Human Physiology Textbook, 12th Edition, Volume 1 PDF

Ie Twelfth Edition ___ Editor Nitin Ashok John C BS Dedicated to Education CBS Publishers & Distributors Pvt. Ltd.  Volume 1 Human Twelfth Edition...

Ie Twelfth Edition ___ Editor Nitin Ashok John C BS Dedicated to Education CBS Publishers & Distributors Pvt. Ltd.  Volume 1 Human Twelfth Edition  Contents of Volumes 1 and 2 Volume 1 Section VII Renal Physiology 62. Functional Anatomy of Excretory System Section I General Physiology 63. Renal Blood Flow 1. Homeostasis 64. Glomerular Filtration Rate 2. Cell Physiology, Structure and Functions of Cell Organelle 65. Physiology of Renal Tubules: Water and Electrolytes Balance and 3. Transport Across Cell Membrane Counter-current Mechanism 4. Membrane Potential 66. Renal Function Test, Urine, UrincryCharacteristic and its tv\echanism of Formation 5. Body Fluids and Blood Volume 67. Micturition Section II Blood 68. Skin, Body Temperature and its Regulation 6. Composition and Functions of Blood 69. Regulation of Reaction of Blood and Disturbances in Acid-Base 7. Specific Gravity of Blood Regulation 8. Plasma Proteins Appendices 9. Viscosity and Erythrocyte Sedimentation Rate (ESR) Multiple Choice Questions 10. Coagulation of Blood 11. Functions of Bone Marrow Volume 2 12. Red Blood Corpuscles (Erythrocytes) Section VIII Endocrines 13. Haemoglobin 70. Physiological Aspects of Endocrine System and Pituitary Gland 14. Iron Absorption, Transport, Storage and Excretion 71. Integrative Action of Neuroendocrinology 15. Anaemia, Polycythemia, Osmotic Fragility and Blood Indices 72. Thyroid Gland 16. White Blood Cells and Platelets 73. Parathyroid Gland 17. Blood Groups and Blood Transfusion 74. Pancreas 18. Formation of Tissue Fluids 75. Adrenal (Suprarenal) Glands 19. Immunity 76. Local Hormones Section Ill Nerve and Muscle 77. Thymus 20. Structure and Functions of Neuron 78. The Pineal Body 21. Properties, Classification of Nerve Fibres and Nerve Action Potential Section IX Reproductive System 22. Neuromuscular Junction 79. Gonads and Reproduction 23. Classification of Muscular Tissue 80. Male Reproductive Organs 24. Structure of Skeletal Muscle 81. Female Reproductive Organs 25. Muscle Contraction 82. Pregnancy 26. Properties of Skeletal Muscle 83. Parturition 27. Cardiac Muscle 84. Foetal Circulation 28. Smooth Muscles 85. Development of Breast and Lactation Section IV Cardiovascular System 86. Controlled Reproduction and Family Planning 29. Introduction to Cardiovascular System Section X Nervous System 30. Initiation and Spread of Cardiac Impulse 87. Introduction to Nervous System 31. Properties of Cardiac Muscle 88. General Principles of the Nervous System 32. Cardiac Cycle 89. Synapse 33. Pressure and Volume Changes during Cardiac Cycle 90. Nerve Endings and Receptors 34. Electrocardiogram 91. Reflex Action 35. Innervations of Heart and Heart Rate 92. Sensory Systems 36. Cardiac Output 93. Arrangement of Grey and White Matter in the Spinal Cord 37. Blood Pressure 94. The Ascending and Descending Tracts 38. Velocity of Blood Flow and Radial Pulse 95. Brain Stem 39. Regional Circulation 96. Cerebellum 40. Physiology of Exercise 97. Thalamus 41. Applied Cardiovascular Physiology, Haemorrhage, Heart Failure, 98. Mamillary Bodies and Internal Capsule Hypotension, Hypertension and Shock 99. The Basal Ganglia Section V Respiratory System 100. The Reticular Formation 42. Functional Organization of Respiratory System 101. Muscle Tone and Posture 43. Mechanics of Breathing 102. Vestibular Apparatus 44. Pulmonary Volumes and Capacities (Spirometry) 103. Path of Vestibular Impulse 45. Alveolar Ventilation and Gases Exchange in Lung 104. Cerebrum 46. Ventilation and Perfusion in Lungs 105. Limbic Lobe and Limbic System 47. Transport of Oxygen and Carbon Dioxide in Blood 106. Speech 48. Regulation of Respiration 107. Neurophysiology of Leaming and Memory 49. Hypoxia 108. Sleep 50. Compressed Air Sickness 109. Emotion 51. Respiration in Abnormal Conditions 110. Cerebrospinal Fluid 52. Artificial Respiration or Resuscitation 111. Autonomic Nervous System 53. Acclimatization 112. Hypothalamus 54. Underwater Physiology 113. Neurosecretion 55. Vocalisation 114. Cranial Nerves Section VI Gastro-intestinal Tract Section XI Special Senses 56. General Outline of Digestive System 115. Introduction to Special Senses 57. Digestive Juices 116. Sense of Smell (Olfaction) 58. Mechanism of Secretion of Various Digestive Juices 117. Physiology of Vision 59. Movements of Alimentary Canal 118. Hearing 60. Digestion and Absorption of Foodstuffs Appendices 61. Gastro-intestinal Hormones Multiple Choice Questions  Volume 1 Human Twelfth Edition Editor Nitin Ashok John MD. DIH. PGDMLE. PGDHA Professor and Head Department of Physiology Dr. Ram Manohar Lohia Institute of Medical Sciences Lucknow Review Editor Surrinder H Singh MBBS. MD. F1MsA MAMs. FIMA-Ms Ex-Professor and Head Department of Physiology Lady Hardlnge Medical College New Delhi CBS CBS Publishers & Distributors Pvt Ltd New Delhi Bengaluru Chennai Kochi Kolkata Mumbai Bhubaneswar Hyderabad Jharkhand Nagpur Patna Pune Uttarakhand Disclaimer Science and technology are constantly changing fields. New research and experience broaden the scope of information and knowledge. The authors have tried their best in giving information available to them while preparing the material for this book. Although, all efforts have been made to ensure optimum accuracy of the material, yet it is quite possible some errors might have been left uncorrected. The publisher, the printer and the authors will not be held responsible for any inadvertent errors, omissions or inaccuracies. eISBN: 978-93-881-7802-0 Copyright © Authors and Publisher Twelfth eBook Edition: 2018 All rights reserved. No part of this eBook may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system without permission, in writing, from the authors and the publisher. Published by Satish Kumar Jain and produced by Varun Jain for CBS Publishers & Distributors Pvt. Ltd. Corporate Office: 204 FIE, Industrial Area, Patparganj, New Delhi­110092 Ph: +91­11­49344934; Fax: +91­11­49344935; Website: www.cbspd.com; www.eduport­global.com; E­mail: [email protected]; marketing@eduport­global.com Head Office: CBS PLAZA, 4819/XI Prahlad Street, 24 Ansari Road, Daryaganj, New Delhi­110002, India. Ph: +91­11­23289259, 23266861, 23266867; Fax: 011­23243014; Website: www.cbspd.com; E­mail: [email protected]; [email protected]. Branches Bengaluru: Seema House 2975, 17th Cross, K.R. Road, Banasankari 2nd Stage, Bengaluru ­ 560070, Karnataka Ph: +91­80­26771678/79; Fax: +91­80­26771680; E­mail: [email protected] Chennai: No.7, Subbaraya Street Shenoy Nagar Chennai ­ 600030, Tamil Nadu Ph: +91­44­26680620, 26681266; E­mail: [email protected] Kochi: 36/14 Kalluvilakam, Lissie Hospital Road, Kochi ­ 682018, Kerala Ph: +91­484­4059061­65; Fax: +91­484­4059065; E­mail: [email protected] Mumbai: 83­C, 1st floor, Dr. E. Moses Road,Worli, Mumbai ­ 400018, Maharashtra Ph: +91­22­24902340 ­ 41; Fax: +91­22­24902342; E­mail: [email protected] Kolkata: No. 6/B, Ground Floor, Rameswar Shaw Road, Kolkata ­ 700014 Ph: +91­33­22891126 ­ 28; E­mail: [email protected] Representatives Hyderabad Pune Nagpur Manipal Vijayawada Patna  Preface to the Twelfth Edition I t gives me immense pleasure in writing the Preface to the twelfth edition of CC Chatterjee's Human Physiology. This book has been very popular and widely country for contents to be included in the book and this was immensely helpful. The twelfth edition of CC Chatterjee's Human read from its first edition which was published in 1951. Physiology is especially designed for undergraduate and Dr CC Chatterjee, a doyen in the field of physiology, postgraduate students of medicine, paramedical was a dedicated academician, devoted teacher, author sciences and allied health sciences, and will help them par excellence, a noble friend, philosopher and a guide in excelling in their examinations and professional to his colleagues and students. He was an enthusiastic career as well. physiologist who strived with greatest zeal to give the The key features of this book are the simple language best integrative knowledge of basic medical sciences, and comprehensiveness which have remained especially that of physiology, to his students. unchanged ever since the first edition. All the topics of I express my special gratitude and sincere thanks to physiology are correlated with anatomy, biochemistry, Dr Surrinder H Singh, Ex-Professor and Head, pathophysiology and applied physiology for a Department of Physiology, Lady Hardinge Medical thorough integrated learning of the functional aspects College, New Delhi, a renowned teacher of physiology, of human body. Recent advances have been included who provided regular review inputs for updating the to give better insight to understanding the physiological book from time to time, and for her devotion in reading principles. Clinical case scenarios are included to help the manuscript thoroughly and providing valuable students in learning of physiological basis of clinical feedback so that no part of the information is left signs and symptoms. Moreover, this book retains the uncovered by oversight. ideas, thought process, knowledge, lucidity and I express my sincere thanks to my colleagues comprehensiveness, original diagrams and intellectual Dr Neelam Mishra, Professor and Head, Department concepts of the doyen physiologist Dr Chandi Charan of Physiology, Government Medical College, Nagpur; Chatterjee whose contribution to physiology will always Dr MS Phatak, Professor and Head, Department of be remembered in the times to come. Physiology, Indira Gandhi Government Medical In spite of all the untiring efforts, any mistakes or College, Nagpur; Dr Geeta Kurhade, Senior Lecturer, omissions left unknowingly may please be excused, Department of Physiology, University of West Indies; while valuable suggestions are welcome from faculty and Dr SV Umadevi and Dr D Niraimathi, Associate students for future printings and editions of the book. Professors, Department of Physiology, Indira Gandhi I wish to acknowledge and give special thanks to Medical College and Research Institute, Puducherry; Mr SK Jain, Chairman and MD, Mr Varun Jain, Director and Dr Rakhee Tirpude, Associate Professor, Department Mr YN Arjuna, Senior Vice President-Publishing and Publicity of Physiology, NKP Salve Institute of Medical Sciences for their suggestions and eagerness to make this twelfth and LMH, Nagpur, and Dr Sanjay Andrew Rajaratnam, edition colourful and informative so that the text is updated Professor and Head, Department of Physiology, with advancements in medical sciences to this day. Chettinad Hospital and Research Institute, Chennai, for I am thankful to Mrs Ritu Chawla ACM-Production, their valuable suggestions. Mr Vikrant Sharma DTP operator, Mrs Baljeet Kaur, As Prof AM Seligman, Dr Barbasa R Betty and Mr Sanjay Chauhan, Mr Neeraj Prasad, Graphic designers, Dr Davenport permitted the inclusion of the reference Mr Ananda Mohanty Proofreader, and all publishing of illustration in the earlier reprint edition and as these team of CBS Publishers & Distributors, New Delhi, are included in this edition too, I extend my gratitude for their excellent inputs in shaping the book to its to them. I am also thankful to CBS representatives present form. Mr Ajay (Kamataka), Mr Sarvanan and Mr Jyoti (Chennai) And last but not the least, I am thankful to my wife and Mr Ajay Shrivas (Nagpur) for providing constant Dr Jyoti and my son Joshua for all their support and feedback from various faculty members all over the encouragement. Nitin Ashok John Editor  Preface to the First Edition A t the outset, I would like to pay my humble regards to my revered teacher, Dr Charubrata Ray, MB, BSc, from whose lips I learnt how to 'read' and 'think' biochemistry and biophysics which will give the student a bird's-eye view of the whole subject and at the same time enable him to pass the examination with Physiology. A quiet unassuming man, a scholar with credit. This book is an attempt in that line. an inborn spirit of research, a teacher of rare genius­ It has been drawn up to meet the requirements of teaching thousands of students throughout his life the preclinical medical students of the different Indian without the least material interest of his own-Dr Ray and foreign universities mainly. Advanced and post­ represents that long-forgotten school of 'Indian Gurus' graduate students will certainly derive some help from with whom teaching was a creed and not a profession. In it but should not depend on this book alone. I have no teaching he sprouts wings. Seldom a teacher could have hesitation to say that a good deal of attention has been claimed to have so many students and seldom could he paid to assure success in examinations. Each system command so much respect from them. There are thousands has been divided into a number of problems in such a today who take his name with grateful reverence. May way that they are usually set or likely to be set as he livelong and lead us with his kindly light. questions by various examining bodies. At the For the last few decades, physiology has been making beginning of each system a few introductory lines have so rapid progress that it is being increasingly difficult been added in which the fundamental principles of that for the average students to manage the subject within system have been discussed. The students are advised the limited period fixed by the universities. Owing to to read these portions carefully and thoroughly to have this reason, they are compelled to go in for 'notes', a better grasp of the subject. 'synopses', 'made easier' and such other short-cut I have tried to avoid as much of the applied aspects devices which somehow enable them to squeeze as possible because it is my experience that a book through the examinations but fail to give them a meant for the pre-clinical students, should not contain comprehensive knowledge of the subject as a whole. much of applied discussions. The beginner only gets This state of affairs is cutting at the root of medical confused and tries to cram up the unnecessary applied education and is likely to undermine the standard details, leaving aside those portions more essential for medical graduates. What is required today is a textbook him. The little 'applied' necessary for them should best of reasonable size, including the essentials of histology, be left to the teachers. 18th July, 1951 CC Chatterjee  Contents Preface to the Twelfth Edition V Preface to the First Edition vi Ion Channels 30 Section I General Physiology Types of Transport Mechanism 31 Passive Transport Mechanism 31 1. Homeostasis 2 Diffusion 31 Introduction 2 Simple Diffusion 31 Role of Various Systems of Body in Homeostasis 2 Examples of Facilitated Diffusion 32 Feedback Homeostasis Regulations 3 Osmosis 32 Examples of Negative Feedback Mechanism 3 Co-transport Mechanism 33 Example of Positive Feedback Mechanism 4 Active Transport 33 Internal Factors Influencing Homeostasis 5 Primary Active Transport 33 External Factors Influencing Homeostasis 5 Secondary Active Transport 35 Exam-oriented Questions 5 ABC Transporters 36 Vesicular Transport Mechanisms 36 2. Cell Physiology: Structure and Functions Transport through Cellular Sheets 38 of Cell Organelle 6 4. Membrane Potential 40 Introduction 6 Introduction 40 Cell Structure 7 Cytoplasm 7 Role of Ion in Generating Membrane Potential 40 Membranous Organelles 7 Physico-chemical Principles involved in Cell Membrane 9 Generating RMP 40 The Fluid Mosaic Model 9 Nernst Potential 40 Functions of Plasma Membrane 10 Goldman-Hodgkin and Katz (GHK) Equation 40 Endoplasmic Reticulum (Ergastoplasm) 11 Gibbs-Donnan Membrane Equilibrium 41 Functions of Endoplasmic Reticulum 11 Recording of Membrane Potential 41 Microsome and Microsomal Fractions 11 Graded Potential and Action Potential 42 Golgi Apparatus (Golgi Complex) 12 Nerve Action Potential 43 Functions 12 Ionic Basis of Action Potential 44 Mitochondria 12 Cardiac Action Potentials 45 Functions 13 Property of Action Potential 45 Lysosomes 14 Ion Channel Studies 46 Functions 14 Lysosomal Storage Disease 15 5. Body Fluids and Blood Volume 48 Ribosomes or Claude's Particles 15 Centrosome 15 Introduction 48 Functions 16 Total Body Water and its Distribution 48 Nucleus 16 Extracellular Fluid Compartment 49 Nucleolus 17 Intracellular Fluid Compartment 49 Structure of Nucleus 17 Measurement of Body Fluid Compartments 49 Chromatin 19 Total Body Water 50 Chromosomes 19 Extracellular Fluid Volume 50 Autosomes and Sex Chromosomes 20 Blood Volume 50 Cell Life 20 Variations Under Different Physiological Conditions 50 Gene Expression and Regulation 20 Methods of Determination of Blood Volume 50 Genes and Genetic Diseases 21 Direct Method 50 Cytoplasmic Inclusion 21 Indirect Method 51 Endogenous Pigments 23 Dye Method 51 Exogenous Pigments 23 Radioactive Methods 51 Cell Division and Nuclear Division 23 Regulation of Blood Volume 52 Life Cycle of Cells 25 Intracellular Fluid Measurement 52 Formation of Tissue, Organ and System 25 Hydrogen Ion Concentration of the Body Fluids 53 Tissue 25 Cell Junctions 26 Cell Adhesion Molecules (CAMs) 26 Molecular Motors 27 Section II Blood Apoptosis 27 6. Composition and Functions of Blood 58 3. Transport Across Cell Membrane 30 Introduction 58 Introduction 30 Functions of Blood 58 Introducing to Key Terms and Concepts 30 Composition of Blood 58 Important Concepts in Transport Mechanism 30 Relative Volume of Corpuscles and Plasma 59  Human Physiology 7. Specific Gravity of Blood 61 13. Haemoglobin 89 Introduction 61 Introduction 89 Method of Determination 61 Chemistry 89 Significance 62 Structure of Haemoglobin 89 Haemoglobin Varieties 90 8. Plasma Proteins 63 Causes of Inclusion of the Haemoglobin in Red Cells 90 Introduction 63 Synthesis of Haemoglobin 91 Plasma Proteins Varieties 63 Methods of Estimation of Haemoglobin 92 Chemistry and Separation of Plasma Proteins 63 Variations of HB Under Different Serum Albumin 63 Physiological Conditions 93 Serum Globulin 63 Derivatives of Haemoglobin 93 Fibrinogen 64 Separation of Plasma Protein 64 14. Iron Absorption, Transport, Storage and Excretion 95 Origin of Plasma Proteins 64 Introduction 95 Rate of Regeneration of Plasma Proteins: Whipple's Absorption and Transport 95 Experiment 64 Absorption of Iron 96 Functions of Plasma Protein 65 Iron in Blood 97 Intrinsic Signals Proteins 66 Storage of Iron 97 Functions of Iron 97 9. Viscosity and Erythrocyte Sedimentation Applied: Iron Deficiency Anaemia 98 Rate (ESR) 67 Introduction 67 15. Anaemia, Polycythemia, Osmotic Viscosity 67 Fragility and Blood Indices 99 Suspension Stability of Blood 67 Introduction 99 ESR Increased and Decreased 67 Classification of Anaemia 99 Significance of ESR 67 Aplastic Anaemia 99 The Erythrocyte Sedimentation Stages 68 Pernicious Anaemia and Magaloblastic Anaemia 99 Physiological Variations in ESR 68 Nutritional Anaemia 100 10. Coagulation of Blood 69 Iron Deficiency Anaemia 100 Sickle Cell Anaemia 100 Introduction 69 Thalassemia 100 Importance of Coagulation of Blood 69 Glucose-6-Phosphate Dehydrogenase Deficiency 100 Mechanism of Coagulation or Clotting of Blood 69 Congenital Spherocytosis 100 General Characteristics of Coagulation 69 Haemolytic Anaemia 101 Blood Coagulation Factors 70 Polycythemia 101 Other Important Factors Participating in Coagulation Blood Indices 101 Mechanism 72 Extrinsic and Intrinsic Mechanisms of 16. White Blood Cells and Platelets 103 Coagulation of Blood 72 White Blood Cells 103 Clot Retraction 74 Variations in Normal Count of White Blood Corpuscles 103 Fibrinolysis 74 Classification and Differential Count of Plasminogen 74 White Blood Corpuscles or Leucocytes 104 Natural Inhibitors of Coagulation 75 Granular Leucocytes or Granulocytes 104 Intravascular Clotting or Thrombosis 75 Neutrophil 104 Heparin as an anticoagulant 75 Arneth Count or Arneth Index (Modified by Factors Preventing Coagulation 75 Von Bonsdorff and Later by Cooke) 104 Factors Hastening Coagulation 76 Arneth Index 104 Methods of Determination of Coagulation of Blood 76 Schilling Index 104 Coagulation Disorders 77 Eosinophil 105 11. Functions of Bone Marrow 79 Basophil 105 Lymphocytes 105 Bone Marrow 79 Small Lymphocyte 105 Red Bone Marrow 79 Large Lymphocyte 106 Yellow Bone Marrow 79 Monocytes 106 Vascular Arrangement in the Bone Marrow 79 Method of Examining Bone Marrow 79 Development of Leucocytes 106 Functions of Bone Marrow 80 Development of Granular Leucocytes or Granulocytes 106 Formed Elements of Blood 80 Precursors of Blood Cells 82 Development of Lymphocytes 107 Role of Lymphocyte in Immunology 107 12. Red Blood Corpuscles (Erythrocytes) 83 Functions of WBC 108 Composition of the Red Cells 83 Control of Leucopoiesis 108 Variations of Red Cell Count under Various Abnormal Variation in White Blood Corpuscles Count 109 Physiological Conditions 83 Platelets 109 Development of Red Blood Corpuscles 84 Methods of Counting of Platelets 110 Stages of Blood Formation in the Embryo and Foetus 84 Development of Platelets 110 Stages of Development 85 Functions of Platelets 111 Factors Controlling Erythropoiesis 86 Energy Metabolism of RBC 87 17. Blood Groups and Blood Transfusion 112 RBC Lifespan and Destruction 87 Blood Groups 112 Functions of Red Blood Corpuscles 88 A, B and O Groups 112  Contents Agglutinogens 112 Indefatigability 148 Rh Factor 113 Metabolism in Nerve Fibres 148 Erythroblastosis Foetalis 113 Heat Production in Nerve Fibre 149 Haemolytic Disease of the Newborn 114 Mechanism of Conduction of the Nerve Impulse 149 M and N Factors: Medicolegal Significance 114 Physiological Properties of the Nerve Fibres 151 Blood Transfusion: Blood Groups 114 Nerve Injury 151 Mismatched Blood Transfusion 115 Degeneration and Regeneration of Nerve 152 Blood Bank 115 Sunderland Classification of Nerve Injury 152 Wallerian Degeneration 152 18. Formation of Tissue Fluids 116 Regeneration 152 Introduction 116 Transneuronal Degeneration 153 Tissue Activities 116 Cathode Ray Oscilloscope (CRO) 153 Composition of Tissue Fluid 117 22. Neuromuscular Junction 155 Functions of Tissue Fluid 117 Oedema and its causes 117 Anatomical Considerations 155 Lymph and lymphatics 117 Synthesis of Acetylcholine in Properties of Lymph 118 Motor Neuron 156 Composition of Lymph 118 Sequence of Events in Neuromuscular Transmission 156 Factors Responsible for Formation of Lymph 118 Neuromuscular Blockers 157 Lymph Node 120 Myasthenia Gravis 158 Functions of Lymph Node 121 Lambert-Eaton Myasthenic Syndrome 158 Synopsis of the Neurophysiological Mechanism 158 Spleen 121 Functions of Spleen 123 23. Classification of Muscular Tissue 160 Functions of the Reticulo-endothelial System 125 Introduction 160 19. Immunity 126 Cohnheim's Area 160 Fibroblast 160 Introduction 126 Muscle Classification 161 Innate Defenses 126 First Line of Defense 126 24. Structure of Skeletal Muscle 162 Second Line of Defense 126 Introduction 162 Complement 127 Origin and Development 162 Adaptive Defenses 128 General Features 162 Development of the Acquired hnmune Histological Structure of Muscle Fibres 162 System 128 Myofibrils 163 Humoral Immunity 129 Myosin Filaments 163 Antibody Mediated Humoral Response 129 Actin Filament 165 Cell-mediated Immune Response 130 Sarcotubular System 165 T Cell Activation 130 Blood Vessels, Lymphatics and Nerves of T Cell Role 130 Skeletal Muscle 166 Organ Transplant 131 Ending of Muscle in Tendon 167 Severe Combined Immunodeficiency (SCID) Syndrome 131 Red and White (or Pale) Muscles 167 Acquired Immune Deficiency Syndrome (AIDS) 131 Hypersensitivity 131 25. Muscle Contraction 168 Mechanism of Contraction 168 Molecular Mechanism of Muscle Contraction 168 Section Ill Nerve and Muscle Mechanism of Relaxation 170 Changes during Muscular Contraction 170 20. Structure and Functions of Neuron 138 Role of Creatine Phosphate or Phosphagen and Adenosine Triphosphate (ATP) 171 Introduction 138 Muscular Contraction and its Relationship Histological Structure 138 with the Breakdown of ATP 172 Neuron 138 Utilization of other Fuels during Muscular Structure of Nerve Fibres 138 Contraction 172 Neuroglia 141 Oxygen Utilization and CO2 Production 173 Functions of Neuroglia 142 Cori Cycle 173 Axonal Transport and Nourishment of Neurons 142 Thermal Changes 173 21. Properties, Classification of Nerve Electrical Changes 174 Chronaxie and Rheobase 174 Fibres and Nerve Action Potential 143 Muscular Disorders 175 Introduction: Properties of Nerve Fibres 143 Excitability 143 26. Properties of Skeletal Muscle 176 Generation of Action Potential and Introduction: Properties of Skeletal Muscle 176 Excitability of the Nerve 143 Contraction of Skeletal Muscle 181 Ionic Basis of Excitability of Nerve 143 Compound Action Potential 145 27. Cardiac Muscle 182 Conductivity 146 Introduction 182 All-or-none Law 147 Fine Structure 182 Refractory Period 147 Sarcotubular System 183 Summation 148 Sarcoplasmic Reticulum 183 Adaptation 148 Transmission of Impulse and Mechanism of Accommodation 148 Contraction 183  Human Physiology Intercalated (Intercalary) Discs 183 Time Relations of the Various Events 219 Blood Vessels, Lymphatics and Nerves of Cardiac Summary of the Time Relations 219 Muscle 185 33. Pressure and Volume Changes during 28. Smooth Muscles 186 Cardiac Cycle 220 Introduction 186 Introduction 220 Distribution 186 Methods of Study 220 Origin and Development 186 Pressure Changes 220 Histology 186 Volume Changes 220 Contractile Mechanism 187 Intraventricular Pressure Changes 220 Properties of Plain (Smooth) Muscles 189 Jugular Pressure Tracing 222 Factors Affecting the Activity of Plain Muscle 189 Ventricular Volume Changes 222 Functions of the Muscular Tissue 189 Heart Sounds 222 Rigor Mortis 190 Cause of Heart Sound 223 First Heart Sound 224 Second Heart Sound 224 Section IV Cardiovascular System Third Heart Sound 224 Fourth Heart Sound 224 29. Introduction to Cardiovascular System 196 Sequential Changes in the Pressure and Volume Events in the Heart and Blood Introduction 196 Vessels during the Cardiac Cycle 225 Anatomical Considerations of the Heart 197 Valves of the Heart 198 34. Electrocardiogram 227 Action of the Valves 199 Introduction 227 Histology of the Cardiac Muscle 199 Methods of Recording Electrocardiogram 227 Arterioles 201 Electrocardiographic Leads Used both Capillaries 201 Clinically and Experimentally 229 Sinusoids 201 Standard Limb Leads 229 Valves of the Veins 202 Normal ECG Recorded in Standard Limb Leads 229 Blood Vessels (Vasa Vasorum) 202 Interpretation of Human Electrocardiogram 229 Lymphatics of Blood Vessels 202 Unipolar Limb Leads 231 Special Junctional Tissues 203 Augmented Unipolar Limb Leads 231 Sino-atrial Node 203 Normal ECG Recorded in Chest Leads 232 Atrioventricular Node 203 Significance of Various Leads and their Limitations 232 Bundle of His 205 Electrocardiographic Appearances under Purkinje Fibres 206 Certain Cardiac Disorders 233 Heart Block 233 30. Initiation and Spread of Cardiac Impulse 207 Ventricular Premature Beat or Extra Systole 234 Origin of the Heartbeat 207 Ventricular Paroxysmal Tachycardia 234 Conduction Over Atrial Muscle 207 Ventricular Fibrillation 234 Conduction Over AV Node 208 Wolff-Parkinson-White Syndrome 235 Conduction Over Bundle of His and the Myocardial Infarction 235 Right and Left Bundle Branches 208 Mean Electrical Axis of the Heart 235 Conduction through Purkinje Systems 208 Ventricular Conditions that may Cause Conduction through Ventricular Muscle 208 Axis Deviation 235 Heart Block 208 ECG Changes due to Altered Ionic Composition 236 31. Properties of Cardiac Muscle 210 35. Innervations of Heart and Heart Rate 238 Introduction 210 Introduction 238 Rhythmicity 210 Nerves of the Heart and their Action 238 Excitability 210 Vagus Nerves 238 Conduction 212 Tonic Action of the Vagus Nerves 238 Contraction 212 Stimulation of the Vagus Nerves 238 All-or-none Response 212 Sympathetic Nerves 239 Staircase Phenomenon 212 Effects of Stimulation of the Sympathetic Nerves 239 Refractory Period 212 Cardiac Centres 239 Tone 213 Heart Rate 240 Functional Syncytium 213 Regulation of Heart Rate 240 Factors Affecting Heart Rate 241 32. Cardiac Cycle 214 36. Cardiac Output 244 Introduction 214 Cardiac Cycle Time 214 Introduction 244 Interrelations of the Various Events in the Distribution of Cardiac Output 244 Cardiac Cycle 214 Cardiac Reserve 244 The Inner Ring Represents the Atrial Events Control of Cardiac Output 244 and the Outer Ring Represents Ventricular Events 214 Venous Return 244 Let us now follow the Ventricular Events in Force of Heartbeat 245 the Outer Ring 215 Frequency of Heartbeat 245 Let us follow the Outer Ring Further 215 Relation with Peripheral Resistance 246 Let us Again follow the Ventricular Methods of Measuring Cardiac Output 246 Diastole on the Outer Ring 216 Dye Method: Stewart and Hamilton's Dye Summary of the Sequence of Events in Cardiac Cycle 217 Dilution Method 246  Contents Fick Principle Using 02 and CO2 246 39. Regional Circulation 266 Physical Method: Ballistocardiography 247 Thermo-dilution Method Introduction 266 (Cold Saline Method) 247 Coronary Circulation 266 Doppler Echocardiography 248 Arterial Supply 266 Venous Drainage 266 37. Blood Pressure 249 Methods of Study 266 Variations of Coronary Inflow during Introduction 249 Different Phases of Cardiac Cycle 268 Basal Blood Pressure 249 Factors Influencing Coronary Circulation 269 Physiological Variations 249 Circulatory Status of the Cardiac Muscle Significance of Blood Pressure 249 tmder Certain Diseased Conditions 271 Systolic Pressure 249 Coronary Spasms and Intercoronary Reflexes 272 Diastolic Pressure 250 Cerebral Circulation 272 Pulse Pressure 250 Anatomical Considerations 272 Physiological Significance of Method of Study: Nitrous Oxide Method: Blood Pressure 250 Fick Principle 272 Measurement and Recording of Blood Pressure 250 Normal Values of Cerebral Circulation 272 Arterial Blood Pressure 250 Regulation of Cerebral Circulation 273 Venous Pressure 252 Existence of Auto-regulation of Cerebral Factors Controlling Arterial Blood Flow 273 Blood Pressure 252 Factors Controlling Cerebral Circulation 273 Adjustment of Blood Pressure 253 Cerebrovascular Resistance 274 Efferent Pathways of this Self-adjustment Pulmonary Circulation 275 or Homoeostasis of Blood Pressure 253 Anatomy of Circulation 275 Vasomotor System 253 Method of Recording Pulmonary Vasomotor Centre (VMC) 253 Arterial Pressure 275 Vasoconstrictor Nerves 254 Vasomotor Supply 276 Vasodilator Nerves 255 Normal Values of Pulmonary Circulation 276 Para-sympathetic (Cranio-sacral) Vasodilators 255 Functions of Pulmonary Circulation 276 Sympathetic Vasodilators 255 Control of Pulmonary Circulation 276 Antidromic Vasodilators 255 Peculiarities of Pulmonary Circulation 277 Afferent Pathways 255 Effect of Respiration on the Systemic Blood Pressure 278 Role of Sino-aortic Mechanism in the Regulation of Normal Blood Pressure 255 Pulmonary Vascular Reflex 278 Sino-aortic Mechanism 256 Pulmonary Depressor Chemoreflex (Paintal, 1955) 278 Chemoreceptors Location 256 Circulatory Status in Different Aortic Bodies 256 Cardiopulmonary Diseases 278 Vascular Receptors other than Hepatic Circulation 279 Sino-aortic for the Control of Blood Vascular Arrangement 279 Pressure and Flow 257 Vasomotor Supply 279 As Chemoreceptors 259 Normal Values of Hepatic Circulation 279 Mechanism of Regulation of Blood Pressure 259 Factors Modifying Hepatic Circulation 280 Short-term Regulating Mechanisms 259 Peculiarities of Hepatic Circulation 280 Baroreceptor Reflex 259 Splenic Circulation 281 Chemoreceptor Reflex 259 Control of Blood Flow 281 CNS Ischaemic Response 259 Renal Circulation 281 Intermediate Mechanism of Regulation of Capillary Circulation 281 Blood Pressure 260 Methods of Study of Capillary Circulation 282 Capillary Fluid Shift Mechanism 260 Vasomotor Supply 282 Long-term Regulation of Blood Pressure 260 Control of Capillary Circulation 283 Role of other Hormone in Regulation of Cutaneous Circulation 283 Blood Pressure 260 Anatomy of Cutaneous Circulation 283 Atrial Natriuretic Peptide (ANP) 260 Regulation of Blood Flow: Role of Humoral Vasoconstrictors and Vasodilators 260 Nervous Control 284 Humoral Vasoconstrictors 260 Vascular Response of Skin 284 Humoral Vasodilators 260 Auto-regulation of Skin Blood Flow 285 Chemical Control of Blood Pressure Skeletal Muscle circulation 285 Influenced by Vasomotor Mechanism 261 Rate of Blood Flow Through Muscle 285 Control of Skeletal Muscle Blood Flow 286 38. Velocity of Blood Flow and Radial Pulse 262 Introduction 262 40. Physiology of Exercise 288 Velocity of Blood 262 Introduction 288 Methods of Measurement of Velocity of Muscular Exercise 288 Blood 262 Changes in Cardiovascular System 288 Mean Volume Flow 263 Heart Rate Changes during Exercise 288 Radial Pulse 263 Circulatory Status during Exercise 290 Pressure Pulse 263 Changes in Respiration 290 Velocity of Pulse Wave 263 Oxygen Exchange during Exercise 291 Recording of Radial Pulse 264 Blood Cell Changes during Exercise 291 Clinical Features of Radial Pulse 264 Body Temperature 292 Special Varieties of Pulse 265 Body Fluid Changes during Exercise 292  Human Physiology Kidney Function in Exercise 292 Functions of Respiratory Tract 309 Digestive System 293 Filtering Effects 309 Endocrine Status 293 Air-conditioning Effects 309 Aerobic Training 293 Cough Reflex 309 Role of Nutrition in Exercise 293 Sneeze Reflex 309 Over-exercising and Ill Effects on Health 293 Respiratory Units 309 Broncho-pulmonary Anastomosis 310 41. Applied Cardiovascular Physiology: Pulmonary Alveoli 310 Haemorrhage, Heart Failure, Functions of Respiration 310 Hypotension, Hypertension and Shock 295 Non-respiratory Functions of Lungs 311 Pleural Cavity and Intra-pleural Haemorrhage 295 Pressure 311 Definition 295 Intra-pleural Pressure 311 Effects of Haemorrhage 295 Surface Tension at the Fluid-Air Role of Atrial and Ventricular Receptors and Interface within the Alveoli and the the Sino-aortic Baroreceptors 295 Role of Surfactant 312 Compensatory Changes After Haemorrhage 295 Pressure Changes in the Pleural Cavity and Changes in Respiration 296 its Relation to Volume Changes in the Lungs 312 Renal Changes 296 Clinical Aids 296 43. Mechanics of Breathing 314 Heart Failure 296 Introduction 314 Types of Heart Failure 296 Right-sided Heart Failure 297 Diaphragm 314 Congestive Heart Failure 297 Intercostal Muscles 314 Motion of the Ribs during Inspiration and Expiration 314 Role of Compensatory Mechanisms in Heart Failure 297 Accessory Muscles of Respiration 316 Management and Prevention 297 Resistance to Breathing 316 Hypotension 297 Orthostatic Hypotension 297 Elastic Resistance 316 Viscous or Non-elastic Resistance 316 Hypertension 298 Signs and Symptoms 298 44. Pulmonary Volumes and Capacities (Spirometry) 318 Primary Hypertension 298 Secondary Hypertension 298 Introduction 318 Malignant Hypertension 298 Lung Volumes 319 Isolated Systolic Hypertension 298 Respiratory Minute Volume (RMV) 319 White Coat Hypertension 298 Inspiratory Reserve Volume (IRV) 319 Resistant Hypertension 298 Expiratory Reserve Volume (ERV) 319 Pathophysiology of Hypertension 299 Residual Volume (RV) 319 Compensatory Mechanism 299 Lung Capacities 319 Management of Hypertension 299 Inspiratory Capacity (IC) 319 Shock 299 Functional Residual Capacity (FRC) 319 Types of Shock 299 Total Lung Capacity (TLC) 319 Hypovolemic Shock 299 Vital Capacity (VC) 319 Cardiogenic Shock 299 Forced Expiratory Volume (FEV) 320 Obstructive Shock 299 Forced Expiratory Volume in 1 (FEVl) Distributive Shock 299 Second 322 Clinical Features of Shock 300 FEVl/FVC Ratio (FEV1%) 322 Stages of Shock 300 Forced Expiratory Flow (FEF) 322 Non-progressive (Compensated) Stage 300 Peak Expiratory Flow (PEF) 322 Progressive Stage 300 Breathing Reserve (BR) 322 Irreversible Stage 300 Applied Physiology: Obstructive and Hypovolemic Shock 300 Restrictive Lung Disease 322 Cardiogenic Shock 300 45. Alveolar Ventilation and Gases Exchange Obstructive Shock 301 3M Distributive Shock 301 Physiological Process in Shock 302 Introduction 324 Cardiac Reflexes 302 Respiratory 'Dead Space' 324 Sympathetic Nervous System 302 Definition 324 Renin-angiotensin Axis 302 Measurement of Dead Space Volume 324 Stretch Relaxation 302 Nitrogen Meter Method 324 Anti-diuretic Hormone 302 Intrapulmonary Gas-mixing or Even Capillary Fluid Shift Mechanism 302 Distribution of Inspired Air 325 Vasodilators 302 Methods of Detection of Uneven Ventilation 325 Overriding of Compensatory Mechanism 302 Alveolar Air 325 Physiology of Treatment in Shock 302 Method of Collection of Alveolar Air 325 Otis-Rahn Method 326 Method of Analysis of Alveolar Air 326 Section V Respiratory System Composition of Alveolar Air 326 Partial Pressure of Gases in Inspired Air, 42. Functional Organization of Respiratory System 308 Expired Air and Alveolar Air 326 Method of Measurement of Alveolar and Definition 308 Arterial pC02 327 Structure of the Respiratory Tract 308 Effect of Voluntary Hyperpnoea on Trachea 308 Alveolar Air 327  Contents Effects of High Altitude on 49. Hypoxia 351 Alveolar Oxygen 328 Factors Controlling Alveolar pC02 328 Definition 351 Physiological Shunt 329 Classification of Hypoxia 351 Hypoxic type of Hypoxia or Arterial Hypoxia 351 46. Ventilation and Perfusion in Lungs 330 Anaemic type of Hypoxia 351 Stagnant Hypoxia or Hypokinetic Hypoxia 351 Diffusion 330 Histotoxic Hypoxia 351 Factors Controlling Diffusion 331 Anoxic Hypoxia or Arterial Hypoxia 351 Pulmonary Diffusing Capacity for Causes of Arterial Hypoxia 351 02 (002) 331 Anaemic Hypoxia 351 Diffusion of CO2 331 Stagnant Hypoxia or Hypokinetic Hypoxia 352 Perfusion 332 Histotoxic Hypoxia 352 47. Transport of Oxygen and Carbon Altitude Hypoxia 352 Dioxide in Blood 333 Respiratory Changes in Hypoxia: Acute and Chronic at High Altitude 352 Introduction 333 Respiration in Altitude Hypoxia in Oxygen Transport 333 Unacclimatised Subjects 352 02 Capacity, 02 Content and Percentage Respiration in Subjects Exposed to Hypoxia of Saturation of Haemoglobin 333 Long Duration (Acclimatised Subjects) 352 02 Content 333 Oxygen Therapy in Hypoxia 353 Saturation of Haemoglobin 333 Dyspnoea 354 Dissociation Curve for Haemoglobin 333 Dyspnoea due to Alteration in Chemical Composition of Delivery of 02 in the Tissues in Anaemia 335 Blood 354 Oxygen Exchange in the Lungs 335 Factors Affecting Diffusion of Gases Across the Oxygen Transport in the Tissues 336 Alveolo-capillary Membrane (Alveolo-capillary Carbon Dioxide Transport 337 Block Syndrome) 354 CO2 Content and Tension of Blood 337 Excessive Work of the Respiratory Muscles 354 CO2 in Physical Solution 337 Applied Physiology 355 Mechanism of Formation of CO2 338 Psychogenic or Emotional Dyspnoea 355 CO2 Transport in the Tissues 338 CO2 Transport in the RBC 339 50. Compressed Air Sickness 356 Carriage of CO2 as Carbamino-compound 339 Dysbarism (Caisson Disease) 356 02 Transport in the Lungs 340 Carbon Dioxide Dissociation Curves 341 51. Respiration in Abnormal Conditions 357 48. Regulation of Respiration 342 Asphyxia 357 Definition 357 Introduction 342 Classification 357 Respiratory Centre 342 Essential Conditions of Asphyxia 357 Pneumotaxic Area 342 Hyperpnoea 357 Apneustic Area 342 Effects of Voluntary Hyperpnoea 358 Botzinger Complex 342 Orthopnoea 358 Mechanism of Rhythmic Respiration 344 Cyanosis 358 Nervous Control of Respiration 344 Factors Causing Cyanosis 358 Role of Abdominal Muscles in Respiration 344 Applied Physiology 358 Role of Reflex in Respiration 344 Asthma 358 The Hering-Breuer Reflexes 344 Acute Bronchitis 359 Inflation Reflex 344 Chronic Bronchitis 359 Deflation Reflex 344 Atelectasis 359 Irritant Receptors 345 Emphysema 359 Impulses from Ascending Tracts of the Chronic Obstructive Pulmonary Disease 359 Spinal Cord 345 Respiratory Distress Syndrome of Newborn 359 Muscular Proprioceptors 345 Adult Respiratory Distress Syndrome (ARDS) 359 Deglutition 346 Juxtapulmonary Receptors: J Reflex 346 52. Artificial Respiration or Resuscitation 360 Hiccup 346 Cough Reflex 346 Indication 360 Sneezing Reflex 347 Principle 360 Reflexes from Sino-aortic Zone 347 Methods of Artificial Respiration 360 Baroreceptor Reflex 347 Manual Methods 360 Distension of Pulmonary Vascular Bed 347 Schafer's Method 360 Voluntary Control of Respiration 347 Sylvester's Method 361 Chemical Control of Respiration 348 Holger-Nielsen Method 361 CO2 and Respiration 348 Mouth-to-mouth Method 361 Role of Central Versus Peripheral Chemoreceptors Eve's Rocking Method 361 in Normal Respiratory Drive 348 Instrumental Method 361 Oxygen Tension and Breathing 348 Drinker's Method 361 Ventilation during Exercise 349 Resuscitator 361 Chemical Factors 349 In the Newborn Baby 361 Nervous Factors Influencing Respiration 349 Periodic Breathing 350 53. Acclimatization 364 Cheyne-Stokes Breathing 350 Compensatory Changes at Moderately High Altitude 364 Mechanism of Cheyne-Stokes Breathing 350 Changes in Acclimatisation 364  Human Physiology Natural Acclimatisation of Natives Residing at High Organic Constituents 397 Altitude 364 Succus Entericus 397 Acute Mountain Sickness 365 Intestinal Juice Enzymes 398 Mountaineering 365 Carbohydrate Splitting 398 Atmosphere High Altitude Physiology 366 Biles 398 Hypoxia 366 Composition of Bile 398 Problem Faced by Aviators 366 Functions of Bile 399 Radiation Hazards 367 Bile Salts 400 Dysbarism at High Altitude (Decompression Variety and Chemistry 400 Sickness) 367 Synthesis of Bile Salts 400 Explosive Decompression 368 Enterohepatic Circulation and Fate of Bile Salts 400 Effect of Centrifugal Acceleratory Forces 368 Functions of Bile Salts 401 Protection of Body against Centrifugal Acceleratory Bile Pigments 401 Forces 369 Origin and Formation 401 Parachute Jump 369 Red Blood Cell Lysis 401 Weightlessness in Space (Zero-G State) 370 Site of Formation, Circulation and Fate 402 54. Underwater Physiology 371 58. Mechanism of Secretion of Various Introduction 371 Digestive Juices 404 Nitrogen 371 Introduction 404 Oxygen 371 Types of Stimuli 404 Mechanism of Oxygen Poisoning 372 Nerve Supply of Salivary Glands 404 Carbon Dioxide 372 Significance of Double Nerve Supply 404 Helium 372 Conditioned Reflex 405 Underwater Respiration 372 Unconditioned Reflex 405 SCUBA Diving 373 Disturbances of Salivary Secretion 406 Hyposalivation 406 55. Vocalisation 375 Hypersalivation 407 Introduction 375 Mechanism of Gastric Secretion 407 Articulation and Resonance 376 Mechanism of Secretion 408 Nervous Phase 408 Cephalic Phase 409 Section VI Castro-intestinal Tract Gastric Phase (Hormonal) 409 Nature and Action of Gastrin 410 56. General Outline of Digestive System 380 Response to Food 410 Intestinal Phase 410 Introduction 380 Interdigestive Phase 410 Anatomical Consideration 380 Hormones on Gastric Secretion 410 Histological Structure 381 Effects of Various Chemicals and Innervation of the Digestive Tract 381 Drugs on Gastric Secretion 411 Details of Extrinsic Nerve Supply 382 Interrelation between the Different Phases 411 Functions of the Digestive System 383 Investigation of Gastric Secretion in Man 411 Histology of Tongue 383 Other Functional Tests 412 Glands 385 Histamine Test of Gastric Sceretion 412 Nerve Supply 385 Insulin Test of Gastric Secretion 413 Functions 385 Oesophagogastro-duodenoscopy 413 Salivary Glands 385 Gastric Tissue Biopsy 413 Histology of Salivary Glands 386 Origin and Character of the Important Constituents of Pharynx or Throat Cavity 388 Gastric Juice 413 Oesophagus 388 Hydrochloric Acid 413 Histology 388 Applied Physiology: Peptic Ulcer 414 Stomach 389 Drug Management of Peptic Ulcer 414 Histology of Stomach 389 Pepsin 414 Functions of Stomach 391 Mucin 415 Small Intestine 392 Intrinsic Factor 415 Vermiform Appendix 393 Neuropoietic Factor 415 Large Intestine 393 Pancreas 415 Rectum 393 Development 416 Anal Canal 393 Mechanism of Pancreatic Secretions 416 Brief Summary of the Chief Identifying Features of Nervous Phase 416 Different Part of the Digestive Tract 394 Chemical Phase 416 57. Digestive Juices 395 Secretin 416 Cholecystokinin Pancreozymin 416 Introduction 395 Influence of Various Foodstuffs on Saliva 395 Pancreatic Secretion 417 Characteristics 395 Pancreatitis 417 Composition 395 Mechanism of Bile Secretion 417 Functions 396 Mechanism of Secretion 418 Gastric Juice 396 The following Substances are Found to Pancreatic Juice 397 Stimulate Bile Secretion 418 Constituents 397 Mechanism of Expulsion of Bile 419 Inorganic Consituents 397 Experiment 419  Contents Factors Controlling Movements of Peristaltic Movement 432 Gall Bladder 420 Mass Peristalsis 432 Functions of Gall Bladder 420 Functions of Large Intestine 433 Applied Physiology 420 Rate of Progress of Barium Meal 433 Mechanism of Secretion of Succus Applied Physiology-Large Intestine 433 Entericus (Intestinal Juice) 420 Irritable Bowel Syndrome 433 Mechanism 420 Hirschsprung's Disease 433 Enterocrinin 421 Constipation 433 Applied Physiology 421 Defaecation 434 Malabsorption Syndrome 421 Mechanism 434 Blind Loop Syndrome 421 Interactions of Gastro-intestinaI 60. Digestion and Absorption of Foodstuffs 435 Hormones 421 Introduction 435 Metabolic Effects of Castro-intestinal Digestion of Carbohydrates 435 Hormones 421 Different forms of Carbohydrates 435 Summary of Secretions of the Various Different Forms of Protein 436 Digestive Juices 422 Digestion of Nucleoprotein 437 Salivary Secretion 422 Digestion of Casein 437 Gastric Secretion: Experiments: Sham Feeding and Digestion of Milk 438 Pavlov's pouch 422 Pancreatic Secretion 422 Digestion of Collagen and Gelatin 438 Bile Secretion 422 Digestion of Mucin 438 For Gastric Secretion 422 Digestion of Lipids 438 For Pancreatic Secretion 422 Digestion in the Pancreatic Juice 438 Absorption 439 For Succus Entericus 422 For Bile Secretion 422 Definition 439 Absorption of Carbohydrates 439 59. Movements of Alimentary Canal 423 Absorption of Proteins 439 Fats Absorption 440 Introduction 423 Process of Absorption 440 Facts about Movement 423 Water Absorption 440 Cause of Movements 423 Absorption of Electrolytes 440 Relation with Degree of Activity 423 Faeces 441 Deglutition 423 Contents and Characteristics 441 Mechanism of Protection of Airway during the Passage of Food through the 61. Gastro-intestinal Hormones 443 Pharyngeal Crossroads 424 Common Disturbances in the Swallowing 425 Introduction 443 Reflux Esophagitis 425 Gastrin 443 Achalasia Cardia 425 Cholecystokinin (CCK) or Pancreozymin 444 Nervous Mechanism 425 Regulation of Secretion of Cholecystokinin or Pancreozymin (CCK) 444 Movements of Stomach 426 Glucagon-like Peptide-I 444 Movements of the Fundus and Body 426 Gastric Inhibitory Polypeptide (GIP) 444 Hunger Contractions 426 Vasoactive Intestinal Peptide (VIP) 444 Other Factors Influencing Control of Urogastrone 444 Pyloric Sphincter 427 Villikinin 445 Emptying of Stomach 427 Enterocrinin 445 Role of the Vagus and the Sympathetic 427 Motilin 445 Role of Hormones and other Chemicals 427 Neurotensin 445 Dumping Syndrome 427 Somatostatin 445 Vomiting (Emesis) 427 Gastrin Releasing Peptide 445 Sequence of Events 427 Ghrelin 445 Mechanism 428 Peptide YY 445 Projectile Vomiting 429 Substance P 445 Persistent Type of Pernicious Vomiting of Pregnancy 429 Bombesin 445 Movements of Small Intestine 429 Clinical Case Scenario 446 Rhythmic Segmentation 429 Gastrointestinal Tract 446 Frequency 429 Recent Advances: Treatment of Peptic Ulcer 446 Cause 430 Functions 430 Peristalsis 430 Causes of Peristalsis 431 Section VII Renal Physiology Role of Endocrines 431 Gastro-ileal Reflex 431 62. Functional Anatomy of Excretory System 450 Functions 431 Introduction 450 Ileocaecal Sphincter 431 Kidneys 451 Movements of Villi 431 Characteristic Features 450 Factors Controlling Movements of Villi 432 Nephron 450 Applied Physiology 432 Uriniferous Tubules 451 Adynamic Ileus 432 Types of Nephrons 451 Movements of Large Intestine 432 Renal Tubules 453 Stationary Movements 432 Proximal Convoluted Tubule (PCT or Translatory Movements 432 Pars Convoluta) 456  Human Physiology Henle's Loop (Pars Reeta) 456 Assuming 482 Distal Convoluted Tubule (DCT) 457 Inulin Clearance (a measure of Collecting Tubule 457 Glomerular Filtration Rate) 483 Juxtaglomerular Apparatus 458 Urea Clearance Test (Van Slyke) 483 Functional Key Features of JGA 458 Creatinine Clearance Test 483 Renal Circulation 460 Estimation of Creatinine Clearance 484 Peculiarities 460 Urine, Urinary Characteristic and its Peculiarities of Renal Circulation 462 Mechanism of Formation 484 Introduction 484 63. Renal Blood Flow 464 Other Characteristics 484 Introduction 464 Colour 484 Autoregulation of Renal Blood Flow 464 Reaction 484 Nervous Control 465 Specific Gravity 484 Other Factors 465 Turbidity 485 Exercise, Posture and Central Blood Volume 465 Odour 485 Hypoxia, Hypercapnia and Acidosis 465 Osmotic Pressure 485 Hormones 466 Composition of Urine 485 Catecholamines 466 Urea 485 Adrenaline 466 Ammonia 485 Pitressin 466 Uric Acid 485 Serotonin (5-hydroxytryptamine) 466 Oxalate 485 Other Pharmacological Agents 466 Amino Acids 485 Ephedrine, Phenylpropanolamine, Hippuric Acid 485 Hydroxyamphetamine 466 Allantonic 485 Dopamine, Nitric Oxide and Bradykinin 466 Vitamins 485 Xanthine Group of Drugs 466 Chloride 485 Protein Diet High 466 Phosphate 485 Anaesthetic Agents 466 Hormones influencing Renal Functions 466 Sulphates 485 Measurement of Renal Blood Flow 467 Minerals 485 Venous Shunt Technique 467 Abnormal Constituent of Urine 485 Para-aminohippurate (PAH) 467 Protein 485 Functions of Kidney and Glomerulus 467 Proteinuria (Albuminuria) 486 Functions of Kidney 467 Glucose 487 Other Sugars 487 64. Glomerular Filtration Rate 469 Ketone Bodies 487 Introduction 469 Indican 487 Filtration Pressure 469 Blood 487 Forces Favouring Filtration 469 Pigments 487 Bowman' Capsule 469 Calculi and Casts 487 Net Filtration Pressure/Effective Filtration Pressure 469 Pus 487 Calculation of GFR 469 Hormones 487 Mechanism Involved in Regulation of GFR 469 Factors Affecting Formation of Urine 487 Functions of Glomerulus 470 Water Intake 487 Effects of Salts 488 65. Physiology of Renal Tubules: Water and Effects of Water Deprivation 488 Electrolytes Balance and Counter-current Reaction of Urine 488 Mechanism 472 Ammonia Mechanism 490 Elimination of Acids 490 Introduction 472 Elimination of Alkalis 491 Methods of Study of Tubular Functions 472 Glycosuria 490 Protein 473 Glycosuria due to Hyperglycaemia 492 Glucose 473 Water 473 Nervous Glycosuria 492 Concentration of Urine 475 Pancreas (Diabetes Mellitus or Pancreatic Diabetes) 492 Summary: Role of ADH 476 Hyperthyroidism 492 Sodium and Chloride 477 Adrenaline (Epinephrine) 492 Potassium 478 Anterior Pituitary 493 Bicarbonate 478 Adrenal Cortex 493 Phosphate 479 Glucagon 493 Reabsorption of other Substances 479 Glycosuria due to Less Tubular Reabsorption 492 Tubular Secretion 480 Renal Glycosuria 492 Determination of Tubular Secretory or Phloridzin Glycosuria 492 Excretory Power 480 Diseases of the Renal Tubule 493 Formation of Some New Substances 480 Due to Heavy Metal Poisoning 493 In Pregnancy 493 66. Renal Function Test, Urine, Urinary Factors Controlling Volume of Urine 493 Characteristic and its Mechanism of Formation 482 Abnormal Volume of Urine 494 Introduction 482 Nocturia 494 Tests Depending upon Urine Analysis only 482 Oliguria 494 Tests Depending upon the Elimination of some Anuria 494 Substances 482 Applied Physiology 494  Contents 67. Micturition 495 Role of Spinal Cord in Heat Regulation 513 Role of Motor fibres of the Cerebrospinal Introduction 495 System in Heat Regulation 513 Structure of Urinary Bladder 495 Interaction of Central and Peripheral Factors 513 Mechanism of Filling of Bladder 496 Role of Endocrines 513 Mechanism of Micturition 497 Adrenal Cortex 514 Micturition Reflex 497 Temperature Regulation in the Newborn Infant 514 Centres of Micturition 498 Effects of Exposure to High and Low Atmospheric Cortical Centre 498 Temperature 514 Hypothalamic Centre 498 Physiological Alterations of Body Brain Stem Centre 498 Mechanisms on Exposure to Hot Atmosphere 514 Spinal Centres 498 Life in Deserts 514 Effect of Lesion of Autonomic Nerves 498 Physiological Alterations of Body Effects of Lesion of the Efferent Mechanisms on Exposure to Cold Atmosphere 514 Para-sympathetic (Sacral Autonomic) Nerves 499 Heat Production 514 Effects of Complete Transection of the Spinal Cord 499 Heat Loss 514 Artificial Kidney 499 Effect of Sudden Change of Atmospheric Temperature 515 Pyrexia 515 68. Skin, Body Temperature and its Regulation 501 Physiological Responses due to Pyrexia (Fever) 515 Introduction 501 Hyp othermia 515 Structure 501 Physiological Responses to (Deliberate) Hypothermia 515 Epidermis 501 Metabolism 515 Stratum Corneum 501 Stratum Lucidum 501 69. Regulation of Reaction of Blood and Stratum Granulosum 501 Disturbances in Acid-Base Regulation 517 Stratum Spinosum 501 Introduction 517 Stratum Germinativum 501 Respiratory H+ 517 Dermis (Cutis Vera or True Skin) 502 Metabolic H+ 517 Functions of Skin 503 Buffers of the Blood 517 Protection 503 Buffers 517 Regulation of Body Temperature 503 Bicarbonate Buffers 517 General Sensation 504 Haemoglobin 518 Excretion 504 Plasma Proteins 518 Secretion 504 Role of Respiration in Acid-Base Balance 518 Absorption 504 Role of Kidneys in Acid-Base Balance 519 Water Balance 504 Absorption of Filtered NaHC03 519 Acid-base Equilibrium 504 Manufacturing 519 Gaseous Exchange 504 Under Conditions of Acidosis 519 Glands in the Skin 504 Disturbances in Acid-Base Regulation 519 Eccrine Sweat Gland 504 Respiratory Acidosis 519 Apocrine Sweat Gland 505 Pathophysiology 519 Mechanism of Secretion of Sweat 505 Compensatory Mechanism 520 Composition of Sweat 506 Metabolic Alkalosis 521 Sebaceous Glands 506 Respiratory Compensation 521 Composition of Sebum 507 Renal Compensation 521 Control 507 Metabolic Acidosis 521 Special Structures of Skin 508 Compensation 521 Nails (Ungues) 508 Respiratory Compensation 521 Hair (Pili) 508 Respiratory Alkalosis 522 Introduction 509 Renal Compensation 522 Normal Temperature 509 Assessment of the Acid-Base Status 522 Oesophageal Temperature 509 Arterial Blood Gas Test 522 Factors Affecting Body Temperature 510 Kidney 523 Size 510 Applied Physiology 523 Sex 510 Food 510 Haemodialysis 523 Exercise 510 Peritoneal Dialysis 523 Atmospheric Conditions 510 Cold and Warm Baths 510 Appendices Sleep 510 Emotion 510 Appendix 1 Some Physico-chemical Laws General Anaesthetics or Chlorpromazie 510 Applied to Physiology (Biophysics) 526 Posture, Piloerection and Clothing 510 Regulation of Body Temperature 511 Units of Cencentration of Solutions 526 Mechanisms of Heat Production (Thermogenesis) 511 Ions, Electrolytes and Non-electrolytes 526 Mechanisms of Heat Loss (Thermolysis) 511 Ions 526 From Lungs 512 Electrolytes 526 By Excreta 512 Non-electrolytes 526 Nervous System and Thermotaxis 512 Filtration 526 Role of Cerebrum 512 Physiological Importance 526 Role of Hypothalamus 512 Diffusion 526 Role of Autonomic Nervous System 512 Concentration 527  Human Physiology Osmosis 527 Calorie 540 Semipermeable Membrane 528 Distribution of Calories in the Diet 541 Clinical use 529 Protein Requirement 541 Laboratory use 529 The Proportion of Fat, Protein and Carbohydrate 543 Methods of Measurement 529 Mineral Requirement 543 By Putting Weights 529 Choice of Foodstuff 543 By a Manometer 529 Value of Cooking 543 Hamburger's Red Corpuscle Method 529 De Vris' Plant Cell Method 529 Conclusions 543 By Noting Depression of Freezing Point 529 Percentage Composition of the Ordinary Ultra-filtration 530 Articles of Diet 544 Dialysis 530 Regulation of Food Intake 546 Surface Tension 530 Adsorption 531 Appendix 3 Energy Metabolism 547 Residual Valence 531 Introduction 547 Electrical State 531 The Body's Input and Output of Energy 547 Hydrotropy 531 Donan Equilibrium 531 Methods for Determination of Energy Output 547 Colloid 532 Respiratory Quotient (RQ) 548 Emulsoid and Suspensoid 532 Factors Affecting Respiratory Quotient 549 Sol and Gel 533 Value of Determining Respiratory Quotient 549 Properties of Colloids 533 The RQ of Various Organs and Tissues 549 Faraday-Tyndall Phenomenon 533 Electrical Phenomenon 533