A TEXT-BOOK FOR NUBSES
JOHN FORSYTH LITTLE, M.D.
ASSISTANT DEMONSTRATOR OF ANATOMY, JEFFERSON MEDICAL COLLEGE
ILLUSTRATED WITH 149 ENGRAVINGS AND
LEA & FEBIGER
PHILADELPHIA AND NEW YORK
Entered according to the Act of Congress, in the year 1914, by
LEA & FEBIGER,
in the office of the Librarian of Congress. All rights reserved.
IN presenting this work to the nursing profession
the author has endeavored to cover in as clear and
untechnical a manner as possible the essentials of
anatomy and physiology. No theories have been
included, except those which have been definitely
accepted by teachers of the subjects. Emphasis has
been placed on the description of organs and their
functions which are of fundamental importance in
the practice work of the nurse.
The questions at the end of each chapter are added
as a means of reviewing the subjects.
The glossary has been added with the object of
explaining all technical words in the text.
J. F. L.
CHEMIC COMPOSITION OF THE HUMAN BODY .... 20
METABOLISM THE CELL, ITS STRUCTURE AND FUNCTIONS 29
OSTEOLOGY THE DESCRIPTION OF BONES AND BONE
ARTICULATIONS OR JOINTS 106
MUSCLE TISSUE . 117
THE DESCRIPTION OF THE ANATOMY AND PHYSIOLOGY OF
THE CIRCULATORY APPARATUS 174
THE LYMPHATIC SYSTEM . . . 225
THE RESPIRATORY APPARATUS .
THE ORGANS OF DIGESTION .
THE FACTORS ESSENTIAL TO THE PRODUCTION OF BODY
TEMPERATURE OR HEAT . .
THE ANATOMY AND PHYSIOLOGY OF THE URINARY APPAR-
ATUS (ORGANS); THE SKIN AND ITS APPENDAGES 314
ANATOMY AND PHYSIOLOGY OF THE NERVE SYSTEM
THE ORGANS OF SPECIAL SENSE . . - 390
ORGANS OF REPRODUCTION 417
ANATOMY AND PHYSIOLOGY
THE human body from birth to old age exhibits in
the living condition a series of phenomena by which it
grows, performs the various and complex movements
of which man is capable in the processes of daily life;
thinks, and is conscious of the sensations which bring
him into relation with his surroundings, and repro-
duces, permitting a continuation of the species.
A study of the functions of the numerous organs
and structures of the body in a state of health, and their
associated phenomena of growth, movement, mentality,
and reproduction, is termed human physiology.
To understand the functions of organs, etc., it is
necessary to first understand the construction of the
human body of which they are a part. To this branch
of science the term human anatomy is applied.
THE ANATOMIC ARRANGEMENT OF THE BODY
AS A WHOLE
The human body is divided into an axial portion
consisting of the head, neck, and trunk; and an appen-
dicular portion, including the limbs or extremities
arms, legs, etc.
The axial portion is subdivided into a posterior or
dorsal cavity, and an anterior or ventral cavity.
The dorsal cavity is formed by the vertebrse and their
arches of bone, and the bones of the skull. If the
dorsal cavity is sectioned in a longitudinal direction
it will show, above, the cranial cavity, and below,
the spinal cord, the former containing the brain and
its membranes, the latter the spinal cord and its
The ventral cavity includes the space within the
trunk and in front of the spinal column. Its walls
consist of skin, fascia, and muscles reinforced by bony
arches, the ribs, and the pelvic bones. The ventral cavity
is subdivided by a musculomembranous wall, the dia-
phragm, into an upper cavity called the thorax, and a
lower one, the abdomen. The former contains the organs
of respiration the lungs and the heart, covered by their
membranes, also the great bloodvessels leading from
the heart, and the esophagus (gullet), which conveys
food from the pharynx to the stomach by passing
through the diaphragm. The abdomen contains the
remaining portions of the tube (alimentary canal),
which receives the food from the esophagus and ends
in the lower part of the cavity called the anus; also
the organs of secretion liver, pancreas, spleen, etc.;
excretion kidneys, bladder, etc., and reproduction in
The appendicular portion of the body consists of four
extremities two upper and two lower limbs. The
upper limbs consist of bones held together by liga-
ments, and covered with muscles, tendons, fascia, and
skin. The lower limbs have the same construction as
the upper, but the joints are not so capable of move-
ment. For example, the shoulder and elbow are freely
movable, as compared with the hip.
The study of anatomy is divided into the following
Osteology: the anatomy of the bones.
Syndesmology : the anatomy of the joints.
Myology: the anatomy of the muscles.
Angiology: the anatomy of the bloodvessels.
Neurology: the anatomy of the nerves.
ANATOMIC ARRANGEMENT OF THE BODY 19
Splanchnology : the anatomy of the internal organs
digestion, respiration, etc.
The construction of each organ and portion of the
body, and its independent function, as well as the
combined actions of several organs entering into
the performance of a definite act, as in digestion, etc.,
are described under the term physiologic apparatus.
Digestive apparatus, by means of which food isdigested.
Absorptive apparatus, for the absorption of nourishment
into the lymph and blood. Circulatory apparatus, for
the distribution of blood from the heart to all portions
of the body. The respiratory apparatus, by means of
which oxygen is absorbed into the blood from the air
breathed into the lungs, and carbon dioxide and other
waste materials are given off from the blood to the
atmosphere. Urinary apparatus, for the elimination
of waste materials from the body through the kidneys
and bladder, as urine. Secretory and perspiratory
apparatuses the former secreting essential materials
for the maintenance of body nutrition; the latter
aiding in regulating heat dissipation and in eliminating
waste materials through the sweat glands of the skin.
1. What do you understand by the term human physiology?
2. Name the two portions the body is divided into.
3. Give the parts of the body included under the axial and appen-
4. Name the cavities included in the subdivision of the axial
5. Describe the dorsal cavity. Ventral cavity.
6. What are the subdivisions of the dorsal cavity and contents?
7. What are the subdivisions of the ventral cavity?
8. Name the structure which subdivides the abdomen and thorax.
9. Wliat are the principal organs, etc., contained in the thorax?
10. How many extremities or limbs are included under the appen-
dicular portion of the body?
11. What do you understand by the following terms: Osteology,
syndesmology, myology, angiology, neurology, splanchnology?
12. What do you understand by the term physiologic apparatus?
CHEMIC COMPOSITION OF THE HUMAN
THE human body after a chemic analysis can be
reduced into its final constituents. The analysis
of the dead body is completed with little difficulty,
while the analysis of the constituents of the living
body is a most complicated and arduous task. The
former procedure is called chemic anatomy, while
the latter is termed chemic physiology.
The analysis of the human body will disclose the
fact that it contains liquid and solid compounds which
belong to both the organic and inorganic chemic
and plant world. These compounds derived from
a proximate analysis are termed proximate principles.
However, to deserve, this term they must be obtained
in the form in which they exist in the living body.
The organic compounds consist of carbohydrates,
fatty and protein groups of organic bodies; the
inorganic compounds consist of water, various acids,
and inorganic salts.
Chemic Elements Found in the Human Body : Oxygen,
72 per cent.; hydrogen, 9.1; nitrogen, 2.5; carbon,
13.5; phosphorus, 1.15; calcium, 1.3; sulphur, 0.147;
sodium, 0.1; potassium, 0.026; chlorin, 0.085; fluorin,
iron, silicon, magnesium, iodine, in small amounts.
The Carbohydrates. The carbohydrates are repre-
sented in the human body mostly as starches and
sugars. They contain carbon, hydrogen, and oxygen,
ORGANIC COMPOUNDS 21
but no J nitrogen the hydrogen and oxygen being
in such proportion as to form water, or as 2 to 1,
as is shown in the chemic formula for starch,
Few of the carbohydrates are found in the human
body, but are found mostly in the foods we eat. They
are the most beneficial nourishment for the mainten-
ance of heat and energy, and are, besides, available
and easy of digestion.
The carbohydrates are divided into three groups:
(1) Amyloses, including starch, dextrin, glycogen, and
cellulose; (2) dextroses, including dextrose, levulose,
galactose; (3) saccharoses, including saccharose, lac-
1. Amyloses (CeHioOs),,. Starch forms about 10
per cent, of the body weight. It is a constituent in
wheat, Indian corn, oats, cereals, plants, potatoes,
peas, beans, and some fruits. In the presence of a
ferment, such as ptyalin in the saliva starch is
converted into maltose and dextrose, two forms of
Dextrin is a substance formed as an intermediary
product in the change of starch into dextrose. It is
divided into two varieties erythrodextrin and achro-
Glycogen, or animal starch, is a constituent of the
animal liver, muscles, arid tissues generally, particularly
the tissues of the embryo.
Cellulose is found mostly in plants.
2. Dextroses (C 6 Hi 2 O 6 ). Dextrose, glucose, or grape-
sugar occurs as irregular, warty masses, usually as a
thick syrup. It is a constituent of the vegetable
kingdom; generally found with fruit-sugar or levulose
in fruits, as grapes, peaches, figs, cherries, mulberries,
strawberries, etc. It is also found in honey, and is
a normal constituent of liver, blood, and urine in small
quantities, in health, and is an indication of the disease
diabetes mellitus when found in larger amounts.
22 CHEMIC COMPOSITION OF THE HUMAN BODY
Levulose or fruit-sugar is associated with dextrose as
a constituent of sweet fruits and honey.
Galactose is obtained when milk-sugar (lactose) is
boiled with dilute sulphuric acid.
3. Saccharoses. Saccharose or cane-sugar occurs as
hard, crystalline granules. It is found in the juices of
plants; in different grasses (sugar-cane); in the forest
trees (maple-sugar); and in the roots and stems of
plants (beet-sugar), etc.
Molasses is a product derived from the evaporation
and refining of cane-sugar, as is caramel or burnt-
Maltose is formed from starch, when acted on by
malt extract or the diastatic ferments in saliva and
pancreatic juice. The diastatic ferment or diastase
is a substance resulting from allowing the seeds of
rye, wheat, barley, etc., to germinate in the manu-
facture of alcoholic liquors. This when formed acts
on the starch and converts it into maltose and dextrin.
Lactose or milk-sugar is found only in the milk of mam-
malia. In the stomach of human beings, in the pres-
ence of the lactic acid bacillus, it is changed to lactic
acid and then to butyric acid.
Fats. Fats or hydrocarbons are organic bodies found
in the tissues of both vegetables and animals. They
are the most valuable food next to the carbohydrates,
as a source of heat and energy, but are not so available
or so easily digested. They are found in the subcuta-
neous tissues, marrow of bones, in and around the
numerous internal organs, back of the eye-balls, the
omentum, in milk; and in very stout persons they are
found in the liver, kidney, heart muscle, and muscles
of the extremities, also along arteries, veins, and
nerves. Fat is found in the animal foods, such as,
meat, fish, butter; in vegetable foods, as oils, cereals,
and in the kernels of nuts,
Fats are compounds consisting of carbon, hydrogen
and oxygen, the first being the main ingredient,
ORGANIC COMPOUNDS 23
forming >by weight about 75 per cent., while oxygen is
present in very small amounts. The fat found in
animals is a mixture of three neutral fats stearin,
palmitin, and olein. Each fat is derived from glycerin
and the acid indicated by its name e. g., oleic acid,
in the case of olein, etc.
When we speak of saponification we mean that a neu-
tral fat has been treated with a superheated steam
or saponified i. e., broken up into glycerin and a
fatty acid, as stearic, oleic, or palmitic, the resulting
acid depending on the neutral fat used.
Soaps. Soaps are formed when saponification takes
place in the presence of an alkali e. g., potassium or
sodium hydroxid the acid combines with the alkali
to form a salt known as soap, the glycerin remaining
Soaps are salts. Soaps made with sodium hydroxid
are hard, those with potassium hydroxid are soft.
Those derived from stearin and palmitin are harder
than those made with olein.
The Animal Fats. Butter, cream, lard, suet, oleo-
margarin, cottolene, butterine, cod-liver oil, and
bone-marrow are the animal fats of the most import-
The Vegetable Fats. Those most commonly em-
ployed are olive oil, cotton-seed oil, linseed oil,
cocoa-butter, and the oils derived from nuts, such
as cocoanut oil, peanut oil, and almond oil.
The Proteins. Proteins are found in both animals
and vegetables, and contain most of the nitrogenous
compounds essential for their physiologic needs. In
the former they are found as constituents of the blood,
tissues, bones, muscles, nerves, glands, and all other
organs; in the latter, in nearly all parts of plants
and seeds. They are represented in the vegetable
food which we eat, as constituents of gluten of grain,
etc. ; in the animal food, as the lean and gristle of beef,
the white of egg, casein of milk (the curd), etc.
24 CHEMIC COMPOSITION OF THE HUMAN BODY
Protein contains carbon, hydrogen, nitrogen, oxygen,
sulphur, and some phosphorus. The chemic constit-
uents, however, are so complex that a definite chemic
formula, representing each ingredient, has not been
satisfactorily determined. They are the most stable
of the constituents of the body, and help to build up
new tissues and replenish the quantity necessary to
maintain the loss from waste of the old, resulting from
the wear and tear of daily existence, through work,
mental or physical, oxidation, elimination, etc. They
are also converted into heat and energy, but are not
so essential to the body for the former purpose, as
the carbohydrates or fats. They are also converted
into fat and stored up in the body for future use.
The proteins and their various tests and physical
properties are too numerous to mention or discuss,
especially as they are not essential to a nurse's knowledge.
I shall simply mention the important ones or the ones
of most interest as constituents of the more familiar
tissues and foods, under the headings as follows:
Albumins, globulins, albuminoids.
Albumins: Serum-albumin in blood, lymph, chyle.
Egg-albumen in white of egg.
Lact-albumin in milk.
Myo-albumin in plasma of muscle.
Globulins: Serum-globulins in blood serum.
Fibrinogen in blood plasma (with serum-albumin
Myosinogen in muscle plasma (very nutritive).
Crystallin or globulin in crystalline lens of eye.
Albuminoids: Collagen and ossein in white fibrous
tissue and bones.
Choridrin in permanent cartilage.
Elastin in fibers of yellow elastic tissue.
Keratin in horny tissues and skin as hairs,
nails, scales, horns of animals, etc.
Caseinogen in milk contains phosphorus.
Vitellin in yolk of egg contains phosphorus.
INORGANIC COMPOUNDS 25
Compound Albuminoids: Hemoglobin in red cells of
blood (coloring matter).
Mucin in secretions of mucous membranes and
Nuclein in the nuclei of tissue cells and sub-
stance (rich in phosphorus).
Proteoses and Peptones. These are resulting proteins
formed during digestion by the action of the gastric
and pancreatic juices upon the proteins as they pass
through the process of digestion in the stomach and
Three coagulated proteins are formed when soluble
proteins are acted upon by animal ferments, e. g.,
fibrin, myosin, casein.
Fibrin. This is formed from the soluble protein
fibrinogen by the action of a special ferment. It is
not found except when blood is withdrawn from the
vessels or when coagulation occurs. Blood-clots fol-
lowing hemorrhage, by the action of the ferment on
the fibrinogen, forming fibrin.
Myosin. This is a protein derived from a soluble
protein myosinogen. It occurs in muscles after death
and accounts for the stiffness of the limbs rigor
Casein. This is formed as a result of the action of
a special ferment rennin, a constituent of the gastric
juice acting upon the protein caseinogen of milk.
This is the ferment which splits milk into curds and
whey or junket. The curds represent the solid por-
tion or casein; the whey, the liquid portion. (See
Water (H 2 O). Water is the most important inor-
ganic substance essential to life. It is in the tissues
and fluids of the body, comprising 75 to 90 per cent,
of its weight. In a person weighing 165 pounds, 115
20 CHE MIC COMPOSITION OF THE HUMAN BODY
pounds of that weight will consist of water. It enters
into the foods and liquids we assimilate; acts as a
solvent for the various salts, carbohydrates, fats,
proteins, etc.; aids in the absorption of fresh material
into the blood and tissues; assists in dissolving and
transferring the products of disintegrating tissues to
the blood from which it is eliminated by way of the
skin (perspiration), kidneys (urine), lungs, and intes-
The Inorganic Salts. These are calcium phosphate,
fluorid and carbonate; sodium chloride, phosphate,
carbonate, and sulphate; potassium chlorid, phosphate
and carbonate; magnesium phosphate and carbonate.
Salts enter into the formation of all tissues of the
body. Sodium chlorid common table salt is the
most important of the group. . It is the chief salt
found in the blood, lymph, and pancreatic juice.
As a seasoning for food, it adds to its relish and thus
promotes digestion. By a chemical process it helps
to form the hydrochloric acid, and produces the alka-
linity of the blood. Potassium chlorid is found in
association with sodium chlorid throughout the tissues,
and is a chemic constituent of muscle, nerve, and red
corpuscles. Calcium salts are found as constituents
of bones, teeth, cartilage, blood, milk, and other tis-
sues. All of the above combinations are to be found
throughout the body, but their various physiologic
and chemic properties are not essential to the nurse's
Phosphorus. Phosphorus is found in the muscles,
bones, nerve system, and blood, in various chemic
combinations, as phosphates, also in both animal
and vegetable foods.
Sulphur. Sulphur is found in the body in the form
of sulphates, which are derived from egg-albumen,
milk, and certain vegetables.
Iron. Iron is an essential constituent of the color-
ing matter (hemoglobin) of the blood, lymph, bile,
gastric juice, pigment of the eyes, hair, and skin. It
is found in chemic combination only, as ferric acid
and in organic compounds.
There are constituents of the body, aside from
proteins, fats, carbohydrates, and inorganic salts,
which can only be located by the various chemic
analyses and tests. They are the substances resulting
from the numerous and complicated changes con-
tinually taking place in the food we eat and water we
drink, as a result of digestion, absorption, etc. They
are carried to the tissues, where they perform their
functions, and then are taken up from the tissues by
the blood and carried to the skin (as perspiration),
kidneys (as urine), lungs (as carbon dioxid), and intes-
tines (as feces), to be eliminated as waste materials.
These substances are: (1) Organic acids, e. g., acetic,
lactic, oxalic, butyric, in combination with alkalin
and earthy bases. (2) Organic substances, e. g., alco-
hol, glycerin, cholesterin. (3) Pigments found in the
bile, urine. (4) Nitrogenized (crystalline), as urea,
uric acid, xanthin, creatin, creatinin, and hippuric
1. What does an analysis of the human body show it to consist
of? To what groups of chemic and plant world do these compounds
2. What do you understand by the term proximate principles?
3. What do the organic compounds consist of? The inorganic?
4. Name the chemical elements found in the human body.
5. What chemic compounds found in the human body represent
6. What do the carbohydrates contain and in what proportion?
7. What is the essential benefit derived from a nourishment rich
8. Name the three groups of carbohydrates?
9. Where is starch found in the vegetable and plant world?
10. Where is dextrose or grape-sugar found? Levulose or fruit-
sugar? Saccharose or cane-sugar? Lactose or milk-sugar?
11. Do fats belong to the organic or inorganic group of compounds?
12. Are they as valuable as carbohydrates as a source of heat
28 CHEMIC COMPOSITION OF THE HUMAN BODY
13. Where is fat usually found in the human body? In the animal
14. Does fat contain carbon, hydrogen, and oxygen?
15. Name the three neutral intermixed fats which are found in
16. What do you understand by saponification?
17. How are soaps formed? What is the difference between a
hard and soft soap?
18. Where are proteins found in the vegetable world? Animal
19. What do proteins contain?
20. Why are proteins so essential to the tissues of the body?
21. What are proteoses and peptones?
22. What percentages of water comprises the body weight?
23. Name the inorganic salts found by analysis in the body tissues.
24. Where is phosphorus found in the body tissues? Sodium
chlorid? Sulphur? Iron?
METABOLISM THE CELL, ITS STRUCTURE
METABOLISM is the term used to express the various
and complex phenomena which are taking place within
tfre protoplasm of the cells of the tissues throughout
the body, whereby the food principles are transferred
into simpler or complex compounds by the action of
digestion, absorption, etc., and by which they are
carried to the cells of the tissues where they are again
converted into other bodies by an inherent function
of the protoplasm of the cells, and' produce energy
that is later transferred into heat and activity.
Oxygen is essential to this chemic change going on
within the cells. But oxygen is not a food.
When food is broken up into simple compounds
it is termed katabolism; and when transformed into
complex chemic bodies it is called anabolism. Both
of the above changes are continually going on within
the body and together comprise the processes of
The body to develop, grow, and perform the various
functions which constitute life, requires material for
the tissues. This is derived from the food we eat and
liquids we drink; and the oxygen we breathe from the
air is essential to promote metabolism. The food
is used by the tissues and the waste materials result-
ing from the processes of metabolism are eliminated.
Food, then, is not only used to create energy, heat,
and activity, but it must replace the loss of tissue in
the body which is continually occurring during the
performance of the processes of life, from birth to old
age. When this waste is not replenished by new tissue,
the body cannot properly carry on its functions.
Every effort of the human body requires a certain
amount of energy or force to bring about its perform-
ance. Thus a man in his daily work lifts a certain
weight; the body cells must reproduce and furnish a
proportionate amount of heat and activity necessary
to accomplish this effort. This he obtains from the
energy developed from a definite amount of food
eaten each day.
Food is held together by a force called potential
energy. When broken up into its more absorbable
substances by the process of digestion, etc., so that
the cells of the tissues can make use of it, to develop