Shobha Rawlani, Shivlal Rawlani-Textbook of General Anatomy-JP Medical LTD (

Textbook of
General Anatomy
Textbook of
General Anatomy
Second Edition
Shobha Rawlani MBBS MS
Professor and Head
Department of Anatomy
Dr Panjabrao Deshmukh Memorial Medical College
Amravati, Maharashtra, India
Formerly
Professor
Mahatma Gandhi Institute of Medical Sciences
Sevagram, Maharashtra, India
Professor
Jawaharlal Nehru Medical College
Sawangi (Meghe), Wardha, Maharashtra, India
Shivlal Rawlani BDS MDS

Associate Professor and Head
Department of Dentistry
Kasturba Health Society (KHS)/Mahatma Gandhi Institute of
Medical Sciences
Sevagram, Maharashtra, India
Formerly
Associate Professor
Department of Oral Medicine and Radiology
Sharad Pawar Dental College
Datta Meghe Institute of Medical Sciences (DMIMS)
Sawangi (Meghe), Wardha, Maharashtra, India
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Textbook of General Anatomy
First Edition: 2011

Second Edition: 2013
ISBN: 978-93-5090-507-4
Printed at
Dedicated to
Our beloved parents
Shri Keshawdas Doultani
Smt Vidya Doultani
and
Our Son-Sudhir Rawlani
Daughter-Sujata Rawlani
Preface to the Second Edition
Textbook of General Anatomy provides the basic knowledge of human

gross anatomy, which is important for every student of medical,
dental, physiotherapy and pharmacy faculties. This book is also useful
for postgraduate entrance examinations. The students pursuing
postgraduation in anatomy will also find this book very beneficial.
In this book, attempt has been made to introduce various structures
of human body, i.e. connective tissue, cartilage, bone, joints, muscles,
blood vessels, nerves, lymphatic system, skin and appendages, etc. in
simple language with plenty of examples.
In this second edition, we have tried to correct the errors of the first
edition. In this edition, all the diagrams are made colorful. We will be
very thankful to the teachers and the students for sending suggestions
and drawing attention towards the errors.
Shobha Rawlani
Shivlal Rawlani
Preface to the First Edition
Textbook of General Anatomy provides the basic knowledge of human

gross anatomy, which is important for every student of medical and
dental faculties, and also preparing for entrance examination. The
student pursuing postgraduation in anatomy will also find this book
very beneficial.
In this book, attempt has been made to introduce various structures
of human body, i.e. connective tissue, cartilage, bone, joints, muscles,
blood vessels, nerves, lymphatic system, skin and appendages, etc. in
simple language with plenty of examples.
As this is the first edition of the book, there may be few errors in
text. We will be very thankful to the teachers and the students for
sending suggestions and drawing attention towards the errors.
Shobha Rawlani
Shivlal Rawlani
Acknowledgments
We would like to thank:

Our guide and mentor, Dr SK Ghosh Sir, Professor and Head,
Department of Anatomy, Nepal Medical College, Kathmandu, for
his encouragement and moral support.
We are immensely thankful to our daughter, Dr Sujata Rawlani, for
her valuable help in drawing the diagrams for this book.
Advocate Arunbhau Shelke (President) and Dr Dilip S Jane (Dean),
Dr Panjabrao Deshmukh Memorial Medical College, Amravati,
Maharashtra, India, for their valuable suggestions and cooperation.
Dr P Narang Madam (Secretary), Kasturba Health Society (KHS),
Mahatma Gandhi Institute of Medical Sciences, Sevagram,
Maharashtra, India, for her appreciable suggestions.
Dr Vedprakash Mishra, Prochancellor, Datta Meghe Institute of
Medical Sciences (Deemed University), Sawangi (Meghe), Wardha,
Maharashtra, India, for his valuable suggestions and cooperation.
Dr Kadasne, for his strong encouragement and guidance.
Dr Anbalgan, for his support and encouragement.
Dr GP Pal, Modern Dental College, Indore, for his valuable suggestions
and support.
Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director)
and Mr Tarun Duneja (Director-Publishing), M/s Jaypee Brothers
Medical Publishers (P) Ltd, New Delhi, India, for accepting our project
and publishing the book.
Dr Shyam Chaudhari, M/s Jaypee Brothers Medical Publishers (P) Ltd,
Nagpur Branch, for his support and encouragement.
Mr Rajesh Sharma, M/s Jaypee Brothers Medical Publishers (P) Ltd,
New Delhi, India, for his coordination.
Our special thanks to our dear friends and colleagues:
Dr MR Shende, Dr Meena Meshram, Dr Ujwal Gajbe, Dr Shirsagar,
Dr Sudhir Pandit, DrMilind Fulpatil, Dr Ravindra Marathe, Dr Pradeep
Bokadia, Dr Jwalant Waghmare, Dr Aditya Tarnekar, Dr Ashok Pal,
Dr Vandana Wankhede, Dr Bharat Sontakke, Dr Sanjay Wanjari,
xii Textbook of General Anatomy
Dr Vilas Chimurkar, Dr Brijraj Singh, Dr Dharmaraj Tamgire, Dr Deepali

Omkar, Dr Anupama Chavan, Dr Yati Phatak, Dr Amol Drugkar,
Dr Nayaran Dongre, Dr Sarita Kadu, Dr Anant Kadbande.
Our special thanks to Dr Anand Bijwe and our ar tist,
Mr Deshmukh, for their kind support.
Our heartful thanks to Rawlani family and our son Dr Sudhir and
daughter-in-law Dr Monika, and Dr Ramesh Rawlani, Dr Chanda
Rawlani, whose valuable support has made possible to complete
the book.
We are also thankful to younger brothers Shyam and Ram
Doultani.
Contents
Chapter 1 Introduction 1
Gross Anatomy 1
History of Anatomy 1
Anatomical Language 2
Anatomy and its Subdivisions 3
Anatomical Position and Body Planes 4
Special Terms for Limbs 7
Terms Used for Describing Movements 9
Introduction to Histology 13
Primary Tissues of the Body 14
Tissue Processing 14
Staining17
Applied Anatomy 18
Chapter 2 Connective Tissue 20

Connective TissueI 20
General Features of Connective Tissue 21
Connective TissueII 29
Connective Tissue Matrix 29
Ground Substance 35
Types of Connective Tissue 36
Applied Anatomy of Connective Tissue 40
Chapter 3 Cartilage 43
Definition43
Structure of Cartilage 44
General Features of the Cartilage 45
Peculiarities of the Cartilage 45
Growth and Development of Cartilage 46
Regeneration48
Calcification48
Types of Cartilage 49
xiv Textbook of General Anatomy
Chapter 4 Sclerous Tissue 53

BoneI53
Definition53
Physical Properties 53
Functions of the Bone 54
Structure of Bone 54
Classification of Bones 56
Bone Markings and Formations 63
Bone as a TissueII 64
Parts of Long Bone 64
Growth of a Long Bone 69
Factors Affecting Growth of a Bone 70
Laws of Ossification 71
Laws of Union of Epiphysis 71
Blood Supply of Bone 72
Nerve Supply of Bone 74
Lymphatics of Bone 76
Fracture of the Bone and its Repair 76
Chapter 5 Joints 78
JointsI78
Definition78
Classification of Joints 78
Structural Classification 80
JointsIi87
Synovial Joints 87
Description of the Component Parts of
Synovial Joints 89
Classification of Synovial Joints 92
Rotation99
Chapter 6 Muscular Tissue 102

MuscleI102
Types of Muscle 102

Skeletal Muscle (Gross Organization) 106

Types of Skeletal Muscle Fibers 110

Parts of a Skeletal Muscle 110

Fascicular Architecture of Muscle 111

MuscleIi114
Mechanism of Lubrication 114
Nomenclature of the Muscles 116
Contents xv
Blood Supply of the Skeletal Muscle 117

Lymphatic Drainage 117
Development of Skeletal Muscle 118
Nerve Supply of the Skeletal Muscle 118
Muscle Tone 122
Actions of Muscle 123
Applied Anatomy 124
Chapter 7 Nervous Tissue 126

Nervous TissueI 126
Parts of the Nervous System 126
Neuron127
Synapse133
Neuroglia135
Nervous TissueIi138
Reflex Arc 138
Peripheral Nerves 142
Injuries to Neurons and Peripheral Nerves and
their Degeneration and Regeneration 143
Autonomic Nervous System 145
Chapter 8 Blood Vascular System 150

Components of the Vascular System 150
Types of Circulation of Blood 152
Classification of Blood Vessels 155
Anastomosis of Blood Vessels 162
End-arteries164
Applied Anatomy of Cardiovascular System
(CVS)164
Chapter 9 The Lymphatic System 166

The Lymphatic SystemI 166
Definition166
Functions of the Lymphatic System 167
Development of Lymphatic Tissues 168
Components of the Lymphatic System 169
The Lymphatic SystemII 174
Components of the Lymphatic System 174
Circulating Lymphocytes 182
Applied Anatomy of Lymphatic System 183
xvi Textbook of General Anatomy
Chapter 10 Skin and its Appendages 185

Skin and its AppendagesI 185
Definition185
Functions of the Skin 185
Surface Area of the Skin 186
Pigmentation of Skin 186
Types of Skin 189
Skin and its AppendagesII 193
Structure of Skin 193
Blood Supply of Skin 199
Appendages of Skin 200
Applied Anatomy of Skin 206
Index209
1 Introduction
GROSS ANATOMY
Introduction to gross anatomy is considered under the following
headings:
1. Introduction
2. History of anatomy
3. Anatomical language
4. Anatomy and its subdivisions
5. Anatomical positions and body planes
6. Special terms for limbs
7. Terms used for describing movements.
INTRODUCTION
Human anatomy is the science which deals with the structure of
human body.
The term Anatomy is derived from a greek word Anatome which
means cutting up.
Anatomy forms firm foundation of the whole art of medicine and
introduces the student to the greater part of medical terminology.
HISTORY OF ANATOMY
The growth and evolution of anatomy as a science is an interesting
story which is dated back from the prehistoric age when the
primitive men used to be egocentric without any family sense.
The fundamental urge was hunger which forced people to move
about in search of food.
2 Textbook of General Anatomy
People used to kill animals with primitive instruments and thus it

was necessary for them to know about the vital parts of animals,
i.e. the heart area, liver area, etc. which they used to strike in order
to kill animals by a single stroke.
In this way they started learning topographical anatomy, not for the
purpose of learning but out of urge for satisfying hunger.
Later on to fight the common enemy or for solving common
problem, brother hood slowly started which paved the way for the
growth of civilization.
With civilization men learnt to live in society and help each other
in distress and diseases.
A class of people acquired the art of healing, which urged them to
know about the human body and these clinical people detailed out
anatomical facts in relation to diseases.
But during those days as there was very little or no scope for
studying human anatomy, due to superstitious beliefs, religious
impositions and faith in supernatural power, people used to
quench their thirst for knowledge by sacrificing animals and began
experimenting on animals.
Zeal for learning human anatomy grew to such a magnitude that some
of the people who were over inquisitive resorted to stealing dead bodies
from the grave yards and thus purposeful anatomy came into existence
and with this the science developed.
The subject history of anatomy has been treated under the following
heads:
Relics of anatomy or anatomy of prehistoric age
Anatomy of antiquity
Anatomy of early civilization
Anatomy of medieval period (414th century)
Anatomy of modern times (15th century to upto date).
ANATOMICAL LANGUAGE
Paris Nomina Anatomica (PNA) is the internationally accepted termi-
nology for anatomical descriptions, which was ratified in New York in
1960. There are about 5500 latin terms in PNA which are freely used
along with English words.
Introduction 3
ANATOMY AND ITS SUBDIVISIONS

The subdivisions of anatomy are listed below:
1. Cadaveric Anatomy or Gross Anatomy
Study of the structure and interrelation of the parts of the body
by dissection
This study is done on dead bodies usually with the naked eye
(macroscopic or gross) anatomy
This can be done by one of the two approaches
In Regional Anatomy the body is studied in parts like the
-- Upper limb, lower limb, thorax, abdomen, head and neck,
and brain.
In Systemic Anatomy the body is studied in systems like
the
-- Skeletal system (Osteology)
-- Muscular system (Myology)
-- Articulatory system (Arthrology)
-- Vascular system (Angiology)
-- Nervous system (Neurology)
-- Respiratory, digestive, urogenital and endocrine systems
(Splanchnology).
2. Living Anatomy
Is studied on living human beings
By inspection, palpation, percussion ascultation endoscopy
(bronchoscopy, gastroscopy, sigmoidosopy, cytoscopy, etc.)
Radiography, electromyography, etc.
3. Applied Anatomy (Clinical Anatomy)
For clinical practice of medicine the basic knowledge of anatomy
is important.
The functional and clinical aspects of anatomy provide a strong
background to build clinical knowledge.
4. Embryology (Developmental Anatomy)
Is the study of the prenatal developmental changes
In an individual in other words
Study of growth and development of the fetus inside the uterus.
5. Neuroanatomy
Study of the structure and organization of the nervous system.
6. Histology (Microscopic Anatomy)

Study of the tissues of the body under the microscope.
7. Surface Anatomy (Topographic Anatomy)
Is the study of the deeper parts of the body in relation to the skin
surface.
It is helpful in clinical practice and surgical operations.
8. Genetics is a branch of anatomy in which there are two compo-
nents of this science.
Heredity: This is the study of similar traits passed from the
parents to their offspring. This gives rise to resemblance of
family members.
Variation: This is the study of traits influenced by internal and
external forces so that no individual is exact replica of other.
9. Radiographic Anatomy
Is the study of deeper structures of body using radiographic
techniques.
10. Sectional Anatomy
Is the study of relationship of structures as visible in sections
cut in different planes.
11. Physical Anthropology
Is the study of external features and measurements of different races
and groups of people and also the study of prehistoric remains.
ANATOMICAL POSITION AND BODY PLANES

Anatomical Position (Fig. 1.1)
All descriptions in the form of body refer to anatomical position of
the body where in the:
Individual is standing upright
With the upper limbs hanging by the sides
And the palms of the hands directed forwards
With head, eyes and toes directed forwards
And the lower limbs are parallel with the toes pointing forwards.
Supine Position
Lying down (recumbent) position with the face directed upwards.
Prone Position
Lying down (recumbent) position with the face directed
downwards.
Introduction 5
Fig. 1.1: Anatomical position and body planes
Lithotomy Position
Lying supine with the buttocks at the edge of the table
The hips and knees fully flexed
And the feet strapped in position.
Superior or Cephalic (Towards the head)
Therefore, refers to the position of a part that is nearest the head
of a supposedly upright body.
Inferior
Means nearer the feet.
Terms of Relation Commonly Used in

Gross Anatomy (Fig. 1.2)
Anterior: Ventral or in front
Means nearest to the front surface of the body
Posterior: Dorsal or behind
Nearer to the back surface of the body
Medial: Nearest to the median plane of body
Lateral: Farther from the median plane of the body
Ventral and dorsal: May be used instead of anterior and posterior
in the trunk.
In the hand
Dorsal commonly replaces posterior
And palmar replaces anterior.
Fig. 1.2: Terms of relation commonly used in gross anatomy

Introduction 7
In the foot
Term superior surface of foot is replaced by the term dorsum of
the foot
And inferior surface of the foot is replaced by term plantar (sole).
Anatomical Planes (Fig. 1.3)

1. Median or midsagittal plane: Divides the body into right and left
halves.
2. Sagittal plane: Any plane parallel to the median plane.
3. Coronal plane or frontal plane: A vertical plane which at right
angle to median plane.
4. Transverse plane: A plane at right angles to a vertical plane.
5. Horizontal plane: A plane parallel to the ground.
6. Oblique plane: Any plane other than of aforementioned planes.
SPECIAL TERMS FOR LIMBS (Fig. 1.4)

Proximal: Nearer to the trunk
Distal: Away from the trunk
Radial: Outer border of upper limb
Ulnar: Inner border of upper limb
Tibial: Inner border of lower limb
Fibular: Outer border of lower limb
Fig. 1.3: Anatomical planes

Fig. 1.4: Special terms for limbs
Preaxial border:
Outer border of upper limb

Inner border of lower limb

Postaxial border:
Inner border of upper limb
Outer border of lower limb.
Flexor Surface
Anterior surface in upper limb
Posterior surface in lower limb.
Extensor Surface
The posterior surface in the upper limb
Anterior surface in lower limb.
Palmar Surface
Pertaining to the palm of hand.
Plantar
Pertaining to the sole of foot.
Introduction 9
Certain Other Terms (Terms Used for Hollow Organs)

(Fig. 1.5)
Interior or inner
Exterior or outer
Invagination or inward protusion
Evagination or outer protusion.
Terms Used for Solid Organs

Superficial: Towards the surface.
Deep: Inner to the surface.
Terms to Indicate the Side

Ipsilateral of the same side
Contralateral of the opposite side.
Terms Used for Describing Movements (Figs 1.6

and 1.7)
Flexion
Approximation of the flexor surfaces
Whereby the angle of joint is reduced
Fig. 1.5: Terms for hallow organs

or example, flexion moves the arm forward and medially, while

F
flexion at knee is posterior bending, where leg comes close to thigh.
Dorsiflexion is the term described for bending at ankle joint, in
which the dorsum of foot comes closer to the anterior surface of leg.
Plantor flexion is reverse of dorsiflexion.
Extension
Approximation of extensor surfaces
Whereby the angle of joint is incresed
For example, extension moves the arm backwards and laterally .
B
Fig. 1.6
Introduction 11
B Circumduction
Fig 1.7
Figs 1.6 and 1.7: Terms used for describing movements
Adduction
Movement towards the central axis.
For example, arm moves medially and backwards.
Abduction
Movement away from central axis that is part of body moves
away from medial plane
For example, arm moves laterally and forwards.
Medial Rotation
Inward rotation, humeral rotation is tested after flexing the

elbow joint in order to avoid confusion between pronation and
supination.
Lateral Rotation
Outward rotation: Medial rotation carries the hand medially and
lateral rotation moves the hand outwards.
Circumduction
Is a succession of the above four movements in an order.
Pronation
Rotation of the forearm so that the palm is turned backwards.
Supination
Rotation of the forearm so that the palm is turned forwards.
Protraction
Forward protusion, e.g. forward movement of mandible at
temporomandibular joint.
Retraction
Movement reverse of protraction.
Inversion
Sole of foot faces medially.
Eversion
Sole of foot faces laterally.
Review QUESTIONS
I. Multiple Choice Questions (MCQs)
1. Rotation of the forearm so that the palm is turned forwards is called
as:
a. Pronation b. Supination
c. Protraction d. Retraction
2. During flexion of arm the arm moves:
a. Forwards b. Backwards
c. Medial d. Lateral
3. Outer border of upper limb is called as:
a. Postaxial b. Preaxial
c. Medial border d. None of the above
4. A plane at right angle to a vertical plane is called as:
a. Transverse plane b. Coronal plane
c. Sagittal plane d. Horizontal plane
Introduction 13
5. Lying down (recumbent) position with the face directed down is

called as:
a. Supine position b. Prone position
c. Anatomical position d. Lithotomy position
Answers
1.b2.c3.b4.a5.b
II. Describe various position of the body.
III. Write short notes on:
1. Special terms of limbs
2. Terms used for describing movements
3. Subdivisions of anatomy.
INTRODUCTION TO HISTOLOGY
Introduction of Histology is considered under the following headings :
1. Introduction
2. Primary tissues of the body
3. Tissue processing
4. Staining
5. Applied anatomy.
INTRODUCTION
Histology is a study of various tissues of the body at the microscopic
level.
Primarily this involves the investigation of the microscopical anatomy
or architecture of more specialized tissues.
It also includes the detailed knowledge of the structure of individual
cellscytology.
The term Histology is derived from the Greek word Histos
meaning tissue and Logiameaning a branch of learning
The term Tissue is derived from the French word tissue
which means a weave. The name was given because the section
seen under the microscope appears as if various components are
woven with each other.
The current concept of the term tissue is a collection of group of
cells and extracellular matrix performing a common function.
Ideally microscopic examination of living tissues should be

carried out so that a true picture can be obtained. But only small
primitive living animals can be examined in this way. As most
tissues are too thick or not accessible for direct inspection.
PRIMARY TISSUES OF THE BODY

There are four primary tissues of the body.
Tissues are found within the organs of the body.
They can be further subdivided into subgroups based on some
common characteristics.
The primary tissues are:
Epithelial tissue
Connective tissue
Muscle tissue
Nervous tissue
To study the following tissues various histological techniques are
used.
The majority of histological techniques are applied to killed tissues
which are preserved in such a way as to retain the structure as
closely as possible to that of the living tissues.
It must be appreciated that the complete histological preparation of
all methods using killed tissues shows alterations of the cells and
of the tissue as a whole. These alterations are called as artefacts.
Histology techniques are capable of displaying beautifully the most
minute cellular details.
TISSUE PROCESSING
This is the first step in the preparation of slides.
As we have already seen:
When you see any organ of the body with the naked eye you can
only make out its gross structure.
If you want to see the detailed microscopic structure of the organ.
It is necessary to cut thin slices or sections of the organ so that
they become translucent.
It is very difficult to cut thin sections of the structures of the body
because the structures are very fragile and if you try to cut them all
the constituents are disrupted.
Introduction 15
To overcome these problems it is necessary to harden the organ in

such a way that its original form is retained and its constituents do
not spread out while cutting.
Now if the tissue undergoes autolysis, then the bacteria and other
organisms also invade the cells and a process of putrifaction sets
in. If these processes occur the cells get distorted and loose their
normal appearance.
So to combact autolysis following procedures are followed.
Fixation
It is the procedure to combact autolysis.
This can be done on small pieces of organs immediately after death
by immersing them in fixative solution.
One or two millimeter pieces of any organ are immersed in a
solution like 10% formaldehyde, which is a routine fixative for
45 days.
Aim of Fixation
1. Preservation of cells and tissue constituents in a condition identical to
that existing during life.
2. To prevent or arrest autolysis and bacterial decomposition and
putrefaction.
3. To leave the tissues in a condition, which facilitate differential
staining with dyes and other reagents.
4. To coagulate and harden the tissue.
Common Fixing Agents
1. Formaldehyde
2. Mercuric chloride
3. Pottassium dichromate
4. Picric acid, etc.
Dehydration
After fixing the tissue the next process is dehydration.
This process is essential because paraffin wax will not penetrate
the tissue in the presence of water.
So this is done by immersion of tissue in ethyl alcohol.
This is usually begun with a dilution of the alcohol in water, e.g.
70% alcohol.
To prevent the distortion which may occur due to direct transference

of tissue from aqueous medium such as 10% formalin to absolute
alcohol.
So in the process of dehydration the tissue is immersed in ascending
grades of alcohol. One after the another, i.e. 70%, 90% and 100%
and (three changes) of alcohol:
16 hoursin 70% alcohol
3 hoursin 90% alcohol
Three consecutive changes of 1 hour each100% alcohol.
Clearing
As alcohol is not miscible with paraffin. So it is to replaced by fluid
which is miscible in both paraffin and alcohol
This fluid is called as clearing agent, e.g. chloroform, xylene, etc.
The tissue is immersed in chloroform for about 16 hours or more till
is becomes translucent.
Paraffin Embedding
Embedding: After clearing, the tissue is put in molten paraffin in
an oven at 60C. Two to three changes of one hour each are given in
each container of molten paraffin, so that all the water of the tissue is
replaced by paraffin.
Block Making: Two L-shaped metallic plates (Leukhardts
Lpieces) are kept in such a way that they enclose a rectangular
space. Molten paraffin is poured into the space and the tissue is
placed inside this molten paraffin and allowed to cool at room
temperature until the paraffin solidifies. The L-blocks are then
removed from the solidified paraffin block.
A block holder of metal is heated and fixed to the paraffin block
on the opposite side of the tissue. This block is then allowed to cool
under water. At this stage, the block is ready for cutting
Sectioning: The block is to be cut into thin slices of 710 microns
on a machine called Microtome. The block holder is fixed to the
microtome, and sections are cut with a special kind of knife. When
the handle is rotated, the block moves across the knife to cut a section.
When this movement is done with some speed, each section sticks at
its edge to the next section forming a ribbon. The tissue slice is present
in each section.
Introduction 17
Mounting: The flat sections have to be mounted on glass slides, which

are coated with a thin layer of adhesive after removing all creases.
Each section is cut out with a scissor and floated in a water bath, so
that the section expands but does not break. For this the water in the
bath is heated up to 40C and not more. Once the section has spread out
it is picked up carefully on a slide and allowed to dry. This section is now
ready for staining.
STAINING
There are many ways to staining the section. We will only see in very
brief the hematoxylin and eosin staining method. The steps are as
follows:
Hydration: Remove the paraffin and replace it with water. Dip the
slides for one minute each in xylene, 100% alcohol, 90%, 70%,
alcohol followed by water. Now the sections are ready for staining.
Put the slides in the following solutions:
Hematoxylin for 10 minutes.
Wash in running tap water until the sections appear blue.
Dip in acid alcohol and keep seeing the wet slide under a
microscope until you find the purple to blue stain has left the
whole section except the nuclei of the cells. This is called
differentiation.
Dip in water for one minute.
Dip in 1% eosin for one minute.
Dip in water for one minute.
Dip in 70%, 90%, 100% alcohol for one minute each.
Dip in xylene for one minute. Give two changes.
Put a drop of DPX on the section. Place a cover slip and press
to remove all traces of air bubbles, which may have been
trapped between the cover slip and the slide.
Let it dry.
Now your slide is ready for viewing under the microscope.
Chemical Basis of Staining with Hematoxylin and Eosin

Eosin is an acidic dye. This means that it carries a negative charge on
its coloured portion.
Hematoxylin is derived from a plant. It acts as a basic colouring agent.
It colours the acidic components from purple to blue.
APPLIED ANATOMY
Artifacts
Some structures seen in the slides are defective appearances because
of defective processing and staining should not be interpreted as a
normal appearance. They are called artifacts.
Shrinkage: Look at the gaps in between structures. This occurs
because of a hurried or rapid dehydration. If you pass the tissue from
one grade of alcohol to the next very rapidly, there is shrinkage of the
tissue components.
Precipitate: Black or coloured spots which seem to be lying on the
sections in a random manner. These could come on the slide because
of dirty stains, which have not been filtered.
Folds: These are produced if the sections have not been straightened
out while picking them up from the water bath.
Pinched tissue: If the tissue is not handled carefully while removing
from the body or during processing, the constituents of the cell break up.
Nick in knife: If the cutting edge of the knife has any nick, the section
shows it.
Autolysis: If the tissue is not fixed immediately autolysis sets in and
the cell constituents are spread out of the cells and do not stain properly.
Review Questions
1. Common fixing agent used in the tissue processing is:
a. Formaldehyde b. Alcohol
c. Xylene d. Chloroform
2. Aim of fixation is to:
a. Soften the tissue
b. Preservation of cells and tissue constitutents
c. Enhance autolysis
d. Enhance putrefaction
3. Rapid or hurried dehydration causes
a. Formation of precipitate b. Shrinkage
c. Formation of folds d. Tissue become pinched
Introduction 19
Answers
1.a2.b3.c
II. Enumerate the reasons why the tissue has to be processed for
histological preparations.
III. Write shorts notes on:
a. Acidic and basic stains
b. Sectioning and mounting
c. Terms histology and tissue
d. Enumerate the steps of H and E staining
e. Primary tissue of the body.
2 Connective Tissue
CONNECTIVE TISSUEI
Connective tissue-I is considered under the following subheadings:
1. Introduction
2. General features of connective tissue
a. Connective tissue cells
b. Connective tissue matrix
INTRODUCTION
Connective tissue is one of the most abundant and widely distributed
tissue of the body.
This owes its name because it binds other tissues of the body.
This does not mean, however, that the connective tissue is merely
supportive in function.
It performs many other important functions.
The cellular components of connective tissue plays the role of
active defence.
Whereas the extracellular components (fibers and ground substance)
serves a number of mechanical functions of support and protection
against the mechanical stresses and strains.
Connective tissue possesses variety of subtypes:
General or ordinary connective tissue
Hematopoietic tissue
Specialized tissue, which include cartilages, bones, joints and
others
The greater part of connective tissue develops from embryonic
mesoderm.
Connective Tissue 21
GENERAL FEATURES OF CONNECTIVE TISSUE

Connective tissue consists of two basic elements:
Cells and matrix
Matrix:
Fills the wide spaces between its cells.
It consists of fibers and ground substance.
Ground substance is a material between the cells and fibers.
It is usually secreted by connective tissue cells and determines the
tissue qualities.
For instance:
In cartilage, the matrix is firm but pliable
In bone, the matrix is hard and not pliable.
In contrast to epithelia:
Connective tissues do not usually occur on body surfaces.
Such as covering or lining of internal organs or lining of body
cavities or external surface of the body.
However, a type of connective tissue called areolar connective
tissue lines joint cavities.
Connective tissues are highly vascular, i.e. they have a rich blood
supply.
Exceptions include:
Cartilage, which is avascular
Tendons, which have a scanty blood supply.
Except for cartilage rest of connective tissues have a nerve supply.
Constituents Elements of Connective Tissue

Connective tissue is made up of cells and extracellular matrix also
called as intercellular substance.
Connective Tissue Cells (Fig. 2.1)

Seven principal types of cells are found in the ordinary connective
tissue.
Fibroblasts
Macrophages (Histiocytes)
Plasma cells
Mast cells
Pigment cells
Fig. 2.1: Loose areolar tissue showing cells of connective tissue
Reticular cells
Fat cells.
A few undifferentiated mesenchymal cells may contribute a part of
cell population and act as stem cells for other cellular components.
Lymphocytes also appear in general connective tissue, under
pathological conditions migrating from lymphoid tissue or from
circulation.
Mesodermal embryonic cells also called as mesenchymal cells
give rise to cells of connective tissue.
Each major type of connective tissue contains an immature class of
cells whose name ends in blast means to bud or sprout.
These immature cells are called fibroblasts in loose and dense
connective tissue.
Chondroblasts in cartilage.
Osteoblasts in bone.
Blast cells retain the capacity for cell division and secrete the matrix
that is characteristic of the cartilage.
In cartilage and bone, once the matrix is produced.
The fibroblasts differentiate into mature cells whose name end
inCyte, namely fibrocytes, chondrocytes and osteocytes.
Mature cells have reduced capacity for cell division and matrix
formation and are mostly involved in maintaining the matrix.
Fibroblasts (Fig. 2.2)

These are most numerous and derived from undifferentiated
mesenchymal cells.
Each cell is flattened or fusiform in shape with a centrally placed
nucleus and presents numerous branching processes.
Fig. 2.2: Structure of fibroblast and fibrocyte
Young and active fibroblasts possess open-faced nuclei

(euchromatic) and abundant basophilic cytoplasm with rough
surfaced endoplasmic reticulum, Golgi apparatus, and mitochondria.
When the fibroblasts become old and inactive they are converted
into fibrocytes.
Which possess flattened and closed-face nuclei (hyperchromatic)
nuclei and a film of cytoplasm with scanty organelles.
Function of Fibroblasts
The fibroblasts help in formation of Collagen fibers by synthesizing
procollagen and tropocollagen proteins and setting free these
materials in the extracellular space.
Collagen formation is impaired in vitamin C deficiency and scurvy,
high levels of steroids, diet, mechanical stress.
In addition fibroblast secrete proteoglycans and mucopoly-
saccarides.
Reticulum for reticular fibers and elastin for elastic fibers.
They help in healing of wounds by continued proliferation and
subsequent conversion into fibrocytes.
Fibroblastic activity in wound healing is delayed by the
glucocorticoids of the suprarenal glands.
Macrophages (Histiocytes or Clasmatocytes) (Fig. 2.3)

MacroLarge
PhagesEaters
Macrophages develop from monocytes, a type of white blood cells
Macrophages have an irregular shape with short branching
projections and are capable of engulfing bacteria and cellular debris
by phagocytosis
Some are fixed macrophages or resting macrophages, which means
they reside in a particular tissue.
Examples are:
Alveolar macrophages in the lungs or
Spleen macrophages in the spleen.
Other areWandering macrophages, which roam in the tissues
and gather at sites of infection or inflammation.
The cytoplasm of macrophages contain numerous lysosomes
filled with hydrolytic enzymes.
Such cells in the living state can be readily, stained, by vital dyes
such as trypan blue, lithium carmine or Indian ink.
When the dyes are introduced locally or in systemic circulation
the macrophages phagocytose the material of the dyes and are
visualized as cytoplasmic granules.
The macrophages are derived from the undifferentiated
mesenchyme or from the fibroblasts or from the monocytes of
the blood.
They are distributed widely in different parts of the body and
belong to the mononuclear phagocyte system (MPS), which
Fig. 2.3: Macrophage cell

subserves an important apparatus for defensive mechanisms of

the body.
Distribution of Macrophages
In the connective tissue, as the histiocytes or clasmatocytes.
In the blood, as the monocytes.
In the sinusoids of the liver (Kuffers cells), spleen, bone marrow
and else where.
In the lymphoid tissues and lymph nodes as the reticular cells.
In the lung alveoli as the alveolar phagocytes.
In the brain and spinal cord, as the microglia.
Function
The Macrophages
Phagocytose and digest particulate organic materials, foreign bodies
or invading microorganisms and thereby eliminate them from the
body to avoid any injurious effects.
Sometimes a number of macrophages form a barricade around
a large foreign material and often coalesce with one another to
form mononucleated masses known as the foreign body Giant cells
(Fig. 2.4).
On occasions, the macrophages ingest nonspecified antigens,
thereafter the antigens may be destroyed or they are transferred
after modification to the immunologically competent cells of
T-lymphocytes or B-lymphocytes.
Fig. 2.4: Giant cells

Plasma Cells (Figs 2.5 and 2.6)

These cells are derived from B-lymphocytes when needed (in
pathological states).
They are found in connective tissue especially of gastrointestinal
tract and respiratory tract and lymphoid tissue.
They are numerous in the mucous and submucous coats of the gut
and in the greater omentum, salivary glands, lymph nodes and bone
marrow. Plasma cells secrete antibodies, proteins that attack or
neutralize foreign substances in the body.
Thus, plasma cells are an important part of the bodys immune
system.
Each of the cell is rounded in shape without any process, and
presents granular cytoplasm which is stained with basic dyes.
Cells are about 15 mm in diameter with a spherical eccentric nucleus.
Fig. 2.5: Plasma cell
Fig. 2.6: Structure of plasma cell

The chromatin granules in the nucleus are arranged in such a way

that the nucleolus is in the center and the chromatin is arranged in
small granules on the inner surface of the nuclear membrane in the
form of a clock face or cart wheel. This is called a clock face or
cart wheel appearance.
Functions
Plasma cells liberate antibodies
Plasma cells are not present at birth
They appear in the postnatal life
Therefore, the antibody formation of the newborn is minimum
Myeloma is malignant proliferation of a particular clone of plasma
cells in bone marrow.
Mast Cells (Fig. 2.7)

These cells are commonly present in loose connective tissue.
Serous membranes and fibrous capsules of certain organs.
For example, liver and are characteristically located abundantly
alongside the blood vessels that supply connective tissues
They are also present beneath the mucosa of alimentary tract,
respiratory tract and in other parts of the body.
Each cell is rounded in shape and presents a central nucleus.
The cytoplasm is closely packed with large membrane bound
granules which stain metachromatically with toluidine blue,
methylene blue etc. (Fig. 2.8)
Substances contained in the granules are heparin, histamine, etc.
Fig. 2.7: Mast cell Fig. 2.8: Structure of mast cell

Functions
Mast cells liberate heparin which is anticoagulant in function.
Heparin in blood dissipates chylomicrons (fat particles) of the blood
plasma by activating an enzyme lipoprotein lipase.
Heparin prevents the fibrinogen, from clotting into fibrin.
Mast cells produce histamine which promotes leakage and edema
and contraction of smooth muscles, which may also produce
anaphylactic or allergic reactions.
The antihistaminic drugs act not by preventing the release of
histamine from the mast cells, but by occupying the receptor sites
on cells where histamine would act.
Pigment Cells
They are also known as melanocytes.
They are present in the epidermis of the skin, in the iris and
choroid coat of the eyeball.
Each cell presents long cytoplasmic processes and contains melanin
granules in the membrane bound organelles the melanosomes of
the cytoplasm.
The melanocytes are derived from neural crest epithelium.
In the skin, the melanocytes protect against the cosmic rays of
the sun.
Reticular Cells
They are present in the reticular connective tissue. Reticular cells are
branched flattened cells with poorly staining nuclei and cytoplasm.
They produce reticular fibers to which the cells are attached.
Functions
Phagocytic: The cells ingest and remove the bacteria
They act as stem cells for the cellular constituents of the blood.
Fat Cells (Fig. 2.9)

Fat cells or adipocytes are numerous in the adipose tissue. Each cell
is spherical or polygonal, consists of peripheral rim of cytoplasm
with an eccentric nucleus and contains a large central lobule of fat.
Fig. 2.9: Fat cell
When stained with H and E, the cell is signet ring in appearance

because the fat is dissolved by the solvent used.
By special method, fat may be fixed and stained with Sudan III, Sudan
black, Scharlach R.
CONNECTIVE TISSUEII
Connective tissueII is considered under the following headings:
Connective tissue matrix
Fibers
Collagen fibers
Elastic fibers
Reticular fibers
Ground substance
Types of mature connective tissue
Applied anatomy of connective tissue.
CONNECTIVE TISSUE MATRIX

The matrix of connective tissue has unique properties due to
accumulation of specific matrix materials between the cells.
The matrix or the intercellular substance is a nonliving material
and is synthesized by the connective tissue cells particularly by
the fibroblasts.
Matrix is composed of (i) Fibers and (ii) Ground substance
The fibers of connective tissue are of three types:

Collagen fibers

Elastic fibers

Reticular fibers

These fibers function to strengthen and support connective tissues.
Collagen Fibers (Fig. 2.10)

These fibers are widely distributed in the connective tissue,
ligament, tendons and aponeurosis.
They are arranged in numerous straight bundles bounded by
mucoproteins.
The bundles are made up of collections of individual collagen fibers
which are 112 mm in diameter
The bundles often branch and anastamose with adjacent bundles,
but the individual fibers do not branch and appear in response to
tensile strain.
Each fiber is composed of bundles of fine fibers of collagen proteins
which get dissociated, when treated with dilute acids and alkalis into
a number of fibrillar subunits known as tropocollagen molecules.
Each molecule of tropocollagen is made up of three polypeptide
chains. Each chain is called as procollagen.
Each procollagen chain consists of a long chain of amino acids
hydroxyproline and hydroxylysine.
Fig. 2.10: Collagen fibers

Varieties of Collagen Fibers and their Distribution

Several types of collagen fibers are recognized depending upon the
diameter of fibers.
Type I
Type I collagen fibers are predominantly found in connective tissue,
tendons, ligaments, fascia, aponeurosis, etc.
They are also present in the dermis of skin, and in meninges. They
form a fibrous basis of bone and of fibrocartilage.
Type I fibers are of large diameter (about 250 nm) and have
prominent cross striations.
Type II
They are of two subtypes.
The larger of the two are about 100 nm in diameter, which form
fibrous basis of hyaline cartilage, while the narrower fibers are
20 nm in diameter. These fine type II fibers are present in the
vitreous body.
Type III
They form the reticular fibers.
Type IV
These type of collagen fibers consists of short filaments that form
sheets.
They are present in the basal laminae of basement membranes.
They are also seen in the lens capsule.
All collagen fibers are very strong and resist pulling forces, but they
are not stiff due to which they promote tissue flexibility.
Different types of collagen fibers in various tissues have slightly
varying properties.
For example, the collagen fibers found in cartilage attract more
water molecules, than do collagen fibers in bone, which gives
cartilage a more cushioning consistency.
Production of Collagen Fibers

The mechanism of production of collagen fibers is done by
fibroblasts.
Amino acids necessary for synthesis of fibers are taken into the
fibroblast cell.
Under the influence of ribosomes located on rough endoplasmic
reticulum the amino acids are bounded together to form polypeptide
chain (alpha chains).
Such chains join to form a procollagen molecule.
Molecules of procollagen are transported to the exterior of the cell.
Where they are acted upon by enzymes (released by fibroblasts) to
form tropocollagen.
Collagen fibers are formed by aggregation of tropocollagen
molecules.
Vitamin C and oxygen are necessary for collagen formation
and wound repair may be interfered with, if either of these is
deficient.
Elastic Fibers (Fig. 2.11)

Elastic fibers are smaller in diameter than the collagen fibers.
They branch and join together to form a network within a tissue.

These fibers are much fewer than the collagen fibers.

They are elastic and stretchable, with perfect recoiling.

The thin elastin fibers branch and rejoin freely.

Elastic fibers are formed by fibroblasts.
But in the walls of arteries they are formed by smooth muscle
cells.
Though elastic fibers are stretchable and elastic, their elasticity
diminishes with age.
The elastic fibers are composed of protein subunits the tropoelastin
which possess high content of amino acid valine.
An enzyme elastase often present in the crude preparation of
trypsin and in some bacteria disintegrates the elastic fibers.
The elastic fibers are stained with orcein and with Verhoeffs stain.
Reticular Fibers (Fig. 2.12)

The fine reticular fibers branch and anastamose freely to form
delicate supporting frameworks of lymphoid organs spleen, lymph
nodes, bone marrow and many glands including liver and kidneys.
These fibers are type III variety of collagen fibers.
They differ from typical (type I) collagen fibers as follows:
They are much finer
They are uneven in thickness
They form a network (or reticulum) by branching and
anastamosing with each other.
They do not run in bundles.
They form a meshwork on which cells of parenchyma of some
organs like lymphoid tissue rest.
They can be stained specifically by silver impregnation which
renders them black (Fig. 2.13).
They can thus be easily distinguished from type I collagen
fibers which are stained brown, because of their affinity for
silver salts reticular fibers are sometimes called argentophil
fibers.
The reticular fibers provide support to the walls of blood vessels

and form a network around the cells in some tissues. For instance
areolar tissue, adipose tissue, and smooth muscle tissue.
Reticular fibers form an essential component of all basement
membranes.
They are also found in relation to smooth muscle and nerve fibers.
Fig. 2.11: Elastic fibers
Fig. 2.12: Reticular fibers

Fig. 2.13: Reticular fibers stained with silver impregnation
GROUND SUBSTANCE
It is the nonfibrous element of the matrix in which cells and fibers
are embedded.
In ordinary connective tissue it is a viscous gel containing high
proportion of water.
Chemically, it is made up of mucopolysaccharides both sulfated
and nonsulfated and proteoglycans.
The sulfated mucopolysaccharides comprise several varieties of
chondroitin sulfates and the keratin sulfates.
Whereas the nonsulfated mucopolysaccaride is the hyaluronic
acid. The latter is more abundant in loose connective tissue
where it keeps the ground substance in solution. It is also found
in the cartilage, umbilical cord, and vitreous body of the eye.
Chondroitin sulfate is found in cartilage, bone, skin, and
cornea. It keeps the ground substance in gel. It provides support
and adhesiveness.
Dermatin sulfate (Chondroitin C) is found in skin, blood
vessels, heart valves, and the lungs.
Keratin sulfate is found in the cornea, cartilage and nucleus
pulposus.
Heparin sulfate is found in the aorta, liver, lungs and mast cell
granules.
The proteins present in the ground substance are responsible for
linking of the components of ground substance to each other and
to the surfaces of the cells.
The main adhesion protein of connective tissue is fibronectin,
which binds to both collagen fibers and ground substance thereby
linking them together.
Functions of the Ground Substance

Provides morphology and framework of tissues.
Protect and binds together connective tissue cells.
Acts as a mechanical barrier to the free movements of the particles
or other dissolved matter in tissue spaces.
Helps in the diffusion of metabolites between the capillaries and
the cells.
Helps in the storage of water.
Excessive accumulation of tissue fluid is called edema, which may
be caused by obstructed venous return or lymphatic obstruction
or insufficient proteins in blood plasma due to malnutrition or
increased permeability of the capillaries.
Formation of ground substance may be influenced by some
hormones. Since in hypothyroidism, myxedema takes place due to
excessive accumulation of ground substance.
With the advancement of age, the amorphous element of the matrix
diminishes and the fibrous element increases.
TYPES OF CONNECTIVE TISSUE

Different types of connective tissue are found in different parts of
the body according to the local functional requirements.
These types are based according to the cell type and character of
ground substance.
Functionally, the connective tissues are classified as follows:
Ordinary Connective Tissue

Irregular connective tissue
Loose connective tissue
Dense irregular connective tissue

Adipose tissue.

Dense regular connective tissue
Fascia, ligaments, tendons, aponeurosis.
Special Connective Tissue

Mucoid tissue
Pigmented connective tissue
Elastic connective tissue
Cartilage
Bone.
Loose Connective Tissue (Fig. 2.14)

It is most extensively distributed in the body.
It consists of a network of thin collagen and elastic fibers embedded
in a semifluid ground substance.
Distribution
In the subcutaneous tissues particularly where fat is absent, for example:
In eyelids, penis, scrotum, and labia minora
Investing sheaths of muscles, vessels and nerves
Internal support of compound glands (binding lobes and lobules)
Submucous coat of alimentary tract
Subserous coat of alimentary tract
Interior of the viscera
Loose connective tissue permits considerable amounts of
movements between the parts it binds.
Dense Irregular Connective Tissue (Fig. 2.15)

It is found in those parts of the body, which are subjected to
mechanical stress.
The tissue contains a high proportion of collagen fibers with a few
fibroblasts.
Its blood supply is poor.
Distribution
Reticular layer of the dermis.
Connective tissue sheaths of muscles, vessels and nerves.
Adventitia of large vessels.

Capsules of various glands.
Sclera of the eye.
Periosteum and perichondrium.
Fig. 2.14: Loose connective tissue
Fig. 2.15: Dense irregular connective tissue

Adipose Tissue (Fig. 2.16)

It is made up of large group of fat cells usually arranged in loculi
formed by fibrous septa carrying blood vessels. Adipose tissue occurs
in abundance in the superficial fascia of buttocks. Loins, nape of neck,
breast, lower part of anterior abdominal wall, front of thighs, fatty
capsules of kidneys, localized pads of fat occur in synovial membrane
of many joints.
Dense Regular Connective Tissue (Fig. 2.17)

This is predominantly collagenous, with a few elastic fibers.
The regular arrangement of collagen fibers form sheets (fasciae
and aponeurosis) or thicker bundles form tendons and ligaments.
Special Connective Tissue

Mucoid Tissue (Fig. 2.18)
It is an embryonic type of connective tissue, which forms Whartons
jelly of the umbilical cord and vitreous body of the eye.
The tissue consists of a copious matrix carrying fine meshwork of
collagen fibers with fibroblasts.
Pigmented Connective Tissue

It occurs in choroid and lamina fusca of the sclera of eye.
Elastic Connective Tissue (Fig. 2.19)

Branching elastic fibers predominate in elastic connective tissue
giving the unstained tissue a yellow color.
Fibroblasts are present in the spaces between the fibers. Elastic
connective tissue is quite strong and can recoil to its original shape
after being stretched.
This elasticity is important for the normal functioning of lung tissue,
which recoils as we exhale and also in elastic arteries whose recoil
between heart beats helps maintaining blood flow by filling the
blood vessels.
Fig. 2.16: Adipose tissue
Fig. 2.17: Dense regular connective tissue
APPLIED ANATOMY OF CONNECTIVE TISSUE

1. Diseases of collagen fibers:
Rheumatic fever, rheumatoid arthritis; disseminated lupus
erythematosus, scleroderma.
These are the diseases of connective tissue characterized by its
fibrinoid necrosis.
2. Inflammations (fibrositis) and injuries (pulls and sprains):
Of the connective tissue are very painful because of its rich nerve
supply or the associated muscle spasm. Relief (healing) of pain
in these disorders is markedly delayed due to poor blood supply
of the connective tissue.
Fig. 2.18: Mucoid tissue
Fig. 2.19: Elastic connective tissue
3. Marfans syndrome:
It is an inherited disorder caused by a defective fibrillin gene.
The result is abnormal development of elastic fibers. Tissues
rich in elastic fibers are malformed or weakened.
Structures affected most seriously are the covering layers of
bones (Periosteum), the ligaments that suspend the lens of the
eye and the walls of large arteries.
People with Marfan syndrome tend to be tall and have

disproportionately long arms, legs, fingers and toes.
A common symptom is blurred vision caused by displacement
of the lens of the eye.
Most life-threatening complication of Marfan syndrome is
weakening of the aorta, which may suddenly burst.
Review Questions
1. Hyaline cartilage is an example of following type of collagen fibers:
a. Type I b. Type II
c. Type III d. Type IV
2. Elastic fibers present in the walls of arteries are formed by:
a. Fibroblasts b. Smooth muscle cells
c. Fibrocytes d. Mesenchymal cells
3. Whartons jelly is an example of:
a. Mucoid Tissue
b. Dense regular connective tissue
c. Loose connective tissue
d. Pigmented connective tissue
4. Collagen formation is impaired in:
a. Vitamin B deficiency
b. Vitamin C deficiency
c. Vitamin K deficiency
d. Vitamin A deficiency
5. Kuffers Cells are present in:
a. Spleen b. Liver
c. Lung d. Brain
Answers
1.b2.a3.a4.b5.b
II. Describe the types of connective tissue.
1. Cells of connective tissue
2. Ground substance of connective tissue
3. Functions of connective tissue.
3 Cartilage
INTRODUCTION
The skeletal tissue is a specialized form of connective tissue is divided
into two types:
Cartilage and Bone

Now when we study the cartilage we see that cartilage is a
phylogenetically older tissue
Most of the human skeleton is formed of cartilage during
development (Intrauterine life), later it is replaced by bone, which
is dense specialized and organized form of connective tissue
Some cartilage persists in adult skeleton
Thus cartilage is a tissue that forms the skeletal basis of some parts
of the body, for example, auricle of the ear, synovial joints, lower
part of the nose (respiratory tract)
When we feel these parts we understand that cartilage is sufficiently
firm to maintain its form and it is not rigid like bone. It can be bent,
returning to its original form when the bending force is removed.
DEFINITION
Cartilage is defined as a modified connective tissue
It resembles ordinary connective tissue in that the cells in it are
widely separated by a considerable amount of intercellular material
or matrix
The matrix consists of ground substance within which fibers are

embedded
Cartilage differs from typical connective tissue mainly in the nature
of the ground substance, which is firm and thus firmness gives
cartilage its characteristic consistency.
STRUCTURE OF CARTILAGE
Like any other connective tissue the cartilage is made up of two main
components:
1. Cells called chondroblasts when active and chondrocytes when
quiescent.
The chondrocytes occur singly or in groups (cell nests) within
spaces called lacunae, in the matrix
Younger cells are small and somewhat flattened
2. Matrix
Matrix is composed of:
Organized fiber meshwork
An amorphous ground substancewhich is a meshwork of
proteins and proteoglycan filaments.
Each cartilage is covered on all sides
By an outer membrane called perichondrium
The perichondrium has two layers:
Outer fibrous layermade up of irregularly arranged collagen
fibers.
Inner smooth layer of closely packed spindle shaped cells. These
cells have the capacity to change into fibroblast. These fibroblasts
cells lie close to the fibrous layer. Deeper cells of this layer form
chondroblasts.
This layer is also called as chondrogenic layer of the
perichondrium
These chondroblasts secrete the matrix and this contribute to the
formation of cartilage proper
Deep to the perichondrium is the cartilage proper which consists
of chondrocytes lying is groups and surrounded by the matrix
The articular cartilage has no perichondrium. So that its
regeneration after injury is inadequate.
Cartilage 45
GENERAL FEATURES OF THE CARTILAGE

Cartilage can endure more stress than loose and dense connective
tissue.
Its resilience (ability to assume its original shape after deformation)
is due to chondroitin sulfate in the ground substance.
It is a stiff load bearing connective tissue with a low metabolic rate
Amorphous ground substance of the cartilage stores energy and
imparts elasticity, resilience and rigidity to the cartilage. It bears
weight without bending and has considerable tensile strength.
Cartilage has no blood vessels or lymphatics (its blood supply is
confined to the periphery). The nutrition of cells diffuse through
the matrix.
Cartilage has no nerves. It is therefore insensitive.
When cartilage calcifiesthe chondrocytes die and the cartilage
is replaced by the bone.
The cartilages which are replaced by bone are known as temporary
cartilages.
Those which persist throughout life are called as permanent
cartilages.
PECULiARITIES OF THE CARTILAGE

Cartilage tissue as we have already seen is avascular and
non-nervous.
It receives nutrition by diffusion from the nearest capillaries.
Many cartilagenous masses are traversed by cartilage canals
which convey blood vessels and are invested by delicate connective
tissue sheaths derived from the invaginations of the overlying
perichondrium.
The time of appearance of canals and their subsequent disappearance
are subjected to regional variations.
The canals provide nutrition to the deepest core of the cartilaginous
masses, which are not getting sufficient nutrition by diffusion
from the perichondrial vessels, because of lower antigenecity of
the cartilagenous matrix and isolation of chondrocytes in separate
lacunae. Homogenous transplantations of cartilages are possible
without reduction.
GROWTH AND DEVELOPMENT OF CARTILAGE (Fig. 3.1)

Cartilage grows by two methods:
1. Appositional growth
2. Interstitial growth
Cartilage is derived (embryologically) from mesenchyme
Some mesenchymal cells differentiate into cartilage forming cells
called as chondroblasts
Chondroblasts produce the intercellular matrix as well as the
collagen fibers that form the intercellular substance of cartilage
Chondroblasts that become imprisoned within this matrix become
chondrocytes
Some mesenchymal cells that surround the developing cartilage
form the perichondrium
Apart from collagen fibers and fibroblasts the perichondrium contain
cells that are capable of transforming themselves into cartilage cells
when required.
Appositional Growth
When growth of cartilage takes place by addition of new cartilage
cells over the surface of existing cartilage.
This is possible because of the presence of cartilage forming cells
in the deeper layers of the perichondrium.
Activity of cells in the inner chondrogenic layer of the perichondrium
leads to growth.
Deeper cells of perichondrium, the fibroblasts divide and some
differentiate into chondroblasts.
As differentiation continues, the chondroblasts surround
themselves with matrix and become chondrocytes.
As a results, matrix accumulates beneath the perichondrium on
the outer surface of the cartilage. Causing it to grow in width.
Appositional growth starts later than interstitial growth and
continues through adolescence.
Interstitial Growth
Newly formed cartilage grows by multiplication of cells throughout
its substance.
Cartilage 47
Fig. 3.1: Growth and development of cartilage

This is possible only as long as the matrix is sufficiently pliable to

allow movement of cells through it.
As the cartilage matures the matrix hardens and the cartilage cells
can no longer move widely apart.
In other words interstitial growth is no longer possible.
At this stage, when a cartilage cell divides the daughter cells remain
close together forming cell nests.
The cartilage increases rapidly in size due to division of existing
chondrocytes and the continuous deposition of increasing amounts
of matrix by the chondrocytes.
As the chondrocytes synthesize new matrix, they are pushed away
from each other.
These events cause the cartilage to expand from within which is
the reason for the term interstitial.
This growth pattern occurs while the cartilage is young and pliable
during childhood and adolescence.
REGENERATION
Cartilage has very limited ability of regeneration (after destruction
by injury or disease).
Defects in cartilage are usually filled by fibrous tissue.
Injuries are not repaired by the cartilage tissue because the adult
cells are imprisoned in matrix and probably never divide.
Tissue from the perichondrium and adjacent fascia proliferate
and fills in the defect or gap.
A fracture of a mature cartilage usually becomes united by dense
fibrous tissue.
Some of the fibrous tissue may be replaced by a bone.
CALCIFICATION
Calcification is a process in which the matrix hardens because of
the deposition of calcium salts in it but true bone is not formed.
Calcification of hyaline cartilage is often seen in old people.
The costal cartilages or the large cartilages of the larynx are
commonly affected.
In contrast to hyaline cartilage, elastic cartilage and fibrocartilage
do not undergo calcification.
Cartilage 49
Although articular cartilage is a variety of hyaline cartilage, it

does not undergo calcification or ossification.
TYPES OF CARTILAGE
Cartilages are classified according to:
The number of the cells and nature of the matrix into the following
types:
Cellular cartilage
White fibrocartilage
Hyaline cartilage
Elastic cartilage.
Cellular Cartilage (Fig. 3.2)

It is almost entirely composed of cartilage cells and the matrix is
minimum
This type of cartilage is present in embryonic life.
White Fibrocartilage (Fig. 3.3)

Here the collagen fibers of the matrix predominate and are arranged
in bundles
The ovoid cartilage cells are arranged in rows between the bundles.
Distribution
Intervertebral discs and interpubic disc
Articular disc of temporomandibular joint
Menisci of knee joint.
Fig. 3.2: Cellular cartilage

Fig. 3.3: White fibrocartilage
Hyaline Cartilage (Fig. 3.4)

Most of the cartilages of the body are hyaline
In this type the cells are arranged in groups of two or more
The matrix presents a ground glass appearance and consists
mostly of chondroitin sulfate and a few collagen fibers.
Distribution
Articular cartilage
Costal and tracheobronchial and laryngeal cartilages
Exceptepiglottis corniculate, cuneiform and apex of arytenoid
cartilages
Except the articular cartilage, all other hyaline cartilages are covered
by a fibrous membrane called as perichondrium.
Elastic Cartilage (Fig. 3.5)

In this type, the matrix is traversed by the yellow elastic fibers which
branch and anastomose in all directions except around the cartilage
cells where amorphous intercellular substance exists.
Fig. 3.4: Hyaline cartilage

Cartilage 51
Fig. 3.5: Elastic cartilage
Distribution
Pinna of external ear
Epiglottis
Corniculate cartilage
Cuneiform cartilage
Apex of arytenoid cartilages.
Review Questions
1. Perichondrium is absent in the following cartilage:
a. Hylanine b. Articular
c. Elastic d. Cellular
2. Example of elastic cartilage is:
a. Trachea b. Intervertebral disc
c. Epiglottis d. Thyroid cartilage
3. Hyaline cartilage has:
a. Bundles of collagen fibers
b. Cell nests
c. Bundles of elastic fibers
d. Large number of chondroblasts
4. In calcification of cartilage matrix hardens because of deposition

of:
a. Calcium salts b. Carbohydrates
c. Proteins d. Chondroblasts
Answers
1. b 2. c 3. b 4. a
II. Describe the type of cartilages.
1. Elastic cartilage.
2. Development and growth of cartilage.
3. General features of cartilage.
4 Sclerous Tissue
BoneI
DEFINITION
Bone is essentially a highly vascular, living, constantly changing
mineralized connective tissue.
It is remarkable for its hardness, resilience, regenerative capacity
and characteristic growth mechanisms.
Like all other connective tissues, bone consists of cells and
intercellular matrix, the great majority of cells (osteocytes), lying
embedded within it.
Matrix is composed of organic materials mainly collagen fibers
(which form 40% weight of mature bone) and inorganic salts rich
in calcium and phosphate. Together these give the bone its unique
mechanical properties.
The fibrous tissue gives the bone toughness and resilience and salts
give them hardness and rigidity and make them opaque to X-rays.
It has blood vessels, lymph vessels and nerves.
It grows and is subject to disease.
When fractured it heals itself and even if the fracture is not set
perfectly its internal structure undergoes compensatory remodeling
in order to withstand strains and stress.
PHYSICAL PROPERTIES
When the bone is submerged in a mineral acid, the salts are
removed but the organic material remains and still displays in detail
the shape of an untreated bone. Such a specimen is flexible (Fig. 4.1).
Fig. 4.1: Flexible bone
The organic material of a buried bone is removed by bacterial

action (i.e. decomposition) and only salts remain. This bone
becomes brittle than procelin; and gets crumbled and fractured
easily.
Bone that has lain buried in limestone cave become petrified (i.e.
calcium carbonate replaces the organic material).
FUNCTIONS OF THE BONE

Bones provide:
1. Protection for vital structures (i.e. brain and spinal cord, heart, lungs,
liver and bladder)
2. Rigid supporting framework of the body
3. Serve as levers for muscles
4. They contain marrow, which is a factory for blood cells.
5. They are storehouses of calcium and phosphate essential for many
functions, e.g. muscle contraction.
STRUCTURE OF BONE
The structure of dried bone shows two forms of bony tissues:
1. Compact or dense
2. Spongy or cancellous
The difference between two types of bone depends on:
1. The relative amount of the solid matter
2. Number and size of the spaces they contain
Sclerous Tissue 55
Compact Bone (Fig. 4.2)

The shaft or the body of all long bones is a compact bone.
When a longitudinal section is made through a long bone it is found
to contain a central cavity within its shaft known as the medullary
cavity.
Externally it is clothed by a membranous sheath known as
periosteum and internally the medullary cavity is lined by similar
membrane like structure known as endosteum.
In between the endosteum and periosteum there is a thick layer of
ivory like substance the compact bone, which is responsible for the
hardness of the long bone, strength for weight-bearing and rigidity.
It gives attachment for muscles and ligaments.
Amount of compact bone is greatest in the middle of the shaft where
it is liable to buckle.
Spongy or Cancellous Bone (Fig. 4.3)

They have a thin outer shell of compact bone and network of
lamellae of bone or bony trabeculae within which they are
honeycombed by large cavities, the bone being reduced to a
latticework of bars and plates.
Fig. 4.2: Compact bone

Fig. 4.3: Spongy bone
These cavities are occupied by the red bone marrow.

The lamellae of plates are arranged in lines of pressure and tension.
Cancellous bone gives additional strength to cortices and supports
the bone marrow.
The ends of long bones are cancellous or spongy type
In shaft of long bone a thick cylinder of compact bone presents only
a few trabeculae and spicules on its inner surface so that a large
central medullary or marrow cavity is enclosed.
CLASSIFICATION OF BONES
The bones of the body are classified as under:
1. Developmentally or according to ossification
2. Regionally or according to position
3. According to shape.
Developmentally or According to Ossification

They are classified according to whether they develop in:
1. Membrane: Intramembranous ossification (directly from mesen-
chyme)
Sclerous Tissue 57
2. Cartilage: Endochondral ossification (cartilage derived from mesen-

chyme)
3. Membranocartilaginous ossification.
Intramembranous Ossification (Membrane Bone Formation)

(Figs 4.4A to D)
Mesenchymal models of bones are formed during the embryonic
period and direct ossification of the mesenchyme begins in the
fetal life.
Osteoblasts simply lay down in fibrous tissue. There is no cartilage
precusor, for example, bones of the skull vault, face and clavicle.
Endochondral Ossification (Figs 4.5A to C)

Pre-existing hyaline cartilage model of the bone is gradually
destroyed and replaced by the bone.
In this type of ossification, cartilage is not converted into the bone.
It is destroyed and then replaced by the bone.
The site where the bone first forms is the primary center of
ossification and in long bones is in the middle of the shaft
(Diaphysis).
This center appears about at eighth week of intrauterine life.
A B
C D
Figs 4.4A to D: Intramembranous ossification. (A) Mesenchymal cells;
(B) Condensation of cells; (C) Apperaeance of blood vessels; (D) Bone
formation
A B
C
Figs 4.5A to C: Endochondral ossification. (A) Mesenchymal cells;
(B) Cartilaginous model (C) Bone formation
The ends of the long bone (epiphysis) remain cartilaginous and acquire
ossification center much later usually after birth.
These are called as secondary center of ossification.
Membranocartilaginous Ossification
These bones develop partly from membrane and partly from cartilage,
e.g. temporal bone, occipital bone.
Regionally or According to Position

The bones are classified regionally as follows:
Axial bones Skull Cranium 22
Face Auditory ossicles 6
Hyoid 1
Vertbrae 26
Ribs 24
Sternum 1
Appendicular bones Upper limb
Girdle (shoulder) 64
Free bones
Lower limb 62
Girdle (pelvis)
Free bones
Total 206
This number is neither important nor exact it varies with age.
Sclerous Tissue 59
According to Shape
1. Long bones Found in limbs
2. Short bones Found in hands
3. Flat Found in skull
4. Irregular Found in axial skeleton and girdle
5. Pneumatic Found in skull
6. Sesamoid Found in certain tendons
Long Bones (Fig. 4.6)

These are tubular and confined to the limbs.
They have a long bones, have a shaft or body and two expanded
ends.
The ends usually being specialized for joints are smooth and
covered with articular cartilage. They are either convex or concave
and enlarged.
The body (medullary cavity) is hollow thus providing maximum
strength with minimum material and weight.
Typically a long bone has three borders that separate three surfaces.
On cross-section it is triangular rather than circular.
Short Bones (Figs 4.7A and B)

These are small polyhedral bones with length and breadth almost
equal.
Each short bone consists of a spongy substance internally with a
thin layer of compact bone externally.
Example: Carpal and tarsal bones. They develop in cartilage, and
begin to ossify soon after birth
Except talus, calcaneous, cuboid which start ossifying after birth.
Flat Bones (Fig. 4.8)

These are expanded elongated plates of bones found to outline the
cavities of the body.
Each bone consist of two plates of compact bone tissue with
intervening spongy bone and marrow.
Example: Bones of vault of skull, ribs, sternum, scapula.
The intervening spongy tissue in the bone of the vault of the skull
is known as diploe which contains numerous veins.
Fig. 4.6: Long bone
A B
Figs 4.7A and B: Short bones Fig. 4.8: Flat bone

(A) Cuboid; (B) Capitate
Irregular Bones (Fig. 4.9)

These bones are irregular in outline and are situated in places where
strength and compactness are required.
They consist of spongy bone tissue and marrow with an outer
covering of compact bone.
Example: Vertebrae, most of the bones of base of skull, hip bone.
Sclerous Tissue 61
Fig. 4.9: Irregular bone
Pneumatic Bones (Fig. 4.10)

These bones possess a hollow space within their body, which
contains air.
They are present in close proximity to nasal cavities and directly
or indirectly communicate with the same.
Functions:
1. It makes the bone lighter.
2. It helps in the resonance of the vibration of sound.
3. It acts as an air conditioning chamber by adding humidity and
temperature to the air and making the air suitable for the purpose
of the body.
4. Sometimes, infection from the nasal cavities extend into the sinuses
and produce sinusitis.
Sesamoid Bone (Fig. 4.11)

Sesamoid bones are small ovoid modules of bones and are named
because of their resemblance to the seeds.
These bones develop in the tendons are subjected to the friction
during the movement of the joints.
Sesamoid bones acts as the pulleys for muscle contraction.
Examples:
1. Patellain quadriceps femoris
2. Pisiformin the flexor carpi ulnaris
Fig. 4.10: Pneumatic bone
Patella
Fig. 4.11: Sesamoid bone
Sclerous Tissue 63
3. Two bones beneath the head of 1st metatarsal in flexor hallucis

brevis
4. Flabellain the lateral head of gastrocnemius
5. On the cuboid bonein peroneus longus tendon.
Accessory Bones
Accessory or supernumerary bones are not regularly present.
They may appear with an extra center of ossification and fail to
unite with the main bone mass.
In X-ray films they may be mistaken for fractures.
Accessory bones are common in the skull.
Example: Sutural or wormian bones
Interparietal bones.
Heterotopic Bones
Bones are sometimes formed in soft tissues where they are not
normally present (e.g. in scars)
Horse riders often develop heterotopic bones in their thighs
(Riders bone) probably because of hemorrhagic bloody areas that
undergo calcification and eventual ossification.
Microscopically
The bones are of four types:
1. Lamellar bone: Most of the mature human bones, whether compact
or cancellous, are composed of thin plates of bony tissue called
lamellae. These are arranged in piles in a cancellous bone, but in
concentric cylinders (Haversian system or secondary osteon) in a
compact bone.
2. Fibrous bone found in young fetal bones.
3. Dentine occur in teeth.
4. Cement occur in teeth.
BONE MARKINGS and FORMATIONS

Bone markings appear wherever tendons, ligaments and fascia are
attached, or where the arteries lie adjacent to or enter bone.
Other formations occur in relation to the passage of a tendon often

to direct the tendon or improve its leverage or to control the type
of movement occurring at the joint.
The various marking and features of bone are:
Condyle: Rounded articular area (the lateral femoral condyle).
Crest: Ridge of a bone (the iliac crest).
Epicondyle: Eminence superior to condyle (the lateral epicondyle of
the humerus).
Facet: Smooth, flat area, usually covered with cartilage, where a bone
articulates with another bone (superior costal facet on the body of
vertebra for articulation with rib).
Foramen: Passage through a bone (the obturator foramen).
Fossa: Hollow or depressed area (the infraspinatus fossa of the scapula).
Groove: Elongated depression or furrow (arterial grooves in calvaria).
Line: Linear elevation (the soleal line of tibia).
Malleolus: Rounded process (the lateral malleolus of fibula).
Notch: Indentation at the edge of the bone (the greater sciatic notch).
Protuberance: Projection of bone (external occipital protuberance).
Spine: Thorn like processes (the spine of the scapula).
Spinous process: Projecting spine like (the spinous process of vertebra).
Trochanter: Large blunt elevation (the greater Trochanter of femur).
Tubercle: Small raised eminence (the greater tubercle of the humerus).
Tuberosity: Large rounded elevation (ischial tuberosity).
BONE AS A TISSUEII
PARTS OF LONG BONE (Figs 4.12A to C)

A growing long bone consists of two cartilaginous ends known as
the epiphysis.
The epiphysis and diaphysis are united together by plate like
cartilage known as epiphyseal cartilage.
The potion of the diaphysis adjacent to epiphysis is called the
metaphysis.
Sclerous Tissue 65
B C
Figs 4.12A to C: Parts of long bone
Diaphysis
The tubular shaft of the long bone, which intervenes between the
two epiphysis, is called as diaphysis.
It ossifies from the primary center of ossification.
The periosteum is firmly attached to the surface of the bone so
from without inwards it is composed of periosteum, cortex and
medullary cavity.
Periosteum
It is a fibrous membrane covering the surface of the bone.
It is made up of the outer fibrous layer and inner cellular layer,
which is osteogenic in nature.
Periosteum is united to the underlying bone by Sharpeys fibers.
At the articular margin periosteum is continuous with the capsule
of the joint.
Periosteum gets its blood supply by periosteal arteries, which
nourish the outer part of the underlying cortex also.
Periosteum has a rich nerve supply, which makes it the most
sensitive part of the bone.
Cortex
It is made up of compact bone, which withstands the mechanical strains.
Medullary Cavity
It is filled with yellow or red bone marrow.
At birth marrow is red with active hemopoiesis.
As the age advances red bone marrow atrophies and is replaced by
yellow bone marrow with no power of hemopoesis.
Red marrow persists in cancellous ends of the long bones.
In sternum, vertebrae and skull bones the red marrow is found
throughout the life.
Metaphysis
The portion of diaphysis adjacent to the epiphysial cartilage is
called as metaphysis.
It consists of vascular tissue where the growth activities are
manifested.
Sclerous Tissue 67
Importance of Metaphysis
Growth activities are marked in this area.
This is the most vascular part of the long bone because most of the
blood vessels supplying the bone anastomose in this area.
Most of the muscles are inserted in this area.
This area is more liable to injury because it is more exposed to
muscular strains due to attachment of muscles.
Epiphysis
The ends of the long bone, which develop from the secondary center
of the ossification, are called as epiphysis.
This is present only in long bones.
The epiphysis becomes continuous with the rest of the bone when
epiphyseal cartilage undergoes ossification.
There are four types of epiphysis:
a. Pressure epiphysis
b. Traction epiphysis
c. Atavistic epiphysis
d. Aberrant epiphysis
Pressure Epiphysis (Fig. 4.13)

It transmits the body weight and protects the epiphyseal cartilage
Examples: Head of the femur
Head of the humerus
Condyles of the humerus and tibia
Traction Epiphysis (Fig. 4.13)

It is produced by the pull of the muscle attached to it.
Examples: Trochanters of femur
Tubercles of humerus
Atavistic Epiphysis (Fig. 4.14)

It is phylogenetically an independent bone but with the progress of
evolution. It has retrogressed and its remnants are found to remain
fused with adjacent bones.
Fig. 4.13: Pressure and traction epiphysis
Fig. 4.14: Atavistic epiphysis

Examples: Coracoid process of scapula
Posterior tubercle of talus also called as os trigonum
Aberrant Epiphysis
(Not always present.) Normally the metacarpal bones have only one
epiphysis at the distal end, except the first metacarpal which has its
epiphysis at the proximal end. Sometimes first metacarpal may have
an additional epiphysis at its distal end. This is called as aberrant
epiphysis.
Sclerous Tissue 69
Epiphyseal Plate of Cartilage (Fig. 4.15)

It separates epiphysis from metaphysis.
Proliferation of cells in this plate are responsible for lengthwise
growth of a long bone.
When bone growth ceases and diaphysis fuses with the epiphysis
the seam formed during this fusion process (synostosis) is dense
and called as epiphyseal line.
The structure of epiphyseal cartilage is as follows (from epiphysis
to diaphysis)
Zone of resting cartilage
Zone of proliferating young cartilage cells, arranged in rows of
longitudinal columns
Zone of mature cartilage
Zone of calcified cartilage (Bone formation).
GROWTH OF A LONG BONE

During growth period a long bone increases in thickness and in
length.
Fig. 4.15: Epiphyseal plate of cartilage

Bone grows in thickness by multiplication of cells in periosteum.

It grows in length by multiplication of cells in epiphyseal cartilage.
Osteoblast cells deposit new bone on the surface and at the ends
of a long bone.
Growth in length of long bone proceeds more in one direction,
which is called as growing end.
The shape of the bone is maintained by the removal of unwanted
bone by osteoclasts.
This process of removal of unwanted bone is called as remodeling
and this is how marrow cavity increases in diameter.
FACTORS AFFECTING GROWTH OF A BONE

Nutritional
a. Deficiency of vitamin A: Causes
In rickets the cartilage cells
disturbances in bone formation and
of epiphyseal plate do
destruction. This reduces the size of not die and plate becomes
spinal and cranial foramina. thick and irregular. Due to
b. Deficiency of vitamin C: Interferes weight-bearing Rachitic
with the production of organic inter- children may be bowlegged.
cellular matrix.
c. Deficiency of vitamin D: Interferes with the calcification of the
osteoid matrix.
d. Disuse atrophy: A local osteoporosis may occur when the limb is
paralyzed or immovable.
Hormonal
Pituitary Gland
Hypersecretion of alpha cells: Osteoporosis: During
Before puberty causes persistent old age both organic and
growth at the epiphyseal cartilage inorganic components of
with consequent gigantism. bone decrease, producing,
After puberty causes renewed osteoporosis a reduction in
subperiosteal deposition of bones the quantity of bone. Hence,
in various parts of body, notably in the bones become brittle,
hands, feet and skull. This is called lose their elasticity, and
as acromegaly. fracture easily.
Sclerous Tissue 71
Hyposecretion of alpha cells:

Causes failure of normal growth of bones. This is called as dwarfism.
Parathyroid gland:
In hypersecretion of parathyroid hormone
Calcium is removed from the bones by stimulating osteoclastic
resorption. This is called as osteitis fibrosa.
Genetic Factors
Chondrodystrophia fetalisthis condition is due to autosomal
dominant inheritance.
Here the endochondral ossification fails to occur properly.
The cartilage bones are affected whereas membrane bones develop
normally.
Mechanical Factors
Tensile forcehelps in bone formation
Compressive forcehelps in bone resorption.
LAWS OF OSSIFICATION
Ossification begins from a particular point and spreads out in a
radiating manner to the different portions of the bone. This is center
of ossification.
The center of ossification may be primary or secondary. Primary
center appears before birth, except cuneiform and navicular.
Secondary center appears after birth, exceptlower end of femur
where secondary center appears before birth.
LAWS OF UNION OF EPIPHYSIS

The epiphysis which begins to ossify first unites with the diaphysis
last. Exceptlower end of fibula where ossification begins earlier
and unites with the body earlier.
The epiphysis towards which the nutrient artery is directed unites
with the diaphysis first.
Center of ossification of epiphysis appears first in the growing end
of the bone.
The different centers of ossification of an epiphysis unite together

first before union with the diaphysis.
BLOOD SUPPLY OF BONE

A bone gets nutrition from the blood.
Distribution of blood vessels differ according to the type of bone.
Blood Supply of Long Bone (Fig. 4.16)

A long bone gets its blood supply from the following sources:
Nutrient Artery
The nutrient artery enters the long bone through the nutrient
foramen.
On entering into the bone artery soon divides into two branches,
one for each end of the bone.
Each artery again break up into smaller parallel branches which run
into the metaphysis where they freely anastomose with terminal
branches of metaphyseal arteries.
Fig. 4.16: Blood supply of long bone

Sclerous Tissue 73
Radial branches enters the Harversian canal and Volkmans canal

and supply the cortex.
Metaphyseal or Juxta-epiphyseal Arteries

These are small arteries derived from arterial anastomosis around
the joint.
Then they enter the bone by piercing it in region of attachment of
capsular ligament.
Epiphyseal Arteries
These are derived from the arterial anastomosis around the joint.
They penetrate into the epiphysis.
Periosteal Arteries
These blood vessels lie within the periosteum, and end by supplying
the superficial portion of the cortex.
Blood Supply of the Short Long Bones (Fig. 4.17)

Short long bones have only one epiphysis and metaphysis.
Fig. 4.17: Blood supply of short long bone

Nutrient Artery
It enters the nutrient foramen and break up into the several branches
which freely anastomose to form plexuses within the shaft.
The tuberculosis and syphillis are common in shaft in early years
of life, because the nutrient artery immediately breaks into plexus
on reaching the medullary cavity.
Epiphyseal and Metaphyseal Arteries

Supply only epiphyseal end of bone.
At the opposite end there is insufficient blood supply.
Periosteal Arteries
In adults, periosteal arteries supply major part of the bone and replace
the nutrient vessels. Hence infection of short long bones is less frequent
in adults.
Blood Supply of Flat Bones (Fig. 4.18)

Nutrient artery: After entering the bone it breaks up into branches,
which ramify all over the bone.
Periosteal arteries: They form main source of blood supply.
Blood Supply of Irregular Bones (Fig. 4.19)

Blood Supply of Vertebra
One or more vessels enter the body through a basivertebral foramen.
A set of arteries pierce anterolateral surface.
One vessel enters root of the tranverse process and supplies
vertebral arch and its processes.
In verterbrae, body is richly supplied by blood vessels thus spread
of tuberculosis and syphilis is common.
NERVE SUPPLY OF BONE

Fine myelinated and nonmyelinated fibers accompany the blood
vessels to enter into the substance of the bone.
Sclerous Tissue 75
Fig. 4.18: Blood supply of flat bone
Fig. 4.19: Blood supply of irregular bone

LYMPHATICS OF BONE
Lymphatic are mostly confined to periosteum and Harvesian system.
FRACTURE OF THE BONE AND ITS REPAIR

A fracture means a break in the continuity of the bone.
Trauma to a bone (during an accident) may break it.
For the fracture to heal properly, the broken ends must be brought
together approximating to their normal position. This is called
reduction of a fracture.
During bone healing, the surrounding fibroblasts (connective tissue
cells) proliferate and secrete collagen that forms a collar of callus to
hold the bones together.
Remodeling of bone occurs in the fracture area and the callus calcifies.
Eventually, the callaus is reabsorbed and replaced by bone. Fractures
are more common in children than in adults. Fortunately, many of these
breaks are Greenstick fractures (incompletes breaks by bending of
bones).
Fractures in growing bones heal faster than in adult bones.
Review Questions
1. Vertebrae are classified as:
a. Short bone b. Irregular bone
c. Flat bone d. Sesamoid bone
2. Following bone develop in a tendon:
a. Pisiform b. Cuboid
c. Scaphoid d. Triquetral
3. Coracoid process of scapula is an example of following type of
epiphysis:
a. Pressure b. Traction
c. Atavistic d. Aberrant
4. Secondary center of lower end of femur appears in:
a. One year of life b. Six months of life
c. Ninth month of intrauterine life d. Just before birth
5. Following cells do the functions of resorption of bone:
a. Osteoblast b. Osteoclast
c. Osteocytes d. Osteogenic
Sclerous Tissue 77
6. Syphilis is common in:

a. Long bone b. Short long bone
c. Irregular bone d. Pneumatic bone
Answers
1. b 2. a 3. c 4. d 5. b 6. b
II. Give the classification of bones.
a. Types of epiphysis.
b. Blood supply of long bones.
c. Endochondral ossification.
d. Intramembranous ossification.
e. Draw a diagram of a long bone.
5 Joints
Jointsi
DEFINITION
A joint is an articulation a place of union or junction between two
or more bones or parts of bones of skeleton.
Joints exhibit a variety of form and functions.
Some joints have no movements. Others allow only slight move-
ment and some are freely movable such as the shoulder joint.
CLASSIFICATION OF JOINTS
Joints are classified structurally, based on their anatomical
characteristics and functionally, based on the type of movement they
permit.
Structural Classification
Structural classification of joints is based on two criteria:
Presence or absence of a space between the articulating bones called
as synovial cavity
Types of connective tissue that binds the bones together.
Structurally joints are classified as one of the following types:
1. Fibrous joints
2. Cartilaginous joints
3. Synovial joints
Joints 79
Functional Classification (Figs 5.1A to C)

Functionally joints are classified according to the degree of mobility:
Synarthrosis (Immovable) like fibrous joints
Amphiarthrosis (Slightly movable) like cartilaginous joints
Diarthrosis (Freely movable) like synovial joints.
Synarthrosis
These are fixed joints at which there is no movement
The articular surfaces are joined by tough fibrous tissue
Often the edges of the bones are dovetailed into one another as in
the sutures of the skull.
Amphiarthrosis
These are joints at which slight movement is possible.
A pad of cartilage lies between the bone surfaces and there is a
fibrous capsule to hold the bones and cartilage in place.
The cartilages of such joints also act as shock absorbers, e.g.
intervertebral discs between the bodies of the vertebrae.
C
Figs 5.1A to C: Functional classification of joints
Diarthrosis or Synovial Joints

They are known as freely movable joints.
Though at some of them movement is restricted by the shape of
the articulating surfaces and by the ligaments which hold the bones
together.
A synovial joint has a fluid filled cavity between articular surfaces.
Articular surfaces are covered by articular cartilage.
Synovial fluid is produced by the synovial membrane which lines
the cavity except for the actual articular surfaces.
Regional Classification
Regionally the bones are classified as:
i. Skull typeImmovable
ii. Vertebral typeSlightly movable
iii. Limb typeFreely movable.
STRUCTURAL CLASSIFICATION IS MOST COMMONLY

FOLLOWED
So coming to structural classification again which we will study in detail.
Structurally joints are classified as one of the following types:
1. Fibrous joints
2. Cartilaginous joints
3. Synovial joints.
Fibrous Joints
These are also considered as synarthrosis with no movement or
slight movement.
In these joints bones are united by fibrous tissue.
Fibrous joints are of three types:
Sutures
Syndesmosis
Gomphosis
Sutures (Figs 5.2 and 5.3)

These are peculiar to the skull and are immovable.
Joints 81
Sutural joints usually appear between those bones which ossify in

membranes.
Sutural membranes or ligaments connect the periosteum covering
the outer and inner surfaces of the bones which provide bone growth
and bind together the apposed margins of bones.
Types of Sutures
1. Serrate suture: The edges of the bones present saw toothed appear-
ance, e.g. sagittal suture of the skull (Fig. 5.2A).
Figs 5.2A to E: Type of joints

Fig. 5.3: Sutural joint
2. Denticulate suture: The margins, present teeth with the tips being
broader that roots, e.g. lambdoid suture (Fig. 5.2B).
3. Squamous suture: Here the edges of the bones are united by over-
lapping, e.g. between parietal bone and squamous part of temporal
bone (Fig. 5.2C).
4. Plane suture: Borders are plane and united by sutural ligaments,
e.g. articulations between palatine processes of maxillae (Fig. 5.2D).
5. Wedge and groove suture (schindylesis): The edge of one bone fits
in the groove of other bone, e.g. between rostrum of sphenoid and
upper margin of vomer (Fig. 5.2E).
Syndesmosis (Fig. 5.4)

It is a type of fibrous joint where the surfaces of the bones are
united by interosseous ligaments, and the bones concerned lie
some distance apart.
Such ligaments persist throughout life and slight amount of move-
ment is possible.
Joints 83
Fig. 5.4: Syndesmosis
Example:
Interosseous membrane of the forearm and leg
Inferior tibiofibular joint.
GomphosisPeg and Socket Joint (Fig. 5.5)

Here the roots of the teeth fit in the sockets of the jaw and are united
by the fibrous membrane.
Cartilaginous Joints
Cartilaginous joints are of two varieties:
Primary cartilaginous joints (Synchondroses)
Secondary cartilagenous joints (Symphysis)
Primary Cartilaginous Joint (Synchondroses) (Fig. 5.6) or

Hyaline Cartilage Joints
The bones are united by a plate of hyaline cartilage so that the
joint is immovable and strong
Fig. 5.5: Gomphosis (peg and socket joint)
Fig. 5.6: Synchondrosis
These joints are temporary in nature because after a certain age the
cartilaginous plate is replaced by a bone (Synostosis) (Fig. 5.7)
No movement is possible at this joint.
It is primarily designed for bone growth
Examples:
1. Joint between epiphysis and diaphysis of a growing long bone
with the help of epiphyseal plate.
The joint is replaced by a bone when longitudinal growth of
the diaphysis is complete
Primary cartilaginous joints permit growth in the length of
a bone
Joints 85
Fig. 5.7: Synostosis
When full growth is achieved the epiphyseal plate converts

to bone and the epiphysis fuse with the diaphysis.
2. First chondrosternal joint
It is considered as synchondrosis and there is subsequent
synostosis which provides stability to the sternoclavicular
joint through which stress is transmitted from the clavicle
to the first costal cartilage during movement of the shoulder
girdle.
Note: This is unlike the second to seventh, chondrosternal
joints which are synovial.
3. Articulation between basiocciput and basisphenoid
Synchondrosis is converted into synostosis at about 25 years.
Secondary Cartilaginous Joints (Symphysis) (Fig. 5.8) or

Fibrocartilaginous Joints
These are strong and slightly movable joints, they provide strength
and absorb shock as well as provide considerable flexibility to the
vertebral column.
The articular surfaces are covered by a thin layer of hyaline cartilage
and united by a disc of fibrocartilage.
These joints are permanent and persist throughout life.
Typically they appear in the median plane of the body.
Examples:
Intervertebral discs (Fig. 5.9)
Between the vertebral bodies.
Fig. 5.8: Secondary cartilaginous joint
Fig. 5.9: Intervertebral disc
Each intervertebral (fibrocartilaginous) disc consist of annulus

fibrosis at the periphery and nucleus pulposus in the center.
The annulus fibrosis is composed of series of concentric layers
and fibers in alternate layers are arranged in X like manner
The nucleus pulposus is a gelatinous mass containing abundant
water, cartilage cells and occasional multinucleated notochordal
cells.
Joints 87
As age advances, notochordal cells disappear and the nucleus

is replaced by fibrocartilage.
The intervertebral discs acts as a shock-absorber.
Offer resistance to compression and ensure even distribution
of compressive forces to the upper and lower surfaces of the
vertebral bodies.
Sometimes the disc is prolapsed posteriorly, resulting in radiating
root pain due to involvement of spinal nerves.
Other examples are:
1. Symphysis pubis
2. Manubriosternal joints.
JOINTSII
Synovial Joints
Definition of Synovial Joints
Synovial joints are the most common type of joint
They are most evolved and; therefore, most mobile type of joints
They provide free movements between the bones, they join and are
typical of all limb joints
Their name comes from the lubricating substance (synovial fluid)
that is present in the joint cavity or synovial cavity which is lined
with synovial membrane or articular cartilage
The synovial membrane consists of vascular connective tissue that
produces synovial fluid.
Characteristics of Synovial Joints (Figs 5.10A and B)

1. The joint presents a cavity called as joint cavity which is filled with
viscous synovial fluid.
The joint cavity allows the joint to be freely movable
Hence all synovial joints are classified functionally as Diarthroses.
2. The articular surfaces are covered with hyaline (articular) cartilage.
Articular cartilage is avascular, non-nervous, and elastic
It is lubricated with synovial fluid.
The cartilage provides slippery surface for free movements
The surface of cartilage shows fine indulations filled with
synovial fluid.
B
Figs 5.10A and B: Synovial joints
3. Between the articular surfaces there is a joint cavity filled with

synovial fluid.
The cavity may be partially or completely subdivided by an
articular disc or meniscus.
4. The joint is surround by an articular capsule (fibrous capsule lined
with synovial membrane).
Because of its rich nerve supply the fibrous capsule is sensitive
to stretches imposed by movements.
This sets up appropriate reflexes to protect the joint from any
sprain
This is called the Watch-dog action of the capsule.
5. Synovial membrane
Lines whole of the interior of the joint
Joints 89
Except for the articular surfaces covered by hyaline cartilage

The synovial membrane secretes a slimy viscous fluid called as
synovial fluid
Synovial fluid lubricates the joint and nourishes the articular
cartilage.
6. Varying degrees of movements are always permitted by the synovial
joints.
Description of the component parts of

synovial joints
Component parts of synovial joint are:
a. Articular cartilage
b. Synovial fluid
c. Articular capsule
d. Synovial membrane
e. Articular disc or meniscus.
Articular Cartilage
The articular cartilage of most joints is hyaline in structure, except
in those bones which are ossified in membrane where it is composed
of fibrocartilage
Hyaline articular cartilage is avascular, non-nervous and elastic
On the convex articular surface (male) the cartilage is thickest in
the center and thinnest at the periphery
On the concave surface (female); however, it is thinnest in the center
and thickest at the periphery
The articular cartilage, once damaged cannot be replaced by hyaline
tissue
Replacement takes place by fibrous tissue hence, articular cartilage
is indispensable.
Functions
It provides a smooth gliding surface.
It reduces forces of compression during weight-bearing or muscle
action.
The surface of cartilage is not perfectly smooth and shows fine
undulations which are filled with synovial fluid.
In fact, articular cartilage is extremely porous and absorbs synovial

fluid in the resting condition
When the joint is compressed, synovial fluid is squeezed out of
the cartilage.
It regulates the growth of epiphysis.
Changes in articular cartilage with age:

1. Degenerative changes
Occur in central part of cartilage.
2. Proliferative changes
Occur around edge of articular cartilage
Cartilage cells proliferate in these regions and are replaced by
bones which are called as osteophytes.
Nutrition
Nutrition of articular cartilage is derived from three sources:
a. From synovial fluid
b. By diffusion from capillaries at the periphery of the articular carti-
lage
c. By diffusion from the adjacent epiphyseal blood vessels.
Synovial Fluid
It is a viscous and glairy fluid which fills the joint cavity
The synovial fluid as a dialysate of the blood plasma into which
hyaluronic acid is added from the synovial membrane
The viscosity of the fluid depends on the concentration of the hyalu-
ronic acid. More acid makes the fluid more viscous.
Function of the Fluid

It maintains nutrition of the articular cartilage
It provides lubrication of joint cavity to prevent wear and tear.
Lubrication is helped by the following factor:
The articular surfaces of the bones are not perfectly congruous.
It provides a space for flushing of the fluid.
The synovial fluid spreads as an elastic fluid film over the
moving articular surfaces.
During weight-bearing the fluid is squeezed out from the
interstices of the porous articular surfaces and exerts a sort of
weeping lubrication.
Joints 91
Entrapped synovial fluid in the articular sponge is enriched with

the secretion of hyaluronic acid from the cartilage cells.
This helps in boostering effect of lubrication by increasing
viscosity.
Viscosity of the fluid maintains lubrication.
In cold temperature viscosity increases and this accounts for
the stiffness of the joints in cold countries.
Move movements of the joint encourage more lubrication:
Sometimes a person experiences difficulty in starting movements
during morning hours but when movements are continued, stiffness
of the joints lessens.
Articular Capsule
It consists of outer fibrous capsule and inner synovial membrane.
Fibrous Capsule
Completely invests the joint and is attached by continuous lines to
the bones forming the joints close to their articular cartilages
Capsule is formed by bundles of collagen fibers which are sensitive
to changes in position of joint
It is pierced by blood vessels and nerves
Sometimes, the capsule presents opening through which synovial
membrance comes out to act as bursa for the tendon of neighboring
muscle.
Functions of Fibrous Capsule

It binds the articulating bones together.
Numerous sensory nerve endings ramify on the capsule.
These nerves when stimulated produce contraction of the muscles
by reflexes and thereby protect the joints.
Synovial Membrane
It is a highly vascular and cellular connective tissue membrane which
lines the inner aspect of the fibrous capsule and the bones lying within
the capsule but ceases at the periphery of the articular cartilage,
articular disc or meniscus.
Functions
The membrane secretes synovial fluid which provides nutrition to
the articular cartilage.
It liberates hyaluronic acid which maintains viscosity of the fluid.
It removes particulate matters and worn-out cartilage cells by the
phogocytic activity.
Articular Disc or Meniscus

Sometimes the joint cavity is divided completely or incompletely
by an articular disk or meniscus which is attached at the periphery
to the fibrous capsule
Structurally, articular disc is fibrocartilaginous.
Examples:
Knee joint (divides joint cavity incompletely)
Temporomandibular joint (divides the joint cavity completely
into two compartments).
Function of the Disc or Meniscus

It helps in lubrication
It prevents wear and tear of the articular cartilage
A disc or meniscus appears in those joints where gliding movement
is associated with angular movement.
Classification of Synovial Joints

Synovial joints are classified as follows:
According to number of articuling bones:
Simple joints
Compound joints
Complex joints.
According to the axis of movements and shape of articular surfaces:
Uniaxial joint
Biaxial joint
Polyaxial joint
Plane joint.
Joints 93
According to the Number of Articulating Bones

Simple Joint (Fig. 5.11)
Occur when two bones enter in the articulation, e.g. interphalangeal
joints of fingers and toes.
Compound Joint (Fig. 5.12)

More than two articular bones are involved.
Sharing a common articular capsule, e.g. ankle joint.
Complex Joint (Fig. 5.13)

When a joint is divided into two compartments by an articular disc
or meniscus, e.g. knee joint.
Fig. 5.11: Simple joints (Interphalangeal joint and meta-

carpophalangeal joint)
Fig. 5.12: Compound joint (Ankle joint)
Fig. 5.13: Complex joint (Meniscus)

Joints 95
According to Axis of Movements and Shape of

Articular Surfaces
Uniaxial Joint
It has one degree freedom of movement and is subdivided into three
types:
Hinge or ginglymus joints (Fig. 5.14)
Moves on a transverse axis.
One articular surface is convex
Other surface is reciprocally curved, e.g. elbow joint.
Pivot or trochoid joint (Figs 5.15A and B)
Movements take place on a vertical axis
One bone acts as a pivot which is encircled by an osseoliga-
mentous ring.
Examples:
Atlantoaxial joint
Fig. 5.14: Hinge joint (Elbow joint)

A B
Figs 5.15A and B: Pivot joint (Superior radioulnar joint)
Superior radioulnar joint

Pivot is formed by the head of radius and the ring is formed by

annular ligament and ulna is fixed.
Condylar joint
It moves mainly on a transverse axis and partly on a vertical axis
Hence also called as modified hinge joint, e.g. knee joint each
bone consists of two distinct articular surfaces, each is known
as condyle.
Biaxial Joints
These joints have two degree freedom of movements.
They are of two types.
Ellipsoid joint (Fig. 5.16)
One articular surface is convex and elliptical
Other articular surface is concave and reciprocally curved
Movements take place around transverse and anteroposterior
axis.
Joints 97
Fig. 5.16: Ellipsoid joints (Radiocarpal joint)
Movements occruing are flexion, extension, adduction, abduction,

circumduction, e.g. radiocarpel joint.
Saddle joint (Fig. 5.17)
The apposing articular surfaces are concavo-convex in reciprocal
manner.
In addition to above movements, rotation also takes place at this
joint, e.g. first carpometacarpal joint.
Polyaxial Joints
Possess three degree freedom of movements
Morphologicallyball and socket type of joint
Axis of movementtransverse, vertical and anteroposterior
Movements permissible areflexion, extension, adduction, abduc-
tion, rotation and circumduction, e.g.shoulder joint.
Plane Joints
The articular surfaces are flat and produce gliding movements in
various directions, e.g. intercarpal and intertarsal joints.
Fig. 5.17: Saddle joint (First carpometacarpal joint)
Peculiarities of Synovial Joints

Articular surfaces are not perfectly congrous
A potential joint space must be available for flushing of the

synovial joint.
Sometimes, folds of synovial membrane
Containing fat projects into the joint cavity
These pads of fat are intracapsular but extrasynovial and are
known as haversian glands
They are in liquid condition at body temperature, e.g. acetabular
fat of hip joint.
Movements and Mechanism of Movements of Synovial Joints

Types of movements in synovial joints are:
Gliding movements
This movement takes place in plane joints where one bone slips
over the other, e.g. small joints of hands and foot.
Angular movements
Flexion and extension. Flexion means bending and extension
means straightening.
Adduction and abduction
Movement away and towards the median plane.
Circumduction
It is a combination of four angular movements
In successive order describing a cone.
Joints 99
ROTATION
This movements occurs around a vertical axis
Axis of rotation in shoulder joint passes through the long axis of
humerus.
Blood Supply of Joints

The articular and epiphyseal branches are given off by neighboring
arteries which form a periarticular arterial plexus
Numerous vessels from this plexus pierce the fibrous capsule and
form a rich vascular plexus in the deeper part of synovial membrane
It supplies capsule, synovial membrane and the epiphysis
The articular cartilage is a vascular.
Lymphatic Drainage of Synovial Joints

Lymphatic form a plexus in the subintima of the synovial membrane
and drain along the blood vesseals to the regional lymph nodes.
Nerve Supply of Synovial Joints

The capsule and ligaments possess a rich nerve supply which make
them acutely sensitive to pain:
The synovial membrane has poor nerve supply
The articular cartilage is non-nervous
Articular nerves contain sensory and autonomic fibers some of
the sensory fibers are proprioceptive in nature
The principles of distribution of nerves to joints were first
described by Hilton, thus it is called as Hiltons law
The law says that the nerves which supply a joint, also furnish
branches to the group of muscles regulating the movements of
the joint and the skin over the joint.
Applied Anatomy
Dislocation of joint
This is a condition in which the articular surfaces of the joint are
abnormally displaced.
Sprain
It is a severe pain in a joint caused by ligamentous tear, but

without any associated dislocation or fracture.
Arthritis
It is inflammation of one or more joints, it can be caused by a
variety of diseases like rheumatic arthritis, osteoarthritis.
Neuropathic joint
It is the result of complete denervation, so that the reflexes
are eliminated and the joint is left unprotected and liable to
mechanical damage.
It is commonly caused by leprosy, tabes dorsalis and syringo-
myelia.
Review Questions
1. Rotatory movements of joints take place on:
a. Transverse axis b. Anteroposterior
c. Vertical axis d. All above axis
2. Articular cartilage of most joints is:
a. Elastic b. Hyaline
c. White fibrocartilage d. Cellular
3. Example of saddle joint is:
a. First carpometacarpel joint
b. Metacarpophalangeal joint
c. First interphalangeal joint
d. Intercarpal joint
4. First chondrosternal joint is:
a. Secondary cartilaginous joint
b. Primary cartilaginous joint
c. Synovial joint
d. Fibrous joint
5. Example of pivot joint is:
a. Metacarpophalangeal joint
b. Superior radioulnar joint
c. Elbow joint
d. Radiocarpal joint
Joints 101
6. Subtype gomphosis is classified under:

a. Biaxial synovial joint b. Symphysis
c. Fibrous joint d. Synchondrosis
Answers
1.c2.b3.a4.b5.b6.c
II. Describe the components of synovial joints.
1. Primary cartilaginous joints.
2. Classification of synovial joints.
3. Peculiarities of synovial joints.
6 Muscular Tissue
MUSCLEI
INTRODUCTION
Muscle is a contractile tissue and is primarily designed for movements.
The fundamental property is contractility which is developed in
highly specialized form.
Muscle cells are often called as muscle fibers or myocytes because
they are long and narrow when relaxed.
They produce contractions that move body parts including internal
organs.
The associated connective tissue conveys nerve fibers and capillaries
to the muscle fibers, as it binds them into bundles or fascicles.
Muscle also gives form to the body and provides heat.
The word muscle is derived from Mouse because of its fancied
resemblance to mice and tendon represents its tail.
TYPES OF MUSCLE
There are three types of muscle:
1. Skeletal muscle
2. Cardiac muscle
3. Smooth muscle
Structurally, on the basis of presence or absence of striations
muscles are subdivided into two groups. Striated and nonstriated
(smooth) muscle.
Muscular Tissue 103
The striated group is further subdivided into skeletal and cardiac

types:
Skeletal Muscle (Fig. 6.1)

Skeletal muscle forms the bulk of the muscular tissue of the body.
It is supplied by the somatic motor nerves.
It consists of parallel bundles of long multinucleated fibers which
is turn are made up of myofilaments, actin, myosin and tropo-
mycin.
It exhibits cross-striations under the microscope.
Skeletal muscle is also called as voluntary muscle because
the movements in which it participates are often initiated under
conscious control.
But this is a misleading term because skeletal muscle is involved
in many such movements. For example, breathing, blinking,
Fig. 6.1: Skeletal muscle

swallowing, action of muscles of perineum, which occur usually

at an unconscious level.
Cardiac Muscle (Fig. 6.2)

Cardiac muscle is found only in the heart and in the walls of large
veins where they enter the heart.
They are supplied by autonomic nerves, thus involuntary.
It consists of branching network of individual cells that are linked
electrically and mechanically to function as a single unit.
Each muscle has a single nucleus placed centrally.
Cross-striations are less prominent.
Cardiac muscle is less powerful than skeletal muscle but more
resistant to fatigue.
It is intrinsically capable of automatic and rhythmic contractions.
Smooth Muscle (Fig. 6.3)

These muscles often encircle or surround the viscera
Autonomic nerves supply them, thus involuntary.
The elongated cells are small and taper at the ends.
Cross-striations are not prominent because the actin and myosin
filaments are not organized into repeating units. Thus, appear
non-striated (smooth).
Nucleus single centrally placed.
Capable of slow and sustained contractions.
Smooth muscle is also called as involuntary muscle.
Fig. 6.2: Cardiac muscle

Muscular Tissue 105
Fig. 6.3: Smooth muscle
For example, all systems of body, in the walls of viscera, GIT, etc.
Tunica media of blood vessels.

In the dermis (Arrector pilorum muscle of skin)

Intrinsic muscles of the eye

Dartos muscle of the scrotum

In some places it is associated with the skeletal muscle, e.g.
Sphincters of anus
Urinary bladder
Transitional zone of esophagus.
Myoepithelial Cells (Fig. 6.4)

They are found in association with number of secretary glands.
They contain contractile elements similar to smooth muscle
They are ectodermal in origin.
Fig. 6.4: Myoepithelial cell

The cells are located between the glandular epithelial cells and the
basement membrane.
These cells are stellae and basket like in form, with long dendritic
extensions clasping on adjacent glandular acini, e.g. salivary glands
and mammary glands.
SKELETAL MUSCLE (GROSS ORGANIZATION) (Fig. 6.5)

Each muscle fiber forms a unit structure of the muscle.
It is long multinucleated cylindrical structure, which is surrounded
by a thin connective tissue sheath known as endomycium.
Several fibers are organized into small bundles, which are called
as fasciculli.
Each fasciculus is surrounded by connective tissue called as
perimycium.
Connective tissue that surrounds the entire muscle is called as
epimycium.
Organization of Skeletal Muscle Fiber (Fig. 6.6)

A skeletal muscle consists of muscle fasciculi.
Each fasciculus consists of a group of muscle fibers.
Each muscle fiber consists of a group of myofibrils.
Each myofibril is composed of a group of myofilaments.
There are two types of myofilaments.
Actin and myosin which differ from each other in chemical
composition and in dimensions.
Single Muscle Fiber (Figs 6.7 and 6.8)

Each muscle fiber is an elongated cell surrounded by sarcolemma
within which are evenly distributed longitudinal threads known as
Myofibrils.
The sarcoplasm is filled with organelles and several nuclei are
arranged at the periphery beneath the sarcolemma.
Each myofibril shows alternate dark and light bands.
Dark bands are called as A-bands (anisotropic).
Light bands are called as I-bands (isotropic) bands.
The bands of adjacent fibrils are aligned transversely so that fiber
appears cross-striated.
Muscular Tissue 107
Fig. 6.5: Skeletal muscle (Gross organization)
Fig. 6.6: Organization of single muscle fiber
Fig. 6.7: Single muscle fiber

Fig. 6.8: Structure of myofibril (Sarcomere)
In the middle of A-band there is light H-band with M-band (dark)

in its middle.
In middle of I-band there is dark Z line or Krause membrane.
The segment of myofibril between two Z lines is called as sarcomere.
Structure of Myofibril (Fig. 6.9)

The segment of myofibril between two Z lines is called
sarcomere.
Each myofibril is composed of longitudinal protein filaments
called myofilaments.
These myofilaments are contractile elements of the striated muscle.
Myofilaments are of two types; the thin Actin filaments and the
thick Myosin filaments.
Muscular Tissue 109
Fig. 6.9: Structure of myofibril (Relaxed and contracted)
During muscle contraction actin filaments slide between the myosin

filaments towards the center of the sarcomere.
Thus the Z line comes closer with shortening of the contractile
unit.
Importance of the Connective Tissue Investments

Connective tissue carry blood vessels which reach each individual
fiber.
These blood vessels provide oxygen and nourishment to individual
muscle fibers.
They eliminate waste products from the muscle fibers.
Connective tissue binds the contractile units (muscle fibers) together
so that when muscle contracts the individual fiber of each muscle
unit add together to a common pool.
TYPES OF SKELETAL MUSCLE FIBERS

There are two types of skeletal muscle fibers:
1. Slow twitch or red fibers or type I fibers
2. Fast twitch or white fibers or type II fibers
Slow or Red Fibers or Type I Fibers

They are red in color due to presence of myohemoglobin.
These are thin fibers rich in mitochondria, and oxidative enzymes,
but poor in phosphorylases and glycogen.
Functionally
These fibers contract slowly
These contractions remain more sustained.
Thus suitable for maintaining posture, e.g. brachialis, soleus.
Fast or White Fibers or Type II Fibers

They are paler and thicker than slow fibers
They have few mitochondria, and less oxidative enzymes
But rich in glycogen and phosphorylases
Functionally
These fibers contract quickly
But their contractions remain less sustained, e.g. biceps brachii,
gastrocnemius.
PARTS OF A SKELETAL MUSCLE (Fig. 6.10)

A skeletal or voluntary muscle consists of fleshy and a fibrous part.
Fleshy belly stretches between two points across a joint.
Attachment proximal to the joint is called as origin.
Attachment distal to the joint is called as insertion.
Fibers of origin are either fleshy or tendinous.
Fibers of insertion are usually tendinous, condensed to form a chord
like structure known as tendon.
When flattened and membranous known as aponeurosis.
Tendons
Tendons are immensely strong.
Fibers of a tendon are strictly parallel but plaited.
Muscular Tissue 111
Fig. 6.10: Parts of skeletal muscle
They twine about each other in such a manner that fibers from any
given point at the fleshy end of the tendon are represented at all
points at the insertional end.
FASCICULAR ARCHITECTURE OF MUSCLE

Arrangement of muscle fiber varies according to direction, force,
range of movement at a particular joint.
Range of movement is directly proportional to the length of fibers.
Force of contraction is directly proportional to the number and size
of muscle fibers.
The muscles are classified according to the arrangement of their
fasciculi into following groups:
Parallel
Pennate
Spiral
Cruciate.
Parallel Muscles (Fig. 6.11)

The muscle fibers are parallel to the line of pull.
The fibers are long but their number is relatively few.
Functions
Range of movement is more in this type of muscle due to increased
length of the fibers.
Force of contraction is less because of less numbers of fibers.
Types
Parallel muscle are divided into following subtypes:
Quadrilateral musclequadratus lumborum, thyrohyoid
Fig. 6.11: Fascicular architecture of muscle (Parallel muscle)
Strap musclesartorius
Straplike with tendinous intersectionsrectus abdominis
Fusiform musclebiceps brachii.
Pennate Muscles (Fig. 6.12)

The fleshy fibers are oblique to the line of pull.
They are attached obliquely to the tendon of insertion.
The fibers are short and number of muscle fibers is more.
Thus force of contraction is increased.
The range of movement is reduced.
Fig. 6.12: Pennate muscle

Muscular Tissue 113
Pennate muscles present the following subtypes:
Unipennate
All fleshy fibers slope into one side of the tendon, which is formed
along one margin of the muscle
This gives the appearance of half a feather
Examples:
Flexor pollicis longus
Extensor digitorum longus
Peroneus tertius.
Bipennate
The tendon is formed in central axis of the muscle
Muscle fibers slope on the two sides of the central tendon.
This gives the appearance of whole feather
Examples:
Tibialis posterior
Rectus femoris.
Multipennate
There are series of tendinous bands within a muscle with tendinous
intersections.
Muscular fasciculi are arranged between these tendinous intersec-
tions.
Example: Acromial fibers of deltoid
Circumpennate
Muscle is cylindrical with central tendon within it.
Oblique muscle fibers converge into the central tendon from all
sides.
Range of movement is diminished due to:
Shortness of muscle fibers
Oblique direction of pull
Total force of contraction is increased due to greater number of
muscle fibers.
Example: Tibialis anterior.
Spiral Muscle (Fig. 6.13)

Muscle is twisted in the arrangement close to its insertion.
Example: Supinator musclethe spiral course imparts rotational
movement to the radius.
Cruciate Muscle
Muscle fibers are arranged in superficial and deep planes
Examples:
Masseter
Sternocleidomastoid muscle.
MUSCLEII
MECHANISM OF LUBRICATION
Bursa
A bursa is a closed sac filled with lubricating synovial fluid.
Fig. 6.13: Spiral muscle

Muscular Tissue 115
It reduces friction and allows free movement between two mobile

but tightly apposed surfaces.
Types of Bursae
Subtendinous bursa is seen
It is seen wherever tendons rub against the resistant structure.

It intervenes between the tendon and bone.

Tendon and ligament and between two adjacent tendons.

Subcutaneous bursa
It is present over bony and ligamentous points subjected to
pressure and friction.
It appears between the skin and bony prominence, e.g. infra-
patellar bursa.
Articular bursais seen in relation with joint cavity
Submuscular bursalies deep to the muscle
Subfascial bursalies deep to the fascia
Communicating bursa is the bursa communicating with joint
cavity, e.g. subscapular bursa.
Tendon Synovial Sheath (Fig. 6.14)

It is tubular bursa that envelops the tendon.
It is in the form of two tubes one within the outer that are continuous
with each other at the ends.
The inner visceral tube adhere closely to the tendon.
It is separated from outer or perietal tube by potential synovial
cavity.
A synovial fold is present between two layers known as meso-
tendon which transmits vessels to the tendon.
Synovial sheath is required where a tendon is subjected to friction
or pressure
This condition occurs at the shoulder, hand and foot.
Fig. 6.14: Tendon synovial sheath

NOMENCLATURE OF THE MUSCLES

Names given to the individual muscle are usually based on their shape,
size and number of bellies or heads, position, depth, attachments or
action.
According to the Shape

1. Deltoidtriangular
2. Quadratussquare
3. Rhomboiddiamond-shaped
4. Lumbricalworm-like
Size
1. Major, minor, longus-longpectoralis major and pectoralis minor,
flexor pollicis longus
2. Brevis-shortextensor pollicis brevis.
3. Longissimus-longestlongissimus cervicis
Number of Heads or Bellies

1. Bicepstwo heads (Biceps brachii)
2. Tricepsthree heads (Triceps brachii)
3. Quadricepsfour heads (Quadriceps femoris)
4. Digastrictwo bellies (Anteror and posterior)
Position
1. Supraspinatusabove spine of scapula
2. Infraspinatusbelow the spine of scapula
3. Abdominisof the abdomen
External oblique abdominis
4. Orisof the mouth
Orbicularis oris.
Depth
1. Superficialis-superficialflexor digitorum superficialis
2. Profundus-deepflexor digitorum profundus
Muscular Tissue 117
3. Externus-externalexternal oblique abdominis

4. Internus-internalinternal oblique abdominis
Attachments
1. Sternocleidomastoidfrom the sternum and clavicle to the mastoid
process
2. Coracobrachialisfrom coracoid process to the arm.
Action
1. Extensor, flexorflexor pollicis longus
2. Adductor, abductorabductor pollicis longus
3. Levator, depressorlevator labii superioris
4. Supinator, pronatorsupinator muscle, pronator teres
5. Constrictor, dilatorconstrictor pupillae.
BLOOD SUPPLY OF THE SKELETAL MUSCLE

Blood supply is derived from muscular branches of the neighboring
arteries
The arteries, veins and the motor nerves pierce the muscle at the
particular point called as the neurovascular hilum.
These arteries break out into capillaries bed, which runs along
the muscle fiber in connective tissue (Perimycium, epimycium,
endomycium).
These vessels anastamose in the muscle to form a rectangular
network of small and large interconnecting branches.
Thus every muscle cell gets adequate blood supply and nutrition.
Some of the blood vessels enters the muscle independent of the
motor nerves and these are called as accessory blood vessels.
Veins, that drain the muscle usually accompany the artery.
LYMPHATIC DRAINAGE
Lymphatic drainage of muscle commences as capillaries in
epimycium and perimycium, but not endomyseal sheaths.
These converge to form larger lymphatic vessels which accompany
the veins to drain into the regional lymph nodes.
DEVELOPMENT OF SKELETAL MUSCLE (Fig. 6.15)

By the end of the fifth week of intrauterine life, prospective muscle
cells are collected into two parts.
A small dorsal portion the epimere formed from the dorsomedial
cells of the somites and larger ventral part the hypomere formed
by migration of dorsolateral cells of the somites.
Nerve innervating the segmental muscles are also divided into a
dorsal primary ramus for epimere and ventral primary ramus
for the hypomere.
These nerves will remain with their original muscle segment
throughout its migration.
Myoblasts from epimeres form the extensor muscle of the vertebral
column and of hypomeres give rise to the muscles of the limbs
and body wall.
NERVE SUPPLY OF THE SKELETAL MUSCLE (Fig. 6.16)

Motor Supply or Efferent Supply
Alpha efferent fibers (thickly myelinated)supply the extrafusal
fibers which are responsible for the movements by contraction.
Gamma efferent (thinly myelinated)supply intrafusal fibers of
muscle spindle for the maintenance of muscle tone.
Fig. 6.15: Development of skeletal muscle

Muscular Tissue 119
Fig. 6.16: Nerve supply of skeletal muscle
Unmyelinated sympathetic fibersprovide vasomotor supply to

the blood vessels.
Sensory or Afferent Nerve Supply

Free nerve endingswithin the muscle carry painful sensation.
Annulospiral and flower spray endings of the muscle spindle are
the stretch receptors and regulate the muscle tone.
Motor point: It is the point of entry of the nerve trunk, which usually
enters the deep surface of muscle.
Motor unit:
The number of muscle fibers in a voluntary muscle supplied by
a single nerve fiber arising from single motor neuron is called as
motor unit.
The motor unit is large or small.
Large motor unit: A single motor neuron supplies about 100200
muscle fibers, e.g. bulky muscle performing gross movements.
Small motor unit: A single motor neuron supplies only 510 muscle
fibers, e.g. small muscle performing delicate and precise movements.
Muscles of thumb
Muscles of eyeball.
Neuromuscular Junction (Fig. 6.17)

Motor end plate (En plaque terminals)found in fast muscles
(phasic contraction).
Tail endings (En grappe terminals)slow muscle (tonic contrac-
tions).
Motor End Plate

1. The junction between an axon terminal and muscle fiber is called
as motor end plate
2. The expanded axon terminal (presynaptic terminal) is not covered
by Schwann sheath and contains within it numerous small spherical
sacs (synaptic vesicles) and mitochondria.
Synaptic vesiclescontain a neurotransmitter called acetyl-
choline
The small gap between the plasma membrane of axon
(presynaptic membrane) and plasma membrane of muscle fiber
(postsynaptic membrane) is called synaptic cleft.
The postsynaptic membrane below the presynaptic membrane is
thrown into numerous folds to increase the surface area.
The sarcoplasm deep to it contains numerous nuclei and
mitochondria.
Fig. 6.17: Neuromuscular junction (Motor end plate)

Muscular Tissue 121
The impulse reaching the axon terminal causes release of

acetylcholine in the synaptic cleft, which binds with receptors
of the postsynaptic membrane and produces an action potential
in postsynaptic membrane (sarcolemma) to make the muscle
contract.
Neuromuscular Spindle (Fig. 6.18)

These are spindle shaped encapsulated specialized sensory receptor
organs distributed longitudinally between the fasciculi of the
extrafusal fibers of voluntary muscle.
They are concerned with the maintenance of muscle tone.
They act as stretch receptors.
Each muscle spindle is about 24 mm long and consists of fibrous
capsule, which contains about 214 intrafusal muscle fibers.
Intrafusal muscle fibers: is of two types:
1. Nuclear bag fibers
2. Nuclear chain fibers.
These two receptors are stimulated when intrafusal fibers are
passively stretched, during relaxation of extrafusal fibers of entire
muscle. And also when polar regions of intrafusal fibers contract
actively. Thus when extrafusal fibers relax the intrafusal fibers
contract.
Fig. 6.18: Neuromuscular spindle

Nuclear Bag Fibers

They are long and large
They present expansion in the equatorial regions called as nuclear
bags.
These bags contain collections of numerous nuclei.
The peripheral ends of these fibers extend beyond the capsule of
the spindle and are attached to perimycium of the extrafusal fibers.
Nuclear Chain Fibers

Short and narrow
Confined within the spindle capsule
Equatorial regions contain a chain of nuclei in single row
Polar ends of these fibers are attached to the capsule or to the sheath
of nuclear bag fibers.
Sensory and Motor Nerves Innervate Intrafusal Fibers

Sensory nerve terminals are of two types:
Annulospiral (primary nerve endings)

Flower spray (secondary nerve endings) both varieties are stretch

receptors.
Annulospiral endings: Surround the equatorial regions of both nuclear
bag and nuclear chain fibers.
Flower spray endings: Enwrap the nuclear chain fibers only. They
are distributed on one or bothsides beyond the equatorial regions.
Motor Nerve Terminals

They are also called as fusimotor fibers.
They supply the polar regions of intrafusal muscles.
The fusimotor fibers when stimulated produce contraction of the
polar regions and eventually the stretch receptors.
MUSCLE TONE
It means a partial state of contraction of a muscle to maintain a constant
muscle length. Therefore, a muscle is not completely relaxed even
in the resting condition.
Muscular Tissue 123
Regulation of Muscle Tone

When the extrafusal fibers of the entire muscle are relaxed, the muscle
spindles are stretched. The afferent impulses thus produced reach
the spinal cord by way of pseudo-unipolar cells to the dorsal root
ganglion and establish mono-synaptic relay with alpha neurons and
gama neurons of the anterior horn cells. Alpha neurons in their turn
fire upon the extrafusal fibers and maintain constant muscle length.
ACTIONS OF MUSCLE
To produce a movement following group of muscles are involved.
1. Prime movers
2. Antagonists
3. Fixation muscle
4. Synergists
Prime Movers
A muscle or group of muscles that directly bring about a desired
movement, e.g. biceps brachii.
Antagonists
These muscles appose the desired movement.
They help prime movers by active relaxation to perform smooth act.
This is due to law of reciprocal innervations, e.g. triceps brachii.
Fixation Muscle
These are group of muscles, which stabilize the proximal joints of a
limb. Thus allow movements at the distal joints by the prime movers,
e.g. biceps brachii.
Synergists Muscle
When a combined action of group of muscles produce a particulate
movement. For example, flexor carpi ulnaris and flexor carpi radialis
by their combined action produce the flexion of wrist joint, but acting
individually the former is adductor and the latter is abductor of the
wrist.
APPLIED ANATOMY
Paralysis
Loss of motor power (power of movement) is called paralysis. This
is due to inability of the muscle to contract caused either by damage
to the motor neural pathway (upper or lower motor neuron), or by
the inherent disease of muscle (myopathy).
Damage to the upper motor neuron causes spastic paralysis with
exaggerated tendon reflex jerks.
Damage to the lower motor neuron causes flaccid paralysis with
loss of tendon jerks.
Muscular Spasm
These are quite painful. Localized muscle spasm is commonly caused
by a muscle pull. In order to relieve its pain the muscle should be
relaxed by appropriate treatment. Generalized muscle spasm occurs
in tetanus and epilepsy.
Disuse Atrophy and Hypertrophy

The muscles which are not used for long time become thin and weak.
This is called as disuse atrophy. Conversely, adequate or excessive use
of particular muscle causes better development, or even hypertrophy.
Myasthenia Gravis
Myasthenia gravis is a neuromuscular disorder characterized by
weakness and fatigue of skeletal muscle. The underlying defect is the
decrease in the number of available acetylcholine receptors at neuro-
muscular junction due to an antibody mediated autoimmune attack.
As a result muscles exhibit a degree of flaccid paralysis.
In Organophosphorus Poisoning
Due to ingestion of some insecticides containing organophosphates.
These organophosphates bind to and inhibit the action of acetylcholine.
This result in accumulation of acetylcholine leading to hyperexcitation
of the muscle. As a result skeletal muscles responsible for respiration
contract continuously but cannot relax (spastic paralysis) which is
Muscular Tissue 125
followed by fatigue. Consequently death occurs due to spastic paralysis

of muscles of respiration.
Review QUESTIONS
1. The characteristic features of smooth muscle fiber are:
a. Prominent striations b. Peripheral nucleus
c. Central nucleus d. Multineucleated
2. Slow twitch fibers are:
a. Rich in myohemoglobin b. Poor in mitochondria
c. Rich in glycogen d. Contract rapidly
3. One of the following is an example of bipennate muscle:
a. Sartorius b. Rectus femoris
c. Flexer pollicis longus d. Deltoid
4. The branching network of muscle fibers is seen in:
a. Smooth muscle b. Skeletal muscle
c. Cardiac muscle d. Myoepithelial cells
5. Tibialis anterior is following type of muscle:
a. Unipennate b. Bipennate
c. Multipennate d. Circumpennate
6. Myoepithelial cell is:
a. Ectodermal in origin
b. Mesodermal in origin
c. Endodermal in origin
d. Party from ectoderm and party from mesoderm in origin
Answers
1.c2.a3.b4.c5.d6.a
II. D
escribe the fascicular architecture of muscle and also describe
the nerve supply of muscle.
1. Skeletal muscle
2. Motor end plate
3. Neuromuscular spindle
4. Muscle tone
5. Cardiac muscle.
7 Nervous Tissue
NERVOUS TISSUEI
INTRODUCTION
Nervous system is the chief controlling and coordinating system
of the body.
It controls and regulates all activities of the body both voluntary on
and involuntary and also adjusts the individual to the surroundings.
This is based on special properties of sensitivity, conductivity and
responsiveness of the nervous system.
PARTS OF THE NERVOUS SYSTEM

The nervous system is broadly divided into:
Central nervous systemwhich consists of brain and spinal cord
Peripheral nervous systemcomposed of 12 pairs of cranial nerves
and 31 pairs of spinal nerves.
The central and peripheral system each have:
Somatic component
Autonomic component
Somatic components: It is concerned with innervations of skeletal
muscle (along efferent pathways) and the transmission of sensory
information (along afferent pathways).
Autonomic components: It is concerned with the control of cardiac
muscle, smooth muscle, and glands (involving afferent and efferent
pathways).
Nervous Tissue 127
Structure of the nervous tissue:

Nervous tissue consists of:
Neurons or nerve cells
Supporting tissue.
Neurons: Peculiarities of Neurons

The neurons do not proliferate by mitosis.
Their number is constant since birth.
In intrauterine life nerve cells proliferate during histogenesis from
the neuroblasts.
There are around 10,000 million of neurons in the cerebral cortex
of the human brain.
Indeed if the nerve cells increase in number in postnatal life we
would have fleeting memories.
Supporting Tissue
It is called neuroglia in the central nervous system.
In the peripheral nervous system, it is formed by Schwann cells and
capsular cells. These cells undergo mitotic divisions.
Most of the brain tumors are neuroglial, meningeal or vascular.
Neuron (Fig. 7.1)

The structural and functional unit of nervous system is the nerve
cell or neuron.
Thus neuron is the name given to the nerve cell and its processes.
They are excitable cells that are specialized for the reception of the
stimuli and conduction of the nerve impulse.
Each neuron possesses a cell body or Perikaryon from whose
surface projects one or more processes called neurites.
Those neurites responsible for receiving information and conducting
it towards the cell body are called dendrites.
A single long neurite that conduct the impulses away from the cell
body is called axon. The dendrites and axon are called as nerve
fibers. Neurons are found in brain, spinal cord and ganglia.
Fig. 7.1: Neuron
Structure of the Neuron (Fig. 7.2)

Each neuron consists of a cell body and neurites (processes):
A nerve cell body consists of a mass of cytoplasm in which a nucleus
is embedded.
It is bounded externally by a cell membrane.
The cell body of small granular cells of cerebellar cortex measures
5 m in diameter.
And of large anterior horn cell measures 135 m in diameter.
Fig. 7.2: Structure of neuron

Nervous Tissue 129
Nucleus
It is centrally located and is large, rounded, pale and fine chromatin
granules are widely dispersed.
There is single prominent nucleolus, which is concerned with the
synthesis of ribonucleic acid (RNA).
Cytoplasm is rich in granular and agranular endoplasmic reticulum
and contains the following cell organelles:
1. Nissl substance
2. Golgi apparatus
3. Mitochondria
4. Microfilaments
5. Microtubules
6. Lysosomes
7. Centrioles
8. Lipofuscin, melanin, glycogen and lipids.
Nissl substance consists of granules that are distributed
throughout the cytoplasm of the cell body except for the region
close to the axon called as Axon Hillock.
The granular material also extends into the proximal parts of
the dendrites.
The granular material not present in the axon.
Nissl substance synthesize proteins, which flow along the
dendrites and axon, and replace the proteins that are broken
down during cellular activity.
Cytoplasm
It is interesting to note that the volume of cytoplasm within the nerve
cell body is often far less than the total volume of cytoplasm in the
neurites.
CLASSIFICATiON OF NEURONS
Neurons are classified as:
According to the polarity
According to the functions
According to relative length of axons and dendrites.
According to Polarity (Figs 7.3A to C)

Unipolar
Pseudounipolar
Bipolar
Multipolar.
Unipolar Neurons
This neuron develops as unipolar cell and sends out single process.
True unipolar cells are found in lower vertebrates.
Neurons in mesencephalic nucleus of trigeminal nerve is
considered as unipolar neuron.
Pseudounipolar Neurons
The cell body of this neuron has a single neurite that divides a short
distance from the cell body into two branches.
One branch enters the central nervous system.
Other proceeds to the same peripheral structure.
Figs 7.3A to C: Classification of neurons (According to polarity).

(A) Unipolar neuron; (B) Bipolar neuron; (C) Multipolar neuron
Nervous Tissue 131
The fine terminal branches at the peripheral end of the axon at the
receptor site are often called as dendrites.
For example, Neurons of the dorsal root ganglion of all spinal
nerves.
Bipolar Neurons
These are spindle shaped cells.
Dendrite extends from the periphery to the cell bodyAxon passes
from the cell body into the nervous system.
Examples:
Olfactory cells of nasal mucous membrane
Bipolar cells of retina
Ganglion cells of auditory nerve.
Multipolar Neurons
Have number of neurites arising from the cell bodyThe long
process is the axon.
The remaining neurites are the dendrites, e.g. most neurons of brain
and spinal cord.
According to Function
Neurons may be classified as:
Sensory
Internuncial
Motor
Sensory or Receptor Neurons

These are bipolar or pseudounipolar neurons
The bodies of all sensory neurons lie outside CNS, except the
mesencephalic nucleus of the trigeminal nerve.
Internuncial or Connector Neurons

These type of neurons connect sensory with motor nerve cells.
They are multipolar in character.
They are located in central nervous system.
For example, majority of ascending and descending tracts are axon
of connecting neurons.
Motor or Efferent Neurons

They are multipolar in character.
They are located in central nervous system.
xcept postganglionic neurons of ANS (Autonomic nervous
E
system).
Motor neurons are of two types:
Upper motor neuronconfined within the cortex of brain
Lower motor neuronconfined in anterior gray column of
spinal cord and brainstem.
In Autonomic Nerves
They are arranged in two sets:
Preganglionic neurons lie within the central nervous system
As craniosacral outflow for parasympathetic nerves
As thoracolumber outflow for sympathetic nerves
Postganglionic neurons
are situated outside the central nervous system.
According to Relative Length of Axons and Dendrites

(Figs 7.4A to C)
Golgi type-I neuron
Golgi type-II neuron
Golgi Type-I Neuron

Have a long axon that may be one meter long or more
Dendrites are short and numerous, e.g. pyramidal cells of cerebral
cortex
Purkinje cells of cerebellar cortex.
Golgi Type-II Neurons

Have a short axon
Dendrites short and numerous
The neurons have star shaped appearance, e.g. neurons in cerebellar
cortex.
Nervous Tissue 133
Figs 7.4A to C: Classification of neurons (according to relative length

of axons and dendrites). (A) Pyramidal cell; (B) Purkinje cell;
(C) Granule cell
SYNAPSE (Fig. 7.5)

Synapses are specialized junctions between two or more adjacent
neurons.
The axon of one neuron divides into number of terminal boutons
or end bulbs which come in contact with the dendrite or the cell
body of another neuron.
Two neurons participate in the formation of a synapse.
The essential components of synapse are:
Presynaptic membrane
Synaptic cleft
Postsynaptic membrane
Presynaptic membrane is formed by the knob like end of an axon.
Synaptic cleft is the space separating the axon terminal and the
cell with which it synapses.
Postsynaptic membraneThe membrane opposed to the presyn-
aptic terminal.
Fig. 7.5: Structure of synapse
Mechanism of Synaptic Transmission

A synaptic cleft is about 200300A wide intervenes between
pre- and postsynaptic membrane. On both sides of the cleft there is
dense zone of cytoplasm and both pre- and postsynaptic membrane
are thickened.
The end bulb of presynaptic neuron contains numerous
mitochondria and synaptic vesicles. These synaptic vesicles contain
catecholamine (epinephrine, dopamine).
During transmission of nerve impulse, the synaptic vesicle move
towards the presynaptic membrane and discharge the stored
chemical substances into the synaptic cleft by a process of
exocytosis.
The neurotransmitter diffuses across the synaptic cleft to bind
with the receptors in the postsynaptic membrane and thus the
transmission of nerve impulses occurs.
Classification of Synapses (Figs 7.6A to C)

They are classified into three basic types:
Axoaxonic
Axosomatic
Axodendritic
Nervous Tissue 135
Figs 7.6A to C: Classification of synapses. (A) Axoaxonic;

(B) Axosomatic; (C) Axodendritic
Axoaxonic Synapses
These are least common
In this type, an axon of presynaptic neuron makes synapse with the
axons of postsynaptic neuron.
Axosomatic Synapses
These are less common
These involve contact between the axon terminals and the soma or
cell body of postsynaptic neuron.
Axodendritic Synapses
These are most common
In this, the presynaptic axon makes contact with the postsynaptic
stem dendrites or dendritic spines.
NEUROGLIA
Neuroglia are the supporting cells of the central nervous system.
The glial cells unlike the nerve cells are nonexcitable and undergo
mitotic division.
Brain tumors are mostly neuroglial, meningeal or vascular in

origin.
The number of neuroglia is 10 times more than that of nerve cells.
Classification of Neuroglia (Figs 7.7A to D)

They are classified into:
Macroglia cells
Microglia cells
Macroglia
Macroglia cells develop from neuroectoderm and include:
Astrocytes
Oligodendrocytes
Ependymal cells
Macroglia cells develop from neuroectoderm
Microglia cells develop from mesoderm.
Astrocytes
Have small cell bodies with branching processes that extend in all
directions.
Figs 7.7A to D: Classification of neuroglia. (A) Protoplasmic astrocyte;

(B) Fibrous astrocyte; (C) Oligodendrocyte; (D) Microglial cell
Nervous Tissue 137
There are two types of astrocytes:

Fibrous
Protoplasmic.
Fibrous Astrocytes
Are found mainly in the white matter
Each process is long slender and smooth
Cell bodies and processes contains many filaments, which course
through cytoplasm.
Protoplasmic Astrocytes
Are found mainly in the gray matter, where their processes ramify
among the nerve cell bodies.
The processes are shorter, thicker and more branched.
The cytoplasm of these cells contain fewer filaments.
Functions of Astrocytes
Astrocytes with their branching processes form a supporting
framework for the nerve cells and the nerve fibers:
They serve as phagocytes by taking up degenerating synaptic
action terminals.
Following the death of neuron due to disease, they proliferate and
fill the spaces previously occupied by neurons a process called as
Regeneration Gliosis.
Oligodendrocytes
They have smaller cell bodies and few dendritic processes.
The filaments are absent in the cytoplasm.
They are found in rows, along nerve fibers or surrounding nerve
cell bodies.
Responsible for the formation of the myelin sheath of nerve fibers
in central nervous system.
Oligodendrocytes surround nerve cell bodies (satellite
oligodendrocytes) and form capsular cells of peripheral sensory
ganglion.
Ependymal Cells
These cells line the cavities of the brain and spinal cord.
They are cuboidal or columnar in shape with cilia and microvilli.
There main function is circulation of cerebrospinal fluid within
ventricular system.
Microglia Cells
Microglia cells develop from Mesoderm.
These are the smallest cells scattered throughout the central nervous
system.
Their function is phagocytosis of damaged nervous tissue.
NERVOUS TISSUEII
REFLEX ARC (Fig. 7.8)

Reflex arc is the basic functional unit of the nervous system.
It is defined as a response to stimulus in a muscle or a gland.
Reflex arc involves two or more neurons and consists of at least
five fundamental parts:
A receptorwhich responds to a stimulus of some kind, e.g.
skin.
A sensory neuron or afferent neuronwhich occupies the
dorsal root ganglion of spinal nerve.
An association neuron in the spinal cord.
A motor neuronwhich occupies anterior gray column of
the spinal cord or corresponding neuron of the brainstem and
transmits the impulse to the effector organ
Fig. 7.8: Reflex arc

Nervous Tissue 139
An effector organsuch as muscle or gland that carries out

the actual response.
When finger is touched with the pin. The sensory receptors in skin
respond to stimuli and produce an action potential in the sensory
neuron.
These impulses are transferred by sensory neuron to the motor
neuron via an association neuron in the spinal cord.
The motor neuron carry impulses from spinal cord to the muscles
(effector organ), which responds to stimulus and moves the finger
away.
Thus an involuntary motor response of the body is called as Reflex
Action.
For example, stretch reflex (tendon jerks), (monosynaptic reflex)
withdrawal reflex (response to painful stimulus) is a polysynaptic
reflex.
Nerve Fibers and Formation of Myelin Sheath

A nerve fiber is a name given to an axon of nerve cell.
Bundles of nerve fibers in the central nervous system are called
as tracts.
Bundles of nerve fibers in the peripheral nervous system are called
as Peripheral nerves.
There are two types of nerve fibers in both central and peripheral
nervous system:
Myelinated nerve fibers
Non-myelinated nerve fibers.
Myelinated Nerve Fibers

A myelinated nerve fiber is surrounded by myelin sheath.
In the central nervous system, the myelin sheath is formed by
Oligodendrocytes.
In peripheral nervous system, the myelin sheath is formed by
Schwann cell.
The myelin sheath is a segmented discontinuous layer interrupted
at regular intervals by the Nodes of Ranvier.
Each segment of the myelin sheath measures approximately
0.51 m in length.
In CNS, each oligodendrocyte may form myelin sheath for 60 nerve

fibers (axons)
In PNS, there is only one Schwann cell for each segment of one
nerve fiber.
Non-myelinated Nerve Fibers

These fibers are gray in color.
They are present in gray matter of brain and spinal cord.
All postganglionic fibers of autonomic nervous system are non-
myelinated.
Somatic fibers of less than 1 m in diameter are non-myelinated.
Formation of Myelin Sheath (Fig. 7.9)

Myelin sheath is formed when an axon comes to be associated with
certain neuroglial cells that provide a sheath for it.
An axon lying near the Schwann cell invaginates into the cytoplasm
of the Schwann cell.
In this process the axon comes to be suspended by a fold of the cell
membrane of the Schwann cell this fold is called as Mesoaxon.
The mesoaxon becomes greatly elongated and comes to be spirally
wound around the axon, which is thus surrounded by several layers
of the cell membrane.
Lipids are deposited between adjacent layers of the cell membrane.
Fig. 7.9: Formation of myelin sheath

Nervous Tissue 141
These layers of mesoaxon along with the lipids form the Myelin
sheath.
Outside the myelin sheath, a thin layer of Schwann cell cytoplasm
persists to form an additional sheath which is called Neurolemma
also known as Schwann cell sheath.
The presence of myelin sheath increases the velocity of conduction
(for a nerve fiber of same diameter).
It also reduces the energy expended in the process of conduction.
An axon is related to a large number of Schwann cells over its
length.
Each Schwann cell provides the myelin sheath for a short segment
of axon.
At the junction of any such two segments there is short gap in the
myelin sheath.
These gaps are called as Nodes of Ranvier (Fig. 7.10A).
The non-myelinated axons invaginate into the cytoplasm of
Schwann cells but the mesoaxons does not spiral around all of them.
Several such axons may invaginate into the cytoplasm of a single
Schwann cell (Fig. 7.10B).
Figs 7.10A and B: Non-myelinated axons. (A) Nodes of ranvier;

(B) Schwann cell
PERIPHERAL NERVES (Fig. 7.11)

The peripheral nerves are the cranial and spinal nerves.
Each peripheral nerve consists of parallel bundles of nerve fibers,
which may be efferent or afferent axons, and may be myelinated or
unmyelinated, and surrounded by connective tissue sheath.
The nerve trunk is surrounded by dense connective tissue sheath
called as Epineurium.
Within the sheath are the bundles of nerve fibers each of which is
surrounded by a connective tissue sheath called as Perineurium.
Individual nerve fiber is surrounded by delicate connective tissue
sheath called as Endoneurium.
Peripheral nerve fibers are classified into three groups.
1. Group A fibers: They are 120 m in diameter.
Conduction velocity is 5120 meters per second, e.g. myelinated
somatic efferent and afferent fibers.
2. Group B fibers: They are 13 m in diameter
Conduction velocity is 315 meters per second, e.g. myelinated
efferent preganglionic autonomic fibers.
Fig. 7.11: Peripheral nerve (transverse section)

Nervous Tissue 143
3. Group C fibers: They are 0.52 m in diameter.

Conduction velocity is 0.52 meters per second, e.g. non-myelinated
afferent or efferent postganglionic fibers.
INJURIES TO NEURONS AND PERIPHERAL NERVES AND

THEIR DEGENERATION AND REGENERATION
Injury to Neuron
Severe damage of nerve cell body may occur due to trauma
interference with blood supply or due to disease.
This may result in degeneration of the entire nucleus including its
dendrites and synaptic endings.
The neuronal debris and fragments of myelin are engulfed and
phagocytosed by microglia cells.
Neighboring astrocytes proliferate and replace neuron by scar
tissue.
Injury to Peripheral Nerves

Peripheral nerves, if injured may regenerate with restoration of
functions due to presence of neurolemma sheath and endoneural
tubes.
Effect of Nerve Injuries

1. Changes in the cell body
2. Changes in nerve fiber.
Changes in the Cell Body (Retrograde Degeneration)

The cell body undergoes chromatolysis within 48 hours of injury.
Nissl bodies disintegrate and disappear.
Cell becomes swollen, nucleus becomes eccentric.
Usually chromatolysis is reversible process due to which Nissl
bodies reappear and proteins are synthesized.
This helps in re-growth of axon in proximal segment.
Changes in Nerve Fiber

Stages of degeneration (Wallerian degeneration)
Distal to the site of injury (Antegrade
degeneration) degeneration extends
from the site of injury to the
The Leprosy bacilli attack
termination of axon. the nerves by entering the
Myelin sheaths disintegrate into skin and travelling proximally
oily droplets and are removed by within the endoneurium
Schwann cells. damaging the Schwann cells
Schwann cells proliferate by mitosis and thereby degenerating the
and form longitudinal Bands of nerve fibers.
Bunger, which fills the endoneural
tubes.
Macrophages from the endoneurium remove the debris of myelin
sheaths and axon by phagocytosis.
Stages of Regeneration
During regeneration
The tip of surviving (proximal)
Sometimes penetrating
axon shows an active growth.
wound of parotid gland
Small axonal sprouts grow into
damages the Auriculotem-
surrounding tissue.
poral and Great Auricular
One sprout succeeds in reaching
nerves. During healing, the
the endoneural tube.
fibers of auriculotemporal
It survives and grows rapidly.
join the great auricular nerve
When the growing axon tip
through which fibers reach
reaches and reinnervates the
the sweat glands in the facial
peripheral end organ.
skin. Therefore, when patients
The surrounding Schwann cells
eats, beads of perspiration
lay down myelin sheath with
appear on skin covering the
appropriate nodes of Ranvier.
Parotid. This complication is
The regeneration of proximal
called as Freys syndrome.
axon takes place with the guiding
factor of neurolemmal sheaths.
Thus a nerve regenerates because
of presence of Neurolemmal
Sheaths.
Nervous Tissue 145
AutoNOMIC NERVOUS SYSTEM

The nervous system may be broadly classified into:
1. Central and peripheral
2. Somatic and autonomic nervous system.
Somatic Nervous System

Deals with the changes in the external environment (exteroceptive
and proprioceptive) and gives the response there of by reflex
activities.
In a typical spinal reflex arc, three neurons are involved
A sensory neuron (dorsal root ganglion) of spinal nerve
A connector or interneuronin gray column of spinal cord
Effector or motor neuronin anterior gray column of spinal
cord.
In cranial nerves
Nuclei of these nerves are located in the brainstem.
The axons of motor neurons go straight to the target striated muscle
and supply both extrafusal and intrafusal fibers.
Autonomic Nervous System

Deals with any changes in internal environment, and controls
involuntary activities of the body.
It possesses motor and sensory components.
Motor Components
Presents two sets of neurons:
1. Preganglionic
2. Postganglionic
The effector or target cells supplied by postganglionic motor
neurons are of three types:
1. Cardiac muscle
2. Smooth muscle
3. Glands
Sensory Components
Sensory neurons are located in the dorsal root ganglion of some spinal
nerves and sensory ganglions of some cranial nerves.
Thus, difference between somatic and autonomic nervous system
are as follows:
Serial number Somatic efferents Autonomic efferents
1 Motor fibers consists of Two successive set of
single set of neurons neurons preganglionic
postganglionic
2 Effector cell is of only Effector cell consists
one type, i.e. skeletal of three types cardiac
muscle muscle smooth muscle
glandular cells
3 Stimulation of effector Produce either excitatory
cells produce excitatory or inhibitory responce
response
Subdivisions of Autonomic Nervous System

1. Sympathetic
2. Parasympathetic
Sympathetic Nervous System (Fig. 7.12)

It arises from T1 to L2 segments of spinal cord.
Thus called as thoracolumbar outflow.
The preganglionic motor neurons arise from lateral horn cells of
spinal cord.
Preganglionic fibers relay in:
Lateral ganglion
Collateral ganglion, and
Terminal ganglion
Lateral ganglion is represented by sympathetic chain.
Collateral ganglions are represented by:
Coeliac
Superior mesenteric
Inferior mesenteric
Aorticorenal
Superior hypogastric ganglion.
Nervous Tissue 147
Fig. 7.12: Sympathetic nervous system
Terminal ganglions are found only in suprarenal medulla

(represented by chromaffin cells).
The postganglionic fibers:
Liberate noradrenaline on the surface of effector cells.
Thus called as adrenergic system
One preganglionic sympathetic fiber makes synaptic connections
with twenty or more postganglionic neurons.
The afferent sympathetic fibers:
Convey visceral pain sensation and their cell bodies are located in
pseudounipolar neurons in dorsal root ganglion of T1 to L2.
All thoracic and upper two lumber spinal nerves.
Effect of sympathetic stimulation

Vasoconstriction of cutaneous blood vessels
Dilatation of pupils
Acceleration of heart rate
Suppression of intestinal peristalsis
Sphincters of gut are closed.
Parasympathetic Nervous System (Fig. 7.13)

The preganglionic motor neurons are partly located in brainstem
in connection with 3rd, 7th, 9th, 10th cranial nerve nuclei.
Fig. 7.13: Parasympathetic nervous system
Lateral horn cells of 2nd to 4th sacral segments of spinal cord.

Therefore, this is called as craniosacral outflow.
The postganglionic neurons consists of:
Collateral ganglia
Terminal ganglia
Collateral ganglia are represented by:
Ciliary ganglion for 3rd cranial nerve
Pterygopalatine ganglion for 7th nerve
Submandibular ganglion for 7th cranial nerve
Otic ganglion for 9th cranial nerve.
Terminal ganglia are located in the walls of target organs in the
form of:
Neurons within the lung roots
Around SA node of the heart
Myenteric plexus of Auerbachs
Submucous plexus of Meissners.
Postganglionic fibers liberate acetylcholine.
Hence called as cholinergic system.
One preganglionic fiber connects with one or two postganglionic
neurons.
The afferent parasympathetic fibers convey:
General visceral sensations
Visceral pain from pelvic organs, and
Their cell bodies are located in superior and inferior ganglia
of glossopharyngeal nerve.
Inferior ganglion (nodose ganglion) of vagus nerve.
Dorsal root ganglion 2nd to 4th sacral spinal nerves.
Nervous Tissue 149
Effect of Parasympathetic Stimulation

Localized and accurate
Heart rate is diminished
Blood pressure falls
Constriction of pupils
Peristalsis and glandular secretions increase.
Review QUESTIONS
1. Nissl granules are absent in:
a. Dendrites b. Axon hillock
c. Cell body d. Nucleus
2. Bipolar neurons are present in:
a. Dorsal root ganglion b. Retina
c. Sympathetic ganglion d. Spinal cord
3. Golgi type II neurons are present in:
a. Cerebellar cortex b. Cerebral cortex
c. Pons d. Midbrain
4. Myelination in peripheral nerves is done by:
a. Oligodendrocytes b. Microglia cells
c. Schwann cells d. Astrocytes
5. Pyramidal cells are present in:
a. Cerebellum b. Cerebrum
c. Spinal cord d. Sympathetic ganglion
Answers
1.b2.b3.a4.c5.b
II. Write classification of neurons and describes the Autonomic
nervous system.
1. Synapse
2. Schwann cells
3. Myelin sheath
4. Reflex arc
5. Peripheral nerves.
8 Blood Vascular
System
Introduction
Vascular system is a transport system of the body through which
nutrients are conveyed to places where they are utilized and the
metabolites (waste products) are conveyed to appropriate places
from where they are excreted.
The conveying medium is a liquid tissue, the blood which flows in
tubular channels called blood vessels.
The circulation is maintained by the central pumping organ called
the heart.
About 5 litres of blood is contained in the vascular system.
COMPONENTS OF THE VASCULAR SYSTEM (Fig. 8.1)

It is a closed system of tubes made up of the following parts:
Heart
Arteries
Veins
Capillaries.
Heart
It is a four chambered muscular organ which pumps blood to various
parts of the body.
Each half of the heart has a receiving chamber called atrium and
a pumping chamber called ventricle.
Blood Vascular System 151
Fig. 8.1: Components of vascular system
Arteries
These are distributing channels which carry blood away from the
heart.
They branch like trees on their way to different parts of the body.
The large arteries are rich in elastic tissue, but as branching
progresses there is smooth muscle in their walls.
The minute branches which are just visible to the naked eye are
called arterioles.
Veins
These are draining channels which carry blood from different parts
of the body to the heart.
Like rivers, the veins are formed by tributaries.
The small veins (venules) join together to form larger veins which
in turn unite to form great veins called venae cavae.
Capillaries
These are networks of microscopic vessels which connect
arterioles with the venules.
They come in intimate contact with the tissues for a free exchange
of nutrients and metabolites across their walls between the blood
and the tissue fluid.
Capillaries are replaced by sinusoids in certain organs like liver
and spleen.
Functionally blood vessels can be classified into five groups:
a. Distributing vessels including arteries
b. Resistance vessels including arterioles and precapillary
sphincters.
c. Exchange vessels including capillaries, sinusoids, postcapillary
venules.
d. Reservoir vessels including large venules and veins.
e. Shunts including various types of anastamosis.
TYPES OF CIRCULATION OF BLOOD (Figs 8.2 to 8.4)

1. Systemic circulation
2. Pulmonary circulation
3. Portal circulation.
Systemic Circulation
From the left arium the oxygenated blood reaches the left ventricle
which pumps the blood to the remotest capillaries through the aorta
and its branches.
At the capillaries nutritive materials and oxygen pass from the
blood to the tissues.
Through them waste products and carbon dioxide return from the
tissues to the blood.
Finally blood is returned to the heart through the venules, veins,
superior vena cava and inferior vena cava.
Pulmonary Circulation
The right atrium receives the venous blood from superior vena
cava, inferior vena cava and from coronary sinus and conveys it to
the right ventricle.
Fig. 8.2: Type of circulation (Systemic)
Fig. 8.3: Type of circulation (Pulmonary and portal)

In turn, the right ventricle pumps the blood to the capillary plexus
of the lungs via the pulmonary trunk.
Here in the carbon dioxide is exchanged for oxygen.
The oxygenated blood reaches the left atrium via the pulmonary
veins.
Fig. 8.4: Type of circulation (Systemic and pulmonary)

Portal Circulation
It is a part of systemic circulation which has the following characteristics:
Blood passes through two sets of capillaries before draining into
a systemic veins.
Vein draining the first capillary network is known as portal vein
which branches like an artery to form a second set of capillaries
or sinusoids, e.g. hepatic portal circulation, hypophyseal portal
circulation and renal portal circulation.
CLASSIFICATION OF BLOOD VESSELS

Blood vessels are classified as under:
Arteries
Arterioles
Capillaries
Sinusoids and cavernous tissues
Venules and veins.
Arteries (Fig. 8.5)

Characteristic features of arteries:
Arteries are thick walled being uniformly thicker than accompanying
veins except for the arteries within the cranium and vertebral canal
where they are thin.
Their lumen is thinner than accompanying veins.
Arteries have no valves.
Fig. 8.5: Structure of artery and vein

An artery is usually accompanied by vein and nerve and the three

together form the neurovascular bundle which is surrounded and
supported by a fibroareolar sheath.
Types of Arteries and Structure

Large arteries of elastic type (aorta and pulmonary artery).
Medium and small arteries of muscular type, e.g. Temporal,
occipital, radial, popliteal artery.
Smallest arteries of muscular type (arterioles)
The arteries measure between 50100 microns. They divide into
terminal arterioles with 1520 micron diameter which have one or
two layers of smooth muscle in their walls.
Side branches from terminal arterioles are called as metarterioles
which measure about 1520 microns at their origin and 5 microns
at their termination.
The terminal narrow end is surrounded by a precapillary sphincter
which regulates the blood flow into the capillary bed.
The muscular arterioles are responsible for generating peripheral
resistance and thereby for regulating the diastolic blood pressure.
Microscopically
All arteries are made up of three coats:
Inner coatTunica intima
It is formed by a layer of flattened endothelial cells which are
supported by subendothelial areolar tissue and fenestrated
internal elastic lamina.
Middle coatTunica media
It is thickest of all coats, and
Made up of smooth muscle and elastic tissue arranged circularly.
It is limited externally by a fenestrated external elastic lamina.
Outer coatTunica adventitia
It is thin but strongest of all coats.
It is made up of longitudinally arranged fibers of both collagen
and elastic tissue making it fibroelastic.
Blood Supply of Arteries (Fig.8.6)

Large arteries (of more than 1 mm in diameter) are supplied with
blood vessels.
These nutrient vessels are called vasa-vasorum which form a dense
capillary network in the tunica adventitia.
Fig. 8.6: Blood supply of artery
They supply adventitia and outer part of tunica media.

The rest of the vessel wall (intima + inner part of tunica media) is
nourished directly by diffusion from the luminal blood.
Fenestrations in the elastic laminae facilitate the diffusion.
Nerve Supply of Arteries

The nerves supplying an artery are called nervi vasularis.
These nerves are mostly non-myelinated sympathetic fibers which
are vasoconstrictor in function.
A few fibers are myelinated, and are believed to be sensory to the
outer and inner coats of the arteries.
Capillaries
Capillaries (capillus = Hair) are networks of microscopic endothelial
tubes interposed between the metarterioles and venules.
The true capillaries (without any smooth muscle cell) begin after
a transition zone of 50100 microns beyond the precapillary
sphincters.
The capillaries are replaced by cavernous (dilated) space in the sex
organs, splenic pulp and placenta.
Size
The average diameter of a capillary is 68 microns, just sufficient
to permit the red blood cells to pass through in single file.
But the size varies from organ to organ.
It is smallest in the brain and intestine, and is largest (20 microns)
in the skin and bone marrow.
Types of Capillaries and Structure (Figs 8.7 and 8.8)

The capillaries are classified as continuous and fenestrated
according to the type of junctions between the endothelial cells.
Continuous capillaries are found in the skin, connective tissue,
skeletal and smooth muscles, lung and brain. They allow passage
of small molecules across their walls (up to 10 m size).
Fenestrated capillaries are found in the renal glomeruli, intestinal
mucosa, endocrine glands and pancreas. They allow passage
across their walls of larger molecules (up to 20100 mm size).
The capillary wall is composed of:
A single layer of endothelial cells,
A basal lamina of glycoprotein which surrounds the
endothelial cells and splits at places to enclose pericapillary
cells called pericytes, and
A pericapillary layer of connective tissue cells and fibers.
The capillary bed and postcapillary venules form an enormous area
for the exchange of nutrients, gases, metabolites and water, between
the blood and interstitial fluid.
Fig. 8.7: Structure of capillary (Continuous type)
Fig. 8.8: Structure of capillary (Fenestrated type)

Capillaries also allow migration of leukocytes out of the vessels.

Sinusoids (Fig. 8.9)
Sinusoids replace capillaries in certain organs, like liver, spleen, bone
marrow, suprarenal glands, parathyroid glands, carotid body, etc.
Characteristics
Sinusoids are large irregular vascular spaces which are closely
surrounded by the parenchyma of the organ.
They differ from capillaries in the following respects:
Their lumen is wider (upto 30 microns) and irregular
Their walls are thinner and may be incomplete. They are lined
by endothelium in which the phagocytic cells (macrophages) are
often distributed. The adventitial support is absent, and the basal
lamina is replaced by a thin layer of reticular fibers.
They may connect arteriole with venule (spleen, bone marrow)
or venule with venule (liver).
Cavernous Tissues
These are blood-filled spaces lined by endothelium and surrounded
by trabeculae. The latter contain smooth muscle fibers. The
arterioles and venules directly open into these spaces.
The cavernous tissues are present in the erectile tissues of the penis
or clitoris and in the nasal mucous membrane.
Veins (Figs 8.10 and 8.11)

Characteristic Features
Veins are thin-walled, being thinner than the arteries.
Their lumen is larger than that of the accompanying arteries.
Fig. 8.9: Structure of a sinusoid

Fig. 8.10: Structure of vein
Fig. 8.11. Structure of valve
Veins have valves which maintain the unidirectional flow of blood,

even against gravity. Since the venous pressure is low (7 mm Hg),
the valves are of utmost value in the venous return. However, the
valves are absent (a) in the veins of less than 2 mm in diameter;
(b) in the venae cavae; and (c) in the hepatic, renal, uterine, ovarian
(not testicular), cerebral, spinal, pulmonary, and umbilical veins.
The muscular and elastic tissue content of the venous walls is
much less than that of the arteries. This is directly related to the
low venous pressure.
Large veins have dead space around them for their dilatation during
increased venous return. The dead space commonly contains the
regional lymph nodes.
Structure of Veins
Veins are made up of usual three coats which are found in the
arteries. But the coats are ill-defined, and the muscle and elastic
tissue content is poor.
A proper internal elastic lamina in the intima is absent.

In the weak and poorly developed tunica media, amount of collagen
fibers is more than the elastic and muscle fibers.
The adventitia is thickest and best developed; it contains the
collagen, elastic as well as muscle fibers.
The smooth muscle is altogether absent in the:
Veins of maternal part of placenta
Cranial venous sinuses and pial veins
Retinal veins
Veins of cancellous bone, and
Venous spaces of the corpora cavernosa and corpus spongiosum.
Blood and Nerve Supply of Veins

The larger veins, like the arteries, are supplied with nutrient vessels
called vasa vasorum. But in the veins, the vessels may penetrate
up to the intima, probably because of the low venous pressure and
the low oxygen tension.
Nerves are also distributed to the veins in the same manner as to
the arteries, but are fewer in number.
Factors Helping in Venous Return

Overflow from the capillaries, pushed from behind by the arteries
(vis-a-tergo).
Negative intrathoracic pressure sucks the blood into the heart from
all over the body.
Gravity helps venous return in the upper part of the body.
Arterial pulsations press on the venae comitantes intermittently and
drive the venous blood towards the heart.
Venous valves prevent any regurgitation (back flow) of the luminal
blood.
Muscular contractions press on the veins and form a very effective
mechanism of venous return. This becomes still more effective
within the tight sleeve of the deep fascia, as seen in the lower
limbs. The calf muscles (soleus) for this reason are known as the
peripheral heart. Thus, the muscle pumps are important factors
in the venous return.
ANASTOMOSIS OF BLOOD VESSELS (Figs 8.12 to 8.14)
Definition
A precapillary or postcapillary communication between the
neighboring vessels is called anastomosis.
Circulation through the anastomosis is called collateral circulation.
Types
Arterial anastomosis is the communication between the arteries
or branches of arteries.
It may be actual or potential
In actual arterial anastomosis the arteries meet end to end.
For example, palmar arches, plantar arch, circle of Willis,
intestinal arcades around the stomach, labial branches of
facial arteries, and the uterine and ovarian arteries.
Fig. 8.12: Arteriovenous anastomosis (shunt)
Fig. 8.13: Structure of shunt

Fig. 8.14: Anastomosis of blood vessels
In potential arterial anastomosis the communication takes place

between the terminal arterioles.
Such communications can dilate only gradually for collateral
circulation.
Therefore on sudden occlusion of a main artery, the
anastomosis may fail to compensate the loss.
The examples are seen in the coronary arteries around the
limb joints, the cortical branches of cerebral arteries, etc.
Venous anastomosis is the communication between the veins or
tributaries of veins.
For example, the dorsal venous arches of the hand and foot.
Arteriovenous anastomosis (shunt) is the communication between
an artery and a vein. It serves the function of phasic activity of
the organ. When the organ is active these shunts are closed and the
blood circulates through the capillaries.
However, when the organ is at rest, the blood bypasses the
capillary bed and is shunted back through the arteriovenous
anastomosis (Fig. 8.14).
The shunt vessel may be straight or coiled, possesses a thick
muscular coat, and is under the influence of sympathetic system.
Shunts of simple structure are found in the skin of nose, lips,
external ear, mucous membrane of nose and alimentary canal.
Specialized arteriovenous anastomoses are found in the skin of
digital pads and nail beds.
They form a number of small units called glomera.
END-ARTERIES
Definition
Arteries which do not anastomose with their neighbours arteries
are called end-arteries. For example,
Central artery of retina is the best example of an absolute
end-artery.
Central branches of cerebral arteries and vasa recta of mesenteric
arteries, arteries of spleen, kidney, lungs and metaphyses of
long bones.
Importance
Occlusion of an end-artery causes serious nutritional disturbances
resulting in death of the tissue supplied by it. For example, occlusion
of central artery of retina results in permanent blindness.
APPLIED ANATOMY OF Cardiovascular System (CVS)

The blood pressure is the arterial pressure exerted by the blood on
the arterial walls.
The maximum pressure during ventricular systole is called
systolic pressure; the minimum pressure during ventricular
diastole is called diastolic pressure.
The systolic pressure is generated by the force of contraction
of the heart.
The diastolic pressure is chiefly due to arteriolar tone (peripheral
resistance).
The heart has to pump the blood against the diastolic pressure
which is a direct load on the heart.
Normally, the blood pressure is roughly 120/80 mm Hg, the
systolic pressure ranging from 110140 mm Hg, and the diastolic
pressure from 7090 mm Hg. The difference between systolic
and diastolic pressure is called pulse pressure.
Hemorrhage (bleeding) is the obvious result of rupture of the
blood vessels.
Venous hemorrhage causes oozing of blood; arterial hemorrhage
causes spurting of blood.
Vascular catastrophies are of three types:
Thrombosis,
Embolism, and
Hemorrhage
All of them result in a loss of blood supply to the area of
distribution of the vessel involved, unless it is compensated by
collateral circulation.
Arteriosclerosis occurs in old age due to which arteries become stiff.
This phenomenon is called arteriosclerosis.
This causes a variable reduction in the blood supply to the tissues
and a rise in systolic pressure.
Arteritis and phlebitis: Inflammation of an artery is known as
arteritis, and inflammation of a vein as phlebitis.
Angeion is a Greek word, meaning a vessel (blood vessel or
lymph vessel). Its word derivatives are angiology, angiography,
hemangioma, and thromboangiitis obliterans.
Review Questions
1. Capillaries are classified as:
a. Distributing vessels b. Exchange vessels
c. Resistance vessels d. Reservoir vessels
2. In portal circulation blood passes through:
a. Two sets of capillaries b. One set of capillaries
c. Two set of sinusoids d. Three sets of capillaries
3. Side branches of terminal arterioles are called:
a. Capillaries b. Meta arterioles
c. Sinusoids d. Venules
4. Following is the example of arteriovenous shunt:
a. Glomerulus b. Dorsal venous arch of foot
c. Coronary arteries d. Central arteries
Answers
1.b2.a3.b4.a
II. Describe the components of vascular system.
a. Anastomosis
b. Vasa vasorum
c. Types of circulation of blood.
9 The Lymphatic
System
The Lymphatic SystemI

Introduction
Lymphatic system helps in maintaining hemostatis in the body.
Our body requires ways to combat harmful agents in our
environment.
Despite constant exposure to variety of pathogens, which are disease
producing microbes such as bacteria and viruses most people remain
healthy.
The body surface also endures cuts and bumps; exposure to
ultraviolet rays in sunlight, minor burns, chemical toxins.
Resistance is the ability to ward off damage or disease through our
defenses, vulnerability or lack of resistance is termed susceptibility.
The body system responsible for specific resistance is the lymphatic
and immune system.
The system is closely allied with the cardiovascular system, and
It also functions with the digestive system in the absorption of
fatty foods.
Definition
Lymphatic system is essentially a drainage system, which is
accessory to the venous system.
Most of the tissue fluid formed at the arterial end of capillaries is
absorbed into the blood by the venous end of the capillaries and
the postcapillary venules.
The Lymphatic System 167
The rest of the tissue fluid (1020%) is absorbed by the lymphatics

that begin blindly in the tissue spaces.
Thus, lymphatic system consists of closed system of vessels, which
ramify in the tissue spaces in and around the blood capillaries
It conveys the tissue fluid into the blood vascular system by acting
as an alternate route.
Hence, the lymphatic system is auxiliary to the venous system.
In their course, the lymphatics are intercepted by chains of lymph
nodes, which filter the lymph and add lymphocytes to the circulating
lymph.
It is important to know that the larger particles (proteins and
particulate matter) can be removed from the tissue fluid only by
the lymphatics.
Therefore, lymphatic system may be regarded as drainage of the
coarse type and venous system as drainage of fine type.
Certain parts of lymphatic system (lymphoreticular organs) however
are chiefly involved in phagocytosis.
Raising immune responses and contributing to cell populations of
the blood and lymph.
The tissue fluid flowing in the lymphatic is called lymph.
It passes through filters (lymph nodes) placed in the course of
lymphatics, and finally drains into the venous blood.
FUNCTIONS OF THE LYMPHATIC SYSTEM

The lymphatic and immune system has three primary functions:
1. Draining excess interstitial fluid: Lymphatic vessels drain excess
interstitial fluid from tissue spaces and return it to the blood.
2. Transporting dietary lipids: Lymphatic vessels transport the lipids
and lipid soluble vitamins (A, D, E and K) absorbed by the gastro-
intestinal tract to the blood.
3. Carrying out immune responses:
Lymphatic tissue initiates highly specific responses directed
against particular microbes or abnormal cells.
Lymphocytes aided by macrophages, recognize foreign cells,
microbes, toxins and cancer cells and respond to them in two
ways.
Fig. 9.1: Parts of lymph node
In cell-mediated immune responses (Fig. 9.1):

T cells destroy the intruders by causing them to rupture or by

releasing cytotoxic (cell killing) substances.
In antibody mediated immune responses:
B-cells differentiate into plasma cells
That protect us against disease by producing antibody proteins
that combine with and cause destruction of specific foreign
substances.
DEVELOPMENT OF LYMPHATIC TISSUES (Fig. 9.2)

Lymphatic tissues begin to develop by the end of the fifth week of
embryonic life.
Lymphatic vessels develop from lymph sacs that arise from
developing veins, which are derived from mesoderm.
First lymph sacs to appear are the paired jugular lymph sacs at
the junction of the internal jugular and subclavian veins. From this
jugular lymph sac lymphatic capillary plexus spread to the thorax
upper limbs, neck and head.
Some of the plexus enlarge and form lymphatic vessels.
The second lymph sac is unpaired, it is retroperitoneal lymph sac
at the root of the mesentery of the intestine.
Fig. 9.2: Development of lymphatic tissues
Third sac is cisterna chyli develops inferior to the diaphragm

on the posterior abdominal wall, gives rise to thoracic duct and
cisterna chyli.
Fourth lymph sac is posterior lymph sac: It produces capillary
plexuses and lymphatic vessels of the abdominal wall, pelvic
regions, and lower limbs.
With the exception of anterior part of the sac from which the cisterna
chyli develops all lymph sacs become invaded by mesenchymal
cells and are converted into groups of lymph nodes.
Spleen develops from mesenchymal cells between two layers of
dorsal mesentery of the stomach.
Thymus arises as an outgrowth of third pharyngeal pouch.
Components of the Lymphatic System

Lymphatic system comprises of:
1. Lymph
2. Lymphatic vessels and lymph circulation
3. Lymph, trunks and ducts

4. Central lymphoid tissues
5. Peripheral lymphoid organs
6. Circulating lymphocytes.
Lymph
Lymph is a transudate from blood.
It contains most constituents of blood plasma that filter through
blood capillary walls to form interstitial fluid.
After interstitial fluid passes into lymphatic vessels, it is called
lymph. Therefore, interstitial fluid and lymph are very similar. Major
difference between the two is location.
Interstitial fluid is found between cells whereas lymph is located
within lymphatic vessels and lymphatic tissue.
Lymphatic Vessels and Lymph Circulation (Fig. 9.3)

The lymph capillaries begin blindly in the tissue spaces and form
intricate networks. They are closed at one end. Their caliber is
greater and less regular than that of blood capillaries.
Fig. 9.3: Lymphatic vessels and lymph circulation

Location: They are located in the spaces between the cells just as
blood capillaries converge to form venules and veins, lymphatic
capillaries unite to form larger lymphatic vessels, which resemble
veins in structure but have thinner walls and more valves.
At the intervals along the lymphatic vessels lymph flows through
lymph nodes, encapsulated masses of B-cells and T-cells.
In the skin, lymphatic vessels lie in the subcutaneous tissue
generally follow veins.
Lymphatic vessels of the viscera generally follow arteries forming
plexuses (networks) around them.
Tissues that lack lymphatic capillaries include avascular tissues
such as:
Cartilage
The epidermis, and cornea of the eye
The central nervous system, brain and spinal cord, portions of
the spleen, (splenic pulp) and bone marrow.
Lymphatic Capillaries (Fig. 9.4)

They are slightly larger in diameter than blood capillaries.
They have a unique structure that permits interstitial fluid to flow
into them but not come out.
The ends of the endothelial cells that make up the wall of a
lymphatic capillary overlap.
Fig. 9.4: Lymphatic capillaries

When pressure is greater in the interstitial fluid than in lymph the

cells separate slightly like the opening of a one-way swinging door
and interstitial fluid enters the lymphatic capillary.
When pressure is greater inside the lymphatic capillary the cells
adhere more closely and lymph cannot escape back into the
interstitial fluid.
Attached to the lymphatic capillaries are anchoring filaments
which contain elastic fibers.
They extend out from the lymphatic capillary attaching lymphatic
endothelial cells to surrounding tissue.
When excess interstitial fluid accumulates and causes tissue
swelling, the anchoring filaments are pulled making the openings
between cells even larger so that more fluid can flow into the
lymphatic capillaries.
In small intestine, specialized lymphatic capillaries called lacteals
carry dietary lipids into lymphatic vessels and ultimately into the
blood. The presence of these lipids causes the lymph draining the
small intestine to appear creamy white such lymph is referred to
as chyle.
Elsewhere lymph is a clear, pale-yellow fluid.
Lymph Trunks and Ducts (Figs 9.5A and B)

Lymph passes from lymphatic capillaries into lymphatic vessels and
then through regional lymph nodes, which trap the particulate matter
The filtered lymph passes through larger lymphatics and is eventually
collected into two large trunks the thoracic duct and right lymphatic
duct, which pour their lymph into the brachiocephalic veins.
The principal lymph trunks are the:
Lumbar
Intestinal
Bronchomediastinal
Subclavian
Jugular trunks from these trunks lymph passes to above two
main channels.
Thoracic Duct (Left Lymphatic Duct) (Fig. 9.5B)

Is about 3845 cm in length and begins as a dilatation called the
cisterna chyli anterior to the second lumbar vertebra.
The Lymphatic System
A B
Figs 9.5A and B: (A) Lymph trunks and ducts; (B) Thoracic duct
173
Thoracic duct is the main duct for return of lymph to blood

It receives lymph from the left side of the head, neck and chest
The left upper limb and the entire body inferior to the ribs
The thoracic duct drains into venous blood via the left subcavian
vein
Cisterna chyli receives lymph from the right and left lumbar trunks
and from the intestinal trunks.
Lumbar Trunks
Drain lymph from the lower limbs, the wall and viscera of the pelvis,
the kidneys, the adrenal glands, and the deep lymphatic vessels that
drain lymph from most of the abdominal wall.
Intestinal Trunks
Drain lymph from the stomach, intestines, pancreas, spleen and
part of the liver.
In the neck, thoracic duct receives lymph from the left Jugular, left
subclavian and left bronchomediastinal trunks.
Right Lymphatic Duct

It is about 1.2 cm long and drains lymph from upper right side of
the body into venous blood via right subclavian vein.
Three lymphatic trunks drain into right lymphatic duct.
Right jugular trunkdraining lymph from right side of head
and neck.
Right subclavian trunkdrains from right upper limb.
Right bronchomediastinal trunkdrains right side of thorax,
right side of heart, right lung and liver.
The Lymphatic SystemII
COMPONENTS OF THE LYMPHATIC SYSTEM

Central Lymphoid Tissues
Central lymphoid tissues comprise of bone marrow and thymus.
All pluripotent lymphoid stem cells are produced by bone marrow

except during early fetal lifewhen these are produced by liver
and spleen.
The stem cells undergo differentiation in the central lymphoid
tissues so that the lymphocytes become competent defensive
elements of the immune system.
Bone marrow helps differentiation of the B-lymphocytes which
are capable of synthesizing antibodies after getting transformed
into plasma cells.
Helps differentiation of immunologically competent but
uncommitted T-lymphocytes (10% of thymic population).
These T-lymphocytes are long lived, join circulating pools of
lymphocytes, and populate the thymus dependent areas of lymph
nodes and other peripheral lymphoid organs.
T-lymphocytes respond by cytotoxic cell killing (killing virus
infected cells, neoplastic cells, fungi, etc.)
By arming macrophages, and by triggering the large mononuclear
cells (killer cells).
And the helper activity of B-lymphocytes.
Thymus (Figs 9.6 to 9.8)

Thymus is an asymmetrical bilobed structure.
It is situated in the superior and anterior mediastinum of thorax.
The two lobes of thymus are connected across the middle line by
fibroareolar tissue.
At birth the thymus weighs about 1015 g.
It progressively increases in size up to age of puberty when it weighs
about 2030 g.
Thereafter, the thymus undergoes involution and is converted into
fibro-fatty mass.
In mid-adult life its weight comes to about 10 g.
Each lobe of thymus develops from endoderm of the third
pharyngeal pouch and undergoes caudal migration in the thorax.
Structure of the Thymus

Each lobe is covered by a fibrous capsule which projects in the
substance of the organ as incomplete trabecular septa which convey
the blood vessels and divide the thymus into numerous lobules.
Fig. 9.6: Thymus (Gross)
Fig. 9.7: Structure of thymus
Each lobule is about 12 mm in width.

The lobules consist of outer cortex and inner medulla.
Cortex contains closely packed numerous lymphocytes and
occasional macrophage cells.
Fig. 9.8: Thymic corpuscles (Hassalls)
In the medulla, the lymphocytes are less in number; in addition, it

contains concentric corpuscles of Hassall.
Four special varieties of structures are encountered in the thymus
these are the reticular epithelial cells, lymphocytes, macrophages
and Hassalls corpuscles.
The antigen macromolecules of the circulating blood are prevented
from coming in contact with the thymic lymphocytes due to
presence of Hemothymic barrier.
The barrier consists of the following structure from outside inwards:
A layer of continuous endothelial cells of capillaries
A thick basement membrane
A tissue space
A continuous layer of reticular epithelial cells.
This barrier is impermeable to antigens but permeable to nutritive
substances and stem cells from the bone marrow, which are
transported to the thymus through this barrier.
In addition, thymic lymphocytes are allowed to pass into the circulating
pool. Thus lymphocytes proliferate in antigen-free environment.
Peripheral Lymphoid Organs

Peripheral lymphoid organs comprise lymph nodes, spleen,
epithelio-lymphoid tissues (lymphoid nodules developed in the
alimentary and respiratory tracts).
Any part of this may become overactive on appropriate stimulation.
Lymphoid Nodules or Primary Lymph Follicles (Fig. 9.9)

Each primary lymph follicle or lymphoid tissue consists of a
collection of B and T-lymphocytes, which are supported by the
reticular fibers.
The center of the follicle is called as germinal center that is
occupied by the lymphoblasts.
The periphery of the follicle consists of free lymphocytes and
plasma cells.
The primary follicles are present in the loose connective tissue of the
wet epithelial membrane of the upper respiratory tract, alimentary
tract, and urinary tracts.
They combat the entrance of antigens from the outside world.
The mucosa associated lymphoid tissue (MALT) in relation to
gut and bronchus are known as GALT and BALT respectively.
Aggregations of lymphatic nodules are present in appendix and
oropharynx, i.e. tonsils.
Peculiarities of the primary follicles.
Absence of definite fibrous capsule.
The follicles filter tissue fluid and act as second line of defense
of the body.
Possess no afferent vessels but are provided with efferent vessels.
Fig. 9.9: Splenic lymphatic nodule

Lymph Nodes (Fig.9.10)

The lymph nodes are small nodules of lymphoid tissue found in the
course of smaller lymphatics.
The lymph passes through one or more lymph nodes before reaching
the larger lymph trunks.
The nodes are oval or reniform in shape about 125 mm long, and
brown in color (hepatic).
Black (pulmonary) or creamy white in color (intestinal) usually they
are in groups but sometimes there may be a solitary lymph node.
Superficial nodes are arranged along the veins and deep nodes are
arranged along the arteries.
About 800 lymph nodes are present in the human body.
Each lymph node has a slight depression on one side called hilum.
The artery enters the node and the vein with efferent lymphatic
comes out of it, at the hilum.
The afferent lymphatics enter the node at different parts of its
periphery.
Structure of a Lymph Node (Fig. 9.11)

Structurally lymph node is made up of following parts:
Fibrous and Reticular Framework
The lymph node is covered by a capsule made up of mainly collagen
fibers and a few elastic fibers.
Deep to the capsule is a space called as subcapsular space, which
receives the terminations of numerous lymphatic vessels.
A number of trabeculae extend into the gland substance from the
capsule radially into the interior of the node.
Lymphatic Channels
The afferent lymphatics of the node open into the subcapsular
sinus, which give rise to numerous cortical sinuses running
towards the medulla.Where they unite with each other to form the
larger medullary sinuses.Which join together to form the efferent
lymphatics (one or two) draining the lymph node.
All sinuses are lined by endothelial cells, which allow a constant
biway passage for lymphocytes, macrophages and other cells, across
the sinus walls.
Fig. 9.10: Lymph node
Cortex
It is made up of lymphatic follicles.
It is far more densely cellular than the medulla.
It is divided into:
Zone I: Containing loosely packed small lymphocytes,
macrophages, plasma cells
Fig. 9.11: Structure of lymph node
Zone II: Contain more densely packed small lymphocytes, and

macrophages
Zone III: Including germinal center, contains large lymphoblasts
and macrophages.
The maturing lymphocytes pass from zone III to zone II to zone I
and to lymph sinus.
According to the distribution of B and T-lymphocytes, the cortex
is divided into:
Outer partcontains immature B-lymphocytes
Inner partbetween the germinal center and the medulla, which
contains T-lymphocytes. This part is known as paracortex or
thymus dependent zone.
The mature B-lymphocytes are present in medulla whether
germinal center contains T or B cells or both is not known.
Medulla
It is the central part of the lymph node.
It contains loosely packed lymphocytes, plasma cells and
macrophages.
Blood Channels
The artery enters the hilum and divides into:
Straight branches which run in the trabeculae
In the cortex arteries divide into arterioles and capillaries
Capillaries give rise to venules and veins which run back to the
hilum.
Hemolymph Nodes
The hemolymph nodes consists of admixture of blood and lymph
which fill up the interstices of reticular fibers
These nodes are rare in man but may be sometimes found in the
retroperitoneal lymph nodes.
Hemal Nodes (Fig. 9.12)

These are small lymphatic bodies resembling lymph nodes in their
structure, which are found in the course of blood vessels
The afferent and efferent lymphatics are absent
Their sinuses are filled with blood rather than lymph
In man, spleen is considered as a large hemal node
Spleen filters blood by taking out worn out erythrocytes, leukocytes
and platelets and microbial antigens from the circulation
It consists of capsule, trabeculae, reticular fibers, red pulp and
white pulp
White pulp is made up of primary lymph follicles.
Each follicle is traversed eccentrically by an arteriole the
T-lymphocytes lie in the periarteriolar lymph sheath and the
B-lymphocytes occupy the rest of the white pulp.
Circulating Lymphocytes
Circulating lymphocytes contain mature progenics of B and
T-lymphocytes, which may be called upon during antigenic
emergencies.
They are formed in lymphoid tissue such as lymph nodes and spleen
and in myeloid tissue, i.e. in red bone marrow.
Fig. 9.12: Spleen (large hemal node)
Applied Anatomy of Lymphatic System

Lymphatics are primarily meant for coarse drainage including cell-
debris and microorganisms from the tissue spaces to the regional
lymph nodes.
While draining from an infected area, the lymphatic and lymph
nodes carrying infected debris may become inflamed resulting in.
Lymphangitis and Lymphadenitis

Lymphangitis is the inflammation of lymphatic vessels
Lymphadenitis is the inflammation of lymph nodes
These conditions occur when the lymphatic system is involved in
the spread (metastasis) of cancer cells.
Lymphedema
Is accumulation of interstitial fluid, which occurs when a lymph
node does not drain from an area of the body, e.g. if cancerous
lymph nodes are surgically removed from the axilla (armpit)
lymphedema of the limb may occur.
Solid cell growths may permeate lymphatic vesels and form minute
cellular emboli (plugs), which may break free and pass to regional
lymph nodes.
In this way, lymphogenous cancer cells spread to other tissues and
organs.
Thus, lymphatics provide most convenient route of spread of

cancer cells.
Elephantiasis
This condition occurs due to filarial parasite Wuchereria
bancrofti which cause blocking of lymphatic vessels giving rise
to solid edema (elephantiasis) in the peripheral area of drainage.
Elephantiasis is characterized by enormous enlargement of the
part due to thickening and reduplication of skin in lower limb and
scrotum.
The microfilaria enter the bloodstream only during night and
therefore the blood for examination may be collected during night.
Review Questions
1. Lymphatic vessels are absent in:
a. Liver b. Brain
c. Lungs d. Uterus
2. Development of lymphatic tissue begins in:
a. 5th month of IUL b. 7th month of IUL
c. 5th week of IUL d. 7th week of IUL
3. Following is considered as a central lymphoid tissue:
a. Spleen b. Bone marrow
c. Lymph node d. Palatine tonsil
4. Lymphedema is a condition which other due:
a. Accumulation of interstitial fluid
b. Accumulation of intercellular fluid
c. Inflammation of lymph node
d. Inflammation of lymphatics
Answers
1. b 2. c 3. b 4. a
II. Describe the components of the lymphatic system.
III. Write Short Notes
1. Lymphatic vessels
2. Development of lymphatic system
3. Applied anatomy of lymphatic system.
10 Skin and its
Appendages
Skin and its AppendagesI
INTRODUCTION
The body is composed of four basic elements:
Epithelium, connective tissue, muscle and nerves.
Every part of the body when examined with the naked eye or micro-
scopically, can only be made of one or more of these four elements.
The skin or cutaneous membrane covers the external surface of
the body.
It is the largest organ of the body in surface area and weight.
DEFINITION
Skin is the general covering of the entire external surface of the
body, including the external auditory meatus and outer surface of
the tympanic membrane.
It is continuous with the mucous membrane at the orifices of the
body, e.g. mucosa of alimentary canal, respiratory tract and geni-
tourinary tracts.
FUNCTIONS OF THE SKIN

Skin forms a self-renewing and self-repairing interface between the
body and its environment.
It also forms barrier against microbial invasion.
It has properties which protect the body against mechanical,
chemical, osmotic, thermal and photal damage.
It is capable of absorption and excretion.

It helps in synthesis of vitamine D from the precursor 7 dihydro-
cholesterol under influence of ultraviolet rays.
It helps in synthesis of cytokines and synthesis of growth factors
thus it is regarded as an endocrine organ.
It helps in control of body temperature which is an important
function of skin.
It is a major sense organ supplied by nerve terminals and receptors
for touch, temperature, pain, mechanical and pleasure stimuli.
Skin is water proof, thereby prevents the loss of body fluid.
It forms unique means of individual identification by the study of
finger prints on the palmar and plantar surfaces (Dermatoglyphics).
SURFACE AREA OF THE SKIN

In adults, the skin covers an area of about 2 square meters (22 square
feet) and weight 4.55 kg, about 16% of body weight.
It ranges in thickness from 0.5 mm on the eyelids to 4.0 mm on
the heels.
However, over most of the body it is 12 mm thick.
In damage of skin by burns an estimate of affected area is important
in assessing the need for fluid replacement therapy.
In order to assess the area involved in burns
One can follow the rule of nine:
Head and neck (9%)
Each upper limb (9%)
The front of the trunk (18%)
The back of the trunk including buttocks (18%)
Each lower limb (18%)
Perineum (1%).
PIGMENTATION OF SKIN (Fig. 10.1)

Color of the skin varies with:
Amount of blood
Degree of oxygenation
Activity of specialized cellsproducing the melanin pigments
Melanin, carotene and hemoglobin are three pigments that
impart a wide variety of colors to skin
Skin and its Appendages 187
Four principal cell types in epidermis
Fig. 10.1: Structure of melanocyte
Melanocytes are derived from neural crest cells. They migrate

in epidermodermal junction
Amount of melanin causes the skins color to vary from pale
yellow to tan to black
Melanocytes are most plentiful in the epidermis of the penis,
nipples of breast, areas around the nipples (areolae) face and limbs
They are also present in the mucous membranes
Number of melanocytes is about the same in all the people,
but differences in color of skin is mainly due to amount
of melanin pigment, which the melanocytes produce and

disperse to keratinocytes.
Melanocytes synthesize melanin from the amino acid tyrosine
in the presence of enzyme called tyrosinase
Synthesis occur in an organelle called melanosome
Exposure to UV light increases the enzymatic activity within
melanosomes and thus stimulates melanin production due to
this both the amount and darkness of melanin increase, which
gives the skin a tanned appearance and further protects the body
against UV radiation
Thus within limits melanin serves a protective function. Never-
theless repeatedly exposing the skin to UV light causes skin
cancer.
Applied Importance
Albinism: Total depigmentation of the skin. It is an autosomal recessive
disorder associated with congenital agenesis of enzyme tyrosinase.
Vitiligo: It is localized depigmentation of skin. It takes place when
melanocytes loose their ability to produce melanin or are themselves
lost.
Moles (Melanocytic naevi): In this condition melanocytes are clustered
in high densities.
Skin Color Clues

Color of skin and mucous membrane can provide clues for diag-
nosing certain conditions.
When the blood is not picking up adequate amount of oxygen
in the lungs due to any disease, in these conditions, the mucous
membranes, nail beds, and skin appear bluish or cynotic.
Jaundice is due to built up of yellow pigment bilirubin in the
blood. This causes yellowish appearance of the sclera of eyes and
the skin
Jaundice indicates liver disease.
Erythema: In this condition in which redness of skin occurs due to
engorgement of capillaries in the dermis with blood due to:
Skin injury
Exposure to heat
Infection
Inflammation or allergic reactions.
TYPES OF SKIN
Based on the structural and functional properties. We classify the
skin into two major types:
Thin hairy skin (Hirsute)

Thick hairless (Glabrous)

Although the skin of whole body is fundamentally similar still there
are local variations.
Variations are in thickness, mechanical strength, softness flexibility,
degree of keratinization, size and number of hair frequency and types
of glands, pigmentation, vascularity, innervation.
Thin Hairy Skin (Hirsute) (Fig. 10.2)

It covers all parts of body except the palms, palmar surfaces of the
digits and soles.
Its epidermis is thin just 0.100.15 mm
Presence of hair follicles: Arrector pilorum muscles, sebaceous
glands, sweat glands (few)
Sparse distribution of sensory receptors
Fig. 10.2: Thin hairy skin

Lacks stratum lucidum and epidermal ridges (because of few dermal

papillae).
Thick Hairless Skin (Glabrous) (Figs 10.3 and 10.4)

This is confined to the palms, soles and flexor surface of the digits.
Its epidermis is relatively thick 0.64.5 mm.
Presence of distinct layer of stratum lucidum.
Thicker stratum spinosum and corneum.
Dermal papillae are larger and more numerous thus presence of
epidermal ridges.
Fig. 10.3: Thick hairless skin

Fig. 10.4: Layers of epidermis

Lacks hair follicles, arrector pilorum muscle and sebaceous glands
Presence of many swreat glands and sensory receptors are more
densely clustered.
Surface Irregularities of the Skin

The skin is marked by four types of surface irregularities:
1. The tension lines
2. Flexure lines
3. Papillary ridges
4. Wrinkle lines
Tension Lines
Form a network of linear furrows or simple lattice pattern of lines.
Occurs on all major areas of the body, which divide the surface into
polygonal or lozenge-shaped areas.
These lines correspond to variations in the patterns of fibers in the
dermis.
Function of tension lines is to permit stretch and recoil of skin.
Flexure Lines (Skin Creases) (Fig.10.5)

These are certain permanent lines along which the skin folds during
habitual movements (Chiefly flexion) of the joints.
Fig. 10.5: Flexure lines (Down syndrome)
The skin along these lines is thin and firmly bound to the deep fascia.
Lines are prominent opposite the flexure of the joints (particularly
on the palms, soles and digits).
In Down syndrome, the distal and middle palmar creases tend to be
united into a prominent single transverse line, a sign of diagnostic
importance.
Papillary Ridges (Friction Ridges)

These are confined to palms and soles and their digits.
They correspond to patterns of dermal papillae.
Their study constitutes a branch of science called dermatoglyphics.
Three major patterns in the human finger prints include loops,
whorls and arches.
These patterns are determined genetically.
Wrinkles Lines
They are caused by contraction of underlying muscle.
These line perpendicular to the axis of the skin.
They are seen as lines of expression on the face.
These lines are also called as lines of Langer.
Incisions made along creases and wrinkle lines heal with a minimum
of scarring. Hence incisions should never be given across lines.
SKIN AND ITS APPENDAGESII

STRUCTURE OF SKIN
The skin is composed of two distinct layers:
Epidermis
Dermis.
Epidermis
Epidermis is the superficial avascular layer of stratified squamous
epithelium (keratinized variety).
It is ectodermal in origin.
It consists of four principal types of cells:

Keratinocytes: 90%
Melanocytes: 8%
Langerhans cells
Merkel cells.
Keratinocytes (Fig.10.6A)
Keratinocytes are epidermal cells which are arranged in four or
five layers.
They produce the protein keratin which protects the skin and under-
lying tissue from heat, microbes and chemicals.
Melanocytes (Fig.10.6B)
Melanocytes are epidermal cells which produce the pigment
melanin.
Their long slender projections extend between the keratinocytes
and transfer melanin granules to them.
Melanin contributes color to skin and absorbs (damaging) ultraviolet
light.
Langerhans Cells (Fig.10.6C)

Langerhans cells arise from red bone marrow. They belong to
mononuclear phagocyte system and migrate to epidermis.
They participate in immune responses and protect skin against viral

and other infections.
Merkel Cells (Fig.10.6D)

Merkel cells are very few in number
They are located in the deepest layer of the epidermis where they
come in contact with the sensory neuron
They detect different aspects of touch sensations.
Epidermis (Figs 10.7 and 10.8)

It consists of stratified epithelium in which following layers can
be recognized
In most of the regions of the body the epidermis has four strata
of layers:
Stratum basale
Stratum spinosum
Stratum granulosum
Thin stratum corneum.
A B
C D
Figs 10.6A to D: Types of cells in epidermis. (A) Keratinocyte;
(B) Melanocyte; (C) Langerhans cell; (D) Merkel cell
Fig. 10.7: Structure of epidermis
Fig. 10.8: Structure of epidermis (Thick skin)

Where exposure to friction is greatest such as in fingerprints, palms

and soles, the epidermis has five layers
1. Stratum basale
2. Stratum spinosum
3. Stratum granulosum
4. Stratum lucidum
5. Thick stratum corneum
When we see the epidermis of the skin, there are downward
projections of epidermis which are called as epidermal papillae
The surface of epidermis is also marked with elevations and
depression which form the papillary ridges.
Layers of Epidermis (Figs 10.9 and 10.10)

Stratum Basale
Deepest layer or basal layer
It is made up of single layer of columnar cells that rest on the base-
ment membrane
These are stem cells that under mitosis to give off cells called
keratinocytes
These keratinocytes form more superficial layers of cells thus this
layer is also called as geminal layer (Stratum germinatum).
Fig. 10.9: Structure of epidermis (Thin skin)

Fig. 10.10: Thin skin (Arrector pilorum muscle) and Hair follicle
Stratum Spinosum
Above basal layer these are several layers of polygonal keratino-
cytes that constitute the stratum spinosum (or Malpighian layer).
The cells of this layer are attached to one another by numerous
desmosomes
During routine preparation of tissue for sectioning the cells retract
from each other except at the desmosomes
As a result cells appear to have a number of spines
Thus this layer is called as stratum spinosum
For the same reason keratinocytes of this layer are also called as
prickle cells.
Stratum Granulosum
This layer consist of 15 layers of flattened cells that are characterized
by the presence of deeply staining granules in their cytoplasm.
Granules contain protein called keratohyalin.
Nuclei of cells in this layers are condensed and dark staining
(Pyknotic).
Stratum Lucidum
This layer is superficial to stratum granulosum
It appears homogenous because the cell boundaries become indis-
tinct
Flattened nuclei may be seen in some cells.
Stratum Corneum
Most superficial layerthis layer is acellular
It is made up of flattened scale like elements containing keratin
filaments embedded in proteins.
The squames are held together by a glue like material containing
lipids and carbohydrates
The presence of lipids makes this layer highly resistant to permea-
tion by water
Stratum corneum is thickest where the skin is exposed to maximal
friction, e.g. on the palms and soles
Superficial layers of epidermis are constantly shed off and are
replaced by proliferation of cells in deeper layers.
Dermis of Skin
Dermis is made up of connective tissue
Just below epidermis the connective tissue is thick and constitutes
the papillary layer
Deep to this there is a network of thick fiber bundles that constitute
the reticular layer of the dermis
Papillary layer includes:
The connective tissue of dermal papillae, each papilla contains a
capillary loop
Some papillae contain tactile corpuscles.
Reticular layer contains:
Mainly bundles of collagen fibers
Considerable numbers of elastic fibers
Adipose tissue in the intervals between the fiber bundles.
The direction of the bundles of collagen fibers constitute the
cleavage lines (Langers lines which are longitudinal in the limbs
and horizontal in the trunk and neck)
Overstretching of the skin may lead to rupture of the fibers, followed

by scar formation.
These scars appear as white streaks on the skin (Stria
gravidarum) Stria distensae are also stretch marks of skin.
Stretch marks usually fade after pregnancy or weight loss but they
never disappear completely.
BLOOD SUPPLY OF SKIN (Fig. 10.11)

Blood supply of the skin comes from the dermis
The epidermis is avascular, it gets nutrition only by diffusion from
the nearest capillary loops of the dermis
A deep network of branches the rete cutaneum, derived from the
main arteries is located deep to the dermis
Some branches from this network project towards the epidermis
and form a second rete subpapillary
Fig. 10.11: Blood supply of skin

At the junction between the papillary and reticular layers of the

dermis, small arterioles from the rete sub-papillary send branches
into the dermal papillae to form extensive capillary bed. These
branches establish connections by their collateral branches with
the neighbouring venules forming arteriovenous anastomosis
(AVA)
When the body is overheated the arteriovenous anastomosis
constricts and blood flow to the capillary plexus of dermal papillae
increases resulting in increased sweating to reduce the body
temperature
In contrast when the body becomes chilled the blood is directed
away from the capillary beds by way of arteriovenous shunt
conserving the body heat
This blood supply to the skin provides nutrition to the epidermis
and helps thermoregulation.
Nerve Supply of Skin

Skin is richly supplied with sensory nerves
Nerve fibers are seen in superficial parts of the dermis
Autonomic nerves supply arrector pilorum muscles and sweat
glands.
APPENDAGES OF SKIN
These includes hairs sebaceous glands, sweat glands, arrector pilorum
muscle and nails.
Hair (Fig. 10.12)

Hair are keratinized elongated structures derived from invagina-
tions of epidermis and project out from most of the body surface
Hairs are absenton palms, soles, lips, nipples, glans penis, clitoris,
prepuce, labia minora and inner surface of labial majora.
Function of Hair
They assist thermoregulations
Provide protection of body surface from external injury
Fig. 10.12: Parts of hair
Help in sensory function

Distribution of hair after puberty possesses distinctive sex differ-
ences.
Parts of the Hair

Each hair consists of shaft projecting out from the body surface
root lying within the hair follicle which is a tubular invagination
of the epidermis
Hair bulb is an expanded deep end of the follicle
Dermal papillaeconical varcular projection at the base of the
hair bulb contains a capillary network which is vital in sustaining
the hair follicle because loss of blood will result in death of follicle.
Melanocytesnumerous melanocytes with their dendritic processes
are interspersed among the differentiating cells of the hair bulb and are
responsible for pigmentation of hair.
Growth rate of hair vary in different regionshairs grow at the rate
of 1.5 to 2 mm/week.
Life spanvaries from 4 months (eyelashes, axillary hair) to 4 years

(Scalp hair).
Alterations of hairs in deseases:
In malnutrition hair become thin, dry and sparse
In hypothyroidism they become coarse and dry
Excessive growth of hair (Hirsutism) occurs in adrenogenital
syndrome
Loss of hair called as alopecia.
Types of Hair
Three types of hair are encountered in the human body:
Lanugo hairsare fine, pigmented primary hairs which appear
on the fetal body by the fifth month. Lanugo hairs are mostly shed
before birth.
Vellus hairsare secondary hairs and replace the lanugo hairs
except in the scalp, eyebrows and eyelashes, which are replaced
by coarse terminal hairs.
Terminal hairsare thick and coarse, in addition to scalp eyebrows
and eyelashes they appeal at puberty on the pubis and axillae in
both sexes.
Sebaceous Glands (Fig. 10.13)

These are holocrine glands because they secrete an oily fluid
(sebum) by complete destruction of cell cytoplasm
Most of the sebaceous glands develop as lateral outgrowths of the
outer root sheath of hair follicles
They are located in the dermis in the triangular space intervening
between the hair follicles, arrector pilorum muscle and overlying
skin surface
Sebaceous glands are abundanton the face, scalp, ears, nostrils,
vulva, and around anus.
Isolated Sebaceous Glands

In certain areas of body the sebaceous glands do not empty into the
hair follicles, but open directly on the skin surface
They are:
On the lips and corners of mouth
Fig. 10.13: Sebaceous gland
On areola around the nipple of female breasts as Montgomerys

tubercles
Glans penis and inner surface of prepuce
Glans clitoridis and labia minora
In eyelids as mebomian glands.
Arrector Pilorum Muscle (Fig. 10.10)

These are small bands of smooth muscles, which extend diagonally
from the dermal coat of the isthmus of hair follicle to the papillary
layer of the dermis and are found on the side of hair follicles.
They makes an obtuse angle with the skin surface.
Contraction of arector pilorum muscle results in erection of hair
shaft to more upright position and depression of the skin where the
muscles are attached to dermis
This produces goose Flesh appearance on exposure to cold or
emotional stimuli.
Arrector pilorum are innervated by cholinergic fibers of sympa-
thetic nerves.
They are absent in facial and axillary hairs, eyebrows and

eyelashes
Hair of nostrils and external acoustic meatus.
Sweat Glands (Fig. 10.14)

These are of two types:
1. Eccrine glands
2. Apocrine glands.
Eccrine Glands
These are widely distributed on entire body surface numerous on
forehead, scalp, palms and soles
They are absent on:
Tympanic membrane
Margins of lips
Labia minora
Glans penis
Fig. 10.14: Sweat gland

Each gland is a long, unbranched tubular structure and presents a

highly coiled secretory portion called as body within the dermis
and a narrower ductal portion, which opens on skin surface
The secretions of sweat glands are clear, colorless and hypotonic.
Apocrine Sweat Glands

These are found in the following areas of the body: Axilla, areola,
perianal regions, prepuce scrotum, mons pubis, ceruminous glands
of external acoustic meatus.
These glands secrete a protein rich, milky fluid which is
initially odorless but acquires a distinctive odor due to bacterial
decomposition.
Nails (Fig. 10.15)

The nails are plates of keratinized epithelial cells on the dorsal
surface of distal phalanx.
Each nail consists of three parts:
Proximal part or root
Exposed part or body
A free distal border.
Structurally body of nail corresponds to stratum corneum of skin
and consists of dead anucleate keratin filled squames.
The body rests on a nail bed which is composed of stratum basale
and stratum spinosum.
Function: It aids in grasping and manipulating small objects.
Fig. 10.15: Structure of nail

APPLIED ANATOMY OF SKIN

The skin becomes pale in anemia and it appears yellow in jaundice
and blue in cyanosis
Boil is an infection and suppuration of hair follicle and sebaceous
gland
When there is loss of sensibility to touch, it is called as anesthesia
And loss of pain sensibility is called as analgesia
And loss of temperature sensibility is called as thermoanesthesia.
Skin Grafting
Skin grafting is of two types:
1. Split thickness skin grafting: Where greater part of epidermis with
the tips of dermal papillae is used.
2. Full thickness skin grafting: Where both epidermis and dermis are
used.
Review Questions
1. Melanocytes are derived from:
a. Ectoderm b. Mesoderm
c. Bone marrow d. Neural crest cells
2. The secretory part of sweat glands is situated in:
a. Epidermis b. Dermoepidermal junction
c. Papillary layer of dermis d. Reticular layer of dermis
3. Sebaceous glands are of following types:
a. Holocrine b. Merocrine
c. Apocrine d. None of the above
4. Thick skin is identified from the presence of a layer:
a. Stratum lucidum b. Stratum spinosum
c. Stratum basale d. Stratum granulosum
Answers
1. d 2. d 3. a 4. a
II. How would you classify skin. What are the structures called
as appendages of skin?
a. Arrector pilorum muscles.
b. Cells of epidermis.
c. Names the layers of skin.
d. Blood supply of skin.
Index
Page numbers followed by f refer to figure
A Argentophil fibers 33
Arrector pilorum muscle 197f, 203
Abductor pollicis longus 117
of skin 105
Aberrant epiphysis 68
Arterial anastomosis 73, 162
Acceleration of heart rate 147
Arteries 151, 155
Accessory
Arterioles 151, 155
blood vessels 117 Arteriosclerosis165
bones63 Arteriovenous
Acetabular fat of hip joint 98 anastomosis162f, 163, 200
Acidic dye 17 shunt200
Actions of muscle 123 Arteritis 100, 165
Adipose tissue 34, 39, 40f Articular
Adrenergic system 147 bursa115
Adrenogenital syndrome 202 capsule 88, 89, 91
Alpha efferent fibers 118 cartilage89
Alveolar macrophages 24 disc or meniscus 88, 89, 92
Amphiarthrosis79 Articulatory system 3
Anastomosis of blood vessels 162, Astrocyte136
163f Atavistic epiphysis 67, 68f
Anatomy of connective tissue 40 Atlantoaxial joint 95
Anchoring filaments 172 Atrium150
Angular movements 98 Autonomic
Ankle joint 94f components126
Annulus fibrosis 86 nerves 104, 132, 200
Antegrade degeneration 144 nervous system 132, 144, 145
Apocrine Avascular tissues 171
glands204 Axial bones 58
sweat glands 205 Axoaxonic synapses 135
Appearance of blood vessels 57f Axodendritic synapses 135
Appendages of skin 200 Axosomatic synapses 135
Appendicular bones 58
Areolar B
connective tissue 21 Bands of Bunger 144
tissue34 Basis of hyaline cartilage 31
Biaxial joint 92, 96 Cavernous tissues 159

Biceps brachii 116, 123 Cells of connective tissue 22f
Bipolar Cellular cartilage 49, 49f
cells of retina 131 Central
neuron130f, 131 lymphoid tissues 174
Blood nervous system 126
and nerve supply of veins 161 Centrioles129
channels182 Cerebellar cortex 128
pressure falls 149 Chains of lymph nodes 167
supply of Characteristics of synovial
arteries 156, 157f joints87
bone72 Cholinergic system 148
flat bone 74, 75f Chondroblasts 44, 46
irregular bone 74, 75f Chondrocytes 22, 44
joints99 Chondrodystrophia fetalis 71
long bone 72, 72f Chondroitin
short long bone 73, 73f C35
skeletal muscle 117 sulfate 45, 50
skin 199, 199f Circulating lymphocytes 182
vertebra74 Cisterna chyli 172
vascular system 150 Clasmatocytes24
vessels150 Classification of
B-lymphocytes175 blood vessels 155
Bone bones56
formation57f, 58f joints78
marrow174 neuroglia 136, 136f
Brachiocephalic veins 172 neurons 129, 130f, 133f
Bursa114 synapses 134, 135f
synovial joints 92
C Closed-face nuclei 23
Calcification of hyaline Cold temperature 91
cartilage48 Collagen fibers 30, 30f, 50
Cancellous bone 55 Collateral
Capillary 152, 155, 157 circulation162
bed200 ganglia148
loop198 ganglions147
Cardiac muscle 102, 104, 104f, 145 Communicating bursa 115
Cardiovascular system 164 Compact bone 55, 55f
Cartilage 43, 45 Complex joint 93, 94f
canals45 Component of
Cartilaginous lymphatic system 169, 174
joints 78, 80, 83 vascular system 150, 151f
model58f Compound joint 92, 93, 94f
plate84 Condensation of cells 57f
Index 211
Condylar joint 96 Diastolic

Congenital agenesis of enzyme blood pressure 156
tyrosinase188 pressure164
Connective tissue 20, 21, 29 Dilatation of pupils 147
matrix29 Diseases of collagen fibers 40
Constituents elements of connective Dislocation of joint 99
tissue21 Distribution of macrophages 25
Constriction of pupils 149 Dorsal root ganglion 131
Constrictor pupillae 117 Down syndrome 192f
Continuous capillaries 158 Draining excess interstitial
Coronary arteries 163 fluid 167
Corpuscles of Hassall 177
Cortex 66, 180 E
of brain 132 Eccrine glands 204
Cranial nerves 145 Edema36
Craniosacral outflow 147 Effect of
Cruciate muscle 114 nerve injuries 143
Cytoplasm129 parasympathetic stimulation 149
sympathetic stimulation 147
D Elastic
Dartos muscle of scrotum 105 cartilage 50, 51f
Deficiency of vitamin connective tissue 39, 41f
A70 fibers 34f
C70 Elbow joint 95f
D70 Elephantiasis184
Definition of synovial joints 87 Eliminate waste products 109
Dehydration15 Ellipsoid joint 96, 97f
Dense Embryonic mesoderm 20
irregular connective tissue 37, Endochondral ossification 57, 71
38f Endocrine organ 186
regular connective tissue 39, 40f Endomysium106
Denticulate suture 82 Endoneural tubes 143
Deposition of calcium salts 48 Endoneurium142
Dermal papillae 201 Ependymal cells 136, 137
Dermatin sulfate 35 Epidermal papillae 196
Dermis of skin 198 Epidermis 193, 194
Description of components parts of Epineurium142
synovial joints 89 Epiphyseal
Development of and metaphyseal arteries 74
lymphatic tissues 168 arteries73
skeletal muscle 118, 118f cartilage67
Diaphysis66 line69
Diarthrosis80 plate of cartilage 69, 69f
Epiphysis67 ground substance 36

Erythema188 hair200
Extensor digitorum longus 113 lymphatic system 167
External oblique abdominis 117 skin185
Functional classification of
F joints79f
Fascicular architecture of Fusiform muscle 112
muscle 111, 112f Fusimotor fibers 122
Fasciculi106
Fat cell 29f G
Fatty foods 166 Ganglion cells of auditory
Fenestrated capillaries 158 nerve131
Fibroblasts22 Geminal layer 196f
Fibrocartilaginous joints 85 Giant cells 25f
Fibrocytes22 Ginglymus joints 95
Fibrous Glans penis 204
astrocyte136f, 137 Glossopharyngeal nerve 148
bone63 Golgi apparatus 129
capsule91 Gomphosis 80, 83, 84f
joints 78, 80, 82 Granular and agranular endoplasmic
membrane83 reticulum129
First Granule cell 133f
carpometacarpal joint 98f Greenstick fractures 76
lymph sacs 168 Growth
Fixation muscle 123 and development of cartilage 46,
Flaccid paralysis 124 47f
Flat bone 59, 60f of long bone 69
Flexible bone 54f rate201
Flexor pollicis longus 113, 117
Flexure lines 191, 192f H
Foramen64 Hair
Formation of bulb201
collagen fibers 23 follicles189
myelin sheath 140, 140f Hassalls corpuscles 177
Fourth lymph sac 169 Haversian glands 98
Fracture of bone 76 Hemal nodes 182
Freys syndrome 144 Hematoxylin17
Function of and eosin staining method 17
astrocytes137 Hemolymph nodes 182
bone54 Hemorrhage164
disc or meniscus 92 Heparin sulfate 36
fibroblasts 23 Heterotopic bones 63
fibrous capsule 91 Hinge joint 95f
fluid 90 Histiocytes24
Index 213
Hyaline cartilage 50, 50f Lanugo hairs 202

joints83 Large
Hyaluronic acid 35, 90 anterior horn cell 128
Hydroxylysine30 arteries156
Hydroxyproline30 hemal node 182
Hypertrophy124 motor unit 119
Hyposecretion of alpha cells 70 Lateral
ganglion147
I horn cells of spinal cord 147
Immune system 166 Law of
Intercellular substance 21 ossification 71
Internal oblique abdominis 117 reciprocal innervations 123
Interosseous ligaments 82 union of epiphysis 71
Interphalangeal joint 93f Layers of epidermis 191f, 196
Interstitial growth 46 Left lymphatic duct 172
Intervertebral disc 85, 86f Leprosy bacilli 144
Intestinal trunks 174 Levator labii superioris 117
Intrafusal Lines of Langer 192
fibers 145 Lipofuscin129
muscle fibers 121 Lithium carmine 24
Intramembranous ossification 57 Long bone 59, 60f
Intrinsic muscles of eye 105 Loose connective tissue 37, 38f
Involuntary muscle 105 Lower
Irregular limb184
bone 60, 61f vertebrates130
connective tissue 36 Lumbar trunks 174
Isolated sebaceous glands 202 Lymph
nodes 167, 169, 179, 180f
J trunks and ducts 172, 173f
Joints78 Lymphadenitis183
Lymphangitis183
K Lymphatic
Keratin sulfate 35 capillaries 171, 171f
Keratinocytes 193, 194f, 196 channels179
Keratohyalin197 drainage117
Killer cells 175 of synovial joints 99
Killing virus 175 of bone 74
Knee joint 92 system 166, 174, 183
Krause membrane 107 vessels
and lymph circulation 170,
L 170f
Lamellar bone 63 of viscera 171
Langers lines 198 Lymphedema183
Langerhans cell 193, 194f Lymphocytes22
Lymphoid nodules 178, 178f Muscle

Lysosomes129 fibers 102, 106
of eyeball 120
M of thumb 120
Macroglia136 tone122
cells136 Muscular
Macrophage cell 24, 24f spasm124
Manubriosternal joints 87 system3
Marfans syndrome 41 tissue102
Margins of lips 204 Myasthenia gravis 124
Mast cell 27, 27f, 28 Myelinated nerve fibers 139
Medulla181 Myeloma27
Medullary cavity 55, 66 Myoepithelial cell 105, 105f
Melanocytes 28, 187, 193, 194f, Myofibrils 106
201 Myofilaments 106, 108
Melanocytic naevi 188 Myohemoglobin110
Membrane bone formation 57, 57f Myosin filaments 108
Membranocartilaginous
ossification 58 N
Merkel cells 193, 194, 194f
Nail bed 205
Mesencephalic nucleus 130, 131
Nerve
Mesenchymal cells 22, 57f, 58f,
cells127
169
fibers 34, 139
Mesodermal embryonic cells 22
supply of
Metacarpophalangeal joint 93f
arteries157
Metaphyseal or juxta-epiphyseal
supply of bone 74
arteries73
Metaphysis66 skeletal muscle 118, 119f
Microglia cells 136, 138 skin200
Microglial cell 136f synovial joints 99
Microtome16 Nervous
Microtubules129 system3
Mineral acid 53 tissue126
Mitochondria129 Neural crest ectoderm 187
Mononuclear phagocyte system 24 Neuroglia 127, 135
Motor Neurolemmal sheaths 143, 144
end plate 120, 120f Neuromuscular
nerve terminals 122 junction120f
Movements of synovial joints 98 spindle 121, 121f
Mucoid tissue 39, 41f Neurons 127, 128f
Multinucleated fibers 103 Neuropathic joint 100
Multipolar Neurovascular
neuron130f bundle156
neurons131 hilum117
Index 215
Nissl long bone 64, 65f

bodies143 lymph node 168f
substance129 nervous system 126
Nodes of Ranvier 141, 141f skeletal muscle 110, 111f
Nomenclature of muscles 116 Peculiarities of
Non-myelinated cartilage45
axons141f neurons127
nerve fibers 139, 140 synovial joints 98
Nuclear Peg and socket joint 83, 84f
bag fibers 122 Pennate muscle 112, 112f
chain fibers 122 Perichondrium44
Nuclei of cells 17 Perimysium106
Nucleus pulposus 86 Perineurium142
Nutrient artery 73 Periosteal arteries 73, 74
Periosteum66
O Peripheral
Olfactory cells of nasal mucous heart161
membrane131 lymphoid organs 177
Oligodendrocytes 136, 136f, 137, nerves 139, 142, 142f, 143
139 nervous system 126
Open-faced nuclei 23 Peroneus tertius 113
Orbicularis oris 116 Phagocytosis167
Ordinary connective tissue 36 Phlebitis165
Organization of Pigment cells 28
single muscle fiber 107f Pigmentation of
skeletal muscle fiber 106 hair201
Organophosphorus poisoning 124 skin186
Osteocytes22 Pigmented connective tissue 39
Osteophytes90 Pituitary gland 70
Pivot joint 95, 96f
P Plane
Paired jugular lymph sacs 168 joint 92, 97
Papillary suture82
layer198 Plasma cells 26, 26f, 175, 178
ridges 191, 192 Plate of hyaline cartilage 83
Paraffin embedding 16 Pneumatic bone 61, 62
Parallel muscle 111, 112f Polyaxial joint 92, 97
Paralysis124 Portal
Parasympathetic nervous circulation155
system 147, 148f vein155
Parathyroid gland 71 Postganglionic
Paris nomina anatomica 2 fibers 147
Parts of neurons 132, 148
hair 201, 201f Postsynaptic membrane 120, 134
Precapillary sphincter 156 fibers 33, 34f, 35f

Preganglionic layer contains 198
motor neurons 147 Ribonucleic acid 129
neurons132 Riders bone 63
Pressure epiphysis 67 Right lymphatic duct 172, 174
Presynaptic membrane 120, 134 Route of spread of cancer cells 184
Primary
cartilaginous joint 83 S
center of ossification 57 Saddle joint 97, 98f
lymph follicles 178 Sarcolemma 106, 121
tissues of body 14 Sarcomere107
Prime movers 123 Scar formation 199
Procollagen molecule 32 Schindylesis82
Production of collagen fibers 32 Schwann cell 139, 140
Pronator teres 117 sheath141
Protoplasmic astrocyte 136f, 137 Sclerous tissue 53
Pseudounipolar neurons 130 Sebaceous gland 202, 203f
Pulmonary Second lymph sac 168
circulation152 Secondary cartilaginous joints 83,
veins154 85, 86f
Pulse pressure 164 Sensory nerves 200
Purkinje cell 133f Serrate suture 81
Pyramidal cell 133f Sesamoid bone 61, 62
Sharpeys fibers 66
Q Short bones 59, 60f
Shortness of muscle fibers 113
Quadriceps femoris 116
Shoulder joint 97
Quadrilateral muscle 111
Silver salts 33
R Simple joint 92, 93, 93f
Single
Radiocarpal joint 97f muscle fiber 106, 107f
Rectus femoris 113 nucleus104
Red bone marrow 182 transverse line 192
Reduction of fracture 76 Sinusoids159
Reflex arc 138, 138f and cavernous tissues 155
Regeneration gliosis 137 Skeletal
Regulation of muscle tone 123 muscle 102, 103, 103f, 106, 106f
Reservoir vessels 152 system3
Resistance vessels 152 Skin
Rete color clues 188
cutaneum199 grafting206
subpapillary 199, 200 Small
Reticular intestine172
cells28 motor119
epithelial cells 177 unit119
Index 217
Smallest arteries 156 shunt162f

Smooth muscle 34, 102, 104, 104f, sinusoid159f
145 skin193
cells33 synapse133f
tissue34 thymus 175, 176f
Solitary lymph node 179 valve160f
Somatic nervous system 145 vein 160, 160f
Spastic paralysis 124 Subcutaneous bursa 115
Sphincters of Subdivisions of autonomic nervous
anus105 system146
gut147 Subfascial bursa 115
Spine64 Submuscular bursa 115
Spiral muscle 114, 114f Subsequent synostosis 85
Spleen183f Subtendinous bursa 115
macrophages24 Superior radioulnar joint 96, 96f
Spongy bone 55, 56f Supinator muscle 117
Squamous suture 82 Suppression of intestinal
Stages of regeneration 144 peristalsis147
Stem cells 22 Suprarenal medulla 147
Sternoclavicular joint 85 Surface irregularities of skin 191
Strap muscle 111 Sutural
Stratum joint82f
basale 194, 196 ligaments82
corneum198 Sutures80
germinatum196 Sweat gland 204, 204f
granulosum 194, 196, 197 Sympathetic nervous system 146,
lucidum 196, 198 146f
spinosum 194, 196, 197 Symphysis 83, 85
Stria pubis87
distensae199 Synaptic
gravidarum199 cleft 120, 134
Structure of vesicles120
artery and vein 155f Synarthrosis 79, 80
bone54 Synchondroses 83, 84f, 85
capillary158f Syndesmosis 80, 82, 83f
cartilage44 Synergists muscle 123
epidermis195f, 196f Synostosis 84, 85f
fibroblast and fibrocyte 23f Synovial
lymph node 179, 181f fluid 89, 90
mast cell 27f joints 78, 80, 87, 88f
melanocyte187f membrane 89, 91
myofibril 108, 108f, 109f Systemic
nail205f circulation 152, 155
neuron 128, 128f veins155
plasma cell 26f Systolic pressure 164
T cartilage49
cells in epidermis 194f
Tactile corpuscles 198
circulation of blood 152
Temporomandibular joint 92
connective tissue 36
Tendon synovial sheath 115, 115f
hair202
Tension lines 191
muscle102
Terminal
skeletal muscle fibers 109
ganglions 147, 148
skin189
hairs202
sutures81
Tetanus and epilepsy 124
Thick U
hairless skin 190, 190f
stratum corneum 196 Uniaxial joint 92, 95
Thin Unipolar neuron 130, 130f
hairy skin 189, 189f Unmyelinated sympathetic
stratum corneum 194 fibers 119
Third pharyngeal pouch 169 Urinary bladder 105
Thoracic duct 172, 173f
V
Thymic corpuscles 177f
Thymus 169, 175, 176f Vasa vasorum 156, 161
dependent zone 181 Vascular
Tibialis connective tissue 87
anterior113 system3
posterior113 Vasoconstriction of cutaneous blood
Tissue fluid 152 vessels147
Traction epiphysis 67 Veins 151, 159
Transitional zone of esophagus Vellus hairs 202
105 Venae cavae 151
Triceps brachii 116, 123 Venous system 167
Trochoid joint 95 Ventricle150
Tropocollagen molecules 30 Venules and veins 155
Trypan blue 24 Verhoeffs stain 33
Tubercle64 Voluntary muscle 103
Tuberosity64
Tunica
W
adventitia156 Walls of large veins 104
intima156 Wandering macrophages 24
media156 Wedge and groove suture 82
of blood vessels 105 Weeping lubrication 90
Tympanic membrane 204 White fibrocartilage 49, 50f
Types of Wrinkle lines 191, 192
circulation 153f, 154f Wuchereria bancrofti184
joints81f
bursae115 Z
capillaries and structure 158 Z line 107

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Textbook of General Anatomy

First Edition: 2011

Textbook of General Anatomy provides the basic knowledge of human

Textbook of General Anatomy provides the basic knowledge of human

We would like to thank:

Dr Vilas Chimurkar, Dr Brijraj Singh, Dr Dharmaraj Tamgire, Dr Deepali

Chapter 2 Connective Tissue 20

Chapter 4 Sclerous Tissue 53

Chapter 6 Muscular Tissue 102

Blood Supply of the Skeletal Muscle 117

Chapter 7 Nervous Tissue 126

Chapter 8 Blood Vascular System 150

Chapter 9 The Lymphatic System 166

Chapter 10 Skin and its Appendages 185

People used to kill animals with primitive instruments and thus it

ANATOMY AND ITS SUBDIVISIONS

6. Histology (Microscopic Anatomy)

ANATOMICAL POSITION AND BODY PLANES

Fig. 1.1: Anatomical position and body planes

Terms of Relation Commonly Used in

Fig. 1.2: Terms of relation commonly used in gross anatomy

Anatomical Planes (Fig. 1.3)

SPECIAL TERMS FOR LIMBS (Fig. 1.4)

Fig. 1.3: Anatomical planes

Fig. 1.4: Special terms for limbs

Certain Other Terms (Terms Used for Hollow Organs)

Terms Used for Solid Organs

Terms to Indicate the Side

Terms Used for Describing Movements (Figs 1.6

Fig. 1.5: Terms for hallow organs

 or example, flexion moves the arm forward and medially, while

Figs 1.6 and 1.7: Terms used for describing movements

5. Lying down (recumbent) position with the face directed down is

 Ideally microscopic examination of living tissues should be

PRIMARY TISSUES OF THE BODY

To overcome these problems it is necessary to harden the organ in

To prevent the distortion which may occur due to direct transference

Mounting: The flat sections have to be mounted on glass slides, which

Chemical Basis of Staining with Hematoxylin and Eosin

GENERAL FEATURES OF CONNECTIVE TISSUE

Constituents Elements of Connective Tissue

Connective Tissue Cells (Fig. 2.1)

Fig. 2.1: Loose areolar tissue showing cells of connective tissue

Fibroblasts (Fig. 2.2)

Fig. 2.2: Structure of fibroblast and fibrocyte

Young and active fibroblasts possess open-faced nuclei

Macrophages (Histiocytes or Clasmatocytes) (Fig. 2.3)

Fig. 2.3: Macrophage cell

subserves an important apparatus for defensive mechanisms of

Fig. 2.4: Giant cells

Plasma Cells (Figs 2.5 and 2.6)

Fig. 2.5: Plasma cell

Fig. 2.6: Structure of plasma cell

The chromatin granules in the nucleus are arranged in such a way

Mast Cells (Fig. 2.7)

Chapter 2 Connective Tissue 20

Chapter 4 Sclerous Tissue 53

Chapter 6 Muscular Tissue 102

Chapter 7 Nervous Tissue 126

Chapter 8 Blood Vascular System 150

Chapter 9 The Lymphatic System 166

Chapter 10 Skin and its Appendages 185

or example, flexion moves the arm forward and medially, while

Ideally microscopic examination of living tissues should be

The reticular fibers provide support to the walls of blood vessels

People with Marfan syndrome tend to be tall and have