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 Human
Anatomy Sixth Edition

Digital Author Kenneth S. Saladin

Christina A. Gan Distinguished Professor of Biology, Emeritus
Highline College Georgia College & State University

sal1026X_fm_i-xx.indd 1 12/11/18 9:42 AM

 PREFACE

Saladin’s Human Anatomy goes beyond descriptions of body struc- nerve, the pediatric auditory tube, lumbar puncture, epidermal
ture to read as a story that weaves together basic science, clinical histology, flat bone structure, gastric and colonic histology, the
applications, the history of medicine, and the evolutionary basis mechanical advantage of levers, and the spermatic cord. Always
of human structure. Saladin combines this humanistic perspective watching for opportunities to enhance topics with photos or to
with vibrant photos and art to convey the beauty and excitement of replace old photos with better ones, this edition has new photos
the subject to beginning students. of diabetic gangrene, rickets, shingles, endemic goiter, muscle his-
tochemistry, rod and cone cell SEMs, an intravenous pyelogram,
and ovulation.
Changes to the Sixth Edition
Attending scientific conferences, subscribing to several scien- Detailed List of Changes
tific and medical journals, and engaging in online forums and Chapter by chapter, the sixth edition’s most significant changes
answering public questions on anatomy, physiology, and health are as follows:
help Ken Saladin stay abreast of advances in the field. In this
Chapter 1, The Study of Human Anatomy, has added descrip-
edition, he introduces newly discovered functions of osteocytes,
tions of dynamic spatial reconstruction, open MRI, and Doppler
astrocytes, dendritic cells, the greater omentum, the corneal epi-
ultrasound.
thelium, and even eyelashes. He reports new research insights on
peroxisome production, tracing white matter tracts of the brain, Chapter 2, Cytology—The Study of Cells, has new clinical topics
and endocrine disruptors; new discoveries of cerebral lymphat- including mitochondrial diseases and birth defects arising from pri-
ics, and pulmonary production of blood platelets; and clinical mary cilium dysfunctions. It has updates on mitochondrial DNA,
advances in asthma and cancer mortality and survival, cord blood the role of gap junctions in the lens and cornea, and peroxisome
transplants, stem-cell harvesting, and regenerative medicine. production. It describes the vascular corrosion cast technique seen
These and more examples are listed chapter by chapter later in in many of the book’s SEM photos.
this section. Chapter 3, Histology—The Study of Tissues, has new Clinical
In response to users and reviewers, the sixth edition has Applications on biopsy and regenerative medicine, and functional
more concise treatments of gametogenesis, sperm capacitation, updates on urothelium (transitional epithelium) and epithelial base-
fertilization, aneuploidy, and embryology of the sense organs, car- ment membranes.
diovascular system, and digestive tract. The muscle chapters are Chapter 4, Human Development, has reduced the level of detail, at
reorganized for better flow, with chapter 10 focusing on the cellular reviewer and user suggestions, on gametogenesis, sperm capacita-
level; chapter 11 on whole-muscle organization, accessory connec- tion, fertilization, and aneuploidy.
tive tissues, musculoskeletal biomechanics, and the axial muscu-
Chapter 5, The Integumentary System, has a new Clinical Applica-
lature; and chapter 12 on the appendicular musculature. Ken has
tion on sunscreens, sunburn, and skin cancer.
also upgraded some of the book’s pedagogical features. There are
new, challenging thought questions, and the Study Guide section Chapter 6, The Skeletal System I: Bone Tissue, has new clinical
presents “What’s Wrong with These Statements?”—10 statements coverage of osteomalacia, rickets, and osteosarcoma, and updates
that all have subtle errors, prompting students to identify what is on osteoporosis, the endocrine role of osteocytes, and limitation of
wrong with them. microfractures by osteon structure. It includes enhanced art on flat
bone structure.
Chapter 7, The Skeletal System II: Axial Skeleton, has a new sec-
New and Enhanced Perspectives
tional view of the head and its cavities, and new clinical coverage of
This sixth edition details enhancements to topics already in the pre-
cleft palate and lip.
vious edition, including new anatomical imaging techniques, ethnic
variations in anatomy, osteon structure and microfractures, vascu- Chapter 8, The Skeletal System III: Appendicular Skeleton, had little
lar aging and hypertension, the scope of the immune system, T cell need for change but has an upgraded illustration of the clavicle for
selection, clinical importance of the cricothyroid ligament, colonic improvement in its surface features.
histology, photosensory effects on the pineal gland, musculoskel- Chapter 9, The Skeletal System IV: Joints, updates the material
etal biomechanics, and more. science of joint prostheses.
Chapter 10, The Muscular System I: Muscle Cells, has improved
New Art and Photography illustrations of the neuromuscular junction, motor units, and
This edition includes new drawings of motor units, sectional the histochemistry of muscle fiber types, and new clinical cover-
anatomy of the head, hand innervation, the course of the vagus age of rigor mortis and fibromyalgia. Chapters 10 to 12 on the
viii

sal1026X_fm_i-xx.indd 8 12/11/18 9:43 AM

 P R E FAC E ix

muscular system are reorganized so that chapter 10 focuses on the Chapter 21, The Circulatory System III: Blood Vessels, gives an
cellular level; chapter 11 discusses the accessory connective tissues updated multicultural perspective on vascular aging and hyperten-
of muscle, whole-muscle structure and organization, musculoskel- sion; adds new challenge questions on identifying arteries in a mag-
etal biomechanics, and the axial muscles; and chapter 12 discusses netic resonance angiogram and identifying blood vessels used for
the appendicular muscles. routine clinical purposes; and treats blood vessel embryology more
Chapter 11, The Muscular System II: Axial Musculature, now incor- concisely.
porates material moved from chapters 10 and 12 and has enhanced Chapter 22, The Lymphoid System and Immunity, now takes an
coverage of accessory connective tissues, muscle compartments, expanded, more contemporary view of the meaning of immune
muscle–bone attachments, musculoskeletal biomechanics, a new system. It reports the recent discovery of cerebral lymphatics and
illustration of lever biomechanics, and a clinical update on types has enhanced discussions of lymphatic vessel peristalsis and lymph
and treatment of inguinal hernias. flow, the maturation and selection of T cells, and the antigen-
Chapter 12, The Muscular System III: Appendicular Musculature, presenting role of dendritic cells.
updates the treatment of carpal tunnel syndrome. Chapter 23, The Respiratory System, has improved descriptions
Chapter 13, The Nervous System I: Nervous Tissue, updates astro- of the nasal and tracheal mucosae, the bronchial tree, and the cri-
cyte functions and the role of electrical synapses in neuronal cothyroid ligament in relation to tracheostomy. It updates asthma
synchrony. mortality rates and lung cancer survival, and reports the newly dis-
covered role of the lungs in producing blood platelets.
Chapter 14, The Nervous System II: Spinal Cord and Spinal
Nerves, now covers lumbar puncture and adds new illustrations Chapter 24, The Digestive System, has new clinical coverage of
of shingles and the distribution of hand innervation from the diverticulosis, diverticulitis, hepatitis, cirrhosis, gastroesophageal
brachial plexus. reflux disease, and gallstones. It has enhanced discussions of mes-
entery structure and omentum function; dental anatomy and pro-
Chapter 15, The Nervous System III: Brain and Cranial Nerves,
prioception; salivary gland innervation; anatomy of the ileocecal
has new drawings of regional functions of the cerebral cortex and
junction; and ethnic variation in colonic anatomy. It has new illus-
distribution of the vagus nerve; new clinical coverage of stroke
trations of histology of the stomach and colon, and a more concise
and trigeminal neuralgia; and scientific updates on brain senes-
treatment of GI embryology.
cence, functions of the red nucleus and insula, and mapping of
the brain with diffusion tensor imaging. Chapter 25, The Urinary System, adds new coverage of intravenous
pyelography and kidney stone treatment, and corrects a common
Chapter 16, The Nervous System IV: Autonomic Nervous System
misconception about female urethral sphincters.
and Visceral Reflexes, has a redrawn figure 16.2 to better compare
sympathetic, parasympathetic, and somatic efferent pathways, Chapter 26, The Reproductive System, has added substantial new
and it expands slightly on pre- and postganglionic fibers and their clinical content, with Clinical Applications and other discussions of
neurotransmitters. varicocele, uterine fibroids, uterine cancer, endometriosis, sexually
transmitted diseases, contraception, testicular cancer, male breast
Chapter 17, The Nervous System V: Sense Organs, has scientific
cancer, and male reproductive tract disorders. It has a new endo-
updates on the roles of the eyelashes, corneal epithelium, and vitre-
scopic photo of ovulation, a revision of penile anatomy to focus
ous body; new clinical coverage of phantom pain, macular degen-
more on the uncircumcised state, and an update on environmental
eration, and diabetic retinopathy; new SEM photos of rod and cone
endocrine disruptors and their effect on fertility.
cells; a new drawing of the pediatric and adult auditory tubes as
related to middle-ear infection; and a more concise treatment of ear
and eye embryology. A Storytelling Writing Style
Chapter 18, The Endocrine System, has enhanced discussions of
Students and instructors alike cite Saladin’s prose style as the
pineal gland innervation and function, melatonin, the endocrine
number one attraction of this book. Students doing blind compari-
pancreas, and endemic goiter (with a new photo), and a new inter-
sons of Ken Saladin’s chapters and those of other anatomy books
pretation of anterior pituitary chromophobes. It has new clinical
routinely find Saladin clearly written, easy to understand, and a
coverage of congenital absence of the pituitary gland (panhypopi-
stimulating, interesting read. Saladin’s analogy-rich writing enables
tuitarism) and hypo- and hyperthyroidism, and has added a basic
students to easily ­visualize abstract concepts in terms of everyday
pathophysiology of diabetes mellitus.
experience. Consider, for example, from chapter 13:
Chapter 19, The Circulatory System I: Blood, updates the status The dimensions of human neurons are more impressive when
of cord blood transfusions and the harvesting of stem cells from we scale them up to the size of familiar objects. If the soma of a
circulating blood; enhances coverage of the role of blood circula- spinal motor neuron was the size of a tennis ball, its dendrites would
tion in thermoregulation and of the role of erythroblasts; and form a huge bushy mass that could fill a 30-seat classroom from
reports a startling new finding on where most blood platelets are floor to ceiling. Its axon would be up to a mile long but a little nar-
produced. rower than a garden hose. This is quite a point to ponder. The neuron
Chapter 20, The Circulatory System II: The Heart, updates the treat- must assemble molecules and organelles in its “tennis ball” soma
ment options for patent ductus arteriosis and has a more concise and deliver them through its “mile-long garden hose” to the end of
treatment of cardiac embryology. the axon.

sal1026X_fm_i-xx.indd 9 12/11/18 9:43 AM

 EVOLUTION OF A STORYTELLER

Ken Saladin’s penchant for writing began early. For his tenth-grade
biology class, he wrote a 318-page monograph on hydras with
53 original India ink drawings and 10 original photomicrographs. We
at McGraw-Hill think of this as Ken’s “first book.” At a young age, Ken

Courtesy of Ken Saladin

already was developing his technical writing style, research habits, and
illustration skills. Courtesy of Ken Saladin

Courtesy of Ken Saladin

Courtesy of Ken Saladin

Ken Saladin’s “first book,” Some of Ken’s first
Hydra Ecology (1965) pen-and-ink artwork (1965) Ken in 1964

Ken served as an A&P textbook reviewer and testbank writer for several
years and then embarked on his first book for McGraw-Hill in 1993. He
published the first edition of Anatomy & Physiology: The Unity of Form and
Function in 1997 and his first edition of Human Anatomy in 2004. The story
continues with Human Anatomy, sixth edition.

Human
ABOUT THE COVER
The front cover shows a human iris against a background of retinal cells. The tall gray columns are the light-absorbing
segments of the rods; the two light green cells are cones; and the basal cell bodies are in violet. The iris is so intricate,
unique to the individual, and forgery-proof that iris recognition technology is rapidly supplementing or replacing other
forms of identity confirmation such as fingerprints, PINs, national identification cards, and even passports. Saladin

McGraw-Hill Education Connect® for Anatomy & Physiology

Anatomy
Human Anatomy

NOW INCLUDES:

Sixth Edition
Fueled by McGraw-Hill LearnSmart® —the most SmartBook® is the first and only adaptive reading
widely used and intelligent adaptive learning experience designed to create personalized
resource—LearnSmart Prep® is designed to get learning for students. SmartBook highlights the
students ready for an upcoming course by quickly most impactful concepts a student needs to learn
and effectively addressing prerequisite knowledge at that moment in time.
gaps that may cause problems down the road.

Practice Atlas for A&P is an interactive tool that APR is an interactive cadaver dissection tool to
pairs images of common anatomical models with enhance lecture and lab. Make use of the custom
stunning cadaver photography, allowing students structure list to focus learning! Now, APR is
to practice naming structures on both models mobile—get the experience anywhere, anytime!
and human bodies, anytime and anywhere.

Ken’s first textbook published in 1997

Connect is the only integrated learning system that empowers students by continuously
adapting to deliver precisely what they need, when they need it.
©McGraw-Hill Education
At McGraw-Hill Education we work every day to unlock the full potential of
each learner, providing data-driven solutions to help students get from
their first college-level course to program readiness.

Sixth
ISBN 978-1-260-21026-2
Edition
MHID 1-260-21026-X
9 0000

9 7 8 1 2 6 0 2 1 02 6 2

Saladin

The story continues in 2019 Essentials book published in 2013

©McGraw-Hill Education ©McGraw-Hill Education

sal1026X_fm_i-xx.indd 10 12/11/18 9:43 AM

 GUIDED TOUR

Instructive Artwork for Visual

Learners

©McGraw-Hill Education/Al Telser

Pancreatic Tail of pancreas
islets
Saladin’s stunning illustrations and photos entice students Bile duct

who regard themselves as “visual learners.”

Vivid Illustrations with rich textures and shading and
bold, bright ­colors bring anatomy to life. (c) Pancreatic islet
Exocrine acinus

©Biophoto Associates/Science Source

Bone marrow Trabecula

Pancreatic Duodenum Head of
©B Christopher/Alamy

ducts pancreas Beta cell

(a) Alpha cell
Delta cell
(b) Pancreatic islet
Compact bone
Figure 18.9 The Pancreas. (a) Gross anatomy and relationship to the duodenum. (b) Cells of a pancreatic islet. PP cells are not shown; they are few
Spongy bone
in number and cannot be distinguished with ordinary histological stains. (c) Light micrograph of a pancreatic islet amid the darker exocrine tissue.
∙ What is the function of the exocrine cells in this gland?
(c) ©McGraw-Hill Education/Al Telser
(a)
digestive gland, and its gross anatomy is therefore discussed in sec- regulate the speed of digestion and nutrient absorption, and
(c) tion 24.6c. Dispersed throughout the exocrine tissue, however, are perhaps modulates the activity of other pancreatic islet cells.
about 1 to 2 million endocrine cell clusters called the pancreatic 4. PP cells, which secrete pancreatic polypeptide (PP) for 4 or
islets (islets of Langerhans22). Although they are less than 2% of the 5 hours after a meal. By acting on receptors in the brain, PP
Nerve
Blood vessel
mass of the pancreas, the islets secrete hormones of vital impor- inhibits stimulation of the pancreas by the vagus nerve.
tance to metabolism—especially insulin and glucagon. The major
Spicules effect of these hormones is to regulate glycemia, the concentration The proportions of these pancreatic cells are about 20% alpha,
of glucose in the blood. 70% beta, 5% delta, and small numbers of PP and other cells.
A typical pancreatic islet measures about 75 × 175 μm. Islets
Trabeculae contain from a few to 3,000 cells, belonging primarily to three classes: 18.3g The Gonads
Spongy bone Like the pancreas, the gonads (ovaries and testes) function as both
Endosteum 1. Alpha (α) cells, or glucagon cells, which secrete glucagon.
endocrine and exocrine glands. Their exocrine products are eggs
Periosteum Glucagon is secreted between meals when the blood glucose
and sperm, and their endocrine products are the gonadal hormones,
Perforating fibers level falls. Its effects are to stimulate the release of stored glucose
most of which are steroids. Their gross anatomy is described in sec-
Perforating canal from the liver and fatty acids from adipose tissue, thereby
tions 26.2b and 26.3a.
providing the body with blood-borne fuel until the next meal.
The ovaries secrete chiefly estrogen, progesterone, and
2. Beta (β) cells, or insulin cells, which secrete insulin and
Process Figures relate numbered steps in the art with
amylin. Insulin is secreted during and immediately after a
inhibin. Each egg develops in its own bubblelike follicle
(fig. 18.10a), which is lined by a wall of granulosa cells and
©Custom Medical Stock Photo/Newscom

meal in response to rising levels of blood-borne nutrients surrounded by a capsule, the theca. The theca and granulosa cells col-
Central
canal Osteon ­corresponding numbered text descriptions.
such as glucose and amino acids. It stimulates most body laborate to produce estrogen. Midway through the monthly ovarian
Lacuna tissues to absorb these nutrients and store or metabolize cycle, the follicle ovulates (releases the egg) and begins to secrete an
Collagen them. Amylin enhances the effects of insulin and influences abundance of progesterone. Estrogen and progesterone contribute
fibers gastric emptying and bile secretion. to the development of the reproductive system and feminine phy-
Lacunae
Concentric
3. Delta (δ) cells, or somatostatin cells, which secrete somatostatin sique, regulate the menstrual cycle, sustain pregnancy, and prepare
lamellae (growth hormone–inhibiting hormone). Somatostatin is the mammary glands for lactation. Inhibin, which is also secreted
Circumferential
lamellae
Canaliculi secreted under the same conditions as insulin. It helps to by the follicle, is a signal from the ovaries to the anterior pituitary.
Central It inhibits the secretion of follicle-stimulating hormone (FSH). The
(b) canal 22
Paul Langerhans (1847–88), German anatomist effects of these hormones are further considered in chapter 26.
Lamella

(d) 1 SA node fires.

20 μm
Figure 6.4 The Histology of Osseous Tissue. (a) Compact and spongy bone in a frontal section of the femur. (b) The three-dimensional structure
of bone. Lamellae of one osteon are telescoped to show their alternating arrangement of collagen fibers. (c) Microscopic appearance of spongy
bone and bone marrow. (d) Microscopic appearance of a cross section of compact bone. 2 Excitation spreads through
• Which type of osseous tissue has more surface area exposed to osteoclast action? Right atrium 1 2 atrial myocardium.
(a) ©B Christopher/Alamy; (c) ©Biophoto Associates/Science Source; (d) ©Custom Medical Stock Photo/Newscom

Sinuatrial node
(pacemaker) Left 3 AV node fires.
atrium
2
Subendocardial
Atrioventricular 3
conducting network 4 Excitation spreads down AV
node bundle.
Bundle
Atrioventricular branches 5 Subendocardial conducting
bundle 4 network distributes excitation
5
through ventricular
myocardium.

Subendocardial
conducting network
Figure 20.13 The Cardiac Conduction System. Electrical signals travel along the pathways indicated by the arrows.
• Which atrium is the first to receive the signal that induces atrial contraction?

4 The atrioventricular (AV) bundle, a cord of modified branches, each cardiomyocyte contacts several other cells, so collec-
cardiomyocytes by which signals leave the AV node. The bundle tively they form a network throughout a heart chamber. A cardiomyo-
soon forks into right and left bundle branches, which enter the cyte usually has only one, centrally placed nucleus, often surrounded
interventricular septum and descend toward the apex of the heart. by a mass of the energy-storage carbohydrate, glycogen; one-quarter
to one-third of the cells, however, have two or more nuclei. The sar-
5 The bundle branches give rise to conducting cardiac myofibers coplasmic reticulum is less developed than in skeletal muscle; it lacks
(formerly called Purkinje cells), which turn upward at the terminal cisterns, although it does have footlike sacs associated with
apex of the heart and spread throughout the ventricular the T tubules. The T tubules are much larger than in skeletal muscle.
myocardium. These myofibers distribute electrical excitation During excitation of the cell, they admit calcium ions from the extra-
to the cardiomyocytes of the ventricles. Collectively, they cellular fluid to activate muscle contraction. Cardiomyocytes have
form the subendocardial conducting network. The network is especially large mitochondria, which make up about 25% of the cell
more elaborate in the left ventricle than in the right. volume, compared to skeletal muscle mitochondria, which are much
smaller and comprise only 2% of the cell volume.
After we examine the structure of cardiac muscle, we will see how
this conduction system relates to the heart’s cycle of contraction
and relaxation. C L I N I C A L A P P L I C AT I O N 20.2
sal1026X_fm_i-xx.indd 11 12/11/18 9:43 AM
 xii P R E FAC E

C LOrientation
I N I C A L A P P L ITools, such 12.2
C AT I O N as dissection planes and a compass The Psychology of Learning
on the anatomical art, clarify the perspective from which a
Carpal Tunnel Syndrome
Prolonged, repetitive motions of the wrist and fingers can cause pianists, meat cutters, and others who spend long hours making Having taught human anatomy and histology for 40 years,
structure
tissues in the carpal tunnel tois viewed.
become inflamed, swollen, or repetitive wrist motions. It can also be caused by other factors
fibrotic. Since the carpal tunnel cannot expand, swelling puts that reduce the size of the carpal tunnel, including tumors, infec- Saladin knows what works in the classroom and incorporates
pressure on the median nerve, which passes through the carpal tions, and bone fractures. Carpal tunnel syndrome is treated
tunnel with the flexor tendons (fig. 12.9). This pressure causes
tingling and muscular weakness in the palm and lateral side of
with aspirin and other anti-inflammatory drugs, immobilization of
the wrist, and sometimes surgical division (splitting) of the flexor
those approaches into the pedagogy of Human Anatomy.
the hand and pain that may radiate to the arm and shoulder. This retinaculum to relieve pressure on the nerve.
condition, called carpal tunnel syndrome, is common among

Palmaris longus tendon (cut) Flexor digitorum superficialis

tendon
Chapters Organized for Preview and Review
Flexor carpi radialis tendon Flexor digitorum profundus
tendon
Flexor carpi ulnaris tendon
Chapter Outline provides a content preview and
Flexor pollicis longus tendon
Ulnar artery facilitates review and study.
Palmar carpal ligament (cut)
Ulnar nerve
Radial artery
Flexor retinaculum covering
carpal tunnel
Clinical Applications pique the interest of health-science
Median nerve
Bursa students by showing the clinical relevance of the core
Trapezium Superficial palmar
arterial arch science.
(a) Anterior view Brushing Up reminds students of the relevance of earlier
chapters to the one on which they are currently
Palmaris longus
tendon Median nerve
embarking.
Thenar muscles Ulnar artery

Anatomy & Physiology REVEALED® icons indicate

Flexor digitorum Flexor retinaculum
superficialis tendons
Carpal tunnel
Trapezium
Flexor digitorum
profundus tendons
Hypothenar muscles

Ulnar bursa
which area of this interactive cadaver dissection
Radial artery
Anterior
Trapezoid
Hamate program corresponds to the chapter topic.
Capitate
Lateral Medial
Scaphoid Extensor tendons

Posterior
(b) Cross section
Figure 12.9 The Carpal Tunnel. (a) Dissection of the wrist (anterior aspect) showing the tendons, nerve, and bursae that pass under the flexor
retinaculum. (b) Cross section of the wrist, viewed as if from the distal end of a person’s right forearm extended toward you with the palm up. Note
how the flexor tendons and median nerve are confined in the tight space between the carpal bones and flexor retinaculum. That tight packing and
repetitive sliding movements of the flexor tendons through the tunnel contribute to carpal tunnel syndrome.

Colorized X-ray of the flexed cervical spine of a 20-year-old female.

©Science Photo Library-ZEPHYR/Getty Images
CHAPTER
THE SKELETAL SYSTEM II
AXIAL SKELETON 7
C HAP T E R OUT LI N E C LI N I CAL AP P LI CAT I ONS
7.1 Overview of the Skeleton 7.1 Injury to the Ethmoid Bone
7.1a Bones of the Skeletal System 7.2 Cleft Palate and Lip
7.1b Anatomical Features of Bones 7.3 Abnormal Spinal Curvatures

7.2 The Skull

7.2a Cranial Bones BRUSHI N G UP
7.2b Facial Bones
7.2c Bones Associated with the Skull To understand this chapter, you may find it helpful
7.2d Adaptations of the Skull for to review the following concepts:
● Directional terms (table 1.1)
Bipedalism
● The axial and appendicular body regions

7.3 The Vertebral Column and Thoracic Cage (section 1.2d)

● The neural tube, somites, and pharyngeal
7.3a General Features of the Vertebral
Column arches of the embryo (section 4.2b)
● General features of bones (section 6.1c)
7.3b General Structure of a Vertebra
● Intramembranous and endochondral
7.3c Intervertebral Discs
7.3d Regional Characteristics of Vertebrae ossification (sections 6.3a, b)
7.3e The Thoracic Cage

7.4 Developmental and Clinical Perspectives

7.4a Development of the Axial Skeleton
7.4b Pathology of the Axial Skeleton

Study Guide

Module 5: Skeletal System

sal1026X_fm_i-xx.indd 12 12/11/18 9:43 AM

 delicate organs. The vertebral column, for example, is only four major categories: bony,­fibrous,­cartilaginous, and synovial­joints.
moderately mobile, for it must allow for flexibility of the torso and yet protect the delicate spinal cord and support much of the
This section will describe the first three of these and the subclasses of each. The rema
and the
A serrate suture is one in which yet protect
adjoiningthebones
delicate spinal cord
firmly and support much of the
Synchondroses of each. The remainder of the chapter will then be concerned pri-
marily
body’s weight. Bones of the cranium must protect the brain and marily with synovi
body’s weight. Bones
interlock by their serrated margins, like pieces of a jigsaw puz- of the cranium must protect the
8 brain and
A synchondrosis (SIN-con-DRO-sis) is a with
joint synovial
in whichjoints.
the bones
zle. It is analogous to a dovetail sense organs,
wood joint. Onbut theneed not allow
surface, it for movement (except during
are bound by hyaline cartilage. An example is the temporary joint sense organs, but need not allow for movement (except during
appears as a wavy line between the birth);
two thus,
bones,they
as we areseelocked
in thetogether by immobile joints, thediaphysis of a long bone in a child,
between the epiphysis and 9.1a Bony Joints birth); thus, they are locked together by immobile joints, the
bones.
suturesthat
coronal, sagittal, and lambdoid sutures studied
borderin section 7.2.
the parietal
In everyday life, we take the greatest
formed by the cartilage of the epiphysial plate. Another is 3the
attachment notice
of theof the
first most
rib to theA sternum
bony joint,by aor hyaline sutures studied in section 7.2.
synostosis
costal(SIN-oss-TOE-sis), is an immobile 9.1a Bony J
A lap (squamous) suture is one freely movable
in which joints ofbones
the adjacent the limbs,cartilage
and it is(fig.
here that(The
9.3a). people jointcartilages
other costal formed when the gap
are joined between two bones ossifies and they
to the
feel most severely compromised
have overlapping beveled edges, like a miter joint in carpentry. by disabling diseases
sternum by synovial joints.) such become, in effect, a single bone. In everyday life, we take the greatest notice of the most
Bony joints can form by ossifica- A bony joint, or
as arthritis. Much of the of
worktheof physical therapists focuses on tion of either fibrous or cartilaginous joints. An infant is born with
An example is the squamous suture that encircles most freely movable joints of the limbs, and it is here that people joint formed whe
temporal bone. Its beveled edge canlimbbemobility.
seen in In this 7.10b.
figure chapter,Onwe will survey all types of joints, right and left frontal and mandibular bones, for example, but these P R E FAC E xiii
from
the surface, a lap suture appears as the utterly
a relatively smoothimmobile
(nonser- to the Symphyses
most mobile, but with an
9
feel most severely compromised by disabling diseases such
soon fuse seamlessly into a single frontal bone and mandible. Three become, in effect,
rated) line. emphasis on the latter. This surveyIn of joint anatomy
a symphysis and move- two
(SIM-fih-sis), bones are
childhood joined ilium,
bones—the by fibro-
ischium, and pubis—fuse to form a sin-
A plane (butt) suture is one ments
in whichwill provide
the adjacenta foundation
bones forcartilage
the study(fig.
of muscle
9.3b, c). actions
One example is the
gle hip bonepubic symphysis,
on each as arthritis. Much of the work of physical therapists focuses on
side of aninadult. The epiphyses and diaphyses tion of either fibro
in chapters 11 and 12. which the right and left pubic bones
of are
the joined
long bonesby the
are cartilagi-
joined by cartilaginous joints in childhood
have straight nonoverlapping edges. The two bones merely bor-
nous interpubic disc. Another is the
andjoint between and
adolescence, the these
bodiesbecome
of
limb mobility. In this chapter, we will survey all types of joints,
synostoses in early adulthood.
right and left fron
der each other, like two boards glued together in a butt joint. An
example is seen in the intermaxillary suture in the roof of the two vertebrae, united by an intervertebral
In old age,disc.
someThe surface
cranial from
of become obliterated
sutures the utterly immobile to the most mobile, but with an
by ossification soon fuse seamless
mouth. each vertebral body is covered with hyaline
and the cartilage.
adjacent cranialBetween
bones, such as the parietal bones, become
emphasis
Reinforced Learning
9.1 Joints and Their the Classification
vertebrae, this cartilage becomes infiltrated
one. The withofcollagen
attachment the first rib to the sternum also becomes ona the latter. This survey of joint anatomy and move- childhood bones—
Gomphoses
bundles to form fibrocartilage. synostosis
Each intervertebral
in old age. disc per- ments will Each
providesection is a conceptually
a foundation unified
for the study topic, actions
of muscle gle hip bone on ea
Expected Learning mits only slight movement between adjacent vertebrae, but
Outcomes
Even though the teeth are not bones, the attachment of a tooth
the collective effect of all 23 discs gives the spine considerable in chapters framed
11 andbetween
12. a pair of learning “bookends”—a of the long bones
to its socket is classified as a gomphosis (gom-FOE-sis). The term
When you have completed this section, you should be able to 9.1b Fibrous Joints
refers to its similarity to a nail hammered into wood.5 The tooth is
flexibility.
a. explain what joints are, how they are named, and what set of learning objectives at the beginning and a set
A fibrous joint is also called a synarthrosis4 (SIN-ar-THRO-sis). It and adolescence, a
held firmly in place by a fibrous periodontal ligament, which con-
functions they serve;
sists of collagen fibers that extend from the bone matrix of the jaw
b. name and describe the four major classes of joints;
is a point at which adjacent bones are bound by collagen fibers
that emerge from the matrix of one bone, cross the space between
of review and self-testing questions at the end. Each In old age, some c
into the dental tissue (fig. 9.1b). The ligament allows the tooth to
c. name some joints that become solidly
move or give a little under the stress of chewing. Along with associ-
Applyfused
What byYoubone
Know as section is numbered for easy reference in lecture,
them, and penetrate into the matrix of the other (fig. 9.1). There are and the adjacent c
they age;
ated nerve endings, this slight tooth movement enables us to sense
d. describe the three types of fibrous
how hard we’re biting and to sense a particle of food stuck between
The intervertebral
joints and
joints
give an
are three kinds
symphyses
through the lumbar region. How would
ofthe
only in
In sutures
fibrous
cervical
and gomphoses,
you classify the 9.1 Joints
joints: sutures,­gomphoses, and syndesmoses.
the fibers are very short and allow for andandTheir
assignments, ancillaryClassification
materials. These “book- one. The attachme
the teeth.
example of each;
e. distinguish between the three types
little or no movement.
intervertebral joints of the sacrum and coccyx in a middle-aged
of sutures; and
In syndesmoses, the fibers are longer and the
ends” provide the student an optimistic impression synostosis in old a
adult? attached bones are more movable.

Syndesmoses
f . describe the two types of cartilaginous joints and give
an example of each.
Expected Learning
of short, Outcomes
easily digestible sections manageable in
Sutures
A syndesmosis6 (SIN-dez-MO-sis) is a fibrous joint at which two
bones are bound by relatively long collagenous fibers. The separa-
Sutures are immobile or only slightly mobile fibrous joints that short bits of reading time.
When you have completed this section, you should be able to
closely bind the bones of the skull to each other; they occur nowhere 9.1b Fibrou
tion between the bones and lengthAny of the fibers
point givetwo
where these meet isBefore
joints
bones You
called a joint Go On
(articulation), else. In chapter 7, we did not take much notice of the differences
more mobility than a suture or gomphosis. An especially mov-
whether or not the bones are movable at that interface. The science a. explain
between one suture and another, but some differences might have what joints
Expected are, howOutcomes
Learning they are named, and
give the what
student A fibrous joint is
able syndesmosis exists between the Answer the following questions 1 to test your understanding of the
of shafts of the radius
joint structure, and ulna,
function, and dysfunction is called arthrology. functions they serve;
caught your attention as you studied the diagrams in that chapter or
which are joined by a broad fibrous Theinterosseous­membrane.
study of musculoskeletal This preceding section:
movement is kinesiology2 (kih-NEE- examined laboratory specimens. Sutures can be classified as serrate,­ a preview of key points to be learned within the is a point at whic
syndesmosis permits such movements as pronation and supina- 1. What is the difference between arthrology and kinesiology?
see-OL-oh-jee). This is a branch of biomechanics, which deals with b. name and describe the four major classes of joints;
lap, and plane­sutures. Readers with some knowledge of woodwork- that emerge from
tion of the forearm. A less mobile
binds the distal ends of the tibia and
syndesmosis
a broad
fibula
variety isofthe
together,
movements 2. Explainprocesses
one that and mechanical the distinction
in the
sis, and synarthrosis.
between
ingamaysynostosis,
recognizeamphiarthro-
that the structures and functional properties of
c. name some nextjoints
few pages.
that become solidly fused by bone as them, and penetra
body, including the side by side
physics of blood circulation, respiration, and these sutures have something in common with basic types of car-
(fig. 9.1c). hearing. 3. Give some examples of joints that become synostoses
pentry joints (fig. 9.2). they age; three kinds of fibr
4.
with age.
Define suture, gomphosis, and syndesmosis, and explain
Before
d. describe You Go
the three Onofprompts
types the student
fibrous joints to pause
and give an In sutures and gom
9.1c Cartilaginous Joints 1 3
syn = together; ost = bone; osis = condition
example and spot-check his or her mastery of the
arthro = joint; logy = study of what these three joints have in common.
2
kinesio = movement; logy = study of
A cartilaginous joint is also called an amphiarthrosis7 (AM-fee-ar- 5.
4
syn = together; arthr = joined; osis = condition
Name the three types of sutures and describe how they
of each; little or no movem
THRO-sis). In these joints, two bones are linked by cartilage differ. e. distinguish between
previous fewthe three
pages typesprogressing
before of sutures; to
andnew attached bones are
(fig. 9.3). The two types of cartilaginous joints are synchondroses 6. Name two synchondroses and two symphyses.
and symphyses. f . describe material.
the two types of cartilaginous joints and give
an example of each. Sutures
Sutures are immo
4. Chorionic villi develop from 8. The feature that distinguishes a fetus from 13. The brain and spinal cord develop from a
5
gomph = nail, bolt; osis = condition
closely bind the bo
6 8
syn = together; desm = band; osis = condition syn = together; chondr = cartilage; osis = condition
7 9
amphi = on all sides; arthr = joined; osis = condition
a. the zona
Vocabulary pellucida. sym = together; physis = growth
Building an embryo is that the fetus has longitudinal ectodermal channel called the
Any point where two bones meet is called a joint (articulation), else. In chapter 7,
a. all of the organ systems. _____.
Severalb. features
the endometrium.
help build a student’s level of comfort with medical whether or not the bones are movable at that interface. The science between one sutur
c. the syncytiotrophoblast. b. three germ layers. 14. Attachment of the conceptus to the uterine
vocabulary.
d. the embryoblast. c. a placenta.
of joint structure, function, and dysfunction is called arthrology.1
wall is called _____.
caught your attent
2
e. the epiblast. d. an amnion. The study of musculoskeletal 15. Fetalmovement
blood flowsis kinesiology (kih-NEE-
through growths called examined laborato
Pronunciation Guides Knowing proper pronunciation is key see-OL-oh-jee). This is a branch lap, and plane­sutu
5. Which of these results from aneuploidy? e. arm and leg buds. _____, which project into thedeals
of biomechanics, which with
placental
to remembering and spelling terms. Saladin gives simple, a broad variety of movements sinus. and mechanical processes in the ing may recognize
a. Down syndrome 9. The first blood and future egg and sperm
intuitive body, including the physics of enzymes
blood circulation, respiration,
a sperm and these sutures have
b. fetal“pro-NUN-see-AY-shun”
alcohol syndrome guides to helpcells students over
come from 16. The with which pen-
this hearing. etrates an egg are contained in an organelle pentry joints (fig.
c. hurdle and widen the student’s comfort zone
nondisjunction a. for
themedical
mesoderm.
d. mutation b. the hypoblast. called the _____.
vocabulary.
e. polyspermy c. the syncytiotrophoblast.
1 17.
arthro = joint; logy = study of
Fertilization occurs in a part of the female 3
syn = together; ost =
2 reproductive tract called the _____. 4
syn = together; arthr
Word Origins Accurate spelling
6. Fetal urine accumulates in the _____ and and insight into d.
medical the placenta.
terms kinesio = movement; logy = study of
e. the used
yolk sac. 18. Bone, muscle, and dermis arise from
arecontributes
greatly enhanced
to the fluidbythere.
a familiarity with commonly word segments of mesoderm called _____.
a. placental
roots, prefixes,sinus
and suffixes. 10. For the first 8 weeks of gestation, a concep-
19. The egg cell has fast and slow blocks to
b. yolk sac tus is nourished mainly by
_____, or fertilization by more than one
c. allantois
Footnotes throughout the chapters help build the student’s a. the placenta.
sperm.
d. chorion b. amniotic fluid.
working lexicon of word elements. An end-of-book Glossary 20. A developing individual is first classified as
e. amnion c. colostrum.
provides clear definitions of the most important a/an _____ when the three primary germ
7. A preembryo has d.ordecidual
frequently
cells.
layers have formed.
used
a. aterms.
neural tube. e. yolk cytoplasm.
b. a heart bulge. 11. Viruses and chemicals that cause congenital
Answers in appendix A
Building Your Medical
c. a cytotrophoblast. Vocabulary An exercise atanatomical
the end deformities
of are called _____.
each
d. achapter
coelom.helps students creatively use their 12. Aneuploidy
knowledgeisofcaused by _____, the failure
e. decidual cells. of a pair of chromosomes to separate in
new medical word elements. meiosis.

Building Your Medical Vocabulary

State a meaning of each word element and give 3. zygo- 9. meso-
a medical term from this chapter that uses it or a 4. tropho- 10. terato-
slight variation of it. 5. cephalo-
6. gyneco- Answers in appendix A
1. haplo- 7. -genesis
2. gameto- 8. syn-

What’s Wrong with These Statements?

Briefly explain why each of the following 5. The nervous system arises from the meso- 9. A developing individual is first called a fetus
statements is false, or reword it to make it true. derm of the embryo. when the three germ layers have formed—
6. The “bag of waters” that breaks and dis- ectoderm, mesoderm, and endoderm.
sal1026X_fm_i-xx.indd 13 1. Freshly ejaculated sperm are more capable charges fluid when a woman is about to give 10. The energy for sperm motility comes from 12/11/18 9:43 AM
 ments are named and illustrated in our later discu
wastes, and makes movements at synovial joints almost friction-free. joints, and tendons are more fully considered in ch
A connective tissue joint (articular) capsule encloses the cavity and 12 along with the gross anatomy of muscles.
retains the fluid. It has an outer fibrous capsule continuous with the A bursa13 is a fibrous sac filled with synov
periosteum of the adjoining bones, and an inner, cellular synovial between adjacent muscles, between bone and skin,
membrane. The synovial membrane consists mainly of fibroblast-like passes over a bone (see fig. 9.19). Bursae cush
cells that secrete the fluid, and is populated by macrophages that tendons slide more easily over the joints, and some
remove debris from the joint cavity. Joint capsules and ligaments are mechanical effect of a muscle by modifying the dir
supplied with sensory nerve endings that monitor joint movements. tendon pulls. Bursae called tendon sheaths are el
In a few synovial joints, fibrocartilage grows inward from the cap-
xiv P R E FAC E sule and forms a pad between the articulating bones. In the jaw and
wrapped around a tendon. These are especially num
and foot (fig. 9.5), and allow easier longitudinal m
distal radioulnar joints, and at both ends of the clavicle (sternocla- don as forearm muscles pull on bones of the hand.
vicular and acromioclavicular joints), the pad crosses the entire joint mation of a bursa, usually due to overexertion of a
Self-Assessment
(b) Tools capsule and is called an articular disc (see fig. 9.18c). In the knee, two a form of bursitis in which a tendon sheath is infla
cartilages extend inward from the left and right but do not entirely
Saladin provides students with abundant opportunities to evaluate
ome. (a) A child with Down syndrome (center) and her sisters. (b) The karyotype, a chart of the chromosomes of a Figure cross
Legend
the jointQuestions posed
(see fig. 9.23d). Each in many
is called of12 the
a meniscus figure
because of
. Notice that all chromosomes are paired except for three copies of chromosome 21, hence the alternative name of
their comprehension of concepts. A wide variety of questions from
(The karyotype is for a boy, XY, not a girl.) legends prompt the student to interpret the art and apply
9.2b Classes of Synovial Joints
zana Egertova / Alamy Stock Photo
simple recall to analytical evaluation cover all six cognitive levels of
11
= egg
it to ovi
the 12reading.
men = moon, crescent; iscus = little
There are six fundamental classes of synovial joi
by patterns of motion determined by the shape
Bloom’s Taxonomy of Educational Objectives. surfaces of the bones (table 9.1). We will exam
y pregnancy, often before they knew which are not noticed until a child begins school. Alcohol
he time it was removed from the world abuse during pregnancy can cause fetal alcohol syndrome (FAS), descending order of mobility, from multiaxial to m
Before
fected an estimated 10,000 to 20,000
You Go On questions test simple recall and lower-level
characterized by a small head, malformed facial features, car-
them born with unformed arms orinterpretation
legs of information
diac and central nervous systemread instunted
defects, the previous
growth, andfew pages. 13
burs = purse
defects of the ears, heart, and intestines. behavioral symptoms such as hyperactivity, nervousness, and a
ess obvious effects, including physical or poor attention span. Cigarette smoking also contributes to fetal
Apply
rritability, inattention, strokes, seizures,What
and You
infant Know
mortality, tests
ectopicapregnancy,
student’s ability to
anencephaly think of the
(failure C L I N I C A L A P P L I C AT I O N
Proximal
th, and cancer. of the cerebrum to develop), cleft lip and palate, and cardiac
birth defects than any other terato-
deeper abnormalities.
implications or clinical applications of a point he or phalanx

man taking one drink a day canshe have just read.

Diagnostic medical X-rays and prenatal infections such as her- Exercise and Articular Cartilage
and childhood development, some of pes simplex, rubella, and human immunodeficiency virus can also When synovial fluid is warmed by exercise, it beco
be teratogenic. viscous), like warm oil, and more easily absorbed
Some congenital anomalies and other developmental disorders cartilage. The cartilage then swells and provides
are described in table 4.6 and Clinical Application 4.4. cushion against compression. For this reason, a
Ligament before vigorous exercise helps protect the articu
undue wear and tear.
Joint cavity Articular
containing cartilages Because cartilage is nonvascular, its repetitive
Apply What You Know ing exercise is important to its nutrition and waste re
synovial fluid
Martha is showing a sonogram of her unborn baby to her 8. The locations and functional differences 2. The differences between afferent and 14.3 Somatic Reflexes a cartilage is compressed, fluid and metabolic was
between the posterior horn, anterior horn,Periosteumefferent nerve fibers; somatic and visceral Fibrous
coworkers. Her friend Betty tells her she shouldn’t have 1. The general characteristics of a reflex, and
out of it. When weight is taken off the joint, the c
and lateral horn of the spinal gray matter fibers; and general and special fibers capsule
how visceral reflexes differ from somatic Joint
sonograms made because X-rays can cause birth defects. Is 9. The funiculi and tracts of spinal white matter 3. The difference between sensory, motor,
Bone and mixed nerves reflexes
capsule synovial fluid like a sponge, and the fluid carries oxy
10. The general function of the ascending tracts; 2. The components of aSynovial
reflex arc and the
Betty’s concern well founded? Explain. the system used for naming most of them; 4. The structure of a ganglion; where ganglia
membrane
path followed by the afferent and efferent to the chondrocytes. Lack of exercise causes the a
and their individual names, locations, and are found; and the relationship between a nerve signals of a somatic reflex
functions ganglion and a nerve 3. The differences between a monosynaptic to deteriorate more rapidly from lack of nutrition,
11. First- through third-order neurons; decussa- 5. The number of spinal nerves and the sys-
tion in the ascending tracts; and the implica- tem for naming and numbering them
and a polysynaptic reflex arc
4. The differences between ipsilateral,
waste removal.
Middle
tion of this decussation for the relationship
between the cerebral hemispheres and the
6. The structure of the proximal portion
ofphalanx
a spinal nerve, including its posterior
contralateral, and intersegmental reflex Weight-bearing exercise builds bone mass and
arcs, and some reflexes that would
origin of sensory signals from the lower body and anterior roots, their rootlets, and employ each type muscles that stabilize many of the joints, thus reduci
Before You Go On 12. The general function of the descending
tracts; the system for naming them; and their
the posterior root ganglion; and how the
posterior and anterior roots relate to the
5. The nature of a stretch reflex, flexor
reflex, crossed extension reflex, and ten- dislocations. Excessive joint stress, however, can ha
individual names, locations, and functions posterior and anterior horns of the spi-
Answer the following questions to test your understanding of the 13. Upper and lower motor neurons; decus- nal cord
don reflex
sion of osteoarthritis by damaging the articular car
preceding section: Figure 9.4 Structure of a Simple Synovial
sation in the descending tracts; and the
implication of this decussation for the rela-
7. The structure of the distal portion of a
spinal nerve, particularly its division into
14.4 Clinical Perspectives
Joint. Most synovial and bicycling are good ways of exercising the jo
1. Causes and risk factors for spinal cord
joints are more complex than the interphalangeal
tionship between the cerebral hemispheres a posterior ramus, anterior ramus, and
trauma joint shown here. damage.
12. In what sense can spontaneous abortion be considered a
protective mechanism? 14.2 The Spinal Nerves
•
and motor control of the lower body meningeal branch, and where these three
branches lead
2. The effects of spinal cord trauma includ-
Why is a meniscus unnecessary in an interphalangeal joint?
ing spinal shock, hyperreflexia,
8. The five plexuses of spinal nerves—their
and flac-
cid and spastic paralysis
1. The structure of a nerve, including its names, locations, and structure; the nerves 3. The differences between paraplegia, quad-
13. Mutation and nondisjunction both produce chromosomal three layers of connective tissue and how that arise from them; and the structures riplegia, and hemiplegia with respect to
abnormalities. What is the difference between them? they relate to the organization of nerve
fibers into fascicles
innervated by these nerves (tables 14.3
through 14.6)
their causes and parts of the body affected

14. Why is a baby more likely to be born with anatomical Testing Your Recall
howing the Effect of Thalidomide defects stemming from teratogen exposure at 30 days
1. Below L2, the vertebral canal is occupied 5. A patient has a gunshot wound that caused d. the arachnoid mater.
than from exposure at 10 days? by a bundle of spinal nerve roots called a bone fragment to nick the spinal cord. e. the dura mater.
a. the terminal filum. The patient now feels no pain or tempera- 9. The intercostal nerves between the ribs
b. the descending tracts. ture sensations from that level of the body arise from which spinal nerve plexus?
c. the gracile fasciculus. down. Most likely, the _____ was damaged. a. cervical
d. the medullary cone. a. gracile fasciculus b. brachial
e. the cauda equina. b. medial lemniscus c. lumbar
2. The brachial plexus gives rise to all of the c. tectospinal tract d. sacral
following nerves except d. lateral corticospinal tract e. none of them
a. the axillary nerve. e. spinothalamic tract
10. All somatic reflexes share all of the follow-
b. the radial nerve. 6. Which of these is not a region of the spinal ing properties except
c. the obturator nerve. cord? a. they are quick.
d. the median nerve. a. cervical b. they are monosynaptic.
e. the ulnar nerve. b. thoracic
Testing Your Recall sections at the end of each chapter
c. they require stimulation.
3. Between the dura mater and vertebral bone, c. pelvic d. they are involuntary.
one is most likely to find d. lumbar e. they are stereotyped.
e. sacral
offer 20 simple recall questions to test retention of a. arachnoid mater.
b. denticulate ligaments.
c. cartilage.
7. In the spinal cord, the neurosomas of the
lower motor neurons are found in
11. Outside the CNS, the neurosomas of neu-
rons are clustered in swellings called _____.
12. Distal to the intervertebral foramen, a spi-

terminology and basic ideas. d. adipose tissue.

e. spongy bone.
a. the cauda equina.
b. the posterior horns.
c. the anterior horns.
nal nerve branches into a posterior and
anterior _____.
13. The cerebellum receives feedback from the
4. Which of these tracts carries motor signals
destined for the postural muscles? d. the posterior root ganglia. muscles and joints by way of the _____
a. the gracile fasciculus e. the funiculi. tracts of the spinal cord.

What’s Wrong with These Statements? requires b. the cuneate fasciculus

c. the spinothalamic tract
8. The outermost connective tissue wrapping
of a nerve is called
14. Motor innervation of the leg proper comes
predominantly from the _____ plexus.
d. the vestibulospinal tract a. the epineurium. 15. Neural circuits called _____ in the spinal

students to concisely explain why the false statements e. the tectospinal tract b. the perineurium.
c. the endoneurium.
cord produce the rhythmic muscular con-
tractions of walking.

are untrue.
What’s Wrong with These Statements?

Testing Your Comprehension questions are clinical

Briefly­explain­why­each­of­the­following­ 5. Reaching behind you to take something out 8. At a cartilaginous joint, the facing surfaces
statements­is­false,­or­reword­it­to­make­it­true. of your hip pocket involves hyperextension of the two bones are covered with layers of
of the elbow. cartilage and there is a narrow space with

application and other interpretive essay questions that 1. More people get rheumatoid arthritis than
osteoarthritis.
2. A doctor who treats arthritis is called a
6. The lateral and medial malleoli are protru-
sions of the two sides of the tibia in the
lubricating fluid between them.
9. Synovial fluid is secreted by the bursae.
tarsal region. 10. Several sutures can be found in the long
require the student to apply the chapter’s basic science kinesiologist.
3. Synovial joints are also known as synarthroses.
7. To stand on tiptoes to reach something on
a high shelf, you would use dorsiflexion of
bones of the upper and lower limbs.

4. The lateral and medial menisci are shock-

to clinical or other scenarios.
the calcaneus. Answers in appendix A
absorbing cartilages in the elbow joint.

Testing Your Comprehension

1. Why are there menisci in the knee joint but ligament? Explain. What would the result- 4. What structure in the elbow joint serves the
not in the elbow, the corresponding joint of ing condition of the ankle be called? same purpose as the anterior cruciate liga-
the upper limb? Why is there an articular 3. In order of occurrence, list the joint actions ment (ACL) of the knee?
disc in the temporomandibular joint? (flexion, pronation, etc.) and the joints 5. List the six types of synovial joints and
2. What ligaments would most likely be torn where they would occur as you (a) sit for each one, if possible, identify a joint in
if you slipped and your foot was suddenly down at a table, (b) reach out and pick the upper limb and a joint in the lower limb
forced into an excessively inverted posi- up an apple, (c) take a bite, and (d) chew that fall into each category. Which of these
tion: (a) the posterior talofibular and cal- it. Assume that you start in anatomical six joints have no examples in the lower
caneofibular ligaments, or (b) the medial position. limb?

sal1026X_fm_i-xx.indd 14 12/11/18 9:43 AM

 P R E FAC E xv

C L I N I C A L A P P L I C AT I O N 14.2

Poliomyelitis and Amyotrophic Lateral Sclerosis

u should be Poliomyelitis15 and amyotrophic lateral sclerosis16 (ALS) are two
diseases that result from the destruction of motor neurons. In both
diseases, the skeletal muscles atrophy from lack of innervation.
a in general; Poliomyelitis (polio) is caused by the poliovirus, which destroys
o the spinal motor neurons in the brainstem and anterior horn of the spinal cord.
Signs of polio include muscle pain, weakness, and loss of some
nerve distal reflexes, followed by paralysis, muscular atrophy, and sometimes
respiratory arrest. The virus spreads through water contaminated by
d describe feces. Historically, polio afflicted many children who contracted the
virus from contaminated public swimming pools. For a time, the polio
each plexus vaccine nearly eliminated new cases, but the disease has lately begun
to reemerge among children in some countries because of antivac-
cination politics.
he spinal
ALS is also known as Lou Gehrig17 disease after the baseball
player who succumbed to it. It is marked not only by the degenera-
tion of motor neurons and atrophy of the muscles, but also sclerosis
(scarring) of the lateral regions of the spinal cord—hence its name.
Most cases occur when astrocytes fail to reabsorb the neurotrans-
mitter glutamate from the tissue fluid, allowing it to accumulate to a
neurotoxic level. The early signs of ALS include muscular weakness
and difficulty in speaking, swallowing, and using the hands. Sensory
and intellectual functions remain unaffected, as evidenced by the
accomplishments of astrophysicist and best-selling author Stephen
body by way of Hawking (fig. 14.7), who was stricken with ALS while he was in college.
nerves, however, Despite near-total paralysis, he had a slowly progressive form of the
rves and ganglia disease, remained intellectually undiminished, and communicated with
the aid of a speech synthesizer and computer. Tragically, many people
e fibers (axons) are quick to assume that those who have lost most of their ability to
we compare a communicate their ideas and feelings have no ideas and feelings to
communicate. To a victim, this may be more unbearable than the loss
Figure 14.7 Stephen Hawking (1942–2018). “When I was first
nt in one direc- diagnosed with ALS, I was given two years to live. Now 45 years later,
of motor function itself. I am doing pretty well” (CNN interview, 2010).
able composed
e directions. A ©Geoff Robinson Photography/REX/Shutterstock

to more than a
r and resemble
aller branches.
Purely sensory nerves, composed only of afferent fibers, are rare;
ches are called Apply What You Know they include the olfactory and optic nerves described in table 15.3.
ly called periph-
How does the structure of a nerve compare to that of a skeletal Motor nerves carry only efferent fibers. Most nerves, however, are
are ensheathed Making it Relevant
muscle? Which of the descriptive terms for nerves have similar mixed. A mixed nerve consists of both afferent and efferent fibers
counterparts in muscle histology? and therefore conducts signals in two directions, although any one
often a myelin
he neurilemma, Clinical Application essays cover the clinical relevance of fiber within the nerve carries signals in one direction only. Many
nerves often described as motor are actually mixed because they
en a thin sleeve basic science. carry sensory signals of proprioception from the muscles back to
In most nerves, Peripheral nerve fibers are of two kinds: sensory (afferent) fibers, the CNS.
fascicles, each which carry signals from sensory receptors to the CNS, and motor If a nerve resembles a thread, a ganglion18 resembles a knot in
perineurium is (efferent) fibers, which carry signals from the CNS to muscles and the thread. A ganglion is a cluster of neurosomas outside the CNS.
ous, epithelium- glands. Both sensory and motor fibers can also be described as It is enveloped in an epineurium continuous with that of the nerve.
er and wrapped somatic or visceral and as general or special depending on the organs Among the neurosomas are bundles of nerve fibers leading into
hole. The tough they innervate (table 14.2). and out of the ganglion. Figure 14.9 shows a type of ganglion asso-
nnective tissue
ciated with the spinal nerves.
Nerves have a
upply, which is 15
polio = gray matter; myel = spinal cord; itis = inflammation
onnective tissue 16
a = without; myo = muscle; troph = nourishment
17 18
Lou Gehrig (1903–41), American baseball player gangli = knot

sal1026X_fm_i-xx.indd 15 12/11/18 9:43 AM

 Students—study more efficiently, retain more
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 For Students
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sal1026X_fm_i-xx.indd 17 12/11/18 9:44 AM

 ACKNOWLEDGMENTS

I wish to thank the hundreds of colleagues who have reviewed my writing over the years and tremendously contributed to the factual
accuracy, scientific currency, and presentation style of the book before you. Much of this has come about through revising my flagship
book, Anatomy & Physiology: The Unity of Form and Function, through eight editions. Human Anatomy and my book coauthored with Robin
McFarland, Essentials of Anatomy & Physiology, have derived their own content improvements as they follow in the wake of the heavily
reviewed two-semester textbook.
I wish to thank specifically all of the reviewers of the fifth edition text (listed below). Their feedback has been instrumental to the revi-
sion process for this sixth edition. In addition to these commissioned reviews of my chapters, spontaneous feedback from other instructors
and from students all over the world has been enormously stimulating and helpful in the incessant effort to approach that elusive asymptote
called textbook perfection. I’m deeply appreciative of all the encouragement, information, corrections, and suggestions these readers have
sent, and I look forward to many more years of such productive correspondence.
Christina Gan updated the question bank and test bank to closely correlate with the intricate changes made in this sixth edition, and
greatly increased the educational value of these books through her work to create self-assessment tools and align McGraw-Hill’s Connect
resources with the textbook. This has contributed greatly to student and instructor satisfaction with our overall package of learning media,
and to the students’ success as they master A&P en route to their career aspirations. I am delighted to have Christina on my team.
I would also like to extend appreciation to members of the Life Sciences Book Team at McGraw-Hill Education who have worked with
me on this project, including Matthew Garcia, Portfolio Manager; Donna Nemmers, Senior Product Developer; Vicki Krug, Senior Content
Project Manager; Lori Hancock, Lead Content Licensing Specialist; Brent dela Cruz, Senior Content Project Manager; David Hash, Lead
Designer; and Jeanne Patterson, freelance copy editor. Their efforts have yielded another great edition of the text and its companion media
suite of Connect products.

Ken Saladin
Georgia College & State University

Reviewers
Fazal K. Aasi Tamara Davault David S. McLeod
Compton Community College University of Texas of the Permian Basin James Madison University
Yael Avissar Bryan Essien Ronald D. Norris
Rhode Island College Ball State University Azusa Pacific University
Guoying Bing Michael T. Griffin Jacqueline Pal
University of Kentucky Angelo State University East Los Angeles College
Erika Brockmann April Richardson Hatcher Behnaz Parhami-Seren
Los Angeles Valley College University of Kentucky Moorpark College
Becky Brown Candi K. Heimgartner Lula Smith
College of Marin University of Idaho Alabama State University
Pamela Byrd-Williams Deborah C. Henry Robert Stow
Los Angeles Valley College Coastline Community College University of Wisconsin—Eau Claire
Jennifer Carr Nicole Houston Curt Walker
Tufts University Indiana University Kokomo Dixie State University
Julie K. Collins Wilfredo López-Ojeda Colonel (Ret.) Michael Yard
Eastern Oklahoma State College UCF-COM Indiana University Purdue University
Kathleen Coughlan Chris T. McAllister Indianapolis (IUPUI)
Redlands Community College Eastern Oklahoma State College—Idabel

xviii

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 LETTER TO STUDENTS

Dear Students,

When I was a young boy, I became interested in what I then called “nature study” for two reasons. One was the sheer beauty of nature.
I reveled in children’s books with abundant, colorful drawings and photographs of animals, plants, minerals, and gems. It was this esthetic
appreciation of nature that made me want to learn more about it and made me happily surprised to discover I could make a career of it.
At a slightly later age, another thing that drew me still deeper into biology was to discover writers who had a way with words—who could
captivate my imagination and curiosity with their elegant prose. Once I was old enough to hold part-time jobs, I began buying zoology and
anatomy books that mesmerized me with their gracefulness of writing and fascinating art and photography. I wanted to write and draw like
that myself, and I began learning from “the masters.” I spent many late nights in my room peering into my microscope and jars of pond
water, typing page after page of manuscript, and trying pen and India ink as an art medium. My “first book” was a 318-page paper on some
little pond animals called hydras, with 53 illustrations, that I wrote for my tenth-grade biology class when I was 16.
Fast forward about 30 years to when I became a textbook writer, and I found myself bringing that same enjoyment of writing and illus-
trating to my own anatomy and physiology textbooks. Why? Not only for its intrinsic creative satisfaction, but because I’m guessing that
you’re like I was—you can appreciate a book that does more than simply give you the information you need. You appreciate, I trust, a writer
who makes it enjoyable for you through scientific, storytelling prose and a conceptualized way of illustrating things to spark interest and
facilitate understanding. Some of you probably think of yourselves as “visual learners” and others as “verbal learners.” Either way, I hope
this book will serve your learning style.
I know from my own students, however, that you need more than captivating illustrations and enjoyable reading. Let’s face it—A&P is
a complex subject and it may seem a formidable task to acquire even a basic knowledge of the human body. It was difficult even for me to
learn (and the learning never ends). So in addition to simply writing this book, I’ve given a lot of thought to pedagogy—the art of teaching.
I’ve designed my chapters to make them easier for you to study and to give you abundant opportunity to check whether you’ve understood
what you read—to test yourself (as I advise my own students) before the instructor tests you. Christina Gan, digital author, also produces rich
Connect interactive questions that test your understanding as you progress through each chapter. Students have commended these online
questions as extremely helpful in learning human anatomy.
Each chapter is broken down into short, digestible bits with a set of learning goals (Expected Learning Outcomes) at the beginning of
each section, and self-testing questions (Before You Go On) just a few pages later. Even if you have just 30 minutes to read during a lunch
break or a bus ride, you can easily read or review one of these brief sections. There are also numerous self-testing questions at the end of each
chapter, in some of the figure legends, and the occasional Apply What You Know questions dispersed through each chapter. The questions
cover a broad range of cognitive skills, from simple recall of a term to your ability to evaluate, analyze, and apply what you’ve learned to new
clinical situations or other problems.
The Guided Tour takes you through the learning aids we’ve created for you within the book itself and additional study aids available
within Connect. I hope you will take a little time to look at the Guided Tour to see what we have to offer you.
I hope you enjoy your study of this book, but I know there are always ways to make it even better. Indeed, what quality you may find in
this edition owes a great deal to feedback I’ve received from students all over the world. If you find any typos or other errors, if you have any
suggestions for improvement, if I can clarify a concept for you, or even if you just want to comment on something you really like about the
book, I hope you’ll feel free to write to me. I correspond quite often with students and would enjoy hearing from you.

Ken Saladin
Georgia College & State University
[email protected]

xix

sal1026X_fm_i-xx.indd 19 12/11/18 9:44 AM

sal1026X_fm_i-xx.indd 20 12/11/18 9:44 AM
 PART O N E
Colorized X-ray of the human skeleton in the style of Leonardo da Vinci’s Vitruvian Man
©Devrimb/Getty Images
CHAPTER

THE STUDY OF
HUMAN ANATOMY 1
C HA P TER OU TLI N E CLI NI CAL AP P LI CAT I ONS
1.1 The Scope of Human Anatomy 1.1 Situs Inversus and Other Unusual Anatomy
1.1a The Anatomical Sciences 1.2 Cardiac Tamponade
1.1b Methods of Study
1.1c Variation in Human Structure

1.2 The Human Body Plan

1.2a Levels of Human Structure
1.2b The Human Organ Systems
1.2c The Terminology of Body Orientation
1.2d Major Body Regions
1.2e Body Cavities and Membranes

1.3 The Language of Anatomy

1.3a The Origins of Medical Terms
1.3b Analyzing Medical Terms
1.3c Variant Forms of Medical Terms
1.3d The Importance of Accuracy

Study Guide

Module 1: Body Orientation

sal1026X_ch01_001-023.indd 1 12/8/18 3:00 PM

 2 PA R T O N E Organization of the Body

T
his book is an introduction to the structure of the human the Persian physician Avicenna (Ibn Sina, 980–1037 ce). For nearly
body. It is meant primarily to provide a foundation for 1,500 years, medical professors in Europe idolized these “ancient
advanced study in fields related to health and fitness. masters” and considered their works above reproach. Modern
Beyond that purpose, however, the study of anatomy can also human anatomy, however, dates to the sixteenth century, when
provide a satisfying sense of self-understanding. Even as chil- Flemish physician and professor Andreas Vesalius (1514–64) ques-
dren, we’re curious about what’s inside the body. Dried skele- tioned the accuracy of the earlier authorities and commissioned the
tons, museum exhibits, and beautifully illustrated atlases of the first accurate anatomical illustrations for his book, De Humani Cor-
body have long elicited widespread public fascination. poris Fabrica (On the Structure of the Human Body, 1543) (fig. 1.1).
This chapter lays a foundation for our study of anatomy by The tradition begun by Vesalius has been handed down to us
­considering some broad, unifying themes. We will consider what through such famous contemporary works as Gray’s Anatomy, Frank
this science encompasses and what methods are used for the Netter’s Atlas of Human Anatomy, and many others, to the richly
study of anatomy. We will lay out a general “road map” of the illustrated textbooks used by college students today.
human body to provide a context for the chapters that follow. For all its attention to the deceased body, or cadaver,2 human anat-
We will also get some insights into how a beginning anatomy omy is hardly a “dead science.” New techniques of study continually
student can become comfortable with medical terminology. produce exciting new insights into human structure and its functional
relevance; anatomists have discovered far more about the human body in
the last century than in the 2,500 years before. Anatomy now embraces
several subdisciplines that study human structure from different per-
1.1 The Scope of Human Anatomy spectives. Gross anatomy is the study of structure visible to the naked
eye, using methods such as surface observation, dissection, X-rays, and
Expected Learning Outcomes MRI scans. Surface anatomy is the external structure of the body, and is
especially important in conducting a physical examination of a patient.
When you have completed this section, you should be able to
Radiologic anatomy is the study of internal structure, using X-rays and
a. define anatomy and some of its subdisciplines; other medical imaging techniques described in the next section.
b. name and describe some approaches to studying Systemic anatomy is the study of one organ system at a time and is
anatomy; the approach taken by most introductory textbooks such as this one.
c. describe some methods of medical imaging; and Regional anatomy is the study of multiple organ systems at once in a
d. discuss the variability of human anatomy. given region of the body, such as the head or chest. (See the Atlas of
Regional and Surface Anatomy following chapter 12.) Medical schools
and anatomy atlases typically teach anatomy from a regional perspec-
Human anatomy is the study of the structural basis of body function. tive, ­because it is more practical to dissect all structures of the head
It provides an essential foundation for understanding p­ hysiology, and neck, the chest, or a limb, than it would be to try to dissect the
the functional relevance of that structure; anatomy and physiol- entire digestive system, then the cardiovascular system, and so forth.
ogy ­together are the bedrock of the health sciences. You can study Dissecting one system almost invariably destroys organs of other sys-
­human anatomy from an atlas; yet as beautiful, fascinating, and tems that stand in the way. Furthermore, as surgeons operate on a
valuable as atlases are, they teach almost nothing but the locations, particular area of the body, they must think from a regional ­perspective
shapes, and names of things. This book is different; it deals with and attend to the inter­relationships of all structures in that area.
what biologists call functional ­morphology1—not just the structure Ultimately, the structure and function of the body result from its
of organs, but the functional reasons behind it. individual cells. To see those, we usually take tissue specimens, thinly
Anatomy and physiology complement each other; each makes slice and stain them, and observe them under the microscope. This
sense of the other, and each molds the other in the course of human approach is called histology (microscopic anatomy). Histopathology3
development and evolution. Thus, we can say that the human body is the microscopic examination of tissues for signs of disease. Cytol-
exhibits a unity of form and function. We can’t delve into the details ogy4 is the study of the structure and function of individual cells.
of physiology in this book, but enough will be said of function to Many important aspects of human structure are so small we can see
help you make sense of human structure and to more deeply appre- them only with the electron microscope (see chapter 2, section 2.1).
ciate the beauty of human form. Structure at the subcellular to molecular level is called ultrastructure.
1.1a The Anatomical Sciences
1.1b Methods of Study
Anatomy is an ancient human interest, undoubtedly older than any
written language we know. We can only guess when people began There are several ways to examine the structure of the human body.
deliberately cutting into human bodies out of curiosity, simply to The simplest is inspection—simply looking at the body’s appearance
know what was inside. Some of the earliest and most influential in careful detail, as in performing a physical examination or making
books of anatomy were written by the Greek philosopher Aristotle a clinical diagnosis from surface appearance. Observations of the
(384–322 bce), the Greek physician Galen (129–c. 200 ce), and
2
from cadere = to fall down or die
3
histo = tissue; patho = disease; logy = study of
1 4
morpho = form, structure; logy = study of cyto = cell; logy = study of

sal1026X_ch01_001-023.indd 2 12/8/18 3:00 PM

 CHAPTER ONE The Study of Human Anatomy 3

(a) (b)
Figure 1.1 Evolution of Medical Art. Two illustrations of the skeletal system made about 500 years apart. (a) From an eleventh-century work
attributed to Persian physician Avicenna. (b) From De Humani Corporis Fabrica (1543) by Andreas Vesalius.
©NLM/Science Source

skin and nails, for example, can provide clues to such underlying tissues and can be used to produce images on X-ray film or through
problems as vitamin deficiencies, anemia, heart disease, and liver electronic detectors. The benefits of ionizing radiation must always
disease. Physical examinations involve not only looking at the body be weighed against its risks. It is called ionizing because it ejects
for signs of normalcy or disease, but also touching and listening to it. electrons from the atoms and molecules it strikes. This effect can
Palpation5 means feeling a structure with the hands, such as palpat- cause mutation and trigger cancer, so ionizing radiation ­cannot be
ing a swollen lymph node or taking a pulse. Auscultation6 (AWS-cul- used indiscriminately. Used ­judiciously, however, the benefits of a
TAY-shun) is listening to the natural sounds made by the body, such mammogram or dental X-ray substantially outweigh the small risk.
as heart and lung sounds. In percussion, the examiner taps on the Some of the imaging methods to follow are considered
body, feels for abnormal resistance, and listens to the emitted sound ­noninvasive because they do not involve any penetration of the skin
for signs of abnormalities such as pockets of fluid, air, or scar tissue. or body orifices. Invasive imaging techniques may entail inserting
A deeper understanding of the body depends on dissection ­ultrasound probes into the esophagus, vagina, or rectum to get
­(dis-SEC-shun)—the careful cutting and separation of tissues to closer to the organ to be imaged, or injecting substances into the
reveal their relationships. The very words anatomy7 and dissection8 bloodstream or body passages to enhance image formation.
both mean “cutting apart”; until the nineteenth century, dissection Any anatomy student today must be acquainted with the basic
was called “anatomizing.” In many schools of health science, cadaver techniques of radiology and their respective advantages and limita-
dissection is one of the first steps in the training of students. tions. Many of the images printed in this book have been produced
Dissection, of course, is not the method of choice when study- by the following techniques.
ing a living person! Not long ago, it was common to diagnose
disorders through exploratory surgery—opening the body and tak- Radiography
ing a look inside to see what was wrong and what could be done Radiography, first performed in 1895, is the process of photograph-
about it. Any breach of the body cavities is risky, however, and ing internal structures with X-rays. Until the 1960s, this was the only
most exploratory surgery has now been replaced by medical imag- widely available imaging method; even today, it accounts for more than
ing techniques—methods of viewing the inside of the body without 50% of all clinical imaging. X-rays pass through the soft ­tissues of the
surgery. The branch of medicine concerned with imaging is called body to a photographic film or detector on the other side, where they
radiology. Anatomy learned in this way is called radiologic anat- produce relatively dark images. They are absorbed, however, by dense
omy, and those who use radiologic methods for clinical purposes matter such as bones, teeth, ­tumors, and tuberculosis nodules, which
include radiologists and radiologic technicians. leave the image lighter in these areas (fig. 1.2a). The term X-ray also
Some radiologic methods involve high-energy ionizing ­radiation applies to a photograph (radiograph) made by this method. Radiogra-
such as X-rays or particles called positrons. These penetrate the phy is commonly used in dentistry, mammography, diagnosis of frac-
tures, and examination of the chest. Hollow organs can be visualized
5
palp = touch, feel; ation = process by filling them with a contrast medium that absorbs X-rays. Barium
6
auscult = listen; ation = process
7
ana = apart; tom = cut sulfate, for example, is given orally for examination of the esophagus,
8
dis = apart; sect = cut stomach, and small intestine, or by enema for examination of the large

sal1026X_ch01_001-023.indd 3 12/8/18 3:00 PM

 4 PA R T O N E Organization of the Body

(a) X-ray (radiograph) (b) Cerebral angiogram (c) Computed tomographic (CT) scan

Figure 1.2 Radiologic Images of the

Head. (a) X-ray (radiograph) showing the
bones and teeth. (b) An angiogram of
the cerebral blood vessels. (c) A CT scan
showing a brain tumor. (d) An MRI scan
at the level of the eyes. (e) A PET scan of
the brain. The metabolic activity of brain
regions is indicated by colors from red
(greatest activity) to yellow to green to
blue (lowest activity, representing brain
cavities filled with cerebrospinal fluid).
• What structures are seen better by MRI
than by X-ray? What structures are seen
better by X-ray than by PET?
(a) ©Science Photo Library/Alamy Stock Photo; (b) ©pang_oasis/
Shutterstock; (c) ©Puwadol Jaturawutthichai/Alamy Stock Photo;
(d) ©Alamy; (e) ©Lawrence Berkeley National Library/Getty Images
(d) Magnetic resonance image (MRI) (e) Positron emission tomographic
(PET) scan

intestine. Other substances are given by injection for a­ ngiography, the these images to construct a three-dimensional image of the body.
examination of blood vessels (fig. 1.2b). Some disadvantages of radi- CT scanning has the advantage of imaging thin sections of the
ography are that images of overlapping ­organs can be confusing and body, so there is little organ overlap and the image is much sharper
slight differences in tissue density are not easily detected. than a conventional X-ray. It requires extensive knowledge of cross-
Blood vessels can be seen much more sharply, however, with sectional anatomy to interpret the images. CT scanning is useful
a new radiographic method called digital subtraction angiography for identifying tumors, aneurysms, cerebral hemorrhages, kidney
(DSA). This entails taking X-rays before and after injecting a con- stones, and other abnormalities.
trast medium into a vessel. A computer then “erases” the first image The dynamic spatial reconstructor (DSR) is a modified CT
from the second, leaving a clear, dark image of just the injected ves- scanner that produces dynamic, three-dimensional video images
sels without the overlying and surrounding tissues. This is useful for rather than two-dimensional static ones. It shows organ motion and
showing vascular blockages and anatomical malformations, abnor- volume changes, and is valuable for visualizing heart movements
malities of cerebral blood flow, and narrowing (stenosis) of renal and blood flow.
arteries, and as an aid in threading catheters into blood vessels.
Magnetic Resonance Imaging
Computed Tomography Magnetic resonance imaging (MRI) (fig. 1.2d) is better than CT for
Computed tomography (a CT scan) is a more sophisticated applica- visualizing soft tissues. The patient lies in either a tube or an open-
tion of X-rays. The patient is moved through a ring-shaped machine sided scanner surrounded by a powerful electromagnet. Hydrogen
that emits low-intensity X-rays on one side and receives them with atoms in the patient’s tissues alternately align themselves with this
a detector on the opposite side. A computer analyzes signals from magnetic field and with a radio-frequency field turned on and off
the detector and produces an image of a “slice” of the body about by the technologist. These changes in hydrogen alignment generate
as thin as a coin (fig. 1.2c). The computer can “stack” a series of signals that are analyzed by computer to produce an anatomical

sal1026X_ch01_001-023.indd 4 12/8/18 3:00 PM

 CHAPTER ONE The Study of Human Anatomy 5

image. MRI can “see” clearly through the skull and spine to produce
images of the nervous tissue within, and it is better than CT for dis-
tinguishing between soft tissues such as the white and gray matter of
the brain. It has some disadvantages, however, such as the claustro-
phobic feeling some patients experience in the scanner, loud noises
generated by the machine, and long exposure times that prevent
sharp images being made of the constantly moving stomach and
intestines. Open-sided MRI machines are favored by some claustro-
phobic or obese patients, but have weaker magnetic fields, produce
poorer images, and may miss important tissue abnormalities.
Functional MRI (fMRI) is a form of MRI that visualizes moment-
to-moment changes in tissue physiology; fMRI scans of the brain,
for example, show shifting patterns of activity as the brain applies (a)
itself to a specific task. This method has been very useful in clari-
fying which parts of the brain are involved in emotions, thought,
language, sensation, and movement. Figure 1.3 Fetal Sonography.
(a) A patient getting a fetal
sonogram. (b) A three-dimensional
Positron Emission Tomography fetal image made at 32 weeks of
Positron emission tomography (the PET scan) is used to assess the meta- gestation.
bolic state of a tissue and to distinguish which tissues are most active at • Why is sonography safer for
a given moment (fig. 1.2e). The procedure begins with an injection of the fetus than radiography or
computed tomography?
radioactively labeled glucose, which emits positrons (electron-like par- (a) ©Keith Brofsky/Getty Images; (b) ©Kenneth Saladin
(b)
ticles with a positive charge). When a positron and electron meet, they
annihilate each other and give off gamma rays that can be detected by
sensors and processed by computer. The result is a color image that shows Apply What You Know
which tissues were using the most glucose. In ­cardiology, PET scans can The concept of MRI was conceived in 1948 but could not
show the extent of tissue death from a heart attack. Since damaged tissue be put into clinical practice until the 1970s. Speculate on a
consumes little or no glucose, it appears dark. In neuroscience, PET scans possible reason for this delay.
can similarly reveal the extent of brain damage from stroke or trauma.
PET scans are also used to diagnose cancer and evaluate tumor status;
they can often reveal small tumors earlier than they would be detected by 1.1c Variation in Human Structure
CT or MRI. The PET scan is an example of nuclear medicine—the use of A quick look around any classroom is enough to show that no two humans
­radioisotopes to treat disease or to form diagnostic images of the body. look exactly alike; on close inspection, even identical twins exhibit differ-
ences. Anatomy atlases and textbooks can easily give you the impression
Sonography that everyone’s internal anatomy is the same, but this simply is not true.
Sonography9 is the second oldest and second most widely used Books such as this one can teach you only the most common structure—
method of imaging. A handheld device pressed against the skin the anatomy seen in approximately 70% or more of people. Someone who
emits high-frequency ultrasound waves and receives the signals thinks that all human bodies are the same internally would make a con-
reflected back from internal organs. Sonography avoids the harm- fused medical student or an incompetent surgeon.
ful effects of X-rays, and the equipment is relatively inexpensive Some people completely lack certain organs. For example, most
and portable. Its primary disadvantages are that it cannot penetrate of us have a palmaris longus muscle in the forearm and a plantaris
bone and it usually does not produce a very sharp image. Although muscle in the leg, but not everyone. Most of us have five lumbar ver-
sonography was first used medically in the 1950s, images of sig- tebrae (bones of the lower spine), but some have four and some have
nificant clinical value had to wait until computer technology had six. Most of us have one spleen, but some people have two. Most have
developed enough to analyze differences in the way tissues reflect two kidneys, but some have only one. Most kidneys are supplied by
ultrasound. Sonography is not very useful for examining bones or a single renal artery and drained by one ureter, but in some people, a
lungs, but it is the method of choice in obstetrics, where the image single kidney has two renal arteries or ureters. Figure 1.4 shows some
(sonogram) can be used to locate the placenta and evaluate fetal common variations in human anatomy, and Clinical Application 1.1
age, position, and development (fig. 1.3). Sonography can also be describes a particularly dramatic variation.
used to view tissues in motion, such as fetal movements, a beating
heart, and blood ejection from the heart. Sonographic imaging of
the beating heart is called echocardiography. A Doppler ultrasound Apply What You Know
scan is a sonographic method for visualizing heart actions and the People who are allergic to penicillin or aspirin often wear
flow of blood through the vessels. bracelets or necklaces that note this fact in case they need
emergency medical treatment and cannot communicate. Why
would it be important for a person with situs inversus (see
9
Clinical Application 1.1) to have this noted on a bracelet?
sono = sound; graphy = recording process

sal1026X_ch01_001-023.indd 5 12/8/18 3:00 PM

Another Random Scribd Document
with Unrelated Content
 THE RANSOM IS PAID 169 was escaped on shore and got
into the castle, demanding of him a tribute or ransom of fire for the
town of Maracaibo ; which being denied, he threatened he would
entirely consume and destroy it. The Spaniards, considering how
unfortunate they had been all along with those Pirates, and not
knowing after what manner to get rid of them, concluded among
themselves to pay the said ransom, although Don Alonso would not
consent unto it. Hereupon they sent unto Captain Morgan to ask
what sum he demanded. He answered them he would have 30,000
pieces-of-eight, and 500 beeves, to the intent his fleet might be well
victualled with flesh. This ransom being paid, he promised in such
case he would give no farther trouble unto the prisoners, nor cause
any ruin or damage unto the town. Finally they agreed with him
upon the sum of 20,000 pieces-of-eight, besides the 500 beeves.
The cattle the Spaniards brought in the next day, together with one
part of the money. And, while the pirates were busied in salting the
flesh, they returned with the rest of the whole sum of 20,000 pieces-
of-eight, for which they had agreed. But Captain Morgan would not
deliver for that present the prisoners, as he had promised to do, by
reason he feared the shot of the artillery of the castle at his going
forth of the lake. Hereupon he told them he intended not to deliver
them till such time as he was out of that danger, hoping by this
means to obtain a free passage. Thus he set sail with all his fleet in
quest of that ship which he had left behind, to seek for the plate of
the vessel that was burnt. He found her upon the place, with the
sum of 15,000 pieces-of-eight, which they had purchased out of the
wreck, besides many other pieces of plate, as hilts of swords and
other things of this kind; also great quantity of pieces-of-eight that
were melted and run together by the force of the fire of the said
ship. Captain Morgan scarce thought himself secure, neither could
he contrive how to evade the damages the said castle might cause
unto his fleet. Hereupon he told the prisoners it was necessary they
should agree with the Governor to open the passage with security
for his fleet ; unto which point, if he should not consent, he would
certainly hang them all up in his ships. After this warning the
prisoners met together to confer upon the persons they should
depute unto the said Governor
 170 DEPUTATION TO THE GOVERNOR Don Alonso ; and
they assigned some few among them for that embassy. These went
unto him, beseeching and supplicating the Admiral he would have
compassion and pity on those afflicted prisoners who were as yet,
together with their wives and children, in the hands of Captain
Morgan, and that unto this effect he would be pleased to give his
word to let the whole fleet of Pirates freely pass, without any
molestation, forasmuch as this would be the only remedy of saving
both the lives of them that came with this petition as also of those
who remained behind in captivity—all being equally menaced with
the sword and gallows, in case he granted not this humble request.
But Don Alonso gave them for answer a sharp reprehension of their
cowardice, telling them: Jf you had been as loyal unto your King in
hindering the entry of these Pirates as I shall do their going out, you
had never caused these troubles, neither unto yourselves nor unto
our whole nation, which have suffered so much through your
pusillanimity. Ina word, I shall never grant your vequest, but shall
endeavour to maintain that respect which is due unto my King,
according to my duty. Thus the Spaniards returned to their fellow-
prisoners with much consternation of mind and no hopes of
obtaining their requests, telling unto Captain Morgan what answer
they had received. His reply was: Jf Don Alonso will not let me pass,
I will find means how to do it without him. Hereupon he began
presently to make a dividend of all the booty they had taken in that
voyage, fearing lest he might not have an opportunity of doing it in
another place, if any tempest should arise and separate the ships, as
also being jealous that any of the Commanders might run away with
the best part of the spoil which then did lie much more in one vessel
than another. Thus they all brought in, according to their laws, and
declared what they had ; having beforehand made an oath not to
conceal the least thing from the public. The accounts being cast up,
they found to the value of 250,000 pieces-of-eight in money and
jewels, besides the huge quantity of merchandize and slaves: all
which purchase was divided into every ship or boat, according to its
share. The dividend being made, the question still remained on foot
how they should pass the castle and get out of the lake. Unto this
effect they made use of a stratagem, of no ill invention, which was
as follows. On the day that preceded the night —————
 MORGAN’S STRATAGEM 171 wherein they determined to
get forth, they embarked many of their men in canoes, and rowed
towards the shore, as if they ' designed tolandthem. Here they
concealed themselves under the branches of trees that hang over
the coast for a while till they had laid themselves down along in the
boats. Then the canoes returned unto the ships, with the
appearance only of two or three men rowing them back, all the rest
being concealed at the bottom of the canoes. Thus much only could
be perceived from the castle ; and this action of false landing of
men, for so we may call it, was repeated that day several times.
Hereby the Spaniards were brought into persuasion the Pirates
intended to force the castle by scaling it, as soon as night should
come. This fear caused them to place most of their great guns on
that side which looks towards the land, together with the main force
of their arms, leaving the contrary side belonging to the sea almost
destitute of strength and defence. Night being come, they weighed
anchor, and by the light of the moon, without setting sail, committed
themselves to the ebbing tide, which gently brought them down the
river, till they were nigh unto the castle. Being now almost over
against it, they spread their sails with all the haste they could
possibly make. The Spaniards, perceiving them to escape,
transported with all speed their guns from the other side of the
castle, and began to fire very furiously at the Pirates. But these,
having a favourable wind, were almost past the danger before those
of the castle could put things into convenient order of offence. So
that the Pirates lost not many of their men, nor received any
considerable damage in their ships. Being now out of the reach of
the guns, Captain Morgan sent a canoe unto the castle with some of
the prisoners ; and the Governor thereof gave them a boat that
every one might return to his own home. Notwithstanding, he
detained the hostages he had from Gibraltar, by reason those of that
town were not as yet come to pay the rest of the ransom for not
firing the place. Just as he departed, Captain Morgan ordered seven
great guns with bullets to be fired against the castle, as it were to
take his leave of them. But they answered not so much as with a
musketshot. The next day after their departure, they were surprised
with a great tempest, which forced them to cast anchor in the depth
of 5 or 6 fathom water. But the storm increased so much that
 172 ATTEMPT ON COMANA they were compelled to weigh
again and put out to sea, where they were in great danger of being
lost. For if on either side they should have been cast on shore, either
to fall into the hands of the Spaniards or of the Indians, they would
certainly have obtained no mercy. At last the tempest being spent,
the wind ceased, which caused much content and joy in the whole
fleet. While Captain Morgan made his fortune by pillaging the towns
above-mentioned, the rest of his companions, who separated from
his fleet at the Cape de Lobos for to take the ship of which was
spoken before, endured much misery, and were very unfortunate in
all their attempts. For, being arrived at the isle of Savona, they found
not Captain Morgan there, nor any of their companions. Neither had
they the good fortune to find a letter which Captain Morgan at his
departure left behind him in a certain place where in all probability
they would meet with it. Thus, not knowing what course to steer,
they at last concluded to pillage some town or other, whereby to
seek their fortune. They were in all 400 men, more or less, who
were divided into ships and one boat. Being ready to set forth, they
constituted an Admiral among themselves, by whom they might be
directed in the whole affair. Unto this effect they chose a certain
person who had _ behaved himself very courageously at the taking
of Porto Bello, and whose name was Captain Hansel. This
Commander resolved to attempt the taking of the town of Comana,
seated nigh upon the continent of Caracas, nigh threescore leagues
from the West side of the isle of Trinidad. Being arrived there, they
landed their men, and killed some few Indians that were near the
coast. But approaching unto the town, the Spaniards, having in their
company many Indians, disputed them the entry so briskly that with
great loss and in great confusion they were forced to retire towards
their ships. At last they arrived at Jamaica, where the rest of their
companions who came with Captain Morgan ceased not to mock and
jeer them for their ill success at Comana, often telling them: Let us
see what money you brought from Comana, and wf it be as good
silver as that which we bring from Maracaibo. The end of the Second
Part
 PARI fi! CHAPTER I Captain Morgan goes to the isle of
Hispaniola to equip anew fleet, with intent to pillage again upon the
coasts of the West Indies CAPTAIN MorGAN perceived now that
fortune favoured his arms by giving good success to all his
enterprizes, which occasioned him, as it is usual in human affairs, to
aspire to greater things, trusting she would always be constant unto
him. Such was the burning of Panama, wherein fortune failed not to
assist him, in like manner as she had done before, crowning the
event of his actions with victory, howbeit she had led him thereunto
through thousands of difficulties. The history hereof I shall now
begin to relate, as being so much remarkable in all its circumstances
as peradventure nothing more deserving memory may occur to be
read by future ages. Not long after Captain Morgan arrived at
Jamaica, he found many of his chief officers and soldiers reduced to
their former state of indigence through their immoderate vices and
debauchery. Hence they ceased not to importune him for new
invasions and exploits, thereby to get something to expend anew in
wine and strumpets, as they had already wasted what was
purchased so little before... Captain Morgan, being willing to follow
fortune while she called him, hereupon stopped the mouths of many
of the inhabitants of Jamaica, who were creditors to his men for
large sums of money, with the hopes and promises he gave them of
greater achievements than ever by a new expedition he was going
about. This being done, he needed not give himself much trouble to
levy men for this or any other enterprize, his name being now so
173
 174. MORGAN EQUIPS A NEW FLEET famous through all
those islands as that alone would readily bring him in more men
than he could well employ.” He undertook, therefore, to equip a new
fleet of ships ; for which purpose he assigned the South side of the
isle of Tortuga as a place of rendezvous. With this resolution, he
wrote divers letters to all the ancient and expert Pirates there
inhabiting, as also to the Governor of the said isle, and to the
planters and hunters of Hispaniola, giving them to understand his
intentions, and desiring their appearance at the said place, in case
they intended to go with him. All these people had no sooner
understood his designs but they flocked unto the place assigned in
huge numbers, with ships, canoes, and boats, being desirous to
obey his commands. Many who had not the convenience of coming
unto him by sea traversed the woods of Hispaniola, and with no
small difficulties arrived there by land. Thus all were present at the
place assigned, and in readiness, against the 24th day of October,
1670. Captain Morgan was not wanting to be there according to his
punctual custom, who came in his ship unto the same side of the
island, to a port called by the French Port Couillon, over against the
island De la Vaca, this being the place which he had assigned unto
others. Having now gathered the greatest part of his fleet, he called
a council, to deliberate about the means of finding provisions
sufficient for so many people. Here they concluded to send four
ships and one boat, manned with 400 men, over to the continent, to
the intent they should rifle some country-towns and villages, and in
these get all the corn or maize they could gather. They set sail for
the continent, towards the river De la Hacha, with design to assault
a small village called La Rancheria, where is usually to be found the
greatest quantity of maize of all those parts thereabouts. In the
meanwhile Captain Morgan sent another party of his men to hunt in
the woods, who killed there an huge number of beasts, and salted
them. The rest of his companions remained in the ships, to clean, fit,
and rig them out to sea, so, at the return of those who were sent
abroad, all things might be in readiness to weigh anchor and follow
the course of their designs.
 CHAPTER II What happened in the river De la Hacha TuE
four ships above-mentioned, after they had set sail from Hispaniola,
steered their course till they came within sight of the river De la
Hacha, where they were suddenly overtaken with atediouscalm.
Being thus within sight of land becalmed for some days, the
Spaniards inhabiting along the coasts, who had perceived them to
be enemies, had sufficient time to prepare themselves for the
assault, at least to hide the best part of their goods, to the end that,
without any care of preserving them, they might be in readiness to
retire when they found themselves unable to resist the force of the
Pirates, by whose frequent attempts upon those coasts they had
already learnt what they had to do in such cases. There was in the
river at that present a good ship, which was come from Cartagena to
lade maize, and was now when the Pirates came almost ready to
depart. The men belonging to this ship endeavoured to escape, but,
not being able to do it, both they and the vessel fell into their hands.
This was a fit purchase for their mind, as being good part of what
they came to seek for with so much care and toil. The next morning
about break of day they came with their ships towards the shore,
and landed their men, although the Spaniards made huge resistance
from a battery which they had raised on that side where of necessity
they were to land ; but, notwithstanding what defence they could
make, they were forced to retire towards a village, unto which the
Pirates followed them. Here the Spaniards, rallying again, fell upon
them with great fury, and maintained a strong combat, which lasted
till night was come ; but then, perceiving they had lost great number
of men, which was no smaller on the Pirates’ side, they retired unto
places more occult in the woods. 175
 P76 SN TE RIVER DE EA TEAC ELA The next day when the
Pirates saw they were all fled, and the town left totally empty of
people, they pursued them as far as they could possibly. In this
pursuit they overtook a party of Spaniards, whom they made all
prisoners and exercised the most cruel torments, to discover where
they had hidden their goods: some were found who by the force of
intolerable tortures confessed, but others who would not do the
same were used more barbarously than the former. Thus, in the
space of fifteen days that they remained there, they took many
prisoners, much plate and movable goods, with all other things they
could rob, with which booty they resolved to return unto Hispaniola.
Yet, not contented with what they had already got, they dispatched
some prisoners into the woods to seek for the rest of the
inhabitants, and to demand of them a ransom for not burning the
town. Unto this they answered, they had no money nor plate; but, in
case they would be satisfied with a certain quantity of maize, they
would give as muchas they could afford. The Pirates accepted this
proffer, as being more useful to them at that occasion than ready
money, and agreed they should pay 4000 hanegs? (or bushels) of
maize. These were brought in three days after, the Spaniards being
desirous to rid themselves as soon as possible of that inhuman sort
of people. Having laded them on board their ships, together with all
the rest of their purchase, they returned unto the island of
Hispaniola, to give account unto their leader, Captain Morgan, of all
they had performed. They had now been absent five entire weeks,
about the commission aforementioned, which long delay occasioned
Captain Morgan almost to despair of their return, as fearing lest they
were fallen into the hands of the Spaniards, especially considering
that the place whereunto they went could easily be relieved from
Cartagena and Santa Maria, if the inhabitants were anything careful
to alarm the country: on the other side he feared lest they should
have made some great fortune in that voyage, and with it escaped
to some other place. But at last seeing his ships return, and in
greater number than they had departed, he resumed new courage,
this sight causing both him and his companions infinite joy. This was
much 1 hanega, Portug. fanega, a dry measure of capacity, about a
bushel to a bushel and a half English.
 FIGHTING STRENGTH OF THE FLEET 177 increased when,
being arrived, they found them full laden with maize, whereof they
stood in great need for the maintenance of so many people, by
whose help they expected great matters through the conduct of
their Commander. After Captain Morgan had divided the said maize,
as also the flesh which the hunters brought in, among all the ships
according to the number of men that were in every vessel, he
concluded upon the departure, having viewed beforehand every
ship, and observed their being well equipped and clean. Thus he set
sail, and directed his course towards Cape Tiburon, where he
determined to take his measures and resolution of what enterprize
he should take in hand. No sooner were they arrived there but they
met with some other ships that came newly to join them from
Jamaica. So that now the whole fleet consisted of 37 ships, wherein
were 2000 fighting men, besides mariners and boys ; the Admiral
hereof was mounted with 22 great guns and 6 small ones, of brass ;
the rest carried some 20, some 16, some 18, and the smallest vessel
at least 4, besides which they had great quantity of ammunition and
fire balls, with other inventions of powder. Captain Morgan finding
himself with such a great number of ships, divided the whole fleet
into two squadrons, constituting a Vice-Admiral, and other officers
and Commanders of the second squadron, distinct from the former.
Unto every one of these he gave letters patent, or commissions, to
act all manner of hostility against the Spanish nation, and take of
them what ships they could, either abroad at sea or in the harbours,
in like manner as if they were open and declared enemies (as he
termed it) of the King of England, his pretended master. This being
done, he called all his Captains and other officers together, and
caused them to sign some articles of common agreement betwixt
them, and in the name of all. Herein it was stipulated that he should
have the hundredth part of all that was gotten to himself alone: That
every captain should draw the shares of eight men, for the expenses
of his ship, besides his own: That the surgeon, besides his ordinary
pay, should have 200 pieces-of-eight, for his chest of medicaments:
And every carpenter, above his common salary, should draw 100
pieces-of-eight. As to recompenses and rewards, they were
regulated in this voyage much higher than was expressed in the First
Part of this book. Thus, for N
 178 DECISION TO ATTACK PANAMA the loss of both legs,
they assigned 1500 pieces-of-eight or 15 slaves, the choice being left
to the election of the party ; for the loss of both hands, 1800 pieces-
of-eight or 18 slaves ; for one leg, whether the right or the left, 600
pieces-of-eight or 6 slaves ; for a hand, as much as fora leg ; and for
the loss of an eye, 100 pieces-of-eight or 1 slave. Lastly, unto him
that in any battle should signalize himself, either byentering the first
any castle, or taking down the Spanish colours and setting up the
English, they constituted 50 pieces-of-eight for a reward. In the
head of these articles it was stipulated that all these extraordinary
salaries, recompenses, and rewards should be paid out of the first
spoil or purchase they should take, according as every one should
then occur to be either rewarded or paid. This contract being signed,
Captain Morgan commanded his Vice-Admirals and Captains to put
all things in order, every one in his ship, for to go and attempt one of
three places, either Cartagena, Panama, or Vera Cruz; but the lot fell
upon Panama as being believed to be the richest of all three:
notwithstanding this city being situated at such distance from the
Northern sea, as they knew not well the avenues and entries
necessary to approach unto it, they judged it necessary to go
beforehand to the isle of St Catharine, there to find and provide
themselves with some persons who might serve them for guides in
this enterprize ; for in the garrison of that island are commonly
employed many banditti and outlaws belonging to Panama and the
neighbouring places, who are very expert in the knowledge of all
that country. But, before they proceeded any farther, they caused an
act to be published through the whole fleet, containing that, in case
they met with any Spanish vessel, the first Captain who with his men
should enter and take the said ship should have for his reward the
tenth part of whatsoever should be found within her.
 CHAPTER III Captain Morgan leaves the island of
Hispaniola, and goes to that of St Catharine, which he takes
CAPTAIN MorGAN and his companions weighed anchor from the
Cape of Tiburon, the 16th day of December in the year 1670. _ Four
days after they arrived within sight of the isle of St Per eam rs
Catharine, which was now in possession of the Spaniards again, as
was said in the Second Part of this history, and unto which they
commonl banish all the malefactors of the Spanish dominions in the
West Indies. In this island are found huge quantities of pigeons at
certain seasons of the year; it is watered continually by four rivulets
or brooks, whereof two are always dry in the summer season. Here
is no manner of trade nor commerce exercised by the inhabitants,
neither do they give themselves the trouble to plant more fruits than
what are necessary for the sustentation of human life ; howbeit the
country would be sufficient to make very good plantations of
tobacco, which might render considerable profit, were it cultivated
for that use. As soon as Captain Morgan came nigh unto the island
with his fleet, he sent before one of his best sailing vessels to view
the entry of the river and see if any other ships were there who
might hinder him from landing ; as also fearing lest they should give
intelligence of his arrival to the inhabitants of the island, and they by
this means prevent his designs. The next day before sunrise, all the
fleet came to anchor nigh unto the island, in a certain bay called
Aguada Grande : upon this bay the Spaniards had lately built a
battery, mounted with four pieces of cannon. Captain Morgan landed
with 1000 men, more or less, and disposed them into squadrons,
beginning his march through the woods, although they had no other
guides than some few of his own men who had been there 179
 180: “GREAT HARDSHIPS ENDURED before when Mansvelt
took and ransacked the island. The same day they came unto a
certain place where the Governor at other times did keep his
ordinary residence: here they found a battery called The Platform,
but nobody in it, the Spaniards having retired unto the lesser island,
which, as was said before, is so nigh: unto the great one that a short
bridge only may conjoin them. This lesser island aforesaid was so
well fortified with forts and batteries round about it as might seem
impregnable. Hereupon, as soon as the Spaniards perceived the
pirates to approach, they began to fire upon them so furiously that
they could advance nothing that day, but were contented to retreat
a little, and take up their rest upon the grass in the open fields,
which afforded no strange beds to these people, as being sufficiently
used to such kind of repose: what most afflicted them was hunger,
having not eaten the least thing that whole day. About midnight it
began to rain so hard that those miserable people had much ado to
resist so much hardship, the greatest part of them having no other
clothes than a pair of seaman’s trousers or breeches and a shirt,
without either shoes or stockings. Thus finding themselves in great
extremity, they began to pull down a few thatched houses to make
fires withal: ina word, they were in such condition that one hundred
men, indifferently well armed, might easily that night have torn them
allin pieces. The next morning about break of day the rain ceased, at
which time they began to dry their arms, which were entirely wet,
and proceed on their march. But not long after, the rain
recommenced anew, rather harder than before, as if the skies were
melted into waters, which caused them to cease from advancing
towards the forts, whence the Spaniards did continually fire at the
Pirates, seeing them to approach. The Pirates were now reduced
unto great affliction and danger of their lives through the hardness
of the weather, their own nakedness, and the great hunger they
sustained. For a small relief hereof, they happened to find in the
fields an old horse, which was both lean and full of scabs and
blotches, with galled back and sides. This horrid animal they
instantly killed and flayed, and divided into small pieces among
themselves as far as it would reach, for many could not obtain one
morsel, which they roasted and devoured without either salt or
 GOVERNOR BETRAYS THE ISLAND 181 bread, more like
unto ravenous wolves than men. The rain as yet ceased not to fall,
and Captain Morgan perceived their minds to relent, hearing many of
them say they would return on board the ships. Amongst these
fatigues both of mind and body, he thought it convenient to use
some sudden and almost unexpected remedy: unto this effect he
commanded a canoe to be rigged in all haste, and colours of truce
to be hanged out of it. This canoe he sent to the Spanish Governor
of the island with this message: That if within a few hours he
delivered not himself and all his men into his hands, he did by that
messenger swear unto him and all those that were in his company,
he would most certainly put them all to the sword, without granting
quarter to any. After noon the canoe returned with this answer: That
the Governor desired two hours’ time to deliberate with his officers
in a full council about that affair ; which being past, he would give
his positive answer to the message. The time now being elapsed the
said Governor sent two canoes with white colours, and two persons,
to treat with Captain Morgan ; but before they landed, they
demanded of the Pirates two persons as hostages of their security.
These were readily granted by Captain Morgan, who delivered unto
them two of his Captains, for a mutual pledge of the security
required. With this the Spaniards propounded unto Captain Morgan
that their Governor in a full assembly had resolved to deliver up the
island, as not being provided with sufficient forces to defend it
against such an armada or fleet. But withal he desired that Captain
Morgan would be pleased to use a certain stratagem of war, for the
better saving of his own credit and the reputation of his officers both
abroad and at home, which should be as follows: That Captain
Morgan would come with his troops by night, nigh unto the bridge
that joined the lesser island unto the great one, and there attack the
fort of St Jerome: that at the same time all the ships of his fleet
would draw nigh unto the castle of Santa Teresa, and attack it by
sea, landing in the meanwhile some more troops near the battery
called St Matthew : that these troops which were newly landed
should by this means intercept the Governor by the way, as he
endeavoured to pass unto St Jerome’s fort, and then take him
prisoner, using the formality, as if they forced him to deliver the said
castle ; and that he would lead the English into it, under the fraud of
being his own troops ; that on one side and
 r32, {PIRSA DES FAKE. Si-CALEHARING t’other there should
be continual firing at one another, but without bullets, or at least
into the air, so that no side might receive any harm by this device ;
that thus having obtained two such considerable forts, the chiefest
of the isle, he needed not take care for the rest, which of necessity
must fall by course into his hands. These propositions, every one,
were granted by Captain Morgan, upon condition they should see
them faithfully observed, for otherwise they should be used with all
rigour imaginable: this they promised to do, and hereupon took their
leaves, and returned to give account of their negotiation to the
Governor. Presently after, Captain Morgan commanded the whole
fleet to enter the port, and his men to be in readiness for to assault
that night the castle of St Jerome. Thus the false alarm or battle
began with incessant firing of great guns from both the castles
against the ships, but without bullets, as was said before. Then the
Pirates landed, and assaulted by night the lesser island, which they
took, as also possession of both the fortresses, forcing all the
Spaniards, in appearance, to fly unto the church. Before this assault
Captain Morgan had sent word to the Governor he should keep all
his men together in a body, otherwise, if the Pirates met any
straggling Spaniards in the streets, they should certainly shoot them.
The island being taken by this unusual stratagem, and all things put
in due order, the Pirates began to make a new war against the
poultry, cattle, and all sorts of victuals they could find. This was their
whole employ for some days, scarce thinking of anything else than
to kill those animals, roast, and eat, and make good cheer, as much
as they could possibly attain unto. If wood was wanting, they
presently fell upon the houses, and, pulling them down, made fires
with the timber as had been done before in the field. The next day
they numbered all the prisoners they had taken upon the whole
island, which were found to be in all 450 persons, between men,
women, and children, viz. 190 soldiers belonging to the garrison, 40
inhabitants who were married, 43 children, 34 slaves belonging to
the King, with 8 children, 8 banditti ; 39 negroes belonging to
private persons, with 27 female blacks and 34 children. The Pirates
disarmed all the Spaniards, and sent them out immediately unto the
plantations to seek for provisions, leaving the women in the church,
there to exercise their devotions.
 FORTRESSES OF THE ISLAND 183 Soon after, they took a
review of the whole island and all the fortresses belonging
thereunto, which they found to be nine in all, as follows: the fort of
St Jerome, nighest unto the bridge, had 8 great guns, of twelve, six,
and eight pound carriage, together with 6 pipes of muskets, every
pipe containing 10 muskets. Here they found still 60 muskets, with
sufficient quantity of powder and all other sorts of ammunition. The
second fortress, called St Matthew, had 3 guns, of 8 pound carriage
each. The third and chiefest among all the rest, named Santa
Teresa, had 20 great guns, of 18, 12, 8, and 6 ‘pound carriage, with
10 pipes of muskets, like those we said before, and 90 muskets
remaining, besides all other warlike ammunition. This castle was
built with stone and mortar, with very thick walls on all sides, and a
large ditch round about it of 20-foot depth, the which although it
was dry was very hard to get over. Here was no entry but through
one door, which corresponded to the middle of the castle. Within it
was a mount or hill, almost inaccessible, with four pieces of cannon
at the top, whence they could shoot directly into the port. On the
sea side this castle was impregnable, by reason of the rocks which
surrounded it and the sea beating furiously upon them. In like
manner, on the side of the land, it was so commodiously seated on a
mountain that there was no access to it but by a path of three or
four foot broad. The fourth fortress was named St Augustine, having
3 guns, of eight and six pound carriage. The fifth, named La
Plattaforma de la Concepcion, had only 2 guns, of eight pound
carriage. The sixth, by name San Salvador, had likewise no more
than 2 guns. The seventh, being called Plattaforma de los Artilleros,
had also 2 guns. The eight, called Santa Cruz, had 3 guns. The
ninth, which was called St Joseph’s Fort, had 6 guns, of twelve and
eight pound carriage, besides two pipes of muskets and sufficient
ammunition. In the storehouse were found above thirty-thousand
pound of powder, with all other sorts of ammunition, which were
transported by the Pirates on board the ships. All the guns were
stopped and nailed, and the fortresses demolished, excepting that of
St Jerome, where the Pirates kept their guard and residence. Captain
Morgan inquired if any banditti were there from Panama or Porto
Bello ; and hereupon three were brought before him,-who pretended
to be very expert in all
 m4 BANDITTI ENGAGED AS “GUIDES the avenues of those
parts. He asked them if they would be his guides and show him the
securest ways and passages unto Panama ; which if they performed,
he promised them equal shares in all they should pillage and rob in
that expedition, and that afterwards he would set them at liberty by
transporting them unto Jamaica. These propositions pleased the
banditti very well, and they readily accepted his proffers, promising
to serve him very faithfully in all he should desire ; especially one of
these three, who was the greatest rogue, thief, and assassin among
them, and who had deserved for his crimes rather to be broken alive
upon the wheel than punished with serving in a garrison. This
wicked fellow had a great ascendancy over the other two banditti,
and could domineer and command over them as he pleased, they
not daring to refuse obedience to his orders. Hereupon Captain
Morgan commanded four ships and one boat to be equipped and
provided with all things necessary, for to go and take the castle of
Chagre, seated upon the river of that name. Neither would he go
himself with his whole fleet, fearing lest the Spaniards should be
jealous of his farther designs upon Panama. In these vessels he
caused to embark — 400 men, who went to put in execution the
orders of their chief Commander Captain Morgan, while he himself
remained behind in the island of St Catharine, with the rest of the
fleet, expecting to hear the success of their arms.
 CHAPTER IV Captain Morgan takes the castle of Chagre
with four hundred men sent unto this purpose from the Isle of St
Catharine CAPTAIN MorGAN, sending these four ships and a boat to
the river of Chagre, chose for Vice-Admiral thereof a certain person
named Captain Brodely. This man had been a long time in those
quarters, and committed many robberies upon the Spaniards when
Mansvelt took the isle of St Catharine, as was related in the Second
Part of the history. He, being thereof well acquainted with those
coasts, was thought a fit person for this exploit, his actions likewise
having rendered him famous among the Pirates and their enemies
the Spaniards. Captain Brodely being chosen Chief Commander of
these forces, in three days after he departed from the presence of
Captain Morgan arrived within sight of the said castle of Chagre,
which by the Spaniards is called St Lawrence. This castle is built
upon a high mountain, at the entry of the river, and surrounded on
all sides with strong palisades, or wooden walls, being very well
terre-pleined1, and filled with earth, which renders them as secure
as the best walls made of stone or brick. The top of this mountain is
in a manner divided into two parts, between which lies a ditch of the
depth of thirtyfoot. The castle itself has but one entry, and that by a
drawbridge which passes over the ditch aforementioned. On the
land-side it had four bastions, that of the sea containing only two
more. That part thereof which looks towards the South is totally
inaccessible and impossible to be climbed, through the infinite
asperity of the mountain. The North side is 1 A French fortification
term—the platform on top of a rampart : cf. ‘‘ If it fall so out that
you cannot make trauerses vppon the terreplaine, for that the
enemy doth hinder it . , ,"’—Garrard, Art of Warre [1591], p. 317.
185
 186 THE. CASTLE OF CHAGRE surrounded by the river,
which hereabouts runs very broad. At the foot of the said castle, or
rather mountain, is seated a strong fort, with eight great guns;
which commands and impedes the entry of the river. Not much lower
are to be seen two other batteries, whereof each has 6 pieces of
cannon, to defend likewise the mouth of the said river. At one side of
the castle are built two great storehouses, in which are deposited all
sorts of warlike ammunition and merchandize, which are brought
thither from the inner parts of the country. Nigh unto these houses is
a high pair of stairs, hewed out of the rock, which serves to mount
unto the top of the castle. On the West side of the said fortress lies
a small port, which is not above seven or eight fathom deep, being
very fit for small vessels, and of very good anchorage. Besides this,
there lies before the castle, at the entry of the river, a great rock,
scarce to be perceived above water, unless at low tides. No sooner
had the Spaniards perceived the Pirates to come but they began to
fire incessantly at them with the biggest of their guns. They came to
an anchor in a small port, at the distance of a league more or less
from the castle. The next morning very early they went on shore,
and marched through the woods, to attack the castle on that side.
This march continued until two of the clock of the afternoon before
they could reach the castle, by reason of the difficulties of the way,
andits mire and dirt. And, although their guides served them exactly,
notwithstanding they came so nigh the castle at first that they lost
many of their men with the shot from the guns, they being in an
open place where nothing could cover nor defendthem. This much
perplexed the Pirates in their minds, they not knowing what to do,
nor what course to take, for on that side of necessity they must
make the assault, and, being uncovered from head to foot, they
could not advance one step without great danger. Besides that, the
castle, both for its situation and strength, did cause them much to
fear the success of that enterprize. But to give it over they dared
not, lest they should be reproached and scorned by their
companions. At last, after many doubts and disputes among
themselves, they resolved to hazard the assault and their lives after
a most desperate manner. Thus they advanced towards the castle,
 ASSAULT ON THE CASTLE 187 with their swords in one
hand and fire-balls in the other. The Spaniards defended themselves
very briskly, ceasing not to fire at them with their great guns and
muskets continually, crying withal: Come on, ye English dogs,
enemies to God and our King ; let your other companions that are
behind come on too ; ye shall not go to Panama this bout. After the
Pirates had ‘made some trial to climb up the walls, they were forced
to retreat, which they accordingly did, resting themselves until night.
This being come, they returned to the assault, to try if by the help of
their fire-balls they could overcome and pull down the pales before
the wall. This they attempted to do, and while they were about it
there happened a very remarkable accident, which gave them the
opportunity of the victory. One of the Pirates was wounded with an
arrow in his back, which pierced his body to the other side. This
instantly he pulled out with great valour at the side of his breast:
then, taking a little cotton that he had about him, he wound it about
the said arrow, and putting it into his musket, he shot it back into
the castle. But the cotton, being kindled by the powder, occasioned
two or three houses that were within the castle, as being thatched
with palm-leaves, to take fire, which the Spaniards perceived not so
soon as was necessary. For this fire, meeting with a parcel of
powder, blew it up, and thereby caused great ruin, and no less
consternation, to the Spaniards, who were not able to occur unto?
this accident, not having seen the beginning thereof. Thus the
Pirates, perceiving the good effect of the arrow and the beginning of
the misfortune of the Spaniards, were infinitely gladded thereat.
And, while they were busied in extinguishing the fire, which caused
great confusion in the whole castle, having not sufficient water
wherewithal to do it, the Pirates made use of this opportunity,
setting fire likewise unto the palisades. Thus the fire was seen at the
same time in several parts about the castle, which gave them huge
advantage against the Spaniards. For many breaches were made at
once by the fire among the pales, great heaps of earth falling down
into the ditch. Upon these the Pirates climbed up, and got over into
the castle, notwithstanding that some Spaniards who were not
busied about the fire cast down upon them many flaming pots, full
of combustible matter + Latin occurrere, to meet, prevent,
counteract,
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