By P. Temmy. University of New England.

    Writings more than the human body order motilium 10 mg without prescription, as reflected by their exquisite sculptures generic 10 mg motilium with mastercard. Opium was described as an ex- rected more to intellectual pursuits of science purchase 10 mg motilium with visa, rhetoric, and phi- cellent painkiller. An educated individual was expected to be acquainted Until recently, the Chinese have been possessive of their with all fields of knowledge, and it was only natural that great beliefs, and for this reason Western cultures were not influenced strides were made in the sciences. Per- Perhaps the first written reference to the anatomy of haps the best known but least understood of the Chinese contri- wounds sustained in battle is contained in the Iliad, written by butions to human anatomy and medicine is acupuncture. Homer’s detailed descriptions of the Acupuncture is an ancient practice that was established to anatomy of wounds were exceedingly accurate. Three hundred scribed clean wounds—not the type of traumatic wounds that sixty-five precise meridian sites, or vital points, corresponding to would likely be suffered on a battlefield. This has led to specula- the number of days in a year, were identified on the body (fig. Acupuncture human sacrifice may have served as subjects for anatomical study is still practiced in China and has gained acceptance with some and demonstration. Hippocrates The painkilling effect of acupuncture has been documented and is Hippocrates (460–377 B. Acupuncture sites have been identified cians of his time, is regarded as the father of medicine because of on domestic animals and have been used to a limited degree in the sound principles of medical practice that his school estab- veterinary medicine. His name is memorialized in the Hippocratic tery, although it has recently been correlated with endorphin pro- oath, which many graduating medical students repeat as a duction within the brain (see chapter 11). Hippocrates probably had only limited exposure to human Japan dissections, but he was well disciplined in the popular humoral theory of body organization. Four body humors were recognized, The advancement of anatomy in Japan was strongly influenced by the Chinese and Dutch. The earliest records of anatomical interest in Japan date back to the sixth century. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 Chapter 1 History of Anatomy 9 (a) (b) FIGURE 1. Acupressure is application of finger-point pressure at specific meridian sites to manage pain. Phlegm (pronounced flem) within the upper respiratory sys- tem is symptomatic of several pulmonary disorders. Sanguine, a term with the lungs; and melancholy, or black bile, with the spleen. A that originally referred to blood, is used to describe a passionate healthy person was thought to have a balance of the four hu- temperament. The concept of humors has long since been discarded, but cheerfulness and optimism that accompanied a sanguine personal- it dominated medical thought for over 2,000 years. Perhaps the greatest contribution of Hippocrates was that he attributed diseases to natural causes rather than to the dis- Aristotle pleasure of the gods. He was also a renowned The four humors are a part of our language and medical teacher and was hired by King Philip of Macedonia to tutor his son, practice even today. Melancholy is a term used to describe Alexander, who later became known as Alexander the Great. History of Anatomy © The McGraw−Hill Anatomy, Sixth Edition Companies, 2001 10 Unit 1 Historical Perspective The Hippocratic Oath I swear by Apollo Physician and Aesculapius and Hygeia and Panacea and all the gods and goddesses making them my witnesses, that I will fulfill according to my ability and judgment this oath and this covenant: To hold him who has taught me this art as equal to my parents and to live my life in partnership with him, and if he is in need of money to give him a share of mine, and to regard his offspring as equal to my brothers in male lineage and to teach them this art—if they desire to learn it— without fee and covenant; to give a share of precepts and oral instruction and all the other learning to my sons and to the sons of him who has instructed me and to pupils who have signed the covenant and have taken an oath according to the medical law, but to no one else. I will apply dietetic measures for the benefit of the sick according to my ability and judgment; I will keep them from harm and injustice. I will neither give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect. I will not use the knife, not even on sufferers from stone, but will withdraw in favor of such men as are engaged in this work. Whatever houses I may visit, I will come for the benefit of the sick, remaining free of all intentional injustice, of all mischief, and in particular of sexual relations with both female and male persons, be they free or slaves. What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about.

    The membrane (eardrum) and because of its bitter taste is thought to be lips may appear pale in people with severe anemia purchase motilium 10mg fast delivery, or bluish in an insect repellent cheap motilium 10 mg fast delivery. In some cases cheap motilium 10 mg with amex, it may become impacted and re- those with abnormal amounts of reduced hemoglobin in the blood. A lemon yellow tint to the lips may indicate pernicious anemia or jaundice. A few structural features of the nasal region are apparent from its surface anatomy (fig. The principal function of the nose is associated with the respiratory system, Internal Anatomy and the need for a permanent body opening to permit gaseous ventilation accounts for its surface features. The root (nasion)of The internal anatomy of the head from cadaver dissections is the nose is the point in the skull where the nasal and frontal shown in figures 10. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 304 Unit 4 Support and Movement (a) Central incisor Second premolar Lateral incisor First premolar Canine Second premolar Central incisor Lateral incisor First premolar Canine (b) FIGURE 10. The sensory organs of the head (eyes, ears, taste buds, and olfactory receptors) are discussed and illustrated in Structure Comments chapter 15. Root of nose (nasion) Superior attachment of the nose to the cranium Bridge of nose Bony upper framework of the nose formed by the Knowledge Check (dorsum nasi) union of nasal bones Alar nasal sulcus Lateral depression where the ala of the nose 6. What are the boundaries of the cranial region and why is contacts the tissues of the face this region clinically important? How might this re- Nostril (external nare) External opening into the nasal cavity late to infections? Philtrum Vertical depression in the medial part of the upper lip Lip (labium) Upper and lower anterior borders of the mouth Chin (mentum) Anterior portion of the lower jaw Van De Graaff: Human IV. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 305 Soft palate Palatoglossal arch Palatopharyngeal Lingual arch frenulum Opening of Uvula submandibular duct Palatine tonsil Posterior wall of oral pharynx (a) (b) FIGURE 10. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 306 Unit 4 Support and Movement Scalp Cerebrum Corpus callosum Lateral ventricle Frontal bone Frontal sinus Thalamus Hypothalamus Sphenoidal sinus Brain stem Inferior nasal concha Cerebellum Maxilla Oral cavity Tongue Mandible Cervical vertebra Esophagus Thyroid cartilage Cricoid cartilage Trachea Manubrium FIGURE 10. In roid glands; (2) right and (3) left lateral regions, each composed addition, several major organs are contained within the neck, and of major neck muscles and cervical lymph nodes; and (4) a pos- other vital structures pass through it. The most prominent structure of the cervix of the neck is the thyroid cartilage of the larynx (fig. The laryngeal Objective 9 Name and locate the triangles of the neck and prominence of the thyroid cartilage, commonly called the list the structures contained within these triangles. The The neck is a complex region of the body that connects the head to thyroid cartilage supports the vocal folds (cords). The spinal cord, nerves, trachea, esophagus, and major males than in females because male sex hormones stimulate its vessels traverse this highly flexible area. The hyoid bone can be palpated just above contained entirely within the neck, as are several important glands. Both of these structures are elevated during swallowing, Remarkable musculature in the neck produces an array of movements. Note this action on yourself by gently cupping your fin- surface features provide landmarks for locating internal structures. Surface and Regional © The McGraw−Hill Anatomy, Sixth Edition Anatomy Companies, 2001 Chapter 10 Surface and Regional Anatomy 307 Angle of mandible Anterior cervical Sternocleidomastoid m. Triangles of the Neck The arteries of the head and neck are rarely damaged be- The triangles of the neck, created by the arrangement of specific cause of their elasticity. In a severe lateral blow to the head, however, the internal carotid artery may rupture, resulting in the per- muscles and bones, are clinically important because of the specific ception of a roaring sound as blood rushes into the cavernous si- structures included in each. Containment of carotid hemorrhage important in surface anatomy have already been described, how- within the sinuses may actually be lifesaving.

    The nerve ramifies into terminal branches (parotidplexus) (E11) in the parotid Clinical Note: Injury to the nerve results in atony of all muscles of the affected half of the gland buy motilium 10 mg low price. The mouth region drops order motilium 10 mg without a prescription, and the eye can no The greater petrosal nerve (BC12) buy motilium 10mg otc, the longer close (F). There is increased sensitivity to stapedius nerve (BC13), and the chorda sound, hyperacusis (p. Seventh Cranial Nerve 123 7 12 25 8 13 3 5 15 6 2 4 14 1 10 18 16 19 A Nuclear region of the facial nerve C Facial nerve, course within 2 3 the petrous bone 7 1 4 6 5 8 12 9 13 10 14 D Tongue area supplied B Exit of the facial nerve by taste fibers 20 21 17 22 11 23 18 24 E Muscles innervated F Paralysis of the by the facial nerve left facial nerve Kahle, Color Atlas of Human Anatomy, Vol. It emerges from the pons with a thick and gingiva (D10); and the mandibular sensory root (greater portion) and a thinner nerve supplies the lower region of the oral motorroot (lesser portion) and then passes to cavity (D11) and the cheeks. The trigeminal ganglion (semilunar ganglion, Ophthalmic Nerve (E) Gasser’s ganglion) lies in a dural pocket, the trigeminal cave, and gives off three main The ophthalmic nerve (E12) gives off a re- branches, namely, the ophthalmic nerve, the current tentorial branch and divides into the maxillary nerve, and the mandibular nerve lacrimal nerve (E13), the frontal nerve (E14), (see p. These branches pass through the superior orbital The sensory fibers (B1) originate from the fissure into the orbit; the nasociliary nerve pseudounipolar cells in the trigeminal gan- enters through the medial section of the fis- glion (semilunar ganglion, Gasser’s gan- sure, the two other branches enter through glion) (BE2); the central processes of these the lateral section. Most of the fibers of the epicritic sen- The lacrimal nerve runs to the lacrimal gland sibility (p. Via a communicating cleus) (AB3), while those of the protopathic branch, it receives postganglionic secretory sensibility (p. The fibers for the outermost semi- junctiva, upper eyelid, and the skin of the circle terminate furthest caudally (onion forehead). The mesencephalic tract (B6) carries The nasociliary nerve runs to the medial proprioceptive impulses from the mastica- corner of the eye, which it supplies with its tory muscles. Thenasociliarynervegivesoffthefol- The mesencephalic nucleus of the trigeminal lowing branches: a communicating branch nerve (AB7) consists of pseudounipolar neu- to the ciliary ganglion (E20), the long ciliary rons, the processes of which run through nerves (E21) to the eyeball, the posterior eth- the trigeminal ganglion without interrup- moidal nerve (E22) to the sphenoidal and tion. These are the only sensory fibers for ethmoidal sinuses, and the anterior eth- which the cells of origin do not lie in a gan- moidal nerve (E23); the latter runs through glion outside the CNS but in a nucleus of the the anterior ethmoidal foramen to the eth- brain stem, so to speak representing a moidal plate and through the plate into the sensory ganglion located inside the brain. Its terminal branch, the exter- nal nasal branch, supplies the skin of the dorsum and the tip of the nose. Fifth Cranial Nerve 125 7 3 7 6 8 8 2 1 A Nuclear region of the trigeminal nerve 3 4 5 B Exit of the trigeminal nerve 9 10 9 4 C Somatotopic organization of the spinal nucleus of the trigeminal nerve (according to Dejerine) 11 16 D Sensory innervation of 18 23 13 14 22 15 mucosa by the three 17 branches of the trigeminal nerve 19 12 2 F Skin innervated by 21 20 the ophthalmic nerve E Ophthalmic nerve (according to Feneis) Kahle, Color Atlas of Human Anatomy, Vol. Motor fibers for the ten- Maxillary Nerve (A, B) sortympanimuscleandforthetensormuscle The maxillary nerve (A1) gives off a menin- of the velum palatinum run to the otic gan- geal branch and then passes through the glion (p. It gives off a communicating geal artery and then unite to form the nerve branch, which contains postganglionic (p. The lingual nerve (C20) de- secretory (parasympathetic) fibers from the scends in an arch to the base of the tongue pterygopalatine ganglion for the lacrimal and supplies sensory fibers to the anterior gland, to the lacrimal nerve and divides into two-thirds of the tongue (D). It receives its the zygomaticotemporal branch (A4) (temple) taste fibers from the chorda tympani (facial and the zygomaticofacial branch (A5) (skin nerve). The fibers and give off numerous inferior dental provide sensory innervation to the upper branches (C22) for the teeth of the lower jaw. The buccal nerve (C24) cheek, where it supplies the skin between passes through the buccinator muscle (C25) lower eyelid and upper lip (B). Mandibular Nerve (C–F) After passing through the oval foramen and givingoffameningealbranch(C12)inthein- fratemporal fossa, the nerve divides into the auriculotemporal nerve, the lingual nerve, the inferior alveolar nerve, the buccal nerve, and the pure motor branches. The pure motor branches leave the mandibu- lar nerve shortly after its passage through the foramen: the masseteric nerve (C13) for the masseter muscle (F14), the deep temporal nerves (C15) for the temporal muscle (F16), Kahle, Color Atlas of Human Anatomy, Vol. Fifth Cranial Nerve 127 8 3 4 7 2 1 26 5 6 11 9 10 A Maxillary nerve B Skin supplied (according to Feneis) by the maxillary nerve 26 15 12 19 17 24 20 25 21 13 C Mandibular nerve (according to Feneis) 23 16 22 18 14 D Sensory innervation E Skin supplied by the F Innervation of muscle of the tongue mandibular nerve Kahle, Color Atlas of Human Anatomy, Vol. Apart from the parasympa- which gives off ganglionic branches (pterygo- thetic root (preganglionic fibers), each gan- palatine nerves) (AB12) to the ganglion glion has a sympathetic root (synapsing in (sensory root). Thus, the diate nerve) (AB13) up to the genu of the fa- branches leaving the ganglion contain sym- cial nerve where they branch off as the pathetic, parasympathetic, and sensory greater petrosal nerve (AB14). Sympathetic fibers from the carotid The ciliary ganglion (AB1) is a small, flat plexus form the deep petrosal nerve (AB15) body lying laterally to the optical nerve in (sympathetic root) and join the greater the orbit. Its parasympathetic fibers from petrosal nerve to form the nerve of the ptery- the Edinger–Westphal nucleus run in the goid canal (AB16). The para- pathetic fibers originate from the lateral sympathetic fibers (B17) for the lacrimal horn of the spinal cord C8–T2 (ciliospinal gland (AB18) synapse in the ganglion.

    The radial and ulnar veins join in the cubital fossa to form the brachial vein buy 10 mg motilium fast delivery, which continues up the medial side of the brachium generic 10 mg motilium visa. Veins of the Thorax The main superficial vessels of the upper extremity are the The superior vena cava purchase motilium 10mg free shipping, formed by the union of the two brachio- basilic vein and the cephalic vein. The basilic vein passes on the cephalic veins, empties venous blood from the head, neck, and ulnar side of the forearm and the medial side of the arm. The cephalic vein drains the superficial portion of the In addition to receiving blood from the brachiocephalic hand and forearm on the radial side, and then continues up the veins, the superior vena cava collects blood from the azygos sys- lateral side of the arm. In the shoulder region, the cephalic vein tem of veins arising from the posterior thoracic wall (figs. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 576 Unit 6 Maintenance of the Body External jugular v. It ascends through the mediastinum to and course upward behind and in front of the tibia to the back of join the superior vena cava at the level of the fourth thoracic the knee, where they merge to form the popliteal vein. Tributaries of the azygos include the ascending lumbar popliteal vein receives blood from the knee region. Just above the veins, (not illustrated) which drain the lumbar and sacral re- knee, this vessel becomes the femoral vein. Just above this point, the femoral veins, which form the major tributaries to the left of the verte- vein receives blood from the great saphenous (sa˘-fe-nus) vein and bral column. The external iliac curves upward to the level of the sacroiliac joint, where it merges with the internal iliac vein at the pelvic and genital regions to form the common iliac vein. At Veins of the Lower Extremity the level of the fifth lumbar vertebra, the right and left common The lower extremities, like the upper extremities, have both a iliacs unite to form the large inferior vena cava (fig. The deep veins accompany corresponding arteries and have more valves than do the superficial veins. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 577 FIGURE 16. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 578 Unit 6 Maintenance of the Body Inferior vena cava Right common iliac v. Circulatory System © The McGraw−Hill Anatomy, Sixth Edition Body Companies, 2001 Chapter 16 Circulatory System 579 The superficial veins of the lower extremity are the small soids). The right and left hepatic veins that drain the venous and great saphenous veins. The small saphenous vein arises blood from the liver and empty it into the inferior vena cava from the lateral side of the foot and ascends deep to the skin (fig. As a consequence of the hepatic portal system, the along the posterior aspect of the leg. It empties into the popliteal absorbed products of digestion must first pass through the liver vein, posterior to the knee. The great saphenous vein is the before entering the general circulation. It originates from the medial side of The hepatic portal vein is the large vessel that receives the foot and ascends along the medial aspect of the leg and thigh blood from the digestive organs. The great saphenous vein superior mesenteric vein, which drains nutrient-rich blood from is frequently excised and used as a coronary bypass vessel. If a su- the small intestine, and the splenic vein, which drains the perficial vein is removed, the venous return of blood from the ap- spleen. The splenic vein is enlarged because of a convergence of pendage is through the remaining deep veins. The right gastroepiploic vein, also from the stomach, drains directly into the superior mesenteric vein. The inferior vena cava parallels the abdominal aorta on the Three additional veins empty into the hepatic portal vein.

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