ANATOMY 
AND PHYSIOLOGY 
FOR NURSES 
BY 
leroy^ewis, 
SURGEON TO AND LECTURER ON ANATOMY AND PHYSIOLOGY 
FOR NURSES AT THE LEWIS HOSPITAL, BAY CITY, MICHIGAN 
Illustrated 
PHILADELPHIA AND LONDON 
W. B. SAUNDERS & COMPANY 
1905 Copyright, 1905, by W. B. Saunders & Company. 
ELECTROTYPED BY 
WESTCOTT & THOMSON, PHILA. 
PRESS OF 
W. B. SAUNDERS & CO. PREFACE. 
The frequent request, on the part of those whom 
it has been my pleasure to instruct in Anatomy and 
Physiology during the last few years, to write a book 
based somewhat upon the plan employed in teaching 
this subject has been the principal incentive to my 
action. 
The field of anatomy and physiology is already too 
well cultivated for one, in this brief space, to hope to 
do more than aid the student in acquiring established 
facts. 
In preparing this work I have endeavored to make 
the text as simple and comprehensive as could be 
done, that the students may be able to grasp the 
primary principles, after which they will have suffi- 
cient knowledge to apply themselves to future 
studies. 
The works of Gray, Wilson, Deaver, Brubaker, 
Kimber, and others have been freely consulted, and 
in some instances their language has been employed 
or paraphrased. 
Through the kindness of the publishers I have 
been enabled to make use of many illustrations that 
5 6 
PREFACE. 
will be to the student object-lessons and in many 
instances make the text more comprehensive. 
The author desires to acknowledge the aid derived 
from the sources mentioned, and trusts that the 
reader will find something to commend in the pages 
that follow. 
Bay City, Mich., 
August io, 1905. 
Le ROY LEWIS. CONTENTS. 
PAGE 
Introduction 11 
CHAPTER I. 
OSTEOLOGY 13 
Classification of Bones 16 
The Spinal Column 18 
The Skull 20 
Thorax and Pelvis 26 
Bones of the Upper Extremities 30 
The Hand 33 
Bones of the Lower Extremities 34 
The Foot 36 
The Articulations 37 
CHAPTER 11. 
The Muscular System 45 
Muscles of the Head and Face 48 
Muscles of the Neck 53 
Muscles of the drunk 57 
Muscles of the Upper Extremities 62 
Muscles of the Shoulder and Arm 62 
Muscles of the Forearm 67 
Muscles of the Hand 69 
Muscles of the Lower Extremities 71 
• Muscles of the Leg 77 
Muscles of the Foot 79 
7 8 
CONTENTS. 
The Muscular System (^Continued'}. PAGE 
Muscles of the Perineum 80 
Tendons .............. So 
Adipose Tissue So 
CHAPTER III. 
The Circulatory or Vascular System 84 
The Heart 84 
The Arterial System 90 
The Aorta 4 92 
The Abdominal Aorta 109 
The Venous System 116 
Veins of the Head and Neck 119 
Veins of the Upper Extremities 122 
Veins of the Lower Extremities 124 
Veins of the Trunk 126 
The Portal Circulation 129 
The Pulmonary Circulation 129 
The Blood 130 
The Vascular System of the Fetus 134 
CHAPTER IV. 
The Respiratory System 140 
The Lungs 141 
The Diaphragm 147 
CHAPTER V. 
The Digestive System . 148 
The Stomach 156 
The Intestines 159 
The Lacteals 166 
The Thoracic Duct 168 
Regions of the Abdomen and their Contents. . .170 CONTENTS. 
9 
CHAPTER VI. 
PAGE 
The Excretory System 174 
The Kidneys 177 
The Ureters 178 
The Bladder 178 
The Suprarenal Capsule 183 
The Skin 183 
The Appendages of the Skin 187 
CHAPTER VIL 
The Nervous System 191 
The Nerves 197 
The Brain 203 
The Spinal Cord 212 
The Nerves of the General System 215 
The Great Sympathetic Nerve 226 
CHAPTER VIII. 
The Glandular System 230 
The Lymphatic Glands 230 
The Liver 232 
The Gall-bladder 234 
The Spleen 236 
The Pancreas 238 
The Parotid Glands 239 
The Submaxillary Glands 240 
The Sublingual Glands 241 
The Thyroid Gland 241 
The Prostate Gland 242 
The Lacrimal Glands 242 
The Mesenteric Glands 242 
The Mammary Glands 243 
The Sebaceous Glands 245 
The Sudoriparous Glands 245 10 
CONTENTS. 
CHAPTER IX. 
PAGE 
The Membranes of the Body 249 
CHAPTER X. 
The Organs of Special Sense . .... 252 
The Organs of Sight 252 
The Appendages of the Eye 257 
Physiology of Vision 259 
The Organs of Hearing 261 
The Organs of Taste 264 
The Organs of Smell 266 
The Organs of Touch 269 
CHAPTER XI. 
The Female Organs of Generation 272 
The Vagina • 275 
The Uterus 277 
Appendages of the Uterus 280 
CHAPTER XII. 
Repair and Waste-Nutrition-Animal Heat-Perspi- 
ration-The Power that Supports and Preserves 
Health 289 
Nutrition 291 
Animal Pleat 292 
Perspiration 295 
The Power that Supports and Preserves Health . 298 
Index 3°3 Anatomy and Physiology 
FOR 
Nurses. 
INTRODUCTION. 
In taking up the study of the anatomy of the 
human body we shall confine ourselves to a general 
consideration of those branches that most concern the 
nurse, taking up the anatomy of the various organs 
and their physiologic functions, and omitting the 
minute anatomy that is required only of those who 
desire to perfect themselves in advanced work. The 
essential points that a nurse should be well acquainted 
with are : The regions of the body ; the internal 
organs, their names and their location, the relation 
each organ bears to life. Thus only will we be en- 
abled to understand the conditions of the body in dis- 
ease. 
In applying ourselves to that important subject that 
concerns the nursing of the sick, we should under- 
stand, first what goes to make up the complex organ- 
ization of the body and, second, by what means we 
are to obtain this knowledge. 
We shall begin our first study by taking up the 
several systems that constitute the body, so that the 
11 12 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
nurse may become familiar with the technical terms 
that will be employed in the general work : 
The word anatomy is derived from two Greek 
words, apart, and to cut, meaning liter- 
ally dissection. 
The science of anatomy comprises the study of the 
body as a whole and the relations of its various 
organs. It is divided into the following branches : 
osteology, the anatomy of the bones ; syndesmology, 
that of the joints; myology, that of the muscles ; 
angiology, that of the vessels ; neurology, that of the 
nerves ; splanchnology, that of the internal viscera ; 
adenology, that of the glands ; dermatology, that of 
the skin ; genesiology, that of the generative organs. CHAPTER I. 
OSTEOLOGY. 
We shall first consider the framework (or osseous 
system) that supports the body. This is known as 
"the skeleton" (from the Greek axekrov, a dried 
body), and gives attachment to the muscles and forms 
a protection to the internal organs. 
Bone.-Bone is composed of two kinds of tissues, 
Fig. i.-Portion of a transversely ground disk from the shaft of a human 
femur; X 400 (Bohm and Davidoff). 
one dense and compact, like ivory, the other made up 
of slender fibers (lamella) arranged in the form of 
lattice work, and called cancellated tissue,. The for- 
mer is always external, and the latter internal. These 
combinations vary in different parts of the body. In 
portions of bone subject to great force the tissues are 
more compact, while the parts that are not exposed 
13 14 
ANATOMY AND PHYSIOLOGY HOT NUHSES. 
to severe strain are provided with cancellous tissue. 
Bone tissue contains longitudinal canals that com- 
municate with one another, and arc 
called Haversian canals. They con- 
vey blood-vessels for the nutrition of 
the bone. 
All bones are covered with a dense 
fibrous vascular membrane, the peri- 
osteum. The medullary and cancel- 
lous cavities of bone are lined with 
a delicate membrane, the endosteum 
containing bone-forming cells. In 
their normal state bones have but 
little sensibility ; but when in a state 
of inflammation they are extremely 
sensitive and painful. 
Chemic analysis shows that bone 
consists of organic and. inorganic 
matter ; the organic is called ani- 
mal, the inorganic, earthy material ; 
these are intimately combined ; the 
animal matter furnishes elasticity 
and toughness, the earthy, hardness 
and solidity. 
How can we separate the two 
kinds of tissues to prove that this is 
the case? This is done by steeping 
a portion of bone in dilute nitric or 
hydrochloric acid: in this way the 
earthy material is taken up, leaving 
the animal or organic material be- 
hind, so that the bone can be twisted into any shape, 
thus demonstrating its elasticity and toughness. The 
presence of earthy material may be demonstrated by 
Fig. 2.-Bone tied in 
knot (Raymond). OSTEOLOGY. 
15 
subjecting the bone to strong heat in an open fire where 
the air can have free access, until all the organic ma- 
terial is consumed, when the earthy parts will be found 
to be brittle, preserving the original shape of the bone. 
The organic constituents of bone make up one-third, 
or 33.3 per cent., of the whole ; the inorganic matter, 
two-thirds, or 66.7 percent. For the convenience of 
the nurse we append the following table of analysis 
by Berzelius (from Gray's Anatomy): 
Organic matter : Gelatin and blood-vessels .... 33.30 
Phosphate of lime 5IO4 
Carbonate of lime 11.30 
Fluoride of calcium 2.00 
Phosphate of magnesia 1.16 
Soda and chlorid of sodium . . . 1.20 
Inorganic or earthy 
matter: 
100.00 
Some difference exists in the proportion of the two 
constituents of bone at different periods of life. Thus 
in a child the animal matter predominates, whereas 
in the aged the bones contain a larger proportion of 
earthy matter, the animal matter being deficient in 
quantity and of impaired quality. Hence in children 
it is not uncommon to find, after an injury, that the 
bones become bent or partially broken-a condition 
known as greenstick fracture-whereas in old per- 
sons the bones are more brittle and fracture thus takes 
place more readily. Many of the diseases, also, to 
which bones are liable are due to a disproportion be- 
tween the two constituents of bone. Thus in the 
disease known as rickets, so common among children 
of the poor, the bones become bent or curved, either 
from the superincumbent weight of the body or under 
the action of certain muscles. This is due to some 
defect of nutrition by which bones are deprived of 16 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
their normal proportion of earthy matter, whereas the 
animal matter is of unhealthy quality. 
CLASSIFICATION OF BONES. 
The bones of the body are divided into four groups : 
long, short, flat, and irregular. These go to make up 
the frame that protects the internal organs, and pro- 
vides attachment for the several soft parts. 
The long bones are those that make up the ex- 
tremities ; the short bones are those of the hands 
and feet ; the flat bones are those of the shoulder- 
blades, pelvis, skull, etc. ; the irregular bones are 
those of the spine, as well as the ethmoid, the tem- 
poral, etc. 
What have we to say about the surfaces of bones? 
If you examine a bone, you will notice that it has cer- 
tain eminences and depressions ; these have technical 
names, and it should be the aim of the nurse to be- 
come acquainted with each, so that she will be able 
to describe a part concerned in an injury in a practi- 
cal manner. These bony eminences and depressions 
are of two kinds : articular and non-articular. 
Examples of articular eminences are found in the 
head of the arm bone (humerus) and thigh bone 
(femur). As examples of articular depressions may 
be mentioned the glenoid cavity of the scapula (shoul- 
der-joint) and the acetabulum, the cavity with which 
the thigh bone articulates with the pelvis. 
Non-articular eminences are distinguished by their 
form ; for example, a broad, rough, uneven part of a 
bone is called a tuberosity ; a small, rough promi- 
nence, a tubercle ; a sharp, slender, pointed eminence, 
a spine; a narrow, rough elevation, a ridge or a line. OSTEOLOGY. 
Fig. 3.-The human skeleton. 18 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The non-articular eminences and depressions serve to 
form a larger field for muscular attachments, and are 
greater in persons who are well developed from exer- 
cise. 
Non-articular depressions vary in form, and are 
known as fossae, grooves, furrows, fissures, notches, etc. 
The entire skeleton of the adult is made up of 200 
distinct bones. These are divided, according to Gray, 
as follows : 
Cranium 8 
Spine or vertebral column (including sacrum and coccyx) . 26 
Face 14 
Sternum, ribs, os hyoides 26 
Upper extremities 64 
Lower extremities 62 
200 
This classification does not include the teeth, the 
patella, or the sesamoid bones ; these last are found 
in the substance of the tendons, especially of the 
great toe. Wormian bones are found in the cranial 
sutures of childhood ; they are irregular fragments, 
developed from supplementary centers, ultimately 
closing the fontanel. 
THE SPINAL COLUMN. 
The spine is a flexible column, formed of a series 
of bones called vertebrae. The 33 bones that com- 
prise the vertebrae are divided into five sections, 
named, according to their location, as follows : The 
cervical, consisting of 7 bones ; dorsal, 12 bones ; 
lumbar, 5 bones ; sacral, 5 bones ; coccygeal, 4 bones. 
At a period of life varying between the ages of 
twenty-five and thirty years the bones in the sacral OSTEOLOGY. 
19 
and coccygeal regions become 
united and form two bones. 
The vertebrae vary in size and 
in shape. They are placed one 
upon the other, thus forming a 
support for the head and trunk. 
Each vertebra is divided into two 
parts, the anterior forming the 
body, the posterior, the arch; the 
arch is formed by 2 pedicles and 
2 laminae, supporting 7 processes, 
viz., 4 articular, 2 transverse, and 
1 spinous process. The functions 
of the processes are to give attach- 
ment to the various muscles, lever- 
age to move the spine in different 
positions, besides holding the body 
in an erect position. Within, the 
arch of the several vertebrae form 
a canal for the passage of the spi- 
nal cord; between each pair of 
vertebrae apertures exist through 
which the spinal nerves pass from 
the cord. 
The nurse should study care- 
fully the several illustrations in 
order fully to understand the 
shape of the bones that form the 
upper spine, as each has import- 
ant connections. The atlas sup- 
ports the head ; the axis articu- 
lates with the atlas ; each of the 12 dorsal segments 
articulates with the ribs of each side ; the sacral 
FlG. 4.-The figures 
indicate the relations of 
the vertebral bodies and 
spines to the correspond- 
ing spinal segments of 
the cord (Churchl, 20 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
articulates with the two hip-bones {ossa innomi- 
natd) and the last lumbar; the coccyx articulates 
with the last sacral. The average length of the spine 
is about two feet four inches. It presents several 
curves that correspond to the different regions of the 
column, viz., the cervical with the neck ; the dorsal 
with the chest or thorax ; the lumbar with the ab- 
domen ; the sacral with the pelvis. 
The physician will frequently direct that a nurse 
Fig. 5.-A type-vertebra: 1, body; 2, pedicle; 3, lamina; 4, spinal 
foramen; 5, spinous process; 6, transverse process; 7, articular process 
(Leidy). 
apply a blister or a hot application to one of the sev- 
eral regions, and she must, therefore, be well informed 
in this respect in order that his directions may be 
intelligently carried out. 
THE SKULL. 
The skull is considered an expansion of the verte- 
bral column. It is the bony framework of the head, 
and contains a cavity for the reception of the brain, 
vessels, nerves, and membranes. The bones of the 
skull are divided into two classes-the cranial con- 
sisting of 8 bones, and the facial consisting of 14 OSTEOLOGY. 
21 
bones. The nurse should be familiar with the names 
and location of these bones in order that she may be 
able to describe to the physician the exact location 
of pain, and, in surgical cases, to make accurate 
records during the physician's absence. The follow- 
ing bones enter into the formation of the skull: 
I occipital. 
2 parietal. 
I frontal. 
2 temporal. 
i sphenoid. 
I ethmoid. 
Bones of the cranium : 
Fig. 6.-The skull (anterior region): i, frontal bone ; 2, anterior ethmoid 
canal; 3, supra-orbital foramen ; 4, infra-orbital canal; 6, superior maxillary 
bone; 7, alveolar process of superior maxillary bone; 8, infra-orbital for- 
amen; 9, body of inferior maxillary bone; 10, mental foramen; 11, occi- 
pital bone ; 14, mastoid process ; 15, angle of inferior maxillary bone ; 17, 
posterior ethmoid canal; 18, optic foramen; 19, malar canal; 20, lacrimal 
groove; 21, nasal bone; 22, malar bone; 23, sphenoid bone; 24, lacrimal 
bone; 26, sphenomaxillary fissure; 27, os planum of ethmoid (Leidy). 22 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
2 nasal. 
2 superior maxillary. 
2 lacrimal. 
2 malar. 
2 palate. 
2 inferior turbinated. 
I vomer. 
i inferior maxillary. 
Bones of the face: 
The occipital bone forms the back and base of 
the cranium and the processes that articulate with the 
atlas. It contains the foramen magnum, an opening 
for the exif of the spinal cord. 
The parietal bones form the sides and roof of the 
FIG. 7.-Infant's skull: anterior fontanel above; posterior fontanel below 
(J. P. C. Griffith). 
cranium. The frontal bone forms the forehead, and 
is usually the seat of pain in diseases of the head and 
eye, as it forms part of the bony cavity that receives 
the eye. It also unites with the two parietal bones, OSTEOLOGY. 
23 
and they, in turn,, with the occipital, thus forming 
the space in the center of the head called the fontanel, 
and generally known among mothers as the "soft 
spot" ; this is found in the infant at birth, but ulti- 
mately becomes obliterated. 
The temporal bones are situated at the side of the 
head, and contain the organs of hearing. A knowl- 
edge of the location of these bones is important, as 
they are frequently the seat of disease ; they should, 
Fig. 8.-Temporal bone of infant; lower outer surface, showing squamous, 
tympanic, and petromastoid segments (Randall). 
therefore, be well considered by the nurse. In chil- 
dren, especially after scarlet fever, these bones fre- 
quently become diseased and require the attention 
of the nurse ; such disease may result in chronic 
discharges. 
The sphenoid, and ethmoid bones are situated 
at the base of the skull, and form the connection 
between all the bones of the cranium, with the 
exception of the inferior maxillary. 24 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The two nasal bones form the bridge of the nose ; 
the vomer, the back part of the septum. 
The superior maxillary bones are two important 
bones, as they are subject to many affections that will 
require the attention of the nurse. They form three 
cavities in the head-the roof of the mouth, the floor 
and outer wall of the nose, and the floor of the orbit, 
which receives the eye. There is also within each 
bone a cavity, called the antrum of Highmore ; in 
Fig. 9.-Cartilage and bones of the septum of the nose (Ingals). 
some subjects this becomes the seat of a serious in- 
flammation ; this cavity is situated at about the middle 
of the bone, and renders the bone lighter. The supe- 
rior maxillary is the largest bone of the face, and forms 
the receptacle for the upper teeth. A more detailed 
description will be given when the several affections 
that involve this bone are discussed. 
The malar bones go to make up the prominence 
of the cheek, and assist, in part, in forming the OSTEOLOGY. 
25 
cavity for the reception of the eye. They unite with 
the temporal bone, at its posterior border and lower 
Fig. io.-The bony orbit, showing the optic foramen (Pyle). 
part, and, in conjunction with the two lacrimal bones 
and those bones mentioned before, make up the orbit. 
The palate bones are situated at the back part 
of the nose, and make up the floor and walls ; the 
Fig. ii.-Inferior maxillary bone, outer surface, side view (Gray). 26 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
turbinated bones also go to make up the nasal cavity ; 
the vomer forms the central septum of the nose. 
The inferior maxillary bone is one with whose 
location the nurse should be familiar, as it is subject 
to many conditions that require surgical attention. 
It is most liable to fracture, and frequently becomes 
dislocated as the result of a very light blow. It forms 
a receptacle for the lower teeth. 
The hyoid bone, sometimes called the lingual 
Fig. 12.-The hyoid bone, viewed from above (Toldt). 
bone, supports the tongue and gives attachment to 
numerous muscles ; it is a bony arch shaped like a 
horseshoe. 
The thorax, so called, is that part of the body that 
goes to make up the chest. It forms a protection for 
the organs of respiration and circulation, inclosing 
one of the cavities of the trunk, known as the tho- 
racic cavity, which contains the lungs, heart, trachea, 
THORAX AND PELVIS. OSTEOLOGY. 
27 
esophagus, and the vessels attached to the heart. It 
is formed by the bodies of the dorsal vertebrae poste- 
riorly, the ribs and cartilages laterally, and the ster- 
num in front. 
The cavity is bounded below by the diaphragm, 
Fig. 13.-Thorax (anterior view) (Ingals). 
making attachment with the several sections of its 
muscles. 
The sternum, popularly known as the breast-bone, 
is divided into three parts-the manubrium, or han- 
dle ; the gladiolus, or sword ; and the ensiform, or 
xiphoid appendix. The manubrium articulates with 
the clavicle and first rib ; the gladiolus with cartilages 
of part of the second, all of the third to sixth, and 28 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
part of the seventh ribs on each side ; the ensiform 
articulates with part of the seventh costal cartilage 
and cartilages of the false ribs. 
There are twelve ribs on each side ; these are of 
different shapes, conforming to their location. They 
serve for the attachment of the several muscles of the 
chest and abdomen. They are all connected behind 
FIG. 14.-First dorsal vertebra 
and rib (Reichert). 
FIG. 15.-Sixth dorsal vertebra and rib 
(Reichert). 
with the dorsal vertebrae of the spine, and the first 
seven are connected with the sternum by the costal 
cartilages; these are called true ribs. The remaining 
five pairs are called false ribs; of these, the first three 
are attached in front to the costal cartilages, and are 
termed the vertebrocostal, while the remaining two, 
being unattached in front, are known as vertebral or 
floating ribs. OSTEOLOGY. 
29 
The convexity of each curved rib is turned outward, 
so as to give roundness to the side of the chest and 
increase the dimensions of its cavity ; each slopes 
downward from its vertebral attachment, so that its 
sternal end is considerably lower than its dorsal. 
The ribs are classed as irregular bones. The spaces 
between the ribs are called intercostal spaces, a fact to 
Fig. 16.-Front view of the pelvis, with its ligaments: i, innominate 
bone; 2, crest of ilium; 3, sacrum; 4, pubes; a, anterior sacroiliac liga- 
ment ; b, iliofemoral ligament; c, obturator membrane ; d, symphysis pubis; 
e, sacrosciatic ligament (Dorland). 
be remembered by the nurse when describing location 
of pain, etc. 
Below the diaphragm, and formed by the pelvic 
bones, we have the second cavity of the trunk, called 
the abdominal cavity; this contains the organs of 
digestion, which will be considered when discussing 
visceral anatomy. 
The pelvis is a basin-like cavity, formed by the 
sacrum, coccyx, and two ossa innominata. It is 30 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
divided into two parts-the brim and the cavity 
(called pelvic cavity). The latter contains the organs 
of generation, the rectum, the bladder, the ureters, 
and the blood-vessels. The outlet is formed by the 
pubic arch in front and coccyx behind. Laterally, 
by the ischii, or rump-bones. The diameter of the 
pelvis is in the female about 4I inches ; in the male, 
31 inches. 
The sacrum is a curved, triangular bone, situated 
between the two ossa innominata, and forming, with 
the coccyx, the posterior part of the pelvis. It is 
formed of five bones, which, after the twenty-fifth 
year, become united as one bone. The coccyx con- 
sists of four bones articulating with the sacrum, and 
is subject to fractures and necrosis, conditions that 
require surgical operations for their cure, injuries 
to this bone sometimes occur during labor, due to 
pressure of the child's head during its passage through 
the outlet of the pelvis, especially in instrumental 
cases. 
The ossa innominata are situated on each side, and 
form the brim of the pelvis. They are divided into 
three parts-the ilium, the ischium, and the pubes ; 
in adults these become consolidated and form one 
bone. These bones contain several openings for the 
transmission of the vessels and nerves that supply the 
lower extremities. The upper border of the bone is 
called the crest; the lower, the ischium; and the 
anterior, the pztbes. 
BONES OF THE UPPER EXTREMITIES. 
The bones of the shoulder consist of the clavicle, 
or collar-bone, and the scapula, or shoulder-blade, OSTEOLOGY. 
31 
Fig. 17.-Bones of the upper extremity (Toldt). 
which connect with the arm-bone and trunk by their 
muscular attachments. 32 
ANATOMY AND PHYSIOLOGY HOT NUHSES. 
The clavicle, also known as the collar-bone, is 
shaped like the letter f and is sometimes called the 
key-bone. It articulates with the sternum and the 
scapula. 
The scapula, generally called the shoulder-blade, 
is situated on the posterior and lateral part of the 
thorax, occupying the region from the second to the 
seventh ribs inclusive. It presents two important 
processes-the acromion and the coracoid (is known 
also as "crow's beak,'' from its beak-shaped appear- 
ance)-and forms the glenoid cavity, which receives 
the humerus or upper arm ; it is classified as a flat 
bone. 
The arm. consists of three bones-the humerus, the 
ulna, and the radius. The humerus articulates with 
the scapula above, and with the ulna and radius be- 
low ; it is classified as a long bone. 
The ulna is the internal bone of the forearm ; it is 
longer than the radius, and articulates with the hu- 
merus, but does not enter into the formation of the 
wrist-joint. The upper end presents a curved emi- 
nence, called the olecranon, and the cavity formed 
thereby unites with the humerus and is called the 
sigmoid cavity. 
The radius is the outer bone of the arm, and unites 
in articulation with the wrist, or carpus ; it is shorter 
than the ulna, and its lower end is subject to many 
injuries, the most common of which is that known as 
" Colles' fracture.'' Many suits for malpractice have 
been instituted as the result of this injury, the phy- 
sician often being held responsible for bad results that 
followed carelessness on the part of the patient. OSTEOLOGY. 
33 
Fig. 18.-Bones of the right forearm in a position of supination (Toldt). 
THE HAND. 
The bony framework of the hand is made up of the 
carpus, which consists of eight bones, the metacarpus, 
consisting of five bones, and the fourteen bones termed 
the phalanges. The bones of the carpus, together 
with the radius, enter into the formation of the wrist- 34 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
joint. The bones of the upper row are the scaphoid, 
semilunar, cuneiform, and pisiform ; those of the 
lower row, the trapezium, trapezoid, os magnum, and 
unciform. 
The metacarpus forms the palm of the hand. The 
phalanges form the fingers ; each finger is made up 
of three phalanges, the thumb, of two. Although 
Fig. 19.-Right carpalbones, dorsal surface : S, scaphoid ; L, semilunar; 
C, cuneiform; P, pisiform; U, unciform ; 7, os magnum; jT, trapezoid; T, 
trapezium (Leidy). 
classified as long bones, they are also numbered among 
the short bones of the body. Each bone is composed 
of a base, a shaft, and an extremity. 
BONES OF THE LOWER EXTREMITIES. 
The femur, or thigh-bone, is the longest bone in 
the body, and unites in articulation with the pelvis 
in the acetabulum, and with the tibia below ; these, 
with the two bones posterior, form the popliteal 
space ; it also gives attachment to the strongest mus- 
cles of the body. Fig. 20.-Bones of the lower extremity (Toldt). 36 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The leg consists of two bones,-the tibia and the 
fibula,-the patella making up the contour of the 
knee-joint, though it has no connection with the joint 
proper. 
The tibia helps to make up the ankle-joint, articu- 
lating with the astragalus, and forming at the inner 
side the internal malleolus. 
The fibula is a long, slender bone of the leg, the 
upper end articulating, by a flat facet, with the tibia 
on the outer side, the lower end uniting with the 
lower end of the tibia and forming the external 
malleolus. 
The patella, or knee-cap, is a flat, triangular bone 
Fig. 21.-Right patella: a, Anterior surface; b, posterior surface 
(Nancrede). 
that helps to make up the knee-joint; connected, as 
it is, with muscular bands over the anterior aspect of 
the joint, it serves to protect the joint from injury. 
THE FOOT. 
The foot is divided into the tarsus, which consists 
of 7 bones, the metatarsus, consisting of 5 bones, and 
the phalanges, 14 in number, making a total of 26 
bones. They are placed in two rows. The larger 
bone of the tarsus is called the astragalus, and 
unites in articulation with the tibia. OSTEOLOGY. 
37 
The heel-bone is in the lower posterior part of the 
foot, which forms the heel proper ; it is called the 
os calcis, and is classed as an irregular bone. The 
metatarsal bones are 5 in number and are classed 
as long bones ; they articulate with the tarsus. 
Fig. 22.-Bones of the right foot, dorsal surface: i, Astragalus; 2, head 
of the astragalus; 3, os calcis; 4, navicular bone; 5, internal cuneiform ; 
6, middle cuneiform ; 7, external cuneiform ; 8, cuboid ; 9, metatarsal bones ; 
io, 11, 12, 13, 14, phalangeal bones (Leidy). 
The phalanges of the foot number 14, just as in 
the hand ; the great toe is made up of two phalanges, 
each other toe having three ; they are classed as long 
bones, and, from their location, are subject to many 
injuries. 
The various bones of which the skeleton is made 
up are connected at different parts of their surfaces, 
THE ARTICULATIONS. 38 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
such connection being termed a joint or an articula- 
Fig. 23.-Ligaments of the shoulder: a, Superior acromioclavicular 
ligament; b, coraco-acromial ligament; c, coracohumeral ligament; d, 
transverse ligament; e, coracoclavicular ligament; f anterior costosternal 
ligament; g, interclavicular ligament; h, anterior sternoclavicular ligament; 
i, costoclavicular ligament; j, capsular ligament. 
tion. If the joint is immovable, as are those between 
the cranial and most of the facial bones, the adjacent 
Fig. 24.-Ligaments of the knee-joint: A, Anterior aspect: a, Femur; 
b, ligamentuin patellae; c, internal lateral ligament; d, external lateral liga- 
ment. B, Posterior aspect: a, Femur; b, posterior ligament; c, internal 
lateral ligament; d, external lateral ligament; e, posterior ligament of pero- 
neotibial articulation ; /, interosseous ligament. 
surfaces are brought into almost close approximation ; 
a thin layer of fibrous membrane-the sutural liga- OSTEOLOGY. 
39 
Fig. 25.-Ligaments of the wrist-joint: A, Anterior aspect: a, Radius; 
b, ulna; c, anterior radio-ulnar ligament; d, internal lateral ligament; e, an- 
terior ligaments ; f external lateral ligaments ; g, first metacarpal bone ; h, 
palmar ligaments; i, palmar carpal ligamentscapsular ligament. B, 
Dorsal aspect: a, Ulna; b, radius; c, posterior radio-ulnar ligaments; d, 
posterior ligament. 
ment-and at the base of the skull, in certain situa- 
tions, a thin layer of cartilage, being interposed. 
Fig. 26.-Ligaments of the foot: A, Dorsal aspect: a, Astragalus; b, 
calcaneo-astragaloid ligaments; c, dorsal ligaments of tarsus; d, tarsometa- 
tarsal ligaments; e, transverse ligaments. B, Plantar aspect: a, Os calcis;, 
b, greater calcaneocuboid ligament; c, deep calcaneocuboid ligament; d, 
inferior tarsometatarsal ligament; e, tarsometatarsal ligaments. 
Where slight movement combined with great 
strength is required, as in the joints of the spine, 40 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
the sacro-iliac, and the interpubic articulations, the 
osseous surfaces are united by tough and elastic fibro- 
cartilage ; but in the movable joints the bones form- 
ing the articulation are generally expanded to allow 
greater freedom for mutual connection. These bones 
are covered by an elastic structure called cartilage, 
held together by strong bands or capsules of fibrous 
tissue called ligaments, and lined by a membrane 
FlG. 27.-Horizontal frozen section of the knee-joint, showing lateral extent 
of synovial membrane (Professor Dwight's specimen). 
(the synovial membrane) that secretes a fluid that 
lubricates the various parts of which the joint is 
formed. The structures that enter into the formation 
of a joint are bone, cartilage, fibrocartilage, ligament, 
and synovial membrane. 
Bone constitutes the fundamental element of all the 
joints. Cartilage is a firm, opaque, pearly-white, or 
bluish-white-in some varieties yellow-highly elas- OSTEOLOGY. 
41 
tic, flexible tissue, possessed of considerable cohesive 
power. It yields readily to pressure, and resumes its 
shape when the force is removed. The synovial mem- 
brane will be considered when the membranes of the 
body are described. 
REVIEW QUESTIONS. 
Define the term Anatomy? 
Into what branches is it divided ? 
What is Osteology ? 
What is bone and what is its composition ? 
What canals are there in the bone? 
What is the periosteum, its function? 
Have the bones much sensibility? 
State the chemical analysis of bone. 
How may the constituents of bone be proved ? 
Is there any difference in proportion as to age ? 
How do fractures vary in the young and the old? 
State the reason fully as to the cause. 
In what diseases is there a disproportion in constituents? 
What are some of the signs noticed ? 
Into how many classes are bones divided ? Name them. 
Name their location. 
What are eminences? 
Give an example of same. 
What are depressions? Give an example. 
What number of bones constitutes the adult skeleton? 
How are they divided as to number? 
What are sesamoid bones ? 
What are Wormian bones, and where found? 
Give the several names given to non-articular eminences. 
What are non-articular depressions ? 
What is the spine? 
How many bones constitute same ? 
Into how many divisions is the spine divided? 
Give number in each division. 
What do you understand by vertebra ? 
THE SPINAL COLUMN. 42 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
How is each vertebra divided ? 
What do the several parts form ? 
What is the function of the processes ? 
What does the arch form ? 
What nerves pass through between the vertebrae ? 
What does the atlas provide ? 
With what bone does the atlas articulate ? 
What articulates with the dorsal vertebra ? 
With what does the sacrum articulate ? 
Give articulation of the coccyx. 
What is the average length of the spine? 
What curves does it present? 
What is the skull considered? 
How is it divided ? 
How many bones in the cranium, face ? 
What does the occipital bone form ? 
What foramen is provided in the occipital bone? 
What do the parietal bones form ? 
What does the frontal bone form ? 
With the frontal and parietal bones what cavity is formed ? 
What important relations have the temporal bones? 
Under what circumstances has this bone regarding disease? 
Where are the sphenoid and ethmoid bones located ? 
Where are the superior maxillary bones situated ? 
What cavity has this bone of such importance ? 
How many cavities does this bone form ? 
Give location of the malar bones. 
What bones make up the orbit of the eye ? 
Where are the palate bones situated ? 
What do the turbinated bones assist in making up ? 
What is the vomer, and what does it form? 
What does the inferior maxillary bone form ? 
What is the hyoid bone ? Give location. 
THORAX AND PELVIS. 
What is the thorax ? 
What cavity is formed by the thorax ? 
What bones enter into its formation ? 
What is the sternum, and how is it divided ? 
What separates the thoracic from the abdominal cavity ? 
How many ribs go to make up the thorax ? OSTEOLOGY. 
43 
How are the ribs divided? 
How are the ribs classed ? 
What are the spaces between ribs called ? 
What cavity is formed below the diaphragm ? 
What does this cavity contain ? 
What do you understand by the pelvis, and what forms same ? 
How is the pelvis divided ? 
What is contained in this cavity ? 
What forms the outlet ? 
What is the average diameter of the pelvis? 
What is the sacrum? 
How many bones constitute same, and at what age do they consoli- 
date ? 
What is the coccyx, and what is its liability ? 
What are the ossa innominata bones, and what do they form ? 
Into how many parts are they divided, name them ? 
Give location of the several parts. 
What passes through the openings in this bone ? 
About what age do these several parts become consolidated ? 
What is formed by the union of the ossa innominata bones anteriorly ? 
What bones form the shoulder-joint ? 
What is the clavicle? 
With what bones does it articulate ? 
What is the scapula ? 
Where is it located, between what regions ? 
What important processes does this bone present ? 
What cavity is formed by the scapula ? 
What bone articulates in this cavity ? 
Under what classification is the humerus considered ? 
With what bones does the humerus articulate ? 
How many bones constitute the arm ? . 
Which bone is the inner side of the arm ? 
What is the articulation of the ulna ? 
Which is the longest bone of the forearm ? 
Does the ulna enter into the formation of the wrist-joint? 
What is the curved eminence which is presented upon the ulna ? 
What cavity is formed by the ulna ? 
What is the radius ? 
With what does it articulate ? 
BONES OF THE UPPER EXTREMITIES. 44 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
What is the fracture called which occurs at its lower end? 
How are the bones of the hand divided ? 
How many bones constitute each division ? 
Name the bones in the upper row, the lower. 
What part of the hand does the several parts form ? 
LOWER EXTREMITIES. 
What is the femur, and what articulations are formed by it ? 
What is this bone considered ? 
What space is formed by the tibia and this bone ? 
To what does this bone give attachment? 
What bones constitute the leg ? 
Does the patella enter in the formation of the joint proper? 
What is the tibia, and with what bones does it articulate ? 
What is formed at its lower and inner side ? 
What is the fibula ? 
How does this bone unite with the tibia in its articulation? 
What is formed by its lower extremity ? 
What is the patella ? 
How is the patella connected to the joint ? 
What is this bone considered ? 
How is the foot divided ? 
How many bones are considered in each division ? 
What is the larger bone of the tarsus ? 
With what bone does it articulate? 
What bone forms the heel proper ? 
How many phalanges make up the foot? 
With what do the phalanges articulate ? 
ARTICULATIONS. 
What are articulations ? How many kinds are there ? 
Where do we find sutural ligaments ? 
What is cartilage, and where is it found ? 
What holds the joint together? 
What membrane do joints contain ? 
What is the character of the fluid secreted from them ? 
What structures enter into the formation of joints ? 
Why is the term synovia used ? CHAPTER II. 
THE MUSCULAR SYSTEM, 
The muscles constitute the fleshy parts of the body, 
and are the main organs of motion. They are fibrous 
structures, and consist of a series of bundles of fibers 
invested in sheaths of cellular membrane. 
The fasciculi, or bundles of fibers, are in them- 
selves very minute, but being arranged in compound 
bundles of successively larger size, we have ultimately 
only a single bundle in a muscle. 
The essential characteristic of a muscle is its con- 
tractility-it contracts in length, dilates in breadth, 
its body becoming firm and rigid. 
The muscular fiber is endowed with a peculiar 
property called irritability, and it is upon this that its 
power of contraction depends ; or, in other words, the 
impressibility of the muscle is dependent on nervous 
stimulus. 
Muscles are said to originate at the point where 
they have the most fixed attachment. By insertion 
is understood the opposite end, or that termination or 
attachment that is more movable-that is, the end of 
the muscle that most moves the bone, or portions to 
which it is attached. The muscles are abundantly 
supplied with blood-vessels and nerves. They are 
frequently the seat of rheumatic disorders, as well as 
of inflammation. 
The number of muscles in the human body is com- 
45 46 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
monly estimated at 405 ; with the exception of 9, they 
all occur in pairs. 
The muscles vary widely in size and in form. I11 
the limbs, they are of considerable length ; this is 
true especially of the more superficial muscles, the 
Fig. 28.-Voluntary muscle: A, Three voluntary fibers in long sections: 
a, Three voluntary muscle-fibers ; b, nuclei of same; c, fibrous tissue be- 
tween the fibers (endomysium); dt fibers separated into sarcostyles. B, 
Fiber (diagrammatic): a, Dark band; b, light band; c, median line of 
Hensen ; d, membrane of Krause ; e, sarcolemma ; f, nucleus. C: a, Light 
band ; b, dark band ; c, contracting elements; d, row of dots composing the 
membrane of Krause; e, slight narrowing of contracting element aiding in 
production of median line of Hensen (Leroy). 
deep ones generally being broad. They surround the 
bones, and form an important protection to the vari- 
ous joints. In the trunk the muscles are broad, flat- 
tened, and expanded, forming the parietes of the 
cavities which they inclose. For purposes of descrip- THE MUSCULAR SYSTEM. 
47 
tion, therefore, muscles are termed long, broad, 
short, etc. 
Each muscle is invested externally by a thin cellu- 
lar layer, forming what is called its sheath; this 
not only covers its outer surface, but penetrates its 
interior, in the spaces between the fasciculi, sur- 
rounding these, and serving as a bond of connection 
between them. 
The muscles are connected with the bones, carti- 
lages, ligaments, and skin either directly or through 
the medium of fibrous structures called tendons. 
When a muscle is attached to bone or cartilage, the 
fibers terminate in broad, blunt extremities upon the 
periosteum or perichondrium, and do not come into 
direct relation with the osseous or cartilaginous tissue. 
When muscles are connected with the skin, they 
either lie as a flattened layer beneath it, or are con- 
nected with its areolar tissue by larger or smaller 
bundles of fibers, as in the muscles of the face. 
The muscles of the body are of two kinds-the vol- 
untary (striped muscles), which are capable of being 
moved or controlled by the efforts of the will, and the 
involuntary (non-striped), those that are not under 
the control of the will. The former make up the 
larger bulk of the muscular system. 
For descriptive purposes the muscles of the body 
are arranged in divisions according to their location ; 
as, the head, face, and neck muscles ; the trunk mus- 
cles ; the muscles of the upper and of the lower ex- 
tremities. 
As has been previously stated, in this connection 
only the most important points that a nurse should 
know, or become familiar with, will be described ; as, 48 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
for example, the important relation each organ and 
muscle bears to life, its action, and, in the case of the 
muscles of the head and face, the role they play in 
lending expression to the countenance. 
To facilitate description, muscles are divided into 
groups that take their names from the regions in 
which they are located. Thus we have, in the head 
and face, the following regions : the epicranial, auric- 
ular, palpebral, orbital, superior maxillary, inferior 
maxillary, temporomaxillary, pterygomaxillary, etc. 
MUSCLES OF THE HEAD AND FACE. 
The Occipital Region.-The first muscle to be 
described is the occipitofrontalis. You will note that 
the prefix occipito- has relation to the bone (occipital), 
and the suffix -frontalis, to the frontal bone, showing 
that the muscle extends from the posterior part of the 
head (occiput) to the eyebrows. All muscles derive 
their names in this way, and if the student will study 
them carefully, she will become fully acquainted with 
the origin and insertion of muscles. 
The occipitofrontalis is a broad, musculofibrous 
layer that covers the vertex, and blends in front with 
the muscles of the face, laterally with the fascia of 
the temporal muscles, posteriorly to the occipital protu- 
berance of the occipital bone. Action raises the eye- 
brows and the skin of the nose and causes the trans- 
verse wrinkles of the brow. It is also concerned in 
expressing delight and anger ; the whole scalp may 
be moved forward and backward by the action of this 
muscle. 
Nerve-supply, from the supra-orbital and facial 
nerves and a portion of the auricular. THE MUSCULAR SYSTEM. 
49 
The auricular region contains the three " aurem 
muscles," which are placed immediately beneath the 
skin around the external ear, and are named attollens, 
attrahens, and retrahens; they are fan-shaped, and 
Fig. 29.-Muscles of the right side of the head and neck: 1, Frontalis; 
2, superior auricular; 3, posterior auricular; 4, orbicularis palpebrarum; 
5, pyramidalis nasi; 6, compressor naris ; 7, levator labii superiors ateque 
nasi; 8, levator labii superioris; 9, zygomaticus major; 10, orbicularis oris; 
11, depressor labii inferioris; 12, depressor anguli oris; 13, anterior belly 
of digastric; 14, mylohyoid; 15, hyoglossus; 16, stylohyoid; 17, posterior 
belly of digastric; 18, the masseter ; 19, sternohyoid ; 20, anterior belly 
of omohyoid; 21, thyrohyoid; 22, 23, lower and middle constrictors of 
pharynx; 24, sternomastoid; 25, 26, splenius; 27, levator scapulas; 28, an- 
terior scalenus; 29, posterior belly of omohyoid ; 30, middle and posterior 
scalenus; 31, trapezius. 
their fibers converge in the ear and muscles of the 
head. 
These muscles possess very limited movement : the 
attollens slightly raises the ear, the attrahens draws it 
forward and upward, and the retrahens draws it back- 
ward. 
The palpebral region comprises four muscles- 50 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
the orbicularis palpebrarum, corrugator supercilii, 
levator palpebree, and tensor tarsi. 
The orbicularis palpebrarum is a sphincter muscle 
and surrounds the orbit and eyelids, becoming blended 
with the occipitofrontalis and the corrugator super- 
cilii. Action, closes the eyelids. 
The corrugator supercilii is a small, narrow, 
Fig. 30.-Muscles of the orbit: 1, Levator palpebrae superioris; 2, ob- 
liquus superior ; 3, pulley of obliquus superior ; 4, rectus superior; 5, rectus 
inferior; 6, rectus externus; 7, lower head of rectus externus; 8, upper 
head of rectus externus; 10, obliquus inferior; 11, optic nerve (Leidy). 
pointed muscle, situated immediately above the orbit, 
at the inner extremity of the eyebrow. Action, draws 
the eyebrows downward and inward. 
The levator palpebrse will be considered when de- 
scribing the muscles of the orbital region. 
The tensor tarsi is a small, thin muscle. Action, 
draws the eyelids and the extremities of the lacrimal 
canal inward, and compresses them against the globe THE MUSCULAR SYSTEM. 
51 
of the eye ; in this position they receive the tears that 
are secreted. 
Orbital Region.-As the name implies, these mus- 
cles are connected with the orbit ; there are-i leva- 
tor palpebrae, 4 recti (superior, inferior, internal and 
external), and 2 oblique (superior and inferior). These 
muscles all have their special attachments to the sev- 
eral parts of the globe of the eye and the bony struct- 
ure that incloses it. Action, to control the movements 
of the eye. (Note the arrangement of these muscles in 
Fig. 30.) 
Nasal Region.-In this region there are seven 
pairs of muscles, which control the lip and act as 
levers to lift it ; they also control dilatation of the 
nose. These are, to a certain degree, the muscles of 
expression ; each muscle has its own function to per- 
form, and each acts antagonistically to the other- 
that is, some dilate, while others constrict, the parts 
concerned in their movements. 
Superior Maxillary Region.-In this region there 
are four muscles on each side ; they are connected 
to the superior maxillary and malar bones, and arise 
from the lower margin of the orbit ; some of them 
are inserted into the muscular substance of the upper 
lip. They are named as follows : Levator labii supe- 
rioris, levator anguli oris, zygomaticus major, zygo- 
maticus minor. (See Fig 29.) 
Action, elevate the upper lip ; draw the mouth 
inward and outward, as in laughing or displaying 
any emotion ; as they are able to alter their shape so 
that various expressions may be assumed. 
Inferior Maxillary Region.-Here we have the 
levator labii inferioris, depressor labii inferioris, de- 52 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
pressor anguli oris. Action of the levator labii is to 
raise the lower lip ; it also protrudes it, and at the 
same time wrinkles the chin. The depressor labii 
inferioris draws the lip downward and outward. The 
depressor anguli oris draws the angle of the mouth 
directly backward. These muscles all blend with 
other muscles of the face (Fig. 29.) 
Intermaxillary Region.-Contains the orbicularis 
oris, buccinator, and risorius. The orbicularis oris 
is a sphincter muscle, elliptic in form, and surrounds 
the oral aperture (mouth) ; it unites with the buc- 
cinator on each side, as well as with the several 
muscles of the face. Action, closes the lips. 
The buccinator is a broad, thin muscle. Action, 
assists in the process of mastication ; compresses the 
cheeks, so that the food is kept in immediate contact 
with the teeth. 
The risorius has its insertion in the angle of the 
mouth. Action, draws out the angle of the mouth 
and compresses the cheek. 
Temporomaxillary Region.-The two muscles 
in this region are of great importance ; they are 
named the masseter and the temporal. The masseter 
is a short, thick muscle, consisting of two portions- 
superficial and deep. It arises from the malar process 
of the superior maxilla and zygomatic arch, and is 
inserted into the angle of the lower jaw. Action, a 
muscle of mastication. 
The temporal is a broad muscle, situated on the 
side of the head, arising in part from the frontal, 
temporal, and parietal bones, and is inserted in the 
coronoid process of the inferior maxillary bone. 
Action, assists in the process of mastication. THE MUSCULAR SYSTEM. 
53 
Pterygomaxillary Region.-In this region there 
are two muscles on each side-the internal and the 
external. They are very powerful in their action. 
The internal pterygoid is a thick, quadrilateral 
muscle, resembling the masseter in form and structure, 
and the fibers run in about the same direction. 
The external pterygoid is a short, thick muscle, 
broader at its base, and arises by two heads-from the 
sphenoid bone by one head, and from the pterygoid 
plate of the ethmoid, palate, and maxillary bones by 
the other. Insertion, to the lower jaw. Action, 
raises the lower jaw with great force, drawing the 
lower jaw forward upon the upper jaw, while the 
masseter draws it backward, assisted by the temporal ; 
by alternation of the muscles of each side the food is 
comminuted and prepared for swallowing. 
The muscles of the neck are : Platysma myoides, 
sternocleidomastoid, sternohyoid, sternothyroid, thy- 
rohyoid, omohyoid, digastric, stylohyoid, geniohyoid, 
geniohyoglossus, hyoglossus, styloglossus, and lin- 
gualis. 
Platysma Myoides.-Arises from the deep fascia 
over the pectoral, deltoid, and trapezius muscles. 
Insertion, in the lower jaw at the angle of the mouth, 
and blends with the muscles of the face. Action, 
depresses the jaw and angle of the mouth, also 
wrinkles the skin of the neck ; its nerve-stipply is 
obtained from the facial nerve, through the infra- 
maxillary branches. 
Sternocleidomastoid.- Arises from the upper 
part of the sternum and inner border of the clavicle. 
MUSCLES OF THE NECK. 54 
ANATOMY AND PHYSIOLOGY FOK NUKSES. 
Inserted in the mastoid process of the temporal bone 
and two-thirds of curved line of the occipital bone. 
Action, flexes the head on the neck and chest, and 
rotates the chin to the opposite side. Nerve-sztpply, 
from the spinal accessory, second and third cervical, 
anterior branches. 
Sternohyoid.-Arises from the sternum and clav- 
Fig.31.-Muscles of the neck from the front: On the left side the pla- 
tysma has been removed, and on the right the digastric, the stylohyoid, 
mylohyoid, sternohyoid, and omohyoid : I, Posterior, and i', anterior belly 
of digastric ; 2, mylohyoid ; 3, geniohyoid ; 4, hyoglossus ; 5, styloglossus ; 6, 
stylohyoid; 7, stylopharyngeus; 8, sternomastoid; 9, 9', omohyoid; 10, 
sternohyoid; 11, 12, sternothyroid; 13, levator scapulse. 
icle. Inserted, in the hyoid bone. Action, depresses 
the hyoid bone. 
Sternothyroid.--Originates in the posterior part 
of the sternum and cartilage of the first rib. Inserted 
in the thyroid cartilage. Action, depresses the larynx. 
Thyrohyoid.-Origin from the thyroid cartilage. 
Inserted in hyoid bone. Action, elevates the larynx 
or depresses the hyoid bone. 
The omohyoid arises from the scapula, and is 
inserted into the hyoid bone and cartilage of the first THE MUSCULAR SYSTEM. 
55 
rib. Action, depresses the hyoid bone and larynx, 
and draws them backward and to one side. 
Digastric.-Arises from two heads, with an inter- 
mediate tendon ; is attached to mastoid process of the 
temporal bone and lower jaw. Insertion, in the 
hyoid bone. Action, raises the hyoid bone and de- 
presses the lower jaw. Nerve-snpply from the facial 
and inferior dental. 
Stylohyoid.-Arises from the styloid process of 
the temporal bone. Insertion, in the body of the 
hyoid bone. Action, same as the former. 
Geniohyoid.-Arises from the lower jaw and is 
inserted in the hyoid bone. Action, same as the 
digastric. 
Geniohyoglossus.-Originates from the superior 
tubercle of the lower jaw. Inserted in the body of 
the hyoid bone, side of the pharynx, and tongue from 
the base to the point. Action, protrudes as well as 
retracts the tongue ; it also acts in depressing this 
organ, as in the act of sucking. Nerve-sztpply, the 
hypoglossal. 
Hyoglossus.-Arises from the hyoid bone ; in- 
serted in the sides of the tongue. Action, convexes 
this organ. Nerve-supply from the hypoglossal. 
Styloglossus.-Arises from the styloid process of 
the temporal bone. Insertion, in the tongue. Action, 
draws the tongue upward and backward. Nerve, 
hypoglossal. 
Dingualis.-Forms the bulk of the tongue, blended 
with the other muscles which make their connection 
with the tongue. Its action is in unison-with that of 
the other muscles. 
Palate Region.-This region is supplied with the 56 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
following muscles : Levator palati, tensor palati, 
azygos uvulse, palatoglossus, palatopharyngeus. They 
form attachments to the bony structure in their origin 
or insertion, and have control over the soft palate and 
uvula, besides assisting in the acts of speech, degluti- 
tion, and mastication. 
Pharyngeal Region.-The muscles connected 
with the pharyngeal region are the following : Three 
constrictors-the inferior, the superior, and the 
medius ; the stylopharyngeus and the palatopharyn- 
geus, which are called the muscles of the pharynx. 
The inferior constrictor rises from the cartilages 
(cricoid and thyroid), and is inserted in its fellow 
muscle. Action, constricts the pharynx during swal- 
lowing. 
The middle constrictor has its origin in the hyoid 
bone and stylohyoid ligament. Insertion, in its fellow. 
Action, same as inferior constrictor. 
The superior constrictor arises from the pterygoid 
plate and palate bones, as well as from the hyoid. 
Insertion, in the occipital bone. Action, same as 
inferior constrictor. 
The stylopharyngeus arises from the inner side 
of the base of the styloid process of the temporal 
bone ; it is inserted in the thyroid cartilage and 
blends with the constrictor muscles. Action, elevates 
the pharynx. 
The palatopharyngeus has its origin in the soft 
palate. Insertion, in the thyroid cartilage and side 
of the pharynx. Action, closes the posterior fauces. 
All the muscles just described, except the palato- 
pharyngeus, are controlled by the spinal accessory, 
glossopharyngeal, pharyngeal plexus, external and THE MUSCULAR SYSTEM. 
57 
recurrent laryngeal nerves ; the palatopharyngeus is 
controlled by the palatoglossus nerve. 
The Pharynx.-The pharynx is a musculomem- 
branous sac, about five inches long, extending from 
under the base of the skull to a point corresponding 
to the sixth cervical vertebra. It is widest above and 
narrowest below, where it terminates in the esophagus. 
It is attached to the styloid processes of the temporal 
bone, and presents seven openings : the two posterior 
nares, two Eustachian tubes, the mouth, the larynx, 
and the esophagus. For purposes of description it is 
divided into three parts-nasal, oral, and laryngeal. 
It is provided with two cartilages-the cricoid and 
the thyroid-and has three coats-an internal mucous 
membrane, a middle fibrous layer, and an external 
muscular coat. 
Anterior Vertebral Region.-This region con- 
tains four muscles-the rectus capitis anticus major, 
the rectus capitis anticus minor, the rectus lateralis, 
the longus colli, and the scalenus anticus, medius, 
and posticus. Action of the several muscles : to con- 
trol the movements of the head and neck ; by means 
of their several attachments the head may be moved 
in any direction. 
MUSCLES OF THE TRUNK. 
These are divided into groups, according to the 
region in which they are located ; thus we have the 
muscles of the back ; of the abdomen ; of the thorax ; 
and of the perineum. 
The muscles of the back are divided into five 
layers, of which the more superficial layer is of most 
interest to the nurse. (In this connection the illus- 58 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
tratious should be carefully studied in order that an 
accurate knowledge of the construction of these mus- 
cles may be obtained.) 
Fig. 32.-Muscles of the trunk from behind (left side, superficial; right 
side, deep): i, Sternomastoid; 2, splenius; 3, trapezius; 4, latissimus 
dorsi; 5, infraspinatus; 6, teres minor; 7, teres major; 8, deltoid; 9, ex- 
ternal oblique of abdomen; 10, gluteus medius; 11, gluteus maximus; 12, 
levator anguli scapulae; 13, rhomboideus minor; 14, rhomboideus major; 
15, part of longissimus dorsi; 16, tendons of insertion of iliocostalis; 17, 
supraspinatus; 18, infraspinatus; 19, teres minor; 20, teres major; 21, 
serratus magnus; 22, upper, and 22', lower part of serratus posticus in- 
ferior; 23, internal'oblique; 24, gluteus medius; 25, pyriformis and superior 
and inferior gemelli; 26, 26', portions of obturator internus; 27, tendon of 
obturator internus ; 28, quadratus femoris. 
The first of these to be described is the large muscle 
situated at the upper and back part of the neck and 
shoulders ; this is known as the trapezius. THE MUSCULAR SYSTEM. 
59 
Trapezius.-Origin, from the occipital bone and 
the processes of the seventh cervical and the twelve 
dorsal vertebrae, as well as from the ligamentum 
nuchae. Insertion, in the clavicle and scapula. Action, 
draws the shoulder upward, backward, and laterally ; 
also moves the scapula on the chest. 
Latissimus Dorsi.- Origin, from the six lower 
dorsal vertebrae ; being a broad muscle, it covers the 
lumbar and lower half of the sacral region. 
It also arises from the crest of the ilium, and is one 
of the important muscles of the body. Insertion, in 
the humerus. Action, draws the humerus downward 
and backward, while rotating it inward ; it raises the 
lower ribs in forcible inspiration, also assisting other 
muscles of the chest in extending force, as in climb- 
ing, pulling, etc. 
(The student should refer to the illustrations, noting 
the relation that the several muscles bear to the act 
of respiration, as well as the number that are concerned 
in the act of moving the trunk in various positions.) 
The muscles of the abdomen are : The obliquus 
externus ; obliquus interims ; transversalis ; rectus ; 
pyramidalis, and quadratus lumborum. 
The external oblique arises from the eight inferior 
ribs ; it is inserted in the anterior half of the iliac 
crest, and mingling with its fellow of the opposite side, 
it forms the linea alba. It is connected above with 
the ensiform cartilage, and below with the pubis ; it is 
continuous with other fascia to the pubic spine,-i. e., 
Poupart's ligament,-between the anterior spine of the 
ilium and the spine of the pubes, and Gimbernat's 
ligament, an extension of the latter to the iliopec- 
tineal line. Action, compresses the viscera, flexes the 60 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
thorax, on the pelvis, or the pelvis on the thorax, 
according to which is the fixed point, also assists 
expiration. Nerve-supply, the lower intercostals. 
Fig. 33.-Muscles of the trunk from before (left side, superficial; 
and right side, deep): 1, Pectoralis major; 2, deltoid; 3, portion of 
latissimus dorsi; 4, serratus magnus; 5, subclavius ; 6, the pectoralis, sterno- 
costal portion; 7, serratus magnus; 12, rectus abdominis; 13, internal ob- 
lique ; 14, external oblique ; 15, abdominal aponeurosis and tendinous inter- 
sections of rectus abdominis ; 16, over symphysis pubis; 17, linea semilu- 
naris; 18, gluteus medius; 19, tensor vaginse femoris; 20, rectus femoris; 
21, sartorius; 22, femoral part of iliopsoas; 23, pectineus; 24, adductor 
longus; 25, gracilis. 
The internal oblique arises from Poupart's liga- 
ment, the outer crest of the ilium, and the lumbar 
fascia. Insertion, crest of os pubis with the trans- THE MUSCULAR SYSTEM. 
61 
versalis muscle-forming the conjoined tendon, a part 
of the external abdominal ring ; it also blends with 
the external oblique to form the linea alba, and with 
the transversalis muscles. Action, same as that of 
the external oblique. Nerve-supply, lower intercos- 
tals, iliohypogastric, and ilio-inguinal. 
The muscles just described are broad and cover the 
greater part of the abdominal wall. They are there- 
fore to be considered in operations in this locality. 
The muscles of the abdomen that have not been 
described may be studied from the illustrations. The 
student should observe especially the linea alba, a 
tendinous raphe or cord seen as a dark, perpendicular 
streak in the middle line of the abdomen. This is 
of some importance, and is of interest to the nurse, 
especially in regard to the discoloration that takes 
place in pregnant women. 
Gray says : The abdominal muscles have a three- 
fold action : They compress the abdominal wall during 
the process of defecation ; they assist in the act of 
respiration, and they help in the expulsion of the 
fetus ; the urine is expelled through the agency of 
this combination of muscular force, and by it, through 
upward pressure, the stomach is relieved of its con- 
tents. From this it will be seen that the action of 
these muscles should be studied closely, making fre- 
quent reference to the illustrations. 
Muscles of the Thorax.-The muscles of the 
thorax are : The external and internal intercostal, the 
infracostales, the triangularis sterni, and the levator 
costarum; of these, the most important are the inter- 
costals. They are all connected with the bony structure 
of the thorax, and are all concerned in respiration. 62 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
Diaphragmatic Region.-The diaphragm is a 
thin, musculofibrous septum, separating the thorax 
from the abdominal cavity. It is divided into two 
parts-a greater and a lesser portion. It is convex 
toward the chest, connected to the ribs, and posterior 
to the vertebrae. It contains openings for the trans- 
Fig. 34.-The diaphragm, inferior surface: 1, 2, 3, Central cordiform 
tendon ; 4, 5, crura; 6, internal arcuate ligament; 7, external arcuate liga- 
ment; 8, aortic opening; 9, esophageal; 10, opening for vena cava (Leidy). 
mission of the aorta, esophagus, vena cava, nerves, 
arteries, and veins. Action, muscle of respiration. 
MUSCLES OF THE UPPER EXTREMITIES. 
MUSCLES OF THE SHOULDER AND ARM. 
Pectoralis major. 
Pectoralis minor. 
Subclavius. 
Serratus magnus. 
Deltoid. 
Subscapularis. 
Supraspinatus. 
Teres major. 
Teres minor. 
Coracobrachialis. 
Biceps flexor cubiti. 
Brachialis anticus. 
Triceps extensor cubiti. 
Subanconeus. THE MUSCULAR SYSTEM. 
63 
MUSCLES OF THE FOREARM. 
Pronator teres. 
Flexor carpi radialis. 
Palmaris longus. 
Flexor carpi ulnaris. 
Flexor sublimis digitorum. 
Superficial layer : 
Deep layer : 
Flexor profundus digitorum. 
Flexor longus pollicis. 
Pronator quadratus. 
Radial region : 
Supinator longus. 
Extensor carpi radialis longior. 
Extensor carpi radialis brevior. 
Posterior radio-ulnar region 
(superficial layer): 
Extensor communis digitorum. 
Extensor minimi digiti. 
Extensor carpi ulnaris. 
Anconeus. 
Supinator brevis. 
Extensor ossis metacarpi pollicis. 
Extensor brevis pollicis. 
Extensor longus pollicis. 
Extensor indicis. 
Deep layer : 
MUSCLES OF THE HAND. 
Abductor pollicis. 
Opponens pollicis. 
Flexor brevis pollicis. 
Abductor obliquus pollicis. 
Adductor transversus pollicis. 
Palmaris brevis. . 
Abductor minimi digiti. 
Flexor brevis minimi digiti. 
Opponens minimi digiti. 
Lumbricales. 
Dorsal interossei (4). 
Palmar interossei (3). 
The pectoralis major muscle is located upon the 
chest. Origin, from the clavicle, sternum, and sixth 
costal cartilage. Insertion, in the humerus. Action, 
draws arm downward and forward. 
Pectoralis Minor.- Origin, from the third, fourth, 
and fifth ribs. Insertion, in the coracoid process of the 64 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
scapula. Action, depresses the shoulder and assists 
in the elevation of the ribs during the act of inspira- 
tion. 
The subclavius arises from the first costal cartilage 
and rib, and is inserted in the inner surface of the 
clavicle. Action, draws the clavicle downward. 
Fig. 35- 
Fig. 35.-Superficial muscles of shoulder and arm (from before) : 1, 
Pectoralis major; 2, deltoid; 3, biceps brachii; 4, brachialis anticus; 5, 
triceps ; 6, pronator radii teres; 7, flexor carpi radialis; 8, palmaris longus; 
9, flexor carpi ulnaris; 10, supinator longus; 11, extensor ossis metacarpi 
pollicis ; 12, extensor brevis pollicis ; 13, flexor sublimis digitorum ; 14, flexor 
longus pollicis; flexor profundus digitorum ; 16, palmaris brevis; 17, ab- 
ductor pollicis. 
Fig. 36.-Superficial muscles of shoulder and arm (from behind): 1, 
Trapezius; 2, deltoid; 3, rhomboideus major; 4, infraspinatus; 5, teres 
minor; 6, teres major; 7, latissimus dorsi; 8, triceps; 9, anconeus; 10, 
brachialis anticus ; 11, supinator longus ; 12, extensor carpi radialis longior; 
13, extensor carpi radialis brevior; 14, extensor communis digitorum; 15, 
extensor carpi ulnaris; 16, flexor carpi ulnaris ; 17, extensor ossis metacarpi 
pollicis ; 18, extensor brevis pollicis ; 19, tendon of extensor longus pollicis. 
Fig. 36. 
The serratus magnus arises by nine fleshy digita- 
tions from the outer surface of the eight upper ribs ; THE MUSCULAR SYSTEM. 
65 
it is inserted in the posterior border of the scapula. 
Action, elevates ribs in inspiration. 
The deltoid is a thick, triangular muscle forming 
the convexity of the shoulder. Origin, from the 
upper border of the clavicle, outer and upper surface 
of the acromion process, and lower border of the scap- 
ula. Insertion, on the outer side of the humerus. 
Action, raises the arm to a right angle, and draws it 
forward and backward. 
(Having studied the muscles just described, the 
nurse should consult the preceding list, and, by a 
careful study of the accompanying illustrations, ascer- 
tain the exact location of each muscle named.) 
The muscles of the forearm are'very numerous, and 
are classed as extensors, supinators, flexors, and pro- 
nators. Those of the hands are as numerous, as will 
be seen by referring to the preceding list. 
The subscapularis arises from the inner two-thirds 
of the subscapular fossa ; is inserted in lesser tuber- 
osity of neck of humerus. Action, rotates the humerus 
inward as well as adducts the same. Nerve, sub- 
scapular. 
The supraspinatus arises from the supraspinous 
fossa. Inserted in the facet on the greater tuberosity 
of the humerus. Action, assists the deltoid, fixes the 
head of the humerus in the socket. Nerve, supra- 
scapular. 
Infraspinatus.-Origin, infraspinous fossa. Inser- 
tion, in middle facet of the greater tuberosity of the 
humerus. Action, rotates the humerus outward. 
Nerve, suprascapular. 
Teres Minor.-Origin, upper two-thirds of the 
dorsal surface of the scapula. Insertion, in facet of 66 
ANATOMY AND PHYSIOLOGY TOR NURSES. 
the greater tuberosity of the humerus. Action, rotates 
the humerus outward. Nerve, circumflex. 
Teres Major.-Origin, lower border of infraspinous 
fossa, and is inserted into the bicipital grove of the 
humerus. Action, draws the humerus downward and 
backward, when raised also rotates it inward. Nerve, 
lower subscapular. 
Coracobrachialis.-Origin, from the coracoid proc- 
ess of the scapula. Insertion, middle and inner 
border of the humerus. Action, draws the humerus 
forward and inward as well as elevates same. Nerve, 
special branch from the outer cord of the brachial 
plexus from the seventh. 
Biceps Flexor Cubiti.- Origin, by two heads : Short 
head, from the coracoid process of the scapula ; long 
head, from upper margin of the glenoid cavity by a 
round tendon continuous with the glenoid ligament. 
Insertion, by a tendon into the back part of the tuber- 
osity of the radius with an aponeurosis opposite the 
elbow, into the fascia of the forearm, which renders 
the forearm fascia tense. Nerve, musculocutaneous. 
Brachialis Anticus.-Origin, outer and inner surface 
of the humerus, in association with the insertion of 
the deltoid. Insertion, into the inferior surface of the 
coronoid process of the ulna. Action, flexes the fore- 
arm. Nerve, musculocutaneous and musculospiral. 
Triceps Extensor Cubiti.-Origin, arises by three 
heads, the long, external, and internal ; long head, 
from the glenoid fossa, the external, from the posterior 
surface of the shaft of the humerus between the upper 
part of the spiral groove and the insertion of the teres 
minor ; internal, from the posterior surface below the 
spiral groove. Insertion, on the olecranon process THE MUSCULAR SYSTEM. 
67 
of the ulna. Action, extends the forearm. Nerve, 
musculospiral. 
Subanconeus.-Origin, above the olecranon fossa 
of the humerus. Insertion, in the posterior ligament 
of the elbow. Action, prevents the capsule from 
injury during extension of the arm. Nerve, musculo- 
spiral. 
The pronator teres arises from the internal condyle 
and coronoid process. Inserted, outer side of shaft 
of radius. Action, pronates hand. Nerve, median. 
Flexor Carpi Radialis.-Origin, internal condyle 
of humerus. Insertion, metacarpal bone of index 
finger. Action, flexes wrist. Nerve, median. 
Palmaris Longus.- Origin, from internal condyle. 
Insertion, in the annular ligament and palmar fascia. 
Action, makes tense the palmar fascia. Nerve, 
median. 
The flexor carpi ulnaris arises by two heads : First, 
from the internal condyle ; second, from the olecranon 
and ulna. Insertion, fifth metacarpal bone, annular 
ligament, and pisiform bone. Action, flexes the wrist. 
Nerve, ulnar. 
Flexor Sublimis Digitorum.-Origin, by three 
heads: First, from the inner condyle ; second, coro- 
noid process; third, oblique line of radius. Insertion, 
in the second phalanges by four tendons. Action, 
flexes second phalanges. Nerve, median. 
The flexor profundus digitorum arises from shaft 
of ulnar. Insertion, in last phalanges by four tendons. 
Action, flexes the phalanges. Nerve, median. 
Flexor Longus Pollicis.-Origin, shaft of radius 
and coronoid process of ulna. Insertion, last phalanx 
MUSCLES OF FOREARM. 68 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
of thumb. Action, flexes the phalanx. Nerve, an- 
terior interosseous. 
Pronator Quadratus.-Origin, from lower fourth 
of ulna. Inserted, in lower one-fourth of radius. 
Action, pronates the hand. Nerve, anterior interos- 
seous. 
Supinator Longus.- Origin, external condyloid 
ridge of humerus. Insertion^ styloid process of 
radius. Action, flexes forearm. Nerve, posterior 
interosseous. 
Extensor Carpi Radialis Longior.-Origin, lower 
one-third of external condyloid ridge of humerus. 
Insertion, base of second metacarpal bone. Nerve, 
musculospiral. Action, extends wrist. 
Extensor Carpi Radialis Brevior.-Origin, external 
condyloid ridge of humerus. Insertion, base of sec- 
ond and third metacarpal bones. Action, extends 
wrist. Nerve, posterior interosseous. 
Extensor Communis Digitorum.- Origin, external 
condyle of humerus. Insertion, the second and third 
phalanges. Action, extends the fingers. Nerve, pos- 
terior interosseous. 
Extensor Minimi Digiti.- Origin, external condyle 
of humerus. Insertion, in the second and third 
phalanges of little finger. Action, extensor of little 
finger. Nerve, posterior interosseous. 
Extensor Carpi Ulnaris.-Origin, by two heads : 
First head, external condyle of humerus ; second 
head, posterior border of ulna. Insertion, base of 
fifth metacarpal bone. Action, extends wrist. Nerve, 
posterior interosseous. 
Anconeus.-Origz'n, back and external condyle ot 
humerus. Insertion, olecranon process and shaft of THE MUSCULAR SYSTEM. 
69 
ulna. Action, extends forearm. Nerve, musculo- 
spiral. 
Supinator Brevis.-Origin, external condyle of 
humerus and oblique line of ulna. Insertion, neck 
of radius and its bicipital tuberosity. Action, supi- 
nates the hand. Nerve, posterior interosseous. 
Extensor Ossis Metacarpi Pollicis.-Origin, back 
of radius and ulna and interosseous membrane. In- 
sertion, base of metacarpal bone of thumb and fascia. 
Extensor Brevis Pollicis.-Origin, back of radius. 
Insertion, inner part of the base of first phalanx of 
thumb. Action, extends the metacarpal and adducts 
the wrist. Nerve, posterior interosseous. 
Extensor Longus Pollicis.-Origin, posterior part 
of the ulna and interosseous membrane. Action, ex- 
tends the thumb and adducts the wrist. Nerve, pos- 
terior interosseous. 
Extensor Indicis.-Origin, posterior part of ulna. 
Insertion, second and third phalanges of index finger. 
MUSCLES OF THE HAND, 
Abductor Pollicis.-Origin, from trapezium, sca- 
phoid, annular ligament, and palmar fascia. Inser- 
tion, first phalanx of thumb. Action, abducts and 
flexes first phalanx of thumb. Nerve, median. 
Opponens Pollicis.-Origin, trapezium and anterior 
ligament. Insertion, metacarpal bone of thumb. 
Action, flexes thumb. Nerve, median, palmar divis- 
ion. 
Flexor Brevis Pollicis.-Origin, by two heads : 
Outer, lower border of superior annular ligament and 
ridge of trapezium ; inner, os magnum, and base, 
first, second, and third metacarpal bones. Insertion, 70 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
base of first phalanx of thumb. Action, flexes the 
thumb at metacarpal articulation. Nerve, outer head, 
median ; inner head, deep ulnar. 
Adductor Obliquus Pollicis.-Origin, from os mag- 
num, second and third metacarpal bones. Insertion, 
base of first phalanx of thumb. Action, draws the 
thumb inward toward the middle line. Nerve, ulnar. 
Adductor Transversus Pollicis.-Origin, third 
metacarpal bone. Insertion, base first phalanx of 
thumb. Action, flexes the phalanx, adducts the 
thumb. Nerve, ulnar. 
Palmaris Brevis.-Origin, from the annular liga- 
ment and palmar fascia. Insertion, skin on inner 
border of palm. Action, wrinkles the skin on the 
palmar side. Nerve, ulnar. 
Adductor Minimi Digiti.-Origin, pisiform bone. 
Insertion, base of first phalanx of little finger. Action, 
draws the little finger from the middle line and flexes 
the metacarpo-phalangeal joint. Nerve, ulnar. 
Flexor Minimi Digiti.-Origin, from the unciform 
bone and annular ligament. Insertion, first phalanx 
of little finger. Action, flexes the first phalanx. 
Nerve, ulnar. 
Opponens Minimi Digiti.-Origin, from the unci- 
form bone. Insertion, whole length of the fifth meta- 
carpal bone. Action, flexes the fifth metacarpal, 
draws it forward and makes the hollow of the palm 
of hand. Nerve, ulna. 
Lumbricales.-Origin, tendon of the deep flexors. 
Insertion, in the dorsum of each finger. Action, flex 
the first and extend the last two phalanges. Nerve, 
two outer by the median, two inner by the ulnar. 
Dorsal Interossei.-Origin, four in number by two THE MUSCULAR SYSTEM. 
71 
heads, from the sides of the metacarpal bones. In- 
sertion, into base of first phalanges of fingers. Action, 
flex the first and extend the last two phalanges, 
addnct the fingers. Nerve, ulnar. 
Palmar Intercssei (three in number). - Origin, 
by single heads, from the palmar side of the 
second, fourth, and fifth metacarpals. Insertion, 
into the second, fourth, and fifth phalanges. Action, 
flex the first, extend the last two 
phalanges, adduct the fingers to- 
ward the middle line. Nerve, 
ulnar. 
MUSCLES OF THE LOWER 
EXTREMITY. 
For convenience in description 
the muscles of the leg will be 
divided into groups according to 
their various locations, only the 
most important ones with which 
the nurse should become ac- 
quainted being described. 
The muscles of the iliac or in- 
guinal region are : 
Psoas magnus. 
Psoas parvus. 
Iliacus. 
The psoas magnus is a long, 
fusiform muscle, situated on the 
side of the lumbar region of the 
spine and margin of the pelvis. 
Origin, from the processes of the 
last thoracic and all the lumbar vertebrae. Inser- 
Fig. 37.-Superficial 
muscles of hip and thigh 
(from behind): 1, Gluteus 
medius ; 2, gluteus maxi- 
mus ; 3, vastus externus ; 
4, biceps flexor cruris ; 5, 
semitendinosus ; 6, semi- 
membranosus ; 7, gra- 
cilis; 8, Sartorius; 9, ad- 
ductor magnus ; 10, n, 
gastrocnemius; 12, origin 
of plantaris. 72 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
tion, into the lesser trochanter of the femur. Ac- 
tion, flexes the thigh on the pelvis, or vice versa.; 
also rotates the femur outward. Nerve-supply, an- 
terior branches of the second and third lumbar. 
The psoas parvus is a long, slender muscle, situ- 
ated in front of the psoas magnus. It arises fropi 
the last thoracic and the first lumbar vertebrae. 
Insertion, iliac fascia and iliopectineal eminence. 
Action, draws the iliac fascia tense. Nerve, ante- 
rior branch first lumbar. 
The iliacus is a flat, radiated muscle that fills 
up the whole of the iliac fossa (internal), from which 
point, as well as from the inner margin of the iliac 
crest and sacrum, it originates. Inserted, with the 
tendon of the psoas magnus, into the lesser trochanter 
of the femur. Action, same as the psoas magnus. 
Nerve, anterior crural. 
The muscles of the thigh or femoral region are : 
Tensor vaginae femoris. 
Sartorius. 
Rectus femoris. 
Vastus externus. 
Vastus interims. 
Crureus. 
Subcrureus. 
Gracilis. 
Pectineus. 
Adductor longus. 
Adductor brevis. 
Adductor magnus. 
The tensor vaginae femoris is a short, flat muscle, 
situated at the upper and outer side of the thigh. 
Origin, outer part of the crest of the ilium and supe- 
rior spinous process. Inserted in the fascia lata, at 
the outer side of the thigh. Action, rotator of the 
thigh. Nerve, superior gluteal. 
The sartorius, the longest muscle in the body, is a 
flat, narrow, ribbon-like muscle that arises from the 
ilium, passing down the inner side of the thigh ver- THE MUSCULAR SYSTEM. 
73 
tically to the inner side of the knee. Insertion, in 
the inner shaft of the tibia. Action, flexes the leg 
Fig. 38. 
Fig. 39. 
Fig. 40. 
Fig. 38.-Muscles of the inner side of thigh and interior of pelvis: 1, 
Iliacus; 2, psoas magnus; 3, obturator internus; 4, pyriformis; 5, erector 
spinae; 6, gluteus maximus; 7, sartorius; 8, adductor longusj 9, gracilis; 
10, adductor magnus ; 11, semimembranosus ; 12, semitendinosus ; 13, rectus 
femoris ; 14, vastus internus. 
Fig. 39.-Superficial muscles of the leg from inner side: 1, Vastus in- 
ternus; 2, sartorius; 3, gracilis; 4, semitendinosus; 5, semimembranosus; 
6, inner head of gastrocnemius; 7, soleus; 8, tendon of plantaris; 9, tendon 
of tibialis posticus; io, flexor longus digitorum ; 11, flexor longus hallucis; 
12, tibialis anticus ; 13, abductor hallucis. 
Fig. 40.-Superficial muscles of front of thigh: I, Insertion of external 
oblique into iliac crest; 2, aponeurosis of external oblique ; 3, external ab- 
dominal ring; 4, gluteus medius; 5, tensor vaginae femoris; 6, sartorius; 
7, iliopsoas; 8, pectineus; 9, adductor longus; 10, gracilis; 11, adductor 
magnus; 12, vastus externus ; 13, rectus femoris; 14, vastus internus; 15, 
biceps flexor cruris. 
upon the thigh, as well as the thigh upon the pelvis. 
Called also tailors' muscle. Nerve, superior gluteal. 
The rectus femoris arises from the inferior iliac 74 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
spine. Insertion, in the patella. Action, flexes the 
hip-joint. Nerve, anterior crural. 
Vastus Externus.- Origin, tubercle of the femur 
Fig. 41. 
Fig. 42. 
Fig. 41.-Muscles of leg and foot (from before): 1, Tendon of rectus 
femoris; 2, vastus internus ; 3, vastus externus ; 4, sartorius ; 5, iliotibial band; 
6, inner head of gastrocnemius; 7, inner part of soleus; 8, tibialis anticus; 
9, extensor proprius hallucis; 10, extensor longus digitorum ; 11, peroneus 
longus; 12, peroneus brevis; 13, peroneus tertius; 14, origin of extensor 
brevis digitorum. 
Fig. 42.-Superficial muscles of leg (from behind) : 1, Vastus externus; 
2, biceps flexor cruris ; 3, semitendinosus ; 4, semimembranosus ; 5, gracilis; 
6, sartorius ; 7, outer, and 8, inner, head of gastrocnemius ; 9, plantaris ; 10, 
soleus; n, peroneus longus; 12, peroneus brevis; 13, flexor longus digi- 
torum ; 14, tibialis posticus; 15, lower fibers of flexor longus hallucis. 
and the great trochanter. Inserted in the outer side 
of the patella. Action, extends the leg. Nerve, 
anterior crural. 
Vastus Internus and Crureus.-Origin, from the THE MUSCULAR SYSTEM. 
75 
inner side of the femur. Insertion, in the patella. 
Action, extends the leg. Nerve, anterior crural. 
Subcrureus.-Arises by two heads from the femur. 
Inserted in the upper portion of the synovial pouch 
of the knee-joint. Action, retracts the synovial sac. 
Nerve, anterior crural. 
Gracilis.- Origin, ramus of the os pubis. Inserted 
on the inner side of the tibia. Action, flexes the leg, 
rotates it inward, and adducts the thigh. Nerve, the 
obturator. 
Pectineus.- Origin, from the iliopectineal line. 
Inserted in the lesser trochanter. Action, flexes 
and rotates the leg inward, as well as adducts the 
thigh and rotates it outward. Nerves, crural and 
obturator. 
The adductor longus, magnus, and brevis arise 
from the os pubis, and are inserted in the inner side 
of the femur. Action, adduct, rotate, and flex the 
thigh. Nerve, obturator and sciatic. 
The gluteal region contains the largest muscles 
of the body ; these are as follows : 
Gluteus maximus. 
Gluteus medius. 
Gluteus minimus. 
Pyriformis. 
Obturator internus. 
Gemellus superior. 
Gemellus inferior. 
Obturator externus. 
Quadratus femoris. 
The gluteus maximus is the most superficial muscle 
in this region. It is a broad, thick, fleshy muscle, 
quadrilateral in shape, and forming the nates ; it has 
the greatest power of any muscle in the body to 
maintain the body in an erect posture. It arises 
from the ilium, sacrum, and coccyx, and is inserted 
in the great trochanter. Action, holds the trunk 76 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
erect, extends, abducts, and rotates the thigh out- 
ward. Nerve, inferior gluteal. 
Gluteus Medius.-Arises from the outer surface of 
the ilium. It is inserted in the great trochanter. 
Action, supports the trunk, flexes the thigh inward, 
and rotates it inward. Nerve, superior gluteal. 
Gluteus Minimus.-Arises from the outer side of 
the ilium, and is inserted in the 'greater trochanter. 
Action, flexes, abducts, and rotates the thigh inward ; 
it also assists in holding the trunk erect. Nerve, 
superior gluteal. 
The pyriformis is a flat muscle, arising by three 
heads from the sacrum and ilium. It is inserted in 
the greater trochanter. Action, rotates thigh, abducts 
it as well, and draws the pelvis forward. Nerves, 
branches of sacral plexus. 
The obturator internus is situated partly in the 
pelvis, and arises from the margin of the obturator 
foramen. It is inserted in the inner part of the great 
trochanter. Action, draws the pelvis forward and 
assists in the rotation and abduction of the thigh. 
Nerve, branch of the sacral plexus. 
Gemellus Superior.-Arises from the ischium, and 
is inserted in the inner part of the great trochanter. 
Action, rotates the thigh outward. Nerve, obturator 
internus. 
Gemellus Inferior.-Arises from the ischium, and is 
inserted in the great trochanter of the femur. Action, 
external rotator of thigh. Nerve, branch of quad- 
ratus fem oris. 
The obturator externus is a flat, triangular muscle, 
situated in the inner wall of the pelvis. Arises from 
the obturator foramen, and is inserted in the femur. THE MUSCULAR SYSTEM. 
77 
Action, rotates thigh. Nerve-supply, from branch of 
obturator. 
The quadratus femoris is a short, flat muscle, 
quadrilateral in shape. Origin, from the tuberosity 
of the ischium. Insertion, in the trochanter major. 
Action, rotates as well as abducts the thigh. Nerve, 
branch of the sacral plexus. 
The muscles of the femoral region are the biceps, 
the semitendinosus, and the semimembranosus. 
The biceps is a large muscle situated on the outer 
part of the thigh. It arises by two heads, the long 
from the tuberosity of the ischium, and the short 
from the linea aspera. Insertion, head of the fibula, 
the tendon thereof splitting, one band embracing the 
lateral ligament, and the other extending to the outer 
tuberosity of the tibia; this muscle is called the outer 
hamstring. Action, extends the hip, flexes the leg, 
after which it rotates it outward. Nerve, great sciatic. 
The semitendinosus is situated on the inner side of 
the thigh ; this is a remarkable muscle, as it provides 
a very extensive tendon. It arises from the tuberosity 
of the ischium and is associated with the biceps ; it 
continues down the thigh, terminating a little below 
the middle of the thigh. It is inserted in the upper 
and inner part of the tibia. Action, extends the hip, 
flexes the leg on the thigh, and rotates it inward. 
Nerve, great sciatic. 
The semimembranosus arises from the tuberosity 
of the ischium. It is inserted on the inner and back 
part of the tuberosity of the tibia. Action, flexes the 
leg on the thigh and rotates it inward. Nerve, great 
sciatic. 
Muscles of the I^eg.-Having described the mus- 78 
ANATOMY AND PHYSIOLOGY TOR NURSES. 
cles of the tliigli and hip, those of the leg and foot 
will now be considered. Of these, only the most 
important, and especially the most superficial, will 
be described. 
There are thirteen muscles in the leg ; these are as 
follows : 
The tibialis anticus, extensor longus digitorum 
pedis, extensor longus pollicis, peroneus tertius, 
gastrocnemius, plantaris, popliteus, flexor longus pol- 
licis, flexor longus digitorum pedis, tibialis posticus, 
peroneus longus, peroneus brevis. 
The fascia forms a complete investment of the 
entire region of the leg, excepting the inner side of 
the tibia, to which it is unattached. 
The tibialis anticus is a thick, fleshy muscle, situ- 
ated on the outer side of the tibia. It arises from 
the tuberosity and shaft of the tibia, the fibers thereof 
terminating in a tendon that passes under the annular 
ligament and is inserted in the great toe at its under 
side. Action, flexes the ankle-joint, rotates the foot 
inward, and abducts the foot. Nerve, anterior tibial. 
The extensor longus digitorum pedis is an elon- 
gated, flattened muscle, situated most externally of 
all the muscles of the leg. It arises from the tuberosity 
of the tibia and shaft of the fibula, extends down- 
ward, and divides into four tendons, which are in- 
serted in second and third phalanges of the four lesser 
toes. Action, extends the toes, flexes the ankle, 
everts the foot, and abducts the forefoot. Nerve, 
anterior tibial. 
The extensor longus pollicis is a thin, elongated 
and flattened muscle. It arises from the anterior 
surface of the fibula and from the interosseous mem- THE MUSCULAR SYSTEM. 
79 
brane ; the fibers pass downward and terminate in a 
tendon that passes under the annular ligament, and 
is inserted in the last phalanx of the great toe. 
Action, same as the tibialis anticus. Nerve, anterior 
tibial. 
The gastrocnemius, the most important muscle of 
the posterior part of the leg, is an elongated, flattened 
muscle. It forms the calf proper. It arises from 
the tibia and fibula by two heads. Insertion, with 
the tendons of the soleus and plantaris to form the 
tendo Achillis, which is finally inserted in the tuber- 
osity of the os calcis. Action, extends the foot and 
slightly rotates it inward. Nerve, internal popliteal. 
The nurse should ascertain, from the illustrations, 
the location of the other muscles of the leg, particu- 
larly of the flexors, which assist in the several move- 
ments of the leg and foot. 
The Muscles of the Foot.-The muscles of the 
foot are the following : The extensor brevis digitorum, 
dorsal interossei, abductor pollicis pedis, abductor 
minimi digiti pedis, flexor brevis digitorum, flexor 
accessorius, lumbricales, flexor brevis pollicis, ad- 
ductor transversus hallucis, flexor brevis minimi 
digiti, transversus pedis, and plantar interossei. 
While an accurate knowledge of the exact location 
of each of the muscles of the foot is not an absolute 
requisite, the nurse should, by reference to the illus- 
trations, seek to familiarize herself with their names 
and their general location. 
The anterior annular ligament consists of an upper 
vertical portion, which binds down the tendons, as 
they descend downward, to their several attachments 
(without this no power would be obtained) and a 80 
ANATOMY AND PHYSIOLOGY FOP NUESES. 
horizontal portion. This, with the internal and ex- 
ternal annular ligaments, supports all the tendons, 
assisted by the fascia of the parts. 
The perineum is the anterior portion of the outlet 
of the pelvis. It is the space that lies between the 
anus and the genital organs. The muscles of this 
region are divided into two groups, those that control 
the organs of generation and those governing the 
urethra, the rectum, or the termination of the same. 
For convenience the muscles connected with the 
coccyx will be described together with the muscles 
of the perineum. 
In the male the muscles of this region are : The 
accelerator urinae, erector penis, transversus perinei, 
compressor urethrae, sphincter ani, levator ani, coc- 
cygeus, and sacrococcygeus anticus. 
In the female the muscles, while similar, are some- 
what smaller than in the male, and receive the fol- 
lowing names : Constrictor vaginae, erector clitoridis, 
transversus perinei, compressor urethrae, sphincter 
ani, levator ani, coccygeus, and sacrococcygeus 
anticus. 
MUSCLES OF THE PERINEUM. 
TENDONS. 
Tendons are white, glistening, fibrous cords, vary- 
ing in length and thickness. They are round, some- 
times flattened, of considerable strength, and only 
slightly elastic. 
Adipose tissue, or fat, is distributed very generally 
throughout the body. It has a copious supply of 
ADIPOSE TISSUE. THE MUSCULAR SYSTEM. 
81 
blood-vessels and lymphatics, but no nerves have 
been known to terminate in it. In some subjects it 
is present in such abundance about the internal organs 
as to interfere with their functions. It helps to main- 
Fig. 43.-Longitudinal section of tendon (x 270) (Bohm and Davidoff). 
tain bodily heat, and rounds ont the contour of the 
body. Its presence or absence is an index of the 
nutritive and assimilative powers of the individual. 
REVIEW QUESTIONS. 
What are muscles ? 
What peculiar property do musc'es possess? 
What is understood by origin and insertion? 
How are muscles described ? 
How many muscles estimated in the body ? 
What is a sheath ? 
How are muscles attached to the ske'eton? 82 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
What kind of muscles has the body as to action ? 
What muscle covers the upper part of the head ? 
How many muscles have we in the auricular region ? Name them. 
What muscles in the palpebral region ? 
Name the several muscles of the orbital region ? 
How many pairs of muscles in the nasal region? 
What do you understand by superior maxillary region? 
What peculiar action has the muscles of this region ? 
What muscles have we in the inferior maxillary region ? Their 
action ? 
What important muscles have we in the intermaxillary region ? 
State the action of the several muscles in the temporomaxillary 
region ? 
How many muscles are there in the pterygomaxillary region ? 
What are the three large muscles of the neck ? 
What action has the digastric muscle ? 
What are the several functions performed by muscles of the palate 
region ? 
Over what function does the pharyngeal muscles control ? 
What muscle elevates the pharynx ? 
What is the pharynx ? 
What muscles control the movements of the head? 
Into how many layers are the muscles of the back divided ? 
Name two of the superficial muscles, and give action. 
Name the muscles of the abdomen. 
What do you understand by linea alba ? 
What important functions do the abdominal muscles assist in per- 
forming ? 
Name three important muscles of the diaphragmatic region. 
State function of the several muscles just described. 
What are the several important muscles of the chest? 
What function do they assist in performing? 
What muscle forms the convexity of the shoulder? 
What are the classes of muscles of the forearm? 
In what manner do the muscles of the forearm become inserted? 
What are fascia?, explain their function ? 
Name the important muscles of the iliac region. 
What is the longest muscle of the body? Where located? 
Name three muscles of the gluteal region. 
What muscle arises from three heads in this region? 
How many muscles are there in the leg? THE MUSCULAR SYSTEM. 
83 
What muscle forms the calf of the leg? 
What is the function of the anterior annular ligament? 
What is the perineum, and how many groups of muscles are there in 
this region ? 
What are tendons? 
What is adipose tissue? State its function. 
What condition is caused through an excess of adipose tissue? CHAPTER III. 
THE CIRCULATORY OR VASCULAR SYSTEM. 
The organs of the circulatory or vascular system 
comprise the heart, the arteries, the veins, and the 
structures concerned in the circulation of the blood. 
Circulation of the Blood.-The heart is the grand 
focus in which the blood is constantly concentrated, 
and from which it is as constantly distributed to all 
parts of the body. In making one complete revolu- 
tion of the body the blood passes twice through this 
organ, making its circuit in the following manner : 
As it returns from all parts of the system, the blood 
is emptied into the right auricle of the heart by what 
is termed the ascending and the descending vena cava; 
thence it passes into the right ventricle, the contrac- 
tion of the heart propelling it through the pulmonary 
artery into the lungs. From this point the blood, 
arterialized by its passage through the lungs, again 
returns through the four pulmonary veins (this is the 
only instance in the entire circulation where the 
veins carry arterial blood) into the left auricle, pass- 
ing thence into the left ventricle ; from which, by 
the contraction of the heart, it is propelled through 
the aorta and its numerous branches, and distributed 
to every part of the body. 
The heart is a hollow, muscular, pear-shaped organ, 
placed obliquely between the lungs. It is nearer the 
THE HEART. 
84 THE CIRCULATORY OR YASCULAR SYSTEM. 
85 
left than the right side of the thorax, its base point- 
ing upward and its apex downward toward the left 
side. It is a strong body, being made up of what is 
known as involuntary muscle. It is inclosed in the 
pericardium, a loose sac that contains a serous fluid 
that lubricates the interior. The heart is commonly 
regarded as the starting-point of the blood in its 
course through the body ; from this point the blood 
is propelled, through the arteries, to every part of the 
Fig. 44.-Orifices of the heart, seen from above, both the auricles and 
the great vessels being removed: PA, Pulmonary artery and its semilunar 
valves; Ao, aorta and its valves; RA V, tricuspid, and LA Y, bicuspid 
valves; mv, segments of mitral valve; Iv, segment of tricuspid valve 
(Huxley). 
system. The heart is divided into two parts-the 
right and the left heart. These are further divided 
into four distinct cavities, called respectively the right 
and the left ventricle and the right and the left 
auricle. By referring to the illustration (Fig. 47) it 
will be seen that the anricles are the npper cavities 
and the ventricles the lower. 
The Valves.-On the right side, the valve which 
controls the opening from the right auricle to the 86 
ANATOMY AND PHYSIOLOGY POP NUPSES. 
right ventricle is known as the tricuspid valve. It 
is composed of three triangular segments, made up 
of fibrous tissue, and continuous with fine cords called 
the cordae tendineae, which close the aperture. The 
valve guarding the left side is composed of two irregu- 
lar segments, and is called the bicuspid or mitral valve. 
If these valves were to become diseased, there would 
Fig. 45.-The heart (Stoney). 
be a regurgitation of blood into the auricle (this will 
be clear to you if you will recollect the manner in 
which the blood passes through the heart, as pre- 
viously explained). When healthy, the valves unite 
and form a complete partition between the auricle 
and the ventricle, and the blood is forced on through 
the large arteries. THE CIRCULATORY OR YASCULAR SYSTEM. 
87 
Each auricle is provided with openings for the 
arteries and veins that enter from the circulation. 
The left ventricle provides openings for the aorta, 
the largest arterial structure in the body. The orifice 
of the aortic opening is guarded by valves, called the 
Fig. 46.-Left auricle and ventricle, opened and part of their walls re- 
moved to show their cavities : 1, Right pulmonary vein cut short; i', cavity 
of left auricle; 3, 3', thick wall of left ventricle; 4, portion of the same 
with papillary muscle attached; 5, the other papillary muscles; 6, 6', the 
segments of the mitral valve; 7, in aorta is placed over the semilunar 
valves; 8, pulmonary artery ; 10, aorta and its branches (Allen Thomson). 
semilunar ; in the fetus two are anterior and one 
posterior, but in the adult one is anterior and two are 
posterior, right and left. 
Contraction of the ventricles takes place, at the 
same time forcing the blood to the lungs from the 88 
ANATOMY AND PHYSIOLOG Y DOR NURSES. 
right heart, through the pulmonary artery, and to the 
circulation from the left heart, through the aorta. 
The aorta, rising from the left ventricle, imme- 
diately gives off, from its ascending portion, the two 
coronary arteries ; at its arch it furnishes the left 
carotid and left subclavian, on one side, and on the 
Fig. 47.-Normal blood-currents in the heart and relative position of the 
ventricles, auricles, and great vessels: I VC, Inferior vena cava; SVC, su- 
perior vena cava; RA, right auricle; TV, tricuspid valves; R V, right ven- 
tricle ; P, pulmonary valves ; PA, pulmonary artery ; Pv, pulmonary veins ; 
LA, left auricle; MV, mitral valves; L V, left ventricle; A, aortic valves; 
Aa, arch of aorta (Page). 
other only one, the innominate, which is larger than 
either of those on the left side. In the thorax the 
aorta gives off- the bronchial arteries-one on each 
side ; these nourish the lungs. It also gives off at 
this portion the esophageal, mediastinal, and inter- 
costal arteries. From the abdominal portion it gives THE CIRCULATORY OR VASCULAR SYSTEM. 
89 
off the celiac axis with its three branches, the gastric, 
hepatic, and splenic arteries ; the superior and in- 
ferior mesenteric, suprarenal, renal, spermatic (or 
ovarian), lumbar, and middle sacral arteries. At this 
junction the aorta bifurcates into two common iliacs, 
which each again divide into the internal and the ex- 
ternal iliac, the internal supplying the pelvic tissues 
and the external the lower extremities. 
The Heart-beat.-The heart in the healthy adult 
beats from 60 to 80 times in a minute ; in children 
and infants the beat is more frequent, varying from 
100 to 150 times in a minute. 
Arteries are all characterized by a vibrating action, 
called pulsation, which corresponds to the working 
of the heart. This pulsation is in part dependent 
upon the action of the latter organ, but partly also 
on a similar power of contraction possessed by the 
arteries themselves. 
The motion of the blood in the arteries is always 
in a direction away from the heart, and this fluid is 
propelled in these vessels by the pulsating force just 
described. 
The circulatory system is made up of two chief 
divisions-the arterial and the venous system. In 
addition to these, two subsidiary systems are described 
-the pulmonary and the portal. We will describe 
first the arterial system, prefacing our remarks by a 
brief description of the arteries themselves. 
The diagram (p. 90), taken from Gray, shows 
the various parts and openings of the heart. The 
nurse will do well to make herself familiar with their 
names, and, by frequent reference to the illustrations, 
seek to learn their location : 90 
ANATOMY AND PHYSIOLOGY TOR NURSES. 
Superior vena cava. 
Inferior vena cava. 
Coronary sinus. 
Foramina Thebesii. 
Auriculoventricular opening. 
Pulmonary artery. 
Pulmonary veins. 
Aorta. 
Auriculoventricular (right). 
Relics of fetal 
structures: 
Annulus ovalis. 
Fossa ovalis. 
Openings 
in the 
heart: 
Musculi pectinati. 
Valves : 
Eustachian. 
Coronary. 
Valves (right side): 
Tricuspid. 
Semilunar. 
Valves (left side) : 
Mitral. 
Semilunar. 
THE ARTERIAL SYSTEM. 
The arteries are the cylindric tubes that convey the 
blood from the ventricles of the heart to every part 
of the body. They are capable of preserving their 
form at all times. In ancient times, the arteries being 
found to be empty after death and still preserving 
their cylindric form, they were believed to contain air. 
This theory was held until the time of Harvey, who 
discovered the true circulation of the blood and pre- 
sented it to the world as we now teach it. 
Ashas been said, the main artery of the body is the 
aorta ; from this all the arterial tissues derive their 
origin. This will be described further on. The com- 
munications of arteries are numerous. They do not 
terminate in veins, but are connected with the latter 
by an intermediate system of vessels, called capillaries 
(from capillus, a hair). So numerous are these vessels 
that the slightest injury, such as a needle-prick, im- 
plicates many of these vessels and they bleed pro- 
fusely. 
. The capillaries, as has been said, are the inter- 
mediate vessels between the arteries and veins. It is 
in these vessels that the most important functions or THE CIRCULATORY OR VASCUeAR SYSTEM. 
91 
changes of the blood occur-the change from arterial 
to venous blood. Here the phenomena of oxidation 
and calorification take place, and it is from this sys- 
tem that the endless variety of materials is supplied 
to the tissues of the body, and for glandular secre- 
tions and venous absorption. 
The Structure of Arteries.-The arteries are 
composed of three coats-an external, a middle, 
and an internal. 
The external coat is firm and strong, and is made 
up of elastic and areolar tissues containing longitudi- 
Fig. 48.-Section through human artery, one of the smaller of the medium- 
sized (X 640) (Bohm and Davidoff). 
nal and oblique fibers. It is of tougher texture than 
the middle coat. 
The middle coat is a thick, circular coat which con- 
tains muscular tissue, the fibers of which are arranged 
in rings that vary in number according to the size of 
the artery. They contain some elastic tissue, but 
this is lost in the smaller arteries ; in the larger ones 
the elastic tissue is blended with the areolar tissue. 
The internal .coat is a thin, epithelial layer on the 
inside, and has an elastic exterior. In the large ar- 
teries there is an intermediate layer composed of are- 
olar tissue. 92 
ANATOMY AND PHYSIOLOGY LOT NUTSES. 
From what has been said it will be seen that, con- 
sidered from without inward, the external coat con- 
sists of areolar and elastic tissues ; the inner coat of 
smooth muscular fiber and areolar and elastic tissues; 
the internal coat, of elastic tissue and epithelium. 
The walls of the capillaries are composed of only 
one coat, which is thin, transparent, and composed 
of tissue of light structure, which is lost in the elastic 
membrane of the internal coat of the arteries and in 
the middle coat of the veins. The capillaries form 
plexuses, and, as has been said, are very abundant, 
especially in the lungs, liver, kidneys, and other 
secreting glands. The skin and mucous membrane 
contribute very freely to this system. In the bones 
the capillaries are larger, but not so profuse. 
The arteries are inclosed in a loose areolofibrous 
tissue investment called a sheath. This is considered 
an important structure in surgical operations ; it also 
contains the accompanying veins and at times a nerve 
in its interior. 
The coats of the arteries are supplied with blood 
from the small branches which run in line with such 
structures. There are the vasa vasorum, or nutrient 
vessels, and are distributed to the external coat. The 
small veins which return the blood from the capil- 
laries open into the small veins of the arteries. The 
arteries are also supplied with nerves. 
THE AORTA. 
The aorta is the largest arterial trunk in the body. 
It arises from the base of the left ventricle and 
middle of the heart, and at its beginning it presents 
an enlargement, called the bulbus aortae, which THE CIRCULATORY OR VASCULAR SYSTEM. 
93 
corresponds in its dilatation with the semilunar 
valves. 
These valves, which are three in number, prevent 
the blood from reentering the left ventricle, whence 
it comes. Passing upward and slightly backward the 
arch is formed. At this point it gives off two sepa- 
rate branches on the left side, respectively, the left 
carotid and the left subclavian ; on the right side it 
gives off only one, the innominate, which subdivides 
into the two right common carotid and subclavian 
branches. The innominate artery is about two inches 
in length. These arteries will be described'later. 
As the aorta passes down it is called the thoracic 
aorta. After passing through the diaphragm it is 
termed the abdominal aorta. In the abdominal 
division of the aorta the kidneys are supplied-two 
previous branches to the diaphragm, and two others, 
small branches, to the ovaries below. Of these a full 
description will be given further on. 
The first or ascending portion of the aorta is about 
two and one-half inches in length, and is contained 
in the pericardium. Anteriorly, it is in relation with 
the pulmonary artery; on the left side, with the left 
auricle and pulmonary artery; on the right side, with 
the right auricle and superior vena cava ; and behind, 
with the right pulmonary artery and veins. 
The second or transverse portion gives off the in- 
nominate artery, left carotid, and left subclavian 
arteries. It is in relation behind with the left recur- 
rent nerve, trachea, esophagus, thoracic duct, and 
nerves of the cardiac plexus ; in front, with the left 
phrenic nerve, left inferior cardiac, and left pneumo- 
gastric nerves. 94 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The third or descending portion of the arch lies 
adjacent to the third dorsal vertebra and is covered 
with a portion of the pleura. 
The descending aorta proper is divided into two 
great portions, named the thoracic and the abdominal 
aorta. 
The thoracic aorta takes its origin at the lower 
border and to the left of the third dorsal vertebra, 
curves forward to the right, passes through the aortic 
opening in the diaphragm, and lies on the central 
line of the vertebral column. Relations: behind, with 
the vertebral column and vena azygos minor ; an- 
teriorly with the esophagus and right pneumogastric 
nerve ; on the left, with the pleura ; on the right, 
with the thoracic duct. 
The abdominal portion (see Fig. 54) enters through 
the opening in the diaphragm, proceeds downward 
in line with the vertebral column, slightly to the left, 
and extends to the fourth lumbar vertebra, where it 
divides into the two common iliac arteries. Re- 
lations: in front, with the left renal vein, pancreas, 
transverse duodenum and mesentery ; behind, with 
the thoracic duct, receptaculum chyli, and left lum- 
bar veins ; on the left, with the left semilunar gang- 
lion, suprarenal capsule, and sympathetic nerve ; on 
the right, with the right semilunar ganglion and the 
commencement of the vena azygos. 
The branches given off from the aorta are as fol- 
lows : 
Ascending portion. 
Coronary, right and left. 
Arch : 
Innominate: 
Right carotid. 
Right subclavian. 
Transverse portion. 
Left carotid. 
Left subclavian. THE CIRCULATORY OR VASCULAR SYSTEM. 
95 
Pericardiac. 
Bronchial. 
Esophageal. 
Posterior mediastinal. 
Intercostal. 
Thoracic aorta : 
Celiac axis : 
Gastric. 
Hepatic. 
Splenic. 
Inferior phrenic (2) suprarenal. 
Inferior pancreatico- 
duodenal. 
Ileocolic. 
Colica dextra. 
Vasa intestini tenuis. 
Colica media. 
Superior mesenteric: 
Abdominal aorta: 
Colica sinistra. 
Sigmoid. 
Superior hemorrhoidal. 
Inferior mesenteric : 
Middle suprarenal. 
Renal. 
Spermatic. 
Lumbar. 
Dorsal. 
Middle sacral. 
The coronary artery arises from the aortic sinuses 
at the commencement of the ascending portion at 
the arch, immediately above the margin of the semi- 
lunar valves, dividing into the right and the left 
coronary arteries, which inosculate with each other 
and supply the substance of the heart with nutri- 
tion. These arteries encircle the heart in every 
direction. 
The innominate artery is the first and largest 
trunk given off from the arch of the aorta ; it is 
about one and one-half inches in length, and ascends 
obliquely toward the right sternoclavicular articula- 
tion, where it divides into the right common carotid 96 
ANATOMY AND PHYSIOLOGY FOK NURSES. 
and right subclavian arteries. It occasionally gives 
off a small branch to the thyroid gland. 
The Common Carotid Arteries.-The right arises 
from the bifurcation of the innominate artery, oppo- 
site the right sternoclavicular articulation. The left 
ascends from the arch of the aorta. The right is 
shorter than the left, more anterior, and somewhat 
larger. 
The right common carotid ascends the neck per- 
pendicularly by the side of the trachea and larynx, 
from behind the right sternoclavicular articulation, 
level with the upper border of the thyroid cartilage, 
where it divides into the right external and internal 
carotids. 
The left common carotid ascends from the aortic 
arch obliquely outward to the side of the neck, and 
upward by the side of the trachea and esophagus to 
the upper border of the thyroid cartilage, where it 
divides into the external and internal carotids. 
The external carotid ascends perpendicularly be- 
tween the lower jaw and meatus auditorius, where it 
divides into two terminal branches, the temporal and 
the internal maxillary ; it gives off the following 
branches : 
Sternomastoid. 
Occipital. 
Posterior auricular. 
Superior thyroid. 
Ungual. 
Facial. 
Ascending branches. 
Ascending pharyngeal. 
Parotid. 
Superficial temporal. 
Internal maxillary. 
The external branches arise from the commence- 
ment of the external carotid, within a short distance THE CIRCULATORY OR VASCULAR SYSTEM. 
97 
of each other. The lingual and facial sometimes 
bifurcate from the common carotid. 
The superior thyroid artery arises from the ex- 
ternal carotid and is distributed to the thyroid gland ; 
it anastomoses with the opposite side, and gives off 
the following branches : 
Hyoid. 
Superior laryngeal. 
Inferior laryngeal. 
Muscular. 
The lingual artery ascends obliquely from its origin 
parallel with the os hyoides, and directly forward, tak- 
ing the name ranine artery, where it inosculates with 
the opposite side ; it gives off the following branches : 
hyoid, dorsalis linguae, and sublingual and ranine. 
The facial artery arises immediately above the 
lingual, and a short distance above the great cornu 
of the hyoid bone. It is imbedded in the submaxil- 
lary gland, curves around the lower jaw at the inferior 
angle of the masseter muscle, ascends to the angle of 
the mouth, and terminates at the inner angle of the 
eye, under the name of the angular artery. 
The facial artery is tortuous in its course over the 
buccinator muscle, to accommodate itself to the move- 
ments of the jaw. The branches that are given off 
are divided into two sets-those given off below the 
jaw (cervical) and the facial ; these are as follows : 
Inferior palatine. 
Tonsillar. 
Submaxillar. 
Submental. 
Muscular. 
Belozu the jaw : 
Buccal (muscular). 
Inferior labial. 
Inferior coronary. 
Superior coronary. 
Lateralis nasi. 
Angular. 
On the face: 98 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The branches of the facial artery just mentioned 
serve to furnish the muscular structure with energy. 
In its distribution this artery sometimes terminates at 
the angle of the mouth or nose, at the ala ; the in- 
osculations of this artery are numerous. 
Fig. 49-Facial and temporal arteries: Ce, External carotid; tsu, su- 
perior thyroid; Is, superior laryngeal; ct, cricothyroid; hy, hyoid branch 
of lingual; dl, dorsal of tongue ; j, sublingual ; me, facial; smt, submental; 
a, angular; Ibi, inferior labial; lbs, coronary of upper lip ; su, artery of nasal 
septum ; sc, sc', sternomastoids ; ap, posterior auricular ; st, stylomastoids ; 
pda, ascending pharyngeal; mi, internal maxillary ; tps, superficial tem- 
poral ; tf, transverse facial; tm, middle temporal; z, external supra-orbital; 
f frontal; so, supra-orbital; la, lacrimal; n, nasal; parotid branches of 
external carotid (after Henle). 
The sternomastoid {superficial descending branch) 
is distributed to the sternomastoid muscle and lym- 
phatic glands. 
The occipital artery, one of the branches of the 
external carotid, arises opposite the styloid process 
of the temporal bone, and ascends beneath the paro- THE CIRCULATORY OR VASCULAR SYSTEM. 
99 
tid gland and under the sternomastoid muscle, pass- 
ing along to the occipital groove in the mastoid por- 
tion of the temporal bone ; it then ascends and is 
distributed to the back part of the head. It furnishes 
the following branches : muscular (supplying the 
sternomastoid, digastric, stylohyoid), auricular, men- 
ingeal, and arteries princeps cervicis. 
The posterior auricular artery arises from the 
external carotid opposite the styloid process of the 
temporal bone. It is distributed to the external ear 
and side of the head ; it anastomoses with the oc- 
cipital and temporal arteries. It gives off several 
branches to the muscles and furnishes a branch to 
the parotid gland, as well as branches to the mas- 
toid cells of the temporal bone and tympanum of 
the ear. 
The ascending pharyngeal artery is the smallest 
of the branches of the external carotid. Its branches 
are divided into three sets-meningeal, to the dura 
mater ; pharyngeal, to the pharynx, tonsils, soft palate ; 
prevertebral branch, to the posterior part of the throat. 
The parotid arteries give off several branches that 
supply the parotid gland ; they also supply the in- 
teguments of the face and masseter muscle. 
The temporal artery (superficial} is one of the 
terminal branches of the external carotid, and divides 
into anterior and posterior branches. The anterior 
branch is distributed to the temple and arch of the 
skull and unites with the opposite side. The poste- 
rior unites with its fellow on the opposite side. The 
branches given off from this artery are : the anterior 
auricular, which are distributed to the pinna of the ear; 
an orbital branch, which unites with the ophthalmic 100 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
artery ; transverse facial, which arises from the tem- 
poral and unites with the facial and infra-orbital 
arteries ; middle temporal, which supplies the tempo- 
ral muscle, associated with the deep temporal artery. 
The internal maxillary artery is the larger termi- 
nal branch of the external carotid ; it passes inward in 
the deep structure of the face, at the inner side of the 
condyle of the lower jaw, and divides into three por- 
tions-the maxillary, the pterygoid, and the spheno- 
maxillary ; these are subdivided into the following 
branches (See Fig. 49) : 
Maxillary. 
Pterygoid. 
Tympanic. 
Mylohyoid. 
Incisor. 
Mental. 
Deep temporal: 
Anterior. 
Posterior. 
Pterygoid. 
Masseteric. 
Buccal. 
Middle meningeal. 
Small meningeal. 
Sphenomaxillary. 
Sphenopalatine. 
Pterygopalatine. 
Superior dental. 
Infra-orbital. 
Superior palatine. 
Vidian. 
The Internal Carotid Artery.-This arises from 
the common carotid, curves backward and outward, 
and ascends upward by the side of the pharynx to the 
carotid foramen in the petrous portion of the tem- 
poral bone. It then passes inward along the carotid 
canal, where it pierces the dura mater and divides 
into three terminal branches. This artery makes 
many curves, which may be seen at the cervical por- 
tion, at the base of the skull. It divides into the 
anterior and middle cerebral arteries. At the cervical 
portion the artery gives off the following branches 
(See Fig. 49): THE CIRCULATORY OR VASCULAR SYSTEM. 
101 
Tympanic. 
Arteriae receptaculi. 
Ophthalmic. 
Anterior cerebral. 
Middle cerebral-. x 
Posterior coniinunicMjiJg. 
Anterior choroid. 
The tympanic is a small branch given off in the 
carotid canal ; it penetrates the tympanum and unites 
with the tympanic branch of the internal maxillary 
and the stylomastoid arteries. 
The arterise receptaculi are small vessels that sup- 
ply the cavernous and inferior petrosal sinuses, pitu- 
itary body, and Gasserian ganglion, uniting with the 
meningeal branch, and called the anterior meningeal. 
The ophthalmic artery arises from the cavernous 
portion, enters the orbit by the optic foramen, divid- 
ing at the inner angle of the eye into two terminal 
divisions-the frontal and the nasal-which further 
divide into the following branches : 
Lacrimal. 
Supra-orbital. 
Posterior ethmoid. 
Anterior ethmoid. 
Palpebral. 
Frontal. 
Nasal. 
Muscular. 
Anterior ciliary. 
Short ciliary. 
Long ciliary. 
Arteria centralis retinae. 
Orbital: 
Ocular : 
The anterior cerebral artery enters the longitudinal 
fissure between the two hemispheres of the brain ; it 
gives branches to the olfactory and optic nerves. The 
two arteries on each side join, shortly after origin, by 
a short anastomosing branch. (See chapter on the 
Nervous System for a more complete description of 
the arteries that supply the brain, including the mid- 
dle cerebral, posterior communicating, and anterior 
choroid.) 102 
ANATOMY AND PHYSIOLOGY EOK NUKSES. 
The Subclavian Artery.-The subclavian'artery 
takes its origin from the innominate artery, opposite 
the sternoclavicular articulation ; on the left, from the 
aorta. At the lower border of the first rib it ceases 
to be called the subclavian, and becomes the axillary. 
For descriptive purposes the artery is generally divided 
FlG. 5o.-Subclavian artery: Ab, Innominate; Cc, common carotid; S', 
subclavian ; v, vertebral; ba, basilar ; mmi, internal mammary ; es, superior 
epigastric; mp, musculophrenic; is, superior intercostal ; cvp, deep cervical; 
ti, inferior thyroid; cva, ascending cervical; cvs, superficial cervical; ts, 
suprascapular; tc, posterior scapular (after Henle). 
into three sections. This division is necessary, owing 
to the fact that there is a difference in the origin of 
the right and the left arterial trunk ; it follows, there- 
fore, that there is a marked difference in the first part 
of the course of this artery. The first portion ascends 
obliquely and outward to the inner border of the 
scalenus anticus muscle. On the left side it ascends THE CIRCULATORY OR VASCULAR SYSTEM. 
103 
upward to the inner border (not outward); the second 
portion curves outward behind the same muscle ; the 
third passes downward and outward beneath the 
clavicle to the lower border of the first rib, where it 
becomes the axillary artery. 
The branches which this important artery furnishes 
are the following : 
Vertebral. 
Internal mammary. 
Inferior thyroid. 
Suprascapular. 
Transversalis colli. 
Thyroid axis : 
Superior intercostal. 
The vertebral artery is the first and largest branch, 
and arises from the back part of the subclavian artery, 
passes upward and through the foramen in the trans- 
verse process of the sixth cervical vertebra, omitting 
the last ; it turns backward around the articulating 
process of the atlas, after which it enters the dura 
mater ; it enters the skull through the foramen mag- 
num ; the two from each side unite and form the 
basilar artery. 
The basilar artery is situated at the base of the 
brain, runs through the grooves of the middle of 
the pons Varolii, and divides into the following 
branches: 
Vertebral branches. 
Lateral spinal. 
Posterior meningeal. 
Anterior spinal. 
Posterior spinal. 
Inferior cerebellar. 
Basilar branches. 
Transverse. 
Antero-inferior cerebral. 
Superior cerebellar. 
Posterior cerebral. 104 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The internal mammary artery arises from the 
under side of the subclavian, passes to the cartilage 
of the first rib, alongside of the sternum, upon the 
cartilages of the ribs, to the sheath of the rectus 
muscle, where it takes the name of the superior epi- 
gastric ; it continues and joins the epigastric branch 
of the external iliac. This artery is crossed by the 
phrenic nerve just as it enters the chest. It distrib- 
utes to the muscles of the abdominal walls and gives 
off several branches, which are as follows : 
Comes nervi phrenici. 
Mediastinal. 
Pericardiac. 
Sternal. 
Anterior intercostal. 
Perforating. 
Musculophrenic. 
Superior epigastric. 
The thyroid axis is a short trunk, and divides into 
three branches-the inferior thyroid, suprascapular, 
and transversalis colli. 
The superior intercostal artery arises from the sub- 
clavian, and gives off branches to the intercostal spaces 
and to the muscles of the dorsal region ; it runs behind 
the pleura and to the outer side of the sympathetic 
nerve and joins the intercostal branch from the aorta. 
The profunda cervicis is considered a branch of the 
superior intercostal ; it unites with branches from the 
occipital and vertebral arteries, and supplies the sev- 
eral muscles of the parts through which it passes. 
The Axillary Artery.-We will now consider the 
axillary artery and its branches. As has been said, 
this artery takes its name at the axillary space, from 
the lower border of the first rib to the lower border of 
the latissimus dorsi and teres major muscles, where it 
becomes the brachial. Its relations are as follows : THE CIRCULATORY OR VASCULAR SYSTEM. 
105 
In front. 
Inner side. 
Outer side. 
Pectoralis major. 
Pectoralis minor. 
First intercostal muscle. 
Serratus magnus. 
Plexus of nerve. 
Plexus of nerves. 
Tendon of subscapular. 
Coracobrachialis. 
The branches are : 
Superior thoracic. 
Acromial thoracic. 
Long thoracic. 
Thoracica alaris. 
Subscapular. 
Anterior circumflex. 
Posterior circumflex. 
The Brachial Artery. 
-This is a continuation 
of the axillary, passing 
down the inner side of the 
arm to a little below the 
bend of the elbow, where 
it divides into radial and 
ulnar arteries ; it gives off 
the following branches : 
Superior profunda. 
Nutrient. 
Inferior profunda. 
Anastomotica magna. 
Muscular. 
Fig. 51.-Axillary artery and 
branches: Ax, Axillary ; B, brachial ; 
ths, superior thoracic ; tha, acromio- 
thoracic ; thl, external mammary; 
cha, anterior circumflex; chp, pos- 
terior circumflex ; jj, subscapular; 
esc, circumflex of scapula; 1, sub- 
clavius muscle ; 2, pectoralis muscle ; 
3, serratus magnus; 4, latissimus 
dorsi; 5, teres major; 6, long head 
of triceps; 7, deltoid ; 8, subscapular 
muscle; 9, bicipital groove (after 
Henle). 
The radial artery is a 
branch of the brachial, and 
appears to be a continua- 
tion of this artery; its 
course is along the radial 
side of the forearm from 
the elbow to the wrist ; where, passing backward 
around the thumb, it runs between the heads of the 
interosseous muscle into the palm of the hand, form- 
ing the deep palmar arch. 
For descriptive purposes this artery is divided into 106 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
Fig. 52.-Brachial artery and branches: B, Brachial; R, radial; U, 
ulnar ; cis, deltoid artery ; cli, deep radial; pb, superior profunda; cm, arteria 
collateralis media; cui, anastomotic; rr, anterior radial recurrent; ru, an- 
terior ulnar recurrent; ico, common interosseous ; ia, anterior interosseous ; 
ip, posterior interosseous ; ir, posterior interosseous recurrent; iar, palmar 
anterior interosseous; iad, dorsal anterior interosseous; m, median; cvr, 
anterior radiocarpal; cvu, anterior ulnocarpal; cdr, posterior radiocarpal; 
cdu, posterior ulnocarpal; mdu, posterior ulnocarpal; mvs, superficial volar ; 
mvp, ulnar part of deep palmar arch ; de, first palmar digital (after Henle). 
three parts, which correspond with the parts which 
it supplies, viz., the forearm, the wrist, and the hand. 
Its divisions are : 
Forearm. 
Radial recurrent. 
Muscular. 
Superficialis volte. 
Anterior carpal. 
Posterior carpal. 
Metacarpal. 
Dorsalis pollicis. 
Dorsalis indicis. 
Wrist. 
Princeps pollicis. 
Radialis indicis. 
Interosseous. 
Perforating. 
Palmar recurrent. 
Hand. THE CIRCULATORY OR VASCULAR SYS TEAL 
107 
The ulnar artery is larger than the radial, and 
runs obliquely inward to the middle of the forearm ; 
then across the annular ligament to the radial side 
and to the palm, where it unites with the superficialis 
Fig 53.-Dorsal arteries of hand: cdr, Posterior radiocarpal; cdu, dorsal 
ulnocarpal ; mdr, dorsal radiocarpal arteries ; nidu, posterior ulnocarpal ; 
imd\ imd\ imd\ dorsal interossei; imv®, posterior perforating; dd, dorsal 
digital (after Henle). 
volae and princeps pollicis to form the superficial 
palmar arch. The branches of the ulnar artery are 
as follows : 
Forearm. 
Wrist. 
Hand. 
Anterior ulnar recurrent. 
Posterior ulnar recurrent. 
Interosseous (anterior and 
posterior). 
Muscular. 
Anterior carpal. 
Posterior carpal. 
Communicating. 
Digital. 
Superficial palmar arch. 
Deep palmar arch. 
We have considered the arterial structure, of the 
upper portion of the body ; we will now describe the 
several branches of the trunk and lower extremities, 
beginning with the thoracic aorta. 108 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
THE THORACIC AORTA. 
The thoracic aorta commences at the left side of 
the lower border of the fourth thoracic vertebra ; it 
terminates at the aortic opening in the diaphragm, in 
front of the last thoracic vertebra. 
Its branches are as follows : 
Pericardiac. 
Bronchial. 
Esophageal. 
Posterior mediastinal. 
Intercostal. 
The pericardiac arteries are small and irregular 
and are distributed to the pericardium. 
The bronchial arteries are three in number-one 
for the right lung and two for the left ; they are dis- 
tributed to the lung-tissue, and also provide small 
branches that supply the bronchial glands, esophagus, 
and pericardium. 
The esophageal arteries number five or six ; they 
are given off from the anterior part of the aorta, and 
distributed to the esophagus, forming a chain of ar- 
terial supply about it ; they unite freely with the 
arteries in the vicinity. 
The posterior mediastinal arteries are small, 
and are distributed to the lymphatic glands and cel- 
lular tissue of the posterior mediastinum. 
The intercostals ^posterior) arise from the pos- 
terior part of the aorta, and number ten on each side. 
The first intercostal space is supplied by the superior 
intercostal artery, a branch of the subclavian. 
They anastomose freely with the anterior intercostal, 
mammary, axillary, epigastric, phrenic, and lumbar 
arteries. They supply the vertebrae, spinal cord, 
dorsal muscle, and skin. THE CIRCULATORY OR EASCULAR SYS TEAL 
109 
THE ABDOMINAL AORTA. 
This important structure has been briefly described 
in another section. For the purpose of making the 
nurse more familiar with this artery and its branches, 
a more complete description will now be given. 
The abdominal aorta commences at the aortic open- 
Fig. 54.-The abdominal aorta : Ai, Common iliac ; i, external iliac; h, 
internal iliac ; sm, middle sacral; phr, inferior phrenic ; lb, lumbar; c, celiac ; 
mes, superior mesenteric; mei, inferior mesenteric; sr, capsular; r, renal; 
spi, internal spermatic ; hi, internal hemorrhoidal (after Henle). 
ing in the diaphragm, in front of the body of the 
last thoracic vertebra ; descending to the left of the 
vertebral column, it terminates on the body of the 
fourth lumbar vertebra by dividing into the right and 
left common iliac arteries. This portion of the aorta 
gives off the following branches : 110 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
Phrenic. 
Celiac axis : 
Gastric. 
Hepatic. 
Splenic. 
Inferior mesenteric. 
Suprarenal. 
Renal. 
Lumbar. 
Sacra media. 
Superior mesenteric. 
Spermatic. 
The phrenic arteries supply the under surface of 
the diaphragm. Each gives off a superior suprarenal 
branch. 
The celiac axis arises from the aorta opposite the 
margin of the diaphragm, passes out for one-half 
inch, and is divided into three branches-the gastric, 
hepatic, and splenic. 
The gastric (sometimes called the coronary) passes 
along the lesser curvature of the stomach, anastomos- 
ing with the esophageal, splenic, and hepatic arteries. 
The hepatic artery passes along the border of the 
lesser omentum to the liver, where it gives off the 
following branches : Pancreatic, pyloric, gastroduo- 
denalis, and cystic. These are distributed to the 
parts indicated by the names, after which they unite 
with the splenic, gastric, and superior mesenteric 
arteries. 
The splenic branch is the largest of the three 
branches of the celiac axis. It passes to the left 
along the border of the pancreas, and divides into 
five or six branches, which enter the spleen at its 
hilum and are distributed to the structure of the 
spleen. This is what is called a serpentine artery, 
since it sometimes makes a complete turn upon itself. 
It affords several branches ; these are as follows : 
Pancreaticae parvae. 
Pancreatica magna. 
Vasa brevia. 
Gastro-epiploica sinistra. THE CIRCULATORY OR VASCULAR SYSTEM. 
111 
The superior mesenteric artery is given off from 
the abdominal aorta about one-quarter of an inch 
below the celiac axis, passing downward and forward 
to the left side ; it is distributed to the small intes- 
tines, except to the first part of the duodenum. It 
gives off five branches : 
Inferior pancreaticoduodenal. 
Vasa intestini tenuis. 
Ileocolic. 
Colica dextra. 
Colica media. 
The spermatic arteries (ovarian in the female) 
are given off in front of the abdominal aorta on each 
side, below the renals, and pass behind the peri- 
toneum, in the male, that an exit may be made 
through the abdominal ring to the testicles ; in the 
female, between the broad ligament to the ovary, 
Fallopian tubes, uterus, to the inguinal canal. In 
their course they supply the several organs men- 
tioned. 
The inferior mesenteric artery is given off from 
the • aorta about two inches above the bifurcation, 
passing to the left and supplying the descending 
colon, sigmoid flexure, and part of the rectum, join- 
ing the colica media and distributing branches to the 
transverse colon. It gives off the following branches : 
colica sinistra, sigmoid, and superior hemorrhoidal ; 
these furnish nutrition to the pelvic tissues and rec- 
tum, and freely anastomose with arteries therein con- 
tained. 
The suprarenal arteries are two small branches 
that are distributed to the suprarenal capsule of the 
kidney. 
The renal arteries are two large branches given 112 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
off from the abdominal aorta, the right being longer 
and lower than the left. Before entering the kidney 
they divide into several branches which are distrib- 
uted to the substance of the organ. Each vessel gives 
off small branches-one to the ureter and the other 
to the suprarenal capsule. 
The'lumbar arteries are usually five in number 
on each side ; they pass about the lumbar vertebrae, 
and divide into two branches-one dorsal and one 
abdominal-which are distributed to the muscles 
of the back, the vertebrae, the spinal cord, and the 
abdominal muscles. 
The sacra media arises from the bifurcation of the 
abdominal aorta, passes along the anterior part of the 
sacrum to the coccyx, and supplies branches to the 
rectum and anterior sacral nerves ; it unites with the 
lateral sacral arteries. 
The Common Iliac Arteries.-As has been said, 
the abdominal aorta divides into the common iliac 
arteries. These extend from the bifurcation, which 
takes place usually at about the fourth or the fifth lum- 
bar vertebra. These arteries are about two inches long, 
and pass outward and downward to the pelvis oppo- 
site to the sacro-iliac symphysis, where they divide 
into the internal and the external iliac. The right 
artery is longer than the left. In the female the 
bifurcation is more expanded than in the male. 
The Internal Iliac Artery.-This is a short branch 
from the common iliac, extending to the sacrosciatic 
foramen, where it divides into two branches-the 
anterior and the posterior-which subdivide into the 
following : THE CIRCULATORY OR VASCULAR SYSTEM. 
113 
Anterior. 
Posterior. 
Superior vesical. 
Inferior vesical. 
Middle hemorrhoidal. 
Uterine. 
Vaginal. 
Obturator. 
Sciatic. 
Internal pudic. 
Iliolumbar. 
Lateral sacral. 
Gluteal. 
The external iliac artery passes along the psoas 
muscle to Poupart's ligament. A line drawn from 
the umbilicus to the middle of Poupart's ligament 
indicates its course. It gives off the muscular, deep 
epigastric, lymphatic, and deep circumflex iliac 
branches. 
The Femoral Artery.-As has been previously 
stated, when the external iliac passes under Poupart's 
ligament it becomes the femoral. From this point it 
passes down the thigh. A line drawn from the mid- 
point between the anterior superior spine of the ilium 
to a point on the center line of the symphysis pubis 
to the inner side of the internal condyle of the femur 
indicates its course. Associated with its vein it is 
inclosed in a strong sheath, but is separated from the 
vein by a partition of fibrous septum. It is divided 
into a superficial and a deep branch, which are further 
subdivided into the following branches : 
Superficial circumflex iliac. 
Superficial epigastric. 
Superior external pudic. 
Inferior external pudic. 
Muscular. 
Anastomotica magna. 
Profunda : 
External circumflex. 
Internal circumflex. 
Three perforating. 114 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The popliteal artery 
commences at the open- 
ing in the adductor mag- 
Fig. 56.-Posterior tibial artery : 
Po, Popliteal; Ta, anterior tibial; 
Tp, posterior tibial; Pe, peroneal; 
rta, anterior tibial recurrent; rip, 
posterior tibial recurrent ; fs, su- 
perior fibular; nuf nutrient of 
fibula ; nut, nutrient of tibia; ppf, 
anterior peroneal; com, transverse 
anastomotic ; mam, anterior medial 
malleolar ; mat, internal malleolar ; 
mpm, posteromedian malleolar; 
cam, middle calcaneal; plm, inter- 
nal plantar; pll, external plantar 
(after Henle). 
Fig. 55.-Femoral artery : eft, 
Common femoral; esp, superficial 
epigastric ; cis, superficial circum- 
flex iliac ; pue, external pudic ; prf 
deep femoral; efl, external circum- 
flex of thigh ; cfm, internal circum- 
flex of thigh; pf1, first perforat- 
ing; pf2, second perforating; pf*, 
third perforating; ags, anastomotica 
magna; sf, superficial femoral (after 
Henle). 
nus, and, passing downward and outward behind the 
knee-joint, it divides at the border of the poplitens THE CIRCULATORY OR VASCULAR SYSTEM. 
115 
muscle into the anterior and the posterior tibial. 
The walls are exceedingly thick, thus protecting the 
artery, which is subjected to severe strain from the 
pressure that is applied from without, as in the case 
of trapeze performers ; in flexing the limb on the 
thigh severe pressure is brought on this structure. 
The branches which it gives off are as follows : 
Superior muscular. 
Inferior muscular or sural. 
Cutaneous. 
Azygos articular. 
Superior external articular. 
Superior internal articular. 
Inferior internal articular. 
Inferior external articular. 
The anterior tibial artery passes through the 
interosseous membrane to the anterior tibial region, 
and runs down the anterior part of the leg to the 
ankle-joint, where it becomes the dorsalis pedis. The 
branches are the recurrent, muscular, external, mal- 
leolar, and internal malleolar. 
The dorsalis pedis artery is on the tibial side of 
the dorsum of the foot, from the ankle to the base 
of the metatarsal bones of the great toe, where it 
gives off a branch-the dorsalis hallucis : it then 
passes to the sole of the foot, between the heads of 
the interosseous muscles, thus forming, with the ex- 
ternal plantar, the plantar arch. Its branches are the 
tarsal, metatarsal, interosseous, dorsalis hallucis, and 
arteria magna pollicis. 
The posterior tibial artery passes down the tibial 
side of the leg, from the lower border of the popliteal 
muscle to the concavity of the os calcis, where it 
divides into the internal and the external plantar 
arteries. The branches of the posterior tibial are as 116 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
follows : Peroneal, nutritious, muscular, internal cal- 
canean, internal plantar, and external plantar. 
The Pulmonary Ar- 
tery.-The pulmonary ar- 
tery arises from the right 
ventricle of the heart, in 
front of the aorta, and is 
divided into a right and 
a left pulmonary artery, 
which are transmitted to 
the lungs. The right is 
larger than the left. 
These vessels transmit the 
venous blood to the lungs, 
to be supplied with oxy- 
gen. They correspond in 
function with the veins of 
the left side, which trans- 
mit arterial blood from the 
lungs. This interchange 
is due to the strain that 
this portion of the circula- 
tion is naturally subjected 
to. This artery will be de- 
scribed more fully later on. 
Fig. 57.-Dorsal arteries of foot: 
Ta, Anterior tibial; Dpd, dorsal; 
ppf, anterior peroneal; mam, an- 
teromedian malleolar; mal, inter- 
nal malleolar ; ism, internal supra- 
tarsal ; tip, external tarsal; tla, 
metatarsal ; pip, deep plantar; 
imd\ imd\ imd\ the dorsal in- 
terossei; pfp, posterior perforat- 
ing ; pfa, anterior perforating ; spm, 
superficial median of the foot (after 
Henle). 
THE VENOUS SYSTEM. 
The venous system, also known as part of the 
systemic system, is, as its, name would imply, made 
up of the veins of the body. 
The veins take their rise in absorbent radicles from 
the capillaries, and in their course unite and reunite, 
thus forming larger and still larger trunks, until, THE CIRCULATORY OR VASCULAR SYSTEM. 
117 
finally, two large vessels-the ascending and the de- 
scending vena cava-are formed. The office of the 
veins is to absorb and convey the blood from every 
part of the system back to the right auricle of the 
heart. Thus the circulation in the veins is always in 
a direction toward the heart. 
There is no pulsation in veins, as there is in the 
arteries, hence the circulation in them depends upon 
a different arrangement. They are supplied with 
numerous valves, which prevent any reflux of blood, 
and close in a direction so as to force the blood for- 
ward by every motion operating upon them. 
Physiologists are not yet in accord regarding any 
theory that has been projected to account for the 
grand principle of venous circulation or the power 
sustaining it. The valvular arrangement just men- 
tioned at once suggests that an alternate contraction 
and relaxation is exercised upon them ; such action, 
we can readily perceive, is afforded to some extent by 
the movements of the muscles, but this action is not 
sufficiently regular to account for the regularity of the 
venous circulation. Another action, however, that is 
more regular and universal, is that of pulsation of the 
arteries. The swell of the arteries in the diastolic 
motion produces great pressure in every part of the 
system. We have a very striking example of this in 
the throbbing pain in the head in some forms of fever 
or in cases of inflammation, especially when the parts 
are much swollen. 
Thus the impulse of the heart and arteries not only 
propels the blood through the arteries, but tends in- 
directly, also, to force it forward in the veins. 
There is, however, another physical principle which 118 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
is cited as an agency in venons circulation, and that 
is capillary attraction. The following illustrations 
of the venous system, give a fair conception of the 
course of the veins and shows their relation to the 
arterial system. 
The blood in the veins is of much darker color 
than in the arteries. This change takes place during 
the passage of the blood through the capillary system, 
and is dependent upon the phenomena of combustion 
and the general metamorphosis of the materials of the 
tissues, all of which are in contact with the capillary 
system. 
The veins of the body are divided into two groups: 
those that pass by way of the superior and those that 
run from the inferior vena cava. The blood from 
the lower extremities is brought by way of the in- 
ferior vena cava ; the blood from the brain, neck, and 
face passes through the internal and the external 
jugular veins. 
The external jugular vein starts at the junction 
of the angle of the jaw (lower) and terminates in the 
subclavian vein. 
The internal jugular vein passes downward in 
line with the common carotid, and unites with the 
subclavian to form the innominate vein. 
The subclavian vein receives the blood from the 
arm. The veins, with the exception of the super- 
ficial branches, accompany the arteries in the same 
sheath. The right and left azygos veins receive 
the blood from the spine. 
The innominate veins unite in forming the supe- 
rior vena cava. The inferior vena cava is formed by 
the union of the two common iliacs, which receive THE CIRCULATORY OR VASCULAR SYSTEM. 
119 
all the blood from the deep and the superficial veins 
of the lower limbs. The large vein of the leg is 
called the saphenous. 
Sinuses are venous channels found chiefly within 
the cranium. They, together with the blood-supply 
of the cerebrum, will be considered in the chapter on 
the Nervous System. 
The veins of the exterior of the head are as fol- 
lows : 
VEINS OF THE HEAD AND NECK. 
Facial. 
Internal maxillary. 
Temporal. 
Temporomaxillary. 
Posterior auricular. 
Occipital. 
(The student will bear in mind that the veins bear 
the same names as the arteries, and are generally in 
the same sheath ; this is particularly true of the deep 
trunks.) 
The facial vein takes its commencement on the 
anterior part of the head, from a plexus of the tem- 
poral branches. Under the name frontal vein, it 
passes along the middle line of the forehead to the 
root of the nose, where it is connected with its fellow 
of the opposite side by the arch of the nose. It is 
divided into several branches, which are distributed 
about the anterior part of the face ; it receives, in its 
course, the supra-orbital, frontal vein, and dorsal 
veins of the nose, which terminate in the nasal arch ; 
also all veins that correspond with the branches of 
the facial artery. 
The internal maxillary vein joins the temporal 
vein. 120 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The temporal vein enters the parotid gland, after 
which it divides into two brandies that make np the 
external jugular vein. 
Fig. 58.-The internal jugular and common facial veins and their 
branches. The zygoma and the left side of the inferior maxilla, together 
with the masseter, have been removed : 1, Pterygoid muscle ; 2, styloglossus 
muscle ; 3, sublingual gland ; 4, hyoglossus muscle ; 5, geniohyoid muscle ; 
6, mylohyoid muscle; 7, sternohyoid muscle; 8, thyrohyoid muscle; 9, 
omohyoid muscle; 10, stylohyoid muscle; 11, styloglossus muscle; 12, 
stylopharyngeus muscle; ji, je, internal and external jugular vein ; ph, 
pharyngeal vein; dl, dorsal vein of tongue ; I, lingual veins ; j, sublingual 
vein ; tsu, superior thyroid vein ; fc, common facial vein ; fa, anterior facial 
vein ; fa', superficial, and fa", deep branches of same ; f frontal vein ; a, 
angular vein ; os, superior ophthalmic vein ; n, nasal vein ; lbs, superior labial 
vein; fp, posterior facial vein ; fp' ,fp", superficial and deep branches of 
same; tps, tpm, tpr, superficial, middle, and deep temporal veins; Pp, ptery- 
goid plexus ; oi, inferior ophthalmic vein ; sea, anterior jugular vein (after 
Henle). 
The temporomaxillary vein is formed by the 
union of the temporal and internal maxillary. It 
divides into two branches, one joining the facial vein, THE CIRCULATORY OR VASCULAR SYSTEM. 
121 
and the other becoming continuous with the external 
jugular. On its course, before entering the external 
jugular, it receives the lingual, laryngeal, and supe- 
rior thyroid veins. 
The posterior auricular vein begins at the vertex, 
runs behind the ear, and joins the external jugular 
vein. 
The occipital vein follows the direction of the 
Fig. 59.-Innominate vein and its branches: 1, Mylohyoid muscle; 2, 
root of tongue ; 3, larynx; 4, thyroid gland ; 5, trachea; Cs, superior vena 
cava; Abd, Abs, right and left innominate veins; 5, subclavian vein ; ji,je, 
internal and external jugular veins; tsu, ti, superior and inferior thyroid 
vein ; cvp, deep cervical vein ; v, vertebral vein ; mini, internal mammary ; 
is, superior intercostal vein ; sea, anterior jugular vein ; *, thyroid plexus 
(after Henle). 
occipital artery, terminating in the external jugular 
vein, in some instances in the internal jugular. 
The veins of the neck, which return the blood 
from the head and face, are the internal jugular, an- 
terior jugular, external jugular, and vertebral. 
The internal jugular vein is formed by the lateral 
and inferior petrosal sinuses outside of the jugular 
foramen ; it unites with the subclavian to form the 122 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
innominate vein. The facial, lingual, pharyngeal, 
superior, and middle thyroid veins unite to make up 
the supply on its course. At the base of the neck, 
where it unites with the subclavian vein, is a pair of 
valves. 
The anterior jugular begins by many small veins 
about the os hyoid, behind the sternomastoid muscle, 
and enters the subclavian vein. 
The external jugular vein, the superficial division 
of the temporomaxillary and occipital, passes to the 
sternomastoid muscle, thence downward, and termi- 
nates in the subclavian vein. 
The vertebral vein follows the course of the artery ; 
it receives branches in its course, and enters the sub- 
clavian vein. 
The inferior thyroid veins receive the blood from 
the thyroid gland. Each unites with its fellow, and, 
along with the middle and superior, they form a 
plexus in front of the trachea. The right terminates 
in the right innominate vein, and the left, in the left 
innominate vein. 
VEINS OF THE UPPER EXTREMITIES. 
The veins of the upper extremities are superficial 
and deep ; the latter accompany the arteries, and are 
called vence comites; they are sometimes inclosed in 
the same sheath. The superficial veins of the arm- 
the brachial vence comites-are situated on each side 
of the artery, and open into the axillary vein, the 
axillary becomes the subclavian, and the subclavian 
unites with the internal jugular to form the venae 
innominatae. THE CIRCULATORY OR VASCULAR SYSTEM. 
123 
The siiperficial veins of the arm are : 
Anterior ulnar. 
Posterior ulnar. 
Basilic. 
Radial. 
Cephalic. 
Median. 
Median basilic. 
Median cephalic. 
The anterior ulnar vein collects the blood from 
the inner part of the hand, ascends to the elbow, and 
unites with the median ba- 
silic, which becomes the ba 
silic vein. 
The posterior ulnar vein 
takes its beginning at the 
back of the hand, unites 
with the veins of the fin- 
gers, ascends to the back 
part of the elbow, and ter- 
minates in the anterior ul- 
nar vein. 
The basilic vein arises 
from the ulnar, and is 
formed by the coalescence 
of the anterior and poste- 
rior ulnar veins ; it is situ- 
ated on the inner side of 
the arm, passing upward to 
the axilla, terminating in 
the axillary. 
The radial vein starts at 
the back of the hand, by 
the radial termination of 
the arch, and connects with 
the several venous branches 
Fig. 6o.-Superficial veins of 
upper limb: i, Cephalic vein; 
2, basilic vein ; 3, radial vein ; 4, 
median cephalic vein ; 5, median 
vein; 6, median basilic vein ; 7, 
anterior ulnar vein; 8, posterior 
ulnar vein (after Quain). 124 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
from the fingers and thumb, where it is increased in 
size ; it passes on upward, and at the bend of the 
elbow it runs anterior and receives the median ceph- 
alic, when it becomes the cephalic vein. 
The cephalic vein passes along the upper arm and 
terminates in the axillary vein. 
The median vein takes its start at the wrist and 
palm of the hand ; at the elbow it receives other 
branches from the deep structures, and divides into 
two branches-the median basilic and median ceph- 
alic. The two latter mingle with the several muscles 
of the arm. 
The median cephalic unites with the radial to 
form the cephalic vein. 
The median basilic unites with the ulnar to form 
the basilic. 
The deep veins of the upper extremity follow the 
course of the arteries. They have numerous anasto- 
moses, not only with one another, but with the 
superficial veins. 
The axillary vein is formed by the union of the 
veins of the brachial artery with the basilic ; it also 
receives several other branches from the axillary ar- 
tery, and terminates in the subclavian. 
The subclavian vein crosses the first rib and 
passes below the clavicle ; it unites with the internal 
jugular vein, and together they assist in forming the 
innominate vein. 
VEINS OF THE LOWER EXTREMITIES. 
Like those of the upper extremities, the deep veins 
accompany the arteries in pairs, and form the venae 
comites of the anterior and posterior tibial and femoral THE CIRCULATORY OR VASCULAR SYSTEM. 
125 
arteries. The tibial veins unite and form the pop- 
liteal vein. 
The popliteal vein passes through the popliteal 
space and to the outer side 
through an opening in the 
adductor magnus muscle, 
and becomes the femoral 
vein ; it also unites with 
the saphenous vein. It 
usually contains about five 
valves. 
The femoral vein com- 
mences at the opening of 
the adductor magnus mus- 
cle, and is inclosed in the 
sheath of the femoral artery ; 
it enters the pelvis at Pou- 
part's ligament, and then be- 
comes the external iliac vein. 
The valves are about five in 
number. It receives several 
veins fro m the muscular 
structure, as well as the pro- 
funda and the internal saphe- 
nous veins. 
The profunda is made up 
of small branches that are 
associated with the artery, 
and terminates in the femoral vein, below Poupart's 
ligament. 
The external saphenous vein begins in the arch 
and at the ankle on the outer side of the foot; it 
ascends the outer and back part of the leg, between 
Fig. 6i.-Superficial veins of 
lower limb: C, Femoral vein; 
Sam, Sap, internal and external 
saphenous veins; Rd, dorsal rete 
of foot; pl, plantar vein (after 
Henle). 126 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
the heads of the gastrocnemius muscle ; it receives 
many branches from the posterior part of the leg, and 
terminates in the popliteal vein. 
The internal saphenous vein takes its beginning 
at the foot, and passes to the inner part of the ankle; 
thence it ascends to the knee, behind the condyle of 
the femur, passes along upward to the saphenous 
opening, where it enters the femoral sheath and ter- 
minates in the femoral vein below Poupart's ligament. 
It receives the cutaneous veins of the thigh, and 
unites with many deep branches. At the saphenous 
opening it unites with the superficial epigastric and 
superficial circumflex iliac veins, as well as with the 
external pudic. This vein is of importance, for in 
phlebitis it is generally implicated ; in the varicosity 
which occurs in the leg it is also this venous trunk, 
that is involved. 
VEINS OF THE TRUNK. 
The venee innominata are two large trunks formed 
by the union of the internal jugular and subclavian 
on each side. The right innominate unites with the 
opposite side and forms the superior vena cava ; it 
receives the right mammary and right thyroid veins. 
The left innominate passes obliquely across the chest, 
and unites with the right innominate to form the 
superior vena cava. 
The superior vena cava is a short branch, about 
three inches in length, formed by the union of the 
two innominate veins ; it enters the pericardium and 
terminates in the right auricle of the heart. 
The inferior vena cava is made up of the follow- 
ing branches : THE CIRCULATORY OR YASCULAR SYSTEM. 
127 
The external iliac takes its course with the artery, 
uniting with the internal iliac to form the common 
iliac vein. 
The internal iliac is made up of the several pelvic 
and external veins, and, uniting with the external 
iliac, it forms the common iliac veins. 
The uterine plexuses are situated about the vagina, 
uterus, and between the two layers of the broad liga- 
ments. The vesical and prostatic plexuses are dis- 
tributed about the genital organs and bladder. 
The common iliac vein is formed by the union of 
the external and internal iliac veins of each side of the 
pelvis; at the origin of the right common iliac artery 
the iliac veins unite and form the inferior vena cava. 
The inferior vena cava, as has been said, is formed 
by the union of the two common iliac veins ; it 
ascends along the vertebral column to the right of 
the abdominal aorta, passing through the diaphragm, 
and terminating in the inferior and posterior part of 
the rig-ht auricle of the heart ; this vein contains no 
valves. It receives, in its course, the following veins : 
Lumbar, right spermatic, renal, suprarenal, phrenic, 
and hepatic. 
The Azygos Veins.-These connect the superior 
and the inferior vena cava, taking the place of these 
vessels in that part of the chest occupied by the heart. 
The intercostal veins (right) receive the veins of 
the first and second intercostal spaces, and unite with 
the subclavian vein. The left is made up of the six 
intercostals of the left side, and communicates with 
the vena azygos on the left side below ; it terminates 
in the innominate vein of the left side. In its course 
it is united with the bronchial veins. 128 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The Vertebral and Spinal Veins.-The plexuses 
of veins of the vertebral column and spinal cord 
Fig. 62.-Veins and artei'ies of the thoracic and abdominal cavities; 1, 
Root of right lung; 2, section of diaphragm ; 3, suprarenal body ; 4, kidney ; 
5, psoas magnus muscle; 6, quadratus lumborum muscle; Aa, descending 
aorta; aA, arch of aorta; Ab, innominate artery ; cs, left carotid artery ; 
Xr, left subclavian artery ; c, celiac artery : mes. met, superior and inferior 
mesenteric arteries ; cs, ci, superior and inferior venae cavse ; Abd, Abs, right 
and left innominate veins ; S, subclavian vein ; je,ji, external and internal 
jugular ; az, azygos vein ; ic, intercostal vein ; h, hepatic veins ; phr, phrenic 
vein and artery ; sr, suprarenal vein ; r, renal artery and vein ; lb, lumbar 
vein; spi, internal spermatic artery and vein ; sm, middle sacral artery and 
vein ; ai, common iliac artery and vein ; H, hypogastric artery and vein ; /, 
iliac artery and vein (after Henle). 
are : The dorsispinal, meningorachidian, and medulli- 
spinal. THE CIRCULATORY OR VASCULAR SYSTEM. 
129 
The Cardiac Veins.-These veins return the blood 
from the muscular structure of the heart. They are 
divided as follows : Great cardiac vein, posterior car- 
diac vein, anterior cardiac vein, and venae Thebosii. 
They collect the blood from the several portions ©f 
the heart, and terminate in the right auricle. 
The portal circulation is a branch of the general 
circulation ; the stomach, intestines, pancreas, and 
spleen receive their arteries from the aorta, and the 
blood, on leaving these, is received into various veins, 
uniting to form the portal vein ; this enters the sub- 
stance of the liver and breaks up into numerous 
capillaries. The blood is then collected by the hepatic 
vein, which opens into the inferior vena cava just 
before the vessel enters the right auricle. 
The portal system of veins is formed by the 
union of the superior and inferior mesenteric, splenic, 
and gastric veins, collecting the blood from the di- 
gestive viscera. The resulting trunk divides in its 
course to the transverse fissure of the liver into a 
branch each for the right and left lobe, which ramify 
to form plexuses in the liver. The blood from the 
hepatic artery furnishes blood to this vein in the 
interior of the liver, and exterior to this organ the 
vein unites with the pyloric and coronary veins. The 
blood so collected, as previously stated, is transmitted 
to the inferior vena cava by the hepatic vein. 
THE PORTAL CIRCULATION. 
THE PULMONARY CIRCULATION. 
The pulmonary artery, carrying venous blood, 
leaves the right ventricle and divides into branches, 130 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
one for each lung. Inside the lung this vessel breaks 
up into small branches, which form a network around 
the alveoli, or air-cells. The oxygenated blood is 
collected by the pulmonary vein and carried to the 
left auricle. 
The two auricles contract, and force the blood into 
the ventricles ; the two ventricles then contract, and 
the tricuspid and mitral valves close their orifices, 
the blood being propelled on into the large vessels 
(the pulmonary artery and the aorta), the semilunar 
valves then closing. The blood cannot get from the 
right side of the heart to the left without passing 
through the lungs, ox lesser circulation ; neither can 
the blood get from the left side of the heart to the 
right without passing around the general or portal 
circulation. 
The Pulmonary Veins.-The pulmonary veins 
are formed by the union of the capillaries in the lung ; 
they unite in two trunks from each lung, discharging 
their blood, collected separately, into the left auricle 
of the lieart. As has been stated before, this is an 
instance where the veins transmit arterial blood. In 
some instances there are three ve;ns of the right side, 
which terminate in a common opening in the auricle. 
There are no valves in the pulmonary veins. 
We have previously described the manner in which 
the blood passes through the heart in making its 
rounds through the circulation. It now remains for 
us to consider the function of the blood, and to give 
a description of the manner in which it takes on new 
forces. 
THE BLOOD. THE CIRCULATORY OR VASCULAR SYSTEM. 
131 
We have said that the arteries carry arterial blood, 
and the veins, venous blood. We will now show 
how the blood gets to the several divisions of the 
circulation. 
Distribution.-This is accomplished through the 
capillaries, which are a network of small blood-ves- 
sels that are found in every part of the body. In the 
interchange which is going on in the tissues new 
products are taken in and others deposited ; for ex- 
ample, in the lymph-spaces lymph is taken up, car- 
ried to the circulation, and assists in the nutrition of 
the body. 
The blood is of an alkaline reaction. It coagulates 
rapidly, the serum separating and leaving the clot, 
which is termed the crassamentum. 
The composition of the blood varies in different 
individuals ; its normal constituents are, however, 
the following: The plasma contain proteids, fats, ex- 
tractive matters, and salts ; the corpuscles contain 
the red and the white cells. 
The color of the blood is bright red in the arteries 
and dark red in the veins. It has a specific gravity 
of 1.055. Blood has an alkaline taste (salty, from 
the sodium chlorid it contains) and a temperature of 
about 990 to ioo° F. 
To determine the quality of the blood the micro- 
scope is brought into requisition, and under examina- 
tion it is found to be a colorless fluid containing 
minute particles. These are of two kinds, and are 
known as the white and the red corpuscles. 
The Corpuscles.-The red corpuscles {erythro- 
cytes) are round and cup-shaped (biconcave) ; their 
average size is estimated to be about of an inch 132 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
in diameter. They vary in size when disease, such 
as anemia, exists. 
Composition.-The composition of the red cell is 
estimated as follows : 
Water. 90.0 per cent. 
Hemoglobin . 36.0 " 
Proteids . . 3.2 " 
Lecithin and cholesterin 0.2 " 
Inorganic salts 0.6 " 
Their color is due to the hemoglobin which they 
contain ; by some the color is said to be due to iron. 
The function of the red corpuscles is to carry oxygen 
(through the intervention of the hemoglobin they con- 
tain) ; therefore they are denominated "oxygen car- 
Fig. 63.-Cells of blood : a, Colored blood-corpuscles seen on the flat; 
b, on edge; c, in rouleau; d, blood-platelets (Leroy). 
riers. " The blood passing to the lungs receives a 
new supply of oxygen, and returns to the tissues, 
where combustion takes place, which deposits the 
oxygen, whereby heat and energy are produced ; it 
now takes on new substances (carbon dioxid) and 
returns to the lungs (changed in character from red 
to blue blood) through the venous system. 
The white corpuscles are called leukocytes; they 
are few in number in comparison with the red ; they THE CIRCULATORY OR VASCULAR SYSTEM. 
133 
are spheroidal in form, and measure about n mm. in 
diameter, and when there is an increase in their num- 
ber this is very easily noticed by the pallor of the coun- 
tenance. The average proportion of the white to the 
red is i to 400; in certain diseased conditions the 
white cells are rapidly increased ; this abnormal state 
is called leukocytosis. 
The white corpuscles vary in shape-some are 
round or spheroidal. They measure about 23W of an 
inch in diameter and contain no cell-wall. They are 
endowed with the power of spontaneous movement, 
and are capable of changing their form and place. 
Fig. 64.-Various forms of leukocytes: a, Small lymphocyte; b, large 
lymphocyte; c, polymorphonuclear neutrophile ; d, eosinophile (Leroy). 
Ill their movements they pass through the vessels 
in the lymph-spaces ; this movement is called ameboid. 
In an inflamed condition the cells are deposited in 
great number, and develop even in suppurative states. 
The white cells migrate to the part infected, sur- 
round the substances, and, through their protective 
powers, prevent further intoxication of the system. 
The plasma of the blood is a white, sometimes 
yellow, clear fluid, largely composed of water, holding 
in solution various salts, albumin, etc., also holds in 
suspension the blood globules. It contains, in it§ 
folds, proteid substances, fats, etc. The proteid 
materials are made up of albumin, paraglobulin, 134 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
and fibrinogen ; the first two occur in about equal 
quantities, while the last is found in small quantities. 
Nutrition is gained through the albuminoids, 
which replenish the tissues of waste-materials taken 
up through the processes of combustion and disease. 
The paraglobulin has about the same effect as 
albumin. The fibrinogen produces coagulation ; its 
power to coagulate is such that it is impossible to 
obtain it in a fluid condition. 
The salts of the blood are closely associated. 
That which occurs in largest quantity is sodium 
chlorid. 
The quantity of blood contained in the human 
body weighs from sixteen to eighteen pounds. 
THE VASCULAR SYSTEM OF THE FETUS. 
The arterial blood destined for the circulation of 
the fetus is carried from the placenta to the fetus, 
along the umbilical cord, by the umbilical vein. The 
umbilical vein enters the abdomen at the umbilicus, 
and passes upward along the free margin of the sus- 
pensory ligament of the liver to the under surface of 
this organ, where it gives off two or three branches 
to the left lobe ; one of these is of large size ; other 
branches are given off to the several lobes of the 
liver ; they all unite, forming one trunk, which divides 
into two branches ; of these, the larger joins the 
portal vein and enters the right lobe ; the smaller 
branch continues onward under the name of the 
ductus venosus, and joins the left hepatic vein at the 
point of junction of this vessel with the inferior vena 
cava. The blood, therefore, that traverses the um- 
bilical vein reaches the inferior vena cava in three THE CIRCULATORY OR VASCULAR SYSTEM 
135 
differentways : The greater quantity circulates through 
the liver with the portal venous blood before entering 
Fig. 65.-Diagrammatic view of the fetal circulation (Dorland). 
the vena cava by the hepatic veins ; some blood 
enters the liver directly, and is also returned to the 136 
ANATOMY AND PHYSIOLOGY FOK NURSES. 
inferior vena cava by the hepatic veins ; the smaller 
quantity passes directly into the vena cava by the 
junction of the ductus venosus with the left hepatic 
vein. 
In the inferior vena cava the blood carried by the 
ductus venosus and hepatic veins becomes mixed with 
that returning from the lower extremities and viscera 
of the abdomen. It enters the right auricle, and, 
guided by the Eustachian valve, passes through the 
foramen ovale into the left auricle, where it becomes 
mixed with a small quantity of blood returned from 
the lungs by the pulmonary veins. From the left 
auricle it passes into the left ventricle, and from the 
left ventricle, into the aorta, whence it is distributed 
almost entirely to the head and upper extremities, 
a small quantity being carried into the descending 
aorta. From the head and upper extremities the 
blood is returned by the branches of the superior 
vena cava to the right auricle, where it becomes 
mixed with a small portion of the blood from the 
inferior vena cava. 
From the right auricle it descends over the Eu- 
stachian valve into the right ventricle ; and from the 
right ventricle it passes into the pulmonary artery. 
The lungs of the fetus are solid and almost impervi- 
ous, hence only a small quantity of blood is dis- 
tributed to them by the right and left pulmonary 
arteries, and this is returned by the pulmonary veins 
to the left auricle ; the greater part passes through 
the ductus arteriosus into the commencement of the 
descending aorta, where it becomes mixed with a 
small quantity of blood transmitted by the left ven- 
tricle into the aorta. Along this vessel it descends to THE CIRCULATORY OR VASCULAR SYSTEM. 
137 
supply the lower extremities and viscera of the ab- 
domen and pelvis, the chief portion being, however, 
conveyed by the umbilical arteries to the placenta. 
The placenta serves the double purpose of a respi- 
ratory and nutritive organ, receiving the venous blood 
from the fetus, and returning it again reoxygenated 
and charged with additional nutritive material. 
Changes at Birth.-At birth, when respiration is 
established, an increased amount of blood from the 
pulmonary artery passes through the lungs, which 
now perform their office as respiratory organs, and, 
simultaneously, the placental circulation is cut off. 
The opening between the two auricles {fordmen ovale) 
now becomes gradually closed in, generally about the 
tenth day ; valvular folds now form about the valvular 
opening or foramen ; sometimes this opening is per- 
sistent and never closes. 
The other parts of the ducts that furnish the circu- 
lation from the after-birth, through the medium of 
the funis, or cord, become obliterated and form at- 
tachments to the several organs of the internal viscera. 
The illustration (Fig. 65) will give a fair idea of 
the course of the blood to and from the after-birth, 
and of the location of the arterial structure. 
The ductus arteriosus forms a cord that connects 
the left pulmonary artery to the concavity of the arch 
of the aorta. 
The umbilical arteries form ligaments to the blad- 
der, and the umbilical veins and ductus venosus be- 
come obliterated and form the round ligaments of the 
liver. 138 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
REVIEW QUESTIONS. 
What constitutes the circulatory system ? 
Give the circulation of the blood. 
What is the heart, and where located ? 
How is the heart divided, subdivided? 
What membrane incloses the heart ? 
Name the valves contained within the heart, and location of each. 
What valves present themselves at the beginning of the aorta ? 
What takes place by the contraction of the ventricles ? 
How are arteries distinguished ? 
What direction does the arterial blood flow ? 
Give a description of the arteries. 
What are the capillaries? 
What is the aorta, and how is it divided? 
What important arteries are given off from the abdominal aorta? 
What are the coronary arteries ? What do they supply ? 
What important arteries pass to the brain ? 
From what arteries do we have a supply of blood to the face? 
What does the occipital artery assist in supplying? 
What important structures does the temporal artery supply? 
What artery pierces the dura mater and divides into three branches ? 
What does the ophthalmic artery supply ? 
What artery supplies nutrition to the eye ? 
What is the subclavian artery ? 
What do you understand by the vertebral arteries? 
What important artery does the vertebral artery form ? 
What muscles does the mammary artery supply ? 
Name the artery that supplies the intercostal spaces and pleura? 
What artery is in the axillary space ? 
Under what bone do we find the subclavian? 
What is the radial artery a branch of? 
What artery lies on the outer side of the forearm? 
Which is the larger the ulnar or radial artery? 
What forms the palmar arch in the hand ? 
What is the abdominal aorta and what important structures does this 
supply ? 
What artery supplies the diaphragm ? 
What artery supplies the liver ? 
What important structure does the splenic artery supply? 
Into how many branches does the splenic artery divide ? THE CIRCULATORY OR VASCULAR SYSTEM. 
139 
What artery provides nutrition to the small intestine ? 
What artery supplies the upper part of the duodenum and pancreas ? 
What other name is the spermatic artery called ? 
What important structures does the inferior mesenteric artery supply ? 
Name the artery which supplies the kidneys. 
What artery provide nutrition to the pelvic organs ? 
What artery passes down the leg, and how is it divided ? 
What artery forms the plantar arch ? 
Give a descrption of the pulmonary artery. 
What is the venous system ? 
What important veins have we in the neck ? 
In what direction does the blood flow in the veins? 
What are sinuses, and where are they located ? 
What do veins contain ? 
What large vein in the lower extremity becomes frequently diseased? 
What forms the superior vena cava? Inferior? 
What connection do the azygos veins provide ? 
What are plexuses, and where do we find them ? 
Through what veins does the blood from the substance of the heart 
return ? 
What makes up the portal circulation ? What is the course of same ? 
What do you understand by the pulmonary circulation ? 
What is the foramen ovale? 
Where would you make pressure in a lacerated limb if an artery was 
severed ? 
Describe the red corpuscles ; the white. 
What is the function of the hemoglobin? 
What is the function of the plasma ? 
What is the composition of the blood? 
What is the average quantity of blood in the adult? 
Through what medium does the fetus derive its nourishment? 
What is the difference in the circulation of the fetus before birth and 
after? What takes place after birth ? 
What are the changes that take place in the blood? 
On what is the pulse dependent? CHAPTER IV. 
THE RESPIRATORY SYSTEM. 
The substances furnished to the circulation from 
the alimentary canal are in a condition that, with ref- 
ence to the atmosphere, will admit of free combina- 
tion with oxygen ; this latter agent is quite necessary 
to prepare the tissues for the functions of assimilation 
and nutrition. Besides this, the venous blood is also 
charged with carbonated products that, when exposed 
to oxygen, are eliminated and passed off in the form 
of carbonic acid gas. To effect these several pur- 
poses and thus to maintain the motive power of the 
system, eliminating, at the same time, deleterious 
substances, is the function of the apparatus of res- 
piration. 
The respiratory organs consist of the larynx, 
trachea, and lungs. The larynx is composed of car- 
tilages, held together by ligaments, and contain the 
vocal organs. The trachea is a membranous tube 
with cartilaginous rings, which, upon its entrance into 
the chest, divides into right and left bronchi. It is 
about five inches in length and three-quarters of an 
inch in diameter. 
The lungs are so constructed as to receive a very 
large amount of atmospheric air, by the most extraor- 
dinary mechanism ; the entire extent of the respira- 
tory surface in the lungs has been estimated at 130 
square meters (390 square feet). 
140 THE RESPIRATORY SYSTEM. 
141 
Accordingly, the blood in tEe pulmonary capil- 
laries, distributed in this layer over so large a surface, 
and being in immediate proximity to the air in the 
cavity of the vesicles, is placed under the most favor- 
able conditions for its rapid and complete arterializa- 
tion. 
Each pulmonary vesicle is covered upon its exterior 
with a close network of capillary blood-vessels, which 
penetrate into the septa between it and the adjacent 
cavities, and which are thus exposed on both sides to 
the influence of the atmospheric air. The walls of 
the vesicles as well as the interspaces between the 
lobules are supplied with an abundance of elastic 
tissue, which gives to the pulmonary structure its 
property of resiliancy. 
Thus the oxygen of the air combines with the blood, 
while a portion of the carbonated and deleterious ma- 
terial also takes on new combinations and passes off. 
THE LUNGS. 
The lungs are situated in the uppermost portion of 
the chest, and, when inflated, completely fill that 
cavity. They are of irregular shape, having two 
main divisions-one right and the other left ; each is 
inclosed in a sac formed by the pleural membrane and 
the mediastinum. The right lung is the larger of the 
two, and is divided by two fissures into three lobes, 
whereas the left lung is divided by one fissure into 
two lobes. 
In their superior portion the lungs receive the 
trachea or zvindpipe, which divides into the bronchi, 
one of which goes to the right lung and the other to 
the left. These bronchial tubes continue to divide 142 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
and branch off in the parenchymatous substance of the 
lungs until they become extremely minute in their 
ultimate attenuation. The lungs, like the heart (this 
latter is embraced principally under the left lobe of 
the lung), are conical in shape. (Fig. 66 will give 
some idea of the shape of the lungs and the position 
of the heart; it will also serve to illustrate the ar- 
Fig. 66.-Relation of lungs to other thoracic organs (Ingals). 
rangement by which the blood and the air in the 
lungs become exposed by contact.) 
The substance of the lungs is of exceedingly light 
and spongy texture, being made up of air-cells, ves- 
sels, and tubes with their delicate walls. The color 
of the lungs varies with the age of the subject, being 
a light pinkish-red in youth, and becoming darker, 
purplish, or mottled in old age. The weight of the THE RESPIRATORY SYSTEM. 
143 
lungs is about forty ounces, the right lung being two 
ounces heavier than the left. 
The lungs, like the other organs, are supplied with 
nerves and vessels for their nutrition and support. 
Respiration.-The respiration in health is free, 
easy, and noiseless. The number of respirations a 
minute varies, averaging about thirty-five during the 
Fig. 67.-Diagrammatic representation of the termination of a bronchial 
tube in a group of infundibula: B, Bronchial tube; LB, bronchiole: A, 
atrium ; I, infundibulum ; C, alveoli (Nancrede). 
first year of life, twenty-five during the second, twenty 
at puberty, and eighteen in the adult. 
The air which is contained in the pulmonary 
lobules and vesicles, being used for the purpose of 
arterializing the blood, becomes rapidly vitiated in 
in the process of respiration, and requires accordingly 
to be as rapidly expelled and replaced by a fresh sup- 
ply. The exchange or renovation of the air is effected 
by alternate movements of the chest of expansion and 
collapse, which follow each other in regular succes- 
sion, and which are known as the movements of in- 
spiration and expiration. 
In inspiration the lungs fill with air, in expiration 
the air is expelled. In all cases the movements of 
respiration are involuntary in character, and even 144 
ANATOMY AND PHYSIOLOGY TOR NURSES. 
their acceleration or diminution is regulated by influ- 
ences beyond our control. We may for a short time 
control these movements, but that for a limited time 
only, as the nervous impulse becomes so very active 
that we are forced to breathe. Then again if we try 
to breathe more rapidly than the normal respirations 
we become fatigued and return to the normal stand- 
ard. Respiration is therefore automatic in charac- 
ter, as may be noticed in persons during sleep ; it is 
like the heart in that it requires no effort upon our 
part to maintain its action. 
The air which is drawn into the lungs in respira- 
tion is a mixture of oxygen and nitrogen in propor- 
tion in volume, of about 21 parts of oxygen to 79 
parts of nitrogen. It also contains about .05 per cent, 
of carbonic acid, a variable quantity of watery vapor 
and some traces of ammonia. 
If we examine the air at expiration we will find, 
after passing through the lungs, it has become altered 
in the following particulars: First, it has lost its oxy- 
gen ; second, it has gained carbonic acid, watery vapor 
and organic matter which require ventilation during 
sleep to maintain good health. 
The respiratory movements vary according to age 
in sleeping and exercise. There are four pulsations 
of the heart to one respiratory act. 
In regard to the amount of air taken into the lungs 
during respiration the following estimates have been 
made : (1) The residttal air, or that part that cannot 
be expelled from the lungs, but remains after a full 
and forcible expiration, averages 120 cubic inches ; 
(2) the stipplemental or reserve air, or that which can 
be expelled by forcible expiration after an ordinary THE RESPIRATORY SYSTEM. 
145 
out-breathing, measures 130 cubic inches ; (3) the 
breath, tidal or breathing air, averages 26 cubic 
inches ; (4) the complementary air, or that which can 
be inhaled after an ordinary inspiration, measures 100 
cubic inches. Thus this estimate gives 250 cubic 
inches as the average volume of air that the lungs 
contain after an ordinary inspiration. 
From what has been said it is apparent that the 
blood is constantly exposed to the air in the lungs ; 
and it would appear that the residual air, or that 
which remains in the lungs after the expiration, is 
most exposed to the affinities in the materials of the 
blood, and in all probability it is upon this portion 
that the greatest impression is made. The respiration 
replaces this residual air by admixture with the fresh 
portions inspired, and thus the expirations remove 
the mixed air so formed. 
The trachea and bronchi are kept in a distended 
state and their cylindric form maintained by the elas- 
tic annular cartilages of which the walls of these 
tubes are constructed. When in the lungs, these 
cartilages are less apparent, as the tubes ramify and 
diminish, until we find the walls consisting simply 
of an elastic but very delicate membrane. 
The accessory organs of respiration are the dia- 
phragm and the intercostal and abdominal muscles ; 
in difficult respiration other muscles of the chest are 
called into play. These muscles are all under the con- 
trol of one nervous apparatus, called the respiratory 
nerve. The principal nerve concerned in the respira- 
tion is, however, the pneumogastric or par vagum. 
The pleura is a closed sac divided into two sections, 
one occupying the right, the other the left half of the 146 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
thorax. They are perfectly separate, no communica- 
tion existing. They meet in the middle line of the 
chest at the upper part only, this about in line with 
the upper part of the gladiolus of the sternum-a 
space (called the mediastinum) being left between 
them, which contains all of the viscera of the thorax 
excepting the lungs. 
Fig. 68.-Interior view of the diaphragm : 1-3, The three lobes of the 
central tendon, surrounded by the fleshy fasciculi derived from the inferior 
margin of the thorax ; 4, 5, the crura; 6, 7, the arcuate ligaments; 8, aortic 
orifice; 9, esophageal orifice; 10, quadrate foramen ; 11, psoas muscle; 12, 
quadrate lumbar muscle. 
The mediastinum is the space left in the median 
portion of the chest by the non-approximation of the 
two plenra ; it extends from the sternum in front to the 
spine behind. It is divided into several divisions, and 
upper and lower portion ; the upper is called the supe- 
rior, the lower being divided into three sub-divisions, 
called respectively the anterior, middle, and posterior 
parts, which have their several anatomical references. THE RESPIRATORY SYSTEM. 
147 
The ribs are elevated during inspiration and fall 
during expiration, and thus the chest is expanded 
when the air is taken in and contracted when it is 
given out. 
THE DIAPHRAGM. 
The diaphragm is a firm, muscular membrane, 
situated transversely across the cavity of the trunk, 
at the lower margin of the bony walls of the chest. 
It is convex on its upper, and concave on its lower, 
surface. By the contraction of the muscle-fibers in 
inspiration its plane becomes more direct-that is, the 
diaphragm becomes flattened and the lungs swell and 
fill the enlarged cavity of the chest, the air rushing 
in, on the principle of common air-pressure. 
REVIEW QUESTIONS. 
What constitutes the respiratory system? 
What is respiration? 
Into how many acts is it divided ? 
What takes place in respiration? 
How are the lungs divided ? 
What is the weight of the lungs? 
Where are they situated ? 
What membrane surrounds them? 
Which lung is the larger? 
What is the trachea ? 
How are the bronchial tubes divided ? 
What are the volumes of air called ? 
State the average volume of air taken in at an ordinary inspiration. 
Define reserve air, complementary air, and supplementary air. 
What is the constitution of the inspired air, and also of the expired air? 
What accessory organs are involved in respiration ? 
Describe the pleura. 
What is the mediastinum ? 
Describe the diaphragm. 
What nerve controls respiration ? CHAPTER V. 
THE DIGESTIVE SYSTEM. 
The lungs, as we have seen in the chapter on the 
Respiratory System, supply oxygen to the blood and 
remove certain waste-products. The tissues of the 
body, however, require many other substances besides 
oxygen to maintain life. 
The needed nutrition is derived froiii the food we 
eat. The process by which this food is altered in 
character and prepared so as to become available and 
suitable, for distribution to the different parts of the 
body is known as digestion. 
Digestion is one of the most important functions 
performed in the human system ; and any consider- 
able deviation from its regular action has a ruinous 
influence on the health. In consequence of the great 
number of organs concerned in digestion, the process 
is subject to frequent disturbances ; these occur, more 
or less, in every disease to which the human frame is 
liable. 
It is only by considering the great end of the 
digestive process that we can fully appreciate its vast 
importance to the animal economy. By this process 
our food and drink are prepared to yield their nutri- 
tious particles to the blood, from which all the other 
fluids as well as the solids are made, and upon which 
our very existence depends. Whenever, therefore, 
digestion becomes enfeebled, vitality must also be- 
148 THE DIGESTIVE SYSTEM. 
149 
come weakened ; and a long-continued weakness of 
the digestive organs must produce disease, and ulti- 
mately death. 
Fig. 69.-General scheme of the digestive tract, with the chief glands open- 
ing into it (Stockton). 
The Alimentary Tract.-The digestion of food 
takes place in the series of organs known as the 
alimentary tract or canal. This begins at the month, 
and includes the esophagus, stomach, and intestines, 150 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
the organs chiefly concerned in the digestion of food. 
It is through this canal that aliment or food passes, 
until, having undergone various changes, it yields its 
particles to the blood in the form of chyle. 
Mastication.-By mastication is meant the tritura- 
tion of food, a process accomplished by the teeth and 
the lower jaw, under the influence of muscular con- 
traction. By the same process the food becomes 
mixed with saliva and softened. When thoroughly 
divided, the food presents a greater surface for the 
solvent action of the digestive fluids, thus aiding the 
general process of digestion. 
The lower jaw is capable of making a downward, 
an upward, a lateral, and an anteroposterior move- 
ment, dependent upon the construction of the tem- 
poromaxillary articulation. 
The movements of mastication, though originating 
in an effort of the will and under its control, are, for 
the most part, of an automatic or reflex character, 
taking place through the medium of the medulla 
oblongata and induced by the presence of food within 
the mouth. The nerves and nerve-centers involved 
in this mechanism are the following : 
Afferent or Excitor Nerves : i. Lingual branch of 
the fifth pair. 2. Glossopharyngeal. 
Efferent or Motor Nerves: i. Third branch of the 
fifth pair. 2. Second hypoglossal. 3. Facial. 
The medulla oblongata not only generates motor 
impulses, but coordinates them in such a manner that 
movements of mastication may be directed toward the 
accomplishment of a definite purpose. 
Insalivation.-Insalivation is the incorporation of 
the food with the saliva secreted by the parotid, sub- THE DIGESTIVE SYSTEM. 
151 
maxillary, and sublingual glands. This process will 
be explained in the chapter devoted to the Glandular 
System. 
Saliva.-Saliva is a colorless liquid, viscid in char- 
Fig. 70.-General plan of the branches of the fifth pair: 1, Lesser root 
of the fifth pair; 2, greater root, passing forward into the Gasserian gan- 
glion ; 3, placed on the bone above the ophthalmic division, which is seen 
dividing into the supra-orbital, lacrimal, and nasal branches, the latter con- 
nected with the ophthalmic ganglion ; 4, placed on the bone close to the 
foramen rotundum, marks the superior maxillary division ; 5, placed on the 
bone over the foramen ovale, marks the inferior maxillary division (after a 
sketch by Charles Bell). 
acter, having a specific gravity of 1.005 ; its com- 
position is : 
Water 995.16 
Albuminous matter 1.34 
Potassium sulphocyanide 0.06 
Calcareous magnesium and calcareous phosphates . . . 0.98 
Sodium and potassium chlorides 0.84 
Mixture of epithelium . ' 1.62 
1000.00 152 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The viscidness of the saliva is due to the mucosin 
which it contains. Saliva also contains an enzyme 
called ptyalin, which acts upon the starchy particles 
of food to convert them into dextrin and sugar ; and, 
finally, by the process of hydrolysis into dextrin and 
maltose. The amount of saliva secreted in twenty-four 
hours has been estimated as about 2% pounds. The 
secretion of saliva is influenced through movements 
Fig. 71.-Tooth: a, Enamel; b, dentin; c, pulp-cavity; d, junction of 
enamel and cementum ; e, cementum ; f, alveolar periosteum (Leroy). 
of mastication, by dry substances, and by speaking; 
moreover, saliva is poured out in great quantities 
through the influence of anything which excites taste. 
The Teeth.-The teeth are thirty-two in number. 
There are sixteen in each jaw, divided into four in- 
cisors, or cutting teeth, two canines, four bicuspids, 
and six molars, or grinding teeth. Each tooth con- 
sists of a crown, covered with enamel, a neck, and a THE DIGESTIVE SYSTEM. 
153 
root, surrounded by the crusta petrosa, a thin layer 
of bone, embedded in the alveolar process formed by 
the jaw bones. A section through a tooth shows that 
it is composed of dentine, in the center of which is 
the pulp cavity, containing blood-vessels and nerves. 
Temporary Teeth.-The temporary teeth of chil- 
dren are twenty in number-ten upper and ten lower. 
Fig. 72.-Diagram showing the temporary teeth : a, Central incisors; 
b, lateral incisors; c, canines; d, anterior molars; e, posterior molars 
(J. P. C. Griffith). 
They appear at about the following ages, the lower 
teeth usually being erupted first. For convenience 
a table is appended : 
The first four central incisors 5 1° 7 months. 
' " lateral incisors 6 " io " 
" " " molars it " 16 " 
" " " canines 14 " 21 " 
" " " second molars 20 " 36 " 
Those lettered a (Fig. 72) are the central incisors ; b, 
the lateral incisors ; c, the cuspids ; and and e, the 
temporary molars. All bnt the last (^) are replaced by 
permanent teeth bearing the same names. In the per- 
manent set the first and second bicuspids supplant the 
temporary molars. By referring to the illustration 
(Fig. 73) it will be seen that the ten temporary teeth are 
above, and the permanent teeth are being formed below. 154 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
Fig. 73.'-Schema showing the temporary and permanent teeth in a child 
five years old (right side): 1, Temporary teeth of the upper jaw ; 2, the five 
temporary teeth of the lower jaw; 3, 3', permanent median incisors ; 4, 4', 
permanent lateral incisors; 5,5', permanent canines ; 6, 6Z, the four perma- 
nent bicuspids; 7, 7', first molar; 8, second molar of lower jaw in its alveo- 
lus (in the upper jaw the second molar is not yet formed); 9, inferior dental 
canal; 10, orifice of inferior dental canal (after Testut). 
The permanent teeth appear in the following order: 
The four first molars 5 to 6 years. 
" two central incisors, lower 6 " 7 " 
" " " " upper 7 " 8 " 
" four lateral incisors 7 " 9 " 
" " first bicuspids 9 " 10 " 
" " second " 10 " 11 " 
" " canines II " 12 " 
" " second molars 12 " 15 " 
" " third " (wisdom teeth) . 17 " 23 " 
Deglutition.-Deglutition, or swallowing, is the 
act by which food is forced from the mouth into the 
stomach. The process may be divided into three 
stages : THE DIGESTIVE SYSTEM. 
155 
FIG, 74.-Diagram showing the permanent teeth : a, Central incisors ; b, 
lateral incisors; c, canines ; d, first bicuspids ; e, second bicuspids; f first 
molars; g, second molars ; h, third molars (J. P. C. Griffith). 
FlG. 75.-The palate and superior dental arch (right side): 1, Median 
incisors; 2, lateral incisors; 3, canine; 4, first bicuspid; 5, second bicus- 
pids; 6, first molar; 7, second molar; 8, wisdom tooth; 9, mucous mem- 
brane of the hard palate continuous, behind, with that of the soft palate; 
10, the anteroposterior raphe of palate; 11, pits on each side of the raphe 
perforated with the orifices of glands; 12, anterior rugosities of the mucous 
membrane (after Testut). 
In the first stage, which is entirely voluntary, the 
mouth is closed and respiration momentarily sus- 156 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
pended. The tongue, placed against the roof of the 
mouth, arches upward and backward, and forces the 
bolus of food into the fauces. 
In the second stage, which is entirely reflex, the 
palate is made tense and directed upward and back- 
ward by the levatores palati and tensor palati muscles ; 
the bolus is grasped by the superior constrictor muscle 
of the pharynx and rapidly forced into the esophagus. 
The food is prevented from entering the posterior 
nares by the uvula and the closure of the posterior 
half-arches ; from entering the larynx by its ascent 
under the base of the tongue and the closure of the 
epiglottis. 
In the third stage the longitudinal and circular 
muscular fibers, contracting from above downward, 
propel the bolus into the stomach. 
THE STOMACH. 
The stomach is situated in the left side of the upper 
portion of the abdomen. Its left extremity is in con- 
tact with the diaphragm, and its right is overlapped 
by the liver. It has two openings ; one connected 
with the esophagus, called the cardiac orifice ; the 
other connected with the upper portion of the in- 
testine, called the pyloric orifice. 
It is composed of three coats or membranes ; the 
exterior or serous coat is very tough and strong, and 
invests every part of this important organ. The 
middle coat is composed of two layers of muscular 
fibers, one set' of which is arranged longitudinally, 
the other, circularly. The interior coat is called the 
mucous, and is arranged in rugae or folds. The THE DIGESTIVE SYSTEM. 
157 
stomach is provided with numerous small glands that 
secrete the gastric fluids. 
FiG. 76.-Stomach in place after removal of liver and mass of intestines: 
A, Diaphragm ; B, B', thoraco-abdominal wall; C, right kidney with c, its 
ureter; D, right suprarenal capsule; E, left kidney with e, its ureter; F, 
spleen; G, aponeuroses of transversales; H,H', quadrati lumborum ; I, I', 
psoas muscles; jV esophagus; L, stomach; M, duodenum; N, origin of 
jejunum. 1, cardia; 2, greater curvature; 3, lesser curvature; 4, great 
tuberosity or fundus; 5, small tuberosity or antrum of pylorus; 6, pylorus; 
7, right vagus ; 8, left vagus ; 9, thoracic aorta; 9', abdominal aorta; 10, in- 
ferior diaphragmatic arteries; n, celiac axis; 12, hepatic artery; 13, right 
gastro-epiploic; 14, coronary artery; 15, splenic artery; 16, 16', superior 
mesenteric artery and vein; 17, inferior mesenteric artery; 18, spermatic 
artery; 19, gall-bladder ; 20, cystic duct; 21, hepatic duct; 22, inferior vena 
cava ; 23, portal vein ; 24, great sympathetic (Testut). 
The Gastric Juice.-The gastric juice is of an 
acid character, and possesses very great solvent pow- 158 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
ers. The presence of food in the stomach excites 
the gastric glands to pour forth their secretion into 
the stomach. By the violent mechanical motions of 
this organ, performed by its muscles, whose fibers are 
so diverse in direction, the gastric juice becomes 
Fig. 77.-Cardiac glands : Diagram showing the relation of the ultimate 
twigs of the blood-vessels ( Vand A), and of the absorbent radicals (L) to 
the glands of the stomach, and the different kinds of epithelium-namely, 
above, cylindrical cells ; small pale cells in the lumen; outside which are 
the dark ovoid cells (Yeo). 
thoroughly mixed with the food, while the digestion 
of the latter goes rapidly on. 
The gastric juice is a clear, colorless fluid-acid reac- 
tion, with a specific gravity of 1005 ; its composition 
is as follows : 
Water 994.404 
Hydrochloric acid 0.200 
Organic matter (pepsin) 3.195 
Inorganic salts 2.201 
1000.000 THE DIGESTIVE SYSTEM. 
159 
It will be noted that the water forms the largest 
part of this fluid, and serves in holding the other 
ingredients in solution. The hydrochloric acid occurs 
in a free state, and is secreted during the digestive 
action. It varies in quantity. The pepsin is asso- 
ciated with the enzymes of the secretions. Besides 
pepsin, a second ferment, termed rennin, exists in 
the gastric juice, which has the power of coagulating 
the caseinogen of milk. By this action the caseinogen 
is split into insoluble casein and soluble albumin. 
Calcium phosphate is essential to the action of this 
enzyme (Brubaker). 
The gastric glands are imbedded within the mucous 
membrane in enormous numbers. They are tubular 
in character (Fig. 77), representing the circulation 
within the glands as well as the tubules, and ab- 
sorbent radicals. 
The principal action of the gastric juice is to trans- 
form the different proteid principles of the food into 
peptones, which is due to the hydrochloric acid and 
pepsin ; when the albumins come in relation with the 
acid they are converted into parapeptones, and in a 
short period of time they are converted into albu- 
minose with the aid of the pepsin ; finally, they are 
converted into peptones or proteids and absorbed. 
THE INTESTINES. 
The small intestine is about twenty-five feet in 
length, and is divided, for descriptive purposes, into 
three parts-the duodenum, jejunum, and ileum. 
The large intestine is about five feet in length, 
and is also divided, for purposes of description, into 
three parts-the cecum, colon, and rectum. 160 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The Small Intestine.-The Duodenum.-This 
portion is- somewhat greater in diameter than the 
remainder of the small intestine. It received its 
name from the fact that it is about twelve finger- 
breadths in length. Above, it commences at the 
pylorus, and ascends obliquely backward to the under 
surface of the liver. It then descends perpendicu- 
larly in front of the right kidney, and passes trans- 
Fig. 78.-Duodenum: a, Mucosa; b, submucosa; c, muscularis mucosae; 
d, Brunner's gland; e, crypts of Lieberkuhn (Leroy). 
versely across the lower portion of the spinal column, 
behind the colon, and terminates in the jejunum. The 
ducts from the liver and pancreas open into the per- 
pendicular portion, about six inches from the stomach. 
The Jejunum.-The jejunum is continuous with 
the duodenum. It has a pinkish tinge, and is thicker 
than the remainder of the small intestine. THE DIGESTIVE SYSTEM. 
161 
The ileum is smaller, thinner in texture, and-some- 
what paler than the jejunum. There is nothing to 
mark the termination of the one or the commence- 
ment of the other of these portions. The ileum ter- 
minates, at an obtuse angle, near the right pelvic or 
haunch bone by a valvular opening into the colon, 
called the ileocecal valve. This arrangement pre- 
vents the passing of substances from the colon into 
Fig. 79.-Mucous membrane of the jejunum, highly magnified (sche- 
matic): 1,.1, Intestinal villi; 2, 2, closed or solitary follicles; 3, 3, orifices 
of the follicles of Lieberkuhn (Testut). 
the ileum. The jejunum and ileum are surrounded 
above and at the sides by the colon. 
The small intestine, like the stomach, has three 
coats (some writers include a fourth or submucous 
coat). The inner or mucous coat is thrown into folds 
or valves. In consequence of this valvular arrange- 
ment the mucous membrane is more extensive than 
the other tissues, and gives a greater extent of surface 162 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
with which the aliment comes in contact. There are 
imbedded under this membrane an immense number 
of minute glands, called villi, which give the surface 
the appearance of velvet. For this reason this mem- 
brane is sometimes called the villous coat. 
The small intestine is beset with numerous small 
glands called Peyer's glands or patches; these are 
liable to become ulcerated in chronic dysentery, and 
Fig. 8o.-Portion of the wall of the small intestine, laid open to show the 
valvulse conniventes (Brinton). 
are the seat of the ulceration of the intestine that 
occurs in typhoid or enteric fever ; in fact, this is the 
supposed location and seat of the disease. 
The Targe Intestine.-The cecum (cul-de-sac), 
or blind pouch, as it is sometimes called, is the com- 
mencement of the large intestine. It is closed at the 
end, and has projecting from this end a slender, worm- 
like appendage called the "appendix vermiformis." 
It is situated in the right iliac region, and is about 
three or four fingerbreadths in length. The cecum, 
like the other portions of the intestine, has a pouch- 
like arrangement caused by the peculiar position of 
the fibers of its muscular coat. 
The colon is divided into three parts-the ascend- 
ing, the transverse, and the descending. The ascend- 
ing colon passes upward from the right hip-bone to THE DIGESTIVE SYSTEM. 
163 
the under surface of the liver. It then bends inward 
and crosses the upper part of the abdomen, below the 
liver and stomach, to the left side, under the name 
of transverse colon. At the left side it turns and de- 
scends to the left hip-bone, and is here called the 
descending colon. At this point it makes a peculiar 
curve upon itself, called the ''''sigmoidflexure" from 
its resemblance to the letter S. On its internal sur- 
Fig. 8l.-Mucous membrane of the jejunum: i, Peyer's patch; 2, its 
border; 3, solitary follicles; 4, 4, valvulas conniventes (Testut). 
face the colon has many sac-like folds, which serve to 
retain the contents in its passage for a long period. 
The rectum is the lowermost or last portion of the 
large intestine, and terminates in the anus ; at this 
point it is surrounded by a sphincter or circular 
muscle that keeps the orifice closed except during 
defecation. 
The motions by which the contents of the bowels 
are carried downward are known as the peristaltic 
and vermicular movements of the bowel. 164 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
Besides the organs just described as being concerned 
in the nutrition of the body, we will consider here 
those structures whose function is the absorption of 
the digested food. These are the lymphatics of the 
small intestine, known as the lacteals, the villi, and 
the thoracic dzict. Of these, the villi have already 
been described. 
Intestinal digestion is an important and complex 
function requiring several important secretions- 
namely, the pancreatic juice, the bile, and intestinal 
juice. 
The function of bile is to assist in the emulsifica- 
tion of the fats and their absorption. It prevents 
putrefactive changes in the foods. It stimulates 
secretions of the intestinal glands, and excites peris- 
taltic action of the bowels. It changes the color of 
the foods passing through the intestines to a yellowish 
color in the mixture with other substances in intes- 
tinal digestion, forming nutritive products which are 
absorbed. ■ 
The material passed to the intestine during stomach 
digestion, called chyme, is slightly acid in reaction. 
As it passes through the pylorus into the intestine, it 
excites therein a secretion of the intestinal fluids. 
These latter have an alkaline reaction which neutral- 
izes the substances passed from the stomach ; the 
nutriment which has not been absorbed by the 
stomach is taken up by the absorbents of the intes- 
tines and sent to the several parts of the system, as 
will be noted under the Lacteals. 
It is supposed that in the intestines starchy sub- 
stances are converted into dextrose. This applies 
especially to the conversion of cane sugar, maltose, THE DIGESTIVE SYSTEM. 
165 
and lactose into dextrose, by which process they are 
prepared for absorption. 
The intestinal juice (Succus Entericus) is secreted 
from the small glands of the intestines {glands of 
Lieberkuhn'). It resembles light Rhine wine in color, 
and is strongly alkaline from the carbonate of sodium 
it contains. The constituents are albumin and mucin. 
Pancreatic juice is secreted by the pancreas, the 
duct of which opens into the intestine (duodenum). 
This juice is a transparent, colorless fluid as well as 
strongly alkaline with a specific gravity of 1.040. 
Its composition is as follows : 
Water 900.76 
Albuminoid substances 90.44 
Inorganic salts 8.80 
ICOO.OO 
It is the function of the pancreatic juice to convert 
starch into maltose, and albumin into albumose and 
finally into peptone ; the trypsin contained in it con- 
verts the hemipeptones into leucin and tyrosin. Pan- 
creatic juice has a specific action upon fats, which it 
emulsifies. This action is rapid, and depends upon 
the alkaline substances with which it is combined. 
It is supposed that the neutral fats are acted upon 
and converted into fatty acids and glycerin, as well as 
a ferment called steapsin. The pancreatic juices in- 
crease the peristalsis of the intestines through the 
glycerin which is produced. 
The individual actions of the several ferments of 
the pancreatic juice are as follows : Amylopsin is the 
diastic ferment of the pancreatic juice ; it converts 
starches into maltose and glucose. It transforms gly- 
cogen into grape sugar and dissolves cellulose. This 166 
ANATOMY AND PHYSIOLOGY FOE NEESES. 
action may take place in an alkaline, neutral or acid 
medium. 
Trypsin converts albumin into peptones in alkaline 
medium, also in slightly acid media. 
Steapsin converts fat into fatty acids and glycerin. 
The bile is an important secretion, whose action is 
to prepare the food absorption. It is a golden color 
having an alkaline reaction specific gravity of 1.020. 
Its composition : 
Water 859.2 
Sodium glycocholate 
Sodium taurocholate 
91-4 
Fat 9.2 
Cholestrin 2.6 
Mucus and coloring matter 29.8 
Salts 7.8 
1000.0 
The lacteals are minute vessels that commence in 
the villi upon the small intestine. They pass between 
the membrane of the mesentery to small glands, 
which they enter. The first range of glands collects 
many small vessels, and transmit a few larger branches 
to a second range of glands ; and, finally, after passing 
through several successive ranges of these glandular 
bodies, the lacteals, diminished in number and in- 
creased in size, proceed to the enlarged portion of the 
thoracic duct, into which they open. They are more 
numerous in the upper portion of the small intestine. 
The absorption of digested materials is accom- 
plished by the lymphatics or lacteals of the intestines 
which form part of this great system. The absorp- 
tion takes place in the villi which are situated in the 
THE LACTEALS. THE DIGESTIVE SYSTEM. 
167 
coats of the intestines. Passing through the epithelial 
layer, the lymph conies at once in contact with the 
capillaries of the vascular network. 
Lymphatic absorbent vessels are found in every 
part of the body, in the glandular system, muscular 
Fig. 82.-Diagram showing the course of the main trunks of the absorb- 
ent system: the lymphatics of lower extremities (D) meet the lacteals of 
the intestines (LAC) at the receptaculum chyli (R.C.), where the thoracic duct 
begins. The superficial vessels are shown in the diagram on the right arm 
and leg (s), and the deeper ones on the left arm (d). The glands are here 
and there shown in groups. The small right duct opens into the veins on 
the right side. The thoracic duct opens into the union of the great veins of 
the left side of the neck (t) (Yeo). 
organs, and mucous membranes. The lymph is a 
colorless or slightly yellowish, transparent liquid. 
The lymphatic vessels of the intestines originate, 
as we have said, in the substance of the villi, which 
form plexuses, and continue to build up in size and 
less in number, as stated above, which form at their 168 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
termination a saccular dilatation called the " Recep- 
tacnluin Chyli," which is the beginning of the 
thoracic duct. 
The products of digestion which are taken up by 
the blood-vessels and lymphatics of the intestines 
pass by two different routes into the general circula- 
tion. The blood of the portal system, containing 
albuminose, sugar, and molecular fat, is carried at 
once to the liver, where it traverses the capillary 
vessels of this organ before reaching the ascending 
vena cava and right side of the heart. The chyle, on 
the other hand, containing also a large portion of 
fatty ingredients, passes by the thoracic duct, and 
mingles with the return current of the venous blood 
in the subclavian vein, where it undergoes an imme- 
diate transformation. In this transformation the fatty 
matter loses its distinctive character and is no longer 
visible as oleaginous molecules. The nutritive ele- 
ments of the food, prepared for absorption by the 
digestive process, are taken up into the circulation 
under the different forms of albuminose, sugar, and 
chyle, and accumulate as such, at certain times, in 
the blood. But these conditions are temporary and 
transitional. The nutritive materials soon pass by 
transformation into other forms, and become assimi- 
lated to the pre-existing elements of the circulating 
fluid. In this way they accomplish finally the object 
of digestion, and replenish the blood by a supply of 
new material from without. 
THE THORACIC DUCT. 
The thoracic duct begins in the abdomen by a con- 
siderable dilatation which is situated in front of the THE DIGESTIVE SYSTEM. 
169 
lower portion of the spinal column. From this point 
it passes through the diaphragm, and ascends to the 
lower part of the neck. In its ascent it lies anterior 
to the spine, and by the side of the aorta and esopha- 
Fig. 83.-Topography of the thoracic duct (Zuckerkandl). 
gus. At the lower part of the neck it makes a sudden 
turn downward and forward, and terminates by open- 
ing into the left subclavian vein, which passes to the 
right side of the heart (right auricle). The thoracic 
duct is equal in diameter to a goose-quill, and at its 170 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
termination is provided with a pair of semilunar 
valves, which prevent the admission of venous blood. 
Fig. 84.-Topography of the thoracic duct (Zuckerkandl). 
REGIONS OF THE ABDOMEN AND THEIR 
CONTENTS. 
By referring to the illustration (Fig. 85) you will 
observe that the abdomen is divided into nine re- 
gions ; these are : The right hypochondriac, right 
lumbar, right inguinal, epigastric, umbilical, hypo- 
gastric, left hypochondriac, left lumbar, and left in- THE DIGESTIVE SYSTEM. 
171 
guinal. The division, as will be seen from the 
illustration, is made by drawing an imaginary line 
horizontally between the cartilages of the ninth ribs ; 
another between the crest of the ilia ; and two verti- 
cal lines from the cartilages of the eighth ribs to the 
center of Poupart's ligament. 
The right hypochondriac region contains the 
Fig. 85.-Imaginary lines drawn upon the surface of the abdomen divid- 
ing it into regions : 1, Right hypochondriac region ; epigastric; 3, left 
hypochondriac ; 4. right lumbar; 5, umbilical ; 6, left lumbar ; 7, right iliac ; 
8, hypogastric ; 9, left iliac (Chapman). 
right lobe of the liver, the gall-bladder, the duode- 
num, the hepatic flexure of the colon, the upper part 
of the right kidney, and the right suprarenal capsule. 
The epigastric region contains the right two- 
thirds of the stomach, the left lobe of the liver, the 
celiac axis, the solar plexus, the pancreas, and part 172 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
of tlie aorta, inferior vena cava, vena azygos, and 
thoracic dnct. 
The left hypochondriac region contains the 
splenic end of the stomach, the spleen, the tail of the 
pancreas, the splenic flexure of the colon, the upper 
half of the left kidney and its suprarenal capsule. 
The right lumbar region contains the ascending 
colon, the lower half of the right kidney, and part 
of the small intestine. 
The umbilical region contains the transverse 
colon, the transverse duodenum, part of the great 
omentum and mesentery, and part of the small in- 
testine. 
The left lumbar region contains the descending 
colon, the lower half of the left kidney, and part of 
the small intestine. 
The right inguinal region contains the right 
ureter, the cecum, the appendix vermiformis, and the 
spermatic vessels of that side. 
The hypogastric region contains part of the small 
intestine, the bladder in children (and when distended, 
in adults), and the uterus during pregnancy. 
The left inguinal region contains the left ureter, 
the spermatic vessels, and the sigmoid flexure of the 
colon. 
REVIEW QUESTIONS. 
What organs constitute the digestive system? 
What is mastication ? 
What organs are brought into action in the mastication of foods ? 
What nerve controls this action? 
What is the saliva ? 
What important enzyme does the saliva contain? 
How many temporary teeth are there ? 
What ages are they erupted ? THE DIGESTIVE SYSTEM. 
173 
Give number of permanent teeth. 
What is deglutition ? 
What is the stomach ? 
What important openings does the stomach contain ? 
How many coats are considered ? 
What is the gastric juice ? 
What is its composition ? 
Name the several enzymes of same, and state their several actions. 
State the division of the small intestine. 
Where is the duodenum, jejunum, and ileum located ? 
What valve is at the termination of the small intestine? 
What glands are imbedded in the small intestine? 
What diseases are particularly apt to affect these glands? 
What secretions are afforded to the digestive process ? 
What is the pancreatic juice? 
What is the composition of the pancreatic juice, as well as the action ? 
State fully the individual action of the several ferments of same. 
What is the bile, and from what source is it derived ? 
What is the action of the same ? 
State the estimated amount secreted in twenty-four hours, also color. 
Under inflammatory actions of the intestines, what is produced ? 
What are the glands of Lieberkuhn ? 
What secretions are formed from these glands ? 
How is the large intestine divided as to name ? 
What important flexure is there in the descending portion? 
What is the rectum? In what does it terminate? 
What do you understand by peristaltic movements ? 
What are lymphatics? 
Where is the thoracic duct located ? 
What is provided at its termination ? Why ? 
Where do the lacteals originate? 
1 hrough what route do the products of digestion pass in entering 
the circulation? 
What are the lacteals ? 
Should digestion be interfered with, what would be the result? 
What are the regions of the abdomen ? 
State as nearly as possible what important organs are located in the 
several divisions. CHAPTER VI. 
THE EXCRETORY SYSTEM. 
WE have considered the circulatory, the respira- 
tory, and the digestive systems, with the various 
chemic substances that are required to maintain the 
life, growth, and activity of the body. These sub- 
stances, entering the current of the blood, are carried 
to all organs and tissues, and are incessantly combin- 
ing with the chemic substances of which these tissues 
are composed. These combinations are not dependent 
upon chance ; each tissue has a special affinity for the 
chemic substance in the blood that it requires for its 
own growth and special form of activity; for ex- 
ample, the secretory cell of the liver selects substances 
from which it can elaborate bile and glycogen ; the 
muscle-fiber assimilates those that will promote the 
changes upon which the power of contractility de- 
pends. 
We know that the proteid compounds contain the 
most essential elements for the formation of all forms 
of tissue, and that phosphate of lime is a necessary 
factor in the hardening of bone, but we are utterly 
ignorant of the process by which each tissue element 
is enabled to select the particular substance it needs 
and to reject that which it does not require. 
Metabolism.-Our bodies are masses of changing 
atoms, some of which, we may say, are on the "up 
174 THE EXCRETORY SYSTEM. 
175 
grade," to construct the various tissues, and some on 
the "down grade," to form the waste matters that 
are the final products of the tissues' activity. These 
changes, which are going on incessantly while life 
lasts, are described under the general term metab- 
olism; the constructive changes are termed anabolic; 
the destructive, katabolic. 
The final products, then, of the metabolism of the 
body will be certain waste-matters ; we shall now 
proceed to describe the mechanism of the organs by 
means of which these waste-products are eliminated 
from the body. 
The Elimination of Waste-products.-In pass- 
ing through the blood and tissues of the body the 
proteids, fats, and carbohydrates are transformed into 
urea, or some allied product, carbonic acid, and 
water, the nitrogen of the urea being supplied by the 
proteids alone. Many of the proteids contain sul- 
phur, and in some phosphorus in some combination 
also occurs ; many of the fats taken as food contain 
phosphorus. By oxidation these elements are con- 
verted into phosphates and sulphates, and are ex- 
creted in company with other salts of the body. 
Broadly speaking, then, the waste-products of the 
body consist of urea, carbonic acid, salts, and water. 
These leave the body by one of three main channels- 
the lungs, the skin, or the kidneys. A portion, it is 
true, leaves the body by the bowels, for, as we have 
seen, the feces contain, besides undigested portions 
of food, substances that have been secreted into the 
bowels, and are therefore waste-products; this amount 
is, however, very small, and, except in diseased con- 
ditions, is not of any special importance. The waste- 176 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
matter discharged relatively by the lungs, skin, and 
kidneys may be stated to be as follows : 
By the lungs: The greater part of the carbonic 
acid ; a considerable quantity of water. 
By the skin: A variable but, on the whole, large 
quantity of water, a little carbonic acid, and a small 
amount of salts. 
By the kidneys: All or nearly all the urea and 
Fig. 86.-Diagram of the relation of kidney to viscera, spine, and surface 
points {American Text-Book of Surgery). 
allied bodies ; the greater part of the salts ; a large 
amount of water and a very small quantity of car- 
bonic acid. 
Having studied, in a previous chapter, the mechan- 
ism by which the lungs relieve the blood of carbonic 
acid and water, it now remains for us to consider the 
excretory mechanism of the kidneys and of the skin. 
The former secretes the urine, while the other urinary 
organs, the ureters-, bladder, and urethra, collect the THE EXCRETORY SYSTEM. 
177 
urine and effect its exit from the body. The mechan- 
ism by which the skin excretes waste-products in the 
form of perspiration will be considered further on. 
THE KIDNEYS. 
.The kidneys are two tubular, secreting glands, 
placed at the back of the abdominal cavity, one on 
each side of the lumbar vertebrae. They are bean- 
FIG. 87.-Kidney, longitudinal section, exhibiting general relations of 
microscopic details (after Piersol): A, Renal artery; U, ureter; C, one of 
the calices, into which a papilla projects; x, cortex containing labyrinth (/) 
and medullary rays (m) ; 2, medulla; M, Malpighian pyramids, some ob- 
liquely cut at 3, 3 ; b, boundary layer; B, columns of Bertini; 4, masses of 
adipose tissue ; 5, 5, branches of renal artery (after Henle). 
shaped, the concave side turning toward the spine, 
and the convex side directed outward. Each kidney 
is about four inches long, two inches broad, one inch 
thick, weighs from five to six ounces, and extends 178 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
from the eleventh rib to nearly the crest of the ilium. 
The right kidney is a little lower than the left, in 
consequence of the large space occupied by the liver. 
The kidneys are covered by a tough envelop of fibrous 
tissue called the capsule of the kidney, and are usually 
embedded in a considerable quantity of fat. 
The Blood-supply of the Kidneys.-For an 
organ of its size, the kidney is abundantly supplied 
with blood. This is derived from the renal artery, 
which, as we have seen in the description of this 
structure in a previous chapter, comes directly from 
the abdominal aorta. 
THE URETERS. 
The ureters are the excretory ducts of the kidneys. 
They arise in the middle of the concave side, or 
hilus, of each kidney, and proceed obliquely down- 
ward and inward through the lumbar region of the 
abdomen into the pelvis, to open obliquely by two 
constricted orifices into the base of the bladder. 
Each ureter is from sixteen to eighteen inches long, 
of the diameter of a goose-quill, and is made up of 
muscular tissue lined by mucous membrane. The 
muscular coat is arranged in two layers-an outer 
circular and an inner longitudinal layer. Outside 
the muscular coat is a layer of fibrous connective 
tissue carrying the blood-vessels and nerves with 
which the tube is supplied. 
THE BLADDER. 
The bladder is a musculomembranous sac that 
serves as the reservoir for the urine. It is situated 
in the pelvic cavity, behind the pubes, and is held in THE EXCRETORY SYSTEM. 
179 
position by ligaments. During infancy it is conical 
in shape, and projects above the upper border of the 
pubes into the hypogastric region. In the adult, 
when quite empty, it is placed deeply in the pelvis. 
When slightly distended it has a rounded form, but 
when greatly distended it is ovoid in shape and rises 
to a considerable height in the abdominal cavity. 
When moderately distended it measures about five 
inches in length and three inches across. The amount 
of urine which the bladder contains ordinarily is 
about one pint. 
In structure the bladder consists of ordinary mus- 
cular tissue lined by a strong mucous membrane, and 
covered partially by a serous coat derived from the 
peritoneum. The muscular coat has three layers, the 
principal fibers of which run longitudinally and cir- 
cularly, the circular fibers being collected into a layer 
of some thickness around the constricted portion or 
neck, where the bladder becomes continuous with the 
urethra. These circular fibers around the neck form 
a sphincter muscle that normally is in a state of con- 
traction, relaxing only at intervals, when the accu- 
mulation of urine within the bladder renders its 
expulsion necessary. 
The Urethra.-The urethra is a narrow, mem- 
branous canal, about one and one-half inches in 
length in the female, and extending from the neck 
of the bladder to the external orifice, or "meatus 
urinarius.'1'1 It is situated beneath the symphysis 
pubis, and is embedded in the anterior wall of the 
vagina. Its direction is obliquely downward and for- 
ward, its course being slightly curved, the concavity 
directed forward and upward. While it admits of 180 
ANATOMY AND PHYSIOLOGY TOR NURSES. 
considerable dilatation, its normal diameter is about 
one-qnarter of an inch. It is lined by a mucous coat 
that is continuous, externally, with that of the vulva, 
and, internally, with that of the bladder. The ex- 
ternal muscular coat is also continuous with that of 
the bladder, but between the mucous and muscular 
coats is a layer of thin, spongy tissue containing a 
network of large veins. (By referring to the illustra- 
tions (Figs. 136, 137) the structures that make up the 
urinary organs may be clearly seen.) 
Micturition.-This act is normally caused by the 
accumulation of urine within the bladder. The ac- 
cumulation stimulates the muscular walls to contract, 
the resistance of the sphincter at the neck of the 
bladder is overcome, and the urine is ejected through 
the urethra. 
Involuntary micturition may occur as a result of 
spinal injury involving the nerve-centers that send 
nerves to the bladder. It may also be due to a want 
of tone in the muscular walls or it may result from 
subnormal irritation. 
The Urine.-General Character of the Urine.- 
Normal urine may be described as a transparent, 
watery fluid, of a pale yellow color, acid reaction, a 
specific gravity of 1018 to 1020, and possessing an 
odor that can only be described as characteristic, or 
urinous. Each one of these characters is subject to 
some variation within the limits of health as well as 
in disease. 
The transparency of urine may be diminished in 
health by the presence of mucus derived from the 
genito-uriuary tract, or by the deposits of salts. In THE EXCRETORY SYSTEM. 
181 
disease the urine may become clouded by the presence 
of pus. 
The color of urine depends mainly upon the amount 
of water it contains ; also upon a diminution or in- 
crease of the coloring-matter. In hysteria, in which 
the urine is copious in amount, the color is very light, 
while in fevers, in which it is scanty, the color is 
very high. It may take on abnormal color as the 
result of the ingestion of certain foods or medicine, 
or this may be due to a diseased condition. 
The reaction of urine should always be tested from 
a collection of urine passed during twenty-four hours, 
for it is affected by diet and exercise ; the reaction of 
mixed urine is normally acid. 
The specific gravity of urine depends upon the 
amount of solid waste-matter present in the urine. 
In health it may vary from 1015 to 1025. When the 
solids are dissolved in a large amount of water the 
specific gravity will naturally be lower than when, 
from a deficiency of water, the urine is more concen- 
trated. In the disease known as diabetes mellitus the 
specific gravity of the urine is considerably height- 
ened, owing to the presence of sugar. 
The Composition of Urine.-The chief constituents 
of normal urine are water, urea, uric acid, coloring- 
matter, and salts. Of these constituents, urea is by 
far the most important, for it is the chief waste- 
product of the body. To eliminate urea is the special 
work of the kidneys, and if, for any reason, they fail 
to do their work, the accumulation of the urea in the 
system eventually leads to the termination of life. 
Urea is the final product of all proteid substances, 182 
A NA TO M Y A ND PH YSIOL OGY FOR NURSES. 
and consequently a diet rich in proteids will increase 
the amount of urea in the system. 
Of the salts, sodium chlorid occurs in the largest 
quantity. In certain inflammatory diseases, in which 
it is needed by the blood, it sometimes disappears 
temporarily from the urine. 
When the kidneys are diseased, it is customary for 
physicians to lighten their work as far as possible by 
regulating the diet. 
The chief abnormal constituents that are liable to 
appear in the urine are albumin and sugar; the 
former gives rise to a condition known as albumin- 
urial; the latter, to the disease called diabetes. 
The "casts'" which are found in urine in various 
forms of Bright's disease are disintegrated from the 
tubules in the shape of cylindric molds. 
The normal quantity of urine passed in twenty- 
four hours is from forty to fifty ounces, or about three 
pints. This amount will vary in health according to 
the condition of the skin and the amount of fluid 
taken into the body. The excretion of water by the 
kidneys is closely related to a similar process con- 
ducted by the skin. When the body is exposed to 
cold the blood-vessels in the skin are constricted, and 
the discharge of water in the form of sweat is checked ; 
at the same time the blood-vessels of the kidneys are 
dilated, there is a full and rapid stream of blood 
through the glomeruli, and an increased flow of urine 
results. On the other hand, when the body is ex- 
posed to warmth, the cutaneous vessels are widely 
dilated, and the skin perspires freely, while the renal 
vessels, being constricted, only a small and slow THE EXCRETORY SYSTEM. 
183 
stream of blood trickles through the glomeruli, and 
the urine that is secreted is scanty in amount. 
The effect on secretion, however, is governed largely 
by the amount of fluid absorbed through the ali- 
mentary canal; an increased secretion of water always 
follows an ordinary meal, and when large quantities 
of water are drunk, the amount of urine is corre- 
spondingly increased. 
THE SUPRARENAL CAPSULE. 
The suprarenal capsules lie immediately above each 
kidney, and are two small, flattened bodies of a yel- 
lowish color. Having no excretory duct, they are 
usually classified with the ductless glands. Each 
organ is invested by a fibrous capsule that sends 
fibers into the glandular substance ; these fibers form 
a framework for the soft, pulpy substance of the 
gland, and within the spaces of this framework are 
groups of cells. 
The suprarenal capsules are abundantly supplied 
with blood-vessels, nerves, and lymphatics, and con- 
tain remarkable coloring-matters. When these or- 
gans become diseased, the skin frequently becomes 
"bronzed," from an increase of pigment or coloring- 
matter. Their special function is as yet unknown. 
THE SKIN. 
Having described the mechanism by which the 
lungs eliminate carbonic acid and water from the 
body, and the manner in which the kidneys relieve 
it of urea, salts, and water, it now remains for us to 
consider the part played by the skin in eliminating 
water and a certain amount of carbonic acid and salts. 184 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The skin, unlike the kidneys, is not set apart for 
the performance of one special function. It is an im- 
portant excretory organ, but also an absorbing organ ; 
it is likewise the principal seat of the sense of touch, 
and serves, too, as a protective covering for the deeper 
tissues lying beneath it. The skin, like the mucous 
membrane, consists of two distinct layers-an epithe- 
lial covering and a connective-tissue basis. The epi- 
Fig. 88.-Vertical section of skin: sbg, Sebaceous glands; ep, epidermis; 
A, hair; d, derma (Fox). 
thelium is stratified, and is called the epidermis or 
scarf-skin ; the connective-tissue layer is called the 
derma (true skin) or corium. 
The epidermis is composed of layers of cells, the 
deeper of which are soft and protoplasmic, while the 
superficial layers are hard and horny. Between the 
two layers is a fairly distinct line of granular-looking 
cells, the granules in which have been thought to THE EXCRETORY SYSTEM. 
185 
form the horny matter in the superficial cells. In 
the colored races the single layer of elongated cells 
next to the corium contains pigment-granules. 
The epidermis, which is throughout the body of 
horny consistence, but so thin as readily to admit of 
flexibility, is on the ends of the fingers replaced by a 
thicker and more permanent texture of horny sub- 
stance called the nails (clavus). 
In the palms of the hands and on the soles of the 
feet the skin is thickened and more firm, according 
as the parts are exposed to friction or wear. 
The outer surface of the skin is covered by numer- 
ous small eminences or papillce, which are the termi- 
nations of the nerves and vessels, each papilla con- 
taining a nerve and one or more vessels. 
The skin, as has been said, possesses great sensi- 
bility, and is commonly regarded as the starting-point 
of the nervous system to palpable feeling. It is, 
therefore, very largely supplied with nerves, and is 
also well furnished with blood. 
The outer layer, or epidermis, possesses no sensi- 
bility, and yet, being extremely thin and delicate, it 
offers but little resistance to the sense of touch. It 
serves chiefly as a covering or shield for the under 
parts, to prevent irritation, corrosion, and the absorp- 
tion of pernicious substances into the circulation. 
The Sudorific and Sebaceous Glands.-The skin 
is furnished with numerous small glands termed 
secretory organs. 
The sudorific glands secrete sweat or perspirable 
fluid from the circulation. Their function is of great 
importance, and serves, in the first place, to remove 
the recremental or exhausted material from the body ; 186 
ANATOMY AND PPIYSTOLOGY FOR NURSES. 
and, secondly, to regulate the temperature by means 
of evaporation of the fluid thus thrown out. For 
example, when the body has been exposed to heat or 
when exercise has been indulged in, perspiration is 
abundant, so that by its evaporation, the heat may be 
moderated. 
These little sweat or sudorific glands have a spiral 
Fig. 89.-A normal sweat-gland, highly magnified: a, Sweat-coil, with 
secreting epithelial cells; b, sweat-duct; c, lumen of duct; d, connective- 
tissue capsule ; e and f, arterial trunk and capillaries supplying the gland 
(after Neumann). 
outlet upon the surface, but their entire arrangement 
is so delicate and minute that they cannot be viewed 
by the unaided eye. In the illustration (Fig. 89) the 
parts showing the sudorific glands and the spiral out- 
let, passing through the different layers of skin, have 
been highly magnified. 
The skin is also furnished with other glandular THE EXCRETORY SYSTEM. 
187 
organs, as the sebaceous glands, which are situated 
in the armpits, and in the face, as about the nose and 
ears. These furnish an oily secretion to the skin in 
all parts, which keeps it soft and pliable. 
FiG. go.-A normal sebaceous gland in connection with a lanugo hair; 
greatly magnified : a, Connective-tissue capsule; b, fatty secretion ; c, h, 
fat-secreting cells; d, root of a lanugo hair; e, hair-sac; f hair-shaft; g, 
acini of sebaceous gland (after Neumann). 
THE APPENDAGES OF THE SKIN. 
The appendages of the skin are the hair and vails. 
The hair is a peculiar modification of the epider- 
mis, and consists essentially of the same structure as 
that membrane. It consists of a root, a shaft, and a 188 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
point. The root presents a bulbous enlargement at 
its extremity ; the shaft consists of a central part or 
medulla. 
Hairs are found on almost every part of the human 
Fig. 91.-Skin and longitudinal section of hair: a, Epidermis; b, 
corium ; c, sebaceous gland; d, fibrous root-sheath; e, glassy membrane ; 
f, outer root-sheath; g, inner root-sheath; h, expanded bulbous end of 
hair; i, papilla of hair; j, arrector pili; k, adipose tissue (Leroy). 
body, but are most numerous on the scalp, and, in the 
male, on the face, where, in the beard, they are thick 
and coarse in character. At puberty hair appears on 
the pubis and in the armpits. THE EXCRETORY SYSTEM. 
189 
The nails are flattened, elastic structures of a horny 
texture, situated upon the dorsal surface of the ter- 
minal phalanges of the fingers and toes. The nail 
has a firm attachment to the cutis, and the part be- 
neath the body and root is called the matrix, from 
Fig. 92.-Human hair: 1, The hair of a child; 2, hair of an adult; 3, 
pointed extremity of the hair of the eyebrow ; a, transverse section of the 
hair, showing the cortical and medullary portions, and air-cells in the center 
of the cylinder (Chapman). 
which successive growth of the nail is produced, with 
the accumulation of the cells therein. 
The chemic composition of the nails is the same as 
that of the epidermis, with a larger proportion of 
sulphur and carbon. 
What do you understand by metabolism ? 
What is known by elimination? 
What are the waste-products? 
What constitutes the excretory system? 
How many kidneys are there ? 
What is the function of the kidneys? 
Give the location of the kidneys. 
What is their average weight? 
REVIEW QUESTIONS. 190 
A NA TOM Y A ND PH J SIOL OGY HO R NURSES. 
What are the ureters ? 
What is the bladder? 
What is the urethra ? 
What is micturition ? 
How is the urine considered-under what heads? 
What is the specific gravity ? reaction ? 
What is the color dependent upon ? 
What are the chief constituents of urine? 
In what abnormal conditions do we find albumin, sugar, pus, uric 
acid ? 
What is the normal amount secreted in twenty-four hours for an adult 
in health ? 
Under what conditions may it vary? 
What is the suprarenal capsule ? 
How may the specific gravity vary, and under what conditions ? 
What are the sudorific glands? Their function? 
What connection have they ? 
What are sebaceous glands ? 
What important function do they possess? 
How does the skin act as an excretory organ? what is it dependent 
upon ? 
How is the skin divided ? 
What are the appendages of the skin ? CHAPTER VII. 
THE NERVOUS SYSTEM. 
The nervous system is concerned chiefly with the 
functions of sensation, motion, and volition. It is 
through this system that all actions, voluntary and 
involuntary, are controlled. These functions will be 
considered further on. It is made up of the cerebro- 
spinal center, and the numerous slender or thread-like 
prolongations that emanate from the center, called 
nerves, and which are distributed to every tissue and 
part of the body excepting the extremities of the 
nails, the hair, and adipose tissue. The substance 
of the brain, spinal cord, and nerves is very similar. 
It is of soft or pulpy consistence, and of a whitish or 
cineritious color. 
The Brain.-The brain in the human subject is 
large, and, with its membranes and vessels, occupies 
all the cavity of the skull. It consists of three por- 
tions-the cerebrum, or anterior and larger portion, 
the cerebellum, which is about one-seventh the size 
of the cerebrum, and is situated in the back and lower 
portion of the skull, and the medulla oblongata, situ- 
ated below the cerebellum. The brain is entirely 
surrounded by membranes-the dura mater, the 
arachnoid, and the pia mater. 
The dura mater is a very firm membrane, conform- 
ing to the-periosteum of other parts. It lines the 
entire cavity of the skull, and reflects into the sinus 
191 192 
ANATOMY AND PHYSIOLOGY TOR NURSES. 
of the brain, from the falx cerebri, an arched or 
sickle-shaped partition between the right and left 
hemispheres. 
The arachnoid is a serous membrane that invests 
the brain and spinal cord, and, like other serous 
membranes, is a closed sac, containing its invest- 
ment. 
The pia mater is a very vascular membrane. It 
invests nearly the entire surface of the brain, and 
dips into its convolutions. It is the nutrient mem- 
brane of the brain, and receives all the blood from 
the carotid and vertebral arteries, designed for the 
brain. 
The Cerebrum.-The cerebrum is divided into two 
hemispheres by a cleft or fissure. In the fissure we 
find a circular or arched projection of the dura mater, 
called the falx cerebri, which has already been de- 
scribed. The object of this construction is to render 
support to this large pulpy mass. The upper surface 
of the cerebrum is marked by many undulations or 
convolutions, and the under surface admits of three 
divisions in each hemisphere-the anterior, the mid- 
dle, and the posterior divisions. 
When the brain is cut through its upper part hori- 
zontally, and the part removed so as to expose the cut 
surface, it will be discovered that the substance of 
this organ is of two distinct colors. On its outer 
surface the brain, for a small depth, is of an ashy- 
gray or cineritious color, while the central portion is 
white. This darker portion is called its cortical or 
cineritious portion ; in its outlines it follows the con- 
volutions of the brain. The light-colored portion is 
called the medullary portion. The two hemispheres THE NERVOUS SYSTEM. 
193 
of the cerebrum are connected by a dense layer of 
transverse fibers called the corpus callosum. 
The Cerebellum.-This portion of the brain is situ- 
Fig. 93.-Base of brain : 1. 2, 3, Cerebrum ; 4 and 5, longitudinal fissure ; 
6, fissure of Sylvius; 7, anterior perforated spaces; 8, infundibulum; 9, 
corpora albican tia; 10, posterior perforated space; 11, crura cerebri; 
12, pons Varolii; 13, junction of spinal cord and medulla oblongata; 14, 
anterior pyramid; I4X, decussation of anterior pyramid ; 15, olivary body ; 
16, restiform body ; 17, cerebellum ; 19, crura cerebelli; 21, olfactory sulcus ; 
22, olfactory tract; 23, olfactory bulbs; 24, optic commissure; 25, motor 
oculi nerve; 26, patheticus nerve; 27, trigeminus nerve; 28, abducens 
nerve; 29, facial nerve; 30, auditory nerve; 31, glosso-pharyngeal nerve; 
32, pneumogastric nerve ; 33, spinal accessory nerve ; 34, hypoglossal nerve. 
ated in the occipital or back part of the skull. Like 
the substance of the brain, the substance of this por- 
tion is also of two colors. The white portion pre- 194 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
seats, when the cerebellum is cut vertically, a beautiful 
appearance, resembling the trunk and branches of a 
tree, and known as the ''''arbor witce.'1'1 The main 
Fig. 94."-View, from below, of the connection of the principal nerves 
with the brain : I', The right olfactory tract; II, the left optic nerve; II', 
the right optic tract (the left tract is seen passing back into i and e, the in- 
ternal and external corpora geniculata); III, the left oculomotor nerve ; IV, 
the trochlear; V, V, the large roots of the trifacial nerves; + +, the lesser 
roots (the + of the right side is placed on the Gasserian ganglion); i, the 
ophthalmic; 2, the superior maxillary; and 3, the inferior maxillary divis- 
ions ; VI, the left abducens nerve ; VII, VIII, the facial and auditory nerves ; 
IX-XI, the glossopharyngeal, pneumogastric, and spinal accessory nerves; 
XII, the right hypoglossal nerve; Ci, the left suboccipital or first cervical 
nerve (Nancrede). 
stem of this structure contains a pouch of gray matter, 
the corptcs dentatum. 
The Medulla Oblongata.-By referring to the illus- 
tration (Fig. 93) you will see, on the surface of the THE NERVOUS SYSTEM. 
195 
brain, the commencement of the spinal cord, here 
called the medulla oblongata. It is a roundish body, 
consisting of three divisions or pairs of bodies, called 
the corpus pyramidale, corpus restiforme, and corpus 
olivare, united in a single bulb. The medulla ob- 
longata, unlike the brain, is highly sensitive, and if 
even slightly punctured, convulsions ensue. At this 
point all the special nerves diverge, so that an injury 
to this part produces immediate disturbance in the 
location to which the nerve is distributed. 
The Spinal Cord.-The spinal cord continues from 
the medulla oblongata downward, through the spaces 
in the vertebral column, afforded by the correspond- 
ing openings of the vertebrae. It runs throughout the 
entire length of the spinal canal, extending from the 
foramen magnum to the lower border of the first 
lumbar vertebra, where it terminates in slender fila- 
ments of gray substance. Its weight, when divested 
of all its membranes and nerves, is about one and 
one-half ounces. It is usually about sixteen or seven- 
teen inches in length. It varies in its diameter at 
different locations. It is grooved, on both its anterior 
and its posterior surface, by a furrow that divides it 
in its entire length into two great nervous cords inti- 
mately united with each other. These lateral cords 
are each divided by furrows into three distinct sets of 
fibers or columns ; namely, the anterior, lateral, and 
posterior columns. The anterior are the motor 
columns ; the posterior, those of sensation ; the 
lateral columns are divided in their function between 
motion and sensation. 
The spinal cord terminates, at its lower extremity, 
in an oval tubercle, whence arise a number of nerves 196 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
that go to the lower parts of the body. From the 
appearance these numerous nerves assume as they 
emerge from the spinal cord, they have collectively 
been denominated the "cauda equina," from a fancied 
resemblance they bear to a horse's tail. The spinal 
pIG -Different views of a portion of the spinal cord from the cervi- 
cal region, with the roots of the nerves. In A the anterior surface of the 
specimen is shown, the anterior nerve-root of its right side being divided ; 
in B a view of the right side is given; in Cthe upper surface is shown; in 
D the nerve-roots and ganglion are shown from below: i, the anterior 
median fissure; 2, posterior median fissure; 3, anterior lateral depression, 
over which the anterior nerve-roots are seen to spread ; 4, posterior lateral 
groove, into which the posterior roots are seen to sink; 5, anterior roots 
passing the ganglion; 5', in A, the anterior root divided; 6, the posterior 
roots, the fibers of which pass into the ganglion, 6; 7, the united or com- 
pound nerve; 7', the posterior primary branch seen in A and D to be de- 
rived in part from the anterior and in part from the posterior root (Allen 
Thomson). 
cord, as well as the medulla oblongata, is enveloped 
in its entire length by the continuation of the three 
membranes of the brain. A more detailed descrip- 
tion of the anatomic structure of the various portions 
of the nervous system will be given further on. THE NERVOUS SYSTEM. 
197 
THE NERVES. 
The nerves are tubular cords, the substance of 
whose structure is similar to that of the brain and 
spinal cord. All nerves take their origin in the 
medulla oblongata and the spinal cord, and extend in 
Fig. 96.-Longitudinal nerve- 
fiber (diagrammatic) : a, Axis- 
cylinder ; b, medullary sheath ; c, 
neurilemma; d, nucleus; e, node 
of Ranvier (Leroy). 
Fig. 97. - Longitudinal section 
through a nerve-fiber from the sciatic 
nerve of a frog (y 830) (Bohm and 
Davidoff). 
sets to every part of the body by different routes. 
They often unite in their course and form a plexus. 
There are forty-two pairs of primary nerves arising 
from the nervous centers ; these, according to their 
origin, are termed cranial, or encephalic, and spinal 
nerves. Twelve pairs originate within the skull and 198 
ANATOMY ANT PHYSIOLOGY FOR NURSES. 
30 pairs pass from the spinal cord-8 cervical, 12 
dorsal, 5 lumbar, and 5 sacral. 
Each nerve is composed of several filaments or 
cords, lying alongside one another, and surrounded 
Fig. 98.-Transverse section of a nerve: a, Epineurium; b, perineurium; 
c, endoneurium ; d, section of a single fiber (Leroy). 
by the neurilemma. Most of the cranial nerves have 
but a single root, but the spinal nerves arise by two 
roots-one from an anterior fasciculus of filaments 
and the other from a posterior ; these are separated 
Fig. 99.-Nerve-cell with dendrites ending in claw-like telodendria: 
a, Neuraxis; b, telodendrion (Bohm and Davidoff). 
from each other by the ligamentum denticulahim. 
The two roots later join, however, to form one nerve. 
The Spinal nerves, as has just been stated, arise 
by two roots from the anterior and posterior columns THE NERVOUS SYSTEM. 
199 
of the spinal cord. The posterior roots are larger 
than the anterior. The anterior are the motor radi- 
cles, and the posterior, the sensitive. 
On each of the posterior roots, in the openings be- 
tween the bones of the spinal column {intervertebral 
foramina), a ganglion is formed, after which the 
anterior- and posterior roots of the nerve unite and 
form the spinal nerve. 
The ganglia may be considered as distinct centers, 
giving off branches in different directions ; the supe- 
rior, or ascending, to communicate with the ganglion 
above ; the inferior, or descending, to communicate 
with the ganglion below ; the external, to communi- 
cate with the sympathetic filaments. It is generally 
admitted that the nerves that emerge from the ganglia 
are larger than those that enter them-as if the 
ganglia imparted additional power to the nerve. 
The branches of distribution accompany the ar- 
teries that supply the different organs and form com- 
munications around them ; these are called plexuses, 
and take the name of the artery with which they are 
associated. Thus we have the mesenteric, plexus, the 
hepatic plexus, the splenic plexus, etc. All the 
internal organs of the head, neck, and trunk are 
supplied with branches from the sympathetic nerve, 
and some of them exclusively. This nerve, as well 
as the other important nerves of the body, will be 
discussed elsewhere. 
Functions of the Nervous System.-The cere- 
bral hemispheres are the centers of the nervous sys- 
tem, through which are manifested all the phenomena 
of the mind ; they are the centers in which impres- 
sions are registered and subsequently reproduced as 200 
ANATOMY AND PHYSIOLOGY DOT NURSES. 
ideas ; they are the seat of in- 
telligence, reason, and will. 
However important a center 
the cerebrum may be for the 
exhibition of this highest form 
of nervous action, it is not di- 
rectly essential for the continu- 
ance of life, for it exerts no con- 
trol over those automatic reflex 
acts known as respiration, cir- 
culation, etc., which regulate 
the functions of organic life. 
The brain is not a sensitive 
organ, and may be lacerated or 
portions may even be cut away 
without giving rise to much 
pain ; such injuries, however, 
will immediately affect the 
mental faculties. The cerebel- 
lum, on the other hand, is in 
close relation with the func- 
tions of animal life, and any 
interference with it will imme- 
diately affect the various func- 
tions of life, such as the respi- 
ration, the digestion, and the 
circulation. The medulla ob- 
longata appears to be the gen- 
eral receptacle of the impress- 
ions of the nerves of the special 
senses, and the spinal cord, that 
of general sensation. 
Functions of the Nerves.-Of the spinal nerves 
Fig. ioo.--General view 
of the cerebrospinal nervous 
system (after Bourgery; 
Schwalbe). THE NERVOUS SYSTEM. 
201 
and of one of the cranial (trifacial), it may be stated 
that they have two roots-one for conveying motor 
and one for carrying sensory impulses. In other 
words, one set for the functions of motion and the 
other for those of sensation. 
No difference has been discovered in the structure 
of the several kinds of nerves in any part of their 
course, and the functions they are designed to perform 
can only be learned by ascertaining the place of their 
origin. The nerves may be divided into five groups, 
according to their functions : 
i. Nerves of Special Sensation.-These are the 
first, second, eighth, and perhaps one of the branches 
of the fifth pair of cranial nerves, and are concerned 
with smelling, tasting, and hearing. 
2. Nerves of General Sensation.-These embrace 
the fifth pair of cranial nerves and all the spinal 
nerves. In those parts that require sensation for 
safety and the performance of their functions there is 
an abundant supply of sensitive nervous filaments. 
The nerves of sensation are distributed chiefly to the 
skin. Few filaments ramify the mucous membranes 
and muscles. 
3. Nerves of Motion.-To these belong the third, 
sixth, and twelfth pairs of cranial nerves and all the 
spinal nerves. They are distributed upon the mus- 
cular fibers, and, by their action, give rise to muscular 
contraction. (By referring to the illustration (Fig. 
105) the several nerves that control the general system 
may be seen.) 
4. Nerves of Respiration.-These are the fourth, 
seventh, ninth, tenth, and eleventh pairs of cranial 
nerves, besides the phrenic and the external respira- 202 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
tory. All these nerves have their origin in a distinct 
tract or column, called the lateral, in the upper part 
of the spinal cord. This is sometimes called the 
respiratory column. These nerves are distributed to 
one of the muscles of the eye, to the muscles of the 
face, to the tongue, pharynx, esophagus, stomach, 
heart, lungs, diaphragm, and some of the muscles of 
the neck and chest. 
It is through the instrumentality of the spinal ac- 
cessory, phrenic, and external respiratory nerves that 
the muscles concerned in respiration are brought into 
action without the necessary cooperation of the will. 
5. The Sympathetic Nerve.-The sympathetic nerve, 
also called the trisplanchnic nerve, is in reality a 
system of nervous arrangement adapted particularly 
for the performance of the functions of organic life. 
It consists of a series of ganglia united by inter- 
mediate branches, and distributes its regular branches 
in the three great splanchnic cavities-those of the 
head, chest, and abdomen. In the trunk it lies mainly 
on the side of the spine (the student should carefully 
study the illustration (Fig. 105) in order to become 
familiar with this important nerve), and communi- 
cates with all the spinal and several of the cranial 
nerves. 
The sympathetic nerve serves to maintain vitality 
in all the important portions of the system. It exerts 
a controlling influence over the involuntary functions 
of digestion, absorption, secretion, circulation, and 
nutrition. Every portion of the body is, to a certain 
extent, under its influence, as filaments from this 
system of nerves accompany the blood-vessels through- 
out their course. THE NERVOUS SYSTEM. 
203 
An important function of the sympathetic nerve is 
to form a communication of one part of the system 
with another, so that when one organ is affected, 
every other organ will act accordingly. If, for ex- 
ample, disease seizes the brain, the stomach, by its 
sympathetic connection, becomes aware of it ; and 
since nourishment would augment the disease, the 
stomach refuses to receive food, and perhaps throws 
off what has already been taken. The loss of appetite 
in-certain diseases is thus a kind provision of nature 
that prevents our taking food when it would be in- 
jurious ; following this intimation, we, as a general 
rule, should abstain from food until the appetite re- 
turns. 
Having described briefly the several portions that 
go to make up the nervous system, we will now con- 
sider more fully the anatomy of the parts connected 
with these important structures. 
THE BRAIN. 
This is that portion of the cerebrospinal center 
contained in the cavity of the cranium. It is divided 
into four principal parts : the medulla oblongata, pons 
Varolii, cerebrum, and cerebellum. 
The average weight of the brain is about 49 ounces 
in the male and 44 ounces in the female; the heaviest 
male brain of which there is a record weighed 68^ 
ounces ; the lightest, 34 ounces ; the heaviest female 
brain weighed 56 ounces ; the lightest, 30 ounces. 
The brain is divided into fissures and lobes ; the 
fissures divide the several parts of the brain substance, 
and in this manner the several lobes are marked out. 
As has been stated elsewhere, the brain is sur- 204 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
rounded by three membranes: the dura mater, which 
is a tough, fibrous membrane; the arachnoid, a 
serous membrane ; and the pia mater, a vascular 
membrane. 
The Dura Mater.-This is the first membrane to 
be encountered after the removal of the skull-cap. 
It derived its name from the fancied belief that it 
supplied all the membranes of the body. As has 
been said, it is a tough, inelastic, fibrous structure, 
forming the internal periosteum of the skull. It acts 
as a support for the lobes of the brain, and forms 
partitions for the falx cerebri, falx cerebelli, and 
tentorium cerebelli; it also provides sinuses for the 
veins that return the blood from the brain, further, 
it forms sheaths for the nerves as they leave the 
skull. 
The Arachnoid Membrane.-This is the second 
membrane, and takes its name from its resemblance 
to a spider's web. It is a very delicate, serous mem- 
brane, and, like all other serous membranes, is a 
closed sac-one part, forming the parietal layer, 
lines the under surface ; tlie other, or visceral layer, 
being reflected over the brain. 
This membrane is perfectly smooth, and is suffi- 
ciently lubricated to prevent friction. It is in close 
connection with the pia mater. At the base of the 
brain it forms spaces, known as sztbarachnoidean 
spaces, which contain the cerebrospinal fluid; this 
fluid serves to protect the brain and nerve-centers 
from sudden shocks and concussions, such as blows, 
as well as loud noises. The base of the brain is sup- 
ported by a bed of water. In fractures at the base of 
the skull or in the temporal region water will be seen THE NERVOUS SYSTEM. 
205 
to ooze through the ear and along the line of the 
fracture ; this symptom is generally considered as 
being fatal in its results. 
The Pia Mater.-This is the third membrane that 
invests the entire surface of the brain, and forms the 
velum interpositum and choroid plexuses of the third 
and fourth ventricles. It is extremely vascular, its 
blood-supply being derived from the internal carotid 
and vertebral arteries, and forms a bed in which the 
blood-vessels divide and subdivide before they enter 
the brain. It penetrates all the convolutions, as 
well as the lateral ventricles, for the supply of blood 
to the interior of the brain-substance. 
The great mass of nervous matter termed the brain 
is, as we have said, divided into three great parts- 
the cerebrum, the cerebellum, and the medulla ob- 
longata. 
The cerebrum is of oval form ; it is divided in 
the middle line, by the longitudinal fissure, into two 
parts, termed the right and the left hemisphere. The 
surface of the hemispheres is of tortuous character, 
and divided by furrows, or sulci, into convolutions. 
The furrows serve to accommodate the vessels in their 
course to the sinuses ; they also contain fluid from 
the subarachnoid spaces. In old age, or in cases of 
disease in which the convolutions become shrunken, 
large quantities of water are present. The convolu- 
tions are folds of the brain substance, this folding 
serving to give greater extent to the circumference 
of the parts and also a greater area of gray matter. 
This is believed to be the location of the mental 
forces and of intelligence. The number of convolu- 
tions and their depth vary in different individuals. 206 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The under surface of the brain resembles the 
upper ; it presents the same convoluted appearance, 
and is made up of three lobes-the anterior, the 
middle, and the posterior. (See Fig. 93.) 
The anterior lobe rests on the roof of the orbit, and 
is separated from the middle lobe by the fissure of 
Sylvius, which receives the lesser wing of the sphenoid 
bone, and in which there is formed what is called the 
island of Reil; this is considered to be a ganglion of 
the corpus striatum. The middle lobe occupies the 
middle fossa of the base of the skull formed by the 
sphenoid and temporal bones. The posterior lobe 
rests upon the tentorium. 
We will now examine the interior of the brain. 
In separating the hemispheres of the cerebrum in the 
longitudinal fissure we find what is termed the corpus 
callosum. In examining the brain we find it made 
up of two characteristic substances-the white and 
the gray matter. The gray matter is about one- 
eighth of an inch in thickness, and invests the brain 
like a bark, hence it is termed the cortical szibstance. 
The furrows, as previously stated, vary in number 
and in depth, according to the intelligence of the 
individual. To the naked eye the cortical substance 
appears as one layer, but when examined under the 
microscope, six layers are seen-three gray, alter- 
nating with three white. The white is called the 
medullary portion, and forms the mass of the brain- 
substance. 
The corpus callosum is the transverse portion of 
the brain connecting the two hemispheres ; it is 
about four inches long. It is composed of a body THE NERVOUS SYSTEM. 
207 
and an anterior, middle, and posterior horn. It roofs 
in the lateral ventricles of the brain. 
There are five ventricles in the brain : The two 
lateral are covered with the corpus callosum, and are 
formed by the folding backward of the cerebral lobes. 
They contain a quantity of a serous fluid, which, 
when it occurs in excess, as it sometimes does in 
children, constitutes the disease known as hydro- 
cephalus. 
The third ventricle lies between the optic thalami 
and extends to the base of the brain. 
The fourth ventricle is situated between the cere- 
bellum and the posterior palt of the medulla oblon- 
gata and pons Varolii. 
If a perpendicular section of the brain were made, 
the lateral ventricles, as well as the third, would be 
seen ; the corpus callosum, and the fornix and velum 
interpositum below it, would also come into view. 
The fornix is a layer of white matter, arranged in 
the form of an arch, from below backward beneath 
the corpus callosum. 
The velum interpositum is a reflection from the pia 
mater which penetrates the ventricles through the 
fissure beneath the posterior border of the corpus 
callosum. Like the fornix, it is a vascular veil, and 
is rolled up in form of a fringe, which is called the 
choroid plexus. These plexuses are made up of 
minute arteries, and communicate with each other 
through the foramen of Monro. The foramen of 
Monro is not really a foramen, but simply a commu- 
nication between the lateral and the third ventricle. 
The venae Galeni, two in number, return the blood 208 
ANATOMY ANQ PHYSIOLOGY FOR NURSES. 
through these parts and ventricles into the straight 
sinus. 
The optic thalamus is an elevation upon the floor 
of the lateral ventricles immediately behind the corpus 
striatum. 
The corpus striatum is a layer of white and gray 
matter ; the under part corresponds with the convolu- 
tions at the base of the brain known as the island of 
Reil. 
The tubercula or corpora quadrigemina are four 
rounded eminences, situated two on each side behind 
the pineal gland ; they consist of white and gray 
matter; the gray giving off the optic nerve, which 
pierces the ball of.the eye; hence they are sometimes 
termed the optic lobes. 
The cerebellum is situated in the occipital fossa, 
below the posterior lobes of the cerebrum. It is 
elliptic, its broad diameter being transverse. Upon 
transverse section it presents an appearance resem- 
bling the branches of a tree ; hence, as has been 
stated elsewhere, it has been termed the arbor vitce, 
or "tree of life." It is considered to be more com- 
plex in its anatomic arrangement than any other part 
of the body. 
The pons Varolii is situated at the base of the 
brain, just above the medulla oblongata, and located 
in the basilar groove of the occipital bone. It has a 
diameter of about one inch. In the middle of this 
body, through a groove provided for it, runs the 
basilar artery. 
The medulla oblongata is that part of the central 
cerebrospinal axis that connects the cerebellum, by 
the restiform bodies between, with the pons Varolii ; THE NERVOUS SYSTEM. 
209 
it is continuous with the spinal cord. It is one of the 
most important divisions of the nervous system, and 
contains the nerve-centers for speech, deglutition, and 
respiration. Injury to this structure is, indeed, fatal. 
The medulla oblongata is about inches long, and 
lies above the basilar groove of the occipital bone ; it 
diverts backward to and through the foramen mag- 
num, at which junction the spinal cord begins. 
It is divided into anterior pyramids which are con- 
tinuous with the spinal cord on the anterior of the 
same ; they are pyramidal in form, and the fibers of 
each side decussate with one another. This is ap- 
parent from the fact that in conditions in which one 
side of the brain is affected, loss of power is mani- 
fested on the opposite side of the body. The decussa- 
tion takes place only between the inner fibers of the 
pyramids, and also from the lateral columns of the cord. 
The olivary bodies are situated on the outer side 
of the pyramids. The restiform bodies are on the 
outer side of and behind the olivary bodies. They 
diverge from each other and pass into the cerebellum. 
The Arterial Supply to the Brain.-As was 
stated in a previous chapter, the circle of Willis -is 
formed by the union of the internal carotid and the 
two vertebral arteries. 
The internal carotid artery enters the skull through 
a canal in the petrous portion of the temporal bone ; 
it becomes very tortuous, and passes by the side of 
the sphenoid bone, giving off the ophthalmic artery. 
It divides into the anterior and middle cerebral ar- 
teries, which supply the anterior and middle cerebral 
lobes of the brain. (This artery has been more fully 
considered in the chapter on the Circulatory System.) 210 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The anterior cerebral artery distributes branches 
in all directions. It runs along backward upon the 
upper surface of the brain, and curves round in the 
front of the corpus callosum. It is connected, soon 
after its origin, with the anterior of the opposite side ; 
they run close together, and at the base of the brain 
form the communicating branch. The middle cere- 
bral artery runs outward along the fissure of Sylvius, 
distributing large branches to the anterior and middle 
lobes of the brain. 
The vertebral artery, after winding backward along 
the arch of the atlas, enters the skull through the 
foramen magnum, and unites with its fellow at the 
lower border of the pons, to form the basilar artery; 
it then divides at the middle of the pons into the two 
posterior cerebral arteries, which supply the posterior 
cerebral lobes. At the pons the basilar gives off the 
auditory artery, which enters the meatus auditorius 
together with the auditory nerve. It also gives 
off the superior and inferior cerebral arteries for 
the supply of the upper and lower surface of 
the cerebellum, and eventually enters the circle of 
Willis. 
The circle of Willis provides a free supply of blood 
from the several arteries of which it is formed-the 
anterior communicating in front ; the posterior com- 
municating behind ; the former running between the 
two anterior cerebral arteries, the latter from the pos- 
terior cerebral to the carotid. The tortuosity of the 
vessels before entering the brain provides a means to 
divert the excessive force of the blood in the small 
vessels; the four vessels that enter the skull break up 
and form minute branches, and it is for this reason THE NERVOUS SYSTEM. 
211 
that congestion of the brain is relieved only with 
difficulty and recovery therefrom is slow. 
In considering the cerebral circulation, mention 
must be made of the important part played by the 
meningeal arteries. 
The meningeal arteries ramify between the dura 
mater and the skull. Their most important branch 
is the middle meningeal, a branch of the internal 
maxillary artery, which enters the skull through the 
foramen spinosum, passes through a groove in the 
sphenoid bone and anterior angle of the parietal 
bones to the top of the skull, giving off branches in 
every direction. The arteries are accompanied with 
the contingent veins. The other branches are of 
small moment-the anterior is given off from the 
ophthalmic ; the posterior, from the occipital ; they 
enter the jugular foramen. 
The sinuses of the brain are venous channels ; 
they run in pairs and as single sinuses ; there are five 
pairs and five single sinuses. It is a peculiarity of 
the cerebral circulation that the venous blood is re- 
turned through these canals or sinuses. 
The cerebral sinuses are formed by a separation of 
the dura mater into layers and are unyielding struct- 
ure. They are lined by the same smooth membrane 
that lines the veins. 
As has been said, there are fifteen sinuses; their names 
are given below, and their arrangement may be studied. 
Lateral (2). 
Superior petrosal (2). 
Inferior petrosal (2). 
Cavernous (2). 
Occipital (2). 
Circular. 
Superior longitudinal. 
Inferior longitudinal. 
Transverse. 
Straight. 212 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
All these eventually discharge their blood into the 
internal jugular veins. 
The spinal system of veins is considered together 
with the sinuses, as there is an extensive communica- 
tion of vessels along the spinal column, their struct- 
ure resembling that of a ladder ; these all discharge 
through the intervertebral foramina into the several 
regions of the spine as follows: In the cervical re- 
gion, into the vertebral veins ; in the dorsal region, 
into the intercostal veins ; in the lumbar region, 
into the lumbar veins. These veins are not pro- 
vided with valves, which accounts for the serious 
conditions that result from injuries and inflam- 
mation. of the spine. 
THE SPINAL CORD. 
The spinal cord does not occupy the whole area of 
the spinal canal; the space is filled up with a reddish, 
fatty substance and with the associated ramification 
of veins. 
The Membranes of the Cord.-The dura mater 
does not adhere to the vertebra, therefore it is not 
called the internal periosteum, as in the skull; if this 
were the case, the adhesions would interfere with the 
movements of the vertebra upon each other. The 
dura mater sends off branches over each of the spinal 
nerves. The arachnoid membrane is continuous with 
that of the brain. Its spaces contain a watery fluid 
in which the cord may float. 
The pia mater immediately invests the cord, and 
serves to support it ; it plays a different role here, 
therefore, than it does in the brain. It is less vascular 
and more fibrous in structure than the pia mater of THE NERVOUS SYSTEM. 
213 
Fig. ioi.-Spinal cord, cervical region (diagrammatic), showing secondary 
tracts of white matter, the dark area representing descending fibers, dotted 
area ascending fibers, cross-lined area mixed fibers, and clear area gray mat- 
ter : Z./., Direct pyramidal tract; ag.b., anterior ground-bundle ; d.c., direct 
cerebellar tract; a.a.l., ascending anterolateral or Gowers' tract; c.p., crossed 
pyramidal tract; d.a.l., descending anterolateral tract; m.l., mixed lateral 
tract; g, column of Goll; b, column of Burdach (Leroy). 
Fig. io2.-Lumbar section of spinal cord, showing main tracts of white 
substance and location of principal groups of nerve cells in gray matter: a, 
Anterior median fissure ; b, posterior median fissure; c, anterior horn of 
gray matter ; d, posterior horn of gray matter ; e, central canal; f anterior 
white commissure ; g, posterior white commissure; h, i, anterior and pos- 
terior gray commissures ; j, anterior median column ; K, lateral column ; 
L, posterior column ; m, column of Clarke ; n, inner group of nerve cells ; 
o, anterior group ; /, anterolateral group ; q, posterolateral group ; r, lateral 
horn (Leroy). 214 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
the brain. It is closely adherent to the cord, forming 
what is called the neitrilemma. The pia mater sends 
off ligaments from each side to steady the spinal cord ; 
these are called the ligamenta dentata; they are eight- 
een to twenty in number on each side, and lie between 
the anterior and posterior roots of the spinal nerves. 
The spinal cord proper is that part of the cere- 
brospinal axis contained in the vertebral canal. It is 
a continuation of the medulla oblongata, which runs 
to the upper border of the first or the second lumbar 
vertebra, and which, as has been said before, it di- 
vides into a bundle of nerves called the cauda equina; 
these supply the lower limbs. 
The cord is cylindric in form, and slightly flattened 
in front as well as behind. On its anterior and poste- 
rior surfaces it presents fissures ; laterally it is provided 
with two grooves on each side, from which the spinal 
nerves emerge. It is divided into three columns-an- 
terior, posterior, and lateral ; the fibers of the anterior 
are motor, the posterior sensitive, while those of the 
lateral are of both varieties. 
In making a transverse section of the cord it will 
be observed (see Fig. 102) that the interior contains 
gray matter, which resembles two crescents placed one 
in each half, and connected across the center by a 
band called the gray commissure. Bach crescentic 
mass has an anterior and a posterior horn. The pos- 
terior horns are long and narrow, and are connected 
with the posterior roots of the spinal nerves. The 
anterior horns are shorter and thicker, and are di- 
rected forward toward the anterior roots of the nerves, 
but do not reach the surface. 
The spinal nerves will be considered further on. THE NERVOUS SYSTEM. 
215 
THE NERVES OF THE GENERAL SYSTEM. 
We will now discuss the several nerves that control 
the general system. Of these, the first to be consid- 
ered are the cranial. 
The Cranial Nerves.-The first, or olfactory, 
is the nerve of smell. It arises from the olfactory 
bulb and terminates in the olfactory tract ; it has 
three roots-inner, middle, and outer. The inner 
pierces the mucous membrane of the nose ; the mid- 
dle supplies the roof of the nose ; the outer supplies 
the turbinated bones. The common sensibility of the 
mucous membrane of the nose is derived from the 
fifth nerve. 
The second, or optic, nerve is the nerve of sight. 
It arises from the corpora quadrigemina and optic 
thalami. It rests on the sphenoid bone, then passes 
through the optic foramen, and terminates in the 
retina. This nerve decussates at the middle of the 
commissure, a fact for which there seems to be no 
definite reason. 
The third pair, or the motor oculi, arise from the 
pons ; it passes through the sphenoid fissure and sup- 
plies all the muscles of the eye, except the superior 
oblique and the external rectus. 
The fourth nerve, or pathetic, arises from the valve 
of Vieussens, enters the orbit through the sphenoid 
fissure, and supplies the superior oblique muscle of 
the eye. 
The fifth nerve, called the trifacial, is the great 
nerve of the head and face. It is considered a nerve 
of general sensation and motion, and perhaps also of 
the sense of taste. It arises by two roots from the 216 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
floor of the fourth ventricle of the brain. It furnishes 
one of the most important ganglia of the head-the 
Gasserian. This nerve gives off three branches-the 
ophthalmic division of the fifth, the superior maxil- 
lary, and the inferior maxillary (see Fig. 103). 
The ophthalmic division again divides, giving off 
the frontal, the lacrimal, and the nasal branches. The 
ophthalmic is a sensory nerve, and supplies the eye- 
ball, ciliary muscles, iris, lacrimal gland, nasal and 
ocular mucous membrane, skin, and the muscles of 
the eyebrow, forehead, and nose. 
The superior maxillary is also a sensory nerve, and 
is distributed to the temple, cheek, lower eyelid, nose, 
upper lip, teeth, and, by Meckel's ganglion, connected 
with this nerve, the palate and pharynx. This 
branch divides again into the several nerves that supply 
the various parts, as follows : Superior dental, infra- 
orbital, meningeal, two sphenopalatine, and orbital. 
The superior dental divides into the anterior, middle, 
and posterior dental. The infra-orbital divides into 
the palpebral, nasal, and labial. 
The inferior maxillary division of the fifth nerve is 
subdivided into the meningeal, masseteric, three tem- 
poral, buccal, two pterygoids, lingual, auriculoteni- 
poral, and inferior dental, which last subdivides 
into the dental, mylohyoid, incisive, and mental. 
The inferior maxillary is a nerve of common sensa- 
tion and motion. It supplies the muscles of mas- 
tication, gums, temples, external ear, teeth, lower 
lip, tongue, maxillary ganglia, and lower part of 
the face. 
The sixth nerve, or the abducens, arises from the 
medulla oblongata close to the pons, passes through THE NERVOUS SYSTEM. 
217 
the sphenoid fissure, and supplies the external rectus 
of the eye. 
Fig. 103.-Superficial distribution of facial, trigeminal, and other nerves 
of head: I, Trunk of facial nerve after its exit from stylomastoid foramen ; 
2, posterior auricular branch ; 3, filament of great auricular nerve ; 4, occip- 
ital branch; 5, auricular branch ; 6, twig to superior auricular muscle; 7, 
nerve to digastric; 8, that to stylohyoid muscle; 9, superior or temporo- 
facial division of the nerve; 10, 11, temporal branches ; 12, malar; 13, 14, 
infra-orbital; 15, inferior or cervicofacial division of nerve ; 16, mandibular, 
and above this buccal branches; 17, cervical branch; 18, auriculotemporal 
uniting with facial, giving anterior auricular and parotid branches; 19, 20, 
supra-orbital; 21, lacrimal; 22, infratrochlear ; 23, malar twig of the temporo- 
malar , 24, superficial branch of nasal; 25, infra-orbital; 26, buccal; 27, 
mental; 28, great occipital; 29, great auricular; 30, 31, small occipital; 32, 
superficial cervical. 
The seventh nerve takes the name of facial; it 
makes two divisions-the portio dura and portio 
mollis, or auditory nerve. It is the motor nerve of 218 
ANA TOM Y AND PHYSIOL OGY FOR NURSES. 
the muscles of the face. It takes its origin in the 
pons Varolii and lateral columns of the medulla, and 
has its deep origin in the floor of the fourth ventricle. 
Its branches are the tympanic, chorda tympani, pos- 
terior auricular, digastric, stylohyoid, temporofacial 
(which subdivides into temporal, malar, infra-orbital), 
cervicofacial (which subdivides into buccal, supra- 
maxillary, and inframaxillary). The facial communi- 
cates with the auditory nerve ; with Meckel's gan- 
glion by the large petrosal; with the optic ganglion 
by the small petrosal ; with the sympathetic on the 
middle meningeal by the external petrosal nerve ; 
with the pneumogastric, glossopharyngeal, carotid 
plexus, auricularis magnus, auriculotemporal, and 
with the three divisions of the fifth nerve. The im- 
portance of this nerve is apparent from its many com- 
munications, and it can readily be seen that injury to 
a part will interfere with the several relations of this 
nerve structure. 
The eighth, or auditory, sometimes called the portio 
mollis, is the nerve of hearing. It begins by two roots, 
arising from the olivary bodies ; it is distributed to 
the internal ear by two branches-the vestibular, to 
the vestibule, and the cochlear, to the cochlea. 
The ninth, or glossopharyngeal, is a nerve of com- 
mon sensation and taste. It arises from the medulla 
oblongata, behind the olivary bodies, the deeper origin 
being from the floor of the fourth ventricle. This 
nerve emerges through the jugular foramen, and gives 
off two ganglia-the jugular and petrosal. It is dis- 
tributed to the muscles of the pharynx, mucous mem- 
branes of the pharynx, fauces, tonsils, tongue, and 
middle ear ; for that purpose it gives off the following THE NERVOUS SYSTEM. 
219 
Fig. 104.-Distribution and connection of pneumogastric nerve of left 
side in neck and upper part of thorax : i, Pneumogastric nerve; 2, gan- 
glion of its trunk ; 3, accessory part of spinal accessory ; 4, union of pneumo- 
gastric with hypoglossal; 5, pharyngeal branch of pneumogastric ; 6, supe- 
rior laryngeal; 7, external laryngeal; 8, communication of external laryn- 
geal with superior cardiac branch of sympathetic ; 9, inferior or recurrent 
laryngeal; 10, superior, and 11, inferior, cervical cardiac branches; 12, 13, 
posterior pulmonary plexus; 14, lingual branch of inferior maxillary; 15, 
distal part of hypoglossal nerve; 16, glossopharyngeal nerve; 17, spinal 
accessory nerve ; 18, second cervical nerve ; 19, third ; 20, fourth ; 21, origin 
of phrenic nerve; 22,23, fifth, sixth, seventh, and eighth cervical nerves, 
forming with the first dorsal the brachial plexus; 24, superior cervical gan- 
glion of sympathetic ; 25, middle cervical ganglion ; 26, inferior cervical gan- 
glion ; 27, 28, 29, 30, second, third, fourth, and fifth dorsal ganglia. 
branches, which are distributed to the various parts 
indicated by their names : Tympanic, carotid, phar- 
yngeal, muscular, tonsillar, and lingual. 
The tenth, the pneumogastric, called the vagus 220 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
nerve, lias many points of interest; it gives off a 
great many nerves to important structures, and is 
both motor and sensory. It arises from the floor of 
the fourth ventricle, passes through the jugular fora- 
men, and presents two ganglia. It is distributed to 
the vocal cords, lungs, pharynx, esophagus, stomach, 
and heart. It gives off the following branches : Men- 
ingeal, auricular, pharyngeal, superior laryngeal, re- 
current laryngeal, cervical cardiac, thoracic cardiac, 
anterior pulmonary, posterior pulmonary, esophageal, 
gastric, and abdominal plexuses (see Fig. 104). 
The eleventh, or spinal accessory, is a motor nerve, 
having its origin in the medulla oblongata, and 
making its exit through the foramen magnum ; it is 
distributed to the muscles of the neck, pharynx, and 
palate, and is said to be a constrictor nerve of the 
heart. 
The twelfth, or hypoglossal, is a motor nerve that 
supplies the tongue. It arises from the floor of the 
fourth ventricle, and makes its exit through the con- 
dyloid foramen. It gives off the meningeal, mus- 
cular, and vascular branches. It supplies the tongue 
and the internal muscles of the throat, and communi- 
cates with the second and third cervical and sym- 
pathetic nerves. 
The spinal nerves arise from the spinal cord. 
There are 31 pairs of these nerves-8 cervical, 12 
dorsal, 5 lumbar, 5 sacral, 1 coccygeal. The function 
of these nerves has already been described. The fol- 
lowing notes are taken from the researches of Blandin.1 
He says, regarding the relative size of the anterior 
and posterior roots of the several regions of the spine : 
1 Anat, descript., 1838, t. ii., p. 648. THE NERVOUS SYSTEM. 
221 
The posterior roots are to the anterior in the cervical region . . .2 : 1 
The posterior roots are to the anterior in the dorsal region . . . 1 :1 
The posterior roots are to the anterior in the lumbar and 
sacral regions 1 1 : 1 
This writer states further that this relation quite 
accords with the great delicacy of the sense of touch 
in the upper extremities. 
Each spinal nerve, as has been stated, arises by two 
roots-an anterior or motor root, and a posterior or 
sensory root. We will now consider the several spinal 
nerves individually. 
The brachial plexus, sometimes called the axillary, 
is made up of the four lower cervical and first dorsal 
nerves. 
The nerves forming the plexus communicate as 
follows: The fifth and sixth nerves unite near their 
exit from the spine into a common trunk ; the seventh 
nerve joins this trunk near the outer border of the mid- 
dle scalenus muscle, and the three nerves thus form 
one large single cord. The eighth cervical and the first 
dorsal nerves form a common trunk. Thus two large 
trunks are formed, the upper one by the union of the 
fifth, sixth, and seventh cervicals ; and the lower by 
the eighth cervical and the first dorsal. These two 
trunks accompany the subclavian artery to the axilla, 
lying upon the outer side, the trunk formed by the 
union of the last cervical and the first dorsal being 
nearest the vessel. Opposite the clavicle, and some- 
times in the axilla, each of these cords gives off a fas- 
ciculus, which, uniting, form a third trunk, so that in 
the center of the axilla three cords are formed. The 
brachial plexus communicates with the cervical plexus 
by a branch from the fourth to the fifth nerve, and 222 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
with the phrenic by a branch from the fifth cervical, 
which join that nerve on the scalenus muscle. It is 
through this latter addition that in cardiac pains the 
sensation is felt in the elbow, as many complain. 
These are placed one on the inner side of the axillary 
artery, one behind, and the other on the outer side ; 
still farther down it gives off another branch, which 
unites in front of the artery. 
The plexus is broad, becoming narrower as it passes 
down the arm, but at the axilla, where it divides into 
terminal branches, it is larger. This plexus commu- 
nicates with the cervical plexus by a branch from the 
fourth nerve, and also receives branches from the two 
inferior cervical ganglia of the sympathetic. x4t the 
neck it gives off the following branches, which are 
distributed to the several regions that each name 
designates : 
Thoracic region. 
Scapular region. 
Anterior thoracic. 
Posterior thoracic. 
Superior muscular. 
Suprascapular. 
Subscapular. 
Brachial region. 
Musculocutaneous. 
Median. 
Internal cutaneous. 
Ulnar. 
Lesser internal cutaneous. 
Musculospiral. 
Circumflex. 
The Dorsal Nerves.-These are twelve in number, 
and correspond to the dorsal vertebrae ; they supply 
the several muscles of the chest and side. 
The intercostals are formed from the dorsal and 
supply the intercostal spaces, pleura, mammary ves- 
sels, the muscles of the chest and side of the throat; THE NERVOUS SYSTEM. 
223 
the six lower supply the internal oblique and trans- 
versalis muscles, and continue to the sheath of the 
rectus ; after supplying this muscle they go on to the 
linea alba, and, diverging, form the anterior cutaneous 
nerves-of the abdomen. 
The lumbar nerves are five in number on each side. 
The anterior branches of the four upper nerves anas- 
tomose to form the lumbar plexus. The plexus sends 
off the following branches : 
The Iliohypogastric Branch.-This proceeds from 
the first lumbar nerve, and supplies the muscles of 
the hip and abdomen ; it is distributed to the iliac 
region from the iliac branch; to the internal abdom- 
inal ring from the hypogastric branch. 
The ilio-inguinal nerve arises from the first lumbar, 
and supplies the external abdominal ring, the puden- 
dum, spermatic cord, scrotum, and the integument 
of the upper thigh. 
The genitocritral nerve arises from the second 
lumbar, enters the muscles of the anterior part of the 
thigh and descends to near Poupart's ligament, where 
it divides into the genital and crural branches. The 
genital gives off branches to the internal abdominal 
ring and genital organs of the female ; at the internal 
abdominal ring it sends off branches to the internal 
oblique and transversalis muscles, and is lost in the 
integument of the groin. The crural branch, the 
most external, descends along the outer border of 
the external iliac artery, and enters the sheath of the 
femoral artery ; it is distributed to the upper as well 
as the anterior aspect of the thigh, communicating 
with the middle cutaneous nerve. 
The external cutaneozcs nerve arises from the second 224 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
lumbar nerve, or from a loop between it and the 
third ; it passes into the thigh, beneath Poupart's 
ligament, where it divides into two branches-the 
posterior and the anterior, the posterior furnishing 
branches to the tensor vaginae femoris muscle and 
posterior part of the thigh ; the anterior divides into 
several branches, which are distributed to the outer 
border of the thigh and knee. 
The obtzirator is formed from the third and fourth 
lumbar nerves. It makes a distribution to the ob- 
turator muscles, femoral and popliteal arteries, knee- 
joint, hip, and integuments of the upper and inner 
part of the thigh. At its origin it courses along the 
common iliac until it reaches the pelvic brim, where 
it passes through the obturator foramen and joins, in 
its course, the obturator artery ; having escaped from 
the pelvis, it divides into anterior, posterior, and acces- 
sory branches, which supply the several muscular 
structures of the lower extremity. 
The anterior crural nerve, sometimes called the 
femoral nerve, is the largest branch of the lumbar 
plexus ; it is formed by the union of the second, 
third, and fourth lumbar nerves. It is distributed to 
the several muscles of the thigh ; at Poupart's liga- 
ment it separates and is divided into an anterior and a 
posterior part, which give off the following branches, 
which supply the structures their names imply. An- 
terior division : Middle cutaneous, internal cutaneous, 
long saphenous. Posterior division: Muscular and 
articular. 
The sacral nerves are five in number on each 
side ; they pass through the sacral foramina, the last 
one running between the coccyx and sacrum ; their THE NERVOUS SYSTEM. 
225 
function is to supply nerve force to the internal in- 
tegument of the pelvis, as well as to the several 
organs. The coccygeal nerve supplies the coc- 
cygeus muscle and unites with the fifth sacral. 
All the anterior cords of the sacral nerves commu- 
nicate with the sympathetic at the point where it 
leaves the sacral canal. 
The sacral plexus of nerves is composed of the 
lumbosacral and the anterior branches of the three 
upper and fourth sacral nerves ; it gives off the fol- 
lowing branches : Visceral, muscular, superior gluteal, 
pudic, small sciatic, and great sciatic. 
The great sciatic supplies the several muscles of 
the posterior part of the leg, the internal and external 
organs of generation, as well as the several vessels of 
the leg. This is an important nerve structure which 
in its division supplies important structures. 
The internal popliteal nerve is a branch from the 
great sciatic. This nerve with its branches supplies 
the posterior part of the lower leg. The internal and 
external plantar supply the foot. 
The external popliteal is smaller than the internal; 
it supplies the posterior muscles of the leg, and 
divides into two branches-the anterior tibial and 
musculocutaneous. The anterior tibial supplies the 
tibial artery and the several muscles of the anterior 
part of the leg, and furnishes branches to the foot 
and the articulation of the tarsus and metatarsus. The 
musculocutaneous nerve passes down along the fibula, 
supplying the peroneous and extensor muscles of the 
foot; the internal branch supplies the adjacent parts 
of the foot and toes; the external supplies the toes 
and communicates with the external saphenous nerve. 226 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
THE GREAT SYMPATHETIC NERVE. 
This nerve is divided into two portions : the verte- 
bral and the pre vertebral. 
The vertebral portion is divided into ganglia, 
Fig. 105.-Diagrammatic view 
of the sympathetic cord of the 
right side, showing its connec- 
tions with the principal cerebro- 
spinal nerves and the main pre- 
aortic plexuses. (Reduced from 
Quain's Anatomy.) 
Cerebrospinal Nerves: VI, A 
portion of the sixth cranial as it 
passes through the cavernous 
sinus, receiving two twigs from 
the carotid plexus of the sym- 
pathetic nerve; O, ophthalmic 
ganglion connected by a twig with 
the carotid plexus ; M, connection 
of the sphenopalatine ganglion 
by the Vidian nerve with the 
carotid plexus; C, cervical plexus; 
Br, brachial plexus ; D 6, sixth 
intercostal nerve ; D 12, twelfth ; 
L 3, third lumbar nerve ; 6' 1, first 
sacral nerve ; ^3, third ; 5 5, fifth ; 
Cr, anterior crural nerve; Cr, 
great sciatic: Pn, vagus in the 
lower part of the neck ; r, recur- 
rent nerve winding round the sub- 
clavian artery. 
Sympathetic Cord: c, Superior 
cervical ganglion; c', second or 
middle; c", inferior; from each 
of these ganglia cardiac nerves 
(all deep on this side) are seen 
descending to the cardiac plexus ; 
di, placed immediately below the 
first dorsal sympathetic ganglion ; 
d 6 is opposite the sixth ; 11, first 
lumbar ganglion ; eg, the termi- 
nal or coccygeal ganglion. 
Preaortic and Visceral Plex- 
uses: pp, pharyngeal, and, lower 
down, laryngeal plexus ; pl, pos- 
terior pulmonary plexus spreading 
from the vagus on the back of the 
right bronchus ; ca, on the aorta, 
the cardiac plexus, toward which, 
in addition to the cardiac nerve 
from the three cervical sympa- 
thetic ganglia, other branches are THE NERVOUS SYSTEM. 
227 
which unite and form a cord running longitudinally ; 
it passes alongside the vertebral column from the 
head to the coccyx, communicates with the spinal 
and cranial nerves, and distributes branches to the 
internal organs and viscera. 
The prevertebral portion also comprises a number 
of ganglia that form plexuses in the head, chest, ab- 
domen, and pelvis. 
The sympathetic nerve, as has been previously 
stated, communicates with the cerebrospinal nerves 
immediately at their exit from the cranium and ver- 
tebral canal (Fig. 105). 
The branches accompany the arteries that supply 
the several organs, and form plexuses that surround 
the blood-vessels ; they take the name of the artery 
they accompany. All the parts of the head, neck, 
and trunk are supplied, some of them exclusively, by 
seen descending from the vagus and recurrent nerves; co, right, or posterior, 
and co', left, or anterior, coronary plexus; o, esophageal plexus in long 
meshes on the gullet; sp, great splanchnic nerve formed by branches from the 
fifth, sixth, seventh, eighth, and ninth dorsal ganglia; +, small splanchnic 
from the ninth and tenth ; + -|-, smallest, or third, splanchnic from the elev- 
enth ; the first and second of these are shown joining the solar plexus, so ; the 
third descending to the renal plexus, re ; connecting branches between the 
solar plexus and the vagi are also represented-pn', above the place where 
the right vagus passes to the lower or posterior surface of the stomach ; pn", 
the left distributed on the anterior or upper surface of the cardiac portion 
of the organ : from the solar plexus large branches are seen surrounding 
the arteries of the celiac axis, and descending to ms, the superior mesenteric 
plexus; opposite this is an indication of the suprarenal plexus; below re 
(the renal plexus) the spermatic plexus is also indicated ; ao, on the front of 
the aorta, marks the aortic plexus, formed by nerves descending from the 
solar and superior mesenteric plexuses and from the lumbar ganglia; mi, the 
inferior mesenteric plexus surrounding the corresponding artery ; hy, hypo- 
gastric plexus placed between the common iliac vessels, connected above with 
the aortic plexus, receiving nerves from the lower lumbar ganglia, and dividing 
below into the right and left pelvic or inferior hypogastric plexuses ; pl, the 
right pelvic plexus ; from this the nerves descending are joined by those from 
the plexus on the superior hemorrhoidal vessels, mi', by nerves from the 
sacral ganglia, and by visceral nerves from the third and fourth sacral spinal 
nerves, and there are thus formed the rectal, vesical, and other plexuses, 
which ramify upon the viscera, as toward ir, and v, the rectum and bladder. 228 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
branches from the sympathetic ; therefore it has been 
called the nerve of " organic life." Since it contains 
so great a number of ganglia, which is evinced from 
the disposition it has to communicate with others in 
its distribution, it has also been termed ganglionic 
nerve. Its functions has been previously described. 
The Ganglia.-There are four ganglia in the 
head: the ophthalmic, sphenopalatine (Meckel's), 
otic or Arnold's, and the submaxillary ; three in the 
neck: superior, middle, and inferior cervicals; twelve 
in the dorsal region ; four in the lumbar region; and 
four in the sacral region. 
Each ganglion is considered a distinct center, re- 
ceiving and giving branches in four different direc- 
tions-viz., superior, or ascending, to communicate 
with the ganglion above; inferior, or descending, to 
communicate with the ganglion below ; external, to 
communicate with the spinal nerves; and internal, to 
communicate with the sympathetic filaments of the 
opposite side and become distributed to the viscera. 
Fig. 105 illustrates the several portions of the sym- 
pathetic nerve. As has been said, this nerve is one 
of organic life, for there is no organ in the whole 
body but becomes affected when the function of this 
nerve is disturbed ; from this it may be seen how 
sympathy exists between the several structures ; 
this has already been dealt with in another part 
of this chapter. 
REVIEW QUESTIONS. 
What constitutes the nervous system ? 
What is the brain, and of how many parts does it consist? 
What is the average weight of the brain ? 
What membranes surround the brain? Name them. THE NERVOUS SYSTEM. 
229 
Describe the several membranes of the brain. 
What part of the brain does the cerebrum form ? 
What important connection has the arachnoid membrane ? 
What is the relation of the pia mater ? 
Give the relations of the corpus callosum. 
Where is the cerebellum located ? 
How does the medulla oblongata vary as to sensitiveness from the 
cerebrum ? 
Through what foramen does the spinal cord pass ? 
What is the average length of the spinal cord ? 
How is the spinal cord divided ? 
What is the circle of Willis ? 
What are sinuses, and what are their functions? 
How many pairs of nerves are there? 
How many pairs originate from the cranial region ? 
How many pairs originate from the spinal cord ? 
How many roots do the spinal nerves contain? 
What is considered the center of the nervous system ? 
What is the function of the cerebrum? of the cerebellum? 
What important relation has the medulla oblongata ? 
What are the functions of the spinal nerves ? 
Into how many groups are nerves divided ? 
What are the nerves of special sensation ? 
What are the nerves of general sensation ? 
What are the nerves of motion ? 
What nerves are involved in respiration ? 
What is the sympathetic nerve ? What does it maintain ? 
What are ganglia ? 
How is the fifth cranial nerve divided ? 
What is the nerve of smell ? Of sight ? Of taste ? 
What is the auditory nerve as to function ? 
Give the function of the glossopharyngeal nerve. 
What is the tenth nerve called ? 
What is the brachial plexus? How constructed? 
What is the function of the intercostal nerves? 
What do the lumbar nerves form ? 
What parts do the sacral nerves supply with action ? 
What is the efferent nerve ? Afferent ? CHAPTER VIII. 
The glands are secretory bodies of very diverse 
character and location. Some of them, as the liver 
and kidneys, are large, while others, as some of the 
conglobate or lymphatic glands, are quite small. The 
mucous membranes that line the glands also perform 
the function of secretion, for they secrete the mucus 
in which they abound, as is seen in the mouth, nos- 
trils, throughout the alimentary canal, and in the 
urinary organs. We will consider the above and 
some of the soft bulbous organs that perform the 
function of secretion. 
THE GLANDULAR SYSTEM. 
THE LYMPHATIC GLANDS. 
The lymphatic glands, or ganglia, as they are often 
denominated, are found distributed over all the body, 
Fig. 106.-Central (superficial) lymphatic glands of the axilla (after Leaf). 
■ 
230 THE GLANDULAR SYSTEM. 
231 
and consist of numerous small globular bodies con- 
nected with the lymphatic vessels. 
The lymphatic glands are most commonly called 
conglobate glands. They have no excretory duct ex- 
cept the continuation of the lymphatic vessels. The 
largest of the conglobate glands are the mesenteric, 
inguinal, and axillary glands. These glands are not 
Fig. 107.-Lymphatic glands of the head and neck (after Leaf). 
believed to secrete material into the lymphatic sys- 
tem, but simply to alter the character of the fluid pass- 
ing through them. In this sense they are considered 
the outguards of the body, defending it against in- 
jurious substances that are carried into the lym- 
phatics. When poison or any irritating substance is 
forced into the system, as into the extremities, these 232 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
glands, situated between the point of insertion of the 
poison and the body, become swollen and inflamed, 
and absorb the foreign substance into their cells and 
Fig. 108.-Diagram of a lymphatic gland, showing afferent (a. I.) and 
efferent (e. I.) lymphatic vessels; cortical substance (C); medullary sub- 
stance (M); fibrous coat (t); sending trabeculae (tr) into the substance of 
the gland, where they branch, and in the medullary part form a reticulum ; 
the trabeculae are surrounded by the lymph-path or sinus (Z. s), which sepa- 
rates them from the adenoid tissue (Z. h) (Sharpey). 
retain and neutralize it ; or, by softening and suppu- 
ration, they "break out," and thus, by a discharge, 
they expel the offensive material. 
THE LIVER. 
The liver occupies part of the right hypochondriac 
and part of the epigastric region, immediately below THE GLANDULAR SYSTEM. 
233 
the diaphragm. It is the largest gland in the body, 
and weighs about four and one-half pounds. It is 
lobular in form, consisting mainly of two large and 
two smaller lobes. The gall-bladder and its ducts are 
situated in the sinus of the liver, on its under surface. 
This organ will be described further on. 
Function of the Ijver.-Its chief function is to 
secrete bile, a necessary agent in the process of diges- 
tion. It also forms glycogen, assists in the formation 
Fig. 109.-Posterior and inferior surfaces of the liver (Nancrede). 
of urea and allied products, and modifies the blood as 
it passes through it. 
Bile is both a secretion and an excretion ; it con- 
tains but few constituents other than those that are 
formed in the liver, and, as has been said, it is des- 
tined to play an important part in the process of nu- 
trition. The other secretions of the liver are waste- 
products that are associated with the bile. 
The color of the liver is different from that of all 
the other glands. It is dark brown, and sometimes 
stained yellow with bile. 
Blood-supply.-The liver is abundantly supplied 234 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
with blood, and it is thought that the blood is modi- 
fied very materially in its passage through this gland, 
being decarbonized and purified by it. 
Fig. no.-Section through liver of pig, showing chains of liver-cells; X 7° 
(Bohm and Davidoff). 
The blood-vessels that enter the liver are the portal 
vein, made up of the gastric, splenic, superior and in- 
ferior mesenteric veins. The hepatic artery supplies 
the required amount of blood to the structure ; the 
hepatic veins, originating in the interior, collect all 
the blood distributed by the portal vein and hepatic 
artery and conduct it to the ascending vena cava. 
THE GALL-BLADDER. 
The gall-bladder is a pear-shaped sac, about four 
inches in length, situated in the sinus of the liver. 
It is a reservoir for the bile, and is capable of hold- THE GLANDULAR SYSTEM. 
235 
Fig. hi.-Diagram of a segment of a hepatic lobule: i, i, Interlobular 
portal vein ; 2, central vein ; 3, 3, intralobular capillaries ; 4, 4, interlobular 
hepatic artery; 5, 5, ramifications of hepatic artery, contributing to the 
formation of the intralobular capillaries; 6, 6, interlobular bile-duct; 7, 7, 
its ramifications in the lobule, forming a plexus of intercellular canaliculi; 
8, 8, section of biliary canaliculi with their intercellular capillaries; 9, 9, 
hepatic cells; 10, 10, interlobular lymphatics, receiving the intralobular 
lymphatics; 11, 11, 12, intralobular connective tissue (Testut). 
ing about one and one-half ounces of fluid. It is 
made up of three coats-a serous, a fibrous, and a 
mucous. 236 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
THE SPLEEN. 
The spleen is an oblong gland situated in the left 
hypochondriac region, immediately below the dia- 
phragm. It is of a spongy texture and of a reddish 
Fig. 112.-Portion of gall-bladder and bile-ducts: i, Cavity of gall- 
bladder ; a, cavity of calyx; 3, groove separating the calyx from the blad- 
der ; 4, promontory; 5, superior valve of calyx ; 6, cystic canal; 7, common 
bile-duct; 8, hepatic duct (Testut). 
or violet color. It is about five inches in length, six 
ounces in weight. 
Function of the Spleen.-The spleen is probably 
concerned in the preparation of albuminous food for 
nutrition. During digestion the spleen becomes 
larger and its contents are increased in amount; after 
digestion it gradually diminishes in size, returning to 
its normal condition. THE GLANDULAR SYSTEM. 
237 
It is probably in this organ that the red corpuscles, 
after having fulfilled their function in the blood, are 
disintegrated, for the splenic venous blood contains 
Fig. 113.-Part of a section through the human spleen : X 75 (sublimate 
fixation). At a is an oblong Malpighian body with a blood-vessel (Bohm 
and Davidoff). 
relatively a small number of them. The white cor- 
puscles, however, appear to be increased in number, 
for the blood of the splenic vein contains an unusually 
large proportion. The spleen serves also as a reser- 238 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
voir for the blood when the portal circulation becomes 
obstructed. 
Certain it is that this gland, like the conglobate 
glands, under some forms of disease (for instance, those 
that result from contagions, particularly miasma) be- 
comes inflamed and often indurated and swollen, thus 
exhibiting its office in modifying the character of 
some of the materials of the blood. 
THE PANCREAS. 
The pancreas is an oblong, soft, glandular body, 
situated transversely across the posterior wall of the 
Fig. 114.-Pancreas dissected to show (tZ./.) pancreatic duct; d. p.a, 
accessory duct; d. ch, bile-duct. Duodenum laid open to show (/. m.) 
papilla major; /. I, papilla minor; spl., spleen; k, kidney; / jejunum; m. 
v, mesenteric vessels; c. a, celiac axis (Robson and Moynihan). 
abdomen, in the left hypochondriac region, jnst be- 
hind the stomach. It is about six inches long, and 
weighs about four ounces. Its office is to secrete the 
pancreatic juice, which performs a part in the 
digestive process. The function of the pancreatic 
juice is to convert starch into maltose and albumin- THE GLANDULAR SYSTEM. 
239 
oids into peptones ; it also affects the emulsification 
of fats. 
Fig. ng.-Excretory ducts of the pancreas: A, Pancreas, with a, its 
head; B, duodenum; C, jejunum; D, gall-bladder. 1, main pancreatic 
duct of Wirsung; 2, accessory duct with 2', its opening upon the postero- 
internal wall of the duodenum; 3, ampulla of Vater; 4, common bile-duct; 
5, cystic duct; 6, hepatic duct; 7, aorta; 8, superior mesenteric vessels; 9, 
celiac axis with its three branches (Testut). 
These are situated in front of the lower portion of 
the ear, just above the angle of the jaw, one on each 
side. They are small, soft bodies, and their office is 
to secrete the saliva, which affords the necessary 
moisture to the mouth and the requisite fluid for the 
THE PAROTID GLANDS. 240 
ANATOMY AND PHYSIOLOGY FOK NURSES. 
process of mastication. The saliva is also an im- 
portant agent in the function of digestion. The 
practice of diluting the food with large cpiantities of 
water while eating is injurious, for drinking at such 
Fig. 116. Dissection of the side of the face, showing the salivary glands: 
a, Sublingual gland ; b, submaxillary gland, with its duct opening on the 
floor of the mouth beneath the tongue at d; c, parotid gland and its duct, 
which opens on the inner side of the cheek (after Yeo). 
times prevents the flow of saliva into the month that 
would otherwise take place. 
The salivary duct opens into the mouth opposite 
the second molar tooth in the upper jaw. This is 
the gland that is affected in the disease known as 
mumps (parotitis). 
THE SUBMAXILLARY GLANDS. 
These glands are situated on the inner side of the 
lower jaw-one on each side of the mouth anterior 
to the angle of the jaw. Their excretory ducts open 
into the mouth on each side of the frenum, or 
"thread" (bridle), of the tongue. The fluid secreted 
by them may sometimes be seen to ooze forth when THE GLANDULAR SYSTEM. 
241 
the mouth is open, especially when the mind is allowed 
to dwell on the eating of fruits. 
THE SUBLINGUAL GLANDS. 
The sublingual glands are situated beneath the 
tongue, within the lower jaw, one on each side of 
the "thread" of the tongue. They are small, elon- 
gated bodies, and lie immediately under the mucous 
membrane of the floor of the mouth. They have a 
number of ducts or openings that freely discharge the 
fluid secretion of the glands. Their function is simi- 
lar to that of the parotid glands. 
THE THYROID GLAND. 
This is a small, flat, glandular body lying against 
the forepart of the trachea, below the thyroid carti- 
lage. It is susceptible of great enlargement, and is 
Fig. i 17.-The thyroglossal duct (Marshall). 242 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
often found abnormally enlarged, especially in women. 
This enlargement constitutes the disease called goiter, 
bronchocele, and sometimes "big neck." 
The thyroid gland, although supplied with four 
large arteries and veins and also with four nerves, has 
no excretory duct that has yet been discovered. Its 
function has never been thoroughly understood. 
THE PROSTATE GLAND. 
This is a small gland, about the size of a chestnut, 
situated in front of the neck of the bladder, behind 
the symphysis pubis, in the male, and is seen surround- 
ing the first portion of the urethra. Its excretory 
outlets, to the number of ten or more, open into the 
urethra and afford a lubricating fluid to this passage. 
THE LACRIMAL GLANDS. 
These are small glands, situated in depressions in 
the frontal bone at the upper and outer angle of the 
orbit-one in each orbit. 
The size of the lacrimal glands is about that of a 
kernel of a peach-stone. They have many excretory 
ducts, which open into the eye under the upper lid. 
Their function is to furnish moisture to the eyes ; 
these are the organs which secrete the tears. 
THE MESENTERIC GLANDS. 
These glands, which are often called mesenteric 
ganglia, are small, knot-like bodies occurring in the 
course of the chyliferous vessels in the mesentery. 
They are very numerous, but have no excretory duct. 
The lacteals, however, as stated in a previous chapter, 
pass through them. It is not known certainly to what THE GLANDULAR SYSTEM. 
243 
extent the chyle, conveyed through the glands by 
the lacteals, is modified ; and hence the office of the 
mesenteric glands is as yet but little understood. 
THE MAMMARY GLANDS. 
The mammary glands, which secrete the milk, are 
two more or less hemispheric organs, situated in the 
Fig. ii8.-Lacrimal and Meibomian glands, the latter viewed from the 
posterior surface of the eyelids (the conjunction of the upper lid has been 
partially dissected off, and is raised so as to show the Meibomian glands 
beneath) : r, Free border of upper, and 2, free border of lower lid, with 
openings of the Meibomian glands; 5, Meibomian glands exposed, and 6, 
as seen through conjunctiva; 7, 8, lacrimal gland; 9, its excretory ducts, 
with zo, their openings in the conjunctival cul-de-sac; 11, conjunctiva. 
human female on the anterior surface of the chest. 
Though rudimentary in childhood, they gradually in- 
crease in size as the female approaches puberty. 
The gland presents at its convexity a small promi- 
nence of skin, the nipple, which is surrounded by a 
circular area of pigmented skin, the areola. The 244 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
gland proper is covered anteriorly by a layer of adi- 
pose tissue, and attached posteriorly to the pectoral 
muscles by a mesh work of fibrous tissue. 
Changes in the Mammary Glands.-During 
uterogestation the mammary glands become larger, 
firmer, and more tabulated ; the areola darkens, and 
Fig. 119.-Mammary glands: 1, Lacteal ducts; 2, glandular acinus 
(after Playfair). 
the veins become more prominent. At the period of 
lactation the gland is the seat of active histologic and 
physiologic changes correlated with the production 
of milk. At the close of lactation the glands diminish 
in size, undergo involution, and gradually return to 
their original, non-secreting condition. 
Structure of the Mammary Glands.-Each gland THE GLANDULAR SYSTEM. 
245 
consists of an aggregation of some fifteen to twenty 
lobes, each of which is surrounded by a framework 
of fibrous tissue. The lobe is provided with an 
excretory duct, which, as it approaches the base of 
the nipple, expands to form a sinus or reservoir, 
beyond which it opens by a narrowed orifice on the 
surface of the nipple. On tracing the duct into the 
lobe it is found to divide and subdivide, and finally 
to terminate in lobules or acini. Bach acinus con- 
sists of a basement membrane, lined by cells, sup- 
porting blood-vessels, lymphatics, and nerves. 
THE SEBACEOUS GLANDS. 
The sebaceous glands are imbedded in the true 
skin, and consist of grape-like masses opening by a 
duct upon the surface of the epidermis or into the 
hair-follicle. They are found in almost every part 
of the body, but most abundantly upon the face. 
They secrete an oily substance, known as sebum. It 
is obstruction of these ducts that produces what are 
commonly known as "blackheads," seen so often 
upon the face. 
The deposit, so abundant upon some children at 
birth, and which consists of a white, glue-like sub- 
stance, is the residue of the sebaceous matter, and is 
known as the vernix caseosa. 
THE SUDORIPAROUS GLANDS. 
The sudoriparous glands excrete the sweat. They 
consist of minute openings, commonly called the 
pores of the skin. Their function is to extract from 
the blood the excrementitious material (this function 
has been described in a previous chapter). It is esti- 246 
ANATOMY AND 1'HYSIOLOGY LOR NURSES. 
Fig. 120.-Sebaceous glands of the face-simple pouch to compound 
lobular, with lanugo hair and small or rudimentary hair-follicle, the largest 
from the nose (Sappey). THE GLANDULAR SYSTEM. 
247 
mated that the daily excretion from these glands 
amounts to about two pounds, although it varies ac- 
cording to the nature of the food and drink taken, the 
amount of exercise, external temperature, season, etc. 
The secretion of sweat is regulated by the nervous 
system. Here, as in the secreting glands, the fluid is 
formed from material in the lymph-spaces surround- 
ing the glands. Two sets of nerves are concerned : 
J 'asomotor, regulating the blood-supply ; and secre- 
Fig. i21.-Sweat-glands of different size (of moderate magnification), 
showing coil or convolutions forming gland proper, the blind end of tubule, 
and excretory duct (Sappey). 
tory, stimulating the activities of the gland-cells. 
Generally the two conditions, increased blood-flow 
and increased glandular action, coexist. At times a 
profuse, clammy perspiration occurs with a dimin- 
ished blood-flow. 
Besides the glands already described, many others 
of minor importance occur. For a description of 
these the reader is referred to works on anatomy. 248 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
What are glands ? 
What are lymphatic glands ? Their function ? 
Which is the largest gland of the body? Where is it located? 
How many lobes are there in the liver? 
What is the function of the liver? 
What large vein enters the liver ? 
What artery supplies the structure of the liver? 
What is the average weight of the liver ? 
What is the gall-bladder? 
What is the function of the bile ? 
What is the capacity of the gall-bladder ? 
Where is the spleen situated, and what is its function? 
What is the pancreas? Its function? 
What is the function of the pancreatic juice ? 
Where are the parotid glands situated, and what is their function ? 
What disease is liable to attack them ? 
What duct is furnished from this gland, and where does it open? 
Give location of the submaxillary glands. What is their function? 
Give location of sublingual glands. 
What is the thyroid gland ? State location. 
To what disease is this gland most susceptible? 
What is the prostate gland ? 
Give the function of the lacrimal glands and state their location. 
Where do we find the mesenteric glands? What is their function? 
What are the mammary glands? Where situated? 
What are the functions of these glands? 
What changes take place in these glands ? 
Of what does the structure of the mammary glands consist? 
What are the sebaceous glands ? 
Describe the location of the sudoriparous glands. 
How is the secretion of the various glands regulated ? 
REVIEW QUESTIONS. CHAPTER IX. 
THE MEMBRANES OF THE BODY. 
The mucous membrane is the proper lining of 
the alimentary canal, the respiratory, the urinary, 
and the genital organs. It is of a glandular con- 
struction, and in some parts secretes mucus copiously. 
This membrane, like the skin, has vessels opening 
Fig. 122.-Plan of a secreting membrane (Howell). 
upon its surface, through which a large amount of 
fluid materials are removed, as is seen in diarrhea 
and dysentery. The urinary bladder, which is of a 
fibrous texture in its main construction, has a thick 
mucous membrane that protects the organ against 
irritation from the acrid substances in the urine. 
The serous membranes are found on internal 
surfaces that have no outlets, as the pleura, peri- 
toneum, pericardium, and the brain. These mem- 
branes serve to support, in their various places and 
positions, the several organs they invest. 
The pericardium forms a sac inclosing the heart; 
the peritoneum invests the contents of the abdominal 
cavity; and the pleura forms two sacs to support the 
249 250 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
lungs. The diaphragm is a seromuscular membrane. 
All but the last secrete a fluid for their lubrication. 
From the serous membranes a serous or watery 
fluid is exuded, which affords a moist and smooth 
surface for the play of the several organs upon them. 
These membranes are of a light-red color and well 
supplied with blood-vessels. In some places they are 
liable to serious inflammation, often forming attach- 
ments to other organs. 
Synovial membranes resemble the serous mem- 
branes in structure, but differ from them in the nature 
of their secretion, which in the former is thick, 
viscid, and glairy, like the white of an egg ; hence 
called ' ' synovia.'' 
Synovial membrane is a thin, delicate membrane, 
arranged in the form of a short, wide tube, attached 
by its open ends to the margins of the articular ex- 
tremities of the bones, and covering the inner surface 
of the various ligaments that connect the articulating 
surfaces. 
The synovial membranes found in the body admit 
of subdivision into three kinds-articular, bursal, 
and vaginal. The articular synovial membranes are 
found in all movable joints ; the bursce are found in- 
terposed between surfaces that move upon each other, 
producing friction, as the gliding of a tendon or of 
the integument over projecting surfaces; the vaginal 
serve to facilitate the gliding of tendons in the osseo- 
fibrous canals through which they pass, as in the hand 
and foot. 
The membranes of the brain have been described 
in the chapter on the Nervous System. THE MEMBRANES OF THE BODY. 
251 
REVIEW QUESTIONS. 
What kind of membranes have we in the body ? 
What cavities do the mucous membranes supply ? 
Name the serous membranes ? 
What are synovial membranes ? Note the varieties. 
What membrane lines the heart? 
What membrane surrounds the lungs? 
What is the function of the serous membranes? 
Name those of the brain. CHAPTER X. 
THE ORGANS OF SPECIAL SENSE, 
THE ORGANS OF SIGHT. 
The eyes are two globular bodies, situated in the 
orbits of the face, and are the organs of vision. 
They are inclosed in part by the lids and partly by 
the bony sockets. 
The eyeball is covered with several membranes. 
In front we have the conjunctiva, then the sclerotic 
Fig. 123.-The anterior surface of the eyeball (Pyle). 
coat, or white firm membrane that surrounds all the 
ball except the front, where the cornea takes its place. 
The cornea is a transparent membrane that admits 
the ray of light for vision. Then follow the choroid 
coat, iris, and ciliary processes, together constituting 
the second or middle coat of the eyeball. The 
humors or fluids are the aqueous, crystalline, and 
■vitreous. 
252 THE ORGANS OF SPECIAL SENSE. 
253 
The sclerotic coat is a dense, fibrous membrane 
that invests about four-fifths of the globe of the eye. 
It gives form to this organ, and serves for the attach- 
ment of the muscles that move the eye in various 
directions. This coat, from the brilliancy of its 
whiteness, is known as "the white of the eye." 
Anteriorly, the sclerotic coat presents a bevelled edge, 
which receives the cornea in the same way that a 
watch-glass is received by the groove in the case. 
Fig. 124.-Vertical section through the eyeball: a, Sclera; b, choroid; c, 
ciliary muscle; d, iris; e, cul-de-sac of conjunctiva;/! anterior chamber 
and aqueous humor; crystalline lens; h, posterior chamber ; i, angle of 
anterior chamber ; j, suspensory ligament of lens ; k, cornea; I, vitreous ; 
m, optic nerve with central artery of retina; n, retina; o, o', ocular muscles 
(Pyle). 
The cornea is the transparent projecting layer that 
forms the anterior fifth of the globe of the eye. In 
form it is circular, convexoconcave, and resembles a 
watch-glass. It is received by its edge, which is 
sharp and thin, within the bevelled border of the 
sclerotic, to which it is firmly attached. The cornea 
is composed of several different layers ; its blood- 
vessels are so small that they exclude the red particles 
altogether and admit nothing bnt serum. 254 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The choroid coat is a vascular membrane, of a 
rich, chocolate-brown color upon its external surface, 
and of a deep-black color within. It is connected ex- 
ternally with the sclerotic, by an extremely fine cel- 
lular tissue and by the passage of the nerves and 
vessels ; internally it is in contact with the retina. 
The choroid membrane is composed of three layers. 
It secretes upon its internal surface a dark substance, 
Fig. 125.-Choroid membrane and iris, exposed by the removal of the 
sclerotic and cornea: a, One of the segments of the.sclerotic thrown back; 
b, ciliary muscle; c, iris ; e, one of the ciliary nerves; f one of the vasa 
vorticosa or choroidal veins (Zinn). 
called pigmentum nigrum, which is of great impor- 
tance in the function of vision. 
The iris, so called from the variety of its colors in 
different persons, forms a partition between the ante- 
rior and posterior chambers of the eye, and is pierced 
by a circular opening called the pupil. It is composed 
of two layers. The radiating fibers of the anterior 
layer converge from the circumference to the center. 
Through the action of these radiating fibers the pupil 
is dilated. The circular fibers surround the pupil, 77IE ORGANS OF SPECIAL SENSE. 
255 
and their action produces contraction of the area. 
The posterior layer is of deep-purple tint and is called 
uvea, from its resemblance in color to a ripe grape. 
The ciliary processes consist of a number of tri- 
angular folds> formed, apparently, by the plaiting of 
the internal layer of the choroid coat. They are 
about sixty in number. Their external border is 
continuous with the internal layer of the choroid 
coat. The central border is free, and rests against 
the circumference of the crystalline lens. These proc- 
esses are covered by a layer of pigmentum nigrum. 
The retina is composed of three layers : the exter- 
nal, middle or nervous, and the internal or vascular. 
The external layer is extremely thin, and the 
membrane is seen as a flocculent film when the eye 
is suspended in water. 
The nervous membrane is the expansion of the 
optic nerve, and forms a thin, semitransparent, bluish- 
white layer. The vascular membrane consists of the 
ramifications of a minute artery and its accompany- 
ing vein. The vascular layer forms distinct sheaths 
for the nervous papillae which constitute the inner 
surface of the retina. 
The aqueous humor fills the anterior and posterior 
chambers of the eye. It is an albuminous fluid, hav- 
ing an alkaline reaction. Its specific gravity is a 
very little greater than distilled water. The anterior 
chamber is the space intervening between the cornea, 
in front, and the iris and the pupil, behind ; the pos- 
terior chamber is the narrow space, less than half a 
line in depth, bounded by the posterior surface of the 
iris and pupil, in front, and by the ciliary processes 
and crystalline lens, behind. The two chambers are 256 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
lined by a thin layer-the secreting membrane of the 
aqueous humor. 
The crystalline humor, or lens, is situated imme- 
diately behind the pupil, and is surrounded by the 
ciliary processes. This humor is more convex on the 
posterior than on the anterior surface, and in different 
portions of the surface of each the convexity varies. 
The lens is imbedded in the anterior part of the vitre- 
ous humor, from which it is separated by a thin mem- 
Fig. 126.-Crystalline lens and suspensory ligament or zonula: 1, Lens; 
2, posterior, and 3, anterior portion of zonula; 4, its insertion into the pre- 
equatorial region. The black rays are lines of pigment torn from the ciliary 
processes, and belong in reality to the ciliary portion of the retina (Testut). 
brane ; it is invested by a transparent elastic mem- 
brane called the capsule of the lens. The lens consists 
of concentric layers arranged like the coats of an 
onion. The external layer is soft, and each success- 
ive one increases in firmness until the central layer 
forms a hardened nucleus. These layers are best 
demonstrated by boiling or by immersing in alcohol, 
when they easily separate from one another. 
The vitreous humor forms the principal bulk of 
the globe of the eye. It is an albuminous fluid, THE ORGANS OF SPECIAL SENSE. 
257 
resembling the aqueous humor, but is denser, and 
differs from the aqueous in this important particular, 
that it has not the power of reproducing itself. If, 
therefore, by accident it is discharged, the eye is irre- 
coverably lost ; whereas if the aqueous humor is dis- 
charged, it will again be restored. The vitreous is 
inclosed in a delicate membrane, called the hyaloid, 
which sends processes into the interior of the globe 
of the eye, forming the cells in which the humor is 
retained. 
THE APPENDAGES OF THE EYE. 
The appendages of the eye are the eyebrows, eye- 
lids, eyelashes, conjunctiva, caruncula lacrimalis, 
and lacrimal apparatus. 
The eyebrows (supercilia) are. two prominent 
arches of integument covered with short, thick hairs, 
which form the upper boundary of the orbits. They 
serve to shade the eyes from a too vivid light, and 
protect them from the.particles of dust and moisture 
that roll down the forehead. 
The eyelids (palpebrae) are two valvular layers 
placed in front of the eye, serving, by their closure, 
to defend it against injury ; they have been called the 
"blinds of the eye." When drawn up, they disclose 
an elliptic space (fissura palpebrarum), the angle of 
which forms the outer and inner canthi. The inner 
canthus is prolonged for a short distance .inward to- 
ward the nose, and a triangular space is formed which 
is called the puncta lacrimalia. At the commence- 
ment of the puncta upon each of the two lids is a 
small, angular projection, the papilla or tubercle, 
which forms the entrance to the lacrimal canal. 
The tegumentary areolar tissue of the eyelids is 258 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
remarkable for its looseness and absence of fat ; it is 
particularly liable to serous infiltration after injury to 
these parts. 
The tarsal cartilages contribute to the support of 
the eyelids. They are semilunar in form, the supe- 
rior being about one-third of an inch in breadth at 
its middle and tapering toward each extremity. The 
inferior is an elliptic band, narrower than the supe- 
rior, and is situated in the substance of the lower lid. 
FIG. 127--Right eye from before, the eyelids separated by hooks: Ps, 
Plica semilunaris; Pls, PH, superior and inferior lacrimal puncta; Car, 
lacrimal caruncle ; Lpm, internal tarsal ligament. 
Its upper border is flat, and corresponds with the edge 
of the upper cartilage. The lower is held in place by 
the fibrous membrane, which is firmly attached to the 
periosteum around the margin of the orbit. 
The Meibomian glands are imbedded in the sub- 
stance of the cartilages, and are distinctly seen on 
examining the inner aspect of the lids. They have 
the appearance of a string of pearls, and are about 
thirty in number in the upper cartilage, and some- THE ORGANS OF SPECIAL SENSE. 
259 
what fewer in the lower ; they open by minute fora- 
mina on the edges of the lids (see p. 243). 
The edges of the eyelids are provided with a row 
of long, thick hairs (eyelashes) that curve upward 
from the upper lid and downward from the lower, so 
as not to interlace with one another when the eyelids 
close. 
The conjunctiva is the mucous membrane of the 
eye. It covers the whole anterior surface with the 
exception of the cornea, where it is provided with an 
epithelial layer of this membrane, and is reflected 
backward, upward, and downward upon the lids so 
as to form their internal layer. 
The caruncula lacrimalis is a small, reddish 
body that occupies the inner canthus of the eye. In 
health it presents a bright-pink tint ; in sickness it 
loses its color and becomes pale. 
The nasal duct, a part of the lacrimal apparatus, 
is a short canal, about three-quarters of an inch in 
length, directed downward, backward, and a little 
outward to the inferior meatus of the nose, where it 
terminates by an expanded orifice. It is provided 
with a mucous membrane continuous with the con- 
junctiva above and with the membrane of the nose 
below. Obstruction of this duct from inflammation 
and suppuration constitutes the disease termed fistula 
lacrimalis. The nerves and vessels are derived from 
the ophthalmic branches. 
PHYSIOLOGY OF VISION. 
After reviewing the anatomic relation of sight, we 
will now take up a few essential points regarding the 
physiologic action of the various structures. 260 
ANATOMY AND PHYSIOLOGY TOR NURSES. 
It is by the sense of sight that we receive the im- 
pression of light and color, as well as the ideas of 
construction of materials establishing certain fancies, 
likes,, and dislikes of the external surroundings. 
The eyeball is constructed like a photographer's 
camera. The sclerotic and choroid coats correspond 
to the inside walls of the chamber, while by the re- 
fractive power o'f the several parts, as the cornea, aque- 
ous humor, crystalline lens, and vitreous humor the 
image is formed. The retina represents the sensitive 
plate on which the image is received. The iris regu- 
lates the rays of light, acting as a diaphragm to cut 
out certain portions of light that are not required. 
The ciliary muscles adjust the shape of the crystalline 
lens so as to refract images upon the retina. 
The function of the crystalline lens is to focus the 
rays of light with the formation on the retina of the 
image, corresponding with the object from which the 
light proceeds. By accommodation is meant the power 
of adjusting the eye to certain distances. Normal eve 
does not require adjustment for parallel rays ; but for 
divergent rays a change in the eye is necessary ; this 
is termed the lack of accommodation. 
The astigmatic eye is so called from the inability 
to focus vertical and horizontal lines at the same time. 
This is usually due to some irregularity of the curva- 
ture of the refracting surfaces of the eye, and a cylin- 
dric lens is required to correct the defect. 
Myopia, or short-sightedness, is a condition caused 
by an increased anteroposterior diameterof the eyeball, 
causing the parallel rays of light to focus in front of the 
retina. Myopia causes diminution of distance vision, 
and requires concave lenses to correct the deficiency. THE ORGANS OF SPECIAL SENSE. 
261 
Hyperopia, or far-sightedness, is a condition of 
refraction of the eye in which, when the accommoda- 
tion is at rest, the focns of the parallel rays of light 
transmitted through the eye is beyond the retina. 
Convex glasses are recpiired to correct this defect. 
Presbyopia is a condition of the eye in which the 
power of accommodation is partly or wholly lost. 
This condition occurs in the aged usually between 
the ages of forty and fifty years, and requires convex 
spheric lenses for its correction. 
The ear is the organ of hearing, and consists of a 
series of cavities so arranged as to receive the vibra- 
tions (sounds) in the atmosphere 
and convey them to the delicate 
nervous membrane within its 
structure. The ear is com- 
posed of three parts: the ex- 
ternal ear, the tympanum or 
middle ear, the labyrinth or 
internal ear. 
The external ear is com- 
posed of two parts : the pinna 
(auricle or pavilion of the ear) 
and the meatus auditorius ex- 
ternus (auditory canal). 
The pinna is a cartilaginous 
plate that surrounds the en- 
trance of the auditory canal. It presents several 
ridges and furrows, arising from the folds of the car- 
tilages that form it. 
The meatus auditorius is a canal, partly cartilag- 
THE ORGAN OF HEARING. 
Fig. 128.-The external 
ear: a, Helix; b, fossa of 
anthelix; c, tragus ; d, lobule ; 
e, antitragus; f concha ; 
anthelix; h, fossa of helix 
(Randall). 262 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
inous and partly bony, about an inch in length, 
whose walls extend inward from the pinna to the 
membrana tympani or drum of the ear. It is nar- 
rower in the middle than at the extremities. It is 
lined by an extremely thin pouch of cuticle, which, 
when withdrawn after maceration, preserves the form 
of the canal. Stiff, short hairs that stretch across the 
Fig. 129.-Semidiagrammatic section through the right ear: G, external 
auditory meatus; T, membrana tympani; P, tympanic cavity; o, fenestra 
ovalis ; r. fenestra rotunda; B, semicircular canal; X, cochlea; Vt, scala 
vestibuli; Pt, scala tympani (Czermak). 
tube are often found in the interior of the channel, 
and prevent the ingress of insects. Beneath the 
cuticle are a number of small follicles that secrete 
the wax (cerumen) of the ear. 
The membrana tympani is a thin, semitransparent 
membrane of an oval shape. It is about three-eighths 
of an inch in diameter, and is inserted into the groove 
around the circumference of the meatus, near its ter- THE 0 EG ANS OF SPECIAL SENSE. 
263 
initiation. This membrane is placed obliquely across 
the tube. It is concave toward the meatus and con- 
vex toward the tympanum. 
The tympanum is an irregular bony cavity, situ- 
ated within the temporal bone. It is bounded ex- 
ternally by the membrana tympani ; internally, by 
the inner wall ; and in its circumference, by the 
petrous portion of the temporal bone and mastoid 
cells. The tympanum is 
traversed by a chain made 
of three small bones-the 
malleus, incus, and stapes. 
(See Fig. 130.) There are 
ten openings in the in- 
ternal ear, five large and 
five small. 
The mastoid cells are 
very numerous, and oc- 
cupy the whole of the in- 
terior of the mastoid proc- 
ess and part of the petrous portion of the temporal 
bone. They communicate with the upper and poste- 
rior circumference of the tympanum by a large irreg- 
ular opening. 
The Eustachian tube is a canal of communication 
extending obliquely between the pharynx and the 
anterior circumference of the tympanum. In struc- 
ture it is partly fibrocartilaginous and partly bony. 
It is broad and expanded at its pharyngeal extremity, 
and narrow and compressed at the tympanum. 
The nerve supply is mainly from the auditory 
nerve. 
The internal ear, or labyrinth, is the essential 
Fig. 130.-The small bones of 
the ear; external view (enlarged) 
(after Gray). 264 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
part of the organ of hearing. It consists of three 
parts-the vestibule, semicircular canals, and cochlea. 
It receives the ultimate distribution of the auditory 
nerve. It is connected with the middle ear by two 
openings or fenestra. 
(The nurse will do well to devote some time to the 
study of these organs, for she will' often be called 
upon to care for patients in whom these important 
parts are diseased.) 
THE ORGANS OF TASTE. 
The chief organ of taste is the tongue, and yet the 
palate and lips participate in receiving the impres- 
sions made by substances taken into the mouth. 
These impressions are conveyed to the brain by the 
nerves, and thus a perception of the quality of the 
taste or impression on the tongue is effected. 
The tongue is a double organ, composed chiefly 
of muscular fibers which run in almost every direc- 
tion. The two sides are absolutely distinct, so that 
sometimes, as in paralysis, one side is affected while 
the function of the other remains unimpaired. It 
possesses great versatility of motion, and can be 
molded into a variety of shapes. The tongue is an 
auxiliary to other organs in articulation, mastication, 
and deglutition. 
This organ is abundantly supplied with blood- 
vessels, a large artery being sent to each side of it. 
It is also well furnished with nerves, receiving ner- 
vous filaments from the fifth, ninth, and twelfth pairs 
of nerves. The branch of the fifth, called the gusta- 
tory, is the nerve most commonly regarded as the 
nerve of taste, although some impute this sense to THE ORGANS OF SPECIAL SENSE. 
265 
the ninth pair, while others attribute it to the twelfth 
pair ; the more commonly accepted view is that which 
Fig. 131.-Papillar surface of the tongue, with the fauces and tonsils: 
1, 1, Circumvallate papillae, in front of 2, the foramen caecum ; 3, fungiform 
papillae; 4, filiform and corneal papillae; 5, transverse and oblique rugae; 6, 
mucous glands at the base of the tongue and in the fauces; 7, tonsils; 8, 
part of the epiglottis; 9, median glosso-epiglottidean fold (fraenum epi- 
glottidis) (from Sappey). 
assigns it to the concurrent action of the three. The 
twelfth, or hypoglossal, is a nerve of voluntary mo- 
tion. The ninth, or glossopharyngeal, is a nerve of 266 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
voluntary motion. It serves to bring the tongue, 
fauces, esophagus, and larynx together, which is 
necessary in order to get the full effect of taste. 
The surface of the tongue is very thickly beset with 
papillce, or villi, which give the organ a velvety ap- 
pearance. These papillae are of three varieties : The 
first is situated near the base of the tongue, and 
belongs to the class known as mucous follicles. They 
are larger than the others, and are called lenticular, 
being shaped like a lens. These, together with the 
tonsils, secrete mucus that lubricates the food in the 
act of deglutition. 
The other two se'ts of papillae are scattered over the 
whole surface of the tongue ; one set consists of small, 
oval bodies that give it a rough appearance ; these 
are called the filiform papillce. The other set, known 
as the fungiform, are larger than those just described, 
and consist of small, rounded heads, supported on 
short stalks, somewhat resembling a mushroom in 
shape ; from this resemblance they derive their name. 
In the last two described sets of sensitive papillae the 
gustatory branch of the fifth pair of nerves ramifies. 
THE ORGANS OF SMELL. 
The sense of smell is located in the membrane of 
the nose. To understand fully the sense of smell a 
knowledge of the structure of the nasal cavity and the 
distribution of the olfactory nerve is necessary. 
The nose is composed of bones, fibrocartilages, and 
mucous membrane, and an outer covering of integu- 
inent. The bones that make up the nose are the nasal 
and the nasal processes of the upper jaw (superior 
maxillary). The fibrocartilages are five in number, THE ORGANS OF SPECIAL SENSE. 
267 
and give form and stability by their elasticity to the 
framework of the nose, at the same time guarding 
against injury. The mucous membrane which lines 
the interior of the nose is continuous with the skin 
externally and with the lining membrane of the nasal 
fossae. The margins of the nostrils are provided with 
numerous hairs that serve to protect the delicate 
membrane of the nose against the entrance of irritat- 
ing substances. 
The nasal fossae, or nostrils, are two irregular 
Fig. 132.-Lateral cartilages of the nose (Ingals). 
cavities extending upward and backward from the an- 
terior portion of the nose, and terminating in the 
pharynx, where they are called the posterior nares. 
These nostrils are bounded superiorly by the sphe- 
noid and ethmoid bones ; inferiorly, by the hard pal- 
ate. In the middle line they are separated from each 
other by a bony and fibrocartilaginous septum ; upon 
the outer walls of each fossa, in the dried skull, are 
three projecting processes, termed spongy or turbi- 
nated bones. In the fresh fossa these are covered by 
a mucous membrane. 268 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
The space that intervenes between the superior and 
middle spongy bones is termed the superior meatus, 
or channel ; the space between the middle and infe- 
rior-bones, the middle meatus; and that between the 
inferior bone and the floor of the fossa, the inferior 
meatus. The meatuses are passages that extend back- 
ward from the nostrils ; they contain several openings. 
They are lined by a mucous membrane, called the 
Fig. 133.-Nerves of nose and sphenopalatine ganglion, from inner side: 
1, Network, of external branches of olfactory nerve; 2, nasal nerve, giving 
its external branch to outer wall of nose ; the septal branch is cut short; 3, 
sphenopalatine ganglion; 4, ramification of large palatine nerve; 5, small, 
and 6, external palatine nerve; 7, inferior nasal branch; 8, superior nasal 
branch ; 9, nasopalatine nerve cut short; 10, Vidian nerve ; 11, great super- 
ficial petrosal nerve; 12, great deep petrosal nerve; 13, the sympathetic 
nerves ascending on internal carotid artery. 
pituitary, or Schneiderian membrane (from Schnei- 
der, who first showed that the secretion of the nasal 
fossae proceeded from the mucous membrane, and not 
from the brain, as was formerly taught). 
Upon the mucous membrane of the nasal passage 
the olfactory nerve and also branches from other 
nerves ramify. This membrane is quite extensive in 
man, and in those animals whose sense of smell is 
very acute it is still more extensive. 269 
THE ORGANS OF SPECIAL SENSE. 
THE ORGANS OF TOUCH. 
The sense of touch or palpable feeling is the one 
by which the mind becomes acquainted with some of 
the properties of bodies ; thus it enables us to deter- 
mine whether their surfaces are smooth or rough, 
their relative temperature, and, to a certain degree, 
also, their form and weight. The skin, which is the 
principal seat of the sense of touch, has been described 
in a previous chapter. 
Some physiologists make a distinction between the 
sense of touch and of tact. Tact, or feeling, is a more 
general faculty, extending over the whole surface of 
the skin and mucous membranes, whereas touch is con- 
fined chiefly to the fingers of man and the noses of 
quadrupeds. Tact is considered a passive function ; 
for example, when any part of the system conies into 
contact with another body, a sensation of its presence 
is given without the exercise of volition. On the 
other hand, touch is an active sense, and is exercised 
voluntarily, for the purpose of conveying to the mind 
a knowledge of the qualities or properties of the sur- 
faces of bodies ; as, for example, when we feel a piece 
of cloth to ascertain its quality, or a polished surface 
to prove its smoothness. 
In man the hand is admirably adapted for the ex- 
ercise of the sense of touch. The fineness of the skin, 
its great sensibility, the cushion-like pad formed by 
the subcutaneous fat at the extremities of the fingers, 
the length and flexibility of these members, and the 
power we possess of opposing the thumb to the fin- 
gers, thus forming, as it were, a pair of forceps, are 
properties that are essential to the delicacy of touch, 270 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
and that enable ns to appreciate with exactitude the 
qualities of the bodies we may feel. 
REVIEW QUESTIONS. 
What constitute the organs of sight ? 
How many coats has the eye? Name them. 
What is the conjunctiva? 
What is the sclerotic coat? 
Give a description of the cornea. 
What is the choroid coat? 
What is the iris ? 
Give an illustration of the ciliary processes. 
What and where is the retina ? 
What nerve pierces the eyeball posteriorly? 
Name the different humors of the eye. 
What is their function ? 
What are the appendages of the eye ? 
What are the functions of the eyebrows ? 
What is the function of the eyelids? 
What do you understand by canthus? 
What denotes the entrance to the lacrimal canal ? 
What is the function of the tarsal cartilages? 
What is the function of the Meibomian glands? 
What is the caruncula lacrimalis? 
Describe the nasal duct. 
What condition is liable to ensue from obstruction of this duct? 
What are the organs of hearing? 
How is the sound conveyed? 
How is the ear divided? 
What composes the external ear ? 
What is the construction of the meatus auditorius? 
Describe the membrana tympani. 
What is the tympanum ? 
What are the mastoid cells? Where are they located ? 
What is the function of the Eustachian tubes? 
Describe the internal ear. 
What are the organs of taste? 
What are papilla; ? 
Name the varieties and their situation. 
To what class do the follicles at the base of the tongue belong? THE ORGANS OF SPECIAL SENSE. 
271 
What is considered the nerve of taste ? 
What are the organs of the sense of smell ? 
Of what is their structure composed? 
How many fibrocartilages enter into the formation of the nose ? 
What cavities are formed by these structures? 
Where is the septum located ? 
What nerve supplies the sense of smell ? 
What do you mean by the sense of touch ? 
What nerve structures enter into this function ? 
What is the difference between tact and touch ? 
Where is the sense of touch situated in animals? CHAPTER XI. 
THE FEMALE ORGANS OF GENERATION. 
The external organs of generation in the female 
are the mons veneris, labia majora, labia minora, 
clitoris, meatus urinarius, and the orifice of the 
vagina. The term vulva or pudendum, as generally 
applied, includes all these parts. 
The mons veneris is the rounded eminence situated 
in front of the pubes ; it is formed by an accumula- 
tion of fatty tissue beneath the integument. It sur- 
mounts the vulva, and at puberty becomes covered 
with hair. 
The labia majora are two prominent longitudinal 
cutaneous folds extending downward from the mons 
veneris to the anterior boundary of the perineum, 
and inclosing an elliptic fissure, the urinosexual 
opening. Bach labium is formed externally of in- 
tegument covered with hair ; internally, of mucous 
membrane, which is continuous with that of the 
genito-urinary mucous tract. 
The labia minora are two small folds of mucous 
membrane situated within the labia majora, and ex- 
tending from the clitoris obliquely downward and 
outward for about one and one-half inches on each 
side of the orifice of the vagina, at the sides of which 
they are obliterated. They are continuous externally 
with the labia majora, and internally with the surfaces 
of the vagina. 
272 THE FEMALE ORGANS OF GENERATION. 
273 
The clitoris is an erectile structure, situated be- 
neath the anterior commissure, and partially hidden 
between the anterior extremities of the labia minora. 
The hymen is a thin, semilunar fold of mucous 
membrane, stretched across the lower part of the 
Fig. 134.-Virginal vulva : 1, Labia majora; 2, fourchet; 3, labia minora ; 
4, glans clitoridis; 5, meatus urinarius; 6, vestibule; 7, entrance to the 
vagina; 8, hymen; 9, orifice of Bartholin's gland; ro, anterior commissure 
of labia majora; 11, anus ; 12, blind recess ; 13, fossa navicularis ; 14, body 
of clitoris (modified from Tarnier). 
orifice of the vagina ; its concave margin turns up- 
ward toward the pubes. Occasionally this membrane 
forms a complete septum across the orifice of the 
vagina, forming the condition known as imperforate 
hymen. At times it is cribriform, or it may be en- 
tirely absent. The hymen cannot, consequently, be 274 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
considered a test of virginity. Its rupture, or a rudi- 
mentary condition of this membrane, gives rise to 
irregular elevations that surround the opening of the 
vagina. 
The Glands of Bartholin.-These are situated one 
on each side of the commencement of the vagina. 
They are round or oblong bodies, of a reddish-yellow 
color and the size of a bean ; each gland opens by 
Fig. 135.-Normal vulvovaginal gland. The labium majus and minus, 
the sphincter vaginae muscle, and the bulb have been partly removed on the 
right side in order to expose the gland : AA', Section of labium majus and 
minus; B, gland; C, excretory duct; C', stylet introduced into the duct; 
D, glandular end of duct; E, free end of duct; F, section of bulb; G, as- 
cending ramus of ischium (Huguier). 
means of a long single duct, upon the inner side of 
the nympliae, external to the hymen. 
The bladder, because of its proximity to the organs 
of generation, is mentioned here. It is situated at 
the anterior part of the pelvis, and is in relation, in 
front, with the os pubis ; behind, with the uterus, 
some convolutions of the small intestine being inter- 
posed ; its base lies in contact with the neck of the 7 HE FEMALE ORGANS OF GENERATION. 
275 
uterus and with the anterior wall of the vagina. The 
bladder is larger in the female than in the male, and 
it is very broad in its transverse diameter. A more 
Fig. 136.-Sagittal section of the female pelvis (Dickinson). 
exhaustive description of this organ has been given 
in a previous chapter. 
THE VAGINA. 
The vagina is a membranous canal extending from 
the vulva to the uterus. It is situated in the cavity 276 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
of the pelvis, behind the bladder, and in front of the 
rectum. In direction it is curved forward and down- 
ward, following, at first, the line of the axis of the 
cavity of the pelvis, and afterward that of the outlet. 
It is cylindric in shape, flattened from before back- 
ward, and its walls are ordinarily in contact with 
each other. Its length is about four inches along its 
FIG. 137.--View of the pelvis and its organs: B, Bladder; U, uterus 
(drawn down by loop e); F, Fallopian tubes; O, ovaries; L, round liga- 
ments; g, ureter; a, ovarian vessels, often prominent under their peritoneal 
covering (Savage). 
anterior wall. At its commencement it is constricted, 
becoming dilated near the uterine extremity. It sur- 
rounds the cervical portion of the cervix uteri, a short 
distance from the os, and its attachment extends 
higher up on the posterior than on the anterior wall. 
The vagina consists of an internal muscular coat, a 
layer of erectile tissue, and an internal mucous lining. THE FEMALE ORGANS OF GENERATION. 
277 
THE UTERUS. 
The uterus is the organ of gestation, receiving the 
fecundated ovum in its cavity, retaining and support- 
ing it during the development of the fetus, and the 
principal agent in its expulsion at the time of parturi- 
tion. 
In the virgin state it is pear-shaped, flattened from 
before backward, and situated in the cavity of the 
pelvis, between the bladder and the rectum ; it is 
F1G. 138.-Anterior view of virgin uterus, showing relations of cervix to 
corpus uteri and reflection of peritoneum at isthmus {The American Text- 
book of Obstetrics'). 
retained in position by the round and broad liga- 
ments on each side, and projects into the upper end 
of the vagina below. The base projects upward, and 
the cervix downward, in the line of the axis of the 
inlet of the pelvis. The uterus measures about three 
inches in length, two in breadth at its tipper part, 
and an inch in thickness ; it weighs from one to one 278 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
and one-half ounces. For descriptive purposes it is 
divided into three parts-the cervix, the body, and 
the fundus. The fundus is the upper broad extremity 
of the organ ; the body gradually extends toward the 
cervix, which is the lower part, and is divided into 
two sections,-the external cervix and the internal 
cervix,-forming the cavity, which is smaller in com- 
parison to the size of the organ. 
Structure'.-The uterus is composed of three coats 
-the external serous coat, a middle or muscular 
layer, and an internal mucous coat ; the muscular 
coat forms the greater bulk of the organ. In an un- 
impregnated state it is firm, of a grayish color, and 
cuts almost like cartilage. It is classed as an invol- 
untary muscle, and in the impregnated state the mus- 
cular tissue becomes more prominently developed. 
Blood-supply.-The uterus is supplied with blood 
from the internal iliac through the uterine artery, 
and from the ovarian from the aorta. 
The nerves are derived from the inferior hypo- 
gastric and spermatic plexuses, and from the third 
and fourth sacral nerves. 
The form, size, and situation of the uterus varies 
at different periods of life and under different condi- 
tions. 
In the fetus, the uterus is contained in the abdomi- 
nal cavity, projecting beyond the brim of the pelvis. 
The cervix is considerably larger than the body. 
At puberty the uterus is pyriform in shape, and 
weighs from eight to ten drams. It has descended 
into the pelvis, the fundus being just below the level 
of the brim of this cavity. 
During and after menstruation this organ is en- THE FEMALE ORGANS OF GENERATION. 
279 
larged, more vascular, and its surface rounder ; the 
os externum is rounded, its labia are swollen, and the 
lining membrane of the body is thickened, softer, 
and of a darker color. 
Dziring pregnancy the uterus increases in weight 
from one and one-half to three pounds. It becomes 
enormously enlarged, and projects into the hypo- 
gastric and lower part of the umbilical region. The 
Fig. 139.-Longitudinal section of a nulliparous (A) and of a multi- 
parous (B) uterus : A, Cavity of the cervix and arbor vitae; C, cavity of the 
body; O, constriction between body and cervix, the os uteri internum; A, 
wall of body (Tarnier). 
enlargement, which continues up to the sixth month 
of gestation, is due partly to increased development 
of pre-existing and newly-formed muscular tissue. 
The round digaments are enlarged and the broad 
ligaments become encroached upon by the uterus 
making its way between the laminae. The mucous 
membrane becomes more vascular, and its mucous 
follicles and glands enlarge ; the rugae and folds of 
the cervix become obliterated ; the blood-vessels and 280 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
lymphatics, as well as the nerves, become greatly 
enlarged. 
After parturition the uterus almost regains its 
usual size ; its weight now is from two to three 
ounces, but its cavity is larger than in the virgin 
state ; the external orifice is more marked, and as- 
sumes a transverse direction ; its edges present a 
fissured surface ; its vessels are tortuous and its mus- 
cular layers are more clearly defined. 
In old age the uterus becomes atrophied, paler, and 
denser in texture and a more distinct constriction 
separates the body and cervix. The ostium internum 
and, occasionally, the vaginal orifice often become 
obliterated, and its labia almost entirely disappear. 
The cavity of the uterus continues to the fundus. 
It is of an irregular size, a constriction at the cervical 
portion forming the os internum, and the part within 
the vagina the os externum. The cavity is continuous 
with the Fallopian tubes. 
The ligaments are six in number-two posterior, 
two anterior, and two lateral or broad ligaments. 
These are all formed of peritoneum. 
APPENDAGES OF THE UTERUS. 
The appendages of the uterus are the Fallopian 
tubes, the ovaries and their ligaments, and the round 
ligaments. These structures, together with their 
nutrient vessels and nerves and some scattered mus- 
cular fibers, are inclosed between the two folds of 
peritoneum which constitute the broad ligaments. 
They are placed in the following order : in front is 
the round ligament; the Fallopian tube occupies the THE FEMALE ORGANS OF GENERATION. 
281 
free margin of the broad ligament ; the ovary and its 
ligament are behind the latter. 
The Fallopian tubes, or oviducts, convey the 
ova from the ovaries to the cavity of the uterus. 
They are two in number, one on each side, situated 
in the free margin of the broad ligament, extending 
from each superior angle of the uterus to the side of 
the pelvis. Bach tube is about four inches in length ; 
Fig. 140.-Posterior view of left uterine appendages: 1, Uterus; 2, 
Fallopian tubes; 3, fimbriated extremity and opening of the Fallopian tube; 
4, parovarium ; 5, ovary; 6, broad ligament; 7, ovarian ligament; 8, infundi- 
bulopelvic ligament (Henle). 
its canal is exceedingly small, and commences at the 
superior angle of the uterus by a minute orifice, the 
ostium internum; this will hardly admit a fine bristle ; 
it continues narrow along the inner half of the tube, 
and then gradually widens into a trumpet-shaped ex- 
tremity that becomes contracted at its termination. 
This orifice is called the ostium abdominale, and com- 
municates with the peritonal cavity. Its margins are 282 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
surrounded by a series of fringe-like processes, termed 
fimbricz ; one of these processes is connected with 
the outer end of the ovary. The name fimbriated 
extremity is applied to this part of the tube ; owing 
to the peculiar manner in which it embraces the 
surface of the ovary during sexual excitement it is 
also called morsus diaboli. 
Fig. 141.-Transverse section of the human Fallopian tube (Schenck). 
The Fallopian tubes consist of three coats-serous, 
muscular, and mucous. 
The Ovaries.-The ovaries are oval bodies, of an 
elongated form, flattened from above downward, and 
situated one on each side of the uterus in the pos- 
terior part of the broad ligament, behind and below 
the Fallopian tubes. Fach ovary is connected, by its 
anterior margin, with the broad ligament ; by its 
inner extremity, to the uterus by a proper ligament- 
the ligament of the ovary ; and by its outer end, to THE FEMALE ORGANS OF GENERATION. 
283 
the fimbriated extremity of the Fallopian tube by a 
short ligamentous cord. 
The ovaries are of whitish color, and present either 
a smooth or a puckered, uneven surface. They are 
each about one and one-half inches in length, three- 
quarters of an inch in width, and about one-third of 
an inch thick; they weigh from one to two drams. 
They are attached to the broad ligament, and are 
Fig. 142.-Ovary and tube of woman twenty-four years old, seen from 
behind: U, Uterus; T, tube; LO, ovarian ligament; o, ovary ; x, limit of 
peritoneum; b, cicatrix after ruptured Graafian follicle (Waldeyer). 
invested by peritoneum excepting along the anterior 
margin, where they are attached. The ovaries con- 
tain numerous small, round, transparent vesicles in 
various stages of development ; these are called the 
Graafian vesicles, the ovisacs containing the ova. In 
women who have not borne children they vary in 
number from ten to fifteen or twenty, and in size from 
a pin's head to a pea. It has been shown that a large 
number of ovisacs exist in the parenchyma of the 284 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
ovary, few of which produce ova. These vesicles 
have thin, transparent walls, and are filled with a 
Fig. 143.-Section through part of ovary of adult bitch: a, Germinal 
epithelium; b, b, ingrowths (egg-tubes) from the germinal epithelium, seen 
in cross-section ; c, c, young Graafian follicles in the cortical layer; d, a 
more mature follicle, containing two ova (this is rare) ; e and f ova sur- 
rounded by cells of discus proligerus ; g, h, outer and inner capsules of the 
follicle ; i, membrana granulosa ; I, blood-vessels ; m, m, parovarium ; 
germinal epithelium commencing to grow in and form an egg-tube ; z, tran- 
sition from peritoneal to germinal epithelium (from Waldeyer). 
clear, colorless, albuminous fluid. The Graafian vesi- 
cles are, during their early development, small, and 
deeply seated in the substance of the ovary ; as they THE FEMALE ORGANS OF GENERATION. 
285 
enlarge they approach the surface-and when mature 
they form small projections on the exterior of the 
ovary beneath the peritoneum. Bach vesicle consists 
of an external fibrovascular coat, connected with the 
surrounding stroma of the ovary by a network of 
blood-vessels. 
Fig. 144.-Graafian follicle from a girl seven months old: a, Epithelium 
(membrana granulosa) detached from fibrous membrane; b, discus pro- 
ligerus, situated far away from the surface. It contains the ovum, on which 
the zona pellucida and the germinal vesicle are visible. The surrounding 
fibrous membrane is not yet separated into two layers, and there is no dis- 
tinct line of demarcation between it and the surrounding stroma (X 220 
times ; natural size, 0.351 mm. longest diameter) (Kblliker). 
The ovum is an extremely minute, spheric body, 
measuring from 2-0 t° to °f an inc^ diameter. 
Discharge of the Ovum.-The Graafian vesicles, after 
gradually approaching the surface of the ovary, burst; 
the ovum and fluid contents of the vesicle are liber- 
ated and escape on the exterior of the ovary, passing 
thence into the Fallopian tube, the fimbriated proc- 286 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
esses of which are thought to grasp the ovary, the 
aperture of the tube being applied to the part cor- 
responding to the matured and bursting vesicle. 
The maturation and discharge of the ova occur at 
regular periods only ; these periods are known as the 
menstrual periods. Sexual desire is more intense in 
females at this time, and if union of the sexes takes 
place, the ovum may become fecundated. 
The Corpus Luteum.-Immediately after the rupture 
of the Graafian vesicle and the escape of its ovum 
the vesicle becomes filled with blood-stained fluid, 
Fig. 145.-Ovary with mature Graafian follicle about ready to burst 
(Ribemont-Dessaignes). 
and iii a short time the circumference of the vesicle is 
occupied by a firm, yellow substance that is probably 
formed from plasma exuded from its walls. The 
exudation is at first of a dark brown or brownish-red 
color, but it soon becomes paler and its consistence 
denser. 
For every follicle in the ovary from which an ovum 
is discharged a corpus luteum will be found, but the 
character it exhibits and the changes produced in it 
will be determined by the circumstances of the ovum 
being impregnated or not. THE FEMALE ORGANS OF GENERATION. 
287 
Ligaments of the Ovaries.-The ligaments of the 
ovaries are rounded cords that extend from each supe- 
rior angle of the uterus to the inner extremity of the 
ovary. They consist of fibrous tissue and a few 
fibers derived from the uterus. 
The round ligaments are two rounded cords, be- 
tween four and five inches in length, situated between 
the layers of the broad ligaments, in front of and 
below the Fallopian tubes. Commencing on each 
Fig. 146.-Stages in the formation of a corpus luteum : A, Recent blood; 
B, the wrinkling of its walls; C, contracting stage (A. E. Giles). 
side at the superior angle of the uterus, each ligament 
passes forward and outward through the internal ab- 
dominal ring, along the inguinal canal, to the labia 
majora, in which it becomes obliterated. 
Blood-supply of the Ovaries.-The arteries of the 
ovaries and Fallopian tubes are the ovarian, from 
the aorta, anastomosing with the termination of the 
uterine arteries, and entering the attached border of 
the ovary. The veins follow the course of the arteries ; 288 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
they form a plexus near the ovary-the pampiniform 
plexus. 
The nerves are derived from the spermatic plexus, 
the Fallopian tube receiving a branch from one of 
the uterine nerves. 
REVIEW QUESTIONS. 
What are the organs of generation ? 
What is the mons veneris ? 
What are the labia majora ? the labia minora ? 
What is the clitoris ? the hymen ? 
What are the glands of Bartholin ? 
Describe the vagina. 
Name the function of the uterus. 
What arteries supply the uterus ? 
State the changes that take place in the uterus at different periods 
of life. 
What are the appendages of the uterus ? 
What are the Fallopian tubes? 
How many are there ? 
What ligaments hold them in position ? 
What is the function of the Fallopian tubes? 
What do you understand by fimbriated processes ? 
What are the ovaries? 
Where are they located ? 
What is a Graafian vesicle ? 
Describe an ovum. 
What is the corpus luteum ? 
Describe the ligaments of the ovaries. 
What arteries supply the ovaries? CHAPTER XII. 
REPAIR AND WASTE-NUTRITION-ANIMAL 
HEAT-PERSPIRATION-THE POWER THAT 
SUPPORTS AND PRESERVES HEALTH. 
Having- studied concisely the complex nature of 
man, both as regards the substances of which he is 
composed and the organs that go to make up his 
body, and having briefly pointed out the different 
functions of many of the organs and parts described, 
we will now turn our attention to a consideration of 
the power that keeps the organs in motion-the 
phenomenon that essentially constitutes life. 
We have shown that each organ of the body is 
charged with the performance of an office or a func- 
tion. Now, the performance of a function implies 
both an action and the power to act, for without 
action there could be no performance, and without 
the power to act there could be no action. It is clear, 
therefore, that there must be a power either invested 
in or furnished to the organs that enables them to 
act. It is this power, which may be termed the 
living power, vital power, or power of life that we 
will now consider. The various terms applied to it 
are here used synonymously, and must always be 
understood as referring to that power or principle by 
which the vital actions are maintained and life sus- 
tained. 
Waste is continually going on in our bodies ; that 
289 290 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
is, the substances that make up the body are con- 
stantly being exhausted by the activity of the nervo- 
muscular apparatus, and thus arises the necessity for 
our taking food. The phenomena of this waste of 
the substance of our tissues is a matter of interest to 
the general reader as well as to the nurse, and a study 
of the subject will afford much information that will 
be available to any who are seeking to acquire a 
knowledge of our physiologic constitution. 
The necessity of supplying matter to the system 
arises from another necessity-that of the generation 
of force. It may thus be remarked that all available 
or active physical force displayed in the voluntary or 
involuntary motions of our bodies is derived from the 
force of the several affinities of the primary elements 
that enter into the structures. 
By disturbing the static state of the chemic forces 
power is generated. All the materials that have 
their affinities thus exhausted become useless in the 
position they occupy arid must be replaced by other 
or fresh materials. Here, then, is the source of waste. 
Thus, it may again be said, a constant interchange 
of material takes place in the very substance of our 
tissues, new material from without replacing old and 
effete substances that have become so in the genera- 
tion of force. 
It is this vital principle that prescribes the formulae 
for these chemic changes, according as the involun- 
tary actions or motions of the body may require force, 
or as the mind may call upon the voluntary muscles to 
to expend force. If you reflect for a moment you will 
realize that you cannot act, move, or even think with- 
out demanding the sacrifice or destruction of a portion REPAIR AND WASTE. 
291 
of your body equal in extent to such motion, whether 
it be of the mind or of the body. Thus we constantly 
die while we live, and in this we form a complete 
analogy to the entire order of organic life. 
Excretion.-The materials, after having under- 
gone the metamorphosis and having been neutralized 
by the safety of their affinities, now require to be 
removed to prevent the obstruction they would other- 
wise give rise to. 
These materials may be compared to the ashes of a 
furnace-they are the result of combustion or oxida- 
tion. They are absorbed from the circulation by 
means, principally, of the sudorific glands, and car- 
ried off by what is called cutaneous transpiration, or 
perspiration. Mucous surfaces, especially those of 
the alimentary canal, also secrete from the circulation 
pecant or exhausted materials and eliminate them in 
the dejecta. 
Pulmonary transpiration corresponds to the chim- 
ney of the furnace-it gives off the smoke or carbonic- 
acid gas and other dephlogisticated material. The 
kidneys remove saline and acrid products of the tissue 
metamorphosis that are similar to, but much more 
acrid than, the perspirable fluid. 
NUTRITION. 
The processes of nutrition and the necessity for 
the continued supply of material have already been 
dwelt upon. The source of nutrition, as has been 
stated elsewhere, lies in food. A question regarding 
nutrition that still remains unanswered is, What is 
the precise modus opcrandi of nutrition? 
By the action of the various acids, salts, and other 292 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
secreted products of animal combustion, which are 
furnished by the glandular viscera, as the liver, pan- 
creas, and the lymphatics, the food, or ingesta, be- 
comes admixed with these secretions in the process 
of digestion and the course of the circulation, and 
becomes still better fitted for ready combination with 
the substances of the tissues. 
There is no force required for this nutrition except 
the affinity that the several substances have for one 
another. It must, however, be understood that all 
these processes go on under vital direction of these 
affinities. These later are not by any means of a 
definite form, and but for vital direction they might 
form very anomalous combinations. 
ANIMAL HEAT. 
The term "animal heat" we, in common with 
other writers, nse here merely to express the heat of 
the body, without attempting to distinguish one ani- 
mal from another. Its generation in the system is of 
vast importance to health, over which it exercises a 
most controlling influence. It is proper, therefore, 
that we consider the subject somewhat at length here. 
The generation of animal heat has been referred to 
in a previous chapter, where the agency of oxygen in 
the metamorphosis or change of materials composing 
the tissues of the organs was discussed. It may here 
be said that in the course of all these changes modi- 
fications are constantly taking place in the relative 
condition of caloric, whether sensible or latent in its 
state. Oxygen has never been known to combine 
with any other element without affecting, to some 
degree, the temperature of the substances concerned. AEPAIX AND WASTE. 
293 
In the animal body, it is true, oxidation never goes 
on so rapidly as in conflagrations in the open air ; 
yet, as may be seen in the process of respiration 
alone, a great amount of oxygen is taken into the 
system, but it is breathed out again with the expired 
air, not, however, in the same form in which it was 
taken in : it is simply being mechanically received 
and combined with nitrogen, and given off chemically 
united with carbon in the form of carbonic-acid gas. 
While it is known that such a combination of oxygen 
and carbon cannot take place, either in or out of the 
body, without causing the evolution of a large amount 
of heat, it is by no means difficult to believe that 
what is called animal heat has its source in this 
phenomenon. It may be well to suggest that the 
union that occurs between the oxygen of the at- 
mosphere and the blood in the lungs is one of a semi- 
mechanical character, very similar to that previously 
existing between the oxygen and the nitrogen in the 
atmosphere. 
Oxygen does combine with the blood in the lungs ; 
this is shown by the change it produces in the color 
and consistence of this fluid ; these changes have 
been seen to take place in experiments exposing 
venous blood to the action of oxygen outside the 
body. It must, however, be evident that this combi- 
nation occurs with the mass of the blood, and not 
between this element and the individual constituents 
of the vital fluid. In the latter case the effects must 
of necessity be quite different from those that take 
place in the lungs. 
It is a fact, which appears to be self-evident, that 
the combustion of oxygen and carbon, whereby car- 294 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
bonic-acid gas is formed, takes place after the oxygen 
is carried by the circulation into the capillary vessels, 
for it is here that the peculiar effects of the workings 
of this process are evinced. It is in this part of its 
passage that the blood undergoes its remarkable 
change, and it is here that it acquires its dark purple 
color ; it is at this time too that carbonic acid, which 
is the evidence of combustion, or the chemic unit of 
oxygen and carbon, is present. If the point of origin 
of the process of oxidation, here said to be the cause 
of the evolution of animal heat, is traced, it will be 
found that, instead of the phenomenon occurring 
entirely within the lungs, it takes place through the 
system-in every tissue and organ of the entire body. 
In the circulation of the blood we find that two 
important changes occur; these might be said to take 
place at entirely opposite points. By one of these 
changes the color of the blood is altered to a lively 
red ; by the other, to a dark or purple ; and it is this 
last-named change, and not the first, that indicates 
the specific office of the oxygen. In fact, as before 
stated, the agency of the oxygen is concerned in the 
general metamorphosis of the tissues. In this process 
we at once find an evolution of heat and energy, 
which is the result of this phenomenon. 
Heat is disseminated with more or less rapidity 
through all bodies, varying according to their density, 
but in general penetrating with more celerity those 
that are most solid than those more porous. Thus, 
the matter of heat is never at rest, but is continually 
passing and repassing through matter, seeking an 
equilibrium or level. The human body is also subject 
to the same law ; and as heat is constantly being REPAIR AND WASTE. 
295 
generated in its tissues, it must also as constantly be 
eliminated ; and vice versa, for the very reason that 
it is thus perpetually being removed, it must be con- 
tinually generated. Thus since the exercise of the 
day has diminished the force or quantity of the living 
power, the necessity arises for rest to restore it during 
the night. During sleep the functions are performed 
in a slower and more feeble manner or cease entirely ; 
animal heat is less rapidly evolved ; the living power 
accumulates ; the organs recover their tone, and the 
whole vital energies are concentrated, ready to meet 
the exigencies of the coming day. 
PERSPIRATION. 
We have already, in a previous chapter, discussed 
the effects of any check to the perspiratory functions. 
Nevertheless, in order to make the subject more clear, 
we will consider it again in detail, although in doing 
so some repetitions will necessarily occur. 
The perspiratory excretion exerts an important in- 
fluence on the integrity of the living organism. A 
sudden check or prolonged retention of it in the body 
is certain to produce more or less serious derangement 
of the functions. There is no disease, perhaps, in 
which the perspiratory function is not in some measure 
affected. 
The perspirable fluid, or sweat, is secreted from 
the blood, which later, through this process, is kept 
in a state of purity (see, in a previous chapter, the 
section devoted to the appendages of the skin). As 
has been said elsewhere, the organs that separate the 
perspirable fluid from the blood are the sudorific 
glands ; these absorb the watery poison of the blood 296 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
from the capillaries or interstitials of the tissues. 
During the course of the circulation all the blood, no 
doubt, in turn, is presented to the secretory vessels, 
which separate useless portions and remove them from 
the system. 
The perspiratory process, as has been said, is one 
of immense importance to the living body. Its prin- 
cipal uses are : 
First : To moisten the external surfaces of the body. 
Every part of the system-the internal surfaces, even 
the very substance of the organs themselves, and the 
external skin-requires a certain degree of moisture 
to lubricate, soften, and qualify it for the performance 
of its functions. Too great a dryness of the skin 
injures the epidermis, or scarf-skin, and the termina- 
tion of the papillae or ends of the nerves, which 
impairs, and ultimately injures, the true skin and 
diverts sensation. 
Second : To remove the worn-out material from the 
system. By this process the effete substances and 
those which are no longer useful are removed, thereby 
cleansing and purifying the living tissue ; relieving 
it of a mass of morbid putrefactive matter which, if 
retained in the system, would eventually interrupt 
the play of the organs, prove a source of irritation to 
their fibers, and undoubtedly cause disease. By this 
process the blood and all the other fluids are purified, 
and kept in a condition most conducive to sound 
health. The perspiratory organs may justly be re- 
garded as the principal natural outlets or emunctories 
for the surplus matter that is continually accumulating 
in the blood. 
Third : To remove poisonous or other irritating, REPAIR AND WASTE. 
297 
extraneous matter from the body. We have pre- 
viously pointed out the method by which everything 
entering the body is removed from the system. What- 
ever is received into the stomach passes to the intes- 
tine, a portion going thence through the lacteals and 
thoracic duct into the blood ; the gaseous substances, 
which enter the lungs, pass directly from these organs 
into the blood. Solid and liquid poisons usually 
enter the body through the mouth and stomach, and 
gaseous ones by way of the lungs. How, then, when 
a poison has penetrated the system, does nature expel 
it? If the poison is a liquid or a solid substance 
taken into the stomach, the irritation it produces or 
the administration of an emetic may induce vomiting, 
thus ejecting it before any part is absorbed, and so 
saving the system from further ill effects. But if 
the irritant be a gas taken into the lungs, or if the 
poison has had time to enter the circulation before 
vomiting takes place, it must then be removed from 
the system through the grand emunctories of the 
blood-the perspiratory organs ; that is, it must pass 
off with the perspiration. But for this most admirable 
provision of nature to cleanse, to purify, to drain off 
extraneous matter, death would ensue. 
Fourth : Another important use of the perspiration is 
to regulate the temperature of the body. It has already 
been shown that much heat is abstracted by the 
process of evaporation. It cannot but have been ob- 
served by every one how readily exercise is followed 
by perspiration. This, therefore, is nature's method 
of regulating the heat of our bodies and thus dis- 
sipating fevers. 
Failure on the part of the perspiratory organs to 298 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
perform, in any degree, their functions causes a reten- 
tion in the system of matters whose presence is ex- 
ceedingly injurious, for putrefaction is apt to occur, 
whereby all the fluids of the body will become con- 
taminated, their stimulating qualities weakened, and 
all the secretions so necessary to maintain the vital 
actions of the system will become vitiated. . 
When the function of perspiration is impaired, 
good health can never be enjoyed ; hence the pro- 
priety of washing, bathing, frictions, to soften and 
relax the skin, in which are situated the organs that 
separate the perspiratory fluid from the blood. 
THE POWER THAT SUPPORTS AND PRESERVES 
HEALTH. 
It must be evident to tlie reader who lias carefully 
perused the foregoing pages that the preserving power 
of health can be nothing more than the living power 
of the system exercising its full and wholesome in- 
fluence over the vital organs, by which they are kept 
in a healthy condition. This power, although de- 
pending upon matter exterior to the body, may be 
said to be exerted internally ; conjointly with which 
are many causes having an influence upon health that 
depend upon the reasoning faculties and the influence 
of the will. These are, principally, a suitable degree 
of exercise and rest ; the rational indulgence of the 
propensities and passions ; and, in short, the due ob- 
servance of temperance in everything that is capable 
of producing either a moral or a physical effect upon 
the system. REPAIR AND WASTE. 
299 
REVIEW QUESTIONS. 
What are waste-products ? 
Through what channels do they pass out of the system? 
What means are required to supply waste ? 
Should the body become fatigued, what condition would exist? 
What waste-products are cast off from the lungs? 
What waste-products from the kidneys? 
Does the digestive tract enter into the formation of waste-products? 
What is nutrition ? 
What organs are concerned in sustaining nutrition? 
Has affinity any power in its production ? 
What is regarded as animal heat ? 
I low is heat generated in the body ? 
What takes place when oxygen is combined with carbon? 
Where does the blood take on its dark color ? 
What two changes take place in the blood in one revolution of the 
same ? 
With these changes, what supply is provided to the system ? 
Why does the system require rest ? 
What takes place in the system while we sleep? 
What is produced when free perspiration is brought about? 
Should there be a blocking-up of the perspiration, what would follow? 
When poison is taken into the system, why is the skin the best means 
to eliminate it? 
If the poison remains in the system for a great length of time, what is 
the best means to eliminate it? 
Is the temperature of the body influenced by perspiration? 
What are required for the maintenance of good health ? 
TABLE OF PHYSIOLOGIC CONSTANTS.-(Brubaker.) 
Mean height of male : 5 feet 6J inches ; of female : 5 feet 2 inches. 
Mean weight of male : 145 pounds; of female : 121 pounds. 
Number of chemic elements in the human body : From 16 to 18. 
Number of proximate principles in the human body : About 100. 
Amount of water in a body weighing 145 pounds : 108 pounds. 
Amount of solids in a body weighing 14g pounds : 36 pounds. 
Amount of saliva secreted in twenty-four hours : About 3^ pounds. 
Function of saliva : Converts starch into maltose. 
Active principle of saliva : Ptyalin. 300 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
Amount of gastric juice secreted in twenty-four hours: From 8 to 14 
pounds. 
Function of gastric juice : Converts albumin into peptone. 
Active principles of gastric juice : Pepsin and hydrochloric acid. 
Duration of digestion : From three to five hours. 
Amount of intestinal juice secreted in twenty four hours : About I pound. 
Function of intestinal juice : Converts starch into maltose. 
Amount of pancreatic juice secreted in twenty four hours: About ij 
pounds. 
Active principles of pancreatic juice : Trypsin, amylopsin, and steapsin. 
Functions of pancreatic juice: I. Emulsifies fats. 2. Converts albumin 
into peptone. 3. Converts starch into maltose. 
Amount of bile poured into the intestines daily : About 2 J pounds. 
Functions of bile : I. Assists in the emulsification of fats. 2. Stimulates 
the peristaltic movements. 3. Prevents putrefactive changes in the 
food. 4. Promotes the absorption of the fat. 
Amount of blood in the body : From 16 to 18 pounds. 
Size of red corptiscles : of an inch. 
Size of white corpuscles : of an inch. 
Shape of red corpuscles : Circular biconcave disks. 
Shape of white corpuscles : Globular. 
Number of red corpuscles in a cubic millimeter (the cubic of an inch of 
blood}: 5,000,000. 
Function of red corpuscles: To carry oxygen from the lungs to the 
tissues. 
Frequency of the heart's pulsation a minute : 72 on the average. 
Velocity of the blood movement in the arteries : About 12 inches a second. 
Length of time required for the blood to make an entire circuit of the vas- 
cular system : About twenty seconds. 
Amount of air passing in and out of the lungs at each respiratory act: 
From 20 to 30 cubic inches. 
Amount of air that can be taken into the lungs on a forced inspiration : 
110 cubic inches. 
Amount of reserve air in the lungs after an ordinary expiration: too 
cubic inches. 
Amount of residual air always remaining in the lungs : About 100 cubic 
inches. 
Vital capacity of the lungs : About 250 cubic inches. 
Entire volume of air passing in and out of the lungs in twenty four hours : 
About 400 cubic feet. 
Composition of air: Nitrogen, 79.19 ; oxygen, 20.81, in 100 parts. REPAIR AND WASTE. 
301 
Amount of oxygen absorbed in twenty-four hours : 18 cubic feet. 
Amount of carbonic acid exhaled in twenty-four hours : 14 cubic feet. 
Temperature of the human body at the surface : 98.6° Fahrenheit. 
Amount of urine excreted daily : From 40 to 50 ounces. 
Amount of urea excreted daily : 512 grains. 
Specific gravity of urine : From 1.015 to 1.025. 
Number of spinal nerves: 31 pairs. 
Number of roots of origin: Two-first, anterior, efferent; second, pos- 
terior, afferent. 
Kate of transmission of nerve force : About too feet a second. 
Number of cranial nerves : 12 pairs. 
Nerves of special sense: 1. Olfactory, or first pair. 2. Optic, or second 
pair. 3. Auditory, or eighth pair. 4. Chorda tympani for anterior 
two-thirds of tongue. 5. Branches of glossopharyngeal, or eighth 
pair, for posterior one-third of tongue. 
Motor nerves to eyeball and accessory structures: Motor oculi, or third 
pair ; pathetic, or fouth pair ; abducens, or sixth pair. 
Motor nerve to facial muscles : Portio dura, facial, or seventh pair. 
Motor nerve to tongue : Hypoglossal, or twelfth pair. 
Sensory nerve of the face : Trifacial, or fifth pair. 
Sensory nerve of the pharynx : Glossopharyngeal, or ninth pair. 
Sensory nerves of the lungs, stomach, etc. : Pneumogastric, or tenth pair. 
Length of spinal cord : 16 to 18 inches; weight, ounces. 
Point of decussation of motor fibers : At the medulla oblongata. 
Point of decussation of sensory fibers : Throughout the spinal cord. 
Function of the anterolateral columns of the spinal cord : Transmit motor 
impulses from the brain to the muscles. 
Functions of the posterior columns : Assist in the coordination of mus- 
cular movements. 
Functions of the medulla oblongata : Controls the functions of insalivation, 
mastication, deglutition, respiration, circulation, etc. 
Function of the cerebellum: Center for the coordination of muscular 
movements. 
Function of the cerebrum : Center for intelligence, reason, and will. 
Center for articulate language : Third frontal convolution on the left side 
of the cerebrum. 
Number of coats to the eye : Three-first, cornea and sclerotic ; second, 
choroid ; third, retina. 
Function of iris : Regulates the amount of light entering the eye. 
Function of crystalline lens : Refracts the rays of light so as to form an 
image on the retina. 302 
ANATOMY AND PHYSIOLOGY FOR NURSES. 
Function of retina : Receives the impression of light. 
Function of the membrana tympani: Receives and transmits waves of 
sound to the internal ear. 
Function of the Eustachian tube : Regulates the passage of air into and 
from the middle ear. 
Function of the semicircular canals: Assist in maintaining the equipoise 
of the body. 
function of the cochlea: Appreciates the shades and combinations of 
musical tones. 
Size of human ovum: of an inch in diameter. 
Size of spermatozoa : of an inch in length. 
Function of placenta : Acts as a respiratory and digestive organ for the 
fetus. 
Duration of pregnancy: 280 days. INDEX. 
Abdomen, muscles of, 59 
action, 61 
regions of, 170 
Abdominal aorta, 93, 94, 109 
cavity, 29 
arteries of, 128 
veins of, 128 
Abducens nerve, 216 
Abductor pollicis muscle, 69 
Accommodation, 260 
Acini of mammary glands, 245 
Acromion process, 32 
Adductor brevis muscle, 75 
longus muscle, 75 
magnus muscle, 75 
minimi digiti muscle, 70 
obliquus pollicis muscle, 70 
transversus pollicis muscle, 70 
Adenology, definition, 12 
Adipose tissue, 80 
Albuminoids of blood, 134 
Alimentary tract, 149 
Alveoli, 130 
Ameboid movement of leukocytes, 
133 
Amylopsin, 165 
Anabolism, 175 
Anatomy, definition, II, 12 
Anconeus muscle, 68 
Angiology, definition, 12 
Animal heat, 292 
Annular ligaments, 79, 80 
Anterior annular ligament, 79 
auricular artery, 99 
cerebral artery, 101, 210 
chamber of eye, 255 
crural nerve, 224 
cutaneous nerve, 224 
horns of cord, 214 
jugular vein, 122 
Anterior lobe of brain, 206 
meningeal artery, lot, 211 
tibial artery, 115 
nerve, 225 
ulnar vein, 123 
vertebral muscles, 57 
Antrum of Highmore, 24 
Anus, 163 
Aorta, 87, 88, 92 
abdominal, 93, 94, 109 
arch of, 93 
ascending, 93 
branches of, 88, 93, 94, 95 
descending, 94 
thoracic, 93, 94, 108 
transverse, 93 
Appendix vermiformis, 162 
Aqueous humor, 252, 255 
Arachnoid, 192 
membrane, 204, 212 
Arbor vitse, 194, 208 
Arch of aorta, 93 
Areola of breasts, 243 
Arm, bones of, 32 
muscles of, 62, 64 
veins of, 122, 123 
deep, 124 
superficial 123 
Arterias receptaculi, 101 
Arterial system, 89, 90 
Arteries, 89, 90 
blood in, direction of, 89 
supply of, 92 
coats of, 91 
of abdominal cavity, 128 
of thoracic cavity, 128 
sheath of, 92 
structure of, 91 
Articular synovial membranes, 250 
Articulations of bones, 37 
303 304 
INDEX. 
Ascending aorta, 93 
colon, 162 
pharyngeal artery, 99 
Astigmatism, 260 
Astragalus, 36 
Atlas of spine, 19 
Attollens, 49 
Attrahens, 49 
Auditory artery, 210 
canal, 261 
nerve, 218 
organs, 261 
Aurem muscles, 49 
Auricle of ear, 261 
Auricles, 85 
Auricular artery, anterior, 99 
posterior, 99 
muscles, 49 
vein, posterior, 121 
Axillary artery, 102, 104 
glands, 231 
plexus, 221 
vein, 124 
Axis of spine, 19 
Azygos uvulae muscle, 56 
veins, 118, 127 
Back, muscles of, 57 
Bartholin glands, 274 
Basilar artery, 103, 210 
Basilic vein, 123 
median, 124 
Biceps flexor cubiti muscle, 66 
muscle, 77 
Bicuspid valve, 86 
Big neck, 242 
Bile, 164, 166, 233 
Birth, circulatory changes at, 137 
Blackheads, 245 
Bladder, 178 
female, 274 
Blind pouch of large intestine, 162 
Blood, 130 
albuminoids of, 134 
alkaline reaction of, 131 
arterial, direction of, 89 
circulation of, 84 
color of, 131 
composition of, 131 
corpuscles of, 131. See also Cor- 
puscles. 
Blood, distribution, 131 
fibrinogen of, 134 
hemoglobin of, 132 
in veins, 118 
paraglobulin of, 134 
plasma of, 133 
properties of, 131 
proteids of, 133 
quantity of, 134 
reaction of, 131 
salts of, 134 
Bones, 13 
articular eminences of, 16 
articulations of, 37 
cancellated tissue of, 13 
chemical analysis of, 14 
classification of, 16 
composition of, 14, 15 
age and, 15 
depressions of, 16, 18 
eminences of, 16 
flat, 16 
inorganic constituents of, 14, 15 
irregular, 16 
lamellae of, 13 
line of, 16 
long, 16 
non-articular depressions of, 18 
eminences of, 16 
of body, 18 
of nose, 266 
organic constituents of, 14, 15 
ridge of, 16 
sensibility of, 14 
short, 16 
spine of, 16 
surfaces of, 16 
tuberosities of, 16 
Wormian, 18 
Brachial artery, 105, 106 
nerves, 222 
plexus, 221 
venae comites, 122 
Brachialis anticus muscle, 66 
Brain, 191, 203 
arterial supply of, 209 
functions of, 199 
interior of, 206 
lobes of, 206, 208 
membranes of, 191, 204 
sinuses of, 211 INDEX. 
305 
Brain, under surface of, 206 
ventricles of, 207 
Breast-bone, 27 
Breasts, 243. See also Mammary 
glands. 
Breathing air in lungs, 145 
Bridle of tongue, 240 
Bronchi, 141 
in respiration, 145 
Bronchial arteries, 108 
Bronchocele, 242 
Buccinator muscle, 52 
Bulbus aortae, 92 
Bursae, 250 
Canthi, 257 
Capillaries, 90, 131 
walls of, 92 
Capillary attraction, venous circula- 
lation and, Il8 
Capsule of kidney, 178 
of lens, 256 
Cardiac orifice of stomach, 156 
veins, 129 
Carotid arteries, 96 
artery, internal, loo, 209 
Carpus, bones of, 33, 34 
Cartilage, 40 
Caruncula lacrimalis, 259 
Casts, urinary, 182 
Cauda equina, 196, 214 
Cecum, 162 
Celiac axis, no 
Cephalic vein, 124 
median, 124 
Cerebellum, 191, 193, 208 
functions of, 200 
Cerebral artery, anterior, IOI, 210 
middle, 210 
posterior, 210 
hemispheres, functions of, 199 
Cerebrospinal fluid, 204 
nerves, 226 
Cerebrum, 191, 192, 205 
cortical portion of, 192, 206 
functions of, 199 
hemispheres, functions of, 199 
medullary portion of, 192, 206 
Cerumen, 262 
Cervical vertebrae, 18 
Cervix uteri, 278 
Choroid coat, 252, 254 
plexus, 205, 207 
Chyle, 150, 168, 243 
Chyme, 164 
Ciliary processes, 252, 255 
Circle of Willis, 209, 210 
Circular fibers of iris, 254 
Circulation, changes in, at birth, 137 
fetal, 134 
of blood, 84 
portal, 129 
pulmonary, 129 
Circulatory system, 84 
of fetus, 134 
Clavicle, 32 
Clavus, 185 
Clitoris, 273 
Coccygeal nerve, 225 
vertebra?, 18 
Coccyx, 30 
articulation of, 20 
Cochlea, 264 
Cochlear nerve, 218 
Collar-bone, 32 
Colles's fracture, 32 
Colon, 162 
ascending, 162 
descending, 162, 163 
transverse, 162, 163 
Combustion, bodily, 292 
Common carotid arteries, 96 
iliac arteries, 112 
vein, 127 
Complementary air in lungs, 145 
Conglobate glands, 231 
Conjunctiva, 259 
Constants, physiologic, 299 
Constrictor muscles, 56 
Convolutions of cerebrum, 205 
Coracobrachialis muscle, 66 
Coracoid process, 32 
Corium, 184 
Cornea, 252, 253 
Coronary artery, 95, HO 
Corpora quadrigemina, 208 
Corpus callosum, 193, 206 
luteum, 286 
striatum, 208 
Corpuscles, 131 
red, 131 
white, 132 306 
INDEX. 
Corrugator supercilii muscle, 50 
Cortical portion of cerebrum, 192, 206 
Cranial nerves, 215 
Crassamentum, 131 
Crest of pelvis, 30 
Crow's beak, 32 
Crural nerve, 223, 224 
Crureus muscle, 74 
Crystalline humor, 252, 256 
Cuneiform bone, 34 
Cutaneous nerves, 223, 224 
transpiration, 291, 295 
Deglutition, 154 
Deltoid muscle, 65 
Dental nerves, 216 
Depressions of bones, 16, 18 
Depressor anguli oris muscle, 52 
labii inferioris muscle, 51, 52 
Derma, 184 
Dermatology, definition, 12 
Descending aorta, 94 
colon, 162, 163 
Diaphragm, 27, 62, 147, 250 
interior view of, 146 
Diaphragmatic muscles, 62 
Digastric muscle, 55 
Digestion, 148 
intestinal, 164 
Digestive system, 148 
tract, 149 
Dorsal arteries of foot, 116 
of hand, 107 
ganglia, 227 
interossei muscles, 70 
nerves, 222 
vertebrae, 18 
articulations of, 19 
Dorsalis hallucis artery, 115 
pedis artery, 115 
Ductus arteriosus, 137 
venosus, 137 
Duodenum, 160 
Dura mater, 191, 204, 212 
Ear, 261 
external, 261 
internal, 263 
nerves of, 263 
Ear-wax, 262 
Eighth cranial nerve, 218 
Eleventh cranial nerve, 220 
Eminences of bones, 16 
Endosteum, 14 
Ensiform of sternum, 127 
Epidermis, 184 
Epigastric artery, superior, 104 
region, 171 
Erythrocytes, 131 
Esophageal arteries, 108 
Ethmoid bone, 23 
Eustachian tube, 263 
Excretion, bodily, 291 
Excretory system, 174 
Extensor brevis pollicis muscle, 69 
carpi radialis brevior muscle, 68 
longior muscle, 68 
ulnaris muscle, 68 
communis digitorum muscle, 68 
indicis muscle, 69 
longus digitorum pedis muscle, 78 
pollicis muscle, 69, 78 
minimi digiti muscle, 68 
ossis metacarpi pollicis muscle, 69 
Exterior coat of stomach, 156 
External carotid artery, 96 
cutaneous nerve, 223 
ear, 261 
iliac artery, 113 
vein, 127 
intercostal muscle, 61 
jugular vein, 118, 122 
layer of retina, 255 
malleolus, 36 
musculocutaneous nerve, 225 
oblique muscle, 59 
plantar nerve, 225 
popliteal nerve, 225 
pterygoid muscle, 53 
saphenous vein, 125 
Eyeball, 252, 253 
Eyebrows, 257 
Eyelashes, 259 
Eyelids, 257 
Eyes, 252 
appendages of, 257 
Face, muscles of, 48 
Facial arteries, 98 
artery, transverse, 100 
nerve, 217 
veins, 119, 120 INDEX. 
307 
Fallopian tubes, 281 
False ribs, 28 
Falx cerebri, 192 
Far-sightedness, 261 
Fasciculi of muscle, 45 
Fat, 80 
Female organs of generation, 272 
Femoral artery, 113, 114 
muscles, 72, 77 
nerve, 224 
vein, 125 
Femur, 34 
Fenestra of ear, 264 
Fetus, uterus of, 278 
vascular system of, 134 
Fibrinogen of blood, 134 
Fibrocartilage, 40 
Fibrocartilages of nose, 266 
Fibula, 36 
Fifth cranial nerve, 215 
Filiform papillae of tongue, 266 
Fimbriae of oviducts, 282 
Fimbriated extremity of oviducts, 
282 
Fingers, bones of, 34 
First cranial nerve, 215 
Fissura palpebrarum, 257 
Fissure of Sylvius, 206 
Flat bones, 16 
Flexor brevis pollicis muscle, 69 
carpi radialis muscle, 67 
ulnaris muscle, 67 
longus pollicis muscle, 67 
minimi digiti muscle, 70 
profundus digitorum muscle, 67 
sublimis digitorum muscle, 67 
Floating ribs, 28 
Fontanel, 23 
Foot, bones of, 36, 37 
ligaments of, 39 
muscles of, 74 
Foramen magnum, 22 
of Monro, 207 
ovale at birth, 137 
Forearm, bones of, 32, 33 
muscle of, 63, 67 
Fornix of brain, 207 
Fourth cranial nerve, 215 
Fracture, Colles', 32 
greenstick, 15 
Frenum, 240 
Frontal bones, 22 
vein, 119 
Fundus of uterus, 278 
Fungiform papillae of tongue, 266 
Gall-bladder, 233, 234 
Ganglia, 199, 227 
Ganglionic nerve, 228 
Gasserian ganglion, 216 
Gastric artery, no 
glands, 158, 159 
juice, 157 
action of, 159 
composition of, 158 
Gastrocnemius muscle, 79 
Gemellus inferior- muscle, 76 
superior muscle, 76 
Genesiology, definition, 12 
Geniohyoglossus muscle, 55 
Geniohyoid muscle, 55 
Genital nerve, 223 
Genitalia, female, 272 
Genitocrural nerve, 223 
Gladiolus of sternum, 27 
Glands, 230 
Glandular system, 230 
Glenoid cavity, 32 
Glossopharyngeal nerve, 218 
Gluteal muscles, 75 
Gluteus maximus muscle, 75 
medius muscle, 76 
minimus muscle, 76 
Goiter, 242 
Graafian vesicles, 283 
Gracilis muscle, 75 
Gray commissure, 214 
Great sciatic nerve, 225 
Greenstick fracture, 15 
Gustatory nerve, 264 
Hair, 187 
Hand, bones of, 33 
muscles of, 63, 69 
sense of touch and, 269 
Haversian canals, 14 
Head ganglia, 227 
muscles of, 48, 49 
veins of, 119 
Health, power that supports, 298 
preservation of, 298 
Hearing, organs of, 261 308 
INDEX. 
Heart, 84 
openings of. 89, 90 
orifices of, valves of, 85 
Heart-beat, 89 
Heat, bodily, 292 
Heel-bone, 37 
Hemoglobin, 132' 
Hepatic artery, 110 
Horns of cord, 214 
Humerus, 32 
Humors of eye, 252, 255, 256 
Hyaloid, 257 
Hydrocephalus, 207 
Hydrochloric acid in gastric juice, 
158, 159 
Hymen, 273 
imperforate, 273 
Hyoglossus muscle, 55 
Hyoid bone, 26 
Hyperopia, 261 
Hypochondriac regions, 171, 172 
Hypogastric region, 172 
Hypoglossal nerve, 220 
Ileum, 161 
Iliac arteries, common, 112 
muscles, 71 
vein, common, 127 
external, 127 
internal, 127 
Iliacus muscle, 72 
Iliohypogastric nerve, 223 
Ilio-inguinal nerve, 223 
Ilium, 30 
Imperforate hymen, 273 
Incus, 263 
Inferior constrictor muscle, 56 
maxillary bones, 25, 26 
muscles, 51 
nerve, 216 
mesenteric artery, 111 
veins, 122 
vena cava, 118, 126 
Infracostales muscle, 61 
Infra-orbital nerve, 216 
Infraspinatus muscle, 65 
Inguinal glands, 231 
muscles, 71 
regions, 172 
Inner canthus, 257 
Innominate artery, 95 
Innominate veins, 118, 121, 126 
Insalivation, 150 
Insertion of muscles, 45 
Intercostal arteries, posterior, 108 
artery, superior, 104, 108 
muscles, 61 
nerves, 222 
spaces, 29 
veins, 127 
Interior coat of stomach, 156 
Intermaxillary muscles, 52 
Internal carotid artery, 100, 209 
ear, 263 
iliac artery, 112 
vein, 127 
jugular vein, 118, 120, 121 
layer of retina, 255 
malleolus, 36 
mammary artery, 104 
maxillary artery, ioo- 
vein, 119 
musculocutaneous nerve, 225 
oblique muscle, 60 
plantar nerve, 225 
popliteal nerve, 225 
pterygoid muscle, 53 
saphenous vein, 126 
Intervertebral foramina, 199 
Intestinal digestion, 164 
juice, 165 
Intestines, 159 
digestion in, 164 
large, 159, 162 
small, 159, 160 
coats of, 161 
lymphatics of, 164, 166 
villi of, 162, 164 
Involuntary muscles, 47 
Iris, 252, 254 
Irregular bones, 16 
Ischium, 30 
Island of Reil, 206, 208 
Jaws, bones of, 24, 25, 26 
muscles of, 51 
Jejunum, 160 
Joints, 37, 38 
elements of, 40 
Jugular vein, anterior, 122 
external, 122 
veins, 118, 120,121 INDEX. 
309 
Katabolism, 175 
Key-bone, 32 
Kidneys, 177 
blood-supply of, 178 
capsule of, 178 
waste-products eliminated by, 176 
Knee-cap, 36 
Knee-joint, ligaments of, 38 
Labia majora, 272 
minora, 272 
Labyrinth, 263 
Lacrimal glands, 242 
Lactation, 244 
Lacteals, 164, 166 
Lamellae, 13 
Large intestine, 159, 162 
Larynx, 140 
Latissimus dorsi muscle, 59 
Left common carotid artery, 96 
hypochondriac region, 172 
inguinal region, 172 
innominate vein, 127 
intercostal vein, 127 
lumbar region of stomach, 172 
Leg, bones of, 36 
muscles of, 71, 73, 74, 77 
veins of, 124 
Lens, 256 
capsule of, 256 
Lenticular follicles of tongue, 266 
Leukocytes, 132 
Leukocytosis, 133 
Levator costaruni muscle, 61 
labii muscle, 51,52 
palati muscle, 56 
palpebrse muscle, 50 
Lieberkuhn's glands, 165 
Ligamenta dentata, 214 
Ligaments, 40 
annular, 79, 80 
of foot, 39 
of knee-joint, 38 
of shoulder, 38 
of wrist-joint, 39 
sutural, 38 
Ligamentum denticulatum, 198 
Line of bones, 16 
Linea alba, 61 
Lingual artery, 97 
bone, 26 
Lingualis muscle, 55 
Liver, 232 
blood-supply of, 233 
color, 233 
function of, 233 
Long bones, 16 
Longus colli muscle, 57 
Lower extremities, bones of, 34, 35 
muscles of, 71 
veins of, 124 
jaw, bones of, 25, 26 
Lumbar arteries, 112 
nerves, 223 
plexus, 223 
regions of stomach, 172 
vertebrae, 18 
articulations of, 20 
Lumbricales muscles, 70 
Lungs, 140, 141 
air taken into, 144 
breathing air in, 145 
color of, 142 
complementary air in, 145 
relations of, 142 
reserve air in, 144 
residual air in, 144 
shape of, 142 
• situation of, 141 
substance of, 142 
supplemental air in, 144 
tidal air in, 145 
waste-products eliminated by, 176 
weight of, 142 
Lymph, 167 
Lymphatic ganglia, 230 
Lymphatics, 230 
of small intestine, 164, 166 
Malar bones, 24 
Malleoli, 36 
Malleus, 263 
Mammary artery, internal, 104 
glands, 243 
acini of, 245 
changes in, 244 
in interogestation, 244 
in lactation, 244 
structure of, 244 
Manubrium of sternum, 27 
Masseter muscle, 52 
Mastication, 150 310 
INDEX. 
Mastication, nerves involved in, 150 
Mastoid cells, 263 
Matrix of nail, 189 
Maxillary artery, 100 
internal, 100 
bones, inferior, 25, 26 
superior, 24 
muscles, 51 
nerves, 216 
vein, inferior, 119 
Meatus auditorius, 261 
of nose, 268 
urinarius, 179 
Meckel's ganglion, 216 
Median basilic vein, 124 
cephalic vein, 124 
vein, 124 
Mediastinal arteries, posterior, 108 
Mediastinum, 141, 146 
Medulla oblongata, 191, 194, 208 
functions of, 200 
Medullary portion of cerebrum, 192, 
206 
Meibomian glands, 258 
Membrana tympani, 262 
Membranes of body, 249 
Meningeal arteries, 211 
artery, anterior, 101 
Menstrual periods, 286 
Menstruation, 286 
uterus at, 278 
Mesenteric artery, inferior, 111 
superior, 111 
glands, 231, 242 
Metabolism, 174 
Metacarpus, 34 
Metatarsal bones, 37 
Micturition, 180 
involuntary, 180 
Middle cerebral artery, 210 
coat of stomach, 156 
layer of retina, 255 
lobe of brain, 206 
meningeal artery, 211 
temporal artery, too 
Mitral valve, 86 
Monro's foramen, 207 
Mons veneris, 272 
Morsus diaboli, 282 
Motion, nerves of, 201 
Motor oculi nerves, 215 
Mucosin, 152 
Mucous coat of stomach, 156 
follicles of tongue, 266 
membrane, 249 
of nose, 267 
Mumps, 240 
Muscles, anterior vertebral, 57 
contractility of, 45 
diaphragmatic, 62 
femoral, 72, 77 
fibers of, 45 
form of, 46 
gluteal, 75 
grouping of, 48 
inferior maxillary, 51 
insertion of, 45 
intermaxillary, 52 
involuntary, 47 
irritability of, 45 
maxillary, 51 
nasal, 51 
non-striped, 47 
number of, 45 
of abdomen, 59 
action of, 61 
of arm, 62, 64 
of back, 57 
of face, 48 
of foot, 74, 79 
of forearm, 63, 67 
of hand, 63, 69 
of head, 48, 49 
of jaws, 51 
of leg, 71, 73, 74, 77 
of lower extremities, 71 
of neck, 49, 53, 54 
of nose, 51 
of orbits, 50, 51 
of palate, 55 
of pelvis, interior, 73 
of perineum, 80 
of shoulder, 62, 64 
of thigh, 72, 73 
of thorax, 61 
of trunk, 57, 58 
of upper extremities, 62 
origin of, 45 
pharyngeal, 56 
pterygomaxillary, 53 
sheath of, 47 
size of, 46 INDEX. 
311 
Muscles, striped, 46, 47 
structure of, 45 
superior maxillary, 51 
temporomaxillary, 52 
vertebral, anterior, 57 
voluntary, 46, 47 
Muscular coat of stomach, 156 
system, 45 
Musculocutaneous nerve, 225 
Myology, definition, 12 
Myopia, 260 
Nails, 185, 189 
Nasal bones, 24 
duct, 259 
fossae, 267 
muscles, 51 
septum, 24, 267 
bones of, 24 
cartilage of, 24 
Neck, ganglia of, 227 
muscles of, 49, 53, 54 
veins of, 119, 121 
Nerves, 197, 215 
cranial, 215 
functions of, 200 
involved in mastication, 150 
of general sensation, 201 
of motion, 201 
of respiration, 201 
of special sense, 201 
sacral, 224 
spinal, 220 
sympathetic, 202, 226 
Nervous layer of retina, 255 
system, 191 
functions of, 199 
Neurilemma, 198, 214 
Neurology, definition, 12 
Ninth cranial nerve, 218 
Nipple, 243 
Non-striped muscles, 47 
Nose, 266 
bones of, 23, 24, 266 
fibrocartilages of, 266 
fossae of, 267 
meatus of, 268 
mucous membrane of, 267 
muscles of, 51 
septum of, 24, 267 
spongy bones of, 267 
Nose, turbinated bones of, 267 
Nostrils, 267 
Nutrition, 291 
Oblique muscles, 59, 60 
Obturator externus muscle, 76 
internus muscle, 76 
nerve, 224 
Occipital artery, 98 
bone, 22 
muscles, 48 
vein, 121 
Occipitofrontalis muscle, 48 
Ocular arteries, 101 
Olecranon, 32 
Olfactory nerve, 215 
Omohyoid muscle, 54 
Ophthalmic artery, 101 
nerve, 216 
Opponens minimi digiti muscle, 70 
pollicis muscle, 69 
Optic lobes of brain, 208 
nerve, 215 
thalamus, 208 
Orbicularis oris muscle, 52 
palpebrarum muscle, 50 
Orbital arteries, 101 
artery, 99 
< )rbits, 25 
foramen of, 25 
muscles of, 50, 51 
Organs of sight, 252 
of special sense, 252 
Origin of muscles, 45 
Os calcis, 37 
magnum, 34 
Ossa innominata, 20, 30 
Osteology, 13 
definition, 12 
Ostium abdominale, 28} 
internum, 281 
Outer canthus, 257 
Ovarian arteries, 111 
Ovaries, 282 
arteries of, 287 
blood-supply of, 287 
ligaments of, 287 
nerves of, 288 
veins of, 287 
Oviducts, 281 
Ovum, 285 312 
INDEX. 
Ovum, discharge of, 285 
Oxidation, bodily, 292 
Palate bones, 25 
muscles, 55 
Palatoglossus muscle, 56 
Palatopharyngeus muscle, 56 
Palmar arch, superficial, 107 
interossei muscles, 71 
Palmaris brevis muscle, 70 
longus muscle, 67 
Palpebrse, 257 
Palpebral muscles, 49 
Pampiniform plexus, 288 
Pancreas, 238 
Pancreatic juice, 165, 238 
Papillae, 257 
of skin, 185 
of tongue, 266 
Paraglobulin of blood, 134 
Parietal bones, 22 
layer of arachnoid, 204 
Parotid arteries, 99 
glands, 239 
Parotitis, 240 - 
Parturition, uterus after, 280 
Patella, 36 
Pathetic nerve, 215 
Pavilion of ear, 261 
Pectineus muscle, 75 
Pectoralis major muscle, 63 
minor muscle, 63 
Pelvis, 26^ 29 
bones of, 29 
brim of, 30 
cavity of, 30 
crest of, 30 
interior of, muscles of,' 73 
outlet of, 30 
Pepsin in gastric juice, 158, 159 
Pericardiac arteries, 108 
Pericardium, 85, 249 
Perineum, 80 
muscles of, 80 
Periosteum, 14 
Peristalsis, 163 
Peritoneum, 249 
Perspiration, 291, 295 
glands of, 185, 245 
uses of, 296-298 
Peyer's patches, 162 
Phalanges of foot, 37 
of hand, 34 
Pharyngeal artery, posterior, 99 
muscles, 56 
Pharynx, 57 
Phrenic arteries, no 
Physiologic constants, 299 
Physiology of vision, 259 
Pia mater, 192, 205, 212 
Pigmentum nigrum, 254 
Pinna, 261 
Pisiform bone, 34 
Pituitary membrane, 268 
Placenta, 137 
Plantar nerves, 225 
Plasma of blood, 133 
Platysma myoides muscle, 53 
Pleura, 145, 249 
Pleural membrane, 141 
Plexus, 197 
Pneumogastric nerve, 219 
Pons Varolii, 208 
Popliteal artery, 114 
nerves, 225 
space, 34 
vein, 125 
Pores of skin, 245 
Portal circulation, 129 
system, 89 
veins, 129 
Portio dura nerve, 217 
mollis nerve, 217, 218 
Posterior auricular artery, 99 
vein, 121 
cerebral arteries, 210 
chamber of eye, 255 
cutaneous nerve, 224 
horns of cord, 214 
intercostal artery, 108 
lobe of brain, 206 
mediastinal arteries, 108 
meningeal artery, 211 
nares, 267 
tibial artery, 114, 115 
ulnar vein, 123 
Preaortic plexus, 226 
Pregnancy, uterus in, 219 
Presbyopia, 261 
Prevertebral sympathetic nerve, 227 
Profunda, 125 
cervicis, 104 INDEX. 
313 
Pronator quadratus muscle, 68 
teres muscle, 67 
Prostate gland, 242 
Prostatic plexus, 127 
Proteids of blood, 133 
Psoas magnus muscle, 71 
parvus muscle, 72 
Pterygoid artery, 100 
muscles, 53 
Pterygomaxillary muscles, 53 
Ptyalin, 152 
Puberty, uterus at, 278 
Pubes, 30 
Pudendum, 272 
Pulmonary artery, 116, 129 
circulation, 129 
system, 89 
transpiration, 291 
veins, 130 
Pulsation, 89 
Puncta lachrymalia, 257 
Pupil, 254 
Pyloric orifice of stomach, 156 
Pyramidalis muscle, 59 
Pyriformis muscle, 76 
Quadratus femoris muscle, 77 
lumborum muscle, 59 
Radial artery, 105 
vein, 123 
Radiating fibers of iris, 254 
Radius, 32 
Ranine artery, 97 
Receptaculum chyli, 168 
Rectum, 163 
Rectus capitis anticus major muscle, 
57 
minor muscle, 57 
femoris muscle, 73 
lateralis muscle, 57 
muscle, 59 
Red corpuscles, 131 
Reil's island, 206, 208 
Renal arteries, ill 
Rennin in gastric juice, 159 
Repair of body, 289 
Reproductive organs, female, 272 
Reserve air in lungs, 144 
Residual air in lungs, 144 
Respiration, 143 
Respiration, air taken into lungs in, 
144 
bronchi in, 145 
nerves of, 201 
ribs in, 147 
trachea in, 145 
Respiratory column, 202 
system, 140 
Retina, 255 
Retrahens, 49 
Ribs, 28 
false, 28 
floating, 28 
in respiration, 147 
spaces between, 29 
true, 28 
vertebral, 28 
vertebrocostal, 28 
Ridge of bones, 16 
Right common carotid artery, 96 
hypochondriac region, 171 ' 
inguinal region, 172 
innominate vein, 127 
intercostal vein, 127 
lumbar region of abdomen, 172 
Risorius muscle, 52 
Round ligaments, 287 
Sacra media, 112 
Sacral ganglia, 227 
nerves, 224 
plexus, 225 
vertebrae, 18 
articulations of, 20 
Sacrum, 30 
Saliva, 151, 239 
in mastication, 150 
Salivary duct, 240 
Salts of blood, 134 
Saphenous vein, 119 
external, 125 
internal, 126 
Sartorius muscle, 72 
Scalenus anticus muscle, 57 
medius muscle, 57 
posticus muscle, 57 
Scaphoid bone, 34 
Scapula, 32 
Scapular nerves, 222 
Scarf-skin, 184 
Schneiderian membrane, 268 314 
INDEX. 
Sciatic nerve, 225 
Sclera, 252, 253 
Sclerotic coat of eye, 252, 253 
Sebaceous glands, 187, 245 
Sebum, 245 
Second cranial nerve, 215 
Semicircular canals of ear, 264 
Semilunar bone, 34 
valves, 87, 93 
Semimembranosus muscle, 77 
Semitendinosus muscle, 77 
Sensation, nerves of, 201 
Septum of nose, 24, 267 
bones of, 24 
cartilage of, 24 
Serous coat of stomach, 156 
membranes, 249 
Serpentine artery, no 
Serratus magnus muscle, 64 
Sesamoid bones, 18 
Seventh cranial nerve, 217 
Sheath of arteries, 92 
of muscle, 47 
Short bones, 16 • 
Short-sightedness, 260 
Shoulder, bones of, 30 
ligaments of, 38 
muscles of, 62, 64 
Shoulder-blade, 32 
Sight, organs of, 252 
physiology of, 259 
Sigmoid cavity, 32 
flexure, 163 
Sinuses, 119 
Sixth cranial nerve, 216 
Skeleton, 13, 17. 
articulations of, 37 
Skin, 183 
appendages of, 187 
layers of, 184 
papillae of, 185 
pores of, 245 
scarf-, 184 
true, 184 
waste products eliminated by, 176 
Skull, 20 
bones of, 20, 21 
infant's, 22 
Small intestine, 159, 160 
coats of, 161 
lymphatics of, 164, 166 
Small intestine, villi of, 162, 164 
Smell, organs of, 266 
Soft spot, 23 
Special sense nerves, 201 
organs, 252 
Spermatic arteries, 111 
Sphenoid bone, 23 
Sphenomaxillary artery, 100 
Spinal canal, 19 
column, 18, 19 
atlas of, 19 
axis of, 19 
curves of, 20 
length of, 20 
regions of, 20 
cord, 195, 212, 214 
columns of, 195, 214 
fissures of, 214 
functions of, 200 
gray commissure of, 214 
horns of, 214 
membranes of, 212 
nerves of, 198, 220 
nerves, 198, 220 
veins, 128 
Spine, 18. See also Spinal column 
bones of, 16 
Splanchnology, 12 
Spleen, 236 
functions of, 236 
Splenic artery, 110 
Spongy bones, 267 
Stapes, 263 
Steapsin, 165, 166 
Sternocleidomastoid muscle, 53 
Sternohyoid muscle, 54 
Sternomastoid artery, 98 
Sternothyroid muscle, 54 
Sternum, 27 
Stomach, 156 
coats of, 156 
openings of, 156 
Striped muscles, 46, 47 
Styloglossus muscle, 55 
Stylohyoid muscle, 55 
Stylopharyngeus muscle, 56 
Subanconeus muscle, 67 
Subarachnoidean spaces, 204 
Subclavian artery, 102 
vein, 118, 124 
Subclavius muscle, 64 INDEX. 
315 
Subcrureus muscle, 75 
Sublingual glands, 241 
Submaxillary glands, 240 
Subscapularis muscle, 65 
Succus entericus, 165 
Sudorific glands, 185, 295 
Sudoriparous glands, 245 
Sulci of cerebrum, 205 
Supercilia, 257 
Superficial palmar arch, 107 
Superior constrictor muscle, 56 
dental nerve, 216 
epigastric artery, 104 
intercostal artery, 104, 108 
maxillary bones, 24 
muscles, 51 
nerve, 216 
mesenteric artery, III 
thyroid artery, 97 
vena cava, 118, 126 
Supinator brevis muscle, 69 
longus muscle, 68 
Supplemental air in lungs, 144 
Suprarenal arteries, ill 
capsule, 183 
Supraspinatus muscle, 65 
Suspensory ligament, 256 
Sutural ligament, 38 
Swallowing, 154 
Sweat, 291, 295 
glands, 185, 245 
uses of, 296-298 
Sylvius's fissure, 206 
Sympathetic nerve, 202, 226 
Syndesmology, definition, 12 
Synovia, 250 
Synovial membrane, 40, 250 
Tact, sense of, 269 
Tarsal cartilages, 258 
Tarsus, 36 
Taste organs, 264 
Teeth, 152 
permanent, 154 
temporary, 153 
Tegumentary areolar tissue of eye- 
lids, 257 
Temporal arteries, 98 
bones, 23 
of infant, 23 
muscle, 52 
Temporal vein, 120 
Temporomaxillary muscles, 52 
vein, 120 
Tendons, 47, 80 
Tensor palati muscle, 56 
tarsi muscle, 50 
vaginae femoris muscle,- 72 
Tenth cranial nerve, 219 
Teres major muscle, 66 
minor muscle, 65 
Thigh, muscles of, 72, 73 
Thigh-bone, 34 
Third cranial nerve, 215 
Thoracic aorta, 93, 94, 108 
cavity, 26 
arteries of, 128 
veins of, 128 
duct, 164, 168 
nerves, 222 
Thorax, 26, 27 
muscles of, 61 
Thread of tongue, 240 
Thumb, bones of, 34 
Thyroglossal duct, 241 
Thyrohyoid muscle, 54 
Thyroid artery, 97 
axis, 104 
glands, 241 
veins, inferior, 122 
Tibia, 36 
Tibial arteries, 114, 115 
artery, posterior, 114 
nerve, 225 
vein, 125 
Tibialis anticus muscle, 78 
Tidal air in lungs, 145 
Toes, bones of, 37 
Tongue, 264 
bridle of, 240 
nerve supply of, 264 
papillae of, 266 
surface of, 266 
thread of, 240 
Touch, organs of, 269 
Trachea, 140, 141 
in respiration, 145 
Transpiration, cutaneous, 291, 295 
pulmonary, 291 
Transversalis muscle, 59 
Transverse aorta, 93 
colon, 162, 163 316 
INDEX. 
Transverse facial artery, 100 
Trapezium bone, 34 
Trapezius muscle, 59 
Trapezoid bone, 34 
Triangularis sterni muscle, 61 
Triceps extensor cubiti muscle, 66 
Tricuspid valve, 86 
Trifacial nerve, 215 
Trisplanchnic nerve, 202 
True ribs, 28 
skin, 184 
Trunk, muscles of, 57, 58, 60 
veins of, 126 
Trypsin, 166 
Tubercle of eyelids, 257 
Tubercula quadrigemina, 208 
Tuberosity, 16 
Turbinated bones, 26, 267 
Twelfth cranial nerve, 220 
Tympanic artery, 101 
Tympanum, 263 
Ulna, 32 
Ulnar artery, 107 
vein, anterior, 123 
posterior, 123 
Umbilical arteries, 137 
region, 172 
veins, 137 
Unciform bone, 34 
Upper extremities, bones of, 30, 31 
muscles of, 62 
veins of, 122 
deep, 124 
superficial, 123 
jaw, bones of, 24 
Ureters, 178 
Urethra, 179 
Urinary casts, 182 
Urine, 180 
casts in, 182 
characters of, 180 
color of, 181 
composition of, 181 
constituents of abnormal, 182 
normal, 181 
passing of, 180 
quantity of, 182 
reaction of, 181 
specific gravity of, 181 
transparency of, 180 
Urinosexual opening, 272 
Uterine plexuses, 127 
Uterogestation, breasts in, 244 
Uterus, 277 
after parturition, 280 
appendages of, 280 
at menstruation, 278 
at puberty, 278 
blood-.supply of, 278 
body of, 278 
cavity of, 280 
cervix of, 278 
fetal, 278 
fundus of, 278 
gravid, 279 
in old age, 280 
in pregnancy, 279 
ligaments of, 280 
nerves of, 278 
shape of, 277 
size of, 277 
structure of, 278 
Uvea, 255 
Vagina, 275 
Vaginal synovial membranes, 250 
Vagus nerve, 219 
Vasa vasorum, 92 
Vascular layer of retina, 255 
system, 84 
fetus, 134 
Vastus externus muscle, 74 
internus muscle, 74 
Veins, 116 
blood in, 118 
classification of, 118 
function of, 117 
of abdominal cavity, 128 
of arm, 122, 123 
deep, 124 
superficial, 123 
of head, 119 
of leg, 124 
of lower extremities, 124 
of neck, 119, 121 
of thoracic cavity, 128 
of trunk, 126 
of upper extremities, 122 
deep, 124 
superficial, 123 
valves of, 117 INDEX. 
317 
Velum interpositum, 205, 207 
Vena cava, inferior, 126 
superior, 126 
Venae comites, 122 
brachial, 122 
Galeni, 207 
innominatae, 126 
Venous system, 89, 116 
Ventricles, 85 
of brain, 207 
Vermicular movement of bowels, 
163 
Vermiform appendix, 162 
Vernix caseosa, 245 
Vertebrae, 18, 20 
Vertebral artery, 103, 210 
column, 18. See also Spinal 
column. 
muscles, anterior, 57 
ribs, 28 
sympathetic nerve, 226 
vein, 122 
veins, 128 
Vertebrocostal ribs, 28 
Vesical plexus, 127 
Vestibular nerve, 218 
Vestibule of ear, 264 
Villi of small intestine, 162, 164 
Visceral layer of 'arachnoid, 204 
plexus, 226 
Vision, organs of, 252 
physiology of, 259 
Vitreous humor, 252, 256 
Voluntary muscles, 46, 47 
Vomer, 24, 26 
Vulva, 272 
Waste, bodily, 289 
Waste-products, channels of elim- 
ination, 175, 176 
elimination of, 175 
Wax of ear, 262 
White corpuscles, 132 
of the eye, 253 
Willis's circle, 209, 210 
Windpipe, 140, 141 
Wormian bones, 18 
Wrist-joint, ligaments of, 39 
■Zonula, 256 CATALOGUE 
OF 
Books ON Nursing 
AND BOOKS SPECIALLY 
INTERESTING TO NURSES 
Books sent to any part of the world on receipt of price 
PAGE 
Abbott's Hygiene of Transmissible Diseases 10 
American Illustrated Medical Dictionary 9 
American Pocket Medical Dictionary 2 
Barton and Wells' Medical Thesaurus . II 
Beck's Reference Handbook for Nurses 4 
Bergey's Principles of Hygiene 8 
Davis' Obstetrical Nursing 3 
De Lee's Obstetrics for Nurses 11 
Galbraith's Four Epochs of Woman's Life 6 
Grafstrom's Mechano-Therapy 6 
Griffith's Care of the Baby 5 
Griffith's Infant's Weight Chart 5 
Laine's Temperature Chart 9 
Lewis' Anatomy and Physiology for Nurses 4 
Martin's Essentials of Minor Surgery and Bandaging 8 
Morris' Materia Medica, Therapeutics, Prescription-Writing .... 7 
Nancrede's Essentials of Anatomy 8 
Pyle's Personal Hygiene 5 
Stevens' Manual of Practice of Medicine 7 
Stevens' Modern Materia Medica and Therapeutics 7 
Stoney's Materia Medica for Nurses 4 
Stoney's Practical Points in Nursing 2 
Stoney's Surgical Technic for Nurses 3 
Warwick and Tunstall's First Aid to the Injured and Sick 10 
Williams' Practice of Medicine 6 
W. B. SAUNDERS & CO. 
925 WALNUT STREET PHILADELPHIA 
9, Henrietta Street, Covent Garden, London Practical Points in Nursing, recently issued 
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defining all the terms used in Materia Medica, and describing all 
the latest drugs and remedies, which have been generally ne- 
glected by other books of the kind. 
Anatomy and Physiology for Nurses issued 
By LeRoy Lewis, M.D., Surgeon to and Lecturer on Anatomy 
and Physiology for Nurses at the Lewis Hospital, Bay City, 
Michigan. 121110 of 200 pages, with 100 illustrations. 
This book is the outcome of a wide demand for such a work, 
treating the subjects from the nurse's point of view. The author 
has based the plan and scope of the work on the methods he has 
employed in teaching the subjects, and has made the text un- 
usually simple and clear. The object was so to deal with anatomy 
and physiology that the student might easily grasp the primary 
principles, at the same time laying abroad foundation for a wider 
study. There are many practical illustrations. A Manual of Personal Hygiene, recently issued 
J Second Edition. 
Proper Living upon a Physiologic Basis. By American Authors. 
Edited by Walter L. Pyle, A.M., M.D., Assistant Surgeon to 
Wills Eye Hospital, Philadelphia. Octavo, 350 pages. Pro- 
fusely illustrated. Cloth, $1.50 net. 
The object of this manual is to set forth plainly the best means of develop- 
ing and maintaining physical and mental vigor. It represents a thorough exposi- 
tion of living upon a physiologic basis. There are chapters upon the hygiene 
of the digestive apparatus, the skin and its appendages, the vocal and respiratory 
apparatus, eye, ear, brain, and nervous system. In this new second edition there 
have been added chapters on Domestic Hygiene and Home Gymnastics, besides 
an Appendix containing first aids in cases of emergencies. The book has been 
much enlarged. 
"The work has been excellently done : there is no undue repetition, and the 
writers have succeeded unusually well in presenting facts of practical significance 
based on sound knowledge."-Boston Medical and Surgical Journal. 
"Good common-sense advice as to the matter of personal hygiene."-Bulle- 
tin of Johns Hopkins Hospital. 
The Care of the Baby. 
By J. P. Crozer Griffith, M.D., Clinical Professor of Dis- 
eases of Children, University of Pennsylvania; Physician to the 
Children's Hospital, Philadelphia, etc. 436 pages, with 67 illus- 
trations in the text, and 5 plates. i2mo. Price, $i-5° net- 
" The whole book is characterized by rare good sense, and is evidently 
written by a master hand. It can be read with benefit not only by mothers, but 
by medical students and by any practitioners who have not had large oppor- 
tunities for observing children."-American Journal of Obstetrics. 
Infant's Weight Chart. 
Designed by J. P. Crozer Griffith, M.D., Clinical Professor 
of Diseases of Children in the University of Pennsylvania. 25 
charts in each pad. Price per pad, 50 cents net. 
A convenient blank for keeping a record of the child's weight 
during the first two years of life. Printed on each chart is a 
curve representing the average weight of a healthy infant, so that 
any deviation from the normal can readily be detected. Four Epochs of Woman's Life, Second Edition 
Maidenhood, Marriage, Maternity, Menopause. Recent|y ,8SUed 
A Study in Hygiene. By Anna M. Galbraith, M. D., 
Author of " Hygiene and Physical Culture for Womenwith an 
Introductory Note by John H. Musser, M.D., Professor of 
Clinical Medicine, University of Pennsylvania. i2mo, 247 
pages. Cloth, $1.50 net. 
In this instructive work are stated, in a modest, pleasing, and 
conclusive manner, those truths of which every woman should 
have a thorough knowledge. The subject is discussed in language 
readily grasped even by those unfamiliar with medical subjects. 
" The author has treated a difficult subject with tact, wisdom, and dignity.'1 
-American Medicine. 
A Text=Book of Mechano=Therapy „ +1 , „ 
r*-7 Recently Issued 
(Massage and Medical Gymnastics). Second Edition. 
By Axel V. Grafstrom, B. Sc., M. D., late Lieutenant in the 
Royal Swedish Army; late House Physician, City Hospital, 
Blackwell's Island, New York. i2mo, 200 pages, illustrated. 
Cloth, $1.25 net. 
This book is intended as a practical manual of the methods of 
massage and Swedish movements, so rapidly becoming popular in 
this country. It describes clearly and shows by illustration the 
various movements of the system and their mode of application. 
The book has been entirely reset and greatly enlarged. Fourteen 
new illustrations have also been added. 
Practice of Medicine just ready 
By William R. Williams, M. D., formerly Instructor in 
Medicine and Lecturer in Hygiene, Cornell University. i2mo 
of 461 pages. Cloth, $1.75 net. 
Throughout this book special stress has been laid on the more 
common aspects of the various diseases, emphasizing the con- 
trasting points in similar conditions, so as to render differential 
diagnosis as easy as possible. Symptomatology and treatment 
have likewise been adequately, although concisely, considered. A Manual of Practice of Medicine, 
Sixth Edition, Revised and Enlarged-Recently Issued. 
By A. A. Stevens, A.M., M.D., Lecturer in Physical Diag- 
nosis in the University of Pennsylvania, and Professor of Pathol- 
ogy in the Woman's Medical College of Pennsylvania. Post 8vo, 
556 pages. Numerous illustrations and selected formulae. Price, 
bound in flexible leather, $2.25 net. 
It is well-nigh impossible for the student, with the limited 
time at his disposal, to master elaborate treatises or to cull from 
them that knowledge which is absolutely essential. From an ex- 
tended experience in teaching, the author has been enabled, by 
classification, to group allied symptoms, and to bring within a 
comparatively small compass a complete outline of the practice 
of medicine. 
A Text=Book of Modern Therapeutics. 
Third Edition, Revised and Greatly Enlarged-Recently Issued. 
By A. A. Stevens, A. M., M.D., Lecturer on Physical Diag- 
nosis, University of Pennsylvania. Handsome octavo volume of 
663 pages. Cloth, $3.50 net. 
This new volume, including all the latest advances in Materia 
Medica, comprehends the following sections: Physiological Ac- 
tion of Drugs; Drugs; Remedial Measures other than Drugs; 
Applied Therapeutics; Incompatibility in Prescriptions; Table 
of Doses; Index of Drugs; and Index of Diseases, the treat- 
ment being elucidated by more than two hundred formulae. 
" The author has faithfully presented modern therapeutics in a comprehensive 
work, . . . and it will be found a reliable guide and sufficiently comprehensive." 
- University of Pennsylvania Medical Bulletin. 
Essentials of Materia Medica, Thera= Sixth 
Edition. 
peutics, and Prescription=Writing. J^t issued. 
By Henry Morris, M.D., late Demonstrator of Therapeutics, 
Jefferson Medical College, Philadelphia; Fellow of the College 
of Physicians, Philadelphia, etc. Crown octavo, 300 pages. 
Cloth, $1.00; net; interleaved for notes, $1.25 net. 
" Has more value than some of the numerous manuals which, though more 
pretentious, are neither fuller nor more accurate."-Bulletin of Johns Hopkins 
Hospital. Essentials of Anatomy, recently issued 
- " Seventh 
Including the Anatomy of the Viscera. Edition, Revised. 
By Charles B. Nancrede, M.D., Professor of Surgery and 
of Clinical Surgery in the University of Michigan, Ann Arbor. 
Crown octavo, 400 pages; 180 illustrations. With an Appendix 
containing over 60 illustrations of the osteology of the human 
body. Based upon Gray's Anatomy. Cloth, $1.00 net; inter- 
leaved for notes, $1.25 net. 
"A useful little book which has been approved by long service in medical 
schools and training-schools for nurses. It is concise without the sacrifice of 
clearness, and the excellent illustrations assist the text."-Bulletin of Johns 
Hopkins Hospital. 
Essentials of Minor Surgery, Bandaging, 
and Venereal Diseases. Second Edition, Revised. 
By Edward Martin, A. M., M. D., Professor of Clinical Sur- 
gery, University of Pennsylvania. Crown octavo, 166 pages, with 
78 illustrations. Cloth, $1.00 net; interleaved for notes, $1.25 net. 
" The best condensation of the subjects of which it treats yet placed before 
the profession."-The Medical News, Philadelphia. 
Bergey's Principles of Hygiene. ° 
The Principles of Hygiene: A Practical Manual for Students, 
Physicians, and Health Officers. By D. H. Bergey, A. M., 
M. D., Assistant Professor of Bacteriology in the University of 
Pennsylvania. Handsome octavo volume of 536 pages, illus- 
trated. Cloth, $3.00 net. 
" Many practical suggestions that cannot fail to be of much value in their 
respective departments. Sound and practical is the verdict on the book."- 
Birmingham Medical Review, England. 
Temperature Chart. 
Prepared by D. T. Laine, M. D. Size, 8x 13^ inches. Price, 
per pad of 25 charts, 50 cents net. 
A conveniently arranged chart for recording Temperature, with 
columns for daily amounts of Urinary and Fecal Excretions, Food, 
Remarks, etc. On the back of each chart is given in full the 
method of Brand in the treatment of Typhoid Fever. RECENTLY ISSUED-NEW (3d) EDITION 
The American Illustrated Qet the Best 
Medical Dictionary. The New standard 
THIRD EDITION IN THREE YEARS-WITH 1500 NEW TERMS. 
A New and Complete Dictionary of the terms used in Medi- 
cine, Surgery, Dentistry, Pharmacy, Chemistry, and kindred 
branches; together with new and elaborate Tables of Arteries, 
Muscles, Nerves, Veins, etc.; of Bacilli, Bacteria, Micrococci, 
etc. ■ Eponymic Tables of Diseases, Operations, Signs and Symp- 
toms, Stains, Tests, Methods of Treatment, etc. By W. A. N. 
Dorland, M. D. Large octavo, nearly 800 pages, bound in full 
flexible leather. Price, $4.50 net; with thumb index, $5.00 net. 
THIRD EDITION, REVISED, WITH ALL THE NEWEST 
TERMS. 
It furnishes a maximum amount of matter in a minimum 
space, and at the lowest possible cost. 
This is an entirely new and unique work for students and practi- 
tioners. It contains more than twice the matter in the ordinary 
students' dictionary, and yet, by the use of clear, condensed type 
and thin paper of the finest quality, it forms an extremely handy 
volume only one and five-eighth inches thick. It is bound in 
flexible leather, and is just the kind of a book that one will want to 
keep on his desk for constant reference. It is absolutely up-to-date, 
containing hundreds of important new terms not to be found in any 
other dictionary. It is also extremely rich in the matter of tables, 
containing over one hundred original ones, including new tables 
of Stains and Staining Methods, Tests, etc. An important feature 
of the book is its handsome illustrations, many in colors, drawn 
especially for the work, including colored illustrations of Arteries, 
Nerves, Veins, Bacteria, Blood, Karyokinesis, etc. 
" Dr. Dorland's dictionary is admirable. It is so well gotten up and of such 
convenient size. No errors have been found in my use of it."-Howard A. 
KELLY, M.D., Professor of Gynecology, Johns Hopkins University, Baltimore. 
" I must acknowledge my astonishment at seeing how much he has condensed 
within relatively small space. I find nothing to criticise, very much to commend, 
and was interested in finding some of the new words which are not in other 
dictionaries."-ROSWELL Park, Professor of Principles and Practice of Surgery 
and Clinical Surgery, University of Buffalo. The Hygiene of Transmissible Diseases. 
Second Edition, Revised and Enlarged. 
The Hygiene of Transmissible Diseases: their Causation, 
Modes of Dissemination, and Methods of Prevention. By A. 
C. Abbott, M.D., Professor of Hygiene and Bacteriology, Uni- 
versity of Pennsylvania. Octavo, 31 t pages, with numerous 
illustrations. Cloth, $2.50 net. 
This book is devoted to that most important branch of the 
science of hygiene, namely, the prevention of contagious disease. 
It deals most fully with sanitary laws, especially those concerning 
the causation and spread of disease and the means of prevention. 
It treats of modes of infection, methods of disinfection, the 
means for the isolation of the sick, and the general rules for the 
management of contagious diseases. It is a book of the very 
greatest value to the nurse. 
"The book is well calculated to meet a want which has been long felt by 
physicians and nurses."-Bulletin of Johns Hopkins Hospital. 
" The medical student or practitioner wishing to obtain a clearly written and 
accurate conspectus of the subjects enumerated above will find this volume very 
useful."-British Medical Journal. 
" It is scientific, but not too technical; it is as complete as our present-day 
knowledge of hygiene and sanitation allows, and it is in harmony with the efforts 
of the profession, which are tending more and more to methods of prophylaxis." 
- The Medical News. 
First Aid to the Injured and Sick. 
First Aid to the Injured and Sick. By F. J. Warwick, B. A., 
M.B. Cantab., of London, and A. C. Tunstall, M. D., F. R. C. S. 
Ed., of London. 161110 volume of 232 pages and over 200 illus- 
trations. Cloth, $1.00 net. 
This volume of practical information is intended as an aid in rendering im- 
mediate temporary assistance to a person suffering from an accident or sudden 
illness until the arrival of a physician. The importance of first aid is indisput- 
able as a life-saving expedient, for upon the promptness and efficiency of the aid 
first rendered the patient depends, in a great measure, the termination of the 
case. This volume will be found a most useful book of ready aid, and of invalu- 
able service, not only to nurses, railway employees, etc., but also to the laity 
in general, as a book of indispensable first aids. 
" It is a book well adapted for the instruction of nurses and hospital corps 
orderlies ... It well fills the purpose for which it was written."-Philadelphia 
Medical Journal. Obstetrics for Nurses. recently issued 
Obstetrics for Nurses. By Joseph B. DeLee, M.D., Professor 
of Obstetrics in the Northwestern University Medical School, 
Chicago. i2mo of 460 pages, fully illustrated. Cloth, $2.50 net. 
INCLUDING ANATOMY AND PHYSIOLOGY. 
While this work was written particularly for nurses, yet the 
student of obstetrics will find in it much that is useful and in- 
structive, since the duties of a nurse often devolve upon the 
practitioner in the early years of his practice. The illustrations 
are nearly all original, having been made specially for this work. 
The photographs were taken from actual scenes, and the text is the 
result of the author's eight years' experience in lecturing to nurses. 
" Its contents are very practical and in accord with the present stand of sci- 
entific obstetrics. I shall recommend it to the nurses of the hospital training 
schools with which I am connected."-C. S. BACON, M. D., Professor of Obstetrics 
iu the College of Physicians and Surgeons, Chicago. 
A Thesaurus of Medical 
RECENTLY ISSUED 
Words and Phrases. 
A Thesaurus of Medical Words and Phrases. By Wilfred 
M. Barton, M.D., Assistant to Professor of Materia Medica and 
Therapeutics, Georgetown University, Washington, D. C. ; and 
Walter A. Wells, M.D., Demonstrator of Laryngology, George- 
town University, Washington, D. C. Handsome i2mo of 534 
pages. Flexible leather, $2.50 net; with thumb index, $3.00 net. 
THE ONLY MEDICAL THESAURUS EVER PUBLISHED. 
Nurses who are requested to write up case histories, render 
accounts in the hospital, or state or explain any subject in the 
technical language of medicine, will find the work unusually 
helpful. 
" We believe no review can do the work justice. ... It can confidently be 
accepted that few will be disappointed."-Trained Nurse, New York.