GENERAL NURSING

1ST YEAR
English Course

Grammar Lessons

The Present

Present simple: the base form (+ s, es, -ies 3rd person).

Use:

- general truths: Water boils at 100 degrees Celsius.

- habits: The British drink a lot of tea.
- states: I dont like gangster films.
- headlines: Ship sinks in midnight collision.
- instructions: First you peel the potatoes.
- itineraries (future actions): On day three we visit Stratford-upon-Avon.
- summaries of events: 1945: the war comes to an end.
- historic present (in narratives): The second man sees the first one...

Present continuous: be + vb. ing.

Use:

- actions in progress at the moment: The dog is sleeping in our bed!

- actions in progress, but not happening at the moment: Im learning to drive.
- temporary actions: Are you enjoying your stay here?
- complains: You are always complaining about my cooking!
- describing change (development): Things are getting worse!
- future arrangements: Im having a party at the end of the week.

States verbs and event (dynamic) verbs

States verbs do not usually have a continuous form:

believe, belong, consist, doubt, have, know, like, love, matter, mean, prefer, understand,
seem, suppose, suspect, want, wish.

Eg. This book belongs to me.

 Some verbs have a stative meaning and a different active meaning:

be, feel, depend, have, see, taste, think, weigh.

Eg.

Jack is noisy. / John is being noisy.

I think I like you. / He is thinking about getting a new job.

This fish tastes awful! / I am just tasting the soup.

The Future

Future Simple : will + infinitive (shall -expresses obligation- is declining in use formal)

Use:

- predictions: Interest rates will rise next year.

- assumptions: Thatll be Jim at the door.
- immediate decision: Ill take a taxi.

Future Continuous: will + be + present participle (v ing)

Use:

- event happening at a future point: This time next week Ill be lying on the beach.
- polite form: Will you be going to the shops later?
- fixed arrangements, plans: The band will be performing in Paris this summer.

Future Perfect: Simple will + have + past participle

Continuous will + have + been +present participle (v ing)

Use:

- predictions about actions we expect to be completed by a particular time in the future:

Hell have had the operation by May.

- assumption: You wont have heard the news, of course.

- FPC- an action which is still going on at a point in the future (focus on the duration):
 Well have been living in this house for 20 years in December.

Other ways of expressing future

Be going to:

- intention (a more distant point in the future):

He is going to study environmental law next year.

- prediction based on evidence (actions that have already been decided):

Look at those clouds. Its going to rain.

Present Continuous:

- arrangements: Were seeing a musical at the theatre next week.

Is / are to formal arrangements: The prince is to visit France.

Be about to, be on the point of, be due to the next moment: The play is about to start now.

scheduled: Anns flight is due at 6:20.

Present Simple: fixed events: Tom retires in three years.

in future time clauses: When we get there, well have dinner.

Present Perfect: completion of a future event: When we have finished, well go out.

Verbs followed by will-believe, expect, and doubt: I expect the train will be late.

Past Time

Past Simple (the 2 nd form/ Vb ed) Affirmative: He wrote a letter.

 Negative: He didnt write a letter.

Interrogative: Did he write a letter?

Use:

- completed actions: I got up, switched off the radio and sat down again.
- habits: Every day I went to the park.
- states: In those days, I didnt like reading.

Past Continuous (was/were + Vb ing)

Use:

- actions in progress in the past: I was drinking my coffee. / While I was opening the
letter, the phone rang.
- changing states: The car was getting worse all the time.
- criticism: When Jane was at school, she was always losing things.

Past Perfect Simple (had + past participle)

Use:

- events in the past which happen before another event in the past, where there is no time
expression to make this clear:
By the time I got to the station, the train had left.

compare:

The train left five minutes before I got to the station.

Past Perfect Continuous (had + been + Vb ing)

Use:

- actions in progress which happen before a certain time in the past: The place was
deserted, but it was obvious that someone had been living there.

Used to and would: describing habits, repeated actions/states in the past.

Used to + active or stative verbs: I used to like cowboys films.

 I used to go swimming a lot.

Neg. : I didnt use (or used not) to

Would + active verbs: Every week hed buy his mother a bunch of flowers.

Polite forms: I was wondering if you wanted to come to the cinema.

Describing events intended to take place: I was going to phone you, but I forgot.

Past tenses are also used to express unreal time.

Past perfect is also common in indirect speech.

Present Perfect

Present Perfect Simple: have/has + past participle (3 rd form/Vb ed)

Use:

- recent events: We have just missed the turning.

- indefinite time events: Jim has had three car accidents. (up to the present)
Ive twisted my ankle, thats why Im limping. (result in the
present)

Contrasts with past simple

Past simple refers to definite times, stated or understood.

Compare: Ive bought a new car. (indefinite)

I bought a new car last week. (definite)

I bought the car after all. (implied definite: the car we talk about)
Choice between past simple and present perfect for recent events may depend on the mental
attitude of the speaker.

Ive left my wallet in the car. Im going back to get it. (the speaker feels that the event is
connected to the present).

I left my wallet in the car. Im going back to get it. (the speaker feels separated in time
from the event).

Present Perfect Continuous: have/has + been + present participle (Vb ing)

Use:

- a state which lasts up to the present: Ive been waiting for you for three hours.
- an incomplete activity: Ive been cleaning the house, but I still havent finished.
- to emphasize duration: Ive been writing letters all morning.
- a recently finished activity: Ive been running, thats why I look hot.
- a repeated activity: Ive been taking French lessons this year.

Contrasts with present perfect simple:

- very little, when state verbs are used: How long have you lived here?
How long have you been living here?

- some verbs (sit, lie, wait, stay) prefer the continuous form:
Ive been waiting here for more than an hour!

- contrast between completion and incompletion:

Ive ironed five shirts this morning. (completed, emphasis on
achievement)

Ive been ironing my shirts this morning. (incomplete, emphasis on duration)

Time expressions with present perfect:

since 1989, for 3 years, already, just

Time expressions with past simple:

yesterday, last week, on Sunday, ... ago

Some time expressions are not associated with a specific tense:

I havent seen Helen recently.

I saw Jim recently.

Passive voice (1)

Form: be + past participle

Agent and instrument

The person who performs an action in a passive sentence is called the agent, introduced
by by. The agent may or may not be mentioned.

E.g. My purse was found (by one of the cleaners).

An object which causes something to happen is called an instrument, introduced by with.

E.g. He was hit on the head with a hammer.

Transitive and intransitive verbs

Only verbs with an object (transitive) can be made passive.

E.g. Active Voice: They sent the letter. Passive V: The letter was sent.

Active Voice: They arrived late. (intransitive, cannot be made passive)

Verbs with both direct and indirect objects can be made passive in two ways:

E.g. AV: They sent me the letter. PV: I was sent the letter.

IO DO The letter was sent to me.

Verbs with object and complement (nume predicativ)

Some verbs which are transitive can have a noun or an adjective which describes their
object.
E.g. AV: We elected Jim class representative.

DO complement

PV: Jim was elected class representative.

Like and love

Some verbs which are transitive cannot be made passive in some uses.

E.g. AV: I like this place.

Other verbs: become, get, have, lack, let, resemble, suit, etc.

Contexts

1.The passive can change the focus of interest in a sentence:

E.g.: United were beaten by Arsenal. (we are more interested in the United)

2. Impersonal statements: Students are asked not to smoke.

3. Unknown agent: My bike has been stolen!

4. Obvious agent: Mr Jones will be arrested.

5. Generalized agent: Bicycles are widely used in the city.

6. Unimportant agent: I was advised to obtain a visa in advance.

 Passive voice (2)

Have something done

- describes a service performed for us by someone else:

Ive just had my car serviced.

- something unfortunate that happened:

We have had our car stolen.

but We had some friends round for dinner last night. (colloquial, no sense of service)

Get something done

- get is common where there is a feeling that something must be done:

I must get my car serviced.

- orders, imperative: Get your hair cut!

- eventually managing something in some uses: I eventually got the car fixed.

Need + v ing the need to have a service done: Your hair needs cutting.

Passive get used instead of be in spoken language: Martin got arrested.

Reporting verbs (believe, know, say, think etc) are used to give a generalized opinion:

Active Voice: People think that Smith is in England.

Passive Voice: Smith is thought to be in England. (present reference)

AV: People believe that Smith left England last week.

PV: Smith is believed to have left England last week. (past reference)

AV: People thought Sue had paid too much. (past reporting)
 PV: Sue was thought to have paid too much.

AV: Everyone knows the portrait was painted by an Italian.

PV: The portrait is known to have been painted by an Italian.(passive infinitive)

AV: They think that Mary is living in Scotland.

PV: Mary is thought to be living in Scotland.(continuous infinitive)

Ending a sentence with a preposition

AV: Someone broke into our house.

PV: Our house was broken into.

Contexts for the passive: the passive is more common in written (scientific and
technical language especially), is less personal and changes the focus of a sentence.

Questions

Closed questions (yes/no) start with a form of main verb be, an auxiliary verb (be, do,
have) or a modal auxiliary (can, may, will).

E.g. Is your brother staying in Oxford?

Will you be away for long?

Have you registered the birth yet?

Neg. Doesnt time fly quickly when youre having fun?

Open (wh-) questions start with a question word (who, what, where, how).

E.g. What time is Allison arriving this evening? (wh-word + S + vb)

When exactly did the museum open? (wh-word + aux + S + vb)

With more than one auxiliary verb, only the first precedes the subject:
 E.g. How long had you been living there before the war broke out?

Which, what

E.g. Which cake do you want to try first? (limited choice of cakes)

What cakes do you like best? (of all cakes; unlimited choice)

Prepositions: For whom are you buying the bracelet? (formal)

Who are you buying the bracelet for? (informal)

Wh-words = S: Who has been drinking my wine? (S = who + aux + verb)

What happened at the end of the film?

Tag questions they are short questions which we often attach to the end of a sentence.
Tags are formed with do/does/did (in simple tenses) or the auxiliary verbs. Usually, an
affirmative sentence takes a negative tag and viceversa (mixed questions). But there may be
uniform tag questions as well (affirmative sentence + affirmative tag) used to respond to
something we have heard/seen.

E.g. He arrived last night then, did he? (uniform)

Mixed tag questions:

E.g. Im still part of the team, arent I?

She hasnt had the baby yet, has she?

You already know Harriet, dont you?

Modals:

E.g. Tax returns can be submitted online now, cant they?

It may/might be fine tomorrow, mightnt it?

We really ought to leave now, oughtnt we? /shouldnt we?

He neednt repeat the year, need he?

but He doesnt need to repeat the year, does he?

 Negative adverbs: There was hardly enough food for everyone, was there?

Imperatives: Turn the TV off, will you? (command)

Pick me up at eight, could you? (request)

Lets go to the cinema, shall we?

Indefinite/negative pronouns: Someones been taking my food again, havent

they?

Nothing ever happens when Im away, does it?

Intonation: falling = asking for confirmation: Its the 1st of May today, isnt it?

rising = asking for information: You havent talked to Jim, have you?

Contrasts: Oliver has a lot of friends, hasnt he? /doesnt he? (B.E.)

Oliver has a lot of friends, doesnt he? (U.S.E.)

Conditionals

Zero conditionals: what is always true form: (if + present) + present

E.g. If I work late, I get tired.

If the water is boiling, it means the food is nearly ready.

First conditionals: real situations (in the future) form: (if + present )+ (will + inf.)

E.g. If you keep driving like that, youll have an accident.

Second conditionals: hypothetical situations (in the present or future) form: (if + past)+
(would + inf)

E.g. If I knew the answer, Id tell you.

If he were (was informal) at home, he would answer.

Third conditionals: hypothetical past (impossible situations)

form: (if + past perfect) + (would have+past part)

E.g. If I had known you were coming, I would have met you at the station.

Conditionals with modals

E.g. If you get wet, you should change your clothes immediately. (I cond)

If you come early, we can discuss the problem together. (I cond)

If I had the money, I could help you. (II cond)

If you hadnt reminded me, I might have forgotten. (III cond)

Alternatives to if:

But for But for your help, we would have been in trouble.

Unless = if not Unless you come now, Im going to leave without you.

If one situation depends on another, if can be replaced by as / as long, provided or only if:

E.g. Ill do what you say provided the police are not informed.

Supposing you won the match, what would you do?

Mixed conditionals

E.g. If Jim hadnt missed the plane, he would be here by now. (III + II)

Other tenses in conditional sentences

E.g. Id have been there, I would have seen her. (incorrect, colloquial)

If you fall, youre going to hurt yourself. (I)

 If you have finished, then well go. (present perfect, I )

If you should see Ann, could you ask her to call me? (unlikely)

If I were to ask you to marry me, what would you say? (hypothetical)

If you happen to see Helen, could you ask her to call me? (I)

If it werent for Jim, this company would be in a mess. (dependence, II)

If it hadnt been for him, United would have lost. (III)

If you will / would wait here, Ill see if Mr. Green is free. (politeness, I)

If you will stay out late, no wonder you are tired! (emphasis)

Omission of be: If necessary, take a taxi.

Formal if + adj: The room was well furnished, if a little badly decorat

Indirect speech (Reported speech)

Basic rules

1) Tenses are moved into the past after a past tense reporting verb. The past perfect remains the
same.
E.g. Im leaving! / Jane said she was leaving.

But No, I hadnt forgotten. / Greg said that he hadnt forgotten.

Modals: will would, can could, may might; could would, might do not change.

But there is no change:

If the reporting verb is in the present tense:

E.g. Brenda says shes arriving at about 6:00.

If the reported words are always true:

E.g. Harry told me he still likes you.

If a message is being repeated immediately:

 E.g. Mary said shes too busy to come.

2) In complex sentences, only the first verb is changed.

E.g. I was walking home when I saw the accident, said James.

James said he had been walking home when he saw the accident.

In spoken Engl., past tenses are not necessarily shifted into past perfect, if the sequence of events
is clear.

3) Reference words (referring to persons, places and time) change in indirect speech, because
the point of reference changes.
E.g. Ill see you here tomorrow, Jack, said Mary.

Mary told Jack she would see him there the next day.

4) Indirect Questions: the verb is put into the affirmative form:

E.g. Do you like hamburgers? / He asked me if I liked hamburgers.

Where are we going? / I asked Sue where we were going.

S P

Commands: Go away! / He told me to go away.

Requests: Please, help me! / He asked her to help him.

Problems

5) Indirect speech with conditional sentences:

(I) If we leave now, well catch the train. I told him that if we left wed catch the train.

(II) If you came back tomorrow, Id be able to help you. (II) She said that if I came
back the next day, shed be able to help me. (no change reference to a possible future)

But: If I had a spanner, I could fix this. (II) He said that if he had had a spanner,
he could have fixed it. (changes are made hypothetical, impossible event)

(III) Third conditional sentences do not change.

6) Reporting verbs:
a) Ann agreed that I could take a holiday. (vb + that + clause)
-also admit, add, announce, believe, claim, complain, consider, deny, feel, hope, imply,
insist, object, predict, promise, remark, say, state, tell, think, warn

b) Ann invited me to take a holiday. (vb + person + to + inf)

-also advise, ask, forbid, invite, persuade, instruct, order, remind

c) Ann proposed that I should take a holiday. (vb + should)

They suggested that she apply again. (vb + subjunctive)

-also demand, prefer, propose, recommend, suggest, urge, advise

Modal auxiliaries: present and future

Modal verbs (auxiliaries) are used with another verb to express ideas such as: possibility,
permission, obligation etc.

Can (be able to when can does not have the necessary grammatical form)

- ability: I can swim. / Not being able to swim is annoying.

- criticism: You can be really annoying!

- capability: Winter can be really annoying, you know!

- deduction: That cant be Sue. Shes in Brazil.

Could

- possibility/impossibility: This could be the house. / The situation couldnt be worse.

- suggestions: We could go to the restaurant.

- unwillingness: I couldnt possibly leave Tim here on his own.

May and might

- may permission: May I go out?

- uncertainty, possibility; might is less likely than may:

It may/might not rain.

You may as well go home.

Try as I might, I could not pass my driving test.

Must and have to

- must personal obligation: I must leave.

 - have to external obligation: You have to turn left here.

(There may be no difference.)

- mustnt not allowed: You mustnt leave any bags here.

- dont have to not necessary: You dont have to apply yet.

- must deduction: This must be our stop.

Should (ought to)

- expectation: This film should be really good.

- recommendation: You should talk with your parents.

- strong obligation (polite): Guests should vacate their rooms by midday.

- criticism: You shouldnt eat so much late at night.

- opinion (less direct): I should think that model would sell quite well.

- describing chance: Its strange that you should be staying in the same hotel! (also odd,
funny)

- unlikelihood: Im taking an umbrella in case it should rain.

Shall

- certainty (from personal point of view): We shall win!

- formal rules: No player shall knowingly pick up the ball.

Will

- assumption: This call will be for me!

- refusal: I wont do it!

Would

- annoying habit: Jack would get lost!

- certainty: Nobody would agree with that idea.

- unlikelihood: Its unlikely that Jim would do something like that.

Need
- necessity/ obligation: Need you make so much noise?

- normal verb: Do you need to use the photocopier?

Related non-modal expressions

Had better recommendation (present or future): Youd better not phone her again.

Be bound to future prediction: Its bound to rain tomorrow.

Modal auxiliaries: past

Must have past certainty: I must have left the keys in the car.

Had to past obligation: Sorry Im late, I had to post some letters.

(neg: didnt have to)

Should have (ought to have)

- expectation: The parcel I sent you should have arrived by now.

- criticism: You shouldnt have eaten so much last night!

- + verb of thinking: I should have thought you knew.

- describing chance (with adjectives):

It was strange that you should have been staying in the same hotel last
year!

- polite expression: Ive done the washing up for you. - Oh, you really shouldnt have!

Could have (couldnt have)

- possibility: David could have won the race if he had tried.

- uncertainty: It could have been Sue I suppose.

- unwillingness: We couldnt have left the dog on its own! (so we didnt)
Could

- past permission: When I was sixteen, I could stay out till 11:00.

- past ability: Mary could swim when she was three. (she did)

but Mary could have swum when she was three. (but she didnt)

Cant have certainty about a past action: You cant have lost it!

Might have (may)

- past possibility: You might have drowned!

- may/ might have uncertainty: I may have been rather critically.

(or negative forms) They might not have received our letter.

- might have annoyance: You might have told me my trousers were split.

- might have + would irony: I might have known that he would be late.

Would not unwillingness in the past:

Everyone was angry because Sam wouldnt turn off the television.

Would have

- events which did not happen: I would have accepted the job but I didnt want to move
house.

- assumptions about the past: That would have been Cathy, probably.

Neednt have

- an unnecessary action which was actually done:

You neednt have paid all at once. (you did pay)

Didnt need
 - an unnecessary action which was not done:

I didnt need to go to the dentist again, luckily.

Adverbs and modals

You could easily have been killed.

I might well decide to come.

You couldnt really have managed without me.

I might just take you up on that.

She obviously must have left.

Unreal tenses and subjunctives

Unreal tenses

Its (high) time + past simple/cont (unreal time)

Its time we left. / Its high time I was/were going. (was informal)

Wishes

1) wishes about present states: I wish + past simple/cont.

I wish I had a motorbike. / I wish you werent leaving. / I wish I was going on holiday
with you.

2) wishes about past states: I wish + past perfect

I wish I hadnt eaten so much.

If only I had gone to your party last week! (emphatic use regret)

3) wishes about future events: with would (=decided to) or could (ability, future)
 I wish you would leave. / I wish I could come on holiday with you next year.

I wish you wouldnt make such a mess! (annoying habit)

Hope: wishes about simple future events

I hope it doesnt rain tomorrow. / I hope hell stop talking soon!

Id rather / Id sooner + past tenses (personal preference):

Id rather you didnt smoke in here.

+ normal tenses when comparing nouns or phrases:

Id rather be a sailor than a soldier. (present)

Id rather have lived in Ancient Greece than Ancient Rome. (past)

Id prefer it + past tense: Id prefer it if you didnt go. (unreal time)

Id prefer + a real tense: Id prefer you not to go. (Id prefer tea to coffee.)

As if, as though (real and unreal)

He acts as if he were in charge. (He isnt in charge.)

He acts as if he is in charge. (He is in charge.)

I feel as if I were flying! (present reference unreal)

I feel as if an express train had hit me. (past reference unreal)

Suppose and imagine understood conditions

Imagine we won the match! (present reference)

Suppose someone told you that I was a spy! (present reference)

Imagine wed never met! (past reference)

Formal subjunctives it has only one form the infinitive; it is also used after verbs such as
demand, insist, suggest, require or expressions such as it is necessary, essential, important that
etc.

They demanded that he leave at once. / It is essential that you arrive before six.
Less formal usage: They demanded that he should leave.

They demanded that he left. (informal no tense change)

It is essential for you to arrive before six. (infinitive construction)

Formulaic subjunctive (fixed expressions):

God save the Queen!

Be that as it may

Come what may

Verbs followed by ing or infinitive

Verbs followed by either ing or to inf: cant bear, hate, like, love, prefer, attempt, begin,
continue, plan, propose, start, forget, remember, try, go on, mean, regret, stop, hear, see,
watch;

(can be followed by that + clause)

E.g. I remembered to phone the office. (obligation)

I dont remember learning to walk. (past events)

I tried to warn him. (attempt) / Have you tried windsurfing? (new experience)

She went on working. (continuing an action)

The Minister went on to praise the Chancellor. (new subject/activity)

I saw all the cars cross the finishing line. (complete action)

I saw him coming up the stairs. (action still in progress)

Verbs with an object, followed by either ing or to inf: admit, allow, forbid, permit,
consider, imagine, require.

E.g. The school forbids students to smoke. (with an object and to)
 The school does not allow smoking.

She is considered to be the finest pianist. / I considered emigrating to Canada.

They required him to fill out a form. (with an object and to)

These letters require typing.

Verbs normally followed by infinitive with to: agree, appear, arrange, ask, decide,
demand, expect, happen, hope, learn, manage, offer, pay, promise, refuse, seem, swear,
threaten, wish, want.

Verbs normally followed by ing: appreciate, avoid, deny, dislike, enjoy, escape, face,
fancy, involve, mention, mind, miss, practise, suggest, burst out, its no good/use, feel, like,
give up, keep on, put off, cant stand, spend, waste time, risk, excuse.

Verbs followed by infinitive without to: help, make, let.

E.g. I helped George (to) carry the bags.

They made me leave. (I was made to leave)

Verbs followed by an object and to: advise, assist, beg, bribe, dare, employ, enable,
encourage, instruct, invite, lead, order, persuade, select, send, teach, tell, urge.

E.g. They dared him to jump.

I didnt dare (to) say anything.

How dare you speak like that to me!

Auxiliaries: have (got), do, be

There are three auxiliary verbs in English: have, be, do.

We use have and be to make perfect, continuous and passive forms of tenses:
 I havent seen her for ages.

John is working very hard these days.

The flat is watched by the surveillance team 24 hours a day.

They can also be used as main verbs.

We use do to form questions, negatives and negative questions in the present and past
simple.

Do /Did you enjoy going to the theatre?

The thermostat doesnt work anymore. / Doesnt the thermostat control the
heating?

Without contractions: Were you not shown the sights?

Aux.+ S+ not

We dont use auxiliaries with modals: Must we pay excess baggage?

We dont usually repeat the same subject and auxiliary in a sentence:

We were watching television and we were laughing.

Contracted forms: is s | are re | has s | have ve | had d | not nt.

(informal English)

We dont combine contracted auxiliaries with a contracted form of not (but we can do
this with modal verbs):

Ivent seen it. | I havent seen it. or Ive not seen it.

He shouldntve done it.

You may hear aint (all persons, present tense) in conversations:I aint going to the party.

We dont use contractions when there is more than one subject:

The Army and the Navy have / ve launched a recruitment drive.

Emphasis we stress the auxiliary verb:

That holidays done wonders; you are looking well.

We do try our best.

Do shut up! (imperative)

 Do sit down! (suggestion, offer)

Have in B.E. we can use it without do in questions and negatives:

I havent a clue what theyre talking about.

In the passive, it means: be tricked or cheated.

You paid 100 $ for a T-shirt! Youve been had!

We use have to describe many different states: possession, inclusion, relationship etc.

Do
What did you do this morning? (general)

Thats done at last. (complete task)

What does he do? (= Whats his job?)

That child could do with a good telling off. (= deserves / needs)

Five minutes will do if you rushed. (= be sufficient)

Have got alternative to express possession in the present. (infl. B.E.)

Hes got a car but he hasnt got a garage to keep it in.

Shes got a degree in chemistry. (= possesses)

Hed got a certificate from the doctor. (= had obtained)

Hollywood movies have gotten more and more violent. (US Engl. = has become)

We dont use have got:

Im having a shower. (action)

Have you got anything vegetarian?

Yes we do/have. (short answers)

We used to have a place in the country.

 Sample vocabulary lessons

The study of the human body

The human body is one of the most amazing structures in nature and many mysteries
concerning it have not yet been solved.

The human body is like a chemical factory with billions of cells that do the work, not by
means of mechanical devices but with chemical reactions. The tools they use are certain
specialized proteins called ferments or enzymes. For almost every act our body undertakes
biochemically it uses a specific enzyme to increase the speed of the chemical reactions
tremendously. And what is peculiar about enzymes is that they are not used up when they finish
speeding up a reaction but are available to do it again.

Man's interest in his well-being is as old as recorded history, probably as old as man
himself. He has succeeded to develop a vast knowledge of his body, through years of
observation, experimentation and application of known facts.

Many sciences study the normal human body. Biology deals with the study of the living
matter both (vegetal) plant and animal.Since biology is such a broad field it became necessary to
divide it into two major areas: zoology and botany.

Zoology is the biology of animals as distinguished from botany which is concerned with
plants, whether in a living or in a fossil state. There are many specialized subdivisions within
this area.

We call hygiene the science of preserving health. Its practical aim is to render growth
more perfect, decay less rapid, life more vigorous, and death more remote. It is a very wide
subject embracing everything which affects physical and mental well-being of man. It requires
acquaintance with many various sciences such as anatomy, physiology, physics, chemistry,
meteorology, epidemiology etc. Hygiene is concerned with the rules and practices essential for
healthful living.

In order to understand the basis for such rules and practices it is essential to know the
structure of the body. The science of anatomy gives us information on the exact form, position,
size and relationship of the various structures of the human body in health. If we were concerned
only with body structures that can be seen with the unaided eye, the study would be called gross
anatomy (macroscopical). The science dealing with the minute or microscopic structure of
tissues and organs that make up the body is called histology or microanatomy.

Many other specialized areas of study in anatomy have developed such as:

a) systemic anatomy, which stresses the various systems of the body;

 b) regional anatomy dealing with specific regions of the body, such as the chest, the
abdomen etc.;
c) developmental anatomy (embryology) being primarily concerned with the growth
and development of the body and its various structures;
d) comparative anatomy which compares the structures of animals with each other and
with man;
e) pathological anatomy having emphasis on diseased structures and their effects on
the body.
There is a big difference between medical anatomy and artistic anatomy.

Medical anatomy dissects, separates, and divides the human system into the finer
microscopic details of forms to the very cell structure itself. Artistic anatomy visualizes,
combines and fuses the whole from the parts.

It is not enough to know the structures of the body. We must also know how the various
parts of the body function and this leads to the branch of science called physiology. The study of
physiology has been subdivided into three specialized areas:

a) general physiology which is concerned with how the human body normally functions
and how various body activities work together to maintain the healthy body;
b) cellular physiology dealing with activities of individual cells;
c) abnormal physiology (pathophysiology) is the study of disordered function or of
function in diseased tissues.
There are many various branches of biological science that depend upon the stu dy of
anatomy and physiology as a basis.

Genetics stresses inheritance and factors involved in heredity.

Embryology is concerned with growth of the individual form the one-cell stage to the
adult.

Molecular biology studies the relationship of the laws of physics and chemistry to the
living phenomena.

Pathology deals with the cause of disease and deviation from normal function and
structure.

Psychology refers to the study of the mind and behaviour.

Pharmacology is the study of the response of living organisms to chemical stimuli. These
various fields of study are not isolated. They are more and more interrelated and interdependent.

Many horizons have been widened in the last two decades. Electron microscopy,
determination of chromosome abnormalities, chromatography, analysis of nucleic acids, and
special immunologic identification techniques have widened the observational horizon of
oncology. Furthermore, cross fertilization between several basic sciences such as enzymology,
virology, cytology and genetics, has laid the basis for the new discipline of molecular biology
and for the intriguing concept of malignancy as a molecular disease.

Basic phenomena of living organisms

All organisms, whether plants or animals, are made up of a specific material called
protoplasm. This is the stuff of life. The word itself from the Greek protos and plasma means
the first thing formed. This protoplasm is made of units that have a distinct form. These units are
called cells.

Protoplasm, this inconceivably complex, self-renewing substance is an organization of a

hundred million chemical compounds, every compound a molecule with a specific task all in
action. The parts are atoms, ions, electrons. And they do not stand still. Movement is their life,
and movement in the world of atoms is unimaginably swift. If an atom leaps from one compound
to another which we call a chemical reaction the leap is performed in less than a millionth of
a second. Therefore, the modern biophysicist does not count in seconds but in nanoseconds or
thousandths of the millionth part of a second. All events in the world of atoms unroll with atomic
speed and protoplasm is an organization of atoms unimaginable in number and in velocity of
action. We cannot see the protoplasm with the naked eye; we must have an instrument that
magnifies a hundred million times in order to be able to see all its fine details.

In 1924, Louis de Broglie made one of the most spectacular inventions of the beginning of
the 20th century. He discovered that electron particles behaved like waves, as does light. It turned
out that their wave length is one hundred thousand times shorter than the wave length of ordinary
light. As a result, electron microscopes were invented, a stream of electrons taking the role of
light beams and magnetic fields serving as lenses. With the electron microscope magnifications
up to two hundred thousand times are common and, with photographic enlargements we now
view specimens magnified over one million times. This has literally opened up a new field of
investigations inside the cell.

A human cell, greatly magnified as seen in an electron microscope, has a nucleus in the
centre filled with chromatin granules and a dark mass the nucleolus. During cell division the
chromatin and the nucleolus condense into the chromosomes. Surrounding the nucleus is the
dark wreath of the Golgi body. At the top of the cell is the centrosome with strands radiating
from it. To the left, seen as black and white specks, are the microsomes and just below them the
considerably larger mitochondria. At the bottom are the lysosomes.

Protoplasm is composed of protein, carbohydrates, fats, inorganic salts, possibly hormones,

vitamins, and water closely associated.

The following physiological properties of protoplasm may be used to distinguish living

from non-living matter:
 1)
auto regulation (the ability to control all life process);
2)
contractility;
3)
irritability (the ability to respond to stimuli);
4)
conductivity;
5)
metabolism (the sum of all the chemical processes going on within a cell
tissue, or organ);
6) growth occurs by intussusception, on building up of new material by
combinations of smaller molecules, such as the formations of proteins from
aminoacids. Growth in living matter is described as an increase in numbers
accompanied by an increase in mass.
There many other properties by means of which we attempt to judge whether matter is living or
non-living:

a) adaptation (the ability of the cell to modify its behaviour in accordance with a
change in environment);
b) reproduction;
c) spontaneity;
d) rhythmicity (the repeated occurrence of events in a regular sequence, for
example heart beats and breathing) and
e) memory (the ability to profit from previous experience by adjustment of their
behaviour).
In some cases, it is very difficult to say whether life does or does not exist. The viruses
have not yet been definitely classified as living or non-living; they are ultramicroscopic infective
agents that cause various diseases. A virus is little more than genetic material wrapped in a sac of
protein and its life cycle is extremely simple. First, a virus approaches its victim, which may be a
bacterial cell, or any other type of cell, attaches itself to it, and injects its hereditary material into
it. Inside the cell the injected chromosomes proliferate, exploiting the protoplasm of their host.
From the exhausted cell hundreds of new parasitic viruses are disseminated. This power of
reproduction seems, however, to be the only living characteristic of the virus.

In order to understand the fundamentals of physiology we have to know some of the

physico-chemical phenomena associated with the activilies of protoplasm.These phenomena are
important to all living substance and they consist of:

a) surface energy or surface tension; b) adsorption; c) the colloidal state: d) viscosity; e)

diffusion and f) osmosis.
Surface energy is the energy produced at cell surfaces due to molecular action. Adsorption
may be defined as the tendency of molecules or ions to concentrate at a surface. A colloidal
solution is a suspension of molecular aggregates. Although the colloidal particles cannot be
seen with the highest microscopic magnification, their reflection can be seen by means of the
ultramicroscope. Being a coloid, protoplasm may vary in its consistency, or viscosity. It may be
fluid at one moment and jellylike the next, and the change may be either reversible or
irreversible. Diffusion is the continuous movement of molecules in a gaseous, liquid, or solid
state from an area of greater to one of lesser concentration until the molecules are equally
distributed throughout the entire accessible region. The tendency of fluids to pass through
separating semipermeable membrane, as the wall of a living cell so as to equalize concentrations
on both sides of the membrane is known as osmosis.

Enzymes are complex substances, some of them proteins, which act as catalysts for the
chemical reactions going on in the living organism. They are classified according to their action.
Their names end in -ase. Esterases can hydrolyze esters; for example, lipase can split fats into
fatty acids and glycerin. Oxidases, as their name implies, assist in oxidation- reduction reactions
and so on. Therefore much of the chemistry taking place in living organisms happens because of
the presence of enzymes. All these reactions could not be carried out in vitro (outside the body)
without the aid of very concentrated acids or temperatures, that is, acids much more concen-
trated or temperatures much higher than the body could stand. No enzyme has been produced in
the laboratory except by living cells. It has been estimated that there may be twenty thousand or
thirty thousand different enzymes in the human body each constructed in such a way as to
permit it to serve as an effective catalyst for a particular chemical reaction useful to the
organism.

The organization of the body

All living things presenting a visible structure are said to be organized. They possess a
definite structure although, doubtless, the simplest particles of living matter posses a highly
complex molecular structure, which is far beyond the reach of vision. The morphological
differentiation of the cell-protoplasm is the expression of a physiological division of labour of
fundamental importance.

One cell specializes in, for example, secretion, another in contractility, another in receiving
and carrying stimuli and so forth, so that we have the gland cell, the muscle cell, the nerve cell,
each appropriately grouped with its fellows to constitute the particular tissue or organ - gland,
muscle or brain.

A tissue may be defined as a group of cells, all of which have the same origin,. structure
and function. There are four general groups: epithelial, connective, muscular and nervous.
Tissues within the bodies of animals develop to form organs, and the organs form systems, each
of which is concerned with carrying out vital functions. Nine systems may easily be identified.
Historically the oldest and most simple tissue is the gelatinous tissue, called the
mesenchyme. The mesenchymal cells turn into many different cells, among them the fibroblast,
which was given this name because it manufactures fibers. These fibers are the characteristic
feature of connective tissue. In the young the connective fibers are taut and elastic; in the old
they have lost much of their elasticity. Thus the first signs of aging show themselves in the
connective tissue fibers.
 Collections of connective tissue are called ligaments, tendons. Where the connective
tissue must do heavy duty, the fibers form ligaments. The strongest ligaments are those that tie
the trunk to the thigh bones so that we can balance on these audaciously constructed stilts, our
legs. There is a famous story which proves how strong the ligaments of the hips are. When the
regicide Ravaillac stabbed Henry IV in Paris during the celebration of the monarch's wedding,
the murderer was tortured to death. As the climax, the still quivering body was stretched
between four horses and an attempt was made to "quarter" it. But the ligaments of the hips
would not yield, and only by using axes was it possible to separate the limbs from the torso.

Fat tissue serves the human body as a reserve of energy, as padding and protection, and
has insulation against loss of heat. But too much fat is dangerous.

Bone is composed of a gluey substance collagen, which gives it flexibility, and of calcium
and phosphate, which give it rigidity. One of the greatest threats to the aged is the ever -
increasing fragility of the bones; this is due to collagen substance. Often the aging person slips
in the bathtub and fractures his hip. Has anyone ever heard of a child breaking his hip in a
bathtub?

If we proposed to the best architect to build a house that would expand every day, he
would think it is an absurdly impossible proposal. But this is a miracle that takes place in every
human body. The bone does the job with an army of osteoclasts or bone-breakers and
osteoblasts or bone-builders and imperceptibly, as the child grows, the skeleton becomes larger
without ever interrupting the functions of the body. Thus the problem of a skeleton that must
grow for fifteen or more years without for a moment interrupting the activities of life is one that
nature has solved in masterly fashion.

The structure of bone is testimony to natures architectural genius. Bones are continually
undergoing reconstruction and the stresses to which they are subjected cause the formation first
of fibres and then of girders along the line of stress. Gradually the fine filigree work of the inner
bone builds up. In Saint Peters cathedral and the temple Taj Mahal we admire the architecture of
man; in living bones we see the architecture of nature.

The skeletal system has four major functions:

a. it lands support;
b. it serves as a point of attachment of muscles;
c. it protects the vital organs from external forces, the hard bony layers cover the
brain, enclose the spinal cord etc.;
d. it forms the blood cells. In the adult all the erythrocytes and most types of
leukocytes, plus the thrombocytes or platelets, are produced in the red marrow of
bones.
The skeleton also serves as an efficient storage place for calcium, iron and certain metals
which would be extremely toxic if free in the body.
 The muscular system is concerned with movements of the skeletal framework of the body.

The nervous system coordinates the activity of nearly all the other organs and tissues.

The circulatory system transports oxygen, nutrients and products resulting from
metabolism, from the cells to the exhausted organs.

The respiratory system brings oxygen into the body and removes carbon dioxide.

The digestive system breaks down food that must precede its absorption into the blood
stream for transport to cells of the body and subsequent use.

The excretory system is concerned with ridding the body of waste products of metabolism.

The endocrine system, whose glandular organs maintain the delicately balanced function of
cells and tissues, is the second coordinating system of the body. The difference between one
coordinating system and the other is that the effects of endocrine system appear rather slowly
and are of longer duration than in the case of changes caused by the nervous system.

The reproductive system is concerned with the production of ova and sperm. It also
provides nutritional conditions during the prenatal life of the newly formed individual.

The viscera are the interior organs of the body. Viscera is the plural of viscus, a name given
to any large interior organ. This term can be applied to the organs in any of the body cavities,
although it is commonly used especially in reference to the organs of the abdomen.

The viscera are found in the two chief cavities marking up the interior of the body: the
ventral, which is divided by the muscular diaphragm into the thoracic and the abdominopelvic
cavities, and the dorsal, in the cranium and the vertebral canal.

The thoracic (chest) cavity contains the lungs, trachea, heart, great blood vessels, nerves
and esophagus.

The abdominopelvic cavity is further subdivided into two parts:

a) the upper area containing the stomach, liver, gall bladder, small and large intestines,
spleen, pancreas and the kidneys;

b) the lower part which contains the urinary bladder, sigmoid colon, rectum and reproductive
organs.

The brain and spinal cord are located in the dorsal body cavity. The brain is located in the
cranial portion of the cavity formed by the skull bones. The vertebrae enclose the vertebral
portion of the dorsal cavity which contains the spinal cord.
 Structure and movement

The organs which make up the skeletal system are the bones. The bone is covered by a
fibrous membrane called periosteum and inside there is a medullary cavity. The central shaft of
the bone is called the diaphysis and the enlarged ends of the bone constitute the epiphyses. The
medullary cavity is filled with a substance called the bone marrow, of which there are two
types: red and yellow. The red marrow is found in the spongy bone of the short bones and
irregular bones, as well as in the flat bones of the skull, sternum and ribs. Red marrow is also
found in the epiphyses of most of the long bones of the body.

The adult skeleton has 206 bones. The bones of the central axis of the body constitute the
axial skeleton. The bones of the appendages, plus the bones that attach the appendages to the
axial skeleton, make up the appendicular skeleton.

Vitamin D (antirachitic vitamin) is essential for proper bone formation and growth.
Vitamin D requirement is increased during pregnancy. It ensures proper absorption and use of
calcium and phosphorus since the bones of foetus are relatively soft.

There are articulations or joints between bones and they can be divided into three
general groups: fibrous, cartilaginous and synovial.

The spine is composed of vertebrae or bony rings and it curves like an interrogation
mark. Its flexibility enables it to absorb shocks travelling from heel to head. Looked at with the
eye of an engineer, the vertebral column, composed of thirty-three units in flowing curves, is an
audacious design. Nature has dared to use the narrow, bony and curved column of the spine as
the cable for the sensitive and vulnerable spinal cord which carries impulses.

From the top down, the sections of the spine are known as cervical, dorsal, lumbar,
sacral and coccygeal. The first vertebra, carrying the head as Atlas carried the globe is the
Atlas. The second providing a pin for the Atlas is called the axis. The skull pivots on the Atlas,
permitting the two main movements of the head up and down and from side to side.

The skull (the cranium) which lodges the brain, consists of eight bones joined along the
so-called suture lines. The skeleton of the face consists of eight bones with immovable joints.
The mandible, or lower jaw, is the only freely movable bone of the skull.

Below the vertebrae of the neck, twelve dorsal vertebrae project laterally around the trunk
in the shape of ribs. These ribs form a cage enclosing the heart and the lungs. The upper ribs
encircle the chest and meet in a breastbone. The lower ribs do not reach entirely around the
body.

Man wears a harness, the shoulder girdle. It consists of several parts centred around the
articulation of the upper arm. The girdle performs a variety of functions: it connects the arms
with the body; it gives the thorax freedom of breath above; it serves as a scaffold for the
numerous muscles that run together at this traffic triangle. In front are the clavicles, or
collarbones, arching from the top of the arm to the breastbone.

The pelvis is the counterpart of the shoulder girdle. It protects and supports the weighty
mass of the viscera. It is composed of three bones on each side with the os sacrum as the back
wall. Two of the side bones form a pair of rockers on which we swing when we are seated.

A human child needs months before it learns to stand and to walk. The more one studies
mans ability to stand and to walk, the more remarkable these acts seem. We do not really stand
on our feet the way a lamp stands on its base; what we do is balance on a collection of small,
movable and loosely connected bones, only three of which touch the ground. One is at the heel
and the other two at the ball of the foot. At the base is the section, consisting of two axle-like
bones, one above the other, on which is balanced a pair of column-like bones that reach to the
knee; on this combination rests the loose knee joint, and on that in turn rest the thigh bones and
the entire body.

The leg is constructed as a threefold stilt, one balanced on the other in such a way that no
acrobat would attempt to walk on it. That is why a human child needs months before it learns to
stand and years before it learns to dance, ride a bicycle or jump from a springboard. Nature must
have great faith in her engineering skill.

The skeletal muscles

The skeletal muscles, which number over 400, are responsible for the movement of the
body and its parts. They account for about 40 per cent of the total body weight.

Claude Bernard proved that muscle possesses independent irritability. He carried out
experiments with the drug curara. Some tribes of South American Indians used curara on the tips
of their arrows in order to paralyze their enemies. Claude Bernard observed that after exposure to
curara the muscle responds by direct stimulation only, the impulses (from its Cerve) having no
effect.

If a striated muscle is stimulated electrically with intensities between minimal and

maximal, a graded response is obtained. Since Bowditchs discovery in 1871 it has been known
that the contraction of the heart muscle is the same for a weak stimulus as for the strongest that
can be applied safely. This phenomenon is the basis for the all-or-none law: the heart gives a
maximal contraction to a stimulus or else it does not contract at all.

Oxygen is not essential for the contraction of muscle, but rather for its recovery. Lactic
acid, which forms during contraction, disappears only in the presence of oxygen.

Fatigue appears in muscles when they use up their immediate supply of fuel (glycogen)
or when waste products which have collected during contraction in some way cause the muscles
to "fatigue". However, the accumulation of waste products is not the only factor in the onset of
fatigue. Perhaps changes in the physicochemical state of the muscle are more directly
responsible.

In a natural muscle hundreds of fibers are united into a cigar-shaped form provided with
nerves and fed by blood vessels. Just as the electric wires in our homes lead to heaters, electric
lamps, or bells so our motor nerves run to the muscles and end there in "electrodes". With each
nerve impulse these electrodes manufacture a chemical compound, acetylcholine, which has a
stimulating effect. Not long after the discovery of this "nerve hormone", a substance was
discovered that could neutralize its stimulating effect. This substance which belongs to the
family of curare, paralyzes the nerves.

The nervous system

The nervous system can be easily studied if divided into the following three divisions: C.N.S,
P.N.S. and A.N.S. The central nervous system (C.N.S.) includes the brain and the spinal cord.
The peripheral nervous system (P.N.S.) is made up of the cranial and spinal nerves and their
branches. The autonomic nervous system (A.N.S) consists of the autonomic ganglia and their
fibres. It is also referred to as the visceral nervous system because its fibres innervate smooth
muscle, cardiac muscles and glands.
The neuron or a single nerve cell consists of a cell body, dendrites and axon which
terminates in an end arborisation or end brush. The axon and brushes come into close proximity
or contact with dendrites of other neurons. This junction (of two neurons) is referred to as the
synapse. The cell body conducts impulses which pass over the synapse or functional gap. Thus
the synapse, normally, controls the direction that the impulse may follow over a pathway of two
or more neurons.
The neurons are classified on the basis of the number of processes arising from the cell body.
The multipolar neurons are the most common type in the body, the bipolar and unipolar neurons
being found mainly in the cochleas of the ear. Receptors will react to light and to mechanical,
thermal, chemical or electrical stimuli.
The very short period of time when the nerve is no longer sensitive to further stimulations is
referred to as the refractory period. There is an absolute refractory period, when the nerve will
not respond to a second stimulus, no matter how intense it may be. During the relative refractory
period, the nerve is beginning to recover (repolarize) and it requires a stimulus only slightly
greater than the threshold to elicit a response. The neuron follows the all-or-none law or in other
words, when a stimulus is applied to a neuron it results in a maximal response or none-at-all.
Knowledge concerning the chemical activities of nerve has been much slower in
accumulating than that of muscle metabolism. The progress made indicates that, at least, as far as
chemical reactions for furnishing energy are concerned, muscle and nerve tissues are very
similar.
The spinal cord serves as a conducting pathway for impulses travelling to and from the
higher centres of the brain and as an important reflex centre. A cross-section of a spinal cord
reveals the central portion of the cord consisting of grey matter arranged in an H shaped pattern,
surrounded by a white matter.
The spinal nerves are those which arise from each side of the spinal cord and are distributed
to the trunk and limbs, though some of the upper ones supply the lower parts of the head and
face. The division between the cranial and spinal nerves is rather one of convenience than of any
real scientific difference. There are generally thirty one pairs of these nerves, which are
subdivided according to the part of the vertebral column through which they pass out; thus there
are eight cervical (abbreviated C), twelve thoracic (Th) formerly called dorsal five lumbar
(L), five sacral (S), and one coccygeal (coc). The Bell-Magendie Law states that: sensory
impulses enter the cord via dorsal roots whereas motor impulses leave via ventral roots.
In 1649 Descartes postulated the concept of reflex action: the impulses originating at the
receptors of the body surface pass to the central nervous system where they are reflected back to
muscles or glands which then respond mechanically. The onset of fatigue can be at least, partly
explained as follows. It has been found that fatigue first appears in the spinal cord and since it is
known that axons themselves do not fatigue, it probably occurs at the synapses. The resistance is
increased as more and more impulses travel over it until finally the resistance is far too great for
the impulses to pass. The knee jerk is the best known spinal reflex, important for its clinical
value in the detection of certain nervous diseases such as paresis and tabes dorsalis, of syphilis,
poliomyelitis, or mechanical injury to the cortico-spinal tracts of the cord.
The median section of the brain reveals its internal structure. The corpus callosum appears
to be the most conspicuous portion. The third ventricle lies below it. The cerebral aqueduct
leads downward from the third ventricle to the fourth ventricle. The thalamus acts as a receiving
station. There is a wealth of connections in both ingoing and outgoing fibres between the
thalamus and the cerebral cortex. These are optic, auditory, cutaneous and other sensory tracts.
The hypothalamus contains the following six physiological centres in its anterior portion:
a) the parasympathetic centre regulating several activities, such as slowing of the heart,
hyperinsulinemia and urination;
b) the carbohydrate regulating centre;
c) the sleep centre;
d) the hunger centre;
e) a heat regulating centre for decreasing temperature;
f) a centre contributing to the synthesis of hormones in the posterior pituitary.
In its posterior part, there are antagonistic centres to those of the anterior namely:
1) the sympathetic centre;
2) the cardioaccelerator centre;
3) the vasoconstrictor centre;
4) the heat regulating centre for increasing the temperature;
5) the fat metabolism centre.
Scientists suppose that the noticeable autonomic effects brought about by thought may be
due to the effects of impulses produced in the cerebral cortex upon the hypothalamus.
Twelve pairs of cranial nerves are recognized and they are spoken of as often by their
numbers as by their names: 1) Olfactory; 2) Optic; 3) Oculo-motor or Motor oculi; 4) Trochlearis
or Patheticus; 5) Trigeminal or Trifacial; 6) Abducens; 7) Facial; 8) Auditory; 9) Glosso-
pharyngeal; 10) Vagus or pneumogastric; 11) Spinal accessory or accessory; 12) Myoglossal.
Concerning the cranial nerve X it should be noted that the vagus has the widest distribution of
any nerve in the human body and the stimulation of the motor neurons of the vagus nerve will
not elicit the same type of response in the innervated muscle fibre. Stimulation will result either
in increased or inhibited muscle activity.
In order to become a conditionate stimulus producing a conditioned reflex a stimulus must:
1. affect some sense organ; 2. precede or be given simultaneously with the unconditioned
stimulus and 3. be repeated often enough to be learned. Pavlov maintained that sleep occurs
because of the inhibition of conditioned reflexes. However, there have been many sleep theories
not wholly acceptable.
Many changes have been noticed during sleep: the pupils contract, the eyes deviate outward
and upward, the reflexes are diminished and so is the general tonus, respiration is thoracic in
nature, the inspiration is larger and deeper, while the expiration is shorter, the pulse is slowed,
metabolism is lowered, the pH is changed with increased alkalosis, the cholesterol content is
lowered, the intercranial pressure is raised, urinary secretion is reduced and the temperature
decreases toward morning. Sleep is accompanied by dreams.

The transport system or the circulatory system

The circulatory system consists of two components: the vessels and the blood which flows
through the vessels. At the centre of the system the main vessel thickens into a sac of specialized
muscle fibres the heart. By means of rhythmic contractions occurring about once a second, the
heart drives the blood out through the vessels and back again to the heart. This flowing out and
back is called the circulation of the blood.

As we know, the vessels through which the blood flows away from the heart are called
arteries, which is a misnomer since artery means air pipe. In a corpse the vessels radiating
from the heart are found to be empty, which led the early anatomists to believe they were air
conduits. Eventually, in 1628, William Harvey, an English physician, became convinced that
arteries conduct blood and he published a book on the circulation of the blood. Yet his
contemporaries continued to support the old concept, asserting: I prefer to err with Galen that to
accept Harvey. The polemic became so passionate that Harvey had to flee from the howling of
the professional anatomists.

In this treatise Harvey proves:

1) that it is the contraction, not the dilatation of the heart which coincides with the pulse, and
that the ventricles as true muscular sacs squeeze the blood which they contain into the aorta and
pulmonary artery;
 2) that the pulse is not produced by the arteries enlarging and so filling but by the arteries
being filled with blood and so enlarging;

3) that there are no pores in the septum of the heart, so that the whole blood in the right
ventricle is sent to the lungs and round by the pulmonary veins to the left ventricle, and also that
the whole blood in the left ventricle is again sent into the arteries, round by smaller veins into the
venae cavae, and by them to the right ventricle again thus making a complete circulation.

The circulatory system has a variety of functions. It has a respiratory function in that it
carries oxygen to the tissues. It has an excretory function in carrying carbon dioxide to the
alveoli of the lungs and other waste products to the kidneys, skin and intestines for disposal. It
distributes heat uniformly over the body and thus aids in equalizing and controlling
temperature. Its nutritive function is a highly important one. As the body cells cannot live
without proper food material, the blood can pick up materials absorbed through the intestinal
wall and distribute these to the points where they are needed. The circulation system also carries
hormones or internal secretions that regulate and coordinate many bodily processes. This system
provides for proper water distribution throughout the body and it defends the body against the
inroads of disease produced by micro organisms, either by means of phagocytosis or the
formation of immune bodies.

By its ability to clot, the blood is protected from too great a loss in volume when the vessels
which carry it through the body are injured. First of all, when a vessel is injured, platelets stick to
one another and to the edge of the injury, forming a platelet plug and sealing the gap. The
platelets are like matches; they do not act until rubbed against a rough surface. The moment they
are stimulated, platelets produce enzymes, and release them into the surrounding blood plasma.
One of these is a thromboplastic enzyme that helps transform a blood substance prothrombin
into thrombin.

But thrombin is still not the substance that encourages clotting. What is needed is a material
resembling cotton fibres called fibrin. Since it would hinder the free flow of blood, this fibrin
does not appear as such in the blood stream. It remains in an invisible soluble form called
fibrinogen until the platelet prothrombin-thrombin sequence has been completed. It sounds
complicated but it is not more so than the procedure of lighting a cigarette.

The number of red corpuscles per unit volume of normal blood is of sufficient uniformity to
render red cell counts of great value for diagnosis. The mean count for human males is 5,000,000
per cu.mm. and for females, 4,500,000 per cu.mm. of blood. Under normal conditions, the blood
volume tends to remain constant. An increase in blood volume may be the result of the
constriction of the spleen and other blood reservoirs of the water diffusion from the tissues. A
decrease may be brought about by haemorrhage, a decrease in red cell formation (anaemia),
traumatic shock (loss of plasma) and loss of blood water (anhydremia). In many cases the blood
loss can be replaced by transfusion. Incompatibility of blood groups made treatment by
transfusion hazardous and even fatal.

The inherited blood characteristics may be tested for in the determination of questioned
parentage. A parent with 0 type blood can supply only a gene for 0 type. However, one can only
prove that a particular suspect is not the father of the child, never that he is the father. The Rh
(rhesus) is another inherited factor. It is present in 85 per cent of the individuals of the white
race. Each individual who has this factor is said to be Rh positive.

The heart is the pump by which blood is kept moving in the blood vessels. The arteries lead
from the heart and divide into a multitude of capillary vessels and these lead to the veins which
finally pass back to the heart. The heart is a four chambered muscular bag. It lies in the thorax. It
is surrounded by another bag, the pericardium for protective and lubricating purposes. Externally
the heart is somewhat conical, its base being directed upward, backward and to the right, its apex
downward, forward and to the left.

The course of the blood through the heart can be traced as follows: from the venae-cavae
right atrium through the tricuspid valve the right ventricle through the pulmonary semilunar
valve pulmonary artery the lungs pulmonary veins left atrium through the bicuspid
(mitral) valve left ventricle through the aortic semilunar valve aorta. Valves are arranged in
such a way to prevent a backflow. Each contraction or systole of the heart is followed by a
diastole which consists of relaxation and rest, all of which constitute the cardiac cycle. Taking
75 as the average number of heart-beats per minute, each cardiac cycle will occupy 8 seconds.

There are two factors responsible for steady flow and pressure of blood in the vessels. The
first factor is the force of ventricular beat. The greater this force is, the greater will be the
pressure of the blood in the arteries. The less blood is expelled, the lower the arterial pressure
will be. The second factor is the peripheral resistance caused by the friction of the blood against
the walls of the vessels. If it were not for the elasticity of the arterial walls, there would be a
much greater range of pressure in the blood vessels.

The capacity of the venous system is greater than that of the arterial system, not only
because the veins are larger in size, but also because they are more numerous and distensible.
Because of the greater cross sectional area of the venous network, the blood in the veins has a
lower velocity than in the arteries. The greater venous area also contributes to the fall in venous
blood pressure, caused by the lowered resistance to flow of the blood.

After about fifty years of faithful service, the vessels of the circulatory system, just like our
teeth, eyes and hair, show signs of aging. Many heart disease researchers today believe that
many factors can contribute to atherosclerosis, heart attacks and strokes; smoking, fats in the
diet, obesity, high blood pressure are only a few. One of the most mysterious contributors is the
emotional and psychological factor.
 The respiratory system

The intake of oxygen, either free or combined and the output of carbon dioxide make up the
physiological process known as respiration. According to the evidence at present available, it is
only within living cells that the respiratory oxygen is consumed and the carbon dioxide formed.
The mere conveying of oxygen from the surrounding air or water to these cells and of carbon
dioxide from them to the air or water is, however, in itself a complex process in the higher
animals.

There are special respiratory organs in all the more highly organized animals: the lungs in
the higher vertebrates; the gills in fishes; the tracheae in insects; and various rudimentary forms
of lungs or gills in other higher invertebrates.

Air is brought into the lungs by the movements of breathing. Oxygen from this air passes
through the delicate lining membrane of the air cells of the lungs into the blood, where it enters
into loose chemical combination with the haemoglobin of the red corpuscles. In this form it is
conveyed onwards to the heart, and thence through the arteries to the capillaries, where it again
parts from the haemoglobin, and passes through the capillary walls to the tissues, where it is
consumed. Carbon dioxide passes out from the tissues into the blood in a corresponding
manner, enters into loose combination as bicarbonate, and possibly in other ways, in the blood,
and is conveyed by the veins to the lungs, when it passes out in the expired air.

The breathing is regulated from a nervous centre situated in the medulla oblongata, which
is the lowest part of the brain. If this centre is destroyed or injured, the breathing stops and death
rapidly results. From the respiratory centre rhythmic efferent impulses proceed down the motor
nerves supplying the diaphragm, intercostals and other respiratory muscles.

Afferent impulses through various nerves may temporarily affect the rhythm of the
respiratory centre. Of these afferent impulses, by far the most important are those which proceed
up the vagus nerve from the lungs themselves.

The respiratory quotient (the R Q) is the ratio between the volume of carbon dioxide
formed and that of oxygen used up. The R Q varies for different classes of foodstuffs. Ranging
from 0.80 to 0.85, the R Q value for protein oxidation is less than that for carbohydrates (1.0) but
greater than for fats which is found to be much less than 1.0, usually about 0.7.

The respiratory tract consists of the nasal cavities, the pharynx, the larynx, the trachea, the
bronchi and the lungs. The respiratory tract begins at the nostrils or nares which open into the
nasal cavity or nasal fossa. The entire nasal cavity is lined with mucous membrane containing
many goblet cells and numerous blood vessels.
 The nose is like the palazzi of Italy; on the outside they appear to be modest and inside
they are filled with striking and admirable features. The nose is a deep cavity with labyrinthine
passages and many side caves. In passing through this passage and its caves the air is subjected
to a sevenfold control and conditioning: 1. Dust filtering; 2. Wet cleaning; 3. Heating;
4.Humidification; 5. Purification; 6. Odour detecting; 7. Sound resonating.

The inside of the respiratory tube is covered with the ciliated epithelium which consists of
cylindrical cells with hairs or cilia. The hairs wave rhythmically like ears of corn in the wind,
their motion brushing microscopic particles of dust upward out of the respiratory tube and back
up into the nose. The ciliated epithelium is a carpet sweeper that works day and night without
pause. Seen through a microscope the cornfield of the ciliated epithelium in motion is an
impressive sight.

The pharynx is the cavity which serves as a passage both for food and for air. It is divided
into nasopharynx, oropharynx and laryngopharynx.

The larynx is made up of nine cartilages held together by the laryngeal ligaments. The
larynx is commonly called the voice box as the vocal cords are inserted into it. As air is forced
out of the lungs, the edges of the vocal cords are set into vibration, thus producing sound. The
larynx alone does not produce song or speech; it is only a trumpet. Song and speech are the result
of the use of the trumpet together with a whole orchestra of other instruments lips and tongue,
diaphragm and nose and the control exercised by our hearing and brain.

There are two main groups of muscles in the larynx; one group acts on the vocal cords to
change tension of the cords and in this way control pitch of the sounds or to close the glottis, and
the other group acts to fold the epiglottic cartilage down over the larynx while swallowing.

The trachea is a tube containing 15 to 20 incomplete C shaped rings of hyaline cartilage

which serve to keep the trachea open and permit free passage of the air. The bifurcation of the
trachea forms the primary bronchi which continue to divide into smaller and smaller branches,
called bronchioles. From the terminal bronchioles two or more respiratory bronchioles lead
directly to the alveolar ducts. These ducts finally terminate in alveolar air sacs, the walls of
which are made up of many alveoli. The alveoli or air cells are the functional respiratory units
of the lungs.

The act of respiration is primarily a dilation of the thorax and the part played by the lungs
is, as Galen1 knew, a purely passive one. Ordinary quiet breathing movements take place without
ones being aware of them. This type of breathing is known as eupnea. Dypnea is a laboured
breathing and apnea means temporary cessation of breathing. Hyperpnea is an increase in depth
of breathing. Polypnea or tachypnea means an increase in rate of breathing.

1
Galen, Claudius (130-200) A noted Greek physician and medical writer, recognized as the authority on medicine
until the Middle Ages and called the father of the experimental physiology.
 Cheyne-Stokes respiration is characterized by a period of hyperpnea followed by one of
apnea, each lasting about 30 seconds. It is the result of a serious malfunction of the brain caused
by serious diseases. Abnormal oxygenation conditions are repeated over and over again and they
are the explanation of periodic breathing.

The rate and depth of respiration may be controlled by means of a double mechanism,
nervous and humoral. The nervous mechanism constitutes of unconditioned and conditioned
reflexes. A very important part is played in the regulation of respiratory movements by the
impulses arising in the lungs themselves. During inspiration, the vegal terminations of the
alveolar walls being distended discharge the impulses which inhibit the activity of the respiratory
centres and thus the inspiratory musculary contraction ceases, and expiration occurs. During
expiration, the mentioned pulmonary terminations are no longer stimulated, and they do no
longer transmit inhibitory impulses and the respiratory centre starts discharging new impulses to
the inspiratory muscles.

The chemical control of respiration is mainly due to the O2 and CO2 concentration
modifications in the blood irrigating the respiratory centres.

We can live without food for many days or weeks at a time, but without oxygen life is
impossible for more than a few minutes. This applies not only to the body as a whole but to some
individual cells.

Each cell must receive the oxygen it needs or it will deteriorate and die. Oxygen starvation
leads to many serious disorders. The lungs and the circulatory system are functioning every
moment of our life to keep the cells of the body constantly supplied with oxygen.

Nutrition and elimination

The digestive system performs the essential task of breaking up food into its chemical
building units, otherwise food cannot be absorbed through the intestinal wall and pass into the
blood and lymph of the body.

Digestion is the chemical separation of the complex molecules of food into the simple one
that can be absorbed. Carbohydrates, proteins and fats are the three basic foodstuffs. Besides the
basic food substances proteins, carbohydrates, fat, water, minerals a healthy diet must also
contain vitamins.

The carbohydrates are sources of energy, providing fuel for the body machine. This is the
chemical term for the bulk of our food: bread, flour, cereals, potaloes, sugar. The most common
carbohydrate is C6H1206, which is glucose or fruclose. This is the sugar that plants compose out
of the carbon-dioxide of the air and water and solar energy. More complex carbohydrates form
the starches.
 Proteins are the basic material for building up protoplasm, the material of living substance.
Chemically proteins are formidable chains of amino acids. There are more than one hundred
amino acids known to occur in nature, but only about twenty- three of these join in forming
protein chains and twenty are important for human proteins.

Simple fats are compounds of one molecule of glycerol and three molecules of fatty acids.
The fatty acids consist of long rows of atoms, so that the breakdown of a molecule releases the
considerable amount of energy contained in the bonds between atoms. Thus the body can use fat
as a kind of high octane fuel. Burning slowly but intensely, the fats yield more than double the
energy of equal weights of carbohydrates and proteins.

The mouth performs five functions: 1. collecting food 2. salivation. 3. mastication 4. bolus
formation 5. starch digestion. At first the bolus, the nutritive cartridge formed in the mouth, must
pass a dangerous crossing the opening of the trachea, or windpipe. It passes the movable
cartilage known as the epiglottis. Thereafter is thrust along by peristaltic waves until it reaches
the stomach.

The stomach works mechanically through its muscles fibres and chemically through its
glands. Its basic function is the further moistening of the food, churning and grinding it and
partly dissolving it in the gastric juice, which contains hydrochloric acid and the protein-
digesting enzyme pepsin.

The food enters the intestine tract made up of the small and the large intestines thirty-feet
long. The small intestine is much the longer section about twenty five feet in length. It is
confined in a tight space and although the loops intertwine they manage not to become enlarged.
Food moves slowly from loop to loop to allow to be mixed and chemically decomposed. It may
take hours before the food undergoes the process of absorption through the four million villi.
These villi are in constant motion like the fingers of sea anemones, dipping into the digestive
broth, sucking up molecules from it, and making them part of the body. Yesterday meat, eggs or
milk, today human blood and tissue!

The most important segment of the small intestine is the duodenum. The duodenum merits
special attention because there the main glands of the digestive system, the liver and pancreas,
empty their secretions for they attack on the three types of nutritional substances: starches,
proteins and fats.

The pancreas is the most effective of the digestive glands. Its various enzymes break down
the starches into glycogen, the glycogen into maltose and the maltose into glucose. It breaks the
proteins first into polypeptides, then peptides and even into amino acids a tremendous task!
although the enzymes coming from intestinal glands help the final formation into amino acids.
The pancreatic lipase splits the complex molecules of fats into glycerine and fatty acids. The
pancreas tissue is interspersed with islets of a hormonal tissue, which produce insulin and
glucagon.
 The liver is considered one of the busiest organs of the body. It has several, entirely different
functions:

a) It serves a filter from the intestines upward toward the heart in the systemic circulation.
The portal vein divides into millions of blood vessels among the liver cells inside the liver. The
liver cells swarm around the blood from the intestines and filter it. This blood contains the amino
acids and the carbohydrates and the multitude of other ingredients of all the foods we take in.

b) The liver cells test all the imports and decide whether to admit or reject them.

c) The liver becomes the storehouse of digested food.

d) It also detoxifies them.

e) The liver is an enormous chemical factory for the metabolism of carbohydrate, protein and
fat.

f) The liver produces the bile, the digestive juice. The bile drips through the biliary channels
into a sac, the gall bladder. The bile remains in the gall bladder for hours and in time may form
concretions or stones. Most persons do not even know that they carry these dubious gems.

The large intestine is the last part of the digestive tract. The final section is the rectum. In
contrast to the labyrinthine maze of the small intestines, the large intestine has a relatively fixed
shape. It begins as the caecum and ends as the rectum. It is the waste-receiver of the body.
There, bacteria, microscopic fungi, yeast cells and algae thrive undisturbed by acids and
enzymes. In the colon an entirely new process begins: the fermentation of the indigestible
residue of food by several hundred million micro organisms.

One of the most remarkable creations in the human body is the extraordinary pair of organs,
the kidneys, which filters waste products out of 180 quarts of blood fluid every twenty-four
hours. Each human kidney is composed of a million filters called glomeruli attached to a million
long, twisted tubules. As the filtrate flows through the tubules, the cells of the tubular wall
reabsorb over ninety-nine per cent of the water and send it back into the blood stream.

Water is the vehicle of almost all metabolic processes. About a quarter of an hour after we
drink a liquid, some of it appears as urine in the bladder. To get there it puts a burden not only on
the kidneys but on the heart and the liver as well. The heart must pump every gulp of fluid, the
liver must do work of screening, and the kidneys must do the job of filtering the urine.

A trained investigator can see many significant things in the urine the kidney produces. If he
examines the urine microscopically, dead cells normally shed from the walls of the bladder or of
the urethra are seen. If the filter sheds whole rows of cells, if protein is lost in the urine or if
phagocytes are visible, the investigator knows that the kidney is ill and the patient may be
suffering from nephritis, an inflammation of the kidney. The trained investigator can even tell
whether the inflammation is recent or chronic.

The kidneys filter about a hundred compounds the end products of metabolism. The most
conspicuous are the nitrates, the ashes of the amino group NH 3 , which characterize the amino
acids, the chain links of the proteins. The chemical group NH3 appears in the urine as urea. The
human body produces approximately thirty grams of urea daily.

Endocrine glands and reproduction

The pituitary, thyroid, thymus, adrenals, pancreas, ovaries and testes are the endocrine
glands which regulate some of the most important functions of the body.

They are transformed atavistic organs. In contrast to ordinary glands they do not send their
product through ducts into the surrounding areas. Instead, the hormones from endocrine glands
directly enter the blood stream and, through the blood, all parts of the body. Therefore they are
called the glands of internal secretion or the ductless glands.

The subject of endocrinology is (the) study of the structures and the secretions of the
ductless glands along with the effects of their secretion on organ and animal behaviour.

The pituitary gland (also called the hypophysis) is the master gland of the body. It consists
of two lobes: the anterior (the glandular) lobe and the posterior (the neural) lobe. It is situated at
the base of the brain. It is about the size of a pea, weighing approximately 0.5 g and produces the
largest number of hormones, some of which control the other endocrine glands of the body. For
example, the hormone ACTH stimulates the functioning of the adrenal cortex. The hormone
known as TSH stimulates the thyroid gland.

Present-day workers in the field of hormone physiology recognize six distinct hormonal
agents, these being the somatotrophic, follicle-stimulating, luteinizing, lactogenic,
thyrotropic and adrenocorticotrophic hormones.

The growth hormone is responsible for a normal growth. Gigantism and dwarfism are
symptoms related to disorders in the secretory activity of somatotrophin. Acromegaly is
characterized by abnormal enlargements, especially of the jaw, nose, hands and feet.

A pituitary hormone secreted by the posterior lobe commands the uterus of a pregnant
woman to start those rhythmic movements called labour that will help her to expel her child. The
notice it sends out is: the child is ripe for birth. Another posterior-pituitary hormone activates the
breast of the mother to produce milk.

Other hormones of the pituitary gland serve the sex functions. One of them, the
gonadotropic hormone, ripens the gonads or sex-cells, the spermatozoa of the male and the
ovules of the female.
 The thyroid gland consists of two bodies which have a total weight of about 25 g; they are
connected by an isthmus and are located immediately below the larynx. The follicles are the
functional units of the thyroid; they are composed of a lining of cuboidal epithelial cells
surrounding a central mass of colloidal material. The colloid is a viscous protein secretion,
iodothyroglobulin, produced by the epithelial cells, apparently a storage depot for the thyroid
hormone. The thyroid secretion plays an important role in metabolism as well as in development.
There are two thyroid deficiencies: hypothyroidism and hyperthyroidism.

The parathyroid glands regulate the metabolism of phosphorus and calcium in the body
through the parathyroid hormone. Calcium in the blood is necessary for normal nerve function
but when the blood calcium rises too high, nerves react sluggishly to stimuli.

The thymus was a mystery until recently. It is necessary in the late stages of embryonic
development and in early infancy to develop the immunity mechanisms of man and animals. The
thymus sends young lymph cells and probably a hormone to the lymph nodes and spleen. As a
result, the lymph nodes and the spleen become capable of producing antibodies the method by
which the organism combats infection.

In the course of billion years hormonal tissues immigrated in small groups into the pancreas,
the big digestive gland behind the stomach. There they became islets of hormonal tissue (in the
pancreas) producing insulin, which controls the burning of sugar in the cells for the production
of energy. A shortage of insulin may bring about diabetes. The most easily detectable sign of
diabetes is sugar in the urine.

The adrenal glands are double organs with a nervous core and a glandular cortex. The
cortex produces a series of steroids, the cortico-steroids, which have wide-ranging effects. The
core or medulla functions in cooperation with the sympathetic nerve system, regulating the blood
pressure, the heart action and other activities of the body through the secretion of adrenalin and
noradrenalin. A failure in the adrenal cortex may lead to Addisons disease. The patient is treated
with cortico-steroid.

The testes and the ovaries are the glands of the reproductive system. Each testis is a
compound tubular gland enclosed in a fibrous capsule called the tunica albuginea. Other cells
scattered between the seminiferous tubules in the lobules of the testes called the interstitial cells
(cells of Leydig). These are responsible for production of the male sex hormone testosterone.

In the follicular fluid of the ovarian follicle is a hormone called estradiol, which is also a
sterol closely related in chemical structure to the male sex hormones. It is produced by the cells
surrounding the follicle. Estrone (theelin), which is found in urine, is similar in action to
estradiol but only about 20 per cent as potent. Estradiol and estrone are collectively referred to as
estrogens. Progesterone is the hormone produced by the cells surrounding the follicular cavity
after the follicle ruptures. Progesterone is the pregnancy hormone, preparing the uterus still
further for the reception of the egg after the necessary priming action of estradiol.
 After fertilization the egg begins subdividing and multiplying and floats into the cavity of
the uterus. The glands of the mucous membrane of the uterus become active, increasing in size
and the membrane is described as blooming. The blastocyst, the inner mass of cells, receives
nourishment from the uterine mucosa. The placenta that feeds the embryo is formed. The
ruptured follicle continues to develop and secretes progesterone, which is necessary for the
development of the placenta, and becomes the corpus luteum, or yellow body of pregnancy.

As the placenta develops, it takes over the secretion of progesterone as well as estrogen and
other hormones that foster the pregnancy. While progesterone is being secreted the hypophysis
and ovaries will not discharge any other egg cell. Progesterone thus is the protector of the
unborn child.

The name of a Romanian scientist should be remembered as one of the pioneers of the newly
developing medical science endocrinology. C.I. Parhon spared no effort to reveal the
importance of endocrine glands in the perfect functioning of the human body.

In 1909 C.I. Parhon who had published the first world book on endocrinology, laid the
foundation of the Romanian school of endocrinology. His life-long research work dealt with the
relations between the endocrine and the nervous systems, the endocrine-metabolic correlation as
well as the endocrine-viscera correlation; problems of age biology, of hereditary pathology,
oncology, compared endocrinology etc.

Nowadays, thousands of medical research workers all over the world give their days and
nights to the study of the problems which had puzzled Professor C.I. Parhon. Many international
medical societies keep on debating problems on endocrinology, gerontology, genetics, compared
endocrinology asserting the importance of his pioneering ideas.

Repair

Different classes and species of living things differ very greatly in their capacity to repair
injuries and regenerate lost parts. The lower in the scale the animal, the more complete is the
regeneration. In many plants and many of the lower invertebrates, a small fragment can
regenerate a whole organism: e.g. cuttings, or slips from small terminal branches or twigs are the
horticulturalists usual means of propagating many kinds of trees and shrubs: hydra and many
other coelenterates may be cut up into fragments and each fragment will grow into a complete
organism: earthworms may be cut in half and each half will regenerate a new head or tail as
required. Structurally more complex creatures do not show this power of total or nearly total
regeneration; nevertheless some species have retained the ability to grow complete new parts;
thus crabs can regenerate complete claws when these have been lost, snails can regenerate eyes,
and, even amongst vertebrates newts and allied amphibian can regenerate lost limbs or tails, and
some lizards can grow new tails.
 Mammals do not regenerate complex parts such as eyes or limbs: but they possess great
power of regeneration of many individual tissues, especially vascular, connective, bony,
haemopoietic and most epithelial tissues. It is convenient to distinguish two types of regeneration
following injuries in mammals, namely (a) repair which is the proliferation of tissues at the site
of injury to fill the gap, and (b) compensatory regeneration, which is the proliferation of tissues
with specialized functions, e.g. liver epithelium or haemopoietic cells, to compensate for those
destroyed. The local repair of physical injuries is effected by the proliferation of vascular and
connective (or, in bone, bony) tissue to fill the breach, and of the overlying epithelium if a
surface is broken.

It is difficult to draw a hard and fast line between repair and inflammation. Both represent
the reaction of the tissues to an irritant. Repair usually follows inflammation, and is usually
preceded by it, but not always so. An irritant of some intensity produces inflammation and death
in the tissues. At a distance the action is weakened, and the irritant becomes a stimulant, so that
the tissue response now is proliferation. In this way reparative processes may go on at the same
time as inflammation.

Mac Callum compares inflammation to a fire in which, while the flames are still burning
fiercely in one part of the building and the fire engines are pouring on floods of water, gangs of
carpenters have already begun to arrive, and are busy with reconstructive work on burnt-out
portions.

Inflammation

Definition. Inflammation is the local reaction of the body to irritation. The local
inflammatory reaction presents two phases. The object of the first is to destroy and remove the
irritant; the object of the second is to repair the damage done to the tissues. The first subserved
by the wandering mesodermal cells whether of the blood or the tissues, the second by the fixed
cells of the part.

Causes. Any irritant may act as a cause of inflammation. These irritants may be divided
into two great groups, the living and the non-living. Of the living irritants by far the most
important are the pathogenic or disease-producing microorganisms. Of less importance are the
animal parasites. Both of these act as irritants mainly by virtue of chemical poisons which they
produce, and to a lesser degree by the mechanical irritation, which they excite. The pathogenic
bacteria usually excite an acute reaction, as a result of which both the cells and the fluid part of
the blood pass from the vessels into the tissues. Some produce a more chronic form of reaction,
characterized in the main by proliferation of the tissue cells; examples of such chronic irritants
are the microorganisms of tuberculosis and syphilis. These chronic inflammations constitute the
important group of the granulomata. The non-living irritants may be divided into physical and
chemical. Among the physical irritants may be mentioned trauma, the presence of a foreign
body, the action of a undue heat and cold (burns and frostbite), or pressure of light, of electricity,
of roentgen-rays, of the radiations from radium etc. Chemical irritants include strong acids and
alkalis, and poisons of every description.

It should be borne in mind that there is no hard and fast line between an irritant and a
stimulant. If an irritant is sufficiently weakened it becomes a stimulant. It follows, therefore, that
while at the centre of the inflammatory stage we shall find every evidence of intense irritation,
away at the wings the tissues may respond as to a stimulant.

In man and other vertebrates the mesodermal cells of defense may be divided into the
wandering cells of the blood (the leukocytes) and the resting wandering cells of the tissue. It is
the former which play the major part in the earliest stages of acute inflammation. They represent
the police force which appears promptly on the scene when trouble develops. Moreover there is a
humoral factor of defense as well as a cellular factor, and the constituents of the humoral factor
are contained in the blood plasma. In thus becomes necessary for both the white blood cells and
the blood plasma to escape from the interior of the vessels in order that they may reach the
irritant. This escape is brought about by the vascular phenomena of inflammation. At the present
day attention is being directed not so much to the changes seen down the microscope, important
as they are, as to the more subtle chemical and physical mechanisms involved in these changes.

Tumours

A tumour or neoplasm may be defined as local growth of new cells which proliferate
without control and which serve no useful function.

Tumours can be divided into two great groups: the benign, or innocent, and the malignant.
In typical and fully developed cases the distinction can be made at a glance. Unfortunately there
are intermediate forms in which the differentiation may be extremely difficult, and a benign
tumour may develop into a malignant one. All malignant tumours are included under the
common heading of cancer, meaning a crab, for claw-like processes characterize both the tumour
and the animal. Malignant tumours of epithelium are called carcinoma; those of connective tissue
are termed sarcoma.

The features which distinguish a benign from a malignant tumour are easy to enumerate,
but unfortunately, with experience exceptions to nearly all of these will suggest themselves. The
most important of all the many duties of the pathologist is to differentiate between benign and
malignant tumours.

Infiltration. A malignant tumour infiltrates the surrounding tissue. It sends claws into it like
a crab. An innocent tumour grows by expansion like a balloon, and is usually separated from
surrounding structures by a capsule of compressed tissue. But a benign glioma blends
imperceptibly with its surroundings and an angioma infiltrates without being malignant.
Conversely, a malignant tumour in its initial stage may be a non-invasive carcinoma or
carcinoma in situ.
 Rapid growth is characteristic of malignant in contrast to benign tumours, but to this there
are many exceptions. Some cancers, especially in old people, are very slow growth. If a benign
tumour should start to grow quickly it should arouse suspicion.

The presence of numerous mitotic figures is suggestive of malignancy. The more rapid the
growth, the more numerous the mitoses.

Nuclear changes. The reproduction of a cell is governed by the nucleus and in particular by
the nucleoproteins of the chromatin. Ultraviolet spectroscopy shows that there is intense activity
of this mechanism in cancer cells. For this reason the pathologist pays special attention to the
nucleus in determining the question of malignancy of a tumour. The nucleus of a cancer cell is
likely to be large and hyper chromatic, so that it stains intensely with haematoxylin, or the
chromatin network may be coarse. The nucleus varies much in size and shape, and the cells
themselves show similar variation. The nucleolus is large in proportion to the size of the nucleus.

Anaplasia. A malignant tumour fails to reproduce the structure of the tissue from which it
grows, whereas an innocent tumour may reproduce it perfectly. This lack of differentiation is
called anaplasia, a concept first introduced by Hansemann in 1893. the more anaplastic the
tumour, the more malignant is it likely to be.

Tablets

Tablets may be defined as solid pharmaceutical dosage forms prepared by compressing or

moulding. They have been in widespread use since the latter part of the 19 th century. Advantages
of tablet preparation to the manufacturer include: simplicity and economy in fabrication,
stability, and convenience in dispensing and shipping. The advantages to the consumer include:
accuracy and compactness of dosage, portability and blandness of taste.

Definitions. Although tablets are most frequently discoid in form, they may also be round,
oval, oblong, cylindrical or triangular. They are divided into two general classes, depending upon
whether they are made by compression or by moulding. The various tablet types and
abbreviation commonly employed in referring to them are listed below.

Compressed Tablets (C.T.). These tablets are formed by compression and contain no
special coating. They are made from powdery, crystalline, or granular materials, alone or in
combination with binders (adhesive substances), disintegrators (substances facilitating the break
up of the tablets after administration), lubricants (materials preventing sticking of the tablets to
the punches and dies), and fillers (inner diluents). They are formed into many shapes and sizes.

Sugar-Coated Tablets (S.C.T.). These are compressed tablets containing a sugar coating.
Such coatings are beneficial in covering up medicinals possessing objectionable tastes or odours,
and in protecting sensitive medicinals subjects to deterioration.
 Enteric-Coated Tablets (E.C.T.). These are compressed tablets coated with substances
that resist solution in gastric fluid but disintegrate and release their medication in the intestine.

Chocolate-Coloured Tablets (C.C.T.). The abbreviation C.C.T. indicates a chocolate-

coloured tablet. Originally chocolate was used as a colouring material and the same designation
referred to chocolate-coated tablets. Iron oxides, standardizes as to colour are now available
and largely replace chocolate for this purpose.

Moulded Tablets or Tablet Triturates (T.T.). T.T. originally referred to tablet triturates,
made from moist materials on a triturate mould which gave them the shape of cut selections of a
cylinder. Such tablets must be completely and rapidly soluble. Tablet triturates are now usually
made by compression on a tablet machine.

Hypodermic Tablets (H.T.). Hypodermic tablets are those made in a tablet triturate mould
and are intended for use in making hypodermic preparations for injection. Such tablets must be
made with absolute cleanliness for they are usually used to prepare parenteral solutions
extemporaneously (ex-tempore). Therefore, they must be completely and rapidly soluble in the
vehicle.

Parenteral preparations

Parenteral preparations or injections are those sterile solutions or suspensions used for
administering pharmaceutical preparations by various routes of injection, such as intravenous,
subcutaneous, intramuscular and intraspinal. These injectable materials are usually made
available in either ampoules or vials and, although they are rarely preparated by the individual
pharmacist, they constitute a large industry in the pharmaceutical field. They are preferred by
physicians for patients who need immediate therapeutic relief or those who are unable to take
food or drugs by mouth. Also, many substances when given orally are either destroyed or cannot
be absorbed from the intestinal tract and must be given by one of the parenteral routes.

Parenteral solutions and suspensions must be prepared with the greatest of care by properly
trained personnel. A thorough understanding of sterility is required as well as the proper
compounding of the drugs to be administered by injection. The operating room personnel and the
hospital pharmacist in many instances must combine their activities in the preparation and
sterilization of injections. However, the larger hospital may require an entire department headed
by a hospital pharmacist, whose duty is to prepare such products.

A very important part in the production of parenteral solutions is the packaging, since not
only should these drugs be sterile but they must be packaged in containers properly designed to
maintain sterility. Most of these preparations are now classified as injections, although a few of
the injectable liquids are still officially known as solutions anticoagulant: acid citrate, dextrose
solution being an example.
 In general the preparation of a parenteral solution consists of the following steps: an
aqueous solution of the drug is made, it is filtered clear, and then dispensed in measured amounts
into ampoules or vials, sterilized and tested for sterility. If the material is subject to pyrogen
testing, a Pyrogen Test is run and good pharmaceutical practice should require some sort of
animal safety test. If the material will not withstand heat sterilization in the final container, then
the solution must be sterilized by passing through bacteria removing filter and an aseptic
technique, employing sterile equipment, must be used. Solutions for injection are preferably
manufactured, filled into containers, sealed, and sterilized within one day in order to minimize
the changes of contamination and growth, and the formation of pyrogens.

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