PART Ⅰ．PATHOLOGIC PHYSIOLOGY 1
CHAPTER 1 Pathologic Physiology＆By WILLIAM A．SODEMAN 3
ETIOLOGY OF DISEASE 3
Primary Factors 3
Secondary Factors 4
BODY RESPONSES TO ETIOLOGIC AGENTS 5
REFERENCES 6
PART Ⅱ．GENETICS AND DISEASE 7
CHAPTER 2 Genetics and Disease＆By BENJAMIN R．GENDEL 9
INTRODUCTION 9
THE PHYSICAL BASIS OF INHERITANCE 9
Genes 9
Chromosomes 10
Mitosis and Meiosis 10
Determination of Sex 12
Nondisjunction 12
Hereditary Variations 12
MECHANISMS OF INHERITANCE 14
Dominant Inheritance 15
Recessive Inheritance 16
Intermediate Inheritance or Incomplete Dominance 17
Sex-Linked Inheritance 18
Sex-Influenced Inheritance 19
TYPES OF GENETIC DISEASES 20
The Mutant Gene and Mechanisms of Gene Action 20
Lethals 20
Morphologic-Embryologic Defects 20
Inborn Errors of Metabolism 21
Abiotrophic Disturbances 26
Immunologic Disturbances 26
Susceptibility to Infectious Diseases 27
Detoxification of Drugs 27
Chromosomal Accidents 29
Klinefelter＇s Syndrome 29
Turner＇s Syndrome 30
Mongolism 31
Miscellaneous Conditions 31
REFERENCES 32
PART Ⅲ．METABOLISM AND THE ENDOCRINE GLANDS 33
CHAPTER 3 Nutritional Factors;Protein and Fat Metabolism＆By WILLIAM A．SODEMAN 35
INTRODUCTION 35
PROTEINS 38
Protein Deficiency 41
FATS 43
CALORIES 45
General Metabolism 45
Obesity 47
Caloric Deficiency 48
VITAMINS 49
Vitamin A 50
The Vitamin B Complex 51
Ascorbic Acid(Vitamin C) 58
Vitamin D and Calcium 61
Vitamin E 63
Vitamin K 63
Hypervitaminoses 64
MINERALS 65
Magnesium 66
Cobalt 66
Copper 66
Iodine 66
Fluorine 67
Iron 67
REFERENCES 68
CHAPTER 4 Carbohydrate Metabolism＆By HENRY T．RICKETTS AND MAURICE E．KRAHL 70
THE CHEMISTRY OF CARBOHYDRATE UTILIZATION 70
REGULATORY MECHANISMS OF CARBOHYDRATE METABOLISM 71
The Pancreas 72
Other Endocrine Glands 73
PHYSIOLOGIC EFFECTS OF THE ORAL HYPOGLYCEMIC AGENTS 74
THE GLUCOSE TOLERANCE TEST 75
CLINICAL ABNORMALITIES OF CARBOHYDRATE METABOLISM 77
Inborn Metabolic Errors 77
Diabetes Mellitus 77
Hypoglycemia 82
Organic Hypoglycemia 82
Functional Hypoglycemia 83
REFERENCES 84
CHAPTER 5 Water and Electrolyte Balance＆By C．THORPE RAY 86
VOLUMES AND COMPOSITION OF BODY FLUIDS 88
Measurements of the Volumes of Body Fluids 88
Characteristics of Intracellular and Extracellular Fluids 89
Exchanges of Fluids between Cellular and Extracellular Spaces 90
Exchanges of Fluids between Vascular and Extravascular Spaces 91
EXTERNAL EXCHANGES OF FLUIDS—WATER BALANCE 93
The Effect of Solute Load on Water Excretion 94
The Effect of the Antidiuretic Hormone on Water Excretion 95
Turnover of Body Water 97
ELECTROLYTIC BALANCE 97
Sodium 97
Sodium Content of the Body 98
Shifts of Sodium Between Compartments 98
Sodium Balance 99
Factors Which Influence Sodium Excretion by the Kidneys 99
Clinical Examples of Disorders in Sodium Balance 100
Chloride 104
The Chloride Content of the Body 104
Chloride Balance 104
Factors Influencing Renal Excretion of Chloride 105
Clinical Examples of Disorders in Chloride Balance 105
Potassium 105
Potassium Content of the Body 106
Shifts of Potassium between Compartments 106
Potassium Balance 107
Factors Which Influence Renal Excretion of Potassium 108
Clinical Examples of Disorders in Potassium Balance 108
CALCIUM AND MAGNESIUM 113
Calcium 113
Magnesium 114
ACID-BASE EQUILIBRIUM 115
Mechanisms of Production of Alkalosis and Acidosis 116
Respiratory Acidosis 116
Respiratory Alkalosis 117
Metabolic Acidosis 117
Metabolic Alkalosis 119
REFERENCES 120
CHAPTER 6 Endocrine Glands＆By EDWARD C．REIFENSTEIN,JR． 122
GENERAL CONSIDERATIONS 122
Definitions 122
General Outline of Hormone Relations 122
Classification of Hormone Actions 123
Objectives of Hormone Therapy 124
Natural versus Artificial”Hormones＂ 125
The Hormone Content of the Glands 125
Intermediary Metabolism in Disease 126
RESUME OF GLANDULAR PHYSIOLOGY 126
Hypothalamus 126
Anterior Pituitary 127
Posterior Pituitary 128
Ovary 129
Testis 130
Adrenal Cortex 130
Adrenal Medulla 132
Thyroid 133
Parathyroids 133
Pancreas 134
Placenta 135
DYNAMIC PHYSIOLOGY OF THE HORMONES 136
PATHOLOGIC PHYSIOLOGY OF THE MAIN ENDOCRINE ABNORMALITIES 142
Hypothalamic Precocity 143
Fr？hlich＇s Syndrome 143
Adolescent Mammoplasia 144
Hypothalamic or Psychogenic Amenorrhea 144
Acromegaly 146
Panhypopituitarism(Simmonds＇ Cachexia,Sheehan＇s Syndrome,Pituitary Dwarfism) 149
Pituitary Amenorrhea 151
Cushing＇s Syndrome 151
Primary Hyperaldosteronism(Conn＇s Syndrome) 154
Primary Hypoaldosteronism 155
Adaptation Syndrome 155
Disorders of Adaptation;Effects of Pituitary Adrenocorticotropic Hormone and of Adrenal Cortical Steroid Hormones in Nonendocrine Disorders 156
Addison＇s Disease and Adrenal Cortical Insufficiency 159
Adrenogenital Syndrome 160
Adrenal Androgen Hyperfunction Syndromes(Stein-Leventhal Syndrome;Large,Pale Ovary Syndrome) 161
Pheochromocytoma 163
Diabetes Insipidus 163
Menopause and the Menopausal Syndrome 164
Postmenopausal and Senile Osteoporosis 165
Gonadal Dysgenesis(Ovarian Agenesis,Turner＇s Syndrome,Ovarian Short-Stature Syndrome,Functional Prepuberal Castration) 167
Amenorrhea 168
Dysfunctional Uterine Bleeding(Metropathia Hemorrhagica) 170
Presumptive Test for Pregnancy 172
Dysmenorrhea and Endometriosis 172
Premenstrual Tension 175
Anorexia Nervosa 175
Arrhenoblastoma 176
Granulosa Tumors,Theca Cell Tumors,and Luteomas 176
Hypoleydigism 176
Hypospermatogenesis 177
Seminiferous Tubule Dysgenesis(Gynecomastia-and-Small-Testes Syndrome,Klinefelter＇s Syndrome) 178
Cryptorchidism 179
Male＂Climacteric＂ 181
Teratoma,Chorio-epithelioma,and Choriocarcinoma 181
Leydig Cell Tumor 182
Cretinism and Myxedema(Hypothyroidism) 182
Thyrotoxicosis(Hyperthyroidism) 182
Exophthalmic Goiter(Graves＇ Disease) 184
Simple Goiter 185
Thyroiditis 185
Hypoparathyroidism 185
Pseudohypoparathyroidism 186
Hyperparathyroidism 186
Diabetes Mellitus 188
Hyperinsulinism 188
Pregnancy Toxemia Complicating Diabetes Mellitus 189
Recurrent and Theatened Abortion 190
Postpartum Breast Manifestations 191
Endocrine Therapy for Neoplastic Disease 192
SUMMARY 192
REFERENCES 193
PART Ⅳ．INFECTION AND ALLERGY 195
CHAPTER 7 Factors Affecting Infections＆By GEORGE T．HARRELL,JR． 197
FACTORS CONCERNED IN THE NUMBER OF INFECTING ORGANISMS 198
Sources of Infection 198
Agents of Disease 199
Portal of Entry 201
Transmission by Vectors 201
Growth in the Body 202
FACTORS CONCERNED IN THE VIRULENCE OF THE INFECTING ORGANISM 204
Primary and Secondary Infections 204
Conditions Necessary for Infection 205
Routes of Spread 205
Increase in Virulence 206
Reduction in Virulence 207
Variations in Strains 208
FACTORS CONCERNED IN RESISTANCE 209
Nonspecific Factors 210
Specific Resistance 214
REFERENCES 214
CHAPTER 8 Effects of Infection＆By GEORGE T．HARRELL,JR． 215
INFLAMMATION AND FEVER 215
DAMAGE TO ORGANS 216
Direct or Immediate Effects 216
Indirect or Long-Term Effects 221
The Lungs 221
The Kidneys 222
The Heart 223
Effects Not Accompanied by Anatomic Change 224
Circulatory Disturbances 224
Chills 224
Rash 225
Central Circulatory Failure 225
Peripheral Circulatory Failure 226
Disturbances of Venous Circulation 230
Disturbances of the Lymphatic Circulation 232
INDIRECT EFFECTS ASSOCIATED WITH DISTANT INFECTION 232
REFERENCES 233
CHAPTER 9 Recovery from Infection＆By GEORGE T．HARRELL,JR． 235
IMMUNITY 235
Application to Diagnosis 236
Circulating Antibodies 237
Cellular Antibodies 239
Criterion of Cure 240
Response to Reinfections 241
Harmful Effects 242
SUPPORTIVE THERAPY 243
Rest 243
Diet 244
Vitamins 245
Fluids 247
Minerals 248
Measures to Decrease Metabolism 248
Measures to Support the Circulation 249
REFERENCES 250
CHAPTER 10 Alteration of the Course of an Infection＆By GEORGE T．HARRELL,JR． 251
PREVENTION 251
Control of Environment 251
Active Immunization 253
Passive Immunization 254
CHEMOTHERAPY 255
Antiseptics 258
Sulfonamides 259
Antibiotics 260
Other Chemotherapeutic Agents 261
Toxic Effects 262
IMMUNE THERAPY 263
Hypersensitivity Reactions 265
OTHER MEASURES 265
Physical Therapy 265
Biologic Therapy 266
Desensitization 266
Breakdown of Granulomas 267
Inhibition of Antigen-Antibody Reactions 267
REFERENCES 268
CHAPTER 11 Allergy＆By ROBERT A．COOKE AND WILLIAM B．SHERMAN 269
INTRODUCTION 269
ANAPHYLAXIS IN EXPERIMENTAL ANIMALS 270
Arthus Phenomenon 272
ANAPHYLAXIS IN MAN 272
Serum Sickness 273
CLINICAL ALLERGIES 274
Allergies with Immediate Wheal Reactions 274
Late Reactions to Food Allergens 278
Asthma,Rhinitis and Urticaria Due to Infection 278
Delayed and Immediate Reactions to Infective Agents 279
Allergic Dermatitis 281
Drug Allergies 282
EFFECTS OF CORTISONE AND CORTICOTROPIN ON ALLERGIC REACTIONS 283
REFERENCES 283
PART Ⅴ．PHYSICAL,TOXIC AND CHEMICAL AGENTS 285
CHAPTER 12 Physical and Toxic Agents＆By WILLIAM BEAN 287
INTRODUCTION 287
ENVIRONMENTAL TEMPERATURE 288
Heat 288
Source of Heat 288
Heat Load 288
The Basic Heat Equation 289
Acclimatization 290
Syncope 293
Upper Environmental Limits 293
Disease Due to Effect of Heat 294
Cold 296
Source of Cold 296
Acclimatization 297
Effects of Cold 297
Treatment 299
AEROMEDICINE 300
Syndromes Produced by Free Gas 301
MECHANICAL AND HYDRAULIC FACTORS 306
Missile Injury 306
Blast 306
Motion Sickness and Seasickness 307
Gravity and Acceleration 307
RADIUM,ROENTGEN RAYS,RADIOACTIVE SUBSTANCES AND ATOMIC FACTORS 308
ELECTRICAL INJURIES 312
MAN IN SPACE:A NEW DIMENSION 313
CONCLUDING REMARKS 317
REFERENCES 318
CHAPTER 13 Chemical Agents and Disease＆By JOHN H．FOULGER 320
INTRODUCTION 320
GENERAL DISCUSSION OF THE ACTION OF CHEMICALS 321
ROUTES OF ENTRY OF CHEMICALS 324
Inhalation of Chemicals 324
Absorption through the Skin 327
Absorption by the Gastrointestinal Tract 328
SYMPTOMATOLOGY ASSOCIATED WITH TOXIC CHEMICAL AGENTS 328
Symptoms Arising from Irritation and Damage at the Site of Entrance 328
Symptoms Arising from Action at the Site of Excretion 329
Results of Selective Action of Chemicals on Metabolic Processes,Enzyme Systems and Other Cellular Functions 330
EVIDENCES OF ABSORPTION OF CHEMICALS 331
Early Results of Absorption of Chemicals 331
Changes in Blood Pressure 333
Pulse Rates 335
Changes in Low Frequency Cardiac Vibrations 335
Electrocardiographic Changes 336
Other Physiologic Changes 337
MECHANISMS OF ACTION OF FOREIGN CHEMICALS 337
REFERENCES 339
PART Ⅵ．CIRCULATORY SYSTEM 341
CHAPTER 14 Hemodynamics:The Blood Vessels＆By W．A．SODEMAN 343
GENERAL HEMODYNAMICS 343
The Effects of Elasticity 344
Arteriosclerosis 344
Changes in Velocity and Pressure 346
Arterial Pulse 349
Means of Recording and Studying the Pulse 349
Venous Pulse 353
EVIDENCES OF PERIPHERAL VASCULAR DISEASE 354
Pain 355
Skin Color 357
Skin Temperature 359
Oscillometric Index 360
Visualization of Vessels 360
BLOOD PRESSURE 361
Arterial Blood Pressure 362
Measurement 362
Factors Maintaining Pulse Pressure 366
Arterial Hypertension 370
Hypotension 376
Syncope 377
Shock 380
Venous Pressure 383
Measurement 385
Elevation of Venous Pressure 386
Reduction in Venous Pressure 387
Disturbances in Venous Circulation 388
CAPILLARIES 389
BLOOD VELOCITY AND CIRCULATION TIME 390
Circulation Time 391
Circulation Rate 392
THE LESSER CIRCULATION 392
THE LYMPHATICS 392
THE EFFECT OF PREGNANCY ON THE CIRCULATION 393
REFERENCES 393
CHAPTER 15 Dynamics and Circulation of Heart Muscles;Cardiac Reserve;Heart Pain;The Cardiac Cycle＆By J．T．ROBERTS 395
CARDIAC DYNAMICS 395
Structure of the Heart 395
Sino-Atrioventricular System 399
Muscle Fibers 401
Dynamic Properties of Cardiac Muscle 403
CIRCULATION IN THE HEART 408
Coronary Arteriosclerosis 414
Coronary Blood Flow 415
CARDIAC RESERVE 420
Measurement 423
CARDIAC PAIN AND CARDIAC NERVES 424
THE CARDIAC CYCLE 428
Dynamic Interval of Atrial Systole 429
Inflów Phase of Atrial Systole 430
Isometric Ventricular Contraction 430
Isotonic Ventricular Contraction with Maximum Ejection Phase 430
Ventricular Contraction with Reduced Ejection Phase 431
Protodiastolic Phase of Diastole 431
Isometric Relaxation Phase of Diastole 432
Rapid Inflow or Rapid Filling Phase of Ventricular Diastole 432
Diastasis Phase 433
Abnormalities of Cardiac Rate and Rhythm 433
CARDIAC SOUNDS,MURMURS AND THRILLS 441
REFERENCES 447
CHAPTER 16 The Electrocardiogram＆By F．D．JOHNSTON 449
STANDARD LEADS 453
SPREAD OF ACTIVATION WAVE 459
UNIPOLAR EXTREMITY LEADS 462
PRECORDIAL LEADS 463
T WAVES AND VENTRICULAR GRADIENT 468
REFERENCES 470
CHAPTER 17 Cardiac Output;Hypertrophy and Dilatation;Valvular Diseases;Congenital Defects;Pericardial Diseases;Extracardiac Factors＆By EDGAR HULL 472
THE OUTPUT OF THE HEART 472
Methods of Estimation 472
The Fick Principle 472
The Dye Dilution Principle 474
Dye Injection Method 474
Physical Methods 474
Expression of the Cardiac Output 477
Normal Cardiac Output 477
Abnormalities of Cardiac Output Not Related to Cardiovascular Disease 477
The Cardiac Output in Cardiovascular Abnormalities 478
Cardiac Arrhythmias 479
Valvular Disease 480
Heart Failure 480
Myocardial Infarction 481
Pericardial Disease 481
Vascular Fistulas and Septal Defects 481
HYPERTROPHY AND DILATATION OF THE HEART 481
Ventricular Dilatation and Hypertrophy 481
Dilatation 481
Hypertrophy 483
Hypertrophy and Dilatation of the Atria 486
VALVULAR DISEASE OF THE HEART 487
General Considerations 487
Mitral Valve Disease 488
Mitral Insufficiency 488
Mitral Stenosis 490
Mitral Insufficiency and Stenosis 493
Cardiac Catheterization in Mitral Disease 493
Surgery of the Mitral Valve 496
Disease of the Aortic Valve 496
Aortic Stenosis 496
Aortic Insufficiency 500
Aortic Stenosis and Insufficiency 503
Tricuspid Valve Disease 503
Tricuspid Insufficiency 504
Tricuspid Stenosis 504
Tricuspid Insufficiency and Stenosis 505
Pulmonary Valve Disease 505
Cardiac Catheterization in Pulmonary Stenosis 507
Surgery for Pulmonary Stenosis 507
Combined Valvular Disease 507
CONGENITAL CARDIOVASCULAR DEFECTS 508
Atrial Septal Defect 509
Anomalous Pulmonary Veins 512
Pulmonary Hypertension in Atrial Septum Defects 514
Right-to-Left Shunting in Atrial Septal Defect 514
Pulmonary Stenosis with Patent Atrial Septum 515
Ostium Primum Deficit 515
Lutembacher＇s Complex 515
Ventricular Septal Defect 516
Pulmonary Hypertension in Ventricular Septal Defect 517
Right-to-Left Shunting in Ventricular Septal Defect 518
Ventricular Septal Defect with Pulmonary Stenosis(Tetralogy of Fallot) 519
Patent Ductus Arteriosus 520
Coarctation of the Aorta 521
Pulse Pressures,Systolic Pressures,Pulse Forms 523
Mean Pressures 524
Diastolic Pressures 525
Cardiac Catheterization in the Study of Congenital Heart Disease 526
Data Obtainable by Comparative Oxygen Content of Blood Samples 526
Intracardiac and Pulmonary Arterial Pressures in Congenital Defects 530
Dye Injection Techniques in the Study of Congenital Anomalies 530
Gas Inhalation 531
Surgery for Congenital Cardiovascular Defects 532
Corrective Surgery 532
Palliative Surgery 533
PERICARDIAL DISEASE 534
Hemopericardium 534
Pericardial Effusion 534
Constrictive Pericarditis 534
Pulsus Paradoxus and Inspiratory Distention of the Neck Veins 537
Cardiac Catheterization in Constrictive Pericarditis 538
EXTRACARDIAC CONDITIONS AFFECTING FUNCTION OF THE HEART 538
Hypertension 539
Hypotension 539
Anemia 539
Hyperthyroidism 539
Hypothyroidism 540
Pulmonary Disease 540
Pulmonary Embolism and Thrombosis;Primary Pulmonary Hypertension 540
Fever 541
Infectious,Metabolic and Toxic States 541
REFERENCES 542
CHAPTER 18 Cardiac Failure and Function Tests＆By JOHN S．LA DUE 551
CARDIAC DECOMPENSATION 551
Mechanisms of Congestive Heart Failure 553
Pathologic 554
Metabolic 555
Hemodynamic 556
Mechanism of Compensation 561
Manifestations of Left-Sided Heart Failure 566
Dyspnea 566
Pulmonary Edema 568
Hydrothorax 568
Vital Capacity 568
Circulation Time 568
Other Findings 569
Right-Sided Heart Failure 569
Blood Volume 569
Edema 571
Cyanosis 573
Treatment of Congestive Heart Failure 573
ANGINA PECTORIS,CORONARY INSUFFICIENCY AND MYOCARDIAL INFARCTION 576
Angina Pectoris 577
Coronary Insufficiency(Myocardial Ischemia) 578
Myocardial Infarction 579
CARDIAC FUNCTION TESTS 581
Introduction 581
Anoxemia Test 582
Standard Exercise Test 583
Master＇s and Donoso＇s Criteria 584
Vital Capacity 585
Oxygen Debt 586
REFERENCES 587
PART Ⅶ．RESPIRATORY SYSTEM 589
CHAPTER 19 Pulmonary Ventilation and Respiration;Tests of Respiratory Function＆By JOHN H．SEABURY 591
INTRODUCTION 591
ANATOMICO-PHYSIOLOGIC RELATIONS 592
Intrathoracic Pressure 593
Work of Breathing 594
PULMONARY VOLUMINA 595
REGULATION OF PULMONARY VENTILATION 599
Reflex Control 601
Voluntary Control 602
PULMONARY RESPIRATION AND ITS REGULATION 603
The Circulation in the Lung 603
Control of the Pulmonary Circulation 605
Regulation of Pulmonary Respiration 606
Acid-Base Balance 608
Acidosis and Alkalosis 610
Anoxia 611
Cyanosis 613
ABNORMALITIES OF BREATHING 614
Quantitative Arrhythmias 614
Periodic Breathing 615
Qualitative Arrhythmias 616
THE CLINICAL EVALUATION OF PULMONARY FUNCTION 617
Measurement 618
PULMONARY FUNCTION IN DISEASE 624
REFERENCES 627
CHAPTER 20 Protective Mechanisms of the Lungs;Pulmonary Disease;Pleural Disease＆By JOHN H．KILLOUGH 629
INTRODUCTION 629
Nasopharynx 629
Trachea and Bronchi 630
Alveoli 631
PROTECTIVE MECHANISMS 631
PULMONARY DISEASE 634
Bronchial Asthma 634
Emphysema 635
Eosinophilic Pulmonary Infiltration(Loeffler＇s Syndrome) 637
Pulmonary Alveolar Proteinosis 638
Congenital Cystic Disease 639
Pulmonary Arteriosclerosis 639
Pulmonary Embolism 640
Pneumoconiosis 641
Pulmonary Fibrosis 642
Atelectasis 642
Tumor of the Lung 644
Pulmonary Infections 644
Acute Tracheitis and Bronchitis 645
Chronic Bronchitis 645
Lung Abscess 646
Bronchiectasis 647
Pneumonia 647
Lipid Pneumonia 649
Tuberculosis 650
Fungus Infections 652
Clubbing of Fingers and Toes 652
PLEURAL DISORDERS 653
Tumors of the Pleura 653
Pleuritis 653
Empyema 654
Epidemic Pleurodynia 655
Pneumothorax 655
REFERENCES 656
PART Ⅷ．DIGESTIVE SYSTEM 659
CHAPTER 21 The Esophagus＆By JOSEPH B．KIRSNER AND WALTER L．PALMER 661
MECHANISM OF ESOPHAGEAL PAIN 661
FUNCTIONAL DISORDERS OF THE ESOPHAGUS 662
Spasm of Functional Origin 662
Achalasia(Cardiospasm;Megaesophagus) 662
Anatomic Features 662
Pathogenesis 663
Symptoms 664
ORGANIC DISEASES OF THE ESOPHAGUS 665
Plummer-Vinson Syndrome 665
Lower Esophageal Ring 665
Non-specific Esophagitis 666
Peptic Esophagitis 666
Peptic Ulcer of the Esophagus 666
MECHANICAL OBSTRUCTION 667
Benign Stricture 667
Carcinoma of Esophagus 668
Esophageal Varices 669
Esophageal Diverticula 669
Pulsion Diverticula 669
Traction Diverticula 670
Diaphragmatic Hernia 670
Symptoms 672
REFERENCES 673
CHAPTER 22 The Stomach＆By JOSEPH B．KIRSNER AND WALTER L．PALMER 674
ANATOMIC VARIATIONS 674
CONGENITAL ANOMALIES 674
Hypertrophic Stenosis of the Pylorus 674
Diverticula 675
SENSORY DISTURBANCES 675
Appetite and Hunger 675
Vomiting 676
Nausea 676
Belching 676
MOTOR DISTURBANCES 677
SECRETORY DISTURBANCES 677
Physiologic Considerations 677
PATHOLOGIC DISTURBANCES IN GASTRIC SECRETION 679
MECHANISM OF PAIN 681
Location of Pain 682
Pain in Gastric Carcinoma 682
Transmission of Pain 682
Pain in Gastric Crises of Tabes Dorsalis 683
CHRONIC NONSPECIFIC GASTRITIS 683
BENIGN GASTRIC TUMORS 685
CARCINOMA OF THE STOMACH 685
Symptoms 687
PEPTIC ULCER 688
Pathogenesis 688
Symptoms 690
REFERENCES 692
CHAPTER 23 The Small Intestine＆By LEON SCHIFF 694
ANATOMICO-PHYSIOLOGIC CONSIDERATIONS 694
Motility 694
Innervation 695
Secretions 696
SYMPTOMATOLOGY OF SMALL INTESTINAL DISEASE 697
EFFECTS OF DISEASE OF THE SMALL INTESTINE＂ ON DISTURBANCES IN SMALL BOWEL FUNCTION:MECHANISMS OF SYMPTOM PRODUCTION 701
Intestinal Obstruction 701
Diverticula 707
Enteritis 708
Sprue and Spruelike Syndromes(Malabsorption Syndromes) 710
Blind Loop Syndrome 720
Massive Intestinal Resection 720
Irradiation Effects 721
＂Protein-Losing Gastroenteropathy＂ 721
REFERENCES 722
CHAPTER 24 ？e Large Intestine＆By LEON SCHIFF 729
Functions 730
SYMPTOMS AND SlGNS OF COLONIC DISEASE 734
Constipation 735
Diarrhea 737
DISEASES OF THE COLON AND THE MECHANISM OF SYMPTOM PRODUCTION 738
Irritable Colon 738
Ulcerative Colitis 739
Lymphopathia Venereum 743
Amebiasis 743
Shigella Infections 744
Diverticula 744
Tumors and Polyps 745
REFERENCES 747
CHAPTER 25 The Liver＆By FRANZ J．INGELFINGER 750
CHANGES IN HEPATIC STRUCTURE 750
Vascular Congestion 750
Parenchymatous Disorders 751
Biliary Disorders 754
Intrahepatic 754
Extrahepatic 754
Fatty Liver and the Relation of Nutrition to Structural Changes 755
Disorders of Hepatic Blood Flow 757
Pain Sensation 763
CHANGES IN HEPATIC FUNCTION 764
Correlation of Structure and Function 764
Enzyme Systems 765
Jaundice 767
Bile Constituents Other Than Bilirubin 773
Carbohydrate Metabolism 774
Nitrogen Metabolism 776
Lipid Metabolism 780
Vitamin Metabolism 783
Fat-Soluble Vitamins 782
Water-Soluble Vitamins 783
Inactivation and Detoxification 784
EFFECTS OF HEPATIC DISEASE ON OTHER ORGANS 786
Spleen 786
Blood 786
Kidney 787
Bones 787
Gastrointestinal Tract 788
Central Nervous System 788
Cardiovascular System 788
MANIFESTATIONS PRODUCED BY MULTIPLE FACTORS 789
Edema and Ascites 789
Hepatic Coma 791
Liver Failure 792
REFERENCES 792
CHAPTER 26 The Gallbladder and Pancreas＆By FRANZ GOLDSTEIN 795
THE GALLBLADDER 795
THE PANCREAS 801
REFERENCES 807
PART Ⅸ．URINARY TRACT 809
CHAPTER 27 The Kidney＆By A．C．CORCORAN 811
EXCRETORY FUNCTION 811
Renal Blood Flow 811
Glomerular Filtration 812
Proximal Tubule 814
Clearance 817
The Loop of Henle 818
Ion Exchange:Acidification 820
Stop-Flow Technique 822
Diuresis and Diuretics 822
Tests of Excretory Function 826
Tests of Rate of Excretion 827
Clearance Tests 828
Water Tests 829
PRESSOR-ANTIPRESSOR(ENDOCRINE) FUNCTIONS 831
Erythropoietin 833
CLINICAL MANIFESTATIONS OF RENAL DISEASE 833
Proteinuria and the Organized Sediment 833
Edema of Renal Origin 843
FUNCTIONAL PATTERNS IN RENAL DISEASE 847
Essential Hypertension 847
Renal Hypertensions 848
Tubular Dysfunctions 850
Renal Failure;Uremia 851
REFERENCES 856
PART Ⅹ．BLOOD AND SPLEEN 859
CHAPTER 28 Disorders of the Blood＆By WILLIAM B．CASTLE 861
GENERAL FUNCTIONS OF THE BLOOD 861
DISORDERS OF THE ERYTHROCYTES 862
Morphology of Erythrocyte Production 862
Physiology of Erythrocyte Production 865
Biochemistry of Erythrocyte and Hemoglobin Production 868
Production Rates of Erythrocytes and Hemoglobin 872
Erythrocyte Destruction 874
Splenic Functions 876
Hemoglobin Catabolism 880
Excretion of Bilirubin 881
Conservation of Iron 883
General Effects of Anemia 883
Erythrocyte Characteristics 885
Peripheral Blood in Anemia 890
Definition and Classification of Anemia 891
Anemia of Acute Erythrocyte Loss 892
Anemias of Increased Erythrocyte Destruction 894
Extrinsic Causes of Increased Erythrocyte Destruction 895
Intrinsic Causes of Increased Erythrocyte Destruction 901
Anemias of Decreased Erythrocyte Production 916
Nutritional Deficiency of Erythropoiesis 916
Immediate Deficiency Mechanisms in Pernicious and Related Macrocytic Anemias 926
Endocrine Deficiency of Erythropoiesis 936
Toxic Inhibition of Erythropoiesis 937
Physical Injury of Erythropoiesis 941
Mechanical Interference with Erythropoiesis 944
POLYCYTHEMIAS 948
Relative Polycythemia 948
Secondary Polycythemia 948
Polycythemia Vera 950
Neoplastic versus Physiologic Control of Erythropoiesis 951
General Aspects of Polycythemia Vera 954
DISORDERS OF THE LEUKOCYTES 955
Leukocyte Characteristics 956
Leukocytosis 958
Granulocytosis 959
Lymphocytosis 961
Monocytosis 961
Leukopenia 962
Agranulocytosis 966
Leukemias and Malignant Lymphomas 968
Clinical Features 972
Treatment 977
HEMORRHAGIC DISORDERS 981
Extravascular Factors 983
Vascular Factors 984
Intravascular Factors 986
Platelets 987
Coagulation Factors 993
REFERENCES 1004
CHAPTER 29 The Spleen and Reticuloendothelial System＆By CHARLES A．DOAN 1013
THE SPLEEN AS A LYMPHATIC ORGAN 1014
THE SPLEEN AND ITS MUSCULAR CAPSULE 1015
THE SPLEEN AND ITS VASCULAR SINUSES 1015
THE SPLEEN AND THE RETICULOENDOTHELIAL SYSTEM OF CELLS 1017
THE HYPERSPLENIC CLINICAL SYNDROMES 1018
ACCESSORY SPI EENS AND RECURRENT HYPERSPLENISM 1026
REFERENCES 1028
PART Ⅺ．LOCOMOTOR SYSTEM 1031
CHAPTER 30 The Joints＆By RICHARD H．FREYBERG 1033
ANATOMY AND PHYSIOLOGY OF JOINTS 1033
Articular Cartilage 1034
Joint Capsule and Synovium 1036
Synovial Fluid 1037
Exchange of Substances through the Articular Membrane 1038
Functional Alterations Produced by Disease 1039
Joints as Units 1039
Chemistry of Periarticular Connective Tissue 1040
Muscle Function in Relation to Movements of Joints 1041
PATHOLOGIC PHYSIOLOGY OF THE LOCOMOTOR SYSTEM 1042
Effects of Trauma 1042
Neuropathic Joint Disease 1044
Specific Infectious Arthritis 1045
CHRONIC INFLAMMATIONS OF JOINTS AND RELATED CONNECTIVE TISSUE 1046
Rheumatoid Arthritis 1047
Other Diffuse Connective Tissue Diseases(Collagen Diseases) 1053
Rheumatoid Spondylitis 1054
Rheumatic Fever 1055
Gouty Arthritis 1055
NON-ARTICULAR RHEUMATISM 1057
Primary Fibrositis 1057
Tenosynovitis and Other Forms of Fibrositis 1058
DISEASES OF MUSCLES 1058
NERVOUS SYSTEM DISEASE 1059
DISEASES OF BONE 1059
REFERENCES 1060
PART Ⅻ．NERVOUS SYSTEM 1063
CHAPTER 31 The Nervous System＆By BERNARD J．ALPERS AND ELLIOTT L．MANCALL 1065
INTRODUCTION 1065
THE MOTOR SYSTEM 1067
The Neuromuscular Junction and Muscle 1067
The Neuromuscular Junction 1068
The Sarcolemmal Membrane 1071
Muscular Contraction 1073
Electrodiagnosis in Muscle Disease 1077
The Peripheral Neuron 1079
Peripheral Nerve 1079
Anterior Horn 1080
PYRAMIDAL SYSTEM 1083
EXTRAPYRAMIDAL SYSTEM 1085
THE SENSORY SYSTEM 1087
Specificity of Sensory Receptors 1087
Posterior Column System 1088
Spinothalamic System 1089
VESTIBULAR SYSTEM 1091
Vertigo 1092
Nystagmus 1094
CEREBELLUM 1095
SPECIAL SENSES 1096
Olfaction 1096
Vision 1097
Hearing 1101
Taste 1103
THE AUTONOMIC NERVOUS SYSTEM 1104
Central Organization of Vegetative Activity 1104
The Hypothalamus 1104
The Cerebral Cortex 1106
The Amygdala 1107
Brain Stem Structures 1107
Peripheral Organization of Vegetative Activity 1108
CONSCIOUSNESS AND HIGHER INTEGRATIVE FUNCTIONS 1112
Consciousness 1112
Limbic System and Behavior 1115
Memory 1117
The Body Image 1118
Highest Integrative Functions 1120
SEIZURES 1121
VASCULAR SYSTEM 1125
Occlusive Vascular Disease 1126
Cerebral Embolism 1130
Cerebral Hemorrhage 1130
REFERENCES 1131
INDEX 1135