Difference in atmospheric pressure between external surface 
of body and inside of thorax causes blood to be sucked 
into thorax during inspiration. 
Fourth, Muscular movement; acts chiefly in veins. 
Fifth, Gravity; acts in veins above heart, and in aorta (lower 
part). 
FACTORS THAT MODIFY CIRCULATION. 
Blood pressure, the pressure that the blood exerts on the 
walls of the blood vessels in its passage through them. 
High in arteries; diminishes rapidly in capillaries; very 
low in veins; often negative in vena cava. 
Amount dependent on : 
First, Force and frequency of ventricular systole. 
Second, Peripheral resistance met with in capillaries 
and small arteries. 
Peripheral resistance dependent on : 
(1) Increased friction met with in capillaries ; 
(2) Condition of blood in vessels ; 
(3) Vaso-motor influence on calibre of smallest 
arteries. 
Intermittent flow in arteries changed to continuous flow in 
capillaries and veins. 
Rapidity of flow; greatest in arteries, least in capillaries, inter- 
mediate in veins. 
Section XIV.—BLOOD. 
BLOOD, fluid which is contained in blood vessels by means of 
which all parts of the body are nourished. 
Description,— opaque, red fluid; reaction alkaline; specific 
gravity, 1.055. 
Composition : 
First, Plasma, or liquor sanguinis, the fluid portion. 
Second, Blood cells, or corpuscles, small bodies which float 
in the plasma. 29 
Chemical composition of 1,000 parts blood : 
Water, 604 
Fibrin, 7 
Albumen, 52 
Fat, 1 
Organic matter, 3 
Salts, 5 
Cells, 
328. 
Water, 200 
Haemoglobin, n6 
Salts, 2 
Other constituents, 10 
Plasma, 
672. 
Cells (red), small bi-concave disks of protoplasm; color, pale 
yellow; diameter, inch ; no visible nucleus nor cell mem- 
brane. 
Chief constituent haemoglobin, a proteid, which has the 
power of taking up and giving off oxygen. Contains 
coloring matter and iron. 
Salts : most important those of potash. 
Cells have tendency to adhere together in piles. Number 
in health, 5,000,000 red cells to one cubic mm. 
Origin ; marrow of bone, possibly spleen. 
Cells (white), round masses of granular protoplasm, show- 
ing nucleus and amaboid movement; diameter, inch; 
colorless. Proportion to red, xto 300 or 500, 
Plasma, constituents of : 
Albumen, clear, gelatinous substance, resembling white 
of egg. Very important in nutrition of tissues. 
Fibrin, delicate yellow threads or fibres formed in clotted 
blood, the process of clotting or coagulation being that 
the blood cells are caught in meshes of the fibrin. Be- 
lieved to be due to a ferment called “fibrin ferment,” 
acting on two constituents of blood known as paraglobulin 
and fibrinogen. 
Serum is the plasma minus the elements of fibrin. 
Salts : most important sodium chloride. 
Coagulation of blood very important in stopping hemorrhage. 
Does not clot in healthy blood vessels during life; if 
vessels are injured or diseased, may take place. 
Circumstances influencing outside of body ; 
Delayed or destroyed by 
Temperature over 50° C., freezing, certain chemicals. 
Hastened by 
Agitation, large surface, nature of surface. 
Section XV.—LUNGS. 
LUNGS, organs whose office is to expose the blood to the air for 
purification. 
Shape conical, apex pointed, base concave for diaphragm. Anterior border thin and sharp. Below shows notch where 
heart’s apex is seen. 
Posterior border rounded and thick. 
External surface convex, and shaped to correspond to thoracic 
wall. 
Internal surface concave, to accommodate heart. 
Whole surface covered by pleura. 
Partially divided by clefts into lobes. 
Color pink in childhood, gray and mottled in adults. 
Air conveyed to lungs through nose, mouth, pharynx, larynx, 
trachea, and bronchial tubes. 
Only trachea and bronchial tubes have this work as their sole 
office. 
Trachea, straight tube, consisting of rings of cartilage con- 
nected by bands of elastic and muscular fibre. 
Cartilages keep tubes open ; incomplete posteriorly. 
Lined with mucous membrane. 
Lies in front of oesophagus on bodies of vertebra, from 
fifth cervical to third dorsal, and there divided into right 
and left bronchi. 
Bronchi,— one for each lung, right shorter; divide and sub- 
divide into numerous bronchial tubes. 
Structure similar to trachea, except that cartilage is in 
plates, not rings. 
Smallest bronchial tubes have no cartilage, and are called 
bronchioles. 
Bronchioles terminate in expansions known as infundibula, 
walls of which are formed of pulmonary air cells. 
Pulmonary artery and pulmonary veins accompany bronchial 
tubes throughout lungs. 
Branches of pulmonary artery terminate in capillaries at 
infundibula. These capillaries ramify on outside of pul- 
monary air cells. 
Walls of capillary and air cells are so thin that blood is ex- 
posed freely to air. 
Pulmonary veins originate from these capillaries, and carry 
purified blood back to heart. 
Terminal bronchus, with its infundibula, arteries, and veins, 
constitutes a pulmonary lobule. 
Structure of lung may be said to be made up of vast num- 
bers of these lobules, held together by connective tissue. 
Pulmonary artery, pulmonary veins, bronchus, bronchial 
artery and vein, and pneumogastric nerve, all enter lung 
at same place, and make the “ root of the lung.” 31 
Section XVI—THORAX. 
THORAX, a closed cavity, the bony walls of which are covered 
with muscles. Inner surface covered with pleura costalis, which is 
reflected over surface of lungs at the roots, and there called pleura 
pulmonalis. 
Walls elastic, from costal cartilage, which completes it anteriorly. 
Lower limit, upper surface of diaphragm also covered with pleura. 
In health, pleura costalis and pulmonalis are in contact, the 
lungs filling the whole thorax, except part occupied by heart, 
great vessels, and oesophagus. 
Heart lies chiefly on left side, highest portion between third and 
fourth rib. Apex approaching chest wall between fifth and 
sixth rib and about two inches left of sternum. 
Its posterior surface rests on diaphragm. 
Section XVII.—RESPIRATION. 
RESPIRATION (pulmonary), which takes place in the lungs, is 
the process by which the O of air replaces the CO., of blood. 
This is accomplished by the alternate expansion and contraction 
of the thoracic walls, by which air is drawn into and expelled 
from lungs. 
Mechanism consists of two acts 
Inspiration, drawing in air. 
Expiration, expelling air. 
Both involuntary, but may be greatly modified by will. 
Enlargement of thoracic walls in inspiration accomplished by: 
(1) Elevation of ribs, ] , ~ , , 
(2) Descent of diaphragm, f both by muscular actlon- 
Principal muscles engaged in tranquil inspiration: 
Intercostals (External and Internal), Diaphragm. 
Action of Intercostals enlarges cavity laterally and ante- 
riorly. 
Diaphragm, muscular partition separating chest and abdomen. 
Two parts : 
Perpendicular, attached to lumbar vertebrae. 
Horizontal, dome-shaped, attached to sternum, edges of ribs 
7th to 12th, and lumbar vertebrae. 
Convexity toward thorax, concavity toward abdomen. 
Action in inspiration : descends till convex surface ap- 
proaches a plane, lungs follow its movement, abdominal 
organs descend, and abdominal walls expand. 
Action in expiration; relaxation of muscular fibres, and 32 
return to former position, lungs expel air, and abdominal 
organs resume their former level. 
Retraction of chest in ordinary expiration is accomplished by 
relaxation of the inspiratory muscles and elasticity of lungs. 
Very little, if any, muscular action except in forced expiration. 
(Special description of various muscles of respiration and their 
action belongs to the lecturer on muscles of the skeleton.) 
Length of inspiration compared with expiration, 6-8. 
Lung capacity : 
Residual air, that which never leaves lungs (100 cubic 
inches). 
Reserve air, that which can be expelled after an ordinary 
expiration (no cubic inches). 
Complemental air, that which can be inspired after an 
ordinary inspiration (no cubic inches). 
Tidal air, volume inspired and expired with each ordinary 
respiration (20 cubic inches). 
Vital capacity = reserve complemental -f- tidal. 
Normal mechanism of respiration requires,— 
Free mobility of chest walls and diaphragm. 
Mobility of chest walls impeded by 
Tight clothing, 
Faulty position, 
Feeble inspiratory muscles, 
Descent of diaphragm impeded by anything that limits the 
free movement of abdominal walls, such as tight bands 
and belts, long corsets, etc. 
Want of elasticity of costal cartilage. 
Chemistry of respiration. 
Has lost oxygen. 
Has gained carbonic acid. 
Has increased in tempera- 
ture. 
Has gained moisture. 
Contains ammonia and or- 
ganic impurities, the lat- 
ter even more poisonous 
than C02, and supposed 
to belong to class of 
ptomaines. 
Expired air as compared with inspired air 
O CO-2 N 
Pure air contains 20.81 .04 79.15 
Expired air contains 16.03 43S 79.58 
Difference between atmospheric air and air in air cells,— 
Always less O and more CO2 in air deep in lungs than in 
larger bronchi, but the difference is partially equalized ; 
By law of diffusion of gases, 
By action of the cilia of bronchial tubes. 33 
Relative amount of O and CO2 varies greatly with exercise, food, 
temperature, age, sex, etc. 
Respiratory changes in blood. 
Change in color: blood in pulmonary arteries, bluish; 
blood in pulmonary veins, bright red. 
Change in composition : arterial blood contains from 8-12% 
more O and 6°/0 less C 0 venous. 
Amount of O in arterial blood tolerably constant; amount 
of CO2 in venous blood varies greatly in different veins 
and at different times in same veins. 
Condition of Oin blood,— mostly found in red corpuscles 
in combination with haemoglobin, as oxyhcsmoglobin, by 
reason of great affinity that haemoglobin has for O. It 
remains thus combined till the arterial blood reaches the 
capillaries, where the tissues have a still greater affinity 
for O, and therefore take it from the blood, leaving the 
haemoglobin reduced. 
Condition of CO2 in blood not clearly known ; supposed to 
exist in combination with salts of plasma. 
Normal oxygenation of blood requires 
A constant supply of fresh, pure air to pulmonary air cells; 
A regular and free passage of blood from right side of heart 
through lungs back to left auricle. 
Effect of atmospheric pressure. 
High altitudes, as top of mountains, difficult to absorb 
enough O for wants of tissues. 
Effects are congestion of skin, rapid heart action, dyspnoea, 
muscular weakness, and faintness. 
Low altitudes (below surface of earth), skin pale, respira- 
tion and heart’s action slow, inspiration easy, expiration 
difficult. 
VENTILATION. 
Section XVIII.—ABDOMEN. 
ABDOMINAL CAVITY formed by diaphragm superiorly, inlet 
of pelvis inferiorly, lumbar vertebra behind, abdominal and lum- 
bar muscles forming greater part of anterior, lateral, and poste- 
rior walls. In upper portion the lower ribs help to enclose it ante- 
riorly and laterally, while below its contents are further supported 
by flaring sides of the iliac bones. 
Walls of cavity lined with peritoneum, which also forms a more 
or less complete covering of all the abdominal organs except 34 
the kidneys. It also forms folds by which the organs are held 
in place. 
ORGANS OF ABDOMEN; 
Stomach, small intestines, large intestines (alimentary canal), 
liver, gall bladder, pancreas, spleen, kidneys. 
Stomach, large pouch having two openings, cardiac at large, 
or upper end, pyloric at lower, or intestinal end. 
Lies close under diaphragm and behind anterior portions 
of ribs on left side, its pyloric extremity reaching a little 
to right of median line. 
When distended, may extend below ribs and far to right of 
median line. 
From lower border depends a fold of peritoneum, the great 
omentum. 
Small intestine, tube of twenty feet in length, extending 
from pyloric opening of stomach to ileo-caecal valve ; divided 
into duodenum, jejunum, and ileum,— lies coiled in centre of ab- 
domen, and held in place by the mesentery, which attaches 
it loosely to lumbar vertebrae. 
Large intestine opens from small intestine at right angles 
through ileo-caecal valve about level of right antero-superior 
spinous process of ilium, and forms an arch around small in- 
testine till it reaches lower edge of left iliac fossa, where it de- 
scends into pelvis {sigmoidflexure). 
Divided into caecum, colon, and rectum (latter in pelvis). 
Held more or less firmly in place by folds of peritoneum, 
called meso caecum, meso-colon, and meso rectum. 
Liver, large brown gland, occupying space between diaphragm 
and lower ribs on right side. Its left extremity crosses median 
line to edges of ribs on left side. 
In deep inspiration it extends below the ribs. 
It is connected with the duodenum by the ductus communis 
choledochus. 
Pancreas, long, narrow gland, extending transversely across 
the posterior part of the abdomen, behind the stomach. 
Its small end, or tail, rests on the spleen. Its large end, 
or head, fits into the curve of the duodenum, into which 
its duct opens with that of the liver. 
Spleen, dark colored, flat organ, lying to left of stomach and 
against lower ribs. 
Connected with stomach by a fold of peritoneum, the lesser 
omentum. 
Kidneys lie on posterior abdominal wall on each side of the 35 
lumbar vertebrae from the level of eleventh rib to third lumbar 
vertebra. 
Right kidney slightly lower than left. Lie behind peri- 
toneum. From concave border, a tube, the ureter, leads 
into the bladder. 
Section XIX.—ALIMENTARY CANAL. 
ALIMENTARY CANAL is the place into which food is 
received, its nourishing parts digested and absorbed, and from 
which the waste is excreted. 
Extends from mouth to anus, and is a modification of the 
simple tube which serves the same purpose in lower 
animals. 
Divided into mouth, pharynx, oesophagus, stomach, small and 
large intestines. 
Structure ; mucous coat, muscular coat, peritoneal coat. 
Mucous membrane lines it throughout. Contains the glands 
and blood vessels. 
Muscular coat composed of muscular fibre, arranged in 
various directions. Muscular fibres voluntary in mouth, 
pharynx, and upper part of oesophagus. Involuntary 
below diaphragm. Contraction of these fibres propels 
through food canal. 
Peritoneal coat covers muscular coat in parts below dia- 
phragm. Smooth and moist, to prevent friction in move- 
ments. 
Mouth, organ of prehension, mastication, and insalivation. 
These acts performed by muscles of mastication, aided by 
lips, teeth, and tongue. Into it open salivary glands 
Pharynx, passage from mouth to oesophagus. 
(Esophagus, straight tube lying in front of vertebrae from 
pharynx to cardiac orifice of stomach. Forms passage for 
food. 
Stomach, dilatation of the digestive canal for retention of food 
to subject it to action of digestive fluid. 
Shape, orifices, curvatures, direction of muscular fibres, 
movements. 
In mucous membranes lie the glands which secrete gastric 
juice. 
Small intestines, muscular fibres arranged in an outer or lon- 
gitudinal and inner or circular layer. Alternate contraction 
and relaxation of these layers push food on. 36 
Mucous membrane contains glands that secrete intestinal 
fluid. Into it are poured bile and pancreatic secretion. 
Large intestines chiefly for excretion of waste. Diameter larger 
than small intestines. Muscular fibres longitudinal and circu- 
lar, but former arranged in bands which increase their power. 
Section XX.—DIGESTION. 
DIGESTION, the process by which the nourishing parts of the 
food are changed into fluids which can be absorbed into the blood. 
Different parts of alimentary canal digest different classes of 
food. 
Each part has its own secretion and its own peculiar movements, 
by means of which the food is brought in contact with the 
secretion. 
A secretion is a fluid manufactured out of the blood, to be 
used for some special purpose. Secretions usually manu- 
facture in organs called glands. 
Glands are manufactories whose cells have the power of 
taking certain substances out of the blood and making 
them into a new fluid for special use. 
Foods,— classes : 
1. Proteids, containing nitrogen. 
2. Starches and sugars (contain C, H, and O). 
3. Fats (contain C, H, and O). 
4. Water and salts. 
The first three require to be digested before they can be 
absorbed. The fourth require no digestion. 
Changes in different foods by digestive fluids: 
1. Proteids changed to peptones. 
2. Starches and sugars to grape sugar. 
3. Fats emulsified. 
Most foods contain several of these classes, and must 
therefore be acted upon by several digestive fluids 
before digestion is completed. 
Four separate parts of canal which have each their special work 
in digestion : 
i st, Mouth digestion. 
Secretion, saliva from salivary glands. 
Digestive action, changes starch into sugars. 
Mouth digestion feeble and of minor importance. 
Saliva more to moisten food than digest it. 
Mechanical action, movements jaws, lips, and teeth. 37 
2d, Stomach digestion. 
Secretion, gastric juice, from gastric glands. 
Digestive action : changes proteids into peptones ; changes 
cane sugar into grape sugar. 
Mechanical action, contraction of muscular walls of stomach, 
churn food about, till it becomes semi-solid mass called 
chyme, 
3d, Digestion in small intestines. 
Secretions, pancreatic juice from pancreas, bile from liver, 
intestinal secretion from glands of intestines. 
Digestive action: 
(a) Pancreatic secretion changes proteids into pep- 
tones ; starch into sugar; emulsifies fat. 
(b) Bile antiseptic, stimulant to muscular action, aids 
in emulsifying fat. 
(1c) Intestinal secretion has feeble action on all classes. 
Mechanical action, peristaltic movements from contraction of 
muscular coat. 
4th, Digestion in large intestines. 
Secretion, intestinal secretion from intestinal glands, 
action very feeble. Large intestines intended to excrete 
waste, but in case of need, their digestive power may 
be used. 
Mechanical action, same as small intestines. 
Digestion influenced by many circumstances (mouth and stomach 
digestion chiefly). 
Conditions relating to food : 
(a) Temperature; (b) dilution; (c) division; (d) amount 
of indigestible matter. 
Conditions independent of food ; 
(a) Muscular exercise; (b) intellectual work; (c) sleep ; 
(d) condition of nerves. 
All classes of food necessary to a healthy nutrition, but propor- 
tions vary with age, occupation, habits of life, etc. 
Digestibility and nutritive power of food not synonymous. 
Both must be considered in preparing a suitable diet. 
(Digestive food tables, showing proportion of each food 
class and average time of digestion for the ordinary arti- 
cles of diet.) 38 
Section XXL—ABSORPTION AND NUTRITION. 
ABSORPTION, the process by which digested food is carried into 
blood. 
Takes place from all parts of alimentary canal, but chiefly from 
stomach and small intestine. 
Channels of absorption: 
Into capillary vessels. 
Into lymphatics. 
Both eventually carry the digested food into the general 
circulation. 
Absorption from stomach into capillaries, which approach 
the surface between the gastric glands. 
Absorption from intestines through intestinal villi. 
Villi, slight projections from mucous membrane of small 
intestine, each containing blood vessels and lacteals. 
Food absorbed into them carried to larger blood vessels 
and lymphatics at base. 
Food classes absorbed: 
Peptones, grape sugar, water, and salts usually absorbed 
into capillaries. 
Emulsified fats by lacteals of intestinal villi. 
NUTRITION, the process by which materials carried in the blood 
are used to build up and repair the various tissues of the body. 
Capillary blood vessels penetrate more or less freely between 
the elements of nearly all the tissues. Their liquid contents 
are largely exuded into the crevices between the tissue ele- 
ments, so that the latter are constantly bathed in nutritious 
liquid, called lymph. From this liquid the various tissues 
seem to have a selective power, whereby they take what is 
suitable to each. The remainder is carried away by the lym- 
phatics, into which also are poured many of the worn-out 
products of tissue waste. 
Section XXII.—LYMPHATICS. 
LYMPHATICS, name given to series of tubes which are found 
all over the body and whose office is to carry lymph. 
Lymphatic vessels accompany the blood vessels everywhere, col- 
lecting lymph from all the tissues and pouring it into veins. 
Main lymphatic vessel of body, thoracic duct, which extends 
from second lumbar vertebra to neck, where it empties into 
left internal jugular near juncture with left subclavian. 39 
Lymphatics from right side head, neck, upper extremity, thorax, 
right lung, and the heart, empty into smaller duct which enters 
right internal jugular vein. 
Principal lymphatic vessels run through lymphatic glands before 
entering main ducts. 
Seat of most important lymphatic glands : 
Beneath chin, occiput (base of), neck (behind Sterno-cleido- 
mastoid), axilla, groin, and in connection with internal 
organs as mesenteric bronchial. 
Structure of lymphatics; 
Large ones resemble veins; have valves. 
Smallest resemble capillaries. 
Lymphatic spaces, irregular channels in interstices of con- 
nective tissue; contain lymph. 
By means of them the tissue elements are bathed in lymph. 
Lymph is liquor sanguinis, to which are added lymph corpus- 
cles, derived chiefly from lymphatic glands. 
Lacteal lymphatics contain chyle. 
Lymphatics carry lymph where blood cannot go, as cornea 
of eye. 
Liquor sanguinis exudes into lymph spaces from capillaries, 
tissues appropriate what they need, and surplus is carried 
off by lymphatic capillaries, together with various products 
of tissue waste. 
Serous cavities are believed to be enormous lymph spaces. 
When lymph is not removed, it collects in tissues and cavi- 
ties, causing dropsy. 
Movements of lymphatics always toward heart. 
Causes of; muscular movement. 
Suction into veins during inspiration. 
Difference in pressure between lymphatics and veins near 
heart. 
Section XXIII—PELVIC ORGANS (Female). 
PELVIS contains organs of reproduction, bladder, and rectum. 
Organs of reproduction: 
Ovaries, organs in which ovum is formed and ripened. 
Consists of a firm network of fibres holding thousands of 
ova. 
Ova formed in ovary at birth, but do not change or ripen 
till the time of maturity. 
From time of development to forty-five or fifty years of age ova are constantly ripening and approaching the surface 
of the ovary, from which they are discharged. 
Later in life the ova cease to ripen, and the ovary gradually 
shrinks up and becomes useless. 
Uterus, organ in which ovum is developed; pear-shaped 
larger end (body) above, smaller (neck) below. Three 
inches long. Walls firm ; composed largely of involuntary 
muscular fibre. 
Cavity, an isosceles triangle, lower angle being the mouth, 
the two upper opening into the tubes. 
Fallopian tubes, the passages by which ova reach uterus ; 
two twisted narrow tubes about four inches long, leading 
outward from superior angles of uterine cavity. 
Lining of cavity, a modified mucous membrane. 
Diameter of tube very small, but expanded at both extremi- 
ties. 
Outer extremity trumpet-shaped, and bordered by fringes, 
or fimbriae. * 
Vagina, passage with muscular walls, which embraces the 
neck of the uterus above, and opens externally below. 
It is the channel by which the ovum is discharged exter- 
nally. 
Ovum when ripe projects from the surface of the ovary, and in 
this condition is grasped by the fimbriae of the Fallopian tubes, 
so that, when discharged, it falls into the tube and is gradually 
propelled into the cavity of the uterus. 
If, during its passage, it is fertilized, it embeds itself in the 
uterine wall and grows there. 
If not fertilized, it dies, and passes away unseen. 
Bladder, reservoir for urine. 
Lies anterior to uterus. When empty, is entirely within the 
pelvis, but, when full, rises above the symphysis. 
Discharges its contents externally by a narrow passage, the 
meatus urinarius. 
Rectum, termination of alimentary canal. 
Passes through pelvis, lying on the left of the median line and 
posterior to uterus; terminates in median line, its outer 
opening, the anus, being guarded by a strong sphincter 
muscle. 
Organs of pelvis fastened to each other and held in position chiefly 
by folds of peritoneum enclosing a few involuntary muscular fibres 
and known as ligaments of the pelvis. 
Broad ligaments most important; triangular folds stretching from sides of uterus to pelvic walls; in upper border run Fal- 
lopian tubes; from posterior surface project the ovaries; be- 
tween folds, blood vessels and nerves reach the uterus, tubes, 
and ovaries. 
Other ligaments bind bladder to uterus, uterus to rectum, 
and rectum to pelvis. 
Blood vessels of uterus and ovaries. 
Arteries, corkscrew like, called helicine. Veins very numer- 
ous. Walls fastened to muscular fibres, so they cannot col- 
lapse. No valves. Object, to accommodate growth of 
organs during pregnancy. 
GROWTH AND DEVELOPMENT OF REPRODUC- 
TIVE ORGANS. 
At birth very small, and remain so till near age of puberty, 
then begin to grow so rapidly that within a year or two they 
attain their full size and functions. 
Approaching maturity distinguished by both mental and phys- 
ical changes in a young girl. 
Complete maturity manifested by appearance of the menses. 
Menstruation, or monthly flow, a periodical hemorrhage, 
produced by rupture of the numerous capillaries on inner wall 
of uterus, caused by their over-distention from a congestion of 
all the pelvic blood vessels. 
Reason of menstruation,— pelvic organs supplied with more 
blood than they need for their own nutrition, to provide 
for the growth of the ovum. When there is no ovum to 
develop, the extra blood is discharged as the menstrual 
flow. 
Time of menstruation supposed by many to correspond to 
the approach of an ovum to surface of ovary,— not proven. 
Age of maturity or puberty differs with climate, social envi- 
ronments, habits of life, etc. In this climate averages 
thirteen to sixteen. 
Period of development, critical time for young girl. 
Growth of organs so rapid that they must have a plentiful 
supply of healthy blood. 
If the blood is not healthy or is diverted elsewhere, the 
organs are poorly developed and never perform their 
function well. 
Principal causes of imperfect development, mental and 
physical overwork, bad air, poor food, over-stimulation by 
social excitement, sensational novels, artificial life. 
Connection of pelvic organs with nervous system intricate 
and important. 42 
Insufficient or irregular development manifests itself by 
pain or some form of nervous excitement, commonly by 
both. 
Especial disposition among American girls to all forms of 
nervous derangements. Foundation of these often laid 
by improper care at puberty. 
Menstruation a natural process and, in a healthy, well-bal- 
anced person, should cause no interference with the ordi- 
nary habits of life ; but, in this age and country, few are 
so absolutely healthy that they can entirely disregard it. 
Precautions,— avoidance of excessive mental or physical 
work. 
If period painful, least possible exercise. If excessively 
painful, absolute rest. 
Effects of position on circulation in pelvis; peculiar condi- 
tions of circulation render venous stasis very liable to 
occur; effect of standing, sitting, lying, walking, on circu- 
lation. 
Effect of faulty positions on health of pelvic organs. 
Section XXIV.—NERVOUS SYSTEM. 
Complete nervous circuit consists of, ist, an efferent nerve fibre 
which conveys a nerve impulse from the periphery to a nerve 
centre ; 2d, a nerve cell, the source of nerve power; 3d, an efferent 
fibre which conveys the impulse generated in the nerve centre to 
the periphery. 
Nerve fibres are simply receivers and conductors of nerve im- 
pulses. 
Two kinds, white and gray. 
White nerve fibre consists of : 
(1) An outer delicate membrane (neurilemma). 
(2) An intermediate soft white layer (white substance of 
Schwann, or medulla). 
(3) Central gray fibre, or axis cylinder. 
The axis cylinder conducts the nerve impulse ; the medulla 
protects and insulates the axis cylinder; the neurilemma 
keeps fibre in shape. 
Gray nerve fibres have only axis cylinder and neurilemma. 
Nerves are collections of nerve fibres bound together in bundles 
by connective tissue, the whole surmounted by a sheath. 
Nerve cells distinguished by projections called poles, and ac 43 
cording to number of poles are called “ apolar,” “ bipolar,” 
“ multipolar,” etc. From these poles extend delicate gray 
fibres which connect them with poles of other cells, or with 
axes cylinders. 
Collection of nerve cells often called ganglion. 
HUMAN NERVOUS SYSTEM consists of: 
i. Cerebro-spinal system (brain, spinal cord, cerebral and 
spinal nerves). 
2. Sympathetic system (sympathetic ganglia and nerves). 
Cerebro-spinal system controls all voluntary and intellectual 
acts, and partially the work of many internal organs. 
Brain and spinal cord contain nerve centres, to and from 
which all nerves run (afferent and efferent). 
Nerves are composed entirely of white fibres. 
Nerves conveying sensory impulses only, called “sensory 
nerves ” (fibres all afferent). 
Nerves conveying motor impulses only, called “motor 
nerves ” (fibres all efferent). 
Nerves conveying both sensory and motor fibres are “ mixed 
nerves” (fibres both afferent and efferent). 
Spinal nerves (31 pairs), all mixed nerves. Afferent and 
efferent fibres run in same sheath, except at two extremities. 
Central end ; afferent and efferent fibres separate just within 
intervertebral foramen, afferent fibres forming posterior 
nerve root and entering posterior part of cord, efferent 
fibres coming from anterior part of cord and forming ante- 
rior nerve root. 
Posterior root further distinguished by a small ganglion. 
Peripheral end; sensory nerve terminations in skin. Axis 
cylinder of each fibre splits into fibrillae, each of which 
connects itself with cells of derma. 
Special endings in tips of fingers and toes, palms of hands, 
tongue, etc. 
Motor nerve fibres end chiefly in “ muscle plates.” 
Spinal nerves divided into : 
8 pairs cervical. 
12 pairs dorsal. 
5 pairs lumbar. 
5 pairs sacral, 
i pair coccygeal. 
Each nerve on leaving internal verte- 
bral foramen divides into anterior and 
posterior branches; posterior branch 
small, anterior branch gives off chief 
nerves to trunk and extremities. 
Nerve plexuses, union of branches of several nerves from 
which other nerves are given off to special regions. 44 
Section XXV.—SPINAL NERVES AND THEIR 
DISTRIBUTION. 
CERVICAL PLEXUS (Ist, 2d, 3d, and 4th cervical). 
Muscles and skin of occiput, neck, back of ear, shoulder (upper 
part), diaphragm. 
BRACHIAL PLEXUS (sth, 6th, 7th, Bth cervical, Ist dorsal). 
Muscles of chest (Pectorales), scapula (partially), shoulder joint, 
upper extremity. 
External cutaneous, muscles of arm, skin forearm (external). 
Internal cutaneous, skin arm, and forearm (internal). 
Median, muscles forearm (anterior), palm of hand and fingers 
(except as by ulnar). 
Ulnar, muscles of forearm (ulnar side), skin of wrist and fin- 
gers (little and ulnar side of ring). 
Musculo-spiral, muscles and skin arm (chiefly posterior); 
divides into: 
Radial, skin dorsal side of wrist and fingers (with ulnar). 
Posterior Interosseous, muscles forearm (posterior). 
Circumflex, shoulder joint. 
DORSAL NERVES (form no plexuses ; twelve in number). 
Intercostal muscles, breasts, muscles and skin of lower part of 
thorax (anterior surface), and upper part abdomen. 
LUMBAR PLEXUS (12th dorsal, ist, 2d, 3d, 4th lumbar). 
Muscles and skin lower part abdomen, external genitals, hip and 
knee joints, muscles of thigh (anterior surface), skin leg and 
foot (internal surface). 
Anterior Crural, muscles anterior surface thigh, skin inner 
surface leg and foot (by Long Saphenous). 
SACRAL PLEXUS (sth lumbar, ist, 2d, 3d, and 4th sacral). 
Shin and muscles of hip (Gluteal region), external genitals and all 
of lower extremity, except as by lumbar plexus. 
Great Sciatic, muscles posterior part thigh ; divides into: 
Internal Popliteal, muscles of leg, tibial side (by Posterior 
Tibial), plantar surface foot (by External and Internal 
Plantar), ankle joint. 
External Popliteal, knee joint, muscles of leg, anterior 
surface (by Anterior Tibial), fibular side leg, skin of 
dorsum of foot and toes (by Anterior Tibial and Musculo- 
cutaneous). 
Spinal nerves take their names from intervertebral foramen, at 
which enter the spinal canal. Within canal course varies : in cervi- 45 
cal and dorsal regions reach cord near level at which they enter 
canal, but in lumbar and sacral regions (since cord ends at ist 
lumbar vertebra) their course is nearly perpendicular, and they 
form the “ cauda equinse.” 
Section XXVI.—SPINAL CORD. 
SPINAL CORD occupies vertebral canal from foramen magnum 
to lower edge ist lumbar vertebra. 
Length, 18 inches; size varies in different parts. 
Consists of central gray mass surrounded by white fibres (chiefly 
longitudinal). 
Partially divided in halves by anterior and posterior fissures. 
Gray matter arranged in two crescents, joined by their convex 
surfaces, point of union being central canal. 
Anterior horns, or cornua, short, broad, do not reach surface 
of cord. From them issue efferent nerve roots. 
Posterior horns, or cornua, long and thin, and reach sur- 
face. Into them enter posterior nerve roots. 
Consists of nerve cells and fibres (mostly gray), forming 
dense network bound together by connective tissue (neu- 
roglia). 
Cells chiefly in groups in special parts. 
Those of anterior cornua large, multipolar. 
Those of posterior small, scanty, few poles 
Fibres that connect lateral valves of gray matter, (anterior 
and posterior gray commissures). 
White matter consists of fibres, mostly longitudinal; ar- 
ranged in masses called columns (anterior, lateral, posterior). 
Columns of cord form connections between 
Spinal nerves and brain ; 
Gray matter of cord and brain; 
Different levels of cord. 
Afferent nerve fibres all enter posterior cornua. 
Course complicated, but fibres either connect themselves 
with cells of posterior cornua or soon become perpendic- 
ular, and ascend to the brain in posterior or lateral col- 
umns. 
A large portion cross in posterior gray commissure before 
entering columns. 
Efferent nerve fibres originate either in cells of anterior 46 
cornua or are made of fibres descending from brain in ante- 
rior or lateral columns. 
A few white fibres cross from one side to other at bottom 
of anterior fissure, forming “white commissure.” 
Cells of anterior and posterior cornua (same side) connected 
by network of gray fibres. 
Spinal nerves therefore enter into two distinct nervous circuits, 
ist, From posterior nerve roots through cord from posterior 
nerve cells to anterior nerve cells, emerging from anterior 
cornua in anterior nerve roots. 
2d, From posterior nerve roots ascending to nerve centres in 
brain, from which impulses descend the cord to emerge in 
anterior nerve roots. 
Section XXVII.—BRAIN. 
BRAIN consists of cerebrum, cerebellum, pons Varolii, medulla ob- 
longata. 
Cerebrum, upper and larger portion; superior surface convex, 
fills vertex; inferior surface divided into lobes. 
Anterior and middle lobes fill anterior and middle fossae; 
posterior lobe rests on cerebellum. 
Divided into two hemispheres above by longitudinal fissure, 
prolonged anteriorly and posteriorly, as anterior and pos- 
terior fissures. 
Hemispheres united near base by corpus callosum. 
Connected with pons Varolii by two masses of white fibres, 
the crura cerebri. 
Cerebellum (hind brain) lies below posterior cerebral lobe, and 
occupies part of posterior cerebral fossa. 
Connected by bands of fibres called “ peduncles ” with each 
of other part of brain. 
Pons Varolii, “the bridge” which connects different parts of 
brain together. 
Flattened, pyramidal-shaped mass, larger extremity up- 
wards ; lies on basilar process. 
Connected above with cerebrum, by crura cerebri. 
Connected laterally with cerebellum by cerebellar peduncles 
(middle portion). 
Below continuous with medulla. 
Medulla oblongata, enlarged upper end of spinal cord; lies 
on basilar process. 47 
Place where fibres descending from brain to cord cross each 
other and descend on opposite side. 
Membranes of brain, often called “meninges.” 
Dura mater, fibrous membrane ; covers surface, and dips into 
fissures. At base continuous with periosteum anteriorly; 
forms tentorium cerebelli between cerebrum and cerebellum. 
Arachnoid, very delicate membrane ; covers surface. 
Pia mater, delicate lace-like membrane; covers surface, and 
dips down between convolutions; contains blood vessels. 
BASE OF BRAIN includes inferior surface of anterior and middle 
lobes of cerebrum, crura cerebri, pons Varolii, medulla oblongata, 
and cerebellum. 
Anterior and middle lobes separated by fissure of Sylvius. 
Olfactory bulb seen on each side median line on anterior lobe. 
Middle lobes separated in median line by diverging crura 
cerebri, over which wind the optic tracts which form on 
median line the optic commissure. 
Posteriorly, inferior surface of pons and medulla occupy middle 
portion, the cerebellum filling lateral regions. 
Superficial origin of all cranial nerves, all except first two coming 
from pons or medulla : 
CRANIAL NERVES AND THEIR DISTRIBUTION. 
i st, Olfactory. 
Mucous membrane of nose. 
Special sense 
(smell). 
2d, Optic. 
Retina of eye. 
Special sense 
(sight). 
3d. ) 
4th, b 
Muscles of eye. 
Motion. 
6th, ) 
5 th, 1 st Division. 
Orbit, forehead. 
2d 
Face between orbit and 
c 
upper lip, upper teeth. 
> Sensation. 
B 3d 
Face between upper lip and 
bJD 
chin, lower teeth. 
g 3d 
3d 
T ongue. 
Special sense 
(taste). 
Muscles of mastication. 
Motion. 
7th, Facial. 
Muscles of face. 
Motion. 
8th, Auditory. 
Internal ear. 
Special sense. 
9th, Glosso-pha- } 
ryngeal. \ 
Tongue, pharynx, tonsils. 
Sensation. 
10th, Pneumo-7 Larynx,pharynx,oesophagus, ) Motion and 
sensa- 
gastric. J 
heart, lungs, stomach. ] 
tion. 
nth, Spinal Ac-1 
cessory. j 
Trapezius. 
Motion. 
Motion. 
12th, Hypoglossal. Muscles of tongue. 
Cerebrum, structure of: 
Surface, a layer of gray matter arranged in folds or convolu- 
tions. Into these convolutions radiate masses of white 48 
fibres which make connection between cerebral cortex 
and parts within substance of brain. 
Near base several great ganglionic masses; namely, Cor- 
pora Striata, Thalami Optici, Corpora Quadrigemini. 
These occupy partly space between commissure above 
(corpus callosum) and radiating fibres to convolutions 
below. 
Spaces known as ventricles. 
Fibres entering or leaving cerebral hemispheres pass through 
crura cerebri, afferent fibres occupying posterior part, 
efferent fibres anterior part. 
Cerebral localization: areas for localization of different 
muscular movements and conscious sensations have been 
fixed upon to some extent, and it is probable that event- 
ually each convolution will prove to have some special 
work of which it is the centre. 
Best known regions are the motor areas surrounding fissure 
of Rolando. 
Motor area for leg movements. 
Motor area for arm movements. 
Motor area for face movements. 
Centre for speech, fissure of Sylvius, left side. 
Centre for sight, posterior lobe. 
Centre for smell, middle lobe, anterior extremity 
Centre for hearing, temporo-sphenoidal lobe. 
Cerebellum gray externally, white internally; gray and white 
foldings form arbor vitae. 
Pons and medulla chiefly white fibres on their way to or from 
other parts of nervous system. 
Scattered through white matter many gray masses, called 
“ nuclei,” from which all of cranial nerves except optic 
and olfactory take origin. 
SYMPATHETIC NERVOUS SYSTEM controls parts of 
body that act independent of will. 
Great Sympathetic nerve is a double chain of ganglia ex- 
tending from within cranium to front of coccyx, where it ter- 
minates in one small ganglion. 
Lies on each side vertebral column, and its ganglia take 
name of region in which they lie ; namely, cephalic, cer- 
vical, dorsal, lumbar, sacral. 
Each ganglion connected by nerve fibres with one above 
and below, and also with cerebro-spinal system. 
Nerves of sympathetic proper all gray. 49 
Nerves forming connection with cerebro-spinal system white. 
From this chain given of plexuses distributed to blood ves- 
sels and internal organs, chief plexuses : 
Cardiac and Pulmonary to heart and lungs. 
Solar (surrounds coeliac axis, receives splanchnic nerves 
from lower dorsal region), distributed to all abdom- 
inal organs, descending to each by its accompany- 
Hypogastric plexus supplies all pelvic organs. 
PHYSIOLOGY OF NERVE ACTION: 
ing artery; contains “semilunar ganglia.” 
i. Conscious sensation and voluntary motion. 
Sensations received by afferent nerve fibres transmitted to cere- 
bral cortex, the nerve power there developed descending by 
efferent fibres to voluntary muscles. 
Examples in ordinary sensations with their resulting muscu- 
lar movements. 
2. Reflex action, the transmission of an efferent impulse to a 
lower nerve centre, where it gives rise to an efferent impulse 
without any influence of will. 
Seen best in lower animals in spinal cord. 
Reflex centres for vomiting, swallowing, vaso-motor action 
in medulla. 
3. Automatic action differs from reflex action chiefly by the fact 
that an automatic centre may be directly stimulated, the stimu- 
lus not being necessarily an afferent impulse. 
Sympathetic nerve centres. 
Example: respiratory centre stimulated by carbonic acid 
in blood. 
4, Psychical and mental action. 
Power of purely intellectual acts supposed by some to originate 
in cells of cerebral cortex, by others to be stimulated by im- 
pressions received from without by afferent nerves. 
Function of Cerebellum; so far as known, believed to be co-ordinat- 
ing centre through whose means complicated acts are co-ordinated. 
Section XXVIII.—EXCRETIONS AND PROCESS 
OF EXCRETION. 
EXCRETION, the process by which waste and injurious products 
are removed from the body. 
AH parts of body continually wearing out. If worn-out products are not removed, they not only prevent proper nutrition, but 
act as poisons in the system. 
Principal avenues by which worn-out materials leave body: 
1. Lungs, excretion,— CO2 and gaseous impurities, 
2. Skin, excretion,— perspiration. 
3. Kidneys, excretion,— urine. 
4. Liver, excretion,— portion of bile. 
5. Intestines, excretion,— fasces. 
Of these excretory organs, the kidneys alone have excretion for 
their sole work. 
Lungs : excretory work has been described in respiration. 
Skin covers body externally; two layers, epidermis and derma, 
or true skin; protects delicate tissues beneath; retains 
warmth; secretes and excretes perspiration. 
Epidermis, upper layer, consists of flat scales which protect 
parts beneath. 
This layer has no nerves or blood vessels ; is constantly 
being thrown off as dead skin. 
Nails, hair, claws, hoofs, etc., belong to epidermis. 
Thickness inversely as sensitiveness of part; thickest 
wherever greatest pressure occurs, as soles of feet; 
thinnest, ball of fingers, lips, breasts, etc. 
Derma, below epidermis, very sensitive. 
Close, felt-like, fibrous structure above, loose meshes 
below. Contains fat, sweat glands, hair follicles, 
sebaceous follicles, nerves, and blood vessels. 
Surface usually ridged, the ridges forming the papillae 
into which blood vessels and nerves enter. 
Sweat glands, coiled up tubes which open on surface 
between papillae by small ducts surrounded by capil- 
laries, from which they take material to form perspi- 
ration. Have around the mouths of ducts a few 
involuntary muscular fibres, by which they are opened 
or closed. 
Hair follicles, infolding of epidermis to form beds for 
the hair. 
Sebaceous glands, small, flask-like glands, which secrete 
oily fluid which keeps skin and hair moist and soft. 
Usually open into a hair follicle. 
Perspiration (combination of secretions of sweat and seba- 
ceous glands) is a fluid consisting of water, salts, some organic 
matters : the latter are poisonous, if retained in system. Im- 
portant regulator of bodily temperature. Normal body temperature in all climates and conditions, 
98.5. 
When from internal or external cause bodily temperature 
tends to rise, mouths of sweat glands relax, and sweat is 
poured out, evaporation of which rapidly cools body. 
Every process in body accompanied by production of heat. 
When external air is cold, these openings close, and retain 
the heat for keeping body warm. 
Condition of skin very important to bodily health. 
If epidermis is not constantly removed, mouths of sweat 
glands are blocked up, and excretion is hindered. 
If cutaneous circulation is not active, sweat glands cannot 
obtain material to excrete. 
Constant washing and friction of skin necessary to keep it 
healthy. 
Baths,— warm, hot, and cold. 
Kidneys, two glands whose sole office is to manufacture urine. 
Materials of urine taken from blood supplied to kidney by 
renal arteries. 
Conditions regulate hygiene of bathing. 
Consist of outer cortical portion, and inner medullary por- 
tion. 
Cortical portion consists of larger numbers of small tubes, 
or “ tubuli uriniferi,” most of which are convoluted. 
Each tube begins in a bulb-like enlargement, the Malpighian 
body. 
Surrounding the tubes are vast numbers of capillary blood 
vessels, from which the tubes obtain material for urine. 
Medullary portion consists of pyramidal-shaped masses of 
straight tubes, which open by their apices into the pelvis 
of kidney. Between the tubes run many capillary blood 
vessels. 
Urine, secreted in twisted tubes, is poured by straight tubes 
into pelvis. 
Pelvis of kidney, large cavity on its concave border, which 
opens into ureter, by which urine is removed from kidney 
to bladder. 
Secretion of urine is constant, so bladder is the reservoir 
where urine is retained till it can be removed. 
Urine, clear, yellow, acid fluid. Specific gravity, 1.015-1.020. 
Quantity in twenty-four hours averages three pints. 
Principal constituents, water, salts, urea, uric acid, coloring 
matter. Urea and uric acid., products of worn-out nitrogenous tissues 
of body. 
Urea deadly poison, which, if allowed to accumulate in 
system, causes headache, stupor, convulsions, and very 
soon death. 
Amount varies with temperature, amount and nature of food 
and drink taken, action of skin, mental conditions, etc. 
Skin and kidneys have a somewhat reciprocal action. Skin 
can excrete water and salts, and in some cases a small 
amount of urea. 
Pure water in sufficient quantities needed to keep kidneys 
active. 
Liver, largest gland in body; secretes bile. 
Upper surface, smooth and convex. 
Lower surface, divided into lobes, between which blood 
vessels and bile duct enter substance of liver. 
Gall bladder lies in under surface. 
Right extremity rounded and thick ; left sharp and thin. 
Receives venous blood from stomach, intestines, spleen, and 
pancreas by the Vena Porta. 
Framework of connective tissue (capsule of Glisson) rami- 
fies through every part, dividing it into lobules. 
Branches of vena porta, hepatic artery, and hepatic duct, 
follow the capsule of Glisson to every lobule. 
Vena porta by its branches (interlobular) surrounds each 
lobule. 
Interlobular veins send centripetal capillaries to centre of 
lobule. 
Lobular capillaries unite in centre to form intralobular veins. 
Intralobular veins become sublobular as they leave lobule. 
Sublobular veins unite to form hepatic veins. 
PTepatic artery serves chiefly to nourish substance of liver. 
PPepatic or bile duct collects bile. 
Bile formed within the lobules from blood of capillaries, and 
carried by “bile capillaries” to hepatic duct, a branch of 
which surrounds each lobule. 
On leaving liver unites with pancreatic duct to form “ Ductus 
Communis,” and enters duodenum. 
Cystic duct leads from hepatic duct to gall bladder, which is 
an overflow place for bile. 
Bile, clear, golden-brown fluid, alkaline reaction, contains 
salts useful in digestion, coloring matter, and excretory 
substances, chief of which is cholesterine. Cholesterine, if retained, causes symptoms of narcotic poi- 
soning, not so severe as urea. 
Liver also has important office in changing sugar formed in 
digestion into glycogen. Process not well understood. 
Faeces, chiefly waste-food products, mixed with intestinal secre- 
tions and bile, excreted by large intestines. 
If not regularly excreted, these products ferment and putrefy, 
portions of them are gradually reabsorbed into blood, 
causing a form of slow poisoning. 
Chronic constipation causes headache, slow mental processes, 
general sluggishness and torpor, which affects general 
health more or less. 
General directions in regard to regulating bowels. 
(To avoid making this book unduly long, the portions of the 
lectures relating especially to hygiene are only indicated, the full 
synopsis being omitted.)