The Human Body: An Orientation Ch 1.

The Human Body: An Orientation Ch 1

Complementarity of structure and function
Anatomy: Study of the structure of body parts Gross- large body structures Regional- all parts in a specific region Developmental- structural changes over a life time Embryology- developmental changes that occur before birth Physiology: Study of the body’s function Cardiovascular Renal Reproductive Neurophysiology Complementarity of structure and function

Levels of Structural Organization
Atoms Molecules Organelles Cells Tissues Organs Organ Systems Organism

Levels of Structural Organization
DNA molecule organelle carbon atom cell tissue Levels of Structural Organization organism organ system organ

Basic Life Processes Metabolism Responsiveness Movement Growth Differentiation Reproduction

Metabolism The sum total of the chemical processes that occur in living organisms, resulting in growth, production of energy, elimination of waste material, etc. Anabolism- build up of complex molecules Catabolism- break down of complex molecules

Cellular Respiration C6H12O6 + 6O2  6H2O + 6CO2 + energy

Homeostasis All organisms must maintain a constant internal environment to function properly Temperature pH Salinity Fluid levels

Homeostasis Relatively stable internal environment

Negative Feedback vs Positive Feedback

Feedback Systems Receptor Control center Effector

Negative Feedback Body Temperature Regulation

Negative Feedback Blood Sugar Levels

Positive Feedback 1 3 2 4 Break or tear occurs in blood vessel wall.
Positive feedback cycle is initiated. 3 Released chemicals attract more platelets. Platelets adhere to site and release chemicals. 2 Positive feedback loop Feedback cycle ends when plug is formed. Platelet plug forms. 4

Positive Feedback Oxytocin

Homeostasic Imbalance
Moderate imbalance: Disease Disorder Severe imbalance: Death

(a) Integumentary System Forms the external body covering, and
Hair Skin Nails (a) Integumentary System Forms the external body covering, and protects deeper tissues from injury. Synthesizes vitamin D, and houses cutaneous (pain, pressure, etc.) receptors and sweat and oil glands. Figure 1.3a

Protects and supports body organs,
Bones Joint (b) Skeletal System Protects and supports body organs, and provides a framework the muscles use to cause movement. Blood cells are formed within bones. Bones store minerals. Figure 1.3b

Allows manipulation of the environment,
Skeletal muscles (c) Muscular System Allows manipulation of the environment, locomotion, and facial expression. Main- tains posture, and produces heat. Figure 1.3c

As the fast-acting control system of
Brain Nerves Spinal cord (d) Nervous System As the fast-acting control system of the body, it responds to internal and external changes by activating appropriate muscles and glands. Figure 1.3d

Glands secrete hormones that regulate
Pineal gland Pituitary gland Thyroid gland Thymus Adrenal gland Pancreas Testis Ovary (e) Endocrine System Glands secrete hormones that regulate processes such as growth, reproduction, and nutrient use (metabolism) by body cells. Figure 1.3e

(f) Cardiovascular System
Heart Blood vessels (f) Cardiovascular System Blood vessels transport blood, which carries oxygen, carbon dioxide, nutrients, wastes, etc. The heart pumps blood. Figure 1.3f

(g) Lymphatic System/Immunity Picks up fluid leaked from blood vessels
Red bone marrow Thymus Lymphatic vessels Thoracic duct Spleen Lymph nodes (g) Lymphatic System/Immunity Picks up fluid leaked from blood vessels and returns it to blood. Disposes of debris in the lymphatic stream. Houses white blood cells (lymphocytes) involved in immunity. The immune response mounts the attack against foreign substances within the body. Figure 1.3g

(h) Respiratory System Keeps blood constantly supplied with
Nasal cavity Pharynx Bronchus Larynx Trachea Lung (h) Respiratory System Keeps blood constantly supplied with oxygen and removes carbon dioxide. The gaseous exchanges occur through the walls of the air sacs of the lungs. Figure 1.3h

Breaks down food into absorbable units that enter the blood for
Oral cavity Esophagus Liver Stomach Small intestine Large intestine Rectum Anus (i) Digestive System Breaks down food into absorbable units that enter the blood for distribution to body cells. Indigestible foodstuffs are eliminated as feces. Figure 1.3i

Eliminates nitrogenous wastes from the
Kidney Ureter Urinary bladder Urethra (j) Urinary System Eliminates nitrogenous wastes from the body. Regulates water, electrolyte and acid-base balance of the blood. Figure 1.3j

(k) Male Reproductive System (l) Female Reproductive System
Mammary glands (in breasts) Prostate gland Ovary Penis Testis Ductus deferens Scrotum Uterine tube Uterus Vagina (k) Male Reproductive System (l) Female Reproductive System Overall function is production of offspring. Testes produce sperm and male sex hormone, and male ducts and glands aid in delivery of sperm to the female reproductive tract. Ovaries produce eggs and female sex hormones. The remaining female structures serve as sites for fertilization and development of the fetus. Mammary glands of female breasts produce milk to nourish the newborn. Figure 1.3k-l

Orientation & Directional Terms

Body Planes Medial & Lateral Superior Frontal plane Distal
oblique Distal Transverse plane Proximal Posterior Inferior Anterior Midsagittal plane

Dorsal & Ventral Body Cavities

Membranes

Serous Membrane Organs surrounded by double layer membrane called serosa or serous membrane Composed mostly of simple squamous epithelia and a little connective tissue Filled with serous fluid- function reduce friction Parietal (outer) vs Visceral (inner)-- both secrete serous fluid

Serous Membrane Pericardial membrane Parietal pericardium Serous fluid
Visceral pericardium

Serous Membrane Pleural membrane Parietal pleura Visceral pleura
Serous fluid

Serous Membrane Peritoneal membrane Parietal peritoneum
Visceral peritoneum Peritoneal cavity

Diseases pleurisyinflammation of pleura
peritonitisinflammation of peritonea pericarditis inflammation of pericardia

Mucus Membranes Nasal cavity mouth esophagus bronchi stomach

Cutaneous Membranes

Synovial Membranes Synovial membrane Joint cavity
(containing synovial fluid)

Abdominopelvic Regions

Abdominopelvic Regions
Hypogastric- large intestine, sm intestine, bladder Umbilical- sm and lg intestine Epigastric- stomach, liver, spleen, pancreas Right hypochondriac- liver Left hypochondriac- stomach, liver, spleen, pancreas Right lumbar- large and small intestine Left lumbar- large and small intestine Right iliac- large intestine, cecum Left iliac- large intestine

Medical History

Ancient Greece Hippocrates (460 – 370? B.C.) Greek physician
Diseases have natural causes Rejected view that disease caused by evil spirits Believed that the brain was area of higher thought and emotion, not heart Program for good health: rest, good nutrition, and exercise. Started “Western Medicine”

Hippocrates’ Four Humors
Blood: considered to be made by the liver. Phlegm: associated with the lungs. Yellow bile: associated with the gall bladder. Black bile: associated with the spleen. Too much Earth: Melancholic Too much Air: Sanguine Too much Fire: Choleric Too much Water: Phlegmatic. Finally, each element/humor/season was associated with certain qualities. Thus yellow bile was thought of as hot and dry. Its opposite, phlegm (the mucus of colds), was cold and moist. Black Bile was cold and dry, while its opposite, blood was hot and moist. Black Bile: Cold and Dry Blood: Hot and Moist Phlegm: Cold and Moist Yellow Bile: Hot and Dry. As a first step, the prudent Hippocratic physician would prescribe a regimen of diet, activity, and exercise, designed to "void the body of the imbalanced humor." According to Gary Lindquester's History of Human Disease, if it was a fever -- a hot, dry disease -- the culprit was yellow bile. So, the doctor would try to increase its opposite, phlegm, by prescribing cold baths. If the opposite situation prevailed (as in a cold), where there were obvious symptoms of excess phlegm production, the regimen would be to bundle up in bed and drink wine. If this didn't work the next course would be with drugs, often hellebore, a potent poison that would cause vomiting and diarrhea, "signs" the imbalanced humor was eliminated. We might assume such Hippocratic ideas sprang from speculation rather than experimentation, but observation played a key role. Furthermore, it would be simplistic to say ancient Greco-Roman doctors never practiced human dissection. If nothing else, doctors had anatomical experience dealing with war wounds. But especially during the Hellenistic period, there was extensive contact with the Egyptians whose embalming techniques involved removing bodily organs. In the third century B.C. vivisection was permitted in Alexandria where living criminals may have been put to the knife. Still, we believe "Hippocrates," Aristotle, and Galen, among others, only dissected animal bodies, not human. So man's internal structure was known primarily through analogy with animals, inferences from the externally visible structures, from natural philosophy, and from function. Such ideas might seem far-fetched today, but Hippocratic medicine was a great advance over the supernatural model that had preceded it. Even if individuals had understood enough about contagion to realize rodents were involved somehow, it was still the Homeric Apollo, the mouse god, who caused it. The Hippocratic aetiology based on nature permitted diagnosis and treatment of symptoms with something other than prayer and sacrifice. Besides, we rely on similar analogies today, in Jungian personality types and ayurvedic medicine, to name two.

Imbalances of the Humors Cause Disease
Sanguine: Disease, excess blood Phlegmatic: Disease, excess phlegm Choleric: Disease, excess yellow bile Melancholic: Disease, excess black bile

disease resulted from an internal imbalance of the four humors
Roman Times Galen ( A.D.) Anatomy & Physiology disease resulted from an internal imbalance of the four humors Mistakes in understanding circulation Research based on ape dissection Textbook used for 1000 years At the dawn of the sixteenth century, European scholars could gain only a crude understanding of the anatomy of humans and animals. At the handful of universities where students trained in medicine—such as Bologna or Paris—professors read from the books of the Roman physician Galen. Galen had combined the philosophical work of Aristotle and other Greeks with his own lifetime of dissections, creating a system that explained not just the structure of the human body, but how the body worked. After the fall of Rome, Galen’s legacy lived on in Arab cities like Baghdad, where his work was translated, pored over, and encrusted with interpretations and commentaries. In the 1100s, Europeans began to translate Galen from Arabic and made his work the basis of medical training. But in the many steps of translation, much of the spirit of Galen’s work—especially his emphasis on observing for oneself rather than relying on authority—was lost. A tradition had emerged in which professors read Galen to their students, while a surgeon dissected an executed criminal to show the relevant parts of the body. There was no point in the professor looking for himself at the body, since everything worth learning could be found in Galen’s books. The Greek physician Galen ( CE) used Aristotle's theories in his monumental work De usu partium, which served as a standard medical text for nearly a millennium and a half. Some of his discoveries -- the function of the kidneys, for instance, and the realization that severing the spinal cord causes paralysis -- were advances based on empirical observation. But Galen performed no human dissections, and perpetuated a number of errors. His model of the circulatory system, for instance, although it showed the arteries carried blood rather than air, made the liver the source of blood. His system depended on the coexistence of three "spirits" in the body: the liver was the seat of the natural spirit, the heart of the vital spirit, and the brain of the animal spirit.

Dark Ages- 200 to 1200 A.D. Sad time Little new knowledge Taboo against dissecting human cadavers continued Avoided actual involvement Authority prevails

Renaissance da Vinci(1452-1515) Anatomy & Physiology
While it is the paintings of Leonardo that have brought him fame over the years, the full range of his talent can best be seen in his drawings. His many drawings and notes, at least the ones that have survived, have become the basis for the modern scientific illustration, especially important in the field of anatomy. Leonardo's anatomical studies, while great works of art in themselves, were used not only as tools to aid in his artistic understanding of the human form, but also as a means of scientific exploration of human functions.Leonardo da Vinci was born on April 15, 1452, in the town of Vinci, Italy. He was the illegitimate son of Ser Piero da Vinci, a public notary, and a young peasant girl named Caterina, about whom little is known. From a very early age, Leonardo is said to have shown exceptional ability in geometry, music, and artistic expression (Leonardo da Vinci: Anatomical Drawings, 10). Noticing this, Ser Piero took his son's drawings to Andrea del Verrocchio in Florence. Verrocchio was so struck by Leonardo's brilliance that he immediately took him in as his apprentice, and by 1472, at the age of twenty, Leonardo had joined the painters' civic guild in Florence. However, little more is known about the education and training of Leonardo da Vinci, and it is assumed by many that much of his learning came not from traditional sources, but from his personal observations and the practical application of his ideas (Leonardo: Anatomical Drawings, 10). Giorgio Vasari, the artist who was also the first modern historian of art, described Leonardo da Vinci as a "unique genetic mutation", and believed that "his genius was a gift from God" (Keele and Blunt, 11). Furthermore, he believed that Leonardo's approach to the anatomy of the human body was significantly influenced by his own remarkable physical attributes.During the time of the High Renaissance, the artist was primarily interested in the external details of the human form, while the anatomist was mainly concerned with the internal systems of the body. These two seemingly different areas of study were unified as one by Leonardo da Vinci. His anatomical drawings show a knowledge of the anatomy of human beings and animals, based on actual dissection, which exceeds that of his contemporaries in the medical profession (Keele and Blunt, 9). Because of Leonardo's gifted artistic ability, he was able to observe these dissections, and describe what he saw not only in words, but in accurate scientific drawings. In fact, a comment on one of his anatomical sketches states his belief that his drawings give "knowledge that is impossible for ancient or modern writers to convey without an infinitely tedious example and confused prolixity of writing and time" (Leonardo: Anatomical Drawings, 6). Thus, Leonardo's greatest contribution to anatomy lay in the creation of a system of drawing which enabled anatomists, and even modern-day physicians, to transmit their findings to students. Leonardo introduced a system involving the presentation of four views, so that every angle of a subject could be shown at once. He also introduced the technique of cross-sectional representation (Wallace, 105), which he used to display the systems of veins, arteries, and nerves, as well as many cross sectional skull studies. His method began with close observation, followed by repeated testing of the observation from various viewpoints, and concluded with a drawing of the object so that all the world could understand with brief explanatory notes (Wallace, 103).

Followed Galen’s writings, but later found he was wrong
Renaissance Vesalius ( ) Anatomy & Physiology Followed Galen’s writings, but later found he was wrong Observing the Human Body A young Flemish anatomist changed all that when he realized that Galen was dramatically wrong. Andreas Vesalius ( ) started out his career as a defender of “Galenism” at the University of Paris. But when he moved to the University of Padua, he began dissecting corpses for himself to show his students the fine details of anatomy. He drew charts for the students to study, and the exquisite quality of the charts made Vesalius famous—so famous that the criminal court judge of Padua made sure he had a steady supply of cadavers from the gallows. As he grew more familiar with the human body, Vesalius began to notice that here and there, Galen had made mistakes. The human breastbone is made of three segments; Galen said seven. Galen claimed that the humerus (the upper arm bone) was the longest bone in the body, save only the femur; Vesalius saw that the tibia and fibula of the shin pushed the humerus to fourth. Over the centuries, anatomists sometimes had minor quibbles with Galen, but Vesalius began to suspect that there was something seriously wrong with his work. Vesalius widened his scope, dissecting animals, and reading over his Galen more carefully. The source of the mistake dawned on him. Galen had never dissected a human. The traditions of Rome did not allow such a practice, and so Galen had had to make do with dissecting animals and examining his patients during surgery. Instead of humans, Galen was often writing about oxen or Barbary macaques. Vesalius dissects a female cadaver in his anatomy lab

Medieval Human Anatomy Before Vesalius
A late thirteenth-century illustration of the venous system within the body. According to Galen the venous system was distinct from the arterial, and the blood ebbed and flowed through the body. A late thirteenth-century illustration of the venous system within the body.

Post-mortem examinations were rare well into the Middle Ages, largely due to religious and intellectual scruples. This early representation (c. 1300) of a dissection shows a surgeon and a monk.

Vesalius’ Images

Vesalius’ Images The female pelvic anatomy. From Vesalius's De Corporis Humani Fabrica, 1543.

Microscope

William Harvey Discoveries
Discoveries Disproved Galen that blood not made from the liver Heart is a pump not a suction device Showed closed circuit circulation Showed existence of valves in veins

Circulation

Arteries, Veins & Capillaries

Leeches and Maggots make a comeback
At first blush, most trauma patients told they may become host to a slippery, blood-sucking little worm aren't particularly fond of the notion. For many, mention of leeches recalls their famous cameo appearance in "The African Queen," with the ever-less prim Katharine Hepburn bravely plucking the slimy suckers off Humphrey Bogart's bare chest. Still, patients in danger of losing a finger, part of an ear or a piece of scalp quickly warm to Hirudo medicinalis when educated about its near-miraculous ability to reduce swelling and save their body part, says Dr. Nicholas Vedder, chief of the division of plastic surgery at the University of Washington and Harborview Medical Center. "I've never had a patient say no," says Vedder, who orders leeches from Harborview's pharmacy, where several dozen wriggle around in a fish tank. "Once you understand it's the leech or you lose your finger," he says, patients get downright cozy with their little friends. HARLEY SOLTES / THE SEATTLE TIMESA prescription leech at the Harborview Medical Center pharmacy. Rick Koch, 25, was airlifted from Twin Falls, Idaho, to Harborview on July 19 after a table-saw accident at work removed the thumb and fingers of his right hand. All but one finger was reattached, including his ring finger, which sported a fat black leech. "I'm game for anything," said Koch, watching as a nurse coaxed a new leech into place after the last one had done its job. He said he hadn't heard about medical leeches before he came to Harborview, but after an all-night surgery to reattach his digits, he was willing to trust his doctors. The federal Food and Drug Administration, which considers leeches to be medical devices, recently approved a French firm's request to market them in the U.S.; two existing U.S. distributors of medicinal leeches were grandfathered into the rules. Leeches aren't the only critters to make a medical comeback. Maggots, who in literature are often associated with decay and death, are considered invaluable by some practitioners in healing certain kinds of wounds. In January, Dr. Ronald Sherman, a California doctor, received FDA approval to market "medical maggots" for use in removing dead tissue from wounds such as pressure ulcers and nonhealing traumatic or post-surgical wounds. Over the past seven years, Sherman notes, some studies and much anecdotal evidence indicate maggots can help some wounds heal more quickly, helping prevent the need for amputation. Even parasitic worms, a target of many public-health efforts, may have beneficial effects. In a small study by University of Iowa researchers presented at a prestigious gastroenterology conference earlier this year, 72 percent of patients with inflammatory bowel disease who downed a Gatorade cocktail containing parasitic-worm eggs found symptoms relieved within three months. Could it be that bugs are sometimes best? Proponents say the proof is in the healing. Leeches Used by practitioners of the healing arts as early as 1500 B.C., leeches have been employed ever since for a variety of medical purposes. In medieval Europe, they were used for general bloodletting on patients suffering from everything from malaise to cancer. Information International Biotherapy Society: biotherapy.md.huji.ac.il/ Biopharm (leeches): Leeches USA: King County's leech page: dnr.metrokc.gov/ Dr. Ronald Sherman's "Maggot Therapy Project": Worm therapy for inflammatory bowel symptoms: my.webmd.com/content/Article/ In the 1800s, French physicians alone used a billion leeches a year, according to historians, draining "bad humours" and other ills. Not surprisingly, leeches got a bad reputation, sort of the crawling version of snake oil. But over the past decade, with the advent of advanced reconstructive surgery, leeches have, shall we say, crawled back into good repute as an accepted treatment for circulatory difficulties in the microsurgical reattachment of skin or body parts. Some studies say transplanted tissue flaps are much more likely to thrive when treated with leeches, compared with drug treatment or surgery alone. In the past year, Vedder estimates Harborview's leeches get credit for saving a half-dozen digits that had been surgically reattached but were in deep trouble. Typically, what happens is this: Microsurgeons have learned to reconnect small blood vessels so that a finger cut off by a saw, say, can be re-attached. But often, the trauma damages the fragile veins too much to reconnect them, or they're blocked by blood clots when they're attached. With arteries re-attached, blood comes in, but without working veins, the blood can't go out. That means oxygenated blood can't come in to heal the tissue, which will then begin to swell and turn dark. At that point, the body part is in trouble. Enter the leech, says Vedder. Leeches, marvelous "devices" that they are, carry all their medications on board in their saliva: an anesthetic, so you won't notice their tiny, sharp teeth; a substance that dilates blood vessels; and finally, hirudin, which Vedder calls the most potent anti-coagulant known to medicine. "The act of injecting that hirudin is the most important thing it does," says Vedder, because even after a half hour or so when the leech gets full and "kicks back to digest," the anti-coagulant keeps working, so the wound continues to bleed, allowing healing oxygenated blood to flow into tissues. Vedder and other surgeons who use leeches always prescribe antibiotics for patients, too, because even leeches bred specifically for medical use can't be sterile. Current interest in leeches revived after a 1985 case in Boston in which surgeons successfully re-attached a boy's severed ear with the help of leeches, said Lisa Darmo, a biologist with Carolina Biological Supply, a distributor for Biopharm. Biopharm, a Welsh company, is one of two main sources of medicinal leeches in the U.S. The company has about 100 regular hospital customers around the country, mostly trauma centers like Harborview, Darmo said. Harborview sometimes ships "emergency" leeches to other local hospitals, said Drew Edwards, Harborview's director of pharmacy operations. Darmo's company also gets calls from individual surgeons, mostly plastic or reconstructive specialists with a patient having a sudden problem with venous circulation; her company often provides emergency, same-day delivery of leeches, she said. "Sometimes they call, they've never used them before, but they're in a tough situation, and they hear from a colleague that this is a viable treatment option," Darmo said. Maggots Leeches and maggots and worms, oh my! Yucky though they may be, these critters are very good at what they do best. In fact, advocates say, for certain jobs, they're the best alternative modern medicine can offer. There are hundreds of varieties; the most common in microsurgery is Hirudo medicinalis, a 5-inch dark-skinned native of southeast Asia and Europe. Primary use is to relieve congestion in a re-attached body part or flap of skin such as a lip, eyelid, ear, piece of scalp or finger. One leech can suck 5-15 ml of blood (about six to 10 times a leech's body weight), usually within 15 to 60 minutes. When it's "full," and detaches, the bite site may bleed for 10 hours or more, releasing as much as 150 ml of blood. A leech secretes three main substances: hirudin, which keeps blood from clotting; a vasodilator that relaxes smooth muscles of blood vessels; and a morphinelike substance that usually makes the bite painless. Specially raised, disinfected maggots, typically the larvae of Lucilia (or Phaenicia) sericata, the green blowfly, help clean wounds such as pressure sores and diabetic ulcers. They eat only dead tissue. First medical use was after World War I military surgeons noted better healing in maggot-infested wounds. In 1934, maggots were used by an estimated 1,000 American, Canadian and European surgeons. In 1940s, after antibiotics came into widespread use, maggots fell out of favor. Dr. Ronald Sherman, whose maggots recently were cleared for medical use by the FDA, has shown in studies that maggots are more effective than conventional treatment in excising dead tissue and reducing wound size in nonhealing foot and leg ulcers in diabetics. The number of practitioners or centers using maggots has swelled from fewer than a dozen in 1995 to almost 1,000, including more than 70 U.S. practitioners, says Sherman, one of two U.S. suppliers. Parasitic worms Gastroenterologist Joel Weinstock of the University of Iowa noticed there was more inflammatory bowel disease when public-health sanitation efforts improved, yet it was nearly nonexistent in less-developed countries where intestinal parasites are common. He theorized that the human immune system evolved to cope with a gut full of worms, and without them, it can become hyperactive, triggering an autoimmune response. Over 24 weeks, he studied 29 patients with autoimmune inflammatory bowel diseases, such as Crohn's disease and ulcerative colitis. Every three weeks, they drank a cocktail containing 2,500 eggs of the pig parasite Trypanosoma suis. By the 12th week, the disease was in remission for 21 of the 29 patients. Sources: Kowalczyk, "A low-tech approach to venous congestion," RN, Oct. 1, 2002; University of Michigan Museum of Zoology Animal Diversity Web (animaldiversity.ummz. umich.edu/site/index.html); Sherman, "Maggot Therapy for Foot and Leg Wounds," Lower Extremity Wounds, 1(2), 2002, Sherman, "Maggot therapy for treating diabetic foot ulcers unresponsive to conventional therapy," Diabetes Care, Feb. 2003; Knight Ridder News Service. Sharon Mendez, a registered nurse and certified wound-care specialist at Holy Family Hospital in Spokane, has used maggots in wound therapy for more than 20 patients in and out of the hospital. They're used to remove or "debride" dead tissue in a process called "maggot debridement therapy" or MDT. "My patients treated with MDT demonstrate pretty spectacular outcomes," says Mendez, who wrote the hospital's protocol for maggot use in wound therapy. Dr. Loren Engrav, a professor at Harborview in the UW's division of plastic surgery who has used maggots for difficult wounds, says they're a "marvelous debriding device, because they only debride what's dead and not what's alive." No surgeon, even the most skilled, can excise dead tissue with the precision of maggots, Vedder agrees. Sherman, the California doctor, has been sharing medical-grade maggots with other medical practitioners for the past decade. Sherman, who had a lifelong interest in insects, began his focus on maggots during his medical training in the 1980s. "After seeing the miraculous results, I have continued to do everything in my power to help others who want to try maggot therapy," he said. In a journal article in 2002, Sherman noted that there are no formal guidelines for the medical use of maggots. "Practitioners' treatment decisions have been made primarily on the basis of available medical literature, personal experience, and sheer desperation." One patient who became a believer is Pam Mitchell, an Akron, Ohio, diabetes patient who got a cut that wouldn't heal on her foot about five years ago. A break in the skin on her other foot led to another nonhealing wound. Many rounds of antibiotics later, she had two toe-tips amputated. Later, an infection in her heel became so bad doctors told her foot amputation would soon be her only option. "Then by chance I was talking to a co-worker who had seen maggot therapy on the Learning Channel and how well it worked in Europe," she said, and she persuaded her doctor to try it. "My orthopedic surgeon was amazed," said Mitchell, whose foot now has only a small scar. Engrav, at Harborview, stopped using maggots about a decade ago because of the disconnect between the hospital environment and maggots. It's the "yuck" factor, Engrav said. On a scale of 0 to 10, "a leech is maybe a 3 or a 4. But a mass of crawling maggots is maybe a 9." Sherman, in a journal article, noted "patient anxiety," as well as anxiety among nursing and medical staff, which he says can be addressed by education. "We have not found any successful methods of relieving the anxiety of hospital administrators," he conceded. For patients with a nonhealing wound, says Mendez, the Spokane nurse, the "yuck" factor is relative: "What's yuckier than an ugly, smelly wound on your body that's affecting your life and health?" she asks. "Or the doc saying 'I'm gonna have to amputate?' " In some cases, even 48 hours of treatment can do "amazing things," Mendez says. "And when you take that dressing off and see a clean, healthy, healing wound that completely turns a person's life around — it's great." 1600’s Medicine: Leeches A prescription leech at the Harborview Medical Center pharmacy.

Medical Imaging Ultrasound

Medical Imaging X Ray

Medical Imaging Ct Scan 3D reconstruction of CT Scan.
Objects are packets of cocaine.

Medical Imaging MRI

Medical Imaging PET Scan

Modern Technology Smartphone apps Pill cam

Inquiry What are the four types of planes that may be passed through the body? Is the radius proximal to the humerus? Is the esophagus anterior to the trachea? Are the ribs superficial to the lungs? Is the urinary bladder medial to the ascending colon? Is the sternum lateral to the descending colon? Distinguish between negative and positive feedback.

Inquiry What is homeostasis?
What organs would you find in the left iliac region? Galen’s textbook was based on research of ______ not humans. What did Velsalius discover? Leeuwenhoek, Hooke, and Galileo invented the____. List 4 modern “non-evasive” technologies that allow us to look in the body. What are leeches and maggots used for? The pericardium, pleura and peritoneum refer to ________.

The Human Body: An Orientation Ch 1.

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