SECTION Ⅰ．MUSCULAR CONTRACTION AND ASSOCIATED PHENOMENA 25
CHAPTER Ⅰ．PHYSIOLOGY OF SKELETAL MUSCLE 25
Functions of Muscles in Health and Disease 25
Excitation and Contraction of Muscle 27
The Appraisal of Excitability 31
The Reactions of Isolated Muscles 33
Effects of Initial Length and Tension 35
Tetanic Contractions and Summation Nature of Voluntary Contraction 39
The Nature of Voluntary Contractions 41
Physical Properties of Single Muscle Fiber During Rest and Activity 42
Other Shortening Mechanisms 43
Tonus 44
Contracture 44
Rigor 44
Abnormal States of Muscular Contraction 45
Spasticity 45
Fibrillation and Fasciculation 46
Denervation Reactions 47
Atrophy 47
Myasthenia 48
Myotonia 48
CHAPTER Ⅱ．FUNCTIONS OF CARDIAC AND SMOOTH MUSCLE 50
Cardiac Muscle 50
Rhythmicity and Conduction 51
Contractile Responses 53
Excitability 58
The Refractory Phase 59
Smooth Muscle 61
Exitability 62
Tonus 63
CHAPTER Ⅲ．BIOENERGETICS 65
The Caloric Unit 66
The Energy Transformation 66
The Mechanisms of Oxidation 67
Energy Transformations Following Excitation of Muscle 70
Sequence of Chemical Changes 71
The Heat Production of Muscle 74
Mechanical Efficiency of Contraction 76
The Fuel for Muscular Contraction 79
Muscular Fatigue 82
CHAPTER Ⅳ．BIOELECTRIC PHENOMENA 84
Apparatus 84
The Character and Significance of Direct Leads 87
Diphasic Action Potentials 89
The Meaning of Bioelectric Phenomena 92
Indirect Leads—Volume Conductors 95
Local Response—End-plate and Synaptic Potentials 99
Use of Action Potential in Physiological Studies 101
Skeletal Muscle Potentials 101
Cardiac Phenomena 102
Smooth Muscle Organs 102
Secretory Activity 103
Nerve Trunks and Fibers 103
The Retina and the Optic Tracts 103
The Cochlear Functions and Auditory Tract 104
Synaptic Transmission，Conduction，and Inhibitory Phenomena in Ganglia and Spinal Cord 104
Brain and Cortex．The Electroencephalogram and Cortical Electrogram 104
Conditions Modifying Normal EEG．Patterns 106
Clinical Applications 106
SECTION Ⅱ．THE PHYSIOLOGY OF THE PERIPHERAL AND CENTRAL NERVOUS SYSTEMS 109
CHAPTER Ⅴ．PHYSIOLOGY OF AXONS 109
Methods 109
The Characteristics of Nerve Conduction 110
Direction of Conduction 110
Exitability of Nerves 111
Action Potentials of Single Axons 116
Metabolism 117
Interaxonal and Intercellular Currents 119
The Effects of Direct Current 120
Accommodation 122
Repetitive Firing 124
Fatigue 124
CHAPTER Ⅵ．REFLEX ARCS AND REACTIONS OF THEIR COMPONENTS 127
The Morphological Background 127
Concept of the Simple Reflex Arc 127
Principal of Convergence and Divergence 128
Autonomic Reflex Arcs 129
Cranial Nerve Reflexes 129
Intersegmental Reflexes 129
Biophysics of Receptor and Effector Components 130
Sensory End-organs 130
Central Motor Cells 132
Conduction and Excitation in Ganglion Cells 133
Synaptic and End-plate Transmission 135
Biophysical Aspects of Reflex Actions 138
Spinal Cord Potentials 138
After-Discharge 139
CHAPTER Ⅶ．MECHANISMS OF SIMPLER REFLEXES 143
Animal Preparations 143
The Spinal Preparation 143
Spinal Shock and Its Meaning 144
Flexor Reflexes 145
Central Inhibition 147
Reflexes Due to Repetitive Stimuli 149
The Reflex Excitation of Flexors of a Whole Limb 150
Extensor Reflexes 152
De-Emblée and Recruitment in Reflex Muscular Action 152
Inhibition of Crossed Extensors 154
Ipsilateral Extensor Reflexes 154
Myotatic or Stretch Reflexes 154
Reflex Postural Contraction(Plastic Tonus) 155
The Knee-jerk—A Phasic Stretch Reflex 156
CHAPTER Ⅷ．PHYSIOLOGICAL PURPOSES OF REFLEX ACTIONS AND THEIR DISTRUBANCES IN DISEASE 160
The Purposive Character of Reflex Action 161
Protective Reflexes 162
Automatic or Associated Reactions 164
The Integration of Allied and Antagonistic Reflexes 165
Postural Reflexes 165
Stance Reflexes 167
Static Righting Reflexes 70
Source of Labyrinthine Impulses for Control of Static Equilibrium 171
Static Reflexes in Disease 171
Kinetic Equilibrium and Stato-kinetic Reflexes 172
Kinetic Labyrinthine Responses 173
Reflexes in Locomotion 175
CHAPTER Ⅸ．CONTROL OF VOLUNTARY AND INVOLUNTARY MOVEMENTS 178
The Cortical Areas 178
The Motor Cortex 179
The Pyramidal System of Control 180
Electrical Excitation of Motor Cortex 182
Ablation and Injury of Motor Cortex 185
Functions of the Pyramidal Tracts 186
The Extrapyramidal System 186
The Premotor Cortex 186
Decerebrate Rigidity 189
The Interpretation of Spastic Paraplegia and Other Spastic States 189
The Striato-pallidum Syndromes and Their Interpretations 191
CHAPTER Ⅹ．CEREBELLAR CONTROL OF MUSCULAR MOVEMENTS 195
Cerebellar Connections 195
Theories of Cerebellar Function 196
CHAPTER Ⅺ．SOMATIC SENSIBILITIES AND THEIR DISTURBANCES 203
Subjective Attributes of Sensation 209
The Concept of Paleo- and Neosensibilities(Brouwer) 211
The Functions of the Thalamus 213
Cortical Representation of Somatic Sensibilities 216
CHAPTER Ⅻ．SPECIAL SENSIBILITIES 227
Vision 227
The Dioptric Mechanism 227
The Retinal Receptor Mechanism 230
Effects of Light on the Retina 231
Visual Acuity 232
Discrimination of Differences in Light Intensity 232
Flicker 232
Retinal Changes in Stimulation 233
Scotopic and Photopic Vision 233
Optic Nerve Discharges 235
Organization of Impulses by the Retina 236
Electroretinograms and Optic Axon Responses 236
Color Vision 238
Color Blindness 242
Camouflage and Its Detection by Color-blind Eyes 244
Conduction Pathways 244
Some Pupillary Reactions and Reflexes 247
Pathological Disturbances of Vision Due to Lesions of Visual Receptors and Optic Pathways 248
Hearing 251
The External Auditory Apparatus 251
The Middle Ear 251
The Internal Ear 253
Physical Characteristics of Sounds 255
Quality of Timbre 256
The Excitation of Auditory Terminals by Internal Ear Mechanisms 257
Microphonic Responses of the Cochlea 258
Action Potentials of the Cochlear Nerve 259
Nerve Conduction Paths 259
Cortical Representation 260
Auditory Discrimination in Auscultation 260
Noise and Its Measurement 261
Impairment of Hearing 262
Taste 264
Smell 267
CHAPTER ⅩⅢ．ASSOCIATIVE FUNCTIONS OF THE CEREBRAL CORTEX 271
Cortical Control of Verbalization 271
The Alleged Existence of＂Speech Centers＂ 271
The Prefrontal Association Areas 273
Prefrontal Lobectomy 273
Frontal Lesions 274
Prefrontal Lobotomy 274
Conditioned Reflexes 275
CHAPTER ⅪⅤ．THE AUTONOMIC NERVOUS SYSTEM AND HYPOTHALAMUS—SLEEP 286
The Autonomic Nervous System 286
The Concept of the Autonomic Reflex System 288
Autonomic Centers 294
The Hypothalamus 294
The Hypothalamus and Sleep 299
CHAPTER ⅩⅤ．VISCERAL PAIN AND HEADACHE 304
Visceral Sensitivity and Pain 304
Cardiac Pain(Angina Pectoris) 307
Vascular Pains 310
Gastro-intestinal Pains 311
Hepatic and Biliary Pains 312
Renal and Ureteral Pains 312
Headache 313
CHAPTER ⅩⅥ．THE PHYSIOLOGICAL BASIS FOR PSYCHOSOMATIC REACTIONS 319
Emotional Components 319
The Emotional Centers in the Central Nervous System 320
Cortical Factors in Emotional Reactions 322
The Purposeiveness of Emotional Reactions 324
Effects of Non-utilization of Visceral Energy Releases 324
Functional Changes Due to Emotion 324
Human Organ Neuroses 326
SECTION Ⅲ．THE BLOOD 333
CHAPTER ⅩⅦ．THE CORPUSCULAR ELEMENTS OP BLOOD 333
Leucocytes 333
Basal Levels and Physiological Variations 334
Functions and Their Importance 334
Disturbances of the White Cell Systems 336
Erythrocytes 337
Size，Form and Numbers 337
Structure and Constitution 338
Life History and Destruction of Blood Cells 338
Histogenesis 338
Erythropoiesis 339
Granulopoiesis 340
Thrombopoiesis 341
Disturbances of the Red Cell Systems 342
Polycythemia 342
Hemoglobin and Derivatives 344
Abnormal Combinations of Hemoglobin 347
Hematoporphyrinemia 348
Suspension Stability，Sedimentation and Agglutination of Red Cells 348
Hemagglutination 349
Hemolysis 353
CHAPTER ⅩⅧ．BLOOD PLASMA AND COAGULATION 357
Plasma 357
The Plasma Proteins 357
Blood Viscosity 359
Viscosity of Normal Blood 359
Factors Affecting Blood Viscosity 360
Coagulation of the Blood 361
Coagulation Constants of Normal Blood 361
The Coagulation Process 361
The Chemical Mechanisms 362
Theories of Coagulation 367
Thrombosis 369
Anticoagulants 369
Methods of Hastening Coagulation 372
Hemorrhagic Diseases 373
Hemophilia 373
Hemophilioid Conditions 374
CHAPTER ⅪⅩ．ACIDOSIS AND ALKALOSIS 376
The Regulation of the Acid-base Balance 376
The Buffering Systems of the Blood 377
Physiological Factors in the Control of Acid-base Balance 379
Clinical Acidosis and Alkalosis 380
Types of Disturbances 382
CHAPTER ⅩⅩ．BLOOD VOLUME—BLOOD LOSS AND TBANSFUSION 386
Blood Volume 386
Normal Blood Volumes 390
The Control of Blood Volume 391
Blood Volume and Plasma Volume in Disease 391
The Distribution of Blood Losses 393
Transfusions 394
The Time Element 394
Quantity 394
Rate of Infusion 395
Intra-arterial Transfusion 396
Blood Substitutes 396
SECTION Ⅳ．RESPIRATION 407
CHAPTER ⅩⅪ．FUNCTIONS OF RESPIRATORY STRUCTURES AND THEIR DISTURBANCES 407
Prenatal Respiration 407
The Mechanism of External Respiration After Birth 409
Physiological Aspects of Pathological Pulmonary Conditions 411
CHAPTER ⅩⅫ．RESPIRATORY MOVEMENTS AND MECHANICS OP LUNG INFLATION 414
Chest Enlargement and Muscular Action 414
Physiological Mechanisms 417
The Decrease in Thoracic Size During Expiration 418
Modified Respiratory Movements 418
Lung Inflation 419
Changes in the Pleural Pressures and Lung Inflation 420
The Dynamics of Lung Inflation 421
Pneumothorax 423
The Exchange of Air in the Alveoli 423
CHAPTER ⅩⅩⅢ．INTERCHANGE OF GASES IN THE LUNGS AND TISSUES AND THEIR TRANSPORTATION BY THE BLOOD 429
The Physical Conditions for Interchange of Gases 429
Alveolar Gas Volumes and Tensions 429
The Volumes and Tensions of Blood Gases 431
Gas Tensions in Tissues 432
Diffusion of Gases Through Tissue Membranes 433
The Interchange of Gases in the Lungs and Tissues 433
The Transport of Oxygen by the Blood 436
The Kinetics of Oxygenation and Reduction of Hemoglobin 438
The Transport of Carbon Dioxide 439
CHAPTER ⅩⅩⅣ．REGULATION OF RESPIRATION 443
The Respiratory Center 443
The Reflex Control of the Respiratory Center 446
Lung Reflexes 448
Aortic and Sinus Caroticus Reflexes 449
The Chemical Control of Respiration 450
The Functional Organization of the Respiratory Center 452
The Intrinsic Mechanism of Respiratory Automaticity 454
The Humoral Controls 455
The Cellular Theories 456
Chemical Reflexes in Control of Respiration 457
Prenatal Respiratory Movements，Neonatal Apnea and Breathing 460
CHAPTER ⅩⅩⅤ．CLINICAL DISTURBANCES OF RESPIRATION 463
Dyspnea 463
Cardiac Dyspnea 465
Cardiac Asthma 469
Periodic Breathing 471
The Hyperventilation Syndrome 472
Respiratory Failure 474
Responses to Respiratory Resistance 474
Tachypnea 474
Types of Respiratory Failure 475
Artificial Respiration 475
CHAPTER ⅩⅩⅥ．CLINICAL ANOXIA 481
The Effects of Oxygen Deficiency 481
Clinical Types of Anoxia 481
Cyanosis 484
Cyanosis Associated with Congenital Anomalies 485
Acclimatization to Anoxic States and Chronic Altitude Sickness 486
Acclimatization 486
High Altitude Disease(Chronic Mountain Disease，Monge＇s Disease) 487
Oxygen Therapy 487
Toxic Effects of Oxygen Under High Pressure 490
Other Aids in Supplying Oxygen to Tissues 491
CHAPTER ⅩⅩⅦ．AVIATION PHYSIOLOGY 493
The Effects of Altitude 493
Effects of Cold 494
Solar Radiations 494
Anoxia 495
Forces Concerned in Blood Oxygenation 495
Methods for Producing Anoxemic Anoxia 497
Symptoms of Hypoxia and True Anoxia 497
Methods of Increasing Altitude Tolerance 499
Physiological Actions of Anoxia 501
Blood 501
Central Nervous System 502
Effects on Other Organs 502
Heart and Circulation 503
CHAPTER ⅩⅩⅧ．AVIATION PHYSIOLOGY(Continued) 505
Effects of Pressure Changes and Acceleration 505
Paranasal Sinuses and Middle Ear 505
Gastro-intestinal Distention 506
Blood and Tissue Fluids 506
Decompression Sickness 506
Explosive Decompression 508
Effects of Acceleration 509
Parachute Descent 510
Other Aspects of Linear Accelerations 510
Radial Acceleration 511
Physiological Effects of Acceleration 511
Procedures for Circumventing the Effects of Acceleration 514
The Labyrinth in Aviation 514
SECTION Ⅴ．HEART AND CIRCULATION 518
CHAPTER ⅩⅪⅩ．EXCITATION OF THE MAMMALIAN HEART AND ITS NERVOUS CONTROL 518
Anatomical Aspects 518
Cardiac Muscle 518
The Specialized Muscular System 518
Electrographic Methods of Study 521
Initiation of Impulses 521
The S-A Node as Pacemaker 521
Ectopic Rhythmic Centers 522
Conduction of Impulses 523
A-V Conduction 524
Conduction in the Ventricles 525
Interference of Impulses 527
Nervous Control of the Mammalian Heart 527
Right Vagus 528
Left Vagus 529
Accelerator Nerves 530
The Ultimate Cause of Automatism and Its Modifications 531
CHAPTER ⅩⅩⅩ．ELECTROCARDIOGRAPHY 533
The Three Standard Leads and Their Significance 533
The Electrocardiogram Pattern 534
Relation of Waves to Spread of Excitation and Restitution 535
The Physical Meaning of Standard Leads 536
The Physical Character of Resultant Potential Differences and Their Distribution in Volume Conductors 538
The Cause of Abnormal Complexes 544
Precordial Leads 545
Unipolar Limb Leads 547
The Physiological Meaning of Electrocardiogram Deflections 548
Abnormalities in Deflections 549
Some Electrographic Evidences of Conduction Disturbances 550
CHAPTER ⅩⅩⅪ．ABNORMAL CARDIAC RHYTHMS AND THEIR ELECTROCARDIOGRAPHIC INTERPRETATION 552
Normal Heart Rate Standards 552
Abnormal Rhythms 552
Sinus Tachycardia 552
Sinus Bradycardia 553
Phasic Sinus Arrhythmia 554
Ectopic Rhythms 555
A-V Nodal Rhythm 555
Idioventricular Rhythms 556
Disturbances of Impulse Conduction 556
Heart Block 556
Premature Beats and Paroxysmal Tachycardias 563
Premature Atrial Systoles 563
Paroxysmal Tachycardia of Atrial Origin 564
Premature Ventricular Contractions 565
Paroxysmal Ventricular Tachycardia 565
Parasystolic Rhythms 566
Re-entrant Impulses and Circus Movements 566
Fibrillation and Allied Conditions 567
Atrial Fibrillation and Flutter 567
Ventricular Fibrillation 570
The Nature of Fibrillation and Flutter 572
The Initiation of Fibrillation 573
Ventricular Alternation 574
CHAPTER ⅩⅩⅫ．THE CIRCULATION OF THE BLOOD 576
The Circulatory System 577
The Distributing System 578
The Capillaries and Venules 579
The Collecting System 581
Peripheral Blood Shunts and Blood Spaces 582
The Heart as a Pump 582
The Essential Cardiac Structures 582
The Movements of the Heart and Apex Beat 586
The Reservoir Function of the Central Arteries 587
Peripheral Resistance 590
Total Peripheral Resistance 591
Units of Resistance 591
CHAPTER ⅩⅩⅩⅢ．HEMODYNAMIC PRINCIPLES 593
Pressure，Flow and Resistance 593
Velocity 595
The Circulation Time 596
The Hemodynamics of Pulsating Streams 599
CHAPTER ⅩⅩⅩⅣ．MEAN ARTERIAL BLOOD PRESSURE AND ITS CONTROL．THE EFFECTS OF RESPIRATION 604
Methods 604
Factors Affecting Mean Arterial Pressure-Hemodynamics 606
Methods for Evaluating Alterations in Peripheral Resistance 607
Illustrations of Modifications of Mean Arterial Pressure and Organ Volume by Cardiac and Vascular Factors 608
The Effects of Respiration on Blood Pressure 612
CHAPTER ⅩⅩⅩⅤ．NERVOUS AND CHEMICAL CONTROL OF BLOOD PRESSURE 614
The Nervous Control of the Arterioles 614
Vasomotor Nerves and Their Actions 614
The Control of Vasomotor Centers 618
The Nervous Control of Heart Rate 624
The Control of Venous Return 627
Blood Reservoirs 629
Effects of Gravity in the Upright Position 630
CHAPTER ⅩⅩⅩⅥ．THE CEREBRAL，PORTAL，AND SPLENIC CIRCUITS 633
The Cerebral Circulation 633
Cerebral Blood Flow 635
Cerebral Anemia．Increased Intracranial Pressure 638
The Hepatic Circulation 639
Hepatic Blood Flow 639
The Splenic Circulation 642
CHAPTER ⅩⅩⅩⅦ．DYNAMICS OF THE HEART BEAT．PRESSURE AND VOLUME CURVES—CYCLE OF EVENTS—VALVE ACTION—HEART SOUNDS 644
The Pressure Pulses 644
The Ventricular Volume Curves and Their Relation to Pressure Pulses 648
The Sequence of Cardiodynamic Events 651
The Phases of the Cardiac Cycle 654
The Movement of Blood Through the Aorta 654
The Mechanisms of the Heart Beat in Detail 656
Mechanical vs．Electrical Systole 656
The Atrial Contraction and Its Dynamic Function 656
The Play of the Cardiac Valves 657
The Heart Sounds 658
The Audible Heart Sounds 659
Recorded Heart Sounds 661
Normal Phonocardiograms 663
CHAPTER ⅩⅩⅩⅧ．TRANSMISSION OP PRESSURE PULSES TO THE PERIPHERY．ARTERIAL AND VENOUS PULSES 670
The Arterial Pulse 670
Transformation of the Pressure Pulse in Transmission 671
The Genesis of Peripheral Arterial Pulses 674
Clinical Value of Central Pulse Tracings 677
The Practical Value of the Radial Pulse 680
Transmission Time and Velocity of the Pulse Wave 681
The Central Venous Pulse 682
Waves of Optically Recorded Venous Pulse and Their Significance 684
The Clinical Value of the Venous Pulse 686
CHAPTER ⅩⅩⅩⅨ．SYSTOLIC AND DIASTOLIC ARTERIAL PRESSURES．PERIPHERAL AND CENTRAL VENOUS PRESSURES．CAPILLARY PRESSURE 687
Factors Determining Systolic-Diastolic Pressure Relations 687
Physical Experiments by Means of Artificial Circulation Machines 687
Pressure Changes in Experimental Animals 692
Human Blood Pressure 692
Orientation 692
Indirect Methods 693
Normal Values for Human Blood Pressures 698
Venous Pressure 700
Peripheral Venous Pressure 700
Capillary Pressures 704
CHAPTER ⅩL．EFFICIENCY AND ADAPTABILITY OF THE HEART 706
Cardiac Output and Work 706
Physical Factors in Cardiac Adaptation．Compensation and Decompensation 715
The Effects of Increased Venous Supply 716
The Effects of Increased Aortic Resistance 718
The Effects of Heart Rate Changes 719
The Effects of Abnormal Ventricular Excitations 720
Effects of Alterations in the Inherent Condition of Heart Muscle 721
Application of Dynamic Principles to Clinical Disorders 722
Primary Hyperdynamic Action of the Ventricles 723
Primary Hypodynamic Action of the Ventricles 724
The Functions of the Pericardium 727
Effects of Pericardial Effusion(Cardiac Tamponade) 728
Effects of Chronic Adhesive Processes 729
The Question of Cardiac Tonus 730
Hypertrophy 731
CHAPTER ⅩLⅠ．HYPERTENSION 738
Classifications 738
Physiological Aspects 738
Experimental Hypertension 739
Clinical Hypertension 742
Dynamic Characteristics 744
Structures Affected in Hypertension 745
Cardiac Effects 746
CHAPTER ⅩLⅡ．THE PULMONARY CIRCULATION 748
The Normal Pulmonary Circulation 748
Anatomical Characteristics 748
Pressure Values in the Pulmonary Circuit 750
Pressure Pulses 751
The Nervous Control of Pulmonary Vessels 753
Experimental and Pathological Changes in the Pulmonary Circulation 754
Effects of Heart Rate 754
Effects of Systolic Discharge of the Right Ventricle 755
Effects of Abnormal Respiratory Conditions 755
Pulmonary Embolism 756
Fat Embolism 756
Embolism of the Larger Pulmonary Arteries 756
Air Embolism 757
Pulmonary Congestion．Back-Pressure Effects 758
Effects of Systemic Hypertension 748
Effects of Aortic or Mitral Resistance 759
Acute Pulmonary Edema 759
CHAPTER ⅩLⅢ．CORONARY CIRCULATION—ITS CONTROL AND ADJUSTMENTS IN HEALTH AND DISEASE—CORONARY OCCLUSION 764
The Normal Coronary Circulation 764
Coronary Sinus Flow 766
The Question of Functional Collaterals 768
Coronary Arterial Pressures 769
Coronary Flow 770
The Mechanical Effects of the Heart Beat 773
Phasic Changes in Coronary Flow 773
Disturbances of the Coronary Circulation 779
Acute Coronary Occlusion 779
Coronary Insufficiency Due to Other Causes 782
CHAPTER ⅩLⅣ．DYNAMICS OF VALVULAR LESIONS 786
Aortic Stenosis 786
The Cardinal Clinical Signs 786
The Degree of Stenosis as a Physical Factor 786
The Pressure Pulses 786
The Systolic Murmur 789
The Dynamic Changes in the Pulmonary Circuit and Right Heart 789