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SECTION Ⅰ．MUSCULAR CONTRACTION AND ASSOCIATED PHENOMENA25

CHAPTER Ⅰ．PHYSIOLOGY OF SKELETAL MUSCLE25

Functions of Muscles in Health and Disease25

Excitation and Contraction of Muscle27

The Appraisal of Excitability31

The Reactions of Isolated Muscles33

Effects of Initial Length and Tension35

Tetanic Contractions and Summation Nature of Voluntary Contraction39

The Nature of Voluntary Contractions41

Physical Properties of Single Muscle Fiber During Rest and Activity42

Other Shortening Mechanisms43

Tonus44

Contracture44

Rigor44

Abnormal States of Muscular Contraction45

Spasticity45

Fibrillation and Fasciculation46

Denervation Reactions47

Atrophy47

Myasthenia48

Myotonia48

CHAPTER Ⅱ．FUNCTIONS OF CARDIAC AND SMOOTH MUSCLE50

Cardiac Muscle50

Rhythmicity and Conduction51

Contractile Responses53

Excitability58

The Refractory Phase59

Smooth Muscle61

Exitability62

Tonus63

CHAPTER Ⅲ．BIOENERGETICS65

The Caloric Unit66

The Energy Transformation66

The Mechanisms of Oxidation67

Energy Transformations Following Excitation of Muscle70

Sequence of Chemical Changes71

The Heat Production of Muscle74

Mechanical Efficiency of Contraction76

The Fuel for Muscular Contraction79

Muscular Fatigue82

CHAPTER Ⅳ．BIOELECTRIC PHENOMENA84

Apparatus84

The Character and Significance of Direct Leads87

Diphasic Action Potentials89

The Meaning of Bioelectric Phenomena92

Indirect Leads—Volume Conductors95

Local Response—End-plate and Synaptic Potentials99

Use of Action Potential in Physiological Studies101

Skeletal Muscle Potentials101

Cardiac Phenomena102

Smooth Muscle Organs102

Secretory Activity103

Nerve Trunks and Fibers103

The Retina and the Optic Tracts103

The Cochlear Functions and Auditory Tract104

Synaptic Transmission，Conduction，and Inhibitory Phenomena in Ganglia and Spinal Cord104

Brain and Cortex．The Electroencephalogram and Cortical Electrogram104

Conditions Modifying Normal EEG．Patterns106

Clinical Applications106

SECTION Ⅱ．THE PHYSIOLOGY OF THE PERIPHERAL AND CENTRAL NERVOUS SYSTEMS109

CHAPTER Ⅴ．PHYSIOLOGY OF AXONS109

Methods109

The Characteristics of Nerve Conduction110

Direction of Conduction110

Exitability of Nerves111

Action Potentials of Single Axons116

Metabolism117

Interaxonal and Intercellular Currents119

The Effects of Direct Current120

Accommodation122

Repetitive Firing124

Fatigue124

CHAPTER Ⅵ．REFLEX ARCS AND REACTIONS OF THEIR COMPONENTS127

The Morphological Background127

Concept of the Simple Reflex Arc127

Principal of Convergence and Divergence128

Autonomic Reflex Arcs129

Cranial Nerve Reflexes129

Intersegmental Reflexes129

Biophysics of Receptor and Effector Components130

Sensory End-organs130

Central Motor Cells132

Conduction and Excitation in Ganglion Cells133

Synaptic and End-plate Transmission135

Biophysical Aspects of Reflex Actions138

Spinal Cord Potentials138

After-Discharge139

CHAPTER Ⅶ．MECHANISMS OF SIMPLER REFLEXES143

Animal Preparations143

The Spinal Preparation143

Spinal Shock and Its Meaning144

Flexor Reflexes145

Central Inhibition147

Reflexes Due to Repetitive Stimuli149

The Reflex Excitation of Flexors of a Whole Limb150

Extensor Reflexes152

De-Emblée and Recruitment in Reflex Muscular Action152

Inhibition of Crossed Extensors154

Ipsilateral Extensor Reflexes154

Myotatic or Stretch Reflexes154

Reflex Postural Contraction(Plastic Tonus)155

The Knee-jerk—A Phasic Stretch Reflex156

CHAPTER Ⅷ．PHYSIOLOGICAL PURPOSES OF REFLEX ACTIONS AND THEIR DISTRUBANCES IN DISEASE160

The Purposive Character of Reflex Action161

Protective Reflexes162

Automatic or Associated Reactions164

The Integration of Allied and Antagonistic Reflexes165

Postural Reflexes165

Stance Reflexes167

Static Righting Reflexes70

Source of Labyrinthine Impulses for Control of Static Equilibrium171

Static Reflexes in Disease171

Kinetic Equilibrium and Stato-kinetic Reflexes172

Kinetic Labyrinthine Responses173

Reflexes in Locomotion175

CHAPTER Ⅸ．CONTROL OF VOLUNTARY AND INVOLUNTARY MOVEMENTS178

The Cortical Areas178

The Motor Cortex179

The Pyramidal System of Control180

Electrical Excitation of Motor Cortex182

Ablation and Injury of Motor Cortex185

Functions of the Pyramidal Tracts186

The Extrapyramidal System186

The Premotor Cortex186

Decerebrate Rigidity189

The Interpretation of Spastic Paraplegia and Other Spastic States189

The Striato-pallidum Syndromes and Their Interpretations191

CHAPTER Ⅹ．CEREBELLAR CONTROL OF MUSCULAR MOVEMENTS195

Cerebellar Connections195

Theories of Cerebellar Function196

CHAPTER Ⅺ．SOMATIC SENSIBILITIES AND THEIR DISTURBANCES203

Subjective Attributes of Sensation209

The Concept of Paleo- and Neosensibilities(Brouwer)211

The Functions of the Thalamus213

Cortical Representation of Somatic Sensibilities216

CHAPTER Ⅻ．SPECIAL SENSIBILITIES227

Vision227

The Dioptric Mechanism227

The Retinal Receptor Mechanism230

Effects of Light on the Retina231

Visual Acuity232

Discrimination of Differences in Light Intensity232

Flicker232

Retinal Changes in Stimulation233

Scotopic and Photopic Vision233

Optic Nerve Discharges235

Organization of Impulses by the Retina236

Electroretinograms and Optic Axon Responses236

Color Vision238

Color Blindness242

Camouflage and Its Detection by Color-blind Eyes244

Conduction Pathways244

Some Pupillary Reactions and Reflexes247

Pathological Disturbances of Vision Due to Lesions of Visual Receptors and Optic Pathways248

Hearing251

The External Auditory Apparatus251

The Middle Ear251

The Internal Ear253

Physical Characteristics of Sounds255

Quality of Timbre256

The Excitation of Auditory Terminals by Internal Ear Mechanisms257

Microphonic Responses of the Cochlea258

Action Potentials of the Cochlear Nerve259

Nerve Conduction Paths259

Cortical Representation260

Auditory Discrimination in Auscultation260

Noise and Its Measurement261

Impairment of Hearing262

Taste264

Smell267

CHAPTER ⅩⅢ．ASSOCIATIVE FUNCTIONS OF THE CEREBRAL CORTEX271

Cortical Control of Verbalization271

The Alleged Existence of＂Speech Centers＂271

The Prefrontal Association Areas273

Prefrontal Lobectomy273

Frontal Lesions274

Prefrontal Lobotomy274

Conditioned Reflexes275

CHAPTER ⅪⅤ．THE AUTONOMIC NERVOUS SYSTEM AND HYPOTHALAMUS—SLEEP286

The Autonomic Nervous System286

The Concept of the Autonomic Reflex System288

Autonomic Centers294

The Hypothalamus294

The Hypothalamus and Sleep299

CHAPTER ⅩⅤ．VISCERAL PAIN AND HEADACHE304

Visceral Sensitivity and Pain304

Cardiac Pain(Angina Pectoris)307

Vascular Pains310

Gastro-intestinal Pains311

Hepatic and Biliary Pains312

Renal and Ureteral Pains312

Headache313

CHAPTER ⅩⅥ．THE PHYSIOLOGICAL BASIS FOR PSYCHOSOMATIC REACTIONS319

Emotional Components319

The Emotional Centers in the Central Nervous System320

Cortical Factors in Emotional Reactions322

The Purposeiveness of Emotional Reactions324

Effects of Non-utilization of Visceral Energy Releases324

Functional Changes Due to Emotion324

Human Organ Neuroses326

SECTION Ⅲ．THE BLOOD333

CHAPTER ⅩⅦ．THE CORPUSCULAR ELEMENTS OP BLOOD333

Leucocytes333

Basal Levels and Physiological Variations334

Functions and Their Importance334

Disturbances of the White Cell Systems336

Erythrocytes337

Size，Form and Numbers337

Structure and Constitution338

Life History and Destruction of Blood Cells338

Histogenesis338

Erythropoiesis339

Granulopoiesis340

Thrombopoiesis341

Disturbances of the Red Cell Systems342

Polycythemia342

Hemoglobin and Derivatives344

Abnormal Combinations of Hemoglobin347

Hematoporphyrinemia348

Suspension Stability，Sedimentation and Agglutination of Red Cells348

Hemagglutination349

Hemolysis353

CHAPTER ⅩⅧ．BLOOD PLASMA AND COAGULATION357

Plasma357

The Plasma Proteins357

Blood Viscosity359

Viscosity of Normal Blood359

Factors Affecting Blood Viscosity360

Coagulation of the Blood361

Coagulation Constants of Normal Blood361

The Coagulation Process361

The Chemical Mechanisms362

Theories of Coagulation367

Thrombosis369

Anticoagulants369

Methods of Hastening Coagulation372

Hemorrhagic Diseases373

Hemophilia373

Hemophilioid Conditions374

CHAPTER ⅪⅩ．ACIDOSIS AND ALKALOSIS376

The Regulation of the Acid-base Balance376

The Buffering Systems of the Blood377

Physiological Factors in the Control of Acid-base Balance379

Clinical Acidosis and Alkalosis380

Types of Disturbances382

CHAPTER ⅩⅩ．BLOOD VOLUME—BLOOD LOSS AND TBANSFUSION386

Blood Volume386

Normal Blood Volumes390

The Control of Blood Volume391

Blood Volume and Plasma Volume in Disease391

The Distribution of Blood Losses393

Transfusions394

The Time Element394

Quantity394

Rate of Infusion395

Intra-arterial Transfusion396

Blood Substitutes396

SECTION Ⅳ．RESPIRATION407

CHAPTER ⅩⅪ．FUNCTIONS OF RESPIRATORY STRUCTURES AND THEIR DISTURBANCES407

Prenatal Respiration407

The Mechanism of External Respiration After Birth409

Physiological Aspects of Pathological Pulmonary Conditions411

CHAPTER ⅩⅫ．RESPIRATORY MOVEMENTS AND MECHANICS OP LUNG INFLATION414

Chest Enlargement and Muscular Action414

Physiological Mechanisms417

The Decrease in Thoracic Size During Expiration418

Modified Respiratory Movements418

Lung Inflation419

Changes in the Pleural Pressures and Lung Inflation420

The Dynamics of Lung Inflation421

Pneumothorax423

The Exchange of Air in the Alveoli423

CHAPTER ⅩⅩⅢ．INTERCHANGE OF GASES IN THE LUNGS AND TISSUES AND THEIR TRANSPORTATION BY THE BLOOD429

The Physical Conditions for Interchange of Gases429

Alveolar Gas Volumes and Tensions429

The Volumes and Tensions of Blood Gases431

Gas Tensions in Tissues432

Diffusion of Gases Through Tissue Membranes433

The Interchange of Gases in the Lungs and Tissues433

The Transport of Oxygen by the Blood436

The Kinetics of Oxygenation and Reduction of Hemoglobin438

The Transport of Carbon Dioxide439

CHAPTER ⅩⅩⅣ．REGULATION OF RESPIRATION443

The Respiratory Center443

The Reflex Control of the Respiratory Center446

Lung Reflexes448

Aortic and Sinus Caroticus Reflexes449

The Chemical Control of Respiration450

The Functional Organization of the Respiratory Center452

The Intrinsic Mechanism of Respiratory Automaticity454

The Humoral Controls455

The Cellular Theories456

Chemical Reflexes in Control of Respiration457

Prenatal Respiratory Movements，Neonatal Apnea and Breathing460

CHAPTER ⅩⅩⅤ．CLINICAL DISTURBANCES OF RESPIRATION463

Dyspnea463

Cardiac Dyspnea465

Cardiac Asthma469

Periodic Breathing471

The Hyperventilation Syndrome472

Respiratory Failure474

Responses to Respiratory Resistance474

Tachypnea474

Types of Respiratory Failure475

Artificial Respiration475

CHAPTER ⅩⅩⅥ．CLINICAL ANOXIA481

The Effects of Oxygen Deficiency481

Clinical Types of Anoxia481

Cyanosis484

Cyanosis Associated with Congenital Anomalies485

Acclimatization to Anoxic States and Chronic Altitude Sickness486

Acclimatization486

High Altitude Disease(Chronic Mountain Disease，Monge＇s Disease)487

Oxygen Therapy487

Toxic Effects of Oxygen Under High Pressure490

Other Aids in Supplying Oxygen to Tissues491

CHAPTER ⅩⅩⅦ．AVIATION PHYSIOLOGY493

The Effects of Altitude493

Effects of Cold494

Solar Radiations494

Anoxia495

Forces Concerned in Blood Oxygenation495

Methods for Producing Anoxemic Anoxia497

Symptoms of Hypoxia and True Anoxia497

Methods of Increasing Altitude Tolerance499

Physiological Actions of Anoxia501

Blood501

Central Nervous System502

Effects on Other Organs502

Heart and Circulation503

CHAPTER ⅩⅩⅧ．AVIATION PHYSIOLOGY(Continued)505

Effects of Pressure Changes and Acceleration505

Paranasal Sinuses and Middle Ear505

Gastro-intestinal Distention506

Blood and Tissue Fluids506

Decompression Sickness506

Explosive Decompression508

Effects of Acceleration509

Parachute Descent510

Other Aspects of Linear Accelerations510

Radial Acceleration511

Physiological Effects of Acceleration511

Procedures for Circumventing the Effects of Acceleration514

The Labyrinth in Aviation514

SECTION Ⅴ．HEART AND CIRCULATION518

CHAPTER ⅩⅪⅩ．EXCITATION OF THE MAMMALIAN HEART AND ITS NERVOUS CONTROL518

Anatomical Aspects518

Cardiac Muscle518

The Specialized Muscular System518

Electrographic Methods of Study521

Initiation of Impulses521

The S-A Node as Pacemaker521

Ectopic Rhythmic Centers522

Conduction of Impulses523

A-V Conduction524

Conduction in the Ventricles525

Interference of Impulses527

Nervous Control of the Mammalian Heart527

Right Vagus528

Left Vagus529

Accelerator Nerves530

The Ultimate Cause of Automatism and Its Modifications531

CHAPTER ⅩⅩⅩ．ELECTROCARDIOGRAPHY533

The Three Standard Leads and Their Significance533

The Electrocardiogram Pattern534

Relation of Waves to Spread of Excitation and Restitution535

The Physical Meaning of Standard Leads536

The Physical Character of Resultant Potential Differences and Their Distribution in Volume Conductors538

The Cause of Abnormal Complexes544

Precordial Leads545

Unipolar Limb Leads547

The Physiological Meaning of Electrocardiogram Deflections548

Abnormalities in Deflections549

Some Electrographic Evidences of Conduction Disturbances550

CHAPTER ⅩⅩⅪ．ABNORMAL CARDIAC RHYTHMS AND THEIR ELECTROCARDIOGRAPHIC INTERPRETATION552

Normal Heart Rate Standards552

Abnormal Rhythms552

Sinus Tachycardia552

Sinus Bradycardia553

Phasic Sinus Arrhythmia554

Ectopic Rhythms555

A-V Nodal Rhythm555

Idioventricular Rhythms556

Disturbances of Impulse Conduction556

Heart Block556

Premature Beats and Paroxysmal Tachycardias563

Premature Atrial Systoles563

Paroxysmal Tachycardia of Atrial Origin564

Premature Ventricular Contractions565

Paroxysmal Ventricular Tachycardia565

Parasystolic Rhythms566

Re-entrant Impulses and Circus Movements566

Fibrillation and Allied Conditions567

Atrial Fibrillation and Flutter567

Ventricular Fibrillation570

The Nature of Fibrillation and Flutter572

The Initiation of Fibrillation573

Ventricular Alternation574

CHAPTER ⅩⅩⅫ．THE CIRCULATION OF THE BLOOD576

The Circulatory System577

The Distributing System578

The Capillaries and Venules579

The Collecting System581

Peripheral Blood Shunts and Blood Spaces582

The Heart as a Pump582

The Essential Cardiac Structures582

The Movements of the Heart and Apex Beat586

The Reservoir Function of the Central Arteries587

Peripheral Resistance590

Total Peripheral Resistance591

Units of Resistance591

CHAPTER ⅩⅩⅩⅢ．HEMODYNAMIC PRINCIPLES593

Pressure，Flow and Resistance593

Velocity595

The Circulation Time596

The Hemodynamics of Pulsating Streams599

CHAPTER ⅩⅩⅩⅣ．MEAN ARTERIAL BLOOD PRESSURE AND ITS CONTROL．THE EFFECTS OF RESPIRATION604

Methods604

Factors Affecting Mean Arterial Pressure-Hemodynamics606

Methods for Evaluating Alterations in Peripheral Resistance607

Illustrations of Modifications of Mean Arterial Pressure and Organ Volume by Cardiac and Vascular Factors608

The Effects of Respiration on Blood Pressure612

CHAPTER ⅩⅩⅩⅤ．NERVOUS AND CHEMICAL CONTROL OF BLOOD PRESSURE614

The Nervous Control of the Arterioles614

Vasomotor Nerves and Their Actions614

The Control of Vasomotor Centers618

The Nervous Control of Heart Rate624

The Control of Venous Return627

Blood Reservoirs629

Effects of Gravity in the Upright Position630

CHAPTER ⅩⅩⅩⅥ．THE CEREBRAL，PORTAL，AND SPLENIC CIRCUITS633

The Cerebral Circulation633

Cerebral Blood Flow635

Cerebral Anemia．Increased Intracranial Pressure638

The Hepatic Circulation639

Hepatic Blood Flow639

The Splenic Circulation642

CHAPTER ⅩⅩⅩⅦ．DYNAMICS OF THE HEART BEAT．PRESSURE AND VOLUME CURVES—CYCLE OF EVENTS—VALVE ACTION—HEART SOUNDS644

The Pressure Pulses644

The Ventricular Volume Curves and Their Relation to Pressure Pulses648

The Sequence of Cardiodynamic Events651

The Phases of the Cardiac Cycle654

The Movement of Blood Through the Aorta654

The Mechanisms of the Heart Beat in Detail656

Mechanical vs．Electrical Systole656

The Atrial Contraction and Its Dynamic Function656

The Play of the Cardiac Valves657

The Heart Sounds658

The Audible Heart Sounds659

Recorded Heart Sounds661

Normal Phonocardiograms663

CHAPTER ⅩⅩⅩⅧ．TRANSMISSION OP PRESSURE PULSES TO THE PERIPHERY．ARTERIAL AND VENOUS PULSES670

The Arterial Pulse670

Transformation of the Pressure Pulse in Transmission671

The Genesis of Peripheral Arterial Pulses674

Clinical Value of Central Pulse Tracings677

The Practical Value of the Radial Pulse680

Transmission Time and Velocity of the Pulse Wave681

The Central Venous Pulse682

Waves of Optically Recorded Venous Pulse and Their Significance684

The Clinical Value of the Venous Pulse686

CHAPTER ⅩⅩⅩⅨ．SYSTOLIC AND DIASTOLIC ARTERIAL PRESSURES．PERIPHERAL AND CENTRAL VENOUS PRESSURES．CAPILLARY PRESSURE687

Factors Determining Systolic-Diastolic Pressure Relations687

Physical Experiments by Means of Artificial Circulation Machines687

Pressure Changes in Experimental Animals692

Human Blood Pressure692

Orientation692

Indirect Methods693

Normal Values for Human Blood Pressures698

Venous Pressure700

Peripheral Venous Pressure700

Capillary Pressures704

CHAPTER ⅩL．EFFICIENCY AND ADAPTABILITY OF THE HEART706

Cardiac Output and Work706

Physical Factors in Cardiac Adaptation．Compensation and Decompensation715

The Effects of Increased Venous Supply716

The Effects of Increased Aortic Resistance718

The Effects of Heart Rate Changes719

The Effects of Abnormal Ventricular Excitations720

Effects of Alterations in the Inherent Condition of Heart Muscle721

Application of Dynamic Principles to Clinical Disorders722

Primary Hyperdynamic Action of the Ventricles723

Primary Hypodynamic Action of the Ventricles724

The Functions of the Pericardium727

Effects of Pericardial Effusion(Cardiac Tamponade)728

Effects of Chronic Adhesive Processes729

The Question of Cardiac Tonus730

Hypertrophy731

CHAPTER ⅩLⅠ．HYPERTENSION738

Classifications738

Physiological Aspects738

Experimental Hypertension739

Clinical Hypertension742

Dynamic Characteristics744

Structures Affected in Hypertension745

Cardiac Effects746

CHAPTER ⅩLⅡ．THE PULMONARY CIRCULATION748

The Normal Pulmonary Circulation748

Anatomical Characteristics748

Pressure Values in the Pulmonary Circuit750

Pressure Pulses751

The Nervous Control of Pulmonary Vessels753

Experimental and Pathological Changes in the Pulmonary Circulation754

Effects of Heart Rate754

Effects of Systolic Discharge of the Right Ventricle755

Effects of Abnormal Respiratory Conditions755

Pulmonary Embolism756

Fat Embolism756

Embolism of the Larger Pulmonary Arteries756

Air Embolism757

Pulmonary Congestion．Back-Pressure Effects758

Effects of Systemic Hypertension748

Effects of Aortic or Mitral Resistance759

Acute Pulmonary Edema759

CHAPTER ⅩLⅢ．CORONARY CIRCULATION—ITS CONTROL AND ADJUSTMENTS IN HEALTH AND DISEASE—CORONARY OCCLUSION764

The Normal Coronary Circulation764

Coronary Sinus Flow766

The Question of Functional Collaterals768

Coronary Arterial Pressures769

Coronary Flow770

The Mechanical Effects of the Heart Beat773

Phasic Changes in Coronary Flow773

Disturbances of the Coronary Circulation779

Acute Coronary Occlusion779

Coronary Insufficiency Due to Other Causes782

CHAPTER ⅩLⅣ．DYNAMICS OF VALVULAR LESIONS786

Aortic Stenosis786

The Cardinal Clinical Signs786

The Degree of Stenosis as a Physical Factor786

The Pressure Pulses786

The Systolic Murmur789

The Dynamic Changes in the Pulmonary Circuit and Right Heart789