Skulls of Neanderthal man (left) and Cro-Magnon man.
* EVOLUTION
* GENETICS AND INHERITANCE
* PRIMATES
* DISCOVERING THE PAST
* HUMAN PREHISTORY
Physical Evolution (1 of 3)
Human beings are unusual in being the only living species representing an entire biological family, the Hominidae or hominids. The human species is exceptionally widespread, having colonized most land masses of the world. Although closely related to the great apes, such as the gorilla and chimpanzee, humans are distinct from them and all other mammals in many important features. These include bipedal locomotion (walking on two legs) and the large size of the brain in relation to the body. Humans are marked out even more by behavior, in particular the great dependence on learning passed on from generation to generation. This is transmitted largely by language, or by means of other symbols.
Palaeoanthropology is the branch of learning that is concerned with investigating the origins and evolution of the hominids. It includes the study of our early ape ancestors, but much of the interest is centered on the period since our ancestors diverged from the apes. This separation is now generally believed to have occurred 6-8 million years ago. Detailed pictures have been built up of ape species living in East Africa 18-14 million years ago. Species in the genus Proconsul may be typical of the common ancestors of the African apes and the hominids. Other work in Pakistan in sediments about 8 million years old has shown the presence of apes which are probably ancestral to the orangutan.
Early hominids
There is very little fossil evidence of the apes from the last 8 million years, but two lines of evidence strongly indicate that hominids diverged early on during this period. The first is provided by the fossil remains of early hominids from the period 3 to 4.5 million years ago that have been recovered in East Africa since the mid-1970s. The other, biochemical, evidence demonstrates a very close genetic relationship between human beings and the living African apes, particularly the chimpanzee. The relationship is apparent from the form of the chromosomes, sequences of DNA, and resemblances in proteins. Evidently our ancestors and those of the gorilla and chimpanzee had a common line for several million years after they separated from the orangutan ancestors.
The earliest known hominid remains, dated to around 4.4 million years, were discovered in Ethiopia in 1992. They belong to a species called Australopithecus ramidus. The bone remains showed a mixture of chimpanzee-like and later hominid-like features. At Hadar in Ethiopia, and also at Laetoli in Tanzania, the remains of a slightly more advanced creature were found. The material found at Hadar is just over 3 million years old and includes the famous 'Lucy', whose skeleton is over 40% complete. The remains give us a picture of small, slender but very strong hominids, whose pelvis and lower limb bones were already adapted for upright walking. Although the body had already assumed a 'human' form, their brains were no larger than those of apes, and the teeth still retain signs of ape ancestry. The finds from Laetoli, close to the Olduvai Gorge, are 3.5-3.8 million years old. The fossils resemble those from Hadar, but more spectacular are of hominid footprints.
The australopithecines
All earlier hominids known so far are normally grouped in the genus Australopithecus ('southern ape'). They were given this name because the first discovery of the remains of such a hominid was made at Taung in South Africa in 1924. The finds are restricted to eastern and southern Africa.
There is little direct evidence about the behavior of the australopithecines, but these creatures show that the human bodily adaptation was successful before the great development of the brain that has shaped the modern human head. It is likely that the hominids lived in more open country than the great apes, but returned to the trees to avoid danger.
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Physical Evolution (page 2)
ftsTitle
Australopithecus ramidus
lived 4.4 million years ago and was small and slightly built (like a chimpanzee).
It is not known if it stood upright. Its teeth suggest
a diet which included fruit.
Height: approximately 1-1.25 m (3-4 ft).
Australopithecus afarensis
lived 4-2.5 million years ago.
The name means 'southern
ape of Afar', from finds made
in Ethiopia's Afar Triangle. Height: 1-1.3 m (3-4 ft).
Australopithecus africanus
('southern ape of Africa') lived from 3 million to 2.5 million years ago and probably evolved from Australopithecus afarensis.
Height: 1-1.3 m (3-4 ft).
Australopithecus robustus
('robust southern ape') lived 1.5 million years ago, dying out 1 million years ago. Height: 1.3-1.5 m (4-5 ft).
Australopithecus boisei was named after the Englishman Charles Boise, who funded excavations in the 1950s. It lived in East Africa 2.3-1.4 million years ago. Height: 1.3-1.5 m (4-5 ft).
Homo habilis ('handy man') was the first known species of the genus Homo and lived 2.4-1.7 million years ago.
Height: 1.2-1.5 m(4-5 ft).
Homo erectus ('upright man') lived 1.8 million to 500000
or 400000 years ago, probably evolving in Africa and spreading to Europe,
East Asia and Southeast Asia. Height: 1.5-1.8 m (5-6 ft).
Homo sapiens neander-thalensis ('wise Neanderthal man') takes its name from finds in the Neander Valley in the western part of Germany. The species Homo sapiens evolved from about 200000 years ago (or even earlier), and the classic Neanderthals flourished from around
100000-40000 or 30000 years ago. Height: 1.7 m(5.7 ft).
Homo sapiens sapiens
('wise man') evolved as long ago as 100000 years and is the first fully modern human. Height:
1.7-1.8 m (5.6 ft-5.8 ft).
* EVOLUTION
* GENETICS AND INHERITANCE
* PRIMATES
* DISCOVERING THE PAST
* HUMAN PREHISTORY
Physical Evolution (2 of 3)
Early Homo
In the late Pliocene epoch, about 2 million years ago, one line of the australopithecines began to develop a larger brain. Fossils of these hominids are sufficiently human-like that they are classed in our own genus, Homo ('man'). The best known specimens of this line are the Homo habilis ('handy man') found at the Olduvai Gorge in Tanzania.
In the same general period stone tools began to appear, giving us the first direct archaeological evidence of behavior. It cannot be proved that the stone tools are all linked with Homo. Species of hominids such as Australopithecus robustus and Australopithecus boisei survived until about 1 million years ago. They may also have made tools, but as the archaeological record continues without a break after their extinction, the importance of Homo as a tool-maker has to be acknowledged.
Stone tools clearly imparted a major advantage to the hominids leading a hard life on the savannah. They provided sharp edges, allowing the hominids to cut hides, meat and roots and probably to shape wood. It is not clear to what extent animals were hunted rather than scavenged.
Homo erectus
By 1.8 million years ago a variety of Homo rapidly achieved stature similar to that of modern human beings. Brain size increased to about 800-1000 cc (cubic centimeters), compared with the modern average of about 1500 cc. Homo erectus ('upright man'), first known from sites in Java and China, is the principal species of this age. With the exception of a few remains dated at 1.8 million years old, most of the Asian specimens are little more than 500000 years old. Similar, but far older, fossils have been found in Africa, especially from the area of Lake Turkana in Kenya.
Homo erectus is found in Africa, Asia and Europe, indicating a spread of human occupation out of the tropics. How human their behavior was is still debated, but it is clear that they had the ability to adapt to the seasonal climate of the temperate zone.
Early Homo sapiens
Through the Pleistocene epoch (1.6 million to 10000 years ago) the trend towards large brains continued. Homo sapiens ('wise man') appeared about 300000 years ago as the successor of Homo erectus. Early specimens are known from Europe and Africa, but Asia remains a blank except for rare traces in India and China.
In this period there is no sudden change in stone tools to mark the transition to Homo sapiens, but by about 250000 years ago techniques of manufacture had reached a new sophistication.
Wood now appears in the archaeological record, usually surviving only on waterlogged sites. A possible club from Kalambo Falls in Africa and a spear from Essex in England are among the most suggestive evidence that hunting was now practiced, although plant foods undoubtedly remained important.
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p200-3
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Physical Evolution (page 3)
ftsTitle
Hominid footprints, Laetoli, Tanzania.
* EVOLUTION
* GENETICS AND INHERITANCE
* PRIMATES
* DISCOVERING THE PAST
* HUMAN PREHISTORY
Physical Evolution (3 of 3)
The 'Eve hypothesis'
Select studies of DNA in human populations suggest that there is more variety in Africa than in other populations. The DNA in the mitochondria - specialized structures within cells - is a special case, inherited from the mother only. The increased variety in Africa can be taken to suggest that modern populations originated in this continent. It has been suggested that all living human beings have mitochondrial DNA originating from a single woman who lived in Africa about 200000 years ago. This dramatic view does not conflict with the evidence of fossils, but even if this 'Eve' existed, we would have derived only a minimal fraction of our genetic heritage from her.
The Neanderthals
Neanderthal man (named after a valley in Germany) is the best known variety of early Homo sapiens. Widespread in Europe and parts of Asia, they flourished between about 100000 and 30000 years ago, but appear to have evolved gradually from about 250000 years ago.
The Neanderthals are easily recognizable by their combination of long low skull, large face and robust bodily skeleton. Generally they are regarded as a subspecies of Homo sapiens (H. sapiens neanderthalensis). For many years there has been controversy concerning their status - were they ancestors of modern human beings or an evolutionary sideshoot?
Dates obtained from Skhul and Qafzeh in Israel now show that 'early moderns' much more like ourselves than the Neanderthals already existed about 100000 years ago. These dates rule out the possibility that modern human beings evolved from Neanderthals. Although the Neanderthals disappeared by about 30000 years ago it remains likely that modern Homo sapiens obtained some genes from them through interbreeding.
Modern man
The most plentiful evidence for early specimens of anatomically modern human beings (Homo sapiens sapiens) comes from Ice Age Europe. It is in Europe that the remains of Cro-Magnon man are found, dating from about 30000 years ago. The Cro-Magnons are named after a cave in France, but other specimens are distributed across Europe. It is evident that anatomically modern humans had evolved at an earlier date outside Europe.
Even before modern industrial technology, human populations had colonized all the continents except Antarctica, and also many islands. The spread outside the Old World probably happened within the last 100000 years and can be linked with the relatively advanced skills and technologies associated with Homo sapiens sapiens. jgo
FOOTSTEPS IN THE SANDS OF TIME
In 1976 researchers working with Dr. Mary Leakey at Laetoli in Tanzania found footprints in a layer of volcanic ash over 3 million years old. The odds against such a find are enormous, since many millions of footsteps are made for each one that leaves a permanent imprint.
Most footsteps left in sand or clay are rapidly erased. In this case hominids and other creatures had walked over a fall of fine volcanic ash shortly after it had fallen. Then came rain, and the ash hardened like cement. Similar tracks have been preserved at East Turkana in Kenya in sediments about 1.5 million years old, and by the River Severn in England an 8000-year-old set of footprints has been found in hardened mud.
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p202-1
ftsTitleOverride
Reproduction (page 1)
ftsTitle
* PHYSICAL DEVELOPMENT
* GLANDS AND HORMONES
Reproduction (1 of 5)
Every human being begins life as a single cell no bigger than the dot above the letter i and grows to be an individual composed of 6 million million cells. In that first cell and every subsequent one is DNA - the material that lays down the blueprint of what an individual will be like, from the color of eyes to the size of feet.
A baby develops from the union of one of its mother's eggs and one sperm cell from its father. Each of these cells carries 23 chromosomes - threadlike structures that bear genes containing DNA. Every cell that grows from the fused egg and sperm will contain 46 chromosomes.
Sperm and ova
Even before birth a female baby possesses her full quota of ova or eggs which develop in the ovarian follicles. These are stored in the ovaries - two glands that in adults are about the size of pigeons' eggs. Only a few ova will ever ripen and have the potential to be fertilized by sperm.
The human male, too, is born with cells that will produce sperm in adult life. Sperm are manufactured in seminiferous tubules in the testes at the rate of 1000 per second, and stored in the epididymis.
Each sperm starts with 46 chromosomes but sheds half of these as it matures (a process that takes 74 days). If it loses its Y chromosome and goes on to fertilize an egg, the resulting baby will be a girl; if the X chromosome has been shed the child will be a boy. A mature sperm is still less than 0.05 mm (1/500 in) long.
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p202-2
ftsTitleOverride
Reproduction (page 2)
ftsTitle
* PHYSICAL DEVELOPMENT
* GLANDS AND HORMONES
Reproduction (2 of 5)
Ovulation and menstruation
Each month one ovum ripens, breaks free from its protective follicle and is swept up by the fringe-like endings (fimbriae) of one of the fallopian tubes. Its journey down the fallopian tube to the uterus or womb lasts four days. For a few hours only it is in a state of readiness to be fertilized by a sperm. Unfertilized, it will pass on and out of the woman's body. The enriched blood supply lining the uterus in preparation for receiving a fertilized ovum is shed soon after. This loss of blood is menstruation, more commonly referred to as a 'period'.
Coitus and fertilization
During sexual intercourse or coitus, the erect penis is inserted into the vagina and rhythmical movements lead to orgasm and the ejaculation of semen - sperm in a nutrient fluid. A sperm swims by using rapid movements of its long, threadlike tail, and the head of the sperm contains stores of glucose to provide energy for its long swim to the ovum. If it is the first of the 2 - 3 million sperms released during an ejaculation to reach the ovum, its genetic material will mix with the ovum's chromosomes.
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p202-3
ftsTitleOverride
Reproduction (page 3)
ftsTitle
* PHYSICAL DEVELOPMENT
* GLANDS AND HORMONES
Reproduction (3 of 5)
Cell division and implantation
Within hours of conception a fertilized ovum, called a zygote, begins to divide. To do this it needs to be surrounded by the hormone progesterone, which is supplied by cells that develop in the egg's discarded follicle - the corpus luteum. Progesterone also prevents any further ovulations. Three days after fertilization, the zygote has divided three times producing eight cells. Four days later, containing 16 cells, the zygote reaches the uterus.
Three days after that, the zygote implants itself into the uterine wall. Now called a blastocyst and 0.1 mm (1/250 in) in size, its cells change into two types - embryoblast cells that will eventually become the baby, and trophoblast cells that will form the placenta and nourish the growing fetus. The embryo cells themselves soon change into an inner and an outer layer.
The developing embryo
By the start of the third week the inner layer has organized into a pear shape and the outer covering develops a split, allowing a third layer to develop between the other two. Each layer will eventually form specific parts of the body structure.
As the third week ends, two tiny tubes covered by muscle cells merge into one, forming the heart. By week 4 it is already pumping blood through tiny arteries and veins to reach inner cells that are beginning to form internal organs.
In the first month, the embryo has grown to a length of 4 mm (1/6 in) with one end bigger than the other. Groups of cells have clustered in readiness to become specific organs or limbs. The middle layer has begun to lay down what will be the spine and the nervous system, heart and blood vessels.
By the fifth week, the eyes, ears, nose and the nerve cells that interpret sight, smell, sound, taste and touch have started to appear. Arms and legs are beginning to emerge with translucent flipper-like plates showing the forerunners of fingers and toes.
One week later the 10 mm (2/5 in) embryo is already bending its elbows and moving its hands, which have clearly defined fingers. The face is forming recognizable eyes, mouth and ears. The brain has divided into its various parts responsible for thinking, memory, reflexes and emotions. Throughout the embryo cartilage begins to turn to bone.
By the fourteenth week the fetus is completely formed, and from this time on - until week 40 when it is ready to be born - it grows in size rather than complexity.
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Human embryo and fetus$
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ftsTitleOverride
Reproduction (page 4)
ftsTitle
Thousands of sperm will attach themselves to the ovum but only one will succeed in penetrating it. Once penetrated, it discharges enzymes to create an impenetrable barrier to other sperms. The magnification is 1000 times in this false-color electron micrograph.
* PHYSICAL DEVELOPMENT
* GLANDS AND HORMONES
Reproduction (4 of 5)
Birth
When the fetus reaches maturity or outgrows its food supply from the placenta it triggers off the start of labor. The hormone oxytocin begins to circulate in the mother's blood, softening the cervix (the neck of the womb) so that it will be able to stretch and accommodate the baby's head. There are three clearly defined stages of labor. In the first stage, the muscular wall of the uterus gradually builds up the force and frequency of its contractions as it draws up the edges of the now thinned and softened cervix until it is fully dilated (i.e. widened). The first stage of labor is the longest, taking an average of 8 - 10 hours for a first baby. At the end of the first stage the membranes rupture, releasing the amniotic fluid, which surrounds the fetus in the uterus - this is known as the breaking of the waters.
The second stage is shorter ( 1/2 - 2 hours) but harder. This is the stage where the baby is moved down the birth canal (the cervix and vagina) and is born. The uterus contracts swiftly and forcefully and the mother experiences an overwhelming desire to 'bear down' or push with her abdominal muscles to help the baby to be born.
The third stage is the delivery of the placenta or 'afterbirth'.
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Reproduction (page 5)
ftsTitle
The human fetus at 12 weeks, showing the head, upper limbs and umbilical cord, which connects the fetus to the placenta.
* PHYSICAL DEVELOPMENT
* GLANDS AND HORMONES
Reproduction (5 of 5)
CONTRACEPTION
There are five main methods of contraception practiced at present: hormonal, intrauterine device, barrier, sterilization and rhythm.
Hormonal
The Pill is the best-known hormonal contraceptive. Millions of women have used it since it became widely available in the 1960s and have enjoyed a freedom from unwanted pregnancies undreamt of by previous generations. The Pill is highly effective and may protect woman against some gynecological cancers, such as ovarian cancer. Older versions of the Pill that contained higher doses of estrogen and progesterone than today's Pills carried a slightly increased risk of circulatory disease and breast cancer.
Sterilization
In women sterilization involves blocking the fallopian tubes by either cutting or tying them. Male sterilization involves cutting the vas deferens, the channel that transports sperm. The operation, called a vasectomy, can be performed as an out patient procedure.
Barrier
Barrier methods of contraception consist of the condom (sheath) worn over the man's penis, and the diaphragm, which covers the woman's cervix. They are less reliable than the Pill in preventing pregnancies, but have no effects on other body systems. The spread of AIDS has made the condom a popular choice since it forms a complete barrier, the diaphragm may also give some protection against cancer of the cervix. The spermicide normally used with the diaphragm and used to coat some brands of condom has been shown to immobilize the AIDS virus under laboratory conditions.
IUDs
The intra-uterine device (IUD or 'coil') is a small object made from plastic and metal wire, often copper, inserted into the uterus. It probably works by preventing a fertilized egg from implanting into the uterine wall. IUDs have lost popularity since they have been associated with infections and infertility in some women and heavy, painful periods in others. Their advantage is that women can forget about contraception for years at a time.
Rhythm
This is one of the oldest methods of contraception and relies on restricting intercourse to the days in a woman's menstrual cycle when she is unlikely to become pregnant. It is the least reliable way to prevent unwanted pregnancies. More recently, other signs of fertility such as an increase in clear mucus or body temperature have been used by couples to either increase or reduce their chances of conceiving.
Other methods
Many other methods of contraception are currently being researched, including a male pill, a female condom, hormonal implants, an IUD that will prevent sexually transmitted diseases, and pregnancy vaccines.
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Physical Development (page 1)
ftsTitle
* REPRODUCTION
* GLANDS AND HORMONES
THE HUMAN ORGANISM (1 of 3)
Physical Development
Growth begins at conception and proceeds at an increasing rate during the first six months of pregnancy. From this time onwards there is a slowly decelerating growth through infancy and childhood, with a brief increase in rate during puberty. Growth in height stops towards the end of the second decade. Most early growth takes place through cell division, but growth in cell size becomes increasingly important once the full complement of cells has been established.
This is why damage to the developing fetus has particularly severe long-term consequences on growth. Growth that takes place in the uterus or womb and in the first year of life depends almost entirely upon nutrition. Babies grow more quickly if they are given more food - children who are underfed lose out on this phase of infantile growth, which contributes approximately one half of the total growth of the human.
Growth in childhood
Towards the end of the first year of postnatal life, the control of the growth process switches from dependence on nutrition to dependence on growth hormone secretion. Growth hormone is released from the pituitary gland and the rate at which children grow depends on the amount of growth hormone secreted - tall children become tall adults by growing consistently at a faster rate than their shorter peers.
Growth in childhood continues at a slowly decelerating pace until the deceleration is interrupted by the onset of puberty. The increase in height in childhood is roughly the same as that during the first year, but it is the amount and timing of the pubertal component of growth that determines the adult height of men and women.
Puberty
During the 12th year of life secondary sexual characteristics will have become apparent in 50% of girls and boys. These include development of breasts in girls, enlargement of the testes and, later, deepening of the voice in boys, and growth of axillary (underarm) and pubic hair in both sexes. Such developments occur before the age of 9 years in 3% of children, and 97% show some secondary sexual characteristics by the age of 14 years.
As soon as the ovary begins to secrete sufficient estrogen to promote breast enlargement (the earliest change in female puberty), the growth rate increases as a result of an increase in the secretion of growth hormone. Until this age, the heights achieved by boys and girls are virtually the same so that a girl starts her pubertal growth from an average height of about 140 cm (4 ft 7 in). Female pubertal growth adds approximately 20 cm (8 in) to this height. As puberty progresses, girls grow increasingly quickly for about 18 months and then the growth rate begins to fall. By this time the cyclical waxing and waning of estrogen has induced sufficient thickening of the lining of the uterus for the falling estrogen level to induce shedding of the lining, with some blood loss (menstruation or a `period';. The timing of the first period has relatively little biological importance but has occurred in 97% of girls by the age of 15. After the onset of the first period, most bleeding occurs at irregular intervals because ovulation does not become reliably established for at least 18 months.
Secondary sexual characteristics in boys appear at more or less the same time as breast development in girls. Boys continue growing along the childhood (decelerating) curve during the first two years of their pubertal development, and reach an average height of about 150 cm (4 ft 11 in) before the pubertal growth spurt starts. As testosterone produced by the testes is a better stimulator of growth than estrogen, the peak of a boy's growth rate is greater than that of a girl, but it passes more quickly. Whereas boys start to grow during puberty two years later than girls, they stop growing only about one year later - at about 16 rather than 15 years of age on average.
The male growth spurt adds approximately 25 cm (10 in) in height and the final height of adult men is consequently an average 12.6 cm (5 in) greater than that of adult women. This is mainly due to the prolongation of childhood growth in men and not to the contribution of the puberty growth spurt, which is only slightly greater in boys than in girls. As soon as testosterone secretion occurs in the testes, spermatogenesis (the production of sperm) begins in the seminiferous tubules (see diagram, p. 202). Testosterone also promotes muscle development and the growth of body hair, for instance on the chest.
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p204-2
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Physical Development (page 2)
ftsTitle
Barimal Chandra Barman, who was thought to be Bangladesh's tallest man (at around 8 ft), became weak and ill with his continued growth, and died in 1990 shortly after receiving treatment to retard his growth.
* REPRODUCTION
* GLANDS AND HORMONES
THE HUMAN ORGANISM (2 of 3)
The menopause
The developing female is equipped at birth with all the ovarian follicles - in which the ova or eggs develop - she will require for life. The follicles disappear at a rate proportional to the number of follicles remaining - quickly at first, then increasingly slowly. The newborn infant has approximately 1 000 000 follicles, but this has already reduced to 100 000 by the time menstruation begins. Since approximately 20 ovarian follicles are required for each menstrual cycle (from which only one is selected to ovulate) the average woman requires about 250 follicles for each year of reproductive life.
The average age of the menopause is 51 years, so there is an enormous surplus of follicles present in the infantile ovary. The menopause in women is not determined by the use of follicles in the menstrual cycle but by the process of their disappearance. This process is to some extent influenced by environmental circumstances - for example, the age at menopause is lower in women who smoke than in those who do not.
The sudden decline in estrogen secretion in women at the menopause has been blamed for many symptoms, but the only symptoms clearly associated with estrogen deficiency are hot flushes, vaginal dryness and skin changes, osteoporosis (loss of bone density, making them more liable to fracture), and an increase in the rate of development of atherosclerosis (hardening of the arteries). These changes can cause severe psychological and physical symptoms, which is why the question of hormone replacement therapy for post-menopausal women is so important. Now that life expectancy has increased so greatly, a woman can expect three or more decades of post-menopausal life in which the consequences of diminishing estrogen can develop. Men are less severely affected by hormonal changes, since the decline in male sex hormone concentrations occurs over a much longer period.
Old age
The physical changes associated with old age have been much less intensively studied than those of childhood. It is obvious that old people become thinner, more wrinkled through loss both of skin elasticity and of subcutaneous (under-skin) fat, shorter through vertebral compression, and more vulnerable to disease. However, there are no standards comparable to those established in childhood with which to assess individual subjects. As longevity increases, the need for such standards becomes increasingly important.
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p204-3
ftsTitleOverride
Physical Development (page 3)
ftsTitle
People of restricted growth at a fashion show. Today people of small stature participate fully in society.
* REPRODUCTION
* GLANDS AND HORMONES
THE HUMAN ORGANISM (3 of 3)
GIANTISM AND RESTRICTED GROWTH
A disturbance of the pattern of growth hormone secretion is usually the reason why children who otherwise look normal become excessively large (giantism) or small (restricted growth). However, there are also a number of congenital and/or hereditary causes of grossly abnormal stature. In the most extreme cases of excessive or restricted growth, there is a limited amount that the physician can do to alleviate the problem. Mental retardation is not a characteristic feature of small stature or giantism.
The tendency to excessive or restricted growth is usually present at birth and becomes apparent in the early months of life. Some children with giantism may be born large and show an accelerated growth rate from birth. In others the growth rate may speed up abnormally just before puberty and continue up to maturity - most often such growth patterns are due to over-secretion of growth hormone by the pituitary gland because of a pituitary tumor, but the interaction with changes occurring at puberty is relevant to the determination of final height. In this case the problem can be alleviated by surgery.
Restricted growth in children may be hereditary or due to under-secretion of growth hormone by the pituitary. In the latter case it most commonly becomes apparent if the onset of puberty is delayed, and therapies are available in cases where final height may be severely restricted.
Bones, joints, muscles and nerves are the essential requirements for human movement, whether for top athletes or just ordinary people going about their daily lives. Normally, people are born with the same set of anatomical equipment - bones, joints and voluntary muscles supplied with an almost identical network of nerves and blood vessels. Bones account for one sixth of body weight, and muscles make up two fifths.
The speed and control with which individuals move and the suppleness of their bodies depend partly on luck in inheriting the right genes from parents. The length and thickness of bones and the laxity of joint ligaments are determined to a great extent before birth, but regular exercise can strengthen muscles and improve skill in movement.
Bones
Without the rigid support provided by bones we would all be shapeless bags of organs. But the skeleton performs a number of important functions besides giving the body shape and form.
Bones such as the skull, ribs and vertebrae encase vital organs such as the brains, lungs, heart and spinal cord, protecting them from injury.
Other bones such as the femur, tibia and fibula - the long bones of the legs - and the humerus, radius and ulna in the arms serve primarily as levers providing attachments for muscles that propel the body forward or allow it to reach and retrieve objects.
Some bones, including the ribs, pelvis and sternum (the breast bone), contain bone marrow. This is the substance responsible for manufacturing the millions of red blood cells essential to life. Bones also act as reservoirs for calcium and other minerals needed to maintain health.
At birth bones are made up of two thirds fibrous material and one third mineral, while in old age they are two thirds mineral and one third fibrous. Broken bones in children are called greenstick fractures - they are more flexible and do not break completely. In old people bones contain less calcium and break more easily.
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p206-2
ftsTitleOverride
How People Move (page 2)
ftsTitle
* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
How People Move (2 of 7)
Joints
Bones meet one another to form joints, of which there are six main types. The degree of movement possible at a joint is determined by the surface of the bone ends and the joint space and fluid between them.
The hip joint is an example of a ball-and-socket joint, where both bone ends have a large area of smooth surface covered in cartilage and lubricated by synovial fluid. Movement is possible in all directions. The knee and elbow are hinge joints, with movement mostly in one plane. The joint between the thumb and hand is a saddle joint permitting movement in a number of directions, while the joint between the base of the spine and the pelvis - the sacroiliac joint - is a plane joint where very little movement is possible except during pregnancy, when the pelvis expands to accommodate the growing fetus.
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ftsTitleOverride
How People Move (page 3)
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* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
How People Move (3 of 7)
Where the first vertebra - the atlas, so named because it holds the weight of the head - joins the next vertebra, the axis, a pivotal joint is formed. Movement occurs between the ring of the atlas and the toothlike peg of the axis, allowing rotation or turning of the head to look over the shoulder.
Condyloid joints are those between the bones of the hand and the fingers and the foot and toes.
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How People Move (page 4)
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* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
How People Move (4 of 7)
Muscle types
Muscle is basically of two types: the sort we can control, known as voluntary, striped, or skeletal muscle, and the sort we cannot control, otherwise known as smooth, autonomic or involuntary muscle. Although the heart muscle is not under our direct control it is usually classed separately as cardiac muscle.
Voluntary muscle
Voluntary muscle is composed of long thin cells or fibers enclosed in an outer coat. Under the miscroscope the fibers show alternate light and dark bands, which is why they are sometimes referred to as striped. The dark bands contain the protein myosin while the light ones contain actin. In the middle of the dark bands is a lighter area called the H band. In the middle of the light bands is a slim dark band called the Z area and the space between two Z areas is known as a contractile unit or sarcomere.
When a message to move is sent by the brain to a muscle via the nerves or if an electrical stimulus is applied to a muscle fiber, it will contract - the light bands shorten and the actin and myosin filaments slide past each other. When a muscle contracts it can shorten and become thicker - an isotonic contraction - or it can remain the same length but increase in tension - an isometric contraction. If a weight is picked up and the elbow bent, the biceps contract isotomically. If we try to bend the elbow while applying pressure with the other hand to prevent it actually bending, the biceps contracts isometrically.
Although we can directly cause voluntary muscles to contract, we rarely do so. The usual course is to direct a movement like walking upstairs. Such a command initiates action in whole groups of muscles that act in harmony to perform a coordinated maneuver. Some of the muscles perform the move obvious actions like bending the hip and knee, while others come into play to stabilize the trunk and increase strength in the opposite leg, which temporarily bears the entire body weight.
Habitual movements patterns are so well established that the way we move is largely performed unconsciously. Only the dedicated few - for example, tennis players wanting to improve their backhand stroke - study precisely which muscles are working and develop the conscious ability to make fine adjustments to the way they perform.
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How People Move (page 5)
ftsTitle
Muscles usually function in pairs. When one - known as the agonist - contracts, the other - the antagonist - relaxes, producing a smooth movement.
* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
How People Move (5 of 7)
Involuntary muscle
Involuntary or smooth muscle is found in the walls of the digestive tract, in the respiratory system and in the urinary and reproductive tracts. It is the main tissue in the middle coat of the smaller arteries and determines the diameter of these vessels. By regulating the resistance of the vessels it controls the distribution of blood to the various tissues and organs and helps control the blood pressure.
In the eye, involuntary muscle controls the amount of light entering by adjusting the size of the pupil and in the skin it causes the hair to stand erect when we are cold or frightened.
Involuntary muscle is the simplest type of muscle in construction, consisting of spindle-shaped fibers each with a single nucleus. But it is capable of very strong contractions. During birth the smooth muscle of the uterus contracts powerfully to expel the fetus, and the act of defecating or vomiting brings smooth muscle in the digestive tract into play with considerable force.
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How People Move (page 6)
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* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
How People Move (6 of 7)
Cardiac muscle
The heart muscle is unique in construction, consisting of long cylindrical fibers arranged in sheets and bundles. Certain special fibers in the heart muscle make up the conducting system by which electrical impulses spread to the other fibers and bring about the rhythmical sequence of contraction and relaxation that allows the heart to empty itself of blood and then refill.
All types of muscle are influenced by psychological factors. Most people have experienced how feeling nervous can make the hands and legs tremble and the heart beat faster. There may also be a need to rush to the lavatory as the urinary and digestive tracts empty faster than they would under more relaxed circumstances. Some people learn to control unwanted muscle actions using meditation and relaxation techniques.
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How People Move (page 7)
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Arthritis affecting the joints of a hand.
* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
How People Move (7 of 7)
ARTHRITIS
One of the commonest causes of difficulties in moving is arthritis. The term itself means inflammation of a joint, but there are several different reasons why joints can become inflamed, swollen and stiff.
Most people with arthritis suffer from osteoarthritis. This used to be considered to result from general wear and tear because it affects so many old people and people who have suffered an injury affecting joint surfaces. Now it is thought some other unidentified factor is also involved. In osteoarthritis the cartilage covering joint surfaces becomes thinner and bony outgrowths called osteophytes proliferate around the edges of the bone ends. Usually only one joint is affected, such as a hip or knee.
Rheumatoid arthritis is a more crippling disease, believed to be an autoimmune condition. It affects people earlier in life than osteoarthritis, and usually several joints are involved at any one time. The disease begins in the synovial membrane, which lines the joint capsule and provides lubrication. This membrane becomes eaten away by an inflammatory substance that spreads over the bone ends destroying cartilage, bone and even affecting surrounding muscles. This arthritis is extremely painful and causes sufferers a general illness during times when the condition flares up. Damage to the joints can lead to deformity, particularly noticeable in the hands, since the knuckles are often the first joints to be affected.
Less common forms of arthritis can result from infections, including sexually transmitted diseases.
Arthritis is usually treated with anti-inflammatory drugs and pain killers, and antibiotics if an infection is present. Rest is important during attacks but otherwise exercise and physiotherapy is advised to keep the joints from stiffening.
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Food, Diet and Digestion (page 1)
ftsTitle
A child suffering from rickets: a disease caused by deficiency of vitamin D in which the bones of growing children are malformed and fail to harden.
* ARABLE FARMING
* LIVESTOCK FARMING
* THE FOOD-PROCESSING INDUSTRY
* RESPIRATION AND CIRCULATION
* TOUCH, TASTE AND SMELL
* NON-INFECTIOUS DISEASES
* PREVENTING DISEASE
Food, Diet and Digestion (1 of 4)
Unlike plants, which can synthesize everything they require using energy from the Sun, animals, including humans, must obtain their nutrients and energy from food. Digestion is the process in which the energy and nutrients contained in food are broken down into a suitable form to be absorbed by the body and utilized as a source of energy, or to synthesize substances such as proteins, enzymes and hormones that are required for the normal functioning of the body.
The nutrients required by the body are proteins, carbohydrates, fats and vitamins. Water is not a nutrient but an adequate intake is essential to replace the water that is lost each day through the skin and lungs and in urine and feces.
Proteins
Proteins are made up of large numbers of amino acids. There are about 20 amino acids and they can be arranged in any order to produce a larger number of different proteins. Eight amino acids must be provided by the diet - these are called the essential amino acids. The others can be synthesized from one of the other amino acids.
Proteins provide cell structure, help fight infections, transport substances around the body and form enzymes and hormones. They can also provide energy. Meat, eggs, milk and pulses are all rich in proteins.
Carbohydrates
Carbohydrates contain carbon, hydrogen and oxygen and provide energy. The simple carbohydrates are the monosac charides (glucose, fructose and galactose) and the disaccharides (sucrose, lactose and maltose). A disaccharide consists of two molecules of a monosaccharide. Sucrose (table sugar) contains a molecule of glucose joined to a molecule of fructose. Good sources of simple carbohydrates are fruits, honey, milk and table sugar.
Complex carbohydrates (polysaccharides) contain many hundreds of monosaccharides. Starch is a polysaccharide of glucose. Good sources of complex carbohydrates are bread, rice and potatoes. Dietary fiber consists mainly of complex carbohydrates that cannot be digested. It provides bulk and aids bowel function. Sources includes unrefined cereals, fruit and vegetables.
Fats are made up of triglycerides. A triglyceride has a backbone of glycerol with three fatty acids attached to it. Fatty acids can either be saturated or unsaturated. Fats provide twice the amount of energy as carbohydrates and proteins.
Minerals
Mineral salts are essential for many of the body's chemical reactions. Sodium in the fluid surrounding the cells regulates the cells' external environment, while potassium plays the same role inside the cell. Hemoglobin, which transports oxygen, contains iron; many enzymes contain zinc; the transmission of nerve impulses requires sodium and potassium, and the mineral salts calcium and phosphorus are found in bone.
Vitamins
Vitamins are complex chemical compounds that are essential in small quantities for many chemical reactions. If a vitamin is lacking in the diet a deficiency disease arises - for example, lack of vitamin C leads to scurvy. An excess of certain vitamins can also be dangerous.
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Food, Diet and Digestion (page 2)
ftsTitle
* ARABLE FARMING
* LIVESTOCK FARMING
* THE FOOD-PROCESSING INDUSTRY
* RESPIRATION AND CIRCULATION
* TOUCH, TASTE AND SMELL
* NON-INFECTIOUS DISEASES
* PREVENTING DISEASE
Food, Diet and Digestion (2 of 4)
Digestion and absorption
The gastrointestinal tract is a long tube about 9 m long, which passes through the body from the mouth to the anus. Here the complex structures present in food are mixed with enzymes (proteins that act as catalysts in certain biochemical reactions) and broken down into their simple constituents. These are small enough to be absorbed through the wall of the intestine into the bloodstream.
Food is chewed in the mouth and mixed with saliva. It passes through the oesophagus into the stomach. The stomach acts as a temporary store and mixes the food until it is in a semi-fluid state called chyme. This is then released slowly into the duodenum.
Most digestion takes place in the duodenum. Enzymes, secreted by the pancreas into the duodenum, split proteins into amino acids, fats into fatty acids and glycerol and polysaccharides into glucose and fructose. These are then absorbed through the walls of the ileum (part of the small intestine). Glucose, fructose and amino acids are absorbed into the bloodstream and carried to the liver. Fatty acids and glycerol are absorbed into the lymphatic system, and enter the bloodstream later.
Substances that cannot be digested pass into the colon (the large intestine). Some compounds are fermented by the bacteria there and others are excreted as waste products in the feces via the rectum.
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Food, Diet and Digestion (page 3)
ftsTitle
An African mother breastfeeds her baby. The chemical constitution of breast milk is attuned to the digestive system of the baby and has the exact nutritional balance.
* ARABLE FARMING
* LIVESTOCK FARMING
* THE FOOD-PROCESSING INDUSTRY
* RESPIRATION AND CIRCULATION
* TOUCH, TASTE AND SMELL
* NON-INFECTIOUS DISEASES
* PREVENTING DISEASE
Food, Diet and Digestion (3 of 4)
Storage and use of nutrients
The blood carries the absorbed nutrients from the intestine to the liver. After a meal the liver prevents the levels of glucose and amino acids in the blood from rising too much by removing them from the blood. Glucose is stored as glycogen and can be converted back into glucose when the blood levels of glucose begin to fall. Any excess glucose is converted into triglyceride and is stored in adipose tissue - connective tissue packed with fat cells.
Amino acids are stored as proteins, which can be broken down to release the amino acids when they are required. Excess amino acids are converted to carbohydrate by the removal of the 'amino' group, and used as an energy source. The 'amino' group is converted to urea, a waste substance that is excreted in the urine.
Fatty acids are also an energy source. When the supply of glucose begins to fall, triglycerides are broken down in the liver and adipose tissue, and fatty acids are released into the blood to be taken up by other cells.
Energy is produced by the oxidation of either glucose or fatty acids and is stored in the high-energy molecule ATP (adenosine triphosphate). ATP can later release this energy to drive other chemical reactions in the cell. The oxidation of fatty acids produces more than twice as many molecules of ATP as the oxidation of glucose. Carbohydrates and proteins provide 4 kilocalories (17 kilo joules) of energy per gram, and fat 9 kilocalories (39 kilojoules) per gram.
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ftsTitleOverride
Food, Diet and Digestion (page 4)
ftsTitle
* ARABLE FARMING
* LIVESTOCK FARMING
* THE FOOD-PROCESSING INDUSTRY
* RESPIRATION AND CIRCULATION
* TOUCH, TASTE AND SMELL
* NON-INFECTIOUS DISEASES
* PREVENTING DISEASE
Food, Diet and Digestion (4 of 4)
Excretion
Many of the chemical reactions that take place in the body produce compounds that would be toxic if allowed to accumulate. Blood must therefore be purified and the toxic waste products excreted. This takes place in the kidney nephron. There are many hundreds of nephrons in each kidney.
VITAMINS
VITAMIN A (Retinol) Functions: Essential for growth; vision in poor light; health of cornea and resistance to infection. Deficiency causes stunted growth, night blindness and susceptibility to infection.
Sources: Dairy products, fish-liver oils, egg yolks. Carotene, found in carrots and green vegetables, can be converted by the body into retinol.
VITAMIN B1 (Thiamin) Functions: Essential for carbohydrate metabolism and nervous system functioning. Deficiency causes beriberi, with symptoms either of fluid retention or of extreme weight loss.
Sources: Yeast, egg yolks, liver, wheatgerm, peas and beans.
VITAMIN B2 (Riboflavin) Functions: Essential for tissue respiration. Deficiency causes inflammation of tongue and lips.
Sources: Yeast, yeast and meat extracts, milk, liver, kidneys, cheese, eggs, green vegetables.
FOLIC ACID Functions: B vitamin essential for maturing of red blood cells in bone marrow.
b: Spinach, liver, broccoli, peanuts.
NICOTINIC ACID (Niacin) Functions: B vitamin essential for metabolism of carbohydrates; functioning of digestive tract and nervous system. Deficiency causes pellagra, characterized by scaly skin, diarrhoea and depression.
Sources: Yeast, yeast and meat extracts, fish, meat, cereals, peas and beans.
VITAMIN B6 (Pyridoxine) Functions: Essential for metabolism of fat and protein. Sources: Liver, egg yolks, meat, peas and beans.
VITAMIN B12 (Cyanocobalamin) Functions: Essential for maturing of red blood cells in bone marrow.
b: Liver, fish, eggs, meat.
BIOTIN Functions: B vitamin essential for metabolism of fat.
VITAMIN C (Ascorbic acid) Functions: Essential for formation of red blood cells, antibodies and connective tissue; formation and maintenance of bones; maintenance of strength of blood capillaries. Deficiency causes scurvy, with symptoms of swollen bleeding gums, weakness and dizziness.
Sources: Blackcurrants, citrus fruits, green vegetables, potatoes.
VITAMIN D Functions: Essential for absorption of calcium and phosphorus. Deficiency causes rickets.
Sources: Fish-liver oils, eggs, butter, cheese. Humans can synthesize vitamin D from sunlight.
VITAMIN E Functions: Has antioxidant properties, thought to prevent oxidation of unsaturated fatty acids in cells.
Sources: Vegetable oils, cereals, green vegetables, eggs, butter.
VITAMIN K Functions: Associated with clotting mechanism of blood.
Sources: Green vegetables, liver; can be synthesized in the human gut.
A BALANCED DIET
When a baby is born, its mother's milk provides all the nutrients it requires. Once an infant has been weaned, and for the rest of its life, it is necessary to select a diet from a wide range of food sources. An individual's personal requirements depend on many factors such as age, sex and size. It is impossible to know how much of a particular nutrient an individual requires without doing complicated biochemical tests. It is possible, however, to estimate the amount of each nutrient needed by virtually everybody in the population. These 'Recommended Daily Amounts' are defined for different ages and different states - for example, requirements are greater in pregnancy.
A person's energy requirements also depend on their level of activity. Any excess energy taken in is stored in the form of fat. It is therefore important to ensure that the energy taken in is not greater than the amount expended.
The proportion of energy derived from fat, carbohydrate and protein is important, and current dietary guidelines suggest that no more than 35% of energy should come from fat, 10% from protein and 55% from carbohydrates. A diet high in fat, particularly 'saturated fat' (as found in, for example, red meat and dairy products), has been linked to the development of coronary heart disease. Most people would benefit from reducing their total fat intake, particularly if it contains a lot of saturated fatty acids.
To ensure the right balance of nutrients in a diet it is important to base one's eating on a wide range of foods. This should also ensure that adequate amounts of vitamins and minerals are consumed.
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ftsTitleOverride
Respiration and Circulation (page 1)
ftsTitle
* HOW PEOPLE MOVE
* FOOD, DIET AND DIGESTION
* GLANDS AND HORMONES
* NON-INFECTIOUS DISEASES
Respiration and Circulation (1 of 4)
Every cell of the body requires a constant supply of oxygen and nutrients. The immediate source of these is the interstitial fluid, which surrounds the cell and is continuously replenished by the blood supply. Carbon dioxide and other waste produced by the cells are then carried away by the blood.
Carrying gases is one of the many functions of blood, which consists of three types of cell. Suspended in a liquid called plasma are red corpuscles, white corpuscles and platelets. The main function of white corpuscles is to fight infection and the platelets initiate the clotting mechanism, which ensures that when a blood vessel is damaged the wound is sealed before much of the 5 litters (8 pints) of blood that the average person possesses is lost.
Each litter of blood contains about 5 x 1012 red blood corpuscles containing hemoglobin - a substance which combines with oxygen in the lungs and carries it to the tissues, where the oxygen is exchanged for carbon dioxide. This carbon dioxide is then carried to the lungs, where it is exchanged for more oxygen. If a person has a reduced number of red corpuscles or if the corpuscles have a reduced amount of haemoglobin, they are said to be suffering from anemia and not enough oxygen is carried to the tissues. This results in tiredness and breathlessness, particularly on exertion.
Respiration
The oxygenation of blood in the lungs, the use of oxygen and production of carbon dioxide by the tissues and the removal of carbon dioxide from the blood in the lungs is called respiration.
Air enters the respiratory system through the nose or mouth and passes down the trachea, which branches in the lungs into smaller and smaller tubes or bronchioles and finally into alveoli, where blood and gas are in close contact and gases can exchange freely. This occurs as a result of muscle contraction. Breathing in (inspiration) occurs when two sets of muscle contract - the diaphragm, which separates the chest from the abdomen, and the intercostals, which lie between each rib. Contraction of these muscles increases the volume within the thoracic cavity (chest). This causes the lungs to expand and air to rush in. When the muscles stop contracting, they relax passively and the lungs deflate again, forcing the air out (expiration).
William Harvey proved that the heart and blood vessels formed a closed system, with the blood continuously circulating around it. The center point of this system is the heart - the pump which forces the blood through the blood vessels to every part of the body. The heart is in fact a double pump - a right and a left pump, each consisting of two chambers, an atrium and a ventricle. The right atrium receives blood from all parts of the body and passes it on to the right ventricle, which then pumps it to the lungs (pulmonary circulation). The oxygenated blood then returns to the left atrium and into the left ventricle, which pumps it to all parts of the body (systemic circulation). The heart is a very powerful muscle, contracting between 60 and 200 times a minute depending on the level of activity. To ensure that the blood moves in only one direction through the heart, the openings between the atria and ventricles and between the ventricles and blood vessels are guarded by valves.
The blood vessels leaving the heart are called arteries, with the pulmonary artery going to the lungs, and the aorta to all the organs and tissues of the body. As they get further from the heart, they branch into smaller and smaller arteries. Arteries appear circular in cross section, with thick muscular walls. The smaller arteries eventually become capillaries - thin-walled vessels through which the transfer of oxygen and other substances between the blood and interstitial fluid occurs. At the same time, carbon dioxide and other waste products leave the interstitial fluid and enter the blood. The capillaries then converge, forming larger and larger vessels known as veins, which are thin-walled and of indefinite shape. Veins contain valves, which aid the movement of blood from the lower parts of the body against gravity. Eventually they merge into two large veins, the superior vena cava and inferior vena cava, which return blood to the right atrium.
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Respiration and Circulation (page 3)
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* HOW PEOPLE MOVE
* FOOD, DIET AND DIGESTION
* GLANDS AND HORMONES
* NON-INFECTIOUS DISEASES
Respiration and Circulation (3 of 4)
The effects of exercise
As the body changes from a state of rest to one of activity, its requirements alter. At rest the body uses about 0.25 litters of oxygen each minute, and this can rise to three litters a minute in heavy exercise. To make this possible, both the heart and the respiratory system must increase their level of activity. At rest the heart pumps about five litters of blood per minute to the lungs and the same amount around the rest of the body. In heavy exercise, this volume is in creased to about 30 liters per minute - the heart rate increases from about 60 to 200 beats per minute and the amount of blood pumped out with each beat is doubled. Because the amount of blood passing through the lungs increases about six times, more air must be brought into the lungs to provide the necessary oxygen, and this is achieved by breathing more frequently and more deeply. The circulatory and respiratory systems can be finely controlled in this way to meet the prevailing requirements of the body.
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Respiration and Circulation (page 4)
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Each pulmonary artery divides into many branches and eventually into a network of capillaries in the walls of the alveoli, where gases are exchanged. The capillaries rejoin and become two pulmonary veins, conveying oxygenated blood back to the heart.
* HOW PEOPLE MOVE
* FOOD, DIET AND DIGESTION
* GLANDS AND HORMONES
* NON-INFECTIOUS DISEASES
Respiration and Circulation (4 of 4)
Other functions
Nutrients, eaten and digested are absorbed into the bloodstream and transported to the liver and tissues which need them. Water, which accounts for about 60% of the body, is constantly moving around the body and this is brought about by movement into and out of the bloodstream. Hormones are secreted into the bloodstream by the endocrine glands and transported to their target tissues. Waste products are carried to the kidneys for excretion in the urine. Drugs taken by mouth or injected enter the bloodstream and are carried to the organs on which they are expected to act.
Injury or infection causes inflammation - local blood vessels dilate and the in-creased flow of blood brings microphages, macrophages and antibodies to the area. Blood also plays a part in regulating body temperature: in hot weather vessels in the skin dilate allowing heat to escape and in cold weather they contract, conserving body heat.
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The Immune System (page 1)
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* REPRODUCTION
* RESPIRATION AND CIRCULATION
* GLANDS AND HORMONES
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* PREVENTING DISEASE
The Immune System (1 of 4)
Everyday of our lives there is a constant battle between our bodies and a multitude of microbes. To bacteria, viruses and fungi, many of which cause disease, the human body represents a warm haven where food is plentiful. Before a microorganism can install itself, however, it has to breach the body's first line of defense.
The most obvious of these is the skin, which forms a waterproof layer over most of the body. The sebum secreted by the sebaceous glands in the skin contains a substance called lysozyme - also present in tears and nasal mucus - which kills bacteria and viruses.
Those parts of the body open to the exterior have their own specialized de fences. Any bacteria or viruses inhaled may become entangled in mucus produced by the cells lining the tubes leading to the lungs. Tiny hair-like cilia in these tubes constantly beat the mucus upwards towards the throat, where it is either coughed up or swallowed. If it is swallowed, the acid in the stomach juices will usually kill any microorganisms present.
Microorganisms can also enter the body via the urinary opening or, in women, the vagina. In both men and women, the flushing action of urine tends to wash any invading bacteria out of the body. In women, harmless bacteria in the vagina help to prevent those that cause disease from establishing themselves. Harmless bacteria in the gut play a similar role.
Bacteria, viruses, fungi and other microorganisms that cause diseases sometimes manage to evade these defenses and begin to multiply in the body. One of the main functions of the immune system - that of protecting the human body against invading microbes - then comes into play. The immune system can also recognize and reject foreign material, such as transplanted organs, and identify and destroy cancer cells.
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The Immune System (page 2)
ftsTitle
A macrophage (a type of white blood cell) approaching, engulfing and consuming a red blood cell that has reached the end of its life.
* REPRODUCTION
* RESPIRATION AND CIRCULATION
* GLANDS AND HORMONES
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* PREVENTING DISEASE
The Immune System (2 of 4)
The components of the immune system
White blood cells known as lymphocytes form one of the most important components of the immune system. The cells destined to become lymphocytes originate in the bone marrow. Some of them travel in the blood to the thymus gland in the neck, where they mature into T-lymphocytes. The thymus gland seems to have a role in ensuring that only those T cells that recognize foreign proteins (as opposed to the body's own proteins) are released into the circulation. Some of the immature cells remain in the bone mar row for the rest of their development, however, and they become B-lymphocytes. Once mature, the T and B cells migrate in the blood to the spleen, the lymph nodes and other components of the lymphoid tissue, such as the tonsils. The spleen is an organ found on the left side of the body, just below the diaphragm. One of its functions is to filter circulating microorganisms from the blood. Lymphocytes present in the spleen are ready to respond to any foreign microbe that appears.
The lymph nodes, present throughout the body, filter the lymph - a clear fluid that drains from the body tissues. The lymph collects in the vessels of the lymphatic system, and eventually returns to the blood. It first passes through the lymph nodes and any microorganisms or cancer cells are filtered out. If an infection is present, lymphocytes respond by multiplying, which accounts for the swelling of the nodes - for example, in the armpits and under the lower jaw - that sometimes occurs. Vast numbers of other types of white blood cell, e.g. microphages (neutrophils) and macrophages, can engulf and destroy microorganisms. They also destroy red blood cells that have reached the end of their 120-day life span. These so-called phagocytic cells are found in the tissues, lymph nodes and spleen.
Antigens and antibodies
An antigen is any foreign substance - for instance, the protein on the coat of a bacterium - that can stimulate an immune response. When T cells meet antigens they respond by multiplying and dividing, releasing molecules that stimulate other cells of the immune system (including other T cells) to grow.
There are may different kinds of T cells. Cytotoxic T cells can recognize and kill cells infected with viruses. T-helper cells can help macrophages to kill microorganisms. T-helper cells also have an important role in stimulating B cells.
Once stimulated, a B cell multiplies. Its offspring mature into plasma cells, which secrete antibodies. These are specialized molecules that can latch on to antigens and help the rest of the immune system eliminate the foreign particle. There is potentially an infinite variety of anti-bodies, one for every conceivable antigen. Once a B cell is stimulated, the result is a clone of plasma cells, all dedicated to manufacturing the antibody that recognizes the antigen in question.
Immunity and memory
A few of the cells that result when a B cell divides in response to an antigen are so-called memory cells. These remain in the body for life: when the individual meets the same antigen again, they are ready to respond, faster and with more force than before. This explains why people who have one attack of rubella (German measles), for example, are immune to subsequent infections by this virus.
Immunization works on this principle. Vaccines aim to prime the immune system to recognize disease-causing organisms, so that it will spring into action when it encounters the microorganisms concerned. Several vaccines consist of bacteria or viruses that have been killed or weakened; they provoke a protective immune response, but no longer have the capacity to cause the disease.
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The Immune System (page 3)
ftsTitle
Severe combined immune deficiency is a rare condition in which the immune system is seriously defective. Even a mild infection can prove fatal to affected children, who can only survive in the sterile environment of a biological isolation unit. This child lived until the age of 8 in a unit at Texas Children'sHospital, USA.
* REPRODUCTION
* RESPIRATION AND CIRCULATION
* GLANDS AND HORMONES
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* PREVENTING DISEASE
The Immune System (3 of 4)
Autoimmune diseases
Many common diseases - for example rheumatoid arthritis and some types of diabetes mellitus and thyroid disease are thought to be caused by an autoimmune response, in which the body's tissues are attacked by its own antibodies.
Encyclopedia
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The Immune System (page 4)
ftsTitle
An AIDS virus (orange) budding from the plasma membrane (blue) of an infected T-lymphocyte, viewed through a false-color electron microscope.
* REPRODUCTION
* RESPIRATION AND CIRCULATION
* GLANDS AND HORMONES
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* PREVENTING DISEASE
The Immune System (4 of 4)
AIDS AND THE IMMUNE SYSTEM
The human immunodeficiency virus (HIV), which causes AIDS (acquired immune deficiency syndrome), strikes at the heart of the body's defenses. The virus destroys the immune system, including the very cells that should be capable of eliminating it. In infected people the virus is found in the blood, semen and - to a lesser extent - vaginal secretions. It can be transmitted if any of these fluids gains access to another person's blood stream. This can occur through sexual contact involving exposure to semen, as the virus could enter even the most minute cut or abrasion in the vagina or the more delicate rectum. It can also be spread among drug users via shared hypodermic needles.
People infected with HIV may remain apparently well for many years. After a variable incubation period, which may average as long as 9 or 10 years, many affected people - although no one knows exactly what proportion - will go on to develop AIDS. The disease develops when the individual's level of T-helper cells falls drastically.
Without the T-helper cells, which orchestrate many of the components of the immune system, it becomes impossible for the body to fight off infectious agents. The person falls prey to a variety of opportunistic infections, so called because they have taken advantage of the failing immune system. Certain cancers, including the skin cancer known as Kaposi's sarcoma, may also develop in AIDS.
Medical scientists studying AIDS have been puzzled by the observation that HIV seems to infect only a very small proportion of T-helper cells circulating in the blood. Even if these infected cells died, the body would produce T cells at such a rate that they would easily be replaced.
One theory to explain the loss is that some effects of the virus on uninfected cells may be to blame. For example, viral proteins circulating in the blood may attach themselves to the cells that HIV attacks. Cytotoxic T cells may then see these cells as infected (even though they are not) and kill them.
HIV infects not only T-helper cells, but also macrophages. Sometimes the virus can multiply within the macrophages to the point where the cells are bursting with viruses. Possibly, the primary defect in AIDS may lie with the macrophages.
An AIDS virus (orange) budding from the plasma membrane (blue) of an infectedT-lymphocyte, viewed through a false-color electron microscope.
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Glands and Hormones (page 1)
ftsTitle
A eunuch from India. Castration before puberty results in a lack of the male sex hormone testosterone. Without testosterone, secondary sexual characteristics - body and facial hair, deepening of the voice - fail to develop. Because of their sexual impotence, eunuchs were (and still are in some Muslim areas) employed to work in harems.
* REPRODUCTION
* PHYSICAL DEVELOPMENT
* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* NON-INFECTIOUS DISEASES
Glands and Hormones (1 of 3)
As multicellular organisms evolved, it became necessary to establish ways in which cells could communicate with one another. Two basic mechanisms perform this task: the nervous system and the endocrine system. The latter consists of the endocrine glands, scattered throughout the body. The endocrine glands produce chemicals (hormones) that are transported in the blood to distant tissues (targets) whose activity they modify. Hormones exert their effects in four broadly defined biological areas: reproduction, growth and development, control of the internal environment and regulation of energy production.
The first demonstration of hormonal activity came in 1849 when it was noticed that castration caused the loss of secondary sexual characteristics in the cockerel (as a result of the loss of testicular hormones). Since then, a host of different hormones have been identified and a number of disorders resulting from the impairment of endocrine function have been described.
The anterior pituitary
The pituitary gland consists of two lobes, anterior and posterior. It sits in a cavity of the skull, underneath the brain, and despite its small size - less than 1 cm in diameter and 0.5 g in weight (1/50 oz) - it performs a crucial function within the endocrine system. In particular, by their actions on other glands throughout the body, the hormones of the anterior pituitary play a fundamental role in the control of both reproduction and metabolism. The anterior pituitary is itself controlled by the hypothalamus, an area of the brain that receives information about the internal environment of the body and adjusts pituitary output accordingly.
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Glands and Hormones (page 2)
ftsTitle
* REPRODUCTION
* PHYSICAL DEVELOPMENT
* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* NON-INFECTIOUS DISEASES
Glands and Hormones (2 of 3)
Reproduction
Reproductive function in both sexes is controlled by the anterior pituitary gonadotrophins (FSH and LH) and the steroid hormones from ovary or testis. In women, fluctuations of these hormones govern each menstrual cycle, stimulating ovulation and preparing the uterus (womb) for pregnancy. After delivery, prolactin and oxytocin control milk production and expression. In men, pituitary gonadotrophins are responsible for sperm production and fertility.
The sex steroids also bring about the development of secondary sexual characteristics - beard growth, deep voice and muscle increase in males, and breast development in females. The male steroids are anabolic and are among the banned substances occasionally used by athletes to encourage muscle development and enhance performance.
Growth
Many hormones participate in the coordination of growth, both of individual organs and of the whole body. Growth hormone (GH) is particularly important for growth of the skeleton during childhood, while thyroid hormone (TH) is crucial for the maturing of the central nervous system. In the absence of thyroid function during early infancy, physical and mental development fail, giving rise to cretinism - restricted height and mental retardation. An excess of GH in adult life leads to acromegaly, characterized by abnormal thickening of bones and soft tissues.
The internal environment
For the body to function efficiently its internal environment - for example, the volume and composition of the blood - must be carefully controlled. A multitude of hormones participate in such regulation. Antidiuretic hormone from the posterior pituitary and aldosterone from the cortex of the adrenal gland regulate the excretion of water and salt by the kidney; parathyroid hormone, together with vitamin D, controls the level of the minerals calcium and phosphorus in the blood, while the functions of liver, muscle and fat are influenced by GH, insulin, glucagon, adrenaline, sex steroids and cortisol.
Metabolism
The body must convert food into usable energy while storing part of that energy for use in times of fasting. The pancreatic hormones insulin and glucagon have key roles to play here. In addition, thyroxine stimulates metabolism, helping to generate large amounts of energy in the form of heat. People with thyroid insufficiency suffer a variety of metabolic disorders - including extreme cold sensitivity and mental slowing - while in Graves disease (overactive thyroid) metabolic rate is elevated and the patient loses weight and feels hot, hyperactive and anxious.
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Glands and Hormones (page 3)
ftsTitle
Crystals of progesterone - (left) a female sex hormone - seen through a polarized light microscope.
* REPRODUCTION
* PHYSICAL DEVELOPMENT
* FOOD, DIET AND DIGESTION
* RESPIRATION AND CIRCULATION
* NON-INFECTIOUS DISEASES
Glands and Hormones (3 of 3)
Hormone secretion
The output of a hormone is usually regulated so as to allow a response to a biological need without a prolonged high level of secretion. Hormones or the effects they produce often inhibit their own output by negative feedback - their secretion is self-limiting. Many hormones are released in response to stress, while some show a daily (circadian) pattern. ACTH and the adrenal cortical hormones show such a 24-hour rhythm, with a peak occurring in the early morning, probably to prepare the body for the stress of getting up. The symptoms of jet lag may be due to the desynchronization of daily activity with hormonal rhythms.
Measurement of hormones
Hormones are present in tiny amounts in body fluids but modern techniques allow many of them to be measured accurately. Pregnancy, for example, is confirmed by the presence of human chorionic gonadotrophin (HGC) in urine, while the success of in vitro (test tube) fertilization relies on the accurate detection of pituitary gonadotrophins and ovarian hormones. The presence of certain tumors can be detected from abnormal levels of hormones in the blood.
DIABETES MELLITUS
Diabetes is an extremely common and - as yet - incurable metabolic disease. In Western societies 1-2% of the population are affected, while the incidence can reach 15% in certain subpopulations, e.g. Australian Aboriginals and North American Indians.
In many cases the disease is genetically determined but it can also be precipitated by certain viral infections, toxins, chronic disease or pregnancy. In all cases, the primary defect is an absolute or relative deficiency of pancreatic insulin. Insulin plays a pivotal role in the control of the metabolism. It allows glucose, which is derived from food, to enter the cells. There it is broken down in order to generate energy for the work of cells; it promotes the synthesis of new protein and suppresses the breakdown of fat.
Insulin deficiency results in profound metabolic derangements, the most consistent of which is hyperglycemia (blood glucose levels above the normal range of 50-120 mg per 100 milliliters). As blood sugar rises, glucose appears in the urine, carrying water with it and giving rise to the increased urine output and thirst that characterize the disorder - diabetes is the Greek word for 'syphon'. Fat metabolism may also be enhanced, leading to the accumulation of acidic by-products (keto-acids) which, if unchecked, can result in coma or death.
Many diabetic patients are treated by dietary restrictions and the use of drugs but some are dependent upon daily administration of insulin to control their symptoms. Until recently animal insulins were used, but today, using modern techniques of molecular biology, bacteria can be made to synthesize the human hormone. Administration is either by injection, usually before meals, or continuously using a specially-designed mini-infusion pump.
Although the major clinical manifestations of diabetes can usually be controlled, it is difficult to maintain blood glucose levels within the normal range. Consequently, diabetic patients become susceptible to degenerative complications involving the nerves, eyes, kidneys and blood vessels, and it is these secondary problems that make diabetes such a devastating disease.
MAJOR GLANDS AND THEIR HORMONES
Gland Hormone Chief Target Tissue
Brain Releasing hormones Anterior pituitary
(hypothalamus) responsible for
controlling output of
anterior pituitary
hormones, e.g.
thyrotropin releasing
hormone (TRH), which
stimulates secretion of TSH.
Anterior Gonadotrophins Gonads (ovaries and testes)
pituitary (luteinizing hormone, LH;
follicle-stimulating
hormone, FSH)
Prolactin Breast
Adrenocorticotrophic
hormone (ACTH) Adrenal cortex
Thyroid stimulating
hormone (TSH) Thyroid gland
Growth hormone (GH) Most cells
Posterior Antidiuretic hormone
pituitary (ADH) Kidney
Oxytocin Breast
Thyroid gland Thryoxine Most cells
Adrenal cortex Steroids: cortisol Most cells
aldosterone Kidney
Ovaries and Sex steroids: oestrogens Reproductive system
A sweat pore from the palm of a man's hand, viewed through a false-color electron microscope (magnification 180). The skin on human hands is arranged in ridges, with sweat pores appearing as miniature depressions tunneling into the ridges.
* ANIMAL COMMUNICATION
* SEEING AND HEARING
* THE NERVOUS SYSTEM
Touch, Taste and Smell (1 of 5)
The skin covers the body completely, forming a waterproof, protective coat that constitutes the first barrier to invading organisms. It also has sensory and excretory functions, and plays an important part in regulating body temperature. The skin continues in a modified form in the mucous membrane, which lines the nose, mouth and digestive tract. Like the skin, the senses of smell and taste have a protective function and can alert us to the presence of, for example, food that has gone bad.
The skin is composed of two layers - the epidermis and the dermis - with a layer of fatty tissue underneath. The epidermis, or outer layer, itself consists of several layers. Replacement cells are required as the surface cells are shed or rubbed off continuously. The lowest layer or stratum basale contains constantly dividing cells, providing new cells that rise through the layers, gradually becoming flattened and finally reaching the stratum corneum - the outermost layer, in which the cells are flat, thin and filled with the fibrous protein keratin. The epidermis derives oxygen and nutrients from the interstitial fluid.
The dermis is the layer of living tissue, and consists of connective tissue with blood capillaries, lymph vessels, sensory nerve endings, sweat glands and pores, hair follicles and sebaceous glands.
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Touch, Taste and Smell (page 2)
ftsTitle
* ANIMAL COMMUNICATION
* SEEING AND HEARING
* THE NERVOUS SYSTEM
Touch, Taste and Smell (2 of 5)
Touch
The sense of touch is primarily exploratory. Buried within the skin and other exposed surfaces, such as the eyeball and the mouth, are the sensory nerve endings, which have lost their protective myelin sheath and branch out into fine filaments. These are responsible for telling the brain what is in contact with the body and alerting the brain to specific sensations - pressure, warmth, cold and pain. An electrical response is produced in the stimulated nerve ending, and this travels up the sensory fibers of a nerve to the cortex or outer layer of the brain. Certain areas - such as the lips, palms of the hands, soles of the feet and the genitalia - have a far greater concentration of nerve endings than, for example, the skin on the back and are thus more sensitive than other areas.
Specific areas of the brain are responsible for the sense of touch or pain in certain areas of skin. If, at any point in its journey, the nerve is damaged, then the electrical impulse will not be able to travel and the area from which the impulse came will feel numb.
The sensation of touch is not dependent solely on nerve impulses traveling up to the brain. The brain can be selective in what it does with this information, and in some cases can decide to ignore it. It can, for instance, decide to get 'used' to the more repetitive stimuli, such as the weight of clothes on the body, and will cease to register them unless its attention is focused on them specifically.
The skin also contains hairs, whose roots (hair follicles) are embedded in the dermis and expand at their base to form bulbs, which contain dividing cells. Newly formed cells push older cells upwards; these are converted to keratin and form the root and shaft of the hair. Nerves attached to the follicles are activated every time the hair moves, telling the brain that it has just been touched. The sebaceous glands are associated with the hair follicle and produce sebum or oil, which lubricates the hair and skin.
Temperature regulation
The skin is able to regulate body temperature by means of the sweat glands and pores. The eccrine sweat glands, present throughout the skin but more numerous in the palms of the hands, soles of the feet, armpits and groin, produce sweat, which is released through the sweat pores. The evaporation of sweat from the skin cools the body. It also has an excretory function, in that it carries away wastes such as urea and lactic acid. The amount of sweat produced is controlled by the hypothalamus. The apocrine sweat glands, situated in the armpits and genital areas, produce a thicker secretion and do not become active until puberty. The action of bacteria on apocrine sweat is capable of causing a strong odor.
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Touch, Taste and Smell (page 3)
ftsTitle
* ANIMAL COMMUNICATION
* SEEING AND HEARING
* THE NERVOUS SYSTEM
Touch, Taste and Smell (3 of 5)
Smell
In humans, the sense of smell is relatively under-developed when compared to that of the dog or the pig, for example, which depend on it to a far greater extent. The sense of smell is derived from tiny nerve endings that pass through the cribriform plate from the olfactory nerve at the base of the brain into the damp lining of the nose, known as the nasal mucosa. This mucous membrane contains thousands of tiny glands whose job it is to produce the wet, sticky substance known as mucus. Microscopic hairs - cilia - direct the mucus back towards the throat, where it is swallowed. Infection by the common cold virus irritates the lining of the nose, which then produces an excess of mucus.
Substances that have an odor give off molecules, which are present in the air and are breathed in. They dissolve in the nasal mucus, thereby stimulating the olfactory nerve. This information is then passed back to the olfactory lobes in the brain and also to a primitive part of the brain called the limbic system or rhinencephalon.
In lower animals the olfactory lobes are very large, sometimes making up over half the brain mass. Undoubtedly these animals produce smell 'pictures' by which they feed and find a mate. Hence the importance dogs, for instance, place on 'marking' their territory also. Most animals, including humans, produce certain fatty acids called pheromones, which attract members of the opposite sex.
Some people lose their sense of smell completely - permanently, for instance as the result of an accident, or temporarily, when suffering from a cold. This condition is known as anosmia and, while it may not hinder the ability to operate effectively, it is potentially dangerous since smell is relied on to detect such things as gas leaks, fire or food that has gone off.
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Touch, Taste and Smell (page 4)
ftsTitle
* ANIMAL COMMUNICATION
* SEEING AND HEARING
* THE NERVOUS SYSTEM
Touch, Taste and Smell (4 of 5)
Taste
Taste is a complex sensation. The tongue can distinguish between only four basic tastes: sweet, sour, salt and bitter - and nothing else. The surface of the tongue is covered with small projections called papillae, which contain the nerve endings concerned with the sense of taste. These specialized sensory receptors - the taste buds - are stimulated by particles of food dissolving in the saliva. Nerve impulses are sent to the brain via the facial nerve and the glossopharyngeal nerve. The range of tastes normally associated with food depends, in fact, more on the sense of smell than on that of taste - people who lose their sense of smell notice that their food suddenly tastes bland and uninteresting.
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p216-5
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Touch, Taste and Smell (page 5)
ftsTitle
Pain tolerance: a woman walking across
burning coals.
* ANIMAL COMMUNICATION
* SEEING AND HEARING
* THE NERVOUS SYSTEM
Touch, Taste and Smell (5 of 5)
Pain results from the stimulation of nerve fibers in the skin or internally. The sensation of pain can vary from a mild ache to an overpowering agony. Itching is considered to be a very mild form of painful stimulus.
Research has shown that pain stimuli travel at different speeds within these nerves, hence the sensation of 'double pain'. If a finger is put in scalding water there will be sudden, sharp, 'first pain' followed a few moments later by a duller 'second pain'. The first pain is carried quickly in one sort of nerve fiber (A fibers), the second more slowly in another (C fibers).
Pain receptors in the brain are called nociceptors. They respond very quickly to the chemicals that are released from damaged cells. This sensitivity to chemicals allows pain to be treated using pain-killing chemical drugs (analgesics) such as aspirin.
The brain plays an immensely important role in the perception of pain. Indian 'fakirs' for instance sleep on beds of nails or apparently walk over smoldering coals in their bare feet without apparently feeling anything. How can this be? The concept of pain 'tolerance' is important here. A person can put up with almost any degree of pain depending on their state of mind.
An interesting experiment along these lines was carried out in the 1960s by an American professor. He allowed his students to lower a slowly turning drill onto the backs of their hand. He then assessed how much pressure and pain they could withstand. Many appeared to be able to withstand a good deal.
He then allowed the students to rest and to think about what had gone on, then invited them to repeat the experiment. Armed with the knowledge of what it had felt like at the last attempt, all the students found they could now stand only a fraction of the pain that they had happily stood before. Their pain tolerance was much lower than before.
At its most extreme, this tolerance of pain allows the body to deal with major injuries that occur in war or in severe accidents. Many victims claims they feel nothing immediately following the injury, and only later begin to experience the pain.
Pain may sometimes be felt in an area of the body some distance away from the part actually damaged or diseased - for instance, a pain resulting from heart disease is often felt across the chest and down the left arm. This phenomenon is known as referred pain, and results from the fact that sensory nerves from different parts of the body share the same pathways in the spinal cord. Phantom limb pain is often felt by people who have lost limbs: an itch or pain is felt in a part that is no longer there. These phantom sensations are caused by the cut sensory nerves continuing to send messages to the brain.
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Seeing and Hearing (page 1)
ftsTitle
* ACOUSTICS
* OPTICS
* PERCEPTION
* THE POWER OF SPEECH
Seeing and Hearing (1 of 4)
Sight and hearing are the key senses, giving vital information about what is going on in the world around us. The eye, situated in the orbital cavity, is the dominant sense organ, and the eyeballs, measuring about 2.5 cm (1 in) in diameter, function as a pair as each see a slightly different version of the object being looked at. This 3-D or stereoscopic vision is particularly important in order to judge distances and the speed of traveling objects. The ear is the organ of hearing and balance - and both functions share a common nerve pathway to the brain.
The sclera, or white of the eye, is a firm membrane that forms the outer layer of the eyeball. At the front of the eye it continues as the cornea, a transparent convex membrane that refracts the light rays to focus on the retina. The lacrimal glands, situated in recesses just above each eye, secrete tears composed of water, salts and the bacteria-killing enzyme lysozyme. The eyelids form a pair of protective shutters, closing instantly if injury is feared; the eyelids also spread tears over the cornea, keeping it moist and free from infection. The choroid, which is rich in blood vessels, lines the inner surface of the sclera.
The ciliary body, which continues from the choroid, consists of muscle fibers and is connected to the suspensory ligament, which is attached at its other end to a capsule containing the lens. The iris - the part of the eye that regulates the amount of light that enters - lies behind the cornea in front of the lens. It forms a pigmented muscular body with a central aperture, the pupil, which varies in size depending on the intensity of light. In bright light the circular muscle fibers of the iris contract, causing the pupil to constrict; in dim light a set of radiating muscle fibers contract and the pupil dilates. The lens, a transparent crystal-line structure, is enclosed in a thin clear capsule and situated behind the pupil. It bends light rays reflected by objects in front of the eye. It is highly elastic, changing focus by increasing or decreasing its thickness - this is brought about by contraction of the ciliary muscle. The nearer the object, the thicker the lens needs to be in order to bring it into focus. The chamber behind the cornea and in front of the lens is filled with a watery fluid known as aqueous humor, while the chamber behind the lens contains a jelly-like substance, the vitreous humor.
The retina is the light-sensitive layer lining the eye. It contains nerve fibers and specialized cells - rods and cones. The rods, numbering about 125 million, are essential for seeing in dim light. They contain a pigment known as visual purple, which is broken down in the light and regenerated in the dark. The 6-7 million cones function in bright light and are necessary for sharp vision; they are most concentrated in the fovea - a small depression in the retina.
To allow vision in different directions without turning the head, the eye can be swiveled around in its socket by a complex set of ocular muscles.
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Seeing and Hearing (page 2)
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The auditory ossicles, seen here through a false-color electron microscope, are the bones responsible for the conduction of sound waves in the middle ear. At the top left is the malleus (hammer), which strikes the incus (anvil), seen to the right of the malleus. The incus is joined to the stapes (stirrup), which conducts sound towards the inner ear. The stapes is the smallest bone in the body, measuring 2.6-3.4 mm (0.10-0.17 in). Sound waves entering the ear cause the eardrum to vibrate and the bones transmit the vibrations to the structures of the inner ear - the footplate of the stapes presses into the fluid-filled scala vestibuli of the cochlea, which converts vibrations into nerve impulses.
* ACOUSTICS
* OPTICS
* PERCEPTION
* THE POWER OF SPEECH
Seeing and Hearing (2 of 4)
The brain and vision
The human eye is similar in structure to a camera and the principles of vision lie within the basic physical theories of optics. The light image focused by the lens onto the retina is converted into electrical impulses, which are then transmitted to the brain via the optic nerve. These electrical messages from the nasal half of each retina actually cross to opposite sides of the head en route for the brain. Because visual images are split in this way, it can mean that, if a person has an injury to one side of the head, rather than losing all the sight from the right or the left eye, half the sight is lost from each. Those who suffer migraine may sometimes experience this.
Once inside the brain, the electrical image of what the eyes are looking at must be interpreted according to the brain's past experience, so that the image can be 'recognized'. If the eye is shown a table, for instance, the brain will receive electrical messages telling it that something with a horizontal surface and four vertical legs is present. The brain sorts through all the other images it has seen that resemble this - four-legged animals, beds, etc. - eventually matching it up with a table seen in the past and giving it a label. Although complicated, the process takes only a fraction of a second. Even today, the most advanced computers can do nothing so complex so quickly.
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Seeing and Hearing (page 3)
ftsTitle
COLOR BLINDNESS
A color-blind person is unable to tell certain colors apart, usually because of a defect in one of the 3 groups of color-sensitive cone cells in the retina. The majority of cases are hereditary, although occasionally an acquired disease of the retina may be responsible. In some cases blue and yellow are confused, but the most common type of color blindness - affecting about one person in 30 - is an inability to distinguish between red and green. The picture shows a standard test for color blindness: those with normal vision will see the number 74, while those with red-green deficiencies will see the number 21
* ACOUSTICS
* OPTICS
* PERCEPTION
* THE POWER OF SPEECH
Seeing and Hearing (3 of 4)
Visual impairment
The most common reasons for not being able to see properly are myopia (short sight) and hypermetropia (long sight). Short-sighted people find that objects get progressively more blurred the further away they are because parallel light rays are brought to a focus in front of the retina. The condition can be corrected by spectacles with concave lenses. In the case of long sight, parallel light rays are brought to a focus behind the retina, so that close objects appear blurred. Wearing spectacles with convex lenses can restore normal sight. Presbyopia, a condition common in later life, is caused by a gradual loss of elasticity in the lens - it becomes less able to increase its curvature in order to focus on near objects. Cataract is also a common cause of poor sight. The lens begins to become opaque, and the condition may eventually prevent any light coming through at all. Cataract is particularly common in later life - it may be congenital, or may be due to a metabolic disease such as diabetes. It can be treated by surgical removal of the lens.
Glaucoma, or tunnel vision, is an inherited condition in which the pressure of fluid within the eye builds up, thus destroying the nerve cells in the retina. Eventually only a small patch of nerve cells in the center of the retina remains, giving the sufferer the sensation of constantly looking down a tube.
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ftsTitleOverride
Seeing and Hearing (page 4)
ftsTitle
* ACOUSTICS
* OPTICS
* PERCEPTION
* THE POWER OF SPEECH
Seeing and Hearing (4 of 4)
Hearing
The ability to hear has two elements - a mechanical element and an element involving electrical nerve impulses. Sound enters through the external ear or auricle - that part of the ear that is visible. Its scalloped shape ensures that as much sound as possible is reflected into the inside of the ear. In some mammals the ear can actually be swiveled round to face the point from which the maximum amount of noise is coming.
Inside the ear, sound travels down a short tube, the external acoustic meatus, until it hits a very thin sheet of skin called the eardrum or tympanic membrane. The mechanical force of the sound waves sets the eardrum vibrating. This vibration is then transmitted across the cavity, or middle ear, on the other side of the eardrum by a series of tiny bones (auditory ossicles), which form a series of movable joints with each other. The stapes is a stirrup-shaped bone; the incus, an anvil-shaped bone, is situated in the middle, and the malleus, a hammer-shaped bone, is in contact with the tympanic membrane.
Beyond the middle ear is the inner ear or cochlea. This helix-shaped structure is basically a fluid-filled tube lined with nerve endings. Like many musical instruments, it is wider at one end in order to pick up low-pitched sounds and narrower at the other in order to pick up high-pitched ones.
The semicircular canals, three tubes that open into the inner ear, are not connected with hearing but are concerned with balance. Each canal registers movement in a different plane and sends nerve impulses to the brain. The semicircular canals are thus essential in establishing our sense of physical position.
If the vibrations passing through the ear are at any stage impeded - perhaps by a burst eardrum, by damage to the ossicles of the middle ear or by degeneration of the nerves taking the sound messages to the brain, then the individual will become partially or completely deaf in that ear. Children are particularly susceptible to middle-ear infections, and these can frequently lead to eardrum damage. The drum will eventually heal and hearing will be restored, but if the child experiences too many such infections the drum will become scarred and unable to vibrate properly, causing permanent partial deaf-ness.
Elderly people often become slightly deaf because of degeneration of the auditory nerve cells. Hearing aids can be used to boost the sound impulse, thus helping the nerve cells that remain to pick up more of the sound vibration.
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The Nervous System (page 1)
ftsTitle
The human nervous system (shown from behind) comprises two major divisions: the central nervous system (CNS), which consists of the brain and spinal cord, and the peripheral nervous system, which consists of cranial nerves (12 pairs) and spinal nerves (31 pairs) arising from the CNS. Shown here are the spinal nerves; not shown are the cranial nerves, which derive from the brain.
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
The Nervous System (1 of 4)
The nervous system is a vast, complex network that regulates every aspect of human life and endeavor, from breathing to running a marathon. The system weaves throughout the body, picking up, interpreting and acting upon data both from outside and from within. Governing the network is the central nervous system (CNS), consisting of the brain and spinal cord. The role of the CNS is largely to do with sensations and voluntary movement. Messages passing to and from the CNS are carried by way of the branching fibers of the peripheral nervous system, which reaches all the way to the body extremities.
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The Nervous System (page 2)
ftsTitle
Neurons (nerve cells) from the cerebral cortex, seen through a false-color electron microscope. Neurons exist in different sizes and shapes throughout the nervous system, but all have a similar basic structure. From the cell body, which contains the nucleus, extend several processes : the nerve fiber or axon carries impulses away from the cell body, while the dendrites (which vary in number) receive impulses from other neurons.
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
The Nervous System (2 of 4)
The nerve cell
The basic functional unit of the nervous system is the nerve cell or neuron. From the cell body containing the nucleus, branching outgrowths called processes trail in all directions. The cell's longest process - its 'main cable' - is the axon, which carries outgoing signals. An axon may extend all the way from the CNS to a finger or toe to connect with the muscle on which it acts. Processes known as dendrites, which vary in number, pick up messages from other cells.
Axons are like telephone cables, in that they have a central electrical conductor surrounded by an insulating layer. The high electrical resistance of the core, and the thinness of the membrane, would cause simple electrical signals to die out over very short distances. This difficulty is overcome by actively regenerating the signals into discrete, all-or-nothing, on-or-off electrical impulses (as in a digital computer) that are continuously renewed and kept up to strength throughout their transmission.
Smaller axons conduct impulses smoothly and slowly - about 1 m (3 1/4 ft) per second - but larger fibers have specially increased layers of insulation, made up of the fatty substance known as myelin. In these myelinated fibers conduction is much faster - up to 100 m (328 ft) per second. Loss of the myelin sheath, in a disease such as multiple sclerosis, blocks or greatly slows down conduction.
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The Nervous System (page 3)
ftsTitle
The Russian physiologist Ivan Petrovitch Pavlov (1849-1936), who developed the concept of the conditioned reflex. The autonomic nervous system is involved in reflexes that depend on sensory input to the brain or spinal cord; these reflexes are coordinated in the brain without conscious control. In the case of a conditioned reflex, a response occurs not to the stimulus that usually causes it but to another stimulus that has been learned to be associated with it. Pavlov experimented with dogs and showed that nerves stimulated by the presence of food carried a message to the brain which, via other nerves, stimulated the secretion of saliva. He then demonstrated that, if a bell is rung every time a dog is shown food, it will eventually salivate every time the bell rings, even when no food is present.
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
The Nervous System (3 of 4)
The peripheral nervous system
The central nervous system communicates with the peripheral nervous system through 12 pairs of cranial nerves and 31 pairs of spinal nerves, which leave the brain and spinal cord. It is these fibers that eventually make their way to the body extremities.
Individual fibers in a nerve may arise from either afferent or efferent neurons. Afferent neurons are those carrying signals towards the CNS, while outgoing signals are conducted by efferent neurons. Groups of afferent fibers enter the spinal cord at the rear, where they form the dorsal roots; efferent fibers leave the spinal cord at the front, by way of the ventral roots.
The efferent fibers of the peripheral nervous system are divided into the somatic (bodily) nervous system and the autonomic (self-regulating) nervous system. Somatic fibers activate skeletal (voluntary) muscle control, whereas autonomic fibersact on smooth or involuntary muscle (such as that found in the gut), as well as cardiac muscle and the various internal organs and glands. Because the activity of the neurons in the somatic nervous system leads to contraction of muscles, they are often calledmotor neurons. Damage to the cell bodies of motor neurons, which are present in clusters in the brain and spinal cord, results in impaired movement.
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The Nervous System (page 4)
ftsTitle
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
The Nervous System (4 of 4)
The autonomic system
The autonomic nervous system, concerned with involuntary function, breaks down further into the sympathetic and parasympathetic nervous systems. These two components, often present in the same gland or organ, keep each other in check. Broadly, the sympathetic division takes over when rapid action is needed. It enables the appropriate circulatory, metabolic and other adjustments to be made in order to engage in 'fight, flight or fright'.
The autonomic system has been called the 'involuntary nervous system' because of its role in controlling physiological events in which normally there is no conscious input. These include routine matters of body maintenance, such as breathing, heart rate, blood flow, temperature control, digestion, glandular secretion and excretion.
COMMUNICATING CELLS
The functional unit of nervous tissue is the nerve cell or neuron. There are billions of these in the central nervous system (CNS). They vary greatly in shape and size, but all communicate electrochemically with their neighbors, forming an intricate network that far outstrips in complexity the circuitry of the most advanced electronic computer.
Neurons can be classified into three types: interneurons lie entirely within the CNS, while sensory or afferent and motor or efferent neurons have segments outside the CNS. In response to physical or chemical stimuli, receptors at the far ends of the afferent neurons send impulses to the CNS. Efferent neurons conduct signals outwards from the CNS to target tissues, such as muscles. The interneurons, which are by far the most numerous nerve cells in the CNS, form highly complex connections between the terminations of sensory nerves in the CNS and the origins of motor nerves. Higher activities - such as language - involve millions of interneuronal pathways.
The neuron consists of a cell body, with its nucleus, and projecting filaments - the dendrites and the axon. These may show extensive branching, and sometimes carry information over long distances in the body. Information is coded as discrete electrical impulses in the neurons. The nature of the information transmitted depends on which particular set of anatomical pathways is being activated, and the intensity or magnitude of the signal depends on the frequency of impulses and the number of pathways carrying the message. The axon terminates at the synapse - the junction where it makes contact with the dendrites or cell bodies of other neurons, or with secretory cells or muscle cells. At the synapse, the electrical signal in the axon causes the release of a small amount of a chemical transmitter - such as acetylcholine or noradrenaline - which carries the message to the next cell.
There is a profusion of known neuro-transmitters, which enable nerve cells to communicate with each other. Ace tylcholine and noradrenaline are the best known, but there is a whole range of substances, including quite complex molecules such as peptides, that may be released from nerve-cell terminals in the CNS. Transmitters generally stimulate the adjacent cell, but sometimes they inhibit some on-going activity. Some chemical substances produce much more diffuse effects, acting beyond the immediate vicinity of the cells from which they were released, changing the levels of excitability in whole groups of neurons. They are not neurotransmitters in the true sense of the word, since their action is not confined to the synapse where they were released; they are therefore described as neuromodulators.
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The Brain (page 1)
ftsTitle
* THE NERVOUS SYSTEM
* PERCEPTION
* THE POWER OF SPEECH
* LEARNING, CREATIVITY AND INTELLIGENCE
* SLEEP AND DREAMS
* MENTAL DISORDERS
* ARTIFICIAL INTELLIGENCE AND CYBERNETICS
The Brain (1 of 3)
The brain is a highly developed, dense mass of nerve cells that forms the upper end of the central nervous system. An adult brain weighs on average 1400g (49 oz), constituting about 2% of the total body weight. Nerve cells without myelin sheaths form the 'grey matter' of the brain, while those with myelin form the 'white matter'.
Nervous tissue is composed of two types of cells: the neurons, which are the basic functional units of the nervous system, and, sustaining and supporting them, the non-communicating glial cells (or neuroglia). Both the brain and the spinal cord are encased in bone and further protected by three encircling membranes, the meninges. The cerebrospinal fluid (CSF), derived from the choroid plexuses and circulating in the cerebral ventricles, helps to cushion delicate nerve tissue.
Divisions of the brain
The brain has three major divisions. The brainstem and cerebellum are basic structures concerned with life-support, posture and coordination of movement. The forebrain is relatively more developed in humans than in other species. The brainstem - the oldest structure in evolutionary terms - forms the stalk of the brain, where vital functions such as breathing and circulation are integrated.
The cerebellum, like the cerebrum, consists of two hemispheres, one on either side. Also like the cerebrum, it has a grey outer covering (cortex) with a core of white matter. The cerebellum is chiefly involved with the coordination of movement. It ensures coherent muscle function and tone and helps to maintain posture.
The forebrain
Overlying these structures is the forebrain, consisting of a central core (the diencephalon) and the cortex. Key landmarks in the diencephalon include the thalamus, a relay station and integrating center for sensory messages on their way to the cerebral cortex. Below it lies the hypothalamus, which is responsible for regulating the body's internal environment.
In human beings the great mass of the brain is formed by the cerebrum, separated by a deep cleft into two cerebral hemispheres, which are linked at the bottom by a communicating bridge, the corpus callosum. Each cerebral hemisphere has specialized functions.
The cerebrum is the most recently evolved part of the brain, responsible for intelligence, intellectual and creative skills and memory. The cerebral cortex (or 'grey matter'), the fissured outer layer of the cerebrum, processes information that reaches it from the thalamus and other lower centers.
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Brain major divisions
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p222-2
ftsTitleOverride
The Brain (page 2)
ftsTitle
* THE NERVOUS SYSTEM
* PERCEPTION
* THE POWER OF SPEECH
* LEARNING, CREATIVITY AND INTELLIGENCE
* SLEEP AND DREAMS
* MENTAL DISORDERS
* ARTIFICIAL INTELLIGENCE AND CYBERNETICS
The Brain (2 of 3)
The higher centers
The cerebral cortex, then, is the most sophisticated part of the brain, where incoming information of all kinds is processed. The cortex sifts, sorts and generally makes sense of the vast mass of stimuli flooding in from the periphery. It organizes these data into the intelligible sights, sounds, impressions and thoughts that are needed to cope with daily living. The cortex therefore perceives and comprehends. It also initiates, for it is here that decisions are taken and instructions are issued for their implementation.
Anatomists divide the cerebral cortex into four lobes - the frontal, parietal, temporal and occipital lobes, all named after the skull plates beneath which they lie. The frontal lobe, extending back behind the forehead and temples, is the largest of the four, as well as the newest in evolutionary terms. Not surprisingly, therefore, it bears the greatest responsibilities and is regarded as the seat of the most advanced mental processes. The frontal lobe governs all voluntary actions, from the simplest physical movements to the intricate matters of thought, language and speech.
Behind the frontal lobes are the parietal lobes, straddling each hemisphere to-wards the rear. Within the parietal lobes are the primary reception areas for the sensation of touch, as well as zones associated with spatial perception (recognition of body position). Damage in these areas would plunge us into a topsy-turvy world.
Running along the base of the parietal lobes, the temporal lobes lie approximately on a level with the ears. They contain the centers for auditory perception, with both ears represented on each side of the brain. If one of the temporal lobes is damaged, hearing is not lost, as vision is if one of the occipital lobes comes to harm. The smallest of the four, at the rear of the cortex, the occipital lobes receive and process visual images.
Since the information from one sense alone does not always give us a complete picture, all incoming signals are supplemented by, and integrated with, other data being processed simultaneously. This integration process, fulfilled by what are known as association areas in the cortex, gives us total awareness of our surroundings.
Instinctive behavior and emotions
The limbic system is the oldest part of the forebrain and consists of a rim of cerebral cortex around the stalk of each central hemisphere, together with a group of deeper structures concerned with instinctive behavior and the emotional and physical changes that accompany them. These include sexual drive, thirst, hunger, fear and anger.
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The Brain (page 3)
ftsTitle
A phrenologist's division of the head. In the 19th century Franz-Joseph Gall and Johann Kaspar Purzheim popularized the study of phrenology, in which the brain was divided up into distinct regions, each responsible for a different faculty or trait. The size of any one region was held to indicate the strength of that faculty or trait. The theory was not scientifically discredited until well into the 20th century.
* THE NERVOUS SYSTEM
* PERCEPTION
* THE POWER OF SPEECH
* LEARNING, CREATIVITY AND INTELLIGENCE
* SLEEP AND DREAMS
* MENTAL DISORDERS
* ARTIFICIAL INTELLIGENCE AND CYBERNETICS
The Brain (3 of 3)
THE INJURED BRAIN
The 4th-century Greek philosopher Aristotle took a dim view of the brain. He believed that the sole purpose of the brain was to cool the blood; the heart, he said, was the seat of the soul. In this he was out of step with many early physicians, who recognized the pre-eminence of the brain. They came to this realization not least through observing that disorders of mental functioning can result from physical injury to the head and brain. Blows to the head, the growth of brain tumors, or impairment of the brain's blood supply (as in a stroke) can all have serious effects upon our ability to speak and understand, to recognize objects and people, to perform skilled actions or remember past events.
Disorders of language after brain damage (aphasia) come in many forms. The brain-injured person may, for example, no longer be able to formulate coherent sentences. Asked to detail the history of his early life, one man said simply: 'School, marbles, farm, errands, engineer, Glasgow, Philadelphia'. Perhaps we are to gather from this that he enjoyed playing marbles at school, he grew up on a farm and ran errands, trained as an engineer in Glasgow and emigrated to Philadelphia.
Problems with perception and recognition (agnosia) are common after brain damage, even in people with intact vision. Such a person, for instance, might be able to copy a drawing accurately, but be quite unable to recognize what object they had drawn.
Some neurological patients can recognize common objects, but have specific problems identifying faces. They may not recognize the faces of family members or even their own reflections in a mirror. In this condition (prosopagnosia) the person knows a face is a face, but has no idea which one, and is forced to identify individuals by voice or by particular articles of clothing.
A more common consequence of brain damage is visual neglect. Despite having free movement of the head and eyes, the brain-injured person ignores information from one half of the visual field. In extreme cases, he or she may only eat the food on one side of the plate, or shave or apply make-up to just one side of the face.
Sometimes the capacity to sequence actions correctly, or to direct them appropriately in three-dimensional space, is impaired. Asked to demonstrate how to brush the teeth, the patient may make an accurate brushing movement, but do so nearer the forehead than the mouth. Or, asked to make a cup of tea, he or she may tip the sugar into the milk jug, stir the water in the kettle with a spoon, and pour the milk into the kettle. Although none of us have perfect memories, we can remember what we had for breakfast or where we went on holiday. Some forms of brain damage impair these autobiographical memories (retrograde amnesia). In severe cases, a doctor can talk to a patient for half an hour, leave for 10 minutes, and return to find that the patient has no recollection of ever having seen them before. Alcoholism is a common cause of brain damage, in that it destroys areas responsible for the acquisition, storage and retrieval of experienced events. There is often a 'temporal gradient' to retrograde loss of memory, so that events from the distant past may be remembered better than more recent ones. Not all forms of learning are impaired in anterograde amnesia. A patient who solves the same jigsaw day after day may become progressively faster at it, without possessing any memory of having seen it before.
These very specific types of cognitive impairment can be seen in people whose knowledge, skill and ability in other areas is intact. In fact it was from observations of brain-damaged patients that doctors first began mapping the brain, assigning particular functions to its various areas. For instance, the brain appears to be a paired organ: two apparently identical hemispheres connected by a large fiber-tract, the corpus callosum. So we might expect the two half-brains to be equivalent in terms of what they do. Yet the 19th-century French physician Paul Broca (1824-80) noted that language disorder typically follows damage to the left (and not the right) hemisphere.
At about the same time, the English neurologist John Hughlings Jackson (1835-1911) observed that many disorders of visio-spatial perception were associated with right-hemisphere damage. In our own time this notion of 'hemispheric specialization' has been confirmed in patients who have had the corpus callosum surgically severed (for the relief of intractable epilepsy). In these patients, two brains - and perhaps two minds with different capacities, thoughts and feelings - coexist in one body.
There is further specialization of function within a hemisphere of the brain. In the right hemisphere, visual neglect of the left half of space is associated with damage at the rear, while frontal regions (of both hemispheres) are involved in more general functions involved in the planning and regulation of behavior. In the left hemisphere, different areas are concerned with the expression and the comprehension of language, and yet other areas with the organization of skilled movements. Some capacities, including autobiographical memory, are represented equally in both hemispheres.
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Perception (page 1)
ftsTitle
The Ames Room gives the optical illusion that the two men are of markedly different sizes. It is a distorted asymmetrical room, designed to deceive the eye over distance.
* ACOUSTICS
* OPTICS
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE NERVOUS SYSTEM
* THE BRAIN
* LEARNING, CREATIVITY AND INTELLIGENCE
* ARTIFICIAL INTELLIGENCE
* KNOWLEDGE AND REALITY
* MIND AND BODY
Perception (1 of 5)
How the brain experiences the world of objects through information from the senses - sight, hearing, taste, smell and touch - forms the study of perception. Perception has evolved from the reflexes of the most primitive animals, and is also present to some degree in plants, many of which sense gravity to grow upright and grow towards sunlight; some even have touch-sensitive tendrils.
The study of human perception is important for medicine, because perception can go wrong. For example, schizophrenia is associated with visual and auditory hallucinations: knowing why this is so may help the understanding of schizophrenia and its causes. It is important for art, for problems such as dyslexia, for skills such as flying and driving, wine tasting and music, for de signing instruments such as telescopes and microscopes. to match the optics of the eye and predilections of the brain, and for philosophers concerned with how we know and understand. Although hardly, if at all, a subject in schools, perception is central both to all human discovery and know ledge, and to our everyday experience.
Visual perception
There are two essentially different ways of explaining or describing how we see. Classically, vision was supposed to be direct knowledge, picked up by the eye rather in the same way as the sense of touch operates, with the fingers having direct contact with objects. But a lot of guessing is needed to identify objects by touch, and even more for visual perception. It has been known since the early 17th century that vision works from optical images (upside down and right-left reversed) cast on the retina at the back of the eyes. The retina has 120,000,000 light- sensitive 'rod' cells signaling light and dark, and 7,000,000 'cone' cells, of three kinds, signaling color. These cells convert light intensities and frequencies into small pulses of electricity, transmitted to the brain through the bundle of 1,000,000 fibers of the optic nerves. Specialized regions at the back of the brain respond to and analyze particular visual characteristics - movement, orientation, color and so on. Some how these separate representations are combined to create perceptions that are (usually) consistent.
We now know that the classical account is incorrect: vision is indirectly and tenuously linked to the world of objects by complicated physiological processes, some of which are now understood in considerable detail. These processes convert received stimuli into neural signals that are analyzed and 'read' in terms of our knowledge of objects. Perceiving is affected by experience and learning, while sensing is not. Sensations produced by a specific stimulus remain essentially unchanged from one time to another, but our perception of these sensations may be different, depending on what we have learned in the meantime. We may say that 'bottom up' signals from the senses are read by the brain with 'top down' knowledge of the world, de rived from past experience, some of which is inherited.
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ftsTitleOverride
Perception (page 2)
ftsTitle
If looked at for a sufficient length of time the patterns of squares in this picture will be perceived as a recognizable image of Abraham Lincoln: presented with very little visual information, the brain 'fills in' the missing details.
* ACOUSTICS
* OPTICS
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE NERVOUS SYSTEM
* THE BRAIN
* LEARNING, CREATIVITY AND INTELLIGENCE
* ARTIFICIAL INTELLIGENCE
* KNOWLEDGE AND REALITY
* MIND AND BODY
Perception (2 of 5)
Space and distance
Space is perceived in three dimensions - height, width and depth. The eyes, positioned at different points in the skull, receive two slightly different images of the environment, projected upside-down onto each retina. These two retinal images are then combined in the brain into one three-dimensional image, perceived the right way up. The degree of difference between the two images - known as the binocular parallax - depends on the difference between the angles at which an object is fixed by each eye. The greater the difference, the nearer the object is perceived to be. Space perception does not, however, depend solely on vision. Balance is also an important factor in orienting ourselves in the environment. Hearing, and to some extent smell, are, like sight, 'distance' senses: they are capable of obtaining information from distant points. Other senses - touch and taste - provide information about objects in direct contact with the body.
What are perceptions? They are far richer than this mass of data from the senses. They are internal descriptions of the world out there, and of ourselves. They go beyond available data - for example, assuming that partly hidden objects are really complete - and they are predictive into the immediate future. So although there is a reaction-time delay in physiological signaling of about a twentieth of a second, we can hit a cricket ball, play fast table tennis or drive a car, generally anticipating what is about to happen before it happens. It may therefore be said that perceptions are predictive hypotheses of reality.
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Perception (page 3)
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Ambiguities: a meaningful picture will probably be perceived when the drawing above is first seen, but it may then be abruptly replaced by another image. It is not known why the image of a vase first appears to some people and that of two faces to other people, nor is the reason for the sudden change clear. Similarly, the cube below appears to change orientation when looked at continuously.
* ACOUSTICS
* OPTICS
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE NERVOUS SYSTEM
* THE BRAIN
* LEARNING, CREATIVITY AND INTELLIGENCE
* ARTIFICIAL INTELLIGENCE
* KNOWLEDGE AND REALITY
* MIND AND BODY
Perception (3 of 5)
Illusions
Perceptions can be wrong, leading to the experience of illusions . Some illusions are due to physiological abnormalities (which may be permanent, but are usually temporary, such as the after-images that result from seeing a bright light that fatigues or adapts retinal receptor cells). Alternatively, an illusion may be due to the coded signals from the senses being 'cognitively' misread, due to the fact that sensory signals are ambiguous. For example, a given retinal image may be of a small near object or a more distant, larger object, and the same image may be given by an object that could have any of an infinite range of possible shapes - al though some options are usually far more likely than others. For perception from sensory data, our very lives depend on guessing, or betting, on what objects are out there.
Perception (4 of 5)
The philosophers of classical Greece, and the British Empiricists of the 18th and 19th centuries - and indeed most philosophers - have sought essential certainty from perception on which to base beliefs on the nature of things. But the data from instruments and the experimental techniques of science have revealed a very different world; appearances from the senses and from the accounts of science can be very different, and even conflicting. Thus the Moon looks the size of an orange, and appears to be quite near; yet we know it to be far larger than anything on Earth and 384 400 km (238 700 mi) away. Knowledge and sensory experience are different perceptions, which we somehow have to reconcile - to link and harmonize how things appear with what we believe them to be. This is a conflict that stimulates art, but it makes science hard to explain to non-scientists.
This appearance/reality conflict makes the study of illusions of vision and the other senses significant for science. The philosophy of knowledge (epistemology) and the phenomena of illusions are important for revealing processes of normal perception, as well as being tools for the artist. Cognitive errors can occur when normally useful rules, or assumptions of various kinds, do not quite apply, or are not adequate for choosing between possibilities. If we think of perceptions as internal descriptions, hypotheses of the external world and of our own bodies, it is interesting to note that the phenomena of visual illusions can be neatly classified into the same kinds of error we find in written or spoken descriptions with words.
A great challenge for computer technology is to design and build machines that can not only recognize patterns (such as printed or written letters, or spoken words) but to perceive in the full sense - to recognize objects from new view-points, and handle unfamiliar or even entirely unknown objects appropriately. We should expect seeing robots to have cognitive illusions similar to ours, but different physiological ones.
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Perception (page 4)
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Distortion: in the diagram above, two line of equal length are made to appear unequal by the addition of the lines at each end, which lead the eye either inward or outward. The tops of the circles below seem to form a curved line, but in fact are aligned in a straight line. The brain is misled because of the strong curve formed by the bottoms of the circles.
* ACOUSTICS
* OPTICS
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE NERVOUS SYSTEM
* THE BRAIN
* LEARNING, CREATIVITY AND INTELLIGENCE
* ARTIFICIAL INTELLIGENCE
* KNOWLEDGE AND REALITY
* MIND AND BODY
Perception (4 of 5)
ILLUSIONS
Optical illusions can be divided into four types - ambiguities, distortions, paradoxes and fictions. Many of these phenomena of perception are not simply physiological in origin; it is far more likely that many are due to cognitive misreading of the available sensory data.
Ambiguities are spontaneous perceptual changes, the result of searching for the best bet when there are two (or more) equally likely kinds of objects out there. Distortions can be caused by errors of physiological signaling, but most are due to misreading size and distance. Errors are made in judging size, distance, shape or curvature. Objects indicated by perspective, or other cues, as being distant are perceptually expanded in pictures. Paradoxes are figures or objects that appear impossible. They are also related to depth perception, as when near and far features happen to line up and touch. Fictions - edges and surfaces that are not actually there but are clearly seen - lead to the assumption of the presence of an object or a surface. The ghostly surface, though seen, is not really there. Indeed, this going beyond the sensory data to see what 'ought' to be there could be the cause of many reported apparitions.
Auditory illusions are also frequently experienced. For example, the Doppler effect is the term used to describe the impression that a horn sounded by an approaching car changes its pitch as it passes by - it sounds higher as it approaches, and drops again as the car retreats into the distance.
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Perception (page 5)
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Fictions: the edges of the white triangle overlapping the circles are not physically present, but are clearly perceived.
* ACOUSTICS
* OPTICS
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE NERVOUS SYSTEM
* THE BRAIN
* LEARNING, CREATIVITY AND INTELLIGENCE
* ARTIFICIAL INTELLIGENCE
* KNOWLEDGE AND REALITY
* MIND AND BODY
Perception (5 of 5)
Tactile illusions may occur, as, for instance, in the case of the sensations of heat and cold. The skin has different receptors that respond to one or other of these sensations, but not to both; a heat stimulus to a specific small area may therefore produce a sensation of cold. Abrupt changes in temperature may also result in confusion. If one hand is put in hot water and the other in cold, they will after a time adjust to these temperatures; if they are then placed in lukewarm water, the hot hand will feel cold and the cold one will feel warm.
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The Power of Speech (page 1)
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A computer graphics image of the amplitude waveform of the word 'baby', produced on a speech synthesizer.
* ACOUSTICS
* THE RESPIRATORY SYSTEM
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
* BODY LANGUAGE
* LEARNING, CREATIVITY AND INTELLIGENCE
* HOW LANGUAGE WORKS
The Power of Speech (1 of 5)
Speech is the formation of sounds in a meaningful sequence. It depends on the ability of the speaker to reproduce phonemes - vocal 'units' - and to use acquired language. Correct phonation - the articulation of speech - in turn involves the coordination of complex neurological, anatomical and physiological apparatuses. Language distinguishes speech from mere utterance. A one-year-old baby may babble using a wide repertoire of sounds, and may show good comprehension of spoken language. Babies only become lingual, however, when they pronounce, for the first time, a word that has the same meaning for them as for the listener. This single spoken word raises a baby's use of language to the level of communication.
The ability to give form to ideas, to share emotions and to express one's personality imparts to speech a dimension far beyond the mere vocalization of language. The two-way aural/oral process (hearing and producing sound) begins shortly after birth, when a newborn baby already exchanges sounds with its mother and connections begin to develop in the infant brain, linking auditory stimulus and spoken response.
This experience is lacking in babies who are born deaf. If the speech reception center in the brain is not stimulated from early on, devices such as the cochlear implant (which restores hearing) can never be used, because their brain cannot make sense of sound.
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The Power of Speech (page 2)
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* ACOUSTICS
* THE RESPIRATORY SYSTEM
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
* BODY LANGUAGE
* LEARNING, CREATIVITY AND INTELLIGENCE
* HOW LANGUAGE WORKS
The Power of Speech (2 of 5)
The production of speech
Newborn babies display a willingness to communicate. But, even apart from their neurological immaturity, their bodies are not ready to speak: the shapes of the skull and of the oral cavity make phonation impossible.
Vocal production makes use of three 'systems': the phonatory system, including the larynx (voice-box) and its accompanying structures; the respiratory system, including the airways, muscles and nerves that support breathing; and the resonatory system, which is made up of the structures of the skull and the oral and nasal cavities and affects the acoustics of speech.
Voice is produced when air passes through the larynx, a cartilagenous structure positioned in the trachea. Two ligaments - the vocal cords - are attached front and back to bridge the airway. During normal breathing these remain wide apart. If necessary they can be brought together to close off the airway and protect the lungs from an inhaled foreign object. This movement has been adapted for speech. As the cords are brought together, air passing between them under pressure causes them to vibrate. The larynx is served by a rich nerve supply and 17 sets of muscles. All of these control vocal-cord and laryngeal movement to allow the wide repertoire of sounds possessed by the human voice. Each person's voice has a natural frequency, but changes in cord length, tension and mass can alter pitch, volume, intonation and intensity of sound. The respiratory system - lungs, diaphragm and muscles attached to the ribs - draws air in and expels it from the lungs. Prolonged phonation uses a continuous column of air coming from the lungs under steady pressure. Breathing for speech requires fine control of exhalation. Without this control, the speaker would only be able to sigh or utter a few sounds before running out of breath. Too much pressure results in distorted sound, and can damage the delicate vocal cords.
The resonatory system, or vocal tract, is made up of all the other structures that modulate the quality of the voice - its richness, depth and pronunciation of vowels and consonants. The vocal tract comprises the throat, the nose and mouth, the soft palate and the sinuses (hollow spaces in the skull). All the sounds used in speech are created by changing the position of the tongue, lips, soft palate and lower jaw. Changes in the shape and size of the throat and mouth affect the acoustic properties of the voice. Without these features, the most impassioned speech would be reduced to a monotonous drone.
Neurological input
The verbal expression of language brings into play sophisticated neurological pathways. In adults, the language center is usually situated in the left hemisphere of the brain. It comprises areas that perceive language (written and spoken), comprehend it, formulate expression and translate it into coherent speech.
The idea or structure of a phrase arises in one of these areas, Wernicke's area, and reaches another area, Broca's area, via association fibers. From here a 'program' of instructions for vocalization passes to the motor cortex. The phonatory system is served by four cranial nerves, while the resonatory system is served by five.
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The Power of Speech (page 3)
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* ACOUSTICS
* THE RESPIRATORY SYSTEM
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
* BODY LANGUAGE
* LEARNING, CREATIVITY AND INTELLIGENCE
* HOW LANGUAGE WORKS
The Power of Speech (3 of 5)
Speech development
The human infant is, in the most literal sense, a pre-lingual creature: infans in Latin means unable to speak. Speech begins when the necessary neurological pathways are established and the necessary skeletal changes take place. Early articulation of sounds encompasses a much wider range than will be needed for the mother tongue - for example, babies go through a phase of experimenting with blowing raspberries. Gradually, phonetic contraction reduces the phonemes that a baby can distinguish or make. A Japanese baby soon loses the ability to tell the difference between 'l' and 'r' sounds. At the same time, variations in pitch, tone of voice and emphasis develop so that the babbling sounds remarkably like speech.
Despite limitations in their ability to articulate, babies can certainly discriminate between sounds. This was pointed out by a researcher at Harvard, who echoed a young child's pronunciation of 'fis' - and was corrected repeatedly by the child until the researcher finally said, 'fish', the word the child knew she was saying.
Children who are brought up in a multilingual home retain the phonemes found in each of the native languages they have heard from birth. Similarly, those who learn a second language at an early age very easily learn to reproduce the different sounds.
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The Power of Speech (page 4)
ftsTitle
The areas of the cerebral cortex concerned with language.
* ACOUSTICS
* THE RESPIRATORY SYSTEM
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
* BODY LANGUAGE
* LEARNING, CREATIVITY AND INTELLIGENCE
* HOW LANGUAGE WORKS
The Power of Speech (4 of 5)
Aphasia
When the inability to use speech arises in the brain the condition is known as aphasia. Even slight damage to the language centers has grave consequences. Damage in Wernicke's area leaves sufferers with the ability to articulate sounds fluently, but deprived of language comprehension. They can neither make sense of the words of others nor give meaning to their own words.
When a stroke or hemorrhage damages Broca's area, language comprehension is unaffected. Instead, the victim is left with expressive aphasia, and is unable to transform language into speech or writing, because the program that instructs the three vocal systems is no longer sent to the motor cortex. It is very difficult to assess the language competence of someone with expressive aphasia because communication is, in effect, cut off. Global aphasia is the term used for the destruction of the entire language center. It leaves its victim bereft of comprehension and expression. Damage to the pathway between Broca's area and the motor cortex, or to the motor cortex itself, prevents the necessary stimuli from reaching the vocal apparatus. Speech malfunction occurs, likewise, whenever any of the nerves forming the connections between the brain and the organs of speech are injured or severed.
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The Power of Speech (page 5)
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A 'Token and Reporter' test is used to evaluate a subject's receptive and expressive language. The test can be used to screen for aphasia, a disorder of language affecting the generation of speech and its understanding, rather than a disorder of articulation. Aphasia is caused by organic brain disease in the dominant left brain hemisphere in a right-handed person, and of the dominant right brain hemisphere in a left-handed person.
* ACOUSTICS
* THE RESPIRATORY SYSTEM
* TOUCH, TASTE AND SMELL
* SEEING AND HEARING
* THE BRAIN
* BODY LANGUAGE
* LEARNING, CREATIVITY AND INTELLIGENCE
* HOW LANGUAGE WORKS
The Power of Speech (5 of 5)
Vocal therapy
The absence, or loss, of coherent speech is extremely distressing. The sufferer is deprived of the principal means of communication. The deficit can occur at any level, from the brain to the speech apparatuses. The cause may be congenital - as in the case of cleft palate - or acquired as a consequence of disease (for instance, in multiple sclerosis or Parkinson's disease). The vocal cords may be damaged by infection or through over-use. Articulation and resonation also deteriorate in the person who becomes deaf.
Speech therapists are professionals who are trained to diagnose and assess a person's voice. They evaluate all the systems involved in sound production, and decide on appropriate treatment. In many cases, a program of exercises will improve the voice. Treatment may also require medical or surgical intervention. The child with cleft palate will have the defect closed; polyps on the vocal cords may be removed; drugs are given to relieve tremor in Parkinson's disease.
Although the deaf cannot hear their own voice, they can see it with the aid of monitors, which translate sound into visual signals. By using this feedback technique and appropriate exercises, they can retain good speech.
Surgical removal of the larynx means permanent loss of the natural voice. As something must be able to vibrate in order to create sound, an alternative to the vocal cords is needed. This can be provided by an artificial larynx, or the patient can learn oesophageal speech. Whichever means of vocalization is used, patients must relearn how to articulate individual sounds.
Post-operatively, about 60% of people who have their larynxes removed eventually learn esophageal speech. This is achieved by filling the oesophagus with air, then releasing it under controlled pressure to produce vibrations at the pharyngo-esophageal segment, the place where the gullet leads off from the throat. Fluent esophageal speech depends on the continuous intake and expulsion of air. While the voice is fairly low in pitch and husky, it is possible to speak at a rate of more than 100 words a minute.
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Body Language (page 1)
ftsTitle
BATON SIGNALS
Some gestures are like words - they have specific meanings, and most of them are fairly rude. There is, however, another kind of gesture called a 'baton signal', which has a different function. Baton signals are those typical movements of the hands and arms that accompany speech. People 'beat time' as they speak. Being able to use these movements appropriately is important because they do two things - they put emphasis on certain things that are being said, and they maintain the rhythm of the conversation. Experienced politicians speaking on television or addressing meetings are adept at using these gestures, keeping the attention of the audience, stressing the important issues and highlighting the promises they want us to believe.
1. Holding the hand with the thumb and forefinger lightly touching shows that the speaker is striving to express him or herself with great precision.
2. Making a grasping motion in the air indicates that the speaker is attempting to gain control of the situation.
3. Chopping downwards, with the hand straight and rigid, is typical of an aggressive speaker feeling the need to cut through a problem.
4. Jabbing the fingers towards the listener is an aggressive gesture with the aggression directed at the listener.
5. The raised forefinger is an authoritative gesture and can also appear threatening - the finger is a symbolic weapon ready to deliver a blow.
6. Holding out both hands with the palms up is reminiscent of a beggar's gesture: the speaker is begging the listener to agree.
7. Extending the hands with the palms downwards is a restraining gesture, used when the speaker wants to calm down the listener.
8. Holding the hands up with palms facing outwards makes the speaker appear to push away the listener or something another speaker has said.
* ANIMAL COMMUNICATION
* THE POWER OF SPEECH
* WRITING SYSTEMS
* HOW LANGUAGE WORKS
* THE LANGUAGE OF SIGNS
Body Language (1 of 2)
Even in the most casual of conversations, extra messages are communicated by various parts of the body. It is often these signals, rather than the words themselves, that are the more influential - they convey what the speaker truly feels. 'Body language' is the popular term for non-verbal communication - it refers to all those signals that are not transmitted through the verbal channel. >>Deliberate gestures - for example, a shrug of the shoulders, a raised eyebrow or a movement of the hand - can often transmit a message more clearly, and with greater economy, than a lengthy spoken phrase. Unconscious messages are also constantly being transmitted, for in-stance in the way a person sits or stands, or the position of their hands or feet.
Facial expressions
Facial expressions are, perhaps, the most obvious of all non-verbal channels of communication. It is possible that some expressions are innate - they are reactions we possess from birth, rather than something we have to learn. Facial expressions of emotions such as happiness, sadness, fear or anger are basically the same all over the world. Even people who are born blind, and never have the chance to see other people's expressions, grow up using the same emotional signals as people with sight.
Cultural differences
Other elements of body language are learned through imitating others, and may vary from culture to culture. For instance, in the West nodding the head up and down indicates an affirmative answer and shaking the head from side to side means a negative one; in some countries, such as India, the meanings of these gestures are reversed.
The eyes
It has often been claimed that the eyes are a kind of window on the soul - they reveal our innermost feelings. Eye signals, while communicating basic feelings and emotions, are also very important in ordinary, everyday conversation. In a conversation between two people, one speaker will gaze at the other when starting to speak, then look away, then look back at the other person to check the response to what has been said. Similar signals are used during a conversation between a group of people. By holding the gaze of the person who is speaking, we can indicate that we want to speak ourselves. When we want to give someone else the chance to speak, we look up, meet their eyes and in doing so invite them to take over - avoiding lengthy, often embarrassing silences and ensuring that not everybody tries to talk at once.
During friendly encounters, eye contact is held slightly longer than it is in neutral ones. People sexually attracted to each other may gaze at each other for long periods - in this situation the pupils will be dilated. People who dislike one another may also engage in prolonged mutual staring, but in this case the pupils will be constricted. The length of time one person can comfortably gaze at another during conversation also varies from culture to culture - the Japanese keep eye contact to a minimum, while in southern European countries a much longer gaze is permissible.
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Body Language (page 2)
ftsTitle
BARRIER GESTURES
Hiding behind a barrier is symbolized by crossing one or both arms across the chest.
The standard arm cross signifies a negative or defensive state of mind - it is commonly seen in situations where people feel insecure. It can also indicate that a listener disagrees with what is being said.
If the arms are crossed and fists are clenched, the attitude is more strongly defensive and negative.
A partial barrier can be formed by folding one arm over the body to grasp the other arm - this often signifies a lack of self-confidence.
* ANIMAL COMMUNICATION
* THE POWER OF SPEECH
* WRITING SYSTEMS
* HOW LANGUAGE WORKS
* THE LANGUAGE OF SIGNS
Body Language (2 of 2)
Posture
Close friends adopt open postures with the arms away from the body and the general direction of movement towards the other person. They will usually assume very similar positions, perhaps crossing their legs in the same way or leaning forward at the same angle. When one moves, the other may echo the movement.
People who have their arms tightly folded across their chests and their feet and legs pointing away from the other person are clearly not getting on very well. One posture to avoid is the 'oblique' posture. This occurs when one person's body is slanted away from the other person's by about 45 degrees so that they talk to them across their shoulder - this gives a very aloof and unfriendly impression.
Personal space
Humans are territorial - they need to have a territory that is 'theirs'. Similarly, people tend to carry with them their own 'personal space' - an invisible area around them into which other people do not intrude. If others enter this space uninvited, we feel threatened. In a crowd, personal space inevitably shrinks and we allow people to move closer to us than we otherwise would. In a very crowded situation, as on a train in the rush hour, personal space cannot exist at all and bodily contact is inescapable. People usually cope with this by ignoring others completely and avoiding eye contact.
The distance between two people is a good indicator of the relationship between them - in general, people who like each other sit and stand closer together than those who dislike each other. However, different cultures have different concepts of personal space. In southern European or Arab countries, for example, a fairly close distance between two people is acceptable, whereas in northern Europe people tend to stand further apart. This can result in tension during a conversation between two people of different cultures - one person may feel threatened if their personal space is invaded, or the other may feel rejected if their companion stands too great a distance away.
Touch
Touch is a very basic form of body language and varies from country to country. In Mediterranean countries, for example, people touch each other, even in casual conversations, much more frequently than British people do. Even in northern France, teenagers greet each other with kisses on the cheek and touches on the arms and shoulders. Touching, if done appropriately, can be a way of establishing friendly relations with people of both the same and opposite sex, which is why the formal handshake is used as a basic method of greeting strangers. Perhaps surprisingly, psychological research shows that it is girls and women who respond most positively to social touching, so long as it is not seen as an unwelcome sexual advance or a patronizing 'put-down'.
These different types of body language do not, of course, occur in isolation. Gestures, facial expressions, eye movements and changes in posture all occur at the same time and combine to increase the power of the messages that they convey. Basic social skills - the ability to get on with other people and to establish relationships - develop as people begin to 'translate' the body language of others and learn to present themselves in a way which is seen as friendly, open and inviting.
BATON SIGNALS
Some gestures are like words - they have specific meanings, and most of them are fairly rude. There is, however, another kind of gesture called a 'baton signal', which has a different function. Baton signals are those typical movements of the hands and arms that accompany speech. People 'beat time' as they speak. Being able to use these movements appropriately is important because they do two things - they put emphasis on certain things that are being said, and they maintain the rhythm of the conversation. Experienced politicians speaking on television or addressing meetings are adept at using these gestures, keeping the attention of the audience, stressing the important issues and highlighting the promises they want us to believe.
Holding the hand with the thumb and forefinger lightly touching shows that the speaker is striving to express him or herself with great precision.
Making a grasping motion in the air indicates that the speaker is attempting to gain control of the situation.
Chopping downwards, with the hand straight and rigid, is typical of an aggressive speaker feeling the need to cut through a problem.
Jabbing the fingers towards the listener is an aggressive gesture with the aggression directed at the listener.
The raised forefinger is an authoritative gesture and can also appear threatening - the finger is a symbolic weapon ready to deliver a blow.
Holding out both hands with the palms up is reminiscent of a beggar's gesture: the speaker is begging the listener to agree.
Extending the hands with the palms downwards is a restraining gesture, used when the speaker wants to calm down the listener.
Holding the hands up with palms facing outwards makes the speaker appear to push away the listener or something another speaker has said.
PUPIL SIGNALS
The pupil alters its size according to the amount of light available. However, it also changes according to our moods, and can thus transmit strong emotional messages. When we are looking at something pleasing, particularly a person of the opposite sex, the pupil will often expand considerably. An angry, negative mood will cause the pupil to contract. Dilated pupils therefore have the effect of making the face more attractive. Shown two pictures of a face - one with dilated pupils and one with constricted pupils, but identical in every other way - and asked to choose which they prefer, people will choose the face with dilated pupils without being aware of the reason for their choice.
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Learning, Creativity and Intelligence (page 1)
ftsTitle
The above diagram illustrates an experiment in which people are shown on a screen a series of pictures, of which half are cars and half are other objects, and a series of words, of which half are 'car' and the remainder other words. They are asked to focus on a fixation point in the middle of their field of view. The images are flashed onto the screen at random, in either the right or left field of vision, very briefly so that there is no time to change fixation.
* GENETICS AND INHERITANCE
* THE BRAIN
* PERCEPTION
* THE POWER OF SPEECH
* EDUCATION
* HOW LANGUAGE WORKS
Learning, Creativity and Intelligence (1 of 3)
Learning, creativity and intelligence are all concerned with the acquisition and use of knowledge. Philosophers have argued about the nature of knowledge, and how we come by it, for thousands of years. Some have claimed that knowledge is acquired through experience and others that we have inborn ideas about the world. Psychologists have now begun to answer more modest - but solvable - questions. Why is it that some people seem to learn faster than others? Are differences between people due to genetic or environmental influences? What factors make someone creative? >>If the kinds of thinking involved in different subjects or knowledge domains - for example, how we solve problems in mathematics or how we remember events in history - are analyzed we find that they are found to be specific to that domain. A child's understanding of the world seems to be very different from that of an adult: for example, a child might think that the wind is made by trees moving. Such observations led to the idea that intelligence is simply a random collection of independent pieces of knowledge and thinking skills. Yet there are striking regularities in the data that suggest that intelligence and knowledge are not the same thing.
Intelligence
Our ability to think and reason improves as we become older, and this improvement follows the same pattern for all abilities. The major improvements take place in early childhood and end by the late teens.
Everyone has differences between their abilities - some, for instance, do better at science than art, others do better at history than geography. However, when individuals of the same age are compared, someone who is relatively good at one kind of thinking will also tend to be good at others. In other words intelligence is general.
Despite the obvious and large changes in our knowledge over the years, IQ (intelligence quotient) is relatively stable throughout life. So what is it that gives rise to these regularities? One explanation is that although different subjects require different kinds of thinking and reasoning skills, all thought processes are influenced by the biological properties of the brain.
Alternatively, it could be that general intelligence is a result of our environment rather than a property of our brains. In other words, it may be that the environmental circumstances of some individuals provide better learning opportunities.
Nature versus nurture
The study of twins has been the most common method for estimating the relevance of genetic factors to intelligence. Monozygotic (identical) twins have the same genetic constitution (genotype), whereas dizygotic (non-identical) twins have only 50% of their genotype in common (i.e. no more than any two offspring of the same biological parents). The extent to which identical twins are similar in intelligence compared to the extent of similarity in non-identical twins gives us an estimate of the degree to which intelligence is inherited. If identical twins were no more similar than non-identical twins then we could conclude that there is no genetic contribution to intelligence. Because twins have more than their genotype in common - they often have similar environments for example - studies concentrate on twins reared apart.
Identical twins reared apart are more similar in intelligence than non-identical twins reared apart, and so there is little doubt that there is some genetic contribution to intelligence. The best estimate is that at least 50% of the total variance in intelligence in our population is due to inherited differences. Of course, this leaves at least 50% that could be environmental in origin. Heritability estimates apply to populations and tell us that on average genes contribute half of the variation in intelligence. However, we cannot say that half of any particular individual's intelligence is due to genes and half to environment. Either the environmental circumstances or the genetic history of an individual, if extreme enough, could totally determine the level of intelligence.
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Learning, Creativity and Intelligence (page 2)
ftsTitle
A drawing by an idiot savant - a person who, although possessing very low intelligence and limited communicative ability, has one outstanding talent.
* GENETICS AND INHERITANCE
* THE BRAIN
* PERCEPTION
* THE POWER OF SPEECH
* EDUCATION
* HOW LANGUAGE WORKS
Learning, Creativity and Intelligence (2 of 3)
Learnability
It is also interesting that some things that have proved impossible for computers to learn seem remarkably simple for all human beings, irrespective of the level of general thinking ability. For example, there is no computer that has fully mastered the ability to understand human language (as opposed to specially designed computer languages), and yet almost all human beings can do so. Similarly, the process of constructing our perception of the visual world from a retinal image - the image projected onto the light receptors in our eyes - is beyond the capability of any computer but is within the mastery of the human infant.This suggests that evolution has furnished us with specialized brain structures that are unrelated to our ability to think. Occasionally such structures may go wrong, producing people with anomalous abilities.
Specific learning disorders
Undoubtedly some individuals perform less well than we would expect from their level of general intelligence. For example, dyslexic children usually have great difficulty with reading, writing and spelling and yet are of normal intelligence - a complex brain process usually involved in the analysis of words may not be working. There are also cases in which a brain structure is spared the consequences of general brain damage and a spectacular anomalous ability occurs, where some individuals of very low measured intelligence display a single isolated - sometimes remarkable - ability. These abilities range from knowledge of numbers and number systems (for example, being able to say almost immediately what day of the week it was or will be on any given date) to musical and artistic abilities. Some of these individuals appear so talented that they have been used as evidence that creativity is independent of intelligence.
What is creativity?
Creativity is usually thought of as de pending on some special talent that some people are born with. It has been suggested that creativity depends on properties of the right, as opposed to the left, cerebral hemisphere.
While it is true that the two hemispheres seem to be specialized for different kinds of thinking, there is no evidence to suggest that one or the other is specialized for any creative abilities. If we analyze the life history of creative individuals there are few, if any, that would be regarded as generally unintelligent.
It is also clear that many factors such as personality, motivation, parental involvement and practice contribute to an individual's creativity. In addition, be cause much of creativity, particularly in art, may be in the eye of the beholder, many social factors determine whether someone will be called creative or not. Perhaps here, more than in any area related to human intelligence, we see the limitations of analyzing the brain independently of the environment in which it develops.
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Learning, Creativity and Intelligence (page 3)
ftsTitle
A non-verbal reasoning test: choose which of the six boxes completes the pattern. This is a simple example, reduced in size, taken from a series of tests designed for older children and adults; the tests become progressively harder.
* GENETICS AND INHERITANCE
* THE BRAIN
* PERCEPTION
* THE POWER OF SPEECH
* EDUCATION
* HOW LANGUAGE WORKS
Learning, Creativity and Intelligence (3 of 3)
MEASURING HEMISPHERIC DIFFERENCES
When the eyes focus on a spot (fixation point) in the middle of the field of view, everything to the right of that spot (right visual field) will be projected on to the left cerebral hemisphere and everything to the left (left visual field) will be projected to the right cerebral hemisphere. Since both eyes receive information from both visual fields this means that half of the fibers from each eye must cross over on their way to the projection centers of the brain. They do this at the optic chiasma.
Scientists can take advantage of this anatomical feature of the visual system to test the specialization of the cerebral hemispheres by varying the kind of information that is presented in each visual field. Although the cerebral hemispheres communicate with each other by sending messages through the cerebral commissures (the bundle of nerve fibers that connects the two halves of the brain), we know that information in one visual field will be received first in the opposite cerebral hemisphere. Presenting the information in each visual field for a shorter time than it takes to change fixation (about one fifth of a second) ensures that it is only being projected onto the one hemisphere. Any systematic differences in the kinds of information that are processed in each hemisphere can be seen.
If people are asked to make decisions about pictures or about words (for example, are they the same or different?) we find that performance is faster and more accurate for pictures if they are presented in the left visual field (right hemisphere) and for words if they are presented in the right visual field (left hemisphere). This has led scientists to suppose that the right hemisphere is more specialized for visual imagery and the left for verbal processing. Some believe that the difference is more general than this, with the right hemisphere dealing with more intuitive forms of reasoning and the left with more analytical and sequential thinking.
The above diagram illustrates an experiment in which people are shown on a screen a series of pictures, of which half are cars and half are other objects, and a series of words, of which half are 'car' and the remainder other words. They are asked to focus on a fixation point in the middle of their field of view. The images are flashed onto the screen at random, in either the right or left field of vision, very briefly so that there is no time to change fixation. They are asked to press a red button if they see a picture of a car or the word car, and an orange button if they see other words or objects. It is found that when a picture is presented to the left field of vision the response is faster than when it is presented to the right; when a word is presented to the right field of vision the response is faster than when it is presented to the left.
INTELLIGENCE TESTS
Intelligence tests - which were first invented in 1904 by the French psychologist Alfred Binet (1857-1911) - come in many forms. Some test factual knowledge or vocabulary. Other tests include arranging blocks into shapes, quickly substituting geometric symbols for digits, performing calculations and keeping as many numbers as possible in the memory.
Constructing an intelligence test is highly technical. Items are arranged in order of difficulty (an item should not be so easy that everybody gets it right or so hard that everybody gets it wrong) and are given to a representative cross-section of the population. This cross-section provides the sample on which the test's norms are calculated. On the basis of these norms - for example the average score for 12-year-olds - such statistics as mental age or IQ (intelligence quotient) can be calculated from an individual's test score. Mental age is the age for which that test score would be average. Thus a child has a mental age of 7 if its score is typical of a 7-year-old.
IQ is an indication of how the test score compares with that of other children of the same age. An IQ of 100 would mean that the test score was the average score for the child's age group. An IQ greater than 100 indicates that a child has performed better than average for its age. In any age group, 66% will have an IQ between 85 and 115. An IQ less than 70 usually indicates that a child has learning difficulties.
An intelligence test is a sophisticated instrument, and like any instrument the measurements are meaningless if they are not used in the proper way. So, for example, while it is true that someone can improve their score on any intelligence test by practicing at the test, it does not mean that they become more intelligent.
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Sleep and Dreams (page 1)
ftsTitle
Sleep patterns of patients suffering from insomnia are monitored in a laboratory. Probes are attached to the head to measure brain activity while "sleeping".
* THE NERVOUS SYSTEM
* THE BRAIN
* DRUG ABUSE
Sleep and Dreams (1 of 4)
Sleep and wakefulness come and go as a biological rhythm, wakefulness being a time for achievement and sleep for renewal. Sleep is necessary and without it alertness and effort become impaired. Dreams can occur at any time in sleep but the phase known as REM (rapid eye movement) sleep is richest in dreaming. Sleep is less refreshing when there are worries and responsibilities, and it becomes more broken in middle and later life.
Sleep is a time when the brain imposes rest upon itself and the body. Throughout the animal kingdom wakefulness and sleep alternate: the Earth rotates every 24 hours and humans, like all creatures, have through evolution incorporated a 24-hour activity-rest cycle into their genetic material.
This daily rhythm will more forcefully be brought to our attention if, for example, we fly to Tokyo. We then suffer jet lag, which means that for the first few days we are sleepy and inefficient when local people are awake, but lie awake in bed while they sleep.
Why do we fall asleep?
Chiefly we fall asleep when the powerful sleep-wakefulness rhythm forces us to be sleepy, though we also fall asleep more easily if we are short of recent hours of sleep, immobile, warm or bored. Wakefulness and attention are maintained by change; a constant environment makes us drowsy.
If the body is deprived of sleep, then more and deeper sleep is taken later as compensation. Body tissues are at all times being broken down and renewed, but there is relatively greater breakdown when we are awake, and greater renewal during sleep. If people have been kept unnaturally awake, they can by special effort briefly perform what may be required of them, but they progressively lose the ability to sustain that effort, make more and more mistakes, and finally drop off to sleep regardless of surroundings. After sleep, the brain's powers are restored.
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Sleep and Dreams (page 2)
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* THE NERVOUS SYSTEM
* THE BRAIN
* DRUG ABUSE
Sleep and Dreams (2 of 4)
What happens in sleep?
As we fall asleep the body becomes inert and the flow of saliva decreases so we do not drown. Heart rate, oxygen consumption, breathing and temperature all diminish, and the electrical brain waves (measured by a machine called an electroencephalogram) take on changed appearances. Whereas in wakefulness the levels of the stimulant hormone adrenaline in the blood are high and help achievement regardless of cost, in sleep those levels are low and the body-building hormone, somatotrophin, reaches a sustained peak.
In the brain, memory traces of the day are strengthened, but durable new traces are not laid down: dreams are quickly forgotten, and you cannot learn a new language from tape recordings played through the night.
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Sleep and Dreams (page 3)
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Sigmund Freud
* THE NERVOUS SYSTEM
* THE BRAIN
* DRUG ABUSE
Sleep and Dreams (3 of 4)
Dreaming
In dreams we are not passive observers of pictures. People blind from birth do not see in dreams, but like all of us they live in a fantasy world whilst asleep. Throughout history it has been believed that dreams foretell the future and that they contain symbols. In the early 20th century there was a flowering of interest in dreams through the writings of Sigmund Freud and Carl Gustav Jung, who hoped that by understanding symbols in dreams it would be possible to help people with psychological difficulties. Their writings greatly influenced the imagery of creative artists such as the Surrealists, but their hopes have not been realized, and modern psychiatrists usually rely upon the reality of people's waking feelings, relationships and behavior to achieve understanding.
In the 1950s interest in dreaming revived, thanks to research into sleep. Everybody experiences two states of sleep, which alternate four or five times a night. Rapid eye movement (REM) sleep occupies about 20% of the time, and if sleepers are deliberately awakened from REM sleep they are especially likely to describe a dream.
In REM sleep, periods of which last 5-30 minutes, there are intermittent flurries of jerky eye movements accompanied by finger, toe and facial twitchings, erection of the penis or increased vaginal blood flow, and general bodily paralysis. We need both REM and non-REM sleep, and catch up on either if selectively deprived. Although awakenings from REM sleep yield the richest harvest of dreams, mental life goes on all night: dreams are very common when we are merely drowsy at the start of the night, and the most vivid of all dreams, night terrors, occur in non-REM sleep. REM sleep itself is in fact most prominent in infancy (and before birth) when memories and knowledge for the creation of dreams are not available.
When people are awakened from their sleep and their dream reports tape-recorded, most dreams are found to be quite dull and to do with everyday events. Just occasionally there are bizarre or erotic developments that tend to be remembered in the morning. Outside noises may get woven into the dream: for example, in one experiment the name 'Robert' repeatedly spoken to the sleeper led to a dream of 'a rabbit and it looked distorted', while 'Gillian' (the name of an ex-girlfriend) produced a dream of 'an old woman who came from Chile' (a Chilean).
Sleep troubles
The amount of sleep needed varies greatly from individual to individual. Most babies sleep 14-16 hours per 24, most adults 7 or 8. Young adults usually sleep heavily, but, as the years pass, sleep becomes more broken and is increasingly felt to be lighter, so that by their fifties about 25% of all women and 15% of men feel dissatisfied with the quality of their sleep. Their rest is also more easily disturbed by noises or caffeine-containing drinks.
At any age, worry or depression will impair sleep. Since long before Shakespeare's 'drowsy syrups', drugs, including alcohol, have been taken to try to improve sleep. Today's sleeping drugs are safer, give satisfying sleep if used for a short time, and are used mainly by older people. However, over-dependency is a danger and it is wise to use them only occasionally.
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Sleep and Dreams (page 4)
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An image of a nightmare based on a painting by Henry Fuseli called The Nightmare. Night terrors are largely confined to childhood, but in rare cases adults may continue to experience them. These terrors bring on sudden attack of severe anxiety, racing pulse and respiration, and the person may wake up screaming.
* THE NERVOUS SYSTEM
* THE BRAIN
* DRUG ABUSE
Sleep and Dreams (4 of 4)
FREUD, JUNG AND THE UNCONSCIOUS
Many bodily functions are controlled by a part of the nervous system over which we have very limited conscious control. Similarly, much of our mental life is directed by unconscious processes within the central nervous system; a thought suddenly comes into our heads and we have no idea where it came from. The concept of the unconscious was central to the theories of the Austrian neurologist Sigmund Freud (1856-1939) and to those of the Swiss psychiatrist Carl Gustav Jung (1875-1961).
According to Freud and Jung, dreams are the most obvious manifestation of the unconscious, which they conceived of as a vast repository of hidden instincts, memories, ideas and emotions that exists in all of us. They believed that one key to the knowledge of our conscious behavior lay in the unconscious. Freud thought that unpleasant experiences or guilt-provoking desires were repressed, or banished from the conscious mind, but gave rise to such symptoms as anxiety, depression, phobias and 'hysterical' paralysis. Both Freud and Jung hoped to prove that many psychiatric illnesses could be treated successfully by psychoanalysis. Psychoanalysis aims to enable the analyst and the patient to gain access to the unconscious mind through discussion, free association - in which the patient says whatever comes into his or her mind - and dream analysis. Through this method the patient remembers the experience and the emotions associated with it, and is cured.
Freud grew to believe that the experiences, wishes or emotions that were repressed were often sexual and could be traced back to early childhood. He believed that these repressed impulses affected our thoughts and actions, and that dreams are disguised fulfilments of repressed, usually sexual, wishes, with disturbing ideas represented by symbols. Patients could be cured of their symptoms by a successful interpretation of their dreams, their slips of the tongue and of their neurotic behavior itself.
Freud identified five stages in sexual development. The oral stage lasts for the first year of life when the child's pleasure is focused on feeding. The anal stage lasts from the ages of 1 to 3 when the child is learning to control its bowels. The phallic stage, with the penis or clitoris as the center of attention, follows at the age of 3 or 4. There is then a latency period during which sexual impulses are 'sublimated' into other pursuits - social, intellectual, athletic. Finally, the mature genital stage is entered at puberty.
In addition to these stages Freud put forward the concept of the Oedipus complex, a perfectly normal phase through which all male children passed at the age of 4 or 5. During this phase the boy becomes sexually attracted to his mother and wants her totally for himself, so developing aggressive feelings towards his father. These feelings lead to the fear that his father will retaliate by castrating him. The theory takes its name from the Greek myth of Oedipus who, abandoned at birth by his parents, later marries his mother and kills his father.
Freud thought that the mind was divided into three parts - the id, concerned with basic, inherited instincts, the ego, concerned with the tasks of reality and the sense of self within the world, and the superego, a kind of conscience that represents ideals and values derived from parents and society, and that controls the impulses of the id and ego.
According to Jung, dreams are communications from the unconscious but are not necessarily concerned with wishes. Jung divided the unconscious life into two parts - the personal and the collective. The personal unconscious consists of contents that have been forgotten or repressed, while the collective unconscious is an inherited pattern of memories, instincts and experiences common to everyone. He formed his theory of the collective unconscious when he noticed that delusions and hallucinations in different patients seemed to contain similar themes, and often could not be explained as products of the patients' own experiences.
Jung also developed the idea of dividing people into extroverts, or outward-looking personalities, and introverts, or inward-looking personalities - although he recognized that most people combine aspects of both types.
Few of the theories of Freud and Jung are now seen as being capable of scientific testing. However, they had a profound effect on the way we look at the human mind and opened the way for modern psychiatry and psychotherapy.
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Mental Disorders (page 1)
ftsTitle
Bethlehem Royal Hospital in London was infamous for its cruel treatment of mentally ill patients. In the 18th century a tour round the hospital - known as Bedlam - was a popular entertainment.
* THE BRAIN
* SLEEP AND DREAMS
* DRUG ABUSE
* DEVIANCE, CRIME AND LAW ENFORCEMENT
Mental Disorders (1 of 2)
Throughout history people have explained mental disorders in ways that have suited their particular culture and society. In some societies people with mental disorders were regarded as being possessed by devils and were tortured to drive them out, while in others, such people were thought to be divinely inspired. In the case of some artistic geniuses - such as Vincent van Gogh - there appears to have been a link between mental illness and creativity.
In general, however, the mentally ill were badly treated - even King George III of Britain was tied up and beaten. In the 19th century large asylums were built for the mentally ill as places of safety, although these too have been the sites of some appalling treatment. Not until recently, with the introduction of powerful drugs and new psychological theories, has medicine had the means of effectively treating mental illness.
Classification
Mental distress is often treated in the first instance by the general practitioner, who may decide to refer the patient to a psychiatrist for an expert opinion. Mental disorders can be broadly divided into psychosis, neurosis, organic and other disorders.
Psychosis is perhaps what most people think of when they talk of madness. It means being out of touch with reality, and is characterized by frequently bizarre behavior in a seemingly normal setting. The mental symptoms are of a severe disturbance of beliefs and perceptions - the psychotic person may have delusions (false beliefs) and hallucinations (seeing things that are not there, or hearing imaginary voices). Psychotic people are often not aware - at least during severe episodes - that they are ill. The two psychotic disorders are schizophrenia and affective illness.
Schizophrenia can affect every aspect of a person's mind and personality. One of the most distressing symptoms is the belief that one's thoughts are not one's own, and even that one's physical actions are initiated by someone else. The term schizophrenia ('split mind') was first used in 1911 to describe this splitting of mental functions.
Affective or mood disorder can take two forms: mania and depression. Mania is characterized by excessive cheerfulness, over active behavior and impaired judgement. Depression is classified as psychotic when beliefs and perceptions are distorted.
A neurosis is a psychological illness that causes distress but is understandable in terms of more normal mental processes. In anxiety neurosis anxiety is the predominant emotion, to the extent that it becomes impossible to live a normal life. An obsessive-compulsive disorder can involve long complicated rituals, frequently related to the fear of contamination - repeatedly washing the hands, for example. The ritual is omitted only at the cost of unbearable anxiety. In the case of phobias, anxiety is focused on particular objects or situations. Usually these are objects that we have an instinctive capacity to fear, such as snakes or confined spaces. Depressive neurosis involves depression as the principal emotion, and is different from psychotic depression in that perceptions are not distorted. Hysteria is a complicated problem that can take many forms. It involves symptoms with no physical cause that enable the sufferer to escape from an intolerable situation - these can be connected with memory, as in amnesia, or with the body as in hysterical paralysis or blindness. Occasionally more complicated forms, such as multiple personality, may occur.
In organic disorders, mental illness is caused by physical disease. Delirium is an acute, short-term clouding of consciousness, as with a high fever or in delirium tremens (DTs or alcohol withdrawal). Dementia is a chronic or long-term brain dysfunction, which is most commonly seen in old age. It can also be a result of tertiary syphilis (general paralysis of the insane) or of brain damage caused by illness or drugs. There are other mental disorders that may be the province of the psychiatrist, but that are not necessarily termed mental illness. These include personality disorders and problems such as drug abuse and sexual dysfunction.
Causes
Many factors are involved in the origins of mental disorder, including heredity. Exactly what form the inheritance takes is only poorly understood, but some disorders have been shown to be more prevalent in family members of afflicted individuals. Such disorders include schizophrenia, manic-depressive psychosis and alcoholism.
Upbringing too plays its part. It was once thought that mothers were the cause of severe mental illness (such as schizophrenia), but this theory is no longer accepted. The odd ways in which families with a mentally ill member behave are now seen as understandable, given the stress these families live with. Cruelty or neglect, however, do have serious implications for mental health, and family patterns of behavior may contribute to the development of neuroses.
Precipitating factors are easier to identify than original causes. Perhaps the best way to view the development of a mental breakdown is to see people as being more or less vulnerable because of their genes, early life and personality. Stress in their environment, such as leaving home or starting a new job, can be the final straw. In particularly vulnerable people the actual stress may be very minor indeed.
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Mental Disorders (page 2)
ftsTitle
In electroconvulsive therapy the patient is anaesthetized and a modified alternating current is passed through the head between two electrodes placed on the temples, producing a seizure.
* THE BRAIN
* SLEEP AND DREAMS
* DRUG ABUSE
* DEVIANCE, CRIME AND LAW ENFORCEMENT
Mental Disorders (2 of 2)
Treatment
Drug therapy came of age in psychiatry in the early 1950s with the introduction of anti-psychotic drugs called phenothiazines. Until then the old asylums were overcrowded with psychotic patients for whom little could be done, but with the introduction of phenothiazines vast numbers of people have been helped to lead normal lives.
Anti-depressant drugs have also proved effective in many cases. Tranquillizers - benzodiazepines - have a place in short-term treatment, but they are only rarely useful in the longer term, and can be addictive.
Most of the old physical treatments have now fallen into disrepute. One, however - electroconvulsive therapy (ECT) - is still useful. For a specific, selected group of patients ECT can bring about a recovery more rapidly than any other treatment, although it is not known how it works. These people may be severely depressed, unable to eat or sleep, hearing accusatory voices, and genuinely believing that they are totally worthless - perhaps even thinking that they are dead. It is clear then that a recovery as soon as possible is important.
Psychotherapy is a form of treatment that is aimed at helping patients to understand themselves. It is a broad term that covers therapies from classic psychoanalysis to counseling, drama therapy, music therapy and art therapy. These treatments can be used to help people with almost all forms of mental disorder. They can be combined with drug therapy, as drugs and counseling can be aimed at different facets of the same problem.
As well as individual psychotherapy sessions, people can be seen in groups or with their families. Group therapy is especially beneficial for a number of people with the same problem. Family therapy is a particularly useful tool as it acknowledges that individuals are affected by their families and vice versa. It is widely used by therapists working with children and adolescents.
CREATIVITY AND MENTAL ILLNESS
The idea that high achievers are often mentally unstable was given its most familiar form by the poet John Dryden in his diatribe against the politician Lord Bolingbroke in Absolom and Achitophel:
Great wits are sure to madness near alli'd
And thin partitions do their bounds divide.
The link between creativity and mental ill health is probably most apparent in the life and work of Vincent Van Gogh. Although Van Gogh's work as an artist spanned ten years, most of the pictures that made him famous were painted in 1888-90, when he was either clinically insane or very near to it.
Van Gogh's masterpieces date from 1888, starting with his move from Paris to Arles in February and ending with the breakdown in December. His breakdown, including the famous episode in which he cut off part of his left ear, had a typically schizophrenic quality. During these three years he produced 200 canvases of extraordinary originality. Some features of the paintings suggest that his perceptions were enhanced: his suns and stars seem to shimmer and dance, the lights and colors glow and vibrate. Visual experiences of this sort occur in schizophrenia and those taking hallucinogenic drugs. Some people believe that the psychotic distortion of the world around Van Gogh played a central role in pushing him to a creative level that he would not otherwise have achieved.
Schizophrenia is, of course, a destructive illness. Van Gogh's last paintings caricature and debase his style and most critics agree that very little artistically was gained from a psychiatric breakdown. But it is arguable that mental illness has always been a part of the spectrum of human experience and the world would be a poorer place if everyone had textbook standards of mental health.
JOAN OF ARC
A CASE STUDY
One of the most fundamental parts of the Joan of Arc story is that she heard voices. Yet this feature is one which is usually associated with mental illness. So the question arises: was Joan of Arc mentally ill? To answer this it is necessary to look more closely at the nature of psychosis and at her experiences.
Joan of Arc heard voices talking to her, telling her that she was special and that she had a mission. Her mood at the time is not known, but perhaps it involved an element of elation. Later in her life she remained convinced that the voices were from God. She did as the voices told her and was both single-minded and effective, succeeding in defeating the English army in battle.
How do these features fit in with mental illness? Schizophrenia is characterized by the disintegration of the personality; voices usually speak about the affected person and are persecutory. The sufferer may hold beliefs about being special or chosen, but motivation is frequently affected adversely. In the longer term, the afflicted person may recover and see their experiences as hallucinations, or the disease may progress to a state of severe handicap. Only rarely will a delusion persist in an intact personality, and even in such an instance stress would be likely to provoke a more severe relapse.
Manic depressive psychosis is primarily a disorder of mood. We can rule out depression, but could Joan have been manic? Here the mood disorder is elation or irritability with voices frequently being heard talking to, rather than about, the afflicted person. There is an inability to concentrate, a rapid, mid-sentence switch of ideas, and eventual exhaustion. Depression, often longer lasting, is a common outcome.
On balance, then, it would appear to be extremely unlikely that Joan suffered from a mental disorder as we understand it. Was she swept up in the religiosity of her time? A farm girl with a yearning for something more? Perhaps most compelling is the fact that the people of her time did not think of her as mad, but admired and followed her.
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Non-Infectious Diseases (page 1)
ftsTitle
A Down's syndrome child (right). The condition is caused by a chromosome defect - there are three number 21 chromosomes instead of the usual two, resulting in the characteristic slanting eyes, short stature, a varying degree of mental retardation and, sometimes, structural abnormalities of the heart and kidneys.
* GENETICS AND INHERITANCE
* PHYSICAL DEVELOPMENT
* HOW PEOPLE MOVE (ARTHRITIS)
* FOOD, DIET AND DIGESTION
* THE IMMUNE SYSTEM
* PREVENTING DISEASE
* DRUG ABUSE
Non-Infectious Diseases (1 of 3)
Diseases that are not transmitted have now replaced infections as the primary health problem - at least in developed countries. Infectious diseases such as smallpox, tuberculosis and diphtheria have been ousted from their positions as major killers by cancer, heart disease and strokes. While factors such as an inappropriate diet, lack of exercise, excessive intake of alcohol and tobacco smoking have to take the blame for many of the diseases that afflict people today, they are not the only culprits. The genes that each of us inherits from our parents may also put us at risk of developing heart disease, schizophrenia, rheumatoid arthritis or certain types of cancer, for example. Often several genes will contribute to an individual's risk of developing such a disease.
The role of heredity
There are many different types of inherited disease. Some are apparent from birth, while others may take decades to reveal themselves. Abnormalities of the chromosomes may be to blame. In Down's syndrome, for example, the affected child has an extra copy of chromosome number 21.
More than 4000 genetic diseases result from the inheritance of a mutant gene. They include achondroplasia (dwarfism), cystic fibrosis, Huntington's chorea and the blood disorders sickle-cell disease and thalassaemia. Affected couples may seek genetic counseling in order to assess their risk of passing on the disease to their children.
In cystic fibrosis, the mutation results in abnormally thick mucous secretions in the lungs and intestine. Treatment for digestive problems and lung infections can help to prolong the lives of people with cystic fibrosis, many of whom now survive into their mid-twenties. Hopes are high that, now that the exact mutation responsible for this disease has been identified, it may be possible to devise more effective treatments.
Huntington's chorea, which affects about one in 20 000 people, is a particularly distressing disease. Dementia (a disorder of the mental processes) and uncontrolled movements occur, but the symptoms fail to become apparent until the affected person has reached middle age. By this time, he or she has often already had children who risk suffering the same fate.
Sickle-cell disease is a hereditary blood disease that affects mainly people from Africa and their descendants. An abnormal type of haemoglobin is produced in the red blood cells. When carrying oxygen it functions normally, but after passing oxygen to the tissues the hemoglobin molecules change shape and pack together, distorting the blood cells and causing them to become sickle-shaped. Anaemia occurs as these cells are destroyed prematurely by the body. Sickling crises may also be brought about when the oxygen level is reduced, for example after strenuous exercise. In such circumstances, large numbers of red blood cells become sickle-shaped and can cause obstructions in the blood vessels, with possible damage to organs such as the kidneys and the brain. No satisfactory treatment has yet been developed.
Thalassaemia, common in Mediterranean countries, Asia and Africa, is also caused by a hemoglobin abnormality. Affected red blood cells cannot function normally, resulting in anemia, enlargement of the spleen and bone-marrow disorders. The disease can be treated by repeated blood transfusions.
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Non-Infectious Diseases (page 2)
ftsTitle
Secondary cancer (metastases) (above) of the spleen, arising from a primary ovarian cancer. The image was taken by gamma camera scanning and the cancerous cells are indicated by the bright red, pink and white regions.
* GENETICS AND INHERITANCE
* PHYSICAL DEVELOPMENT
* HOW PEOPLE MOVE (ARTHRITIS)
* FOOD, DIET AND DIGESTION
* THE IMMUNE SYSTEM
* PREVENTING DISEASE
* DRUG ABUSE
o Non-Infectious Diseases (2 of 3)
The influence of genes
Many common diseases such as heart disease, diabetes and some types of cancer may result from the inheritance of a blend of 'predisposing' genes, particularly when combined with environmental factors such as diet.
Diabetes may 'run in families'. The brother or sister of a diabetic person is more likely to develop diabetes than a member of the general population. Obesity may also play a role in encouraging the onset of the disease.
Physical and chemical causes of disease
Environmental hazards such as radiation and pollutants account for some types of disease. People normally encounter only small doses of radiation, from diagnostic X-rays or perhaps as a treatment for cancer. In addition, everyone is exposed to low background levels of natural radiation from the Sun and from some types of rock. However, excessive doses of radiation may follow accidents at nuclear reactors or the detonation of nuclear weapons.
People who experience such high exposures develop radiation sickness, with loss of cells from their bone marrow and the lining of their intestine. The person loses appetite and suffers diarrhea, sickness, chills, fever and extreme tiredness. Death may follow because of the damage to the bowel and bone marrow resulting in loss of resistance to infection and severe anemia. Long-term survivors are at increased risk of developing cancers, including cancers of the blood, and cataracts.
Chemical hazards are probably more often encountered at work than at home. The list of industrial diseases is a long one and includes poisoning by lead, mercury and other heavy metals. Many industrial diseases result from inhaling some harmful substance. Asbestosis, for example, results from inhaling fibers of asbestos. The lungs become fibrous and the affected person not only experiences increasing breathlessness, with failure of the heart and lungs, but also has an increased risk of developing cancer of the lung.
Autoimmune disease
Some diseases result from the immune system attacking the body's own tissues or other components. In thyrotoxicosis, antibodies produced by the immune system bind to cells of the thyroid, stimulating them to produce excessive amounts of thyroid hormone. In rheumatoid arthritis there is evidence that the damage to the lining of the joint results from a faulty immune response within the joint.
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p236-3
ftsTitleOverride
Non-Infectious Diseases (page 3)
ftsTitle
A patient undergoing radiotherapy to treat Hodgkin's disease - a cancer of the lymphatic system. The illuminated discs over the patient's chest indicate the areas that are to receive radiation.
* GENETICS AND INHERITANCE
* PHYSICAL DEVELOPMENT
* HOW PEOPLE MOVE (ARTHRITIS)
* FOOD, DIET AND DIGESTION
* THE IMMUNE SYSTEM
* PREVENTING DISEASE
* DRUG ABUSE
Non-Infectious Diseases (3 of 3)
The Western diet has been criticized for being too low in fiber and too high in sugar and other refined carbohydrates and in fat. Heart disease, diabetes, cancer of the colon and of the large bowel, constipation, hemorrhoids and obesity are among the many diseases that may result.
A diet too high in saturated fat may result in an elevated level of blood cholesterol leading to atheroma - degeneration of artery walls due to the formation of fatty deposits. People with this disease are prone to angina (severe pain in the chest on exertion) and heart attacks, which may be fatal.
Obesity can also encourage unwanted health problems. People who are overweight are more likely to suffer from heart disease, diabetes and strokes.
Alcohol
Apart from the social cost of alcohol-related diseases, excessive intake of alcohol exerts a huge toll on physical health. The long-term effects of alcohol taken to excess include cirrhosis of the liver (in which liver cells are replaced by scar tissue), alcoholic hepatitis (inflammation of the liver) and liver cancer. Alcohol can damage the heart, brain and nerves. Cancers of the larynx, esophagus and pancreas are also associated with consumption of alcohol.
Smoking
Cancer of the lung is 10 to 15 times more common in regular tobacco smokers than in people who have never smoked, and up to 40 times commoner in very heavy smokers. Smoking also increases the risk of cancer of the pancreas, oesophagus and larynx. Smokers are more likely than non-smokers to suffer heart attacks, chronic bronchitis and emphysema, a condition in which the sufferer commonly experiences increasing breathlessness.
CANCER
Cancer occurs when cells grow out of control. A single cell can accumulate changes in its genes that allow it to replicate in an uncontrolled way. Such a cell can give rise to a tumor, which may manifest itself as a palpable lump or a mass. Once cells become cancerous they lose the function that they once had: they simply reproduce themselves indefinitely.
A tumor is considered to be benign if it remains localized in the place where it originated. Nevertheless, benign tumors can be life-threatening if they jeopardize normal structures. Benign tumors of the brain, for example, can be fatal.
Malignant tumors have the capacity to spread around the body. Individual cells, or groups of cells, can detach themselves from the primary tumor, migrate via the blood or the lymph around the body and become deposited in other organs such as the brain, the bones or the lungs. There they form secondary tumors. This process is called metastasis, and the secondary tumors are known as metastases.
In many cases the cause of cancer is unknown, and will vary according to the type of cancer. Studies of women who have had breast cancer have provided some indication of the factors at work in the development of this disease. Breast cancer is more common in women who have a close relative, such as a mother or sister, who has also had the disease. This suggests that - in some cases at least - genetic influences are at work.
Cancer of the breast is also more common in women who begin their periods early, who have their first child later in life and who have a late menopause. These observations indicate that hormonal influences on the breast are important. The same appears to be true of cancer of the ovary: this is less common in women who have taken oral contraceptives for several years, thus suppressing the normal monthly cycle of activity in the ovaries.
Environmental factors undoubtedly play a part in the development of some cancers. Excessive exposure to ultraviolet light in sunlight seems to be responsible for melanoma, or cancer of the skin. Almost a third of all deaths from cancer could be avoided if people abandoned smoking tobacco.
Treatment for cancer varies according to the type of tumor, the site of the primary tumor and the extent of the spread of cancerous cells. Chemotherapy (drug therapy) can produce long remissions in some forms of the disease but side effects occur as normal cells are also damaged and the white blood cells become depleted. Radiation therapy uses ionizing radiation - including X-rays and gamma-rays - to destroy cancer cells. Chemicals can be used to sensitize malignant cells to radiation, leaving healthy cells undamaged. Surgery is used to remove malignant growths but is only completely effective if cancer cells have not migrated into other parts of the body.
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Infectious Diseases (page 1)
ftsTitle
The Plague by the Swiss painter Arnold Bocklin (1827-1901).
* THE BEGINNINGS OF LIFE
* PARASITISM AND SYMBIOSIS
* THE IMMUNE SYSTEM
* PREVENTING DISEASE
* THE HISTORY OF MEDICINE
Infectious Diseases (1 of 4)
An infectious disease is one in which one living organism inhabits and multiplies on or within another, harming it in the process, either by the production of toxic substances or by damaging, digesting or destroying part or all of its cellular structure. Such harmful organisms are mostly microscopic - viruses, bacteria and protozoans - but also include various larger organisms such as various kinds of fungi, worms and arthropods. Human beings may be efficient at killing each other, but these other organisms are even more efficient: more people died in the outbreak of Spanish influenza following World War I than died in the war itself. From conception onwards, human beings are under attack from infectious organisms ranging from the rubella virus, which damages embryos, to pneumonia, which quietly ends the lives of many old people.
The existence of bacteria was first demonstrated in the 17th century by Anton van Leeuwenhoek who detected them through a microscope in scrapings of the white film on his teeth. With later microscopes scientists were able to find many more of his 'animalcules', now calling them microorganisms. Some - the viruses - are so small that they can only be seen with an electron microscope. The vast majority of microorganisms are harmless; some live with human beings in harmony, each helping the other in a symbiotic relationship. For example, certain bacteria manufacture some of the vitamins of the B complex in the intestines, at the same time absorbing a tiny amount of our food. However, many organisms are harmful, and such organisms are called pathogens. Pathogens are divided into four main groups: viruses, bacteria, fungi and parasites.
Viruses
Viruses are by far the smallest of the pathogens. They need to live inside the body cells of other organisms to survive, and in reproducing themselves they destroy the host cell.
Our only natural defense against viruses is the formation of antibodies from B cells manufactured in the bone marrow. One other natural substance that is effective against viruses is interferon, but this has proved so difficult to produce commercially that it is not used in the routine treatment of viral disease. Only two or three drugs are of any use, and these only against a limited number of viruses. Treatment at the moment has to be by prevention in the form of immunization, which produces the antibodies in our system before the virus itself attacks. Considerable research has recently been going on into oncogenic (cancer-causing) viruses, which appear to stimulate cells to become malignant, and the near future may well see significant advances in this field.
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p238-2
ftsTitleOverride
Infectious Diseases (page 2)
ftsTitle
Leprosy is a chronic inflammatory disease that affects the skin, mucous membranes and nerves.
* THE BEGINNINGS OF LIFE
* PARASITISM AND SYMBIOSIS
* THE IMMUNE SYSTEM
* PREVENTING DISEASE
* THE HISTORY OF MEDICINE
Infectious Diseases (2 of 4)
Bacteria
Bacteria are much bigger structures, and unlike viruses are visible under the ordinary light microscope. They have four main shapes: round (cocci), straight rods (bacilli), curved rods (vibrios), and coils (spirochetes).
Two groups of drugs are used to treat bacterial infection. The first group, the bacteriostats, prevent the multiplication of bacteria. The second group, the antibiotics, either disrupt the cell membranes or metabolic pathways of bacteria, or act as direct poisons. Matching the infecting bacteria to the appropriate antibacterial drug involves growing the bacteria on a culture dish, and then placing discs impregnated with antibiotics in the dish. With an effective antibiotic the disc will show a clear space around it where the organism does not grow. It is then said to be 'sensitive' to the antibiotic.
Fungi
Fungi are probably the most widespread of organisms, inhabiting virtually every animal and plant species and their habitats. Thus there is essentially no difference between fairy rings on a lawn and ringworm on the skin - the characteristic spreading ring indicates fungi growing in both media.
Very few fungi infect human beings, and those that do mostly colonize the surface (skin, nails and hair). However, there are geographical differences: in North America, for example, there are many deeply invasive fungi, causing such diseases as pneumonia. These fungi are not found in the UK or Europe.
Spores of fungi, carried in the air, may be responsible for asthma and many allergies in human beings, but are not infections in the strictest sense.
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Infectious Diseases (page 3)
ftsTitle
The parasitic flatworm Schistosoma, which causes schistosomiasis.
* THE BEGINNINGS OF LIFE
* PARASITISM AND SYMBIOSIS
* THE IMMUNE SYSTEM
* PREVENTING DISEASE
* THE HISTORY OF MEDICINE
Infectious Diseases (3 of 4)
Parasites
Parasites are divided into three groups - protozoans, worms and arthropods.
Protozoans, although still microscopic, are generally larger than bacteria and possess a more evolved cell structure. They include the amoeba that causes amoebic dysentery. Protozoans are not damaged by antibiotics in the concentrations that would be lethal to bacteria. Some, such as the malaria parasite, go through complicated life cycles.
Parasitic worms affect human intestines in various ways, and in some cases migrate to various other organs of the body, sometimes causing large cysts or swelling of limbs as in elephantiasis. They include threadworms, roundworms, hookworms, flatworms, flukes and tapeworms. Arthropods such as lice, fleas and mites not only infest or infect humans, but some also act as carriers (vectors) of microorganisms, such as those that cause typhus and plague.
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Infectious Diseases (page 4)
ftsTitle
AIDS education campaign in Uganda. One of the best measures to combat the spread of AIDS is education.
* THE BEGINNINGS OF LIFE
* PARASITISM AND SYMBIOSIS
* THE IMMUNE SYSTEM
* PREVENTING DISEASE
* THE HISTORY OF MEDICINE
&Infectious Diseases (4 of 4)
SOME INFECTIOUS DISEASES
AIDS
Cause: HIV virus.
Transmission: Sexual; transfusion; contact with infected blood.
Characteristics: Destruction of immune system. Always fatal.
Prevention: Avoidance of unprotected sex and infected blood.
Treatment: Antiviral drugs (of limited use).
CHOLERA
Cause: Bacterium.
Transmission: Fecally contaminated water. Largely restricted to tropics.
Characteristics: Vomiting and diarrhea leading to dehydration. Often fatal.
Prevention: Clean water supply. Vaccination effective 6-9 months.
Treatment: Antibiotics.
COMMON COLD
Cause: Viruses.
Transmission: Airborne; direct contact.
Characteristics: Inflammation of nose and upper respiratory tract causing sneezing, coughing, sore throat.
Prevention: Avoidance of direct contact.
Treatment: Rest. Proprietary medicines may relieve some symptoms but are of limited use.
DIPHTHERIA
Cause: Bacterium.
Transmission: Airborne.
Characteristics: Infection of pharynx; breathing obstructed; Heart inflammation. Often fatal. Now rare in developed countries.
Prevention: Immunization.
Treatment: Antibiotics.
DYSENTERY
Cause: Amoeba or bacteria. Amoebic dysentery confined to tropics.
Transmission: Contaminated food or water.
Characteristics: Diarrhea, weight loss, dehydration. With amoebic dysentery, liver abscesses.
Prevention: Hygiene, clean water supply.
Treatment: Antibiotics, emetine, rehydration.
FOOD POISONING
Cause: Bacteria, including Salmonella , Listeria or more rarely Clostridium botulinum, which causes botulism. Viruses.
Transmission: Contaminated food or water.
Characteristics: Vomiting and diarrhea. Botulism affects central nervous system and is often fatal.
Characteristics: Fever, swelling of parotid salivary glands. In adults, testicular and ovarian inflammation.
Prevention: Immunization (immunity short-lived).
Treatment: Rest.
PLAGUE
Cause: Bacterium.
Transmission: Airborne or via flea bites.
Characteristics: Fever, weakness, delirium, painful buboes (swelling of lymph nodes). Often fatal.
Prevention: Immunization (partial protection).
Treatment: Antibiotics.
PNEUMONIA
Cause: Bacteria or viruses.
Transmission: Airborne; direct contact.
Characteristics: Inflammation of lung causing pain and breathing difficulty. Can be fatal.
Prevention: Treatment: Antibiotics if caused by bacteria.
POLIOMYELITIS
Cause: Virus.
Transmission: Direct contact.
Characteristics: Infection of central nervous system causing fever, headache, stiffness of neck. Possible paralysis in minority of cases.
Prevention: Immunization.
Treatment: Use of respirator if respiratory paralysis occurs. Physiotherapy if muscles remain affected.
RUBELLA (GERMAN MEASLES)
Cause: Virus.
Transmission: Direct contact.
Characteristics: Headache, sore throat, fever, swelling of neck, pink rash. Can damage developing fetus if caught by pregnant woman.
Prevention: Immunization.
Treatment: Rest.
SCHISTOSOMIASIS (BILHARZIA)
Cause: Parasitic flatworm Schistosoma.
Transmission: Eggs excreted in feces or urine of infected people undergo part of larval development in freshwater snails. Larvae released by snails penetrate skin of person bathing in infected water and colonize blood vessels of intestine.
Characteristics: Diarrhea, enlarged spleen and liver, cirrhosis of the liver. Can be fatal.
Prevention: Clean water supply.
Treatment: Various drugs.
SCARLET FEVER
Cause: Bacterium.
Transmission: Airborne.
Characteristics: Fever, sore throat, scarlet rash, possible ear and kidney infections.
Prevention: Avoidance of contacts.
Treatment: Antibiotics.
SYPHILIS
Cause: Bacterium.
Transmission: Sexual; can also be passed to fetus via placenta.
Characteristics: Hard ulcer on genitals followed by fever, malaise, rash on chest. Eventual heart and brain damage, blindness, general paralysis of the insane.
Prevention: Avoidance of unprotected sex.
Treatment: Antibiotics.
TAPEWORMS
Transmission: Through infested meat.
Characteristics: Weakness, hunger, weight loss caused by parasite absorbing nutrients.
Prevention: Avoiding undercooked meat.
Treatment: Antithelmintics.
TETANUS (LOCKJAW)
Cause: Bacterium.
Transmission: Bacterium entering wounds.
Characteristics: Muscle stiffness, spasm and rigidity, high fever, convulsions, extreme pain. Can be fatal.
Prevention: Immunization.
Treatment: Penicillin and antitoxins.
THREADWORMS
Transmission: Direct contact.
Characteristics: Anal itching caused by female worm emerging at night to lay eggs.
Prevention: Hygiene.
Treatment: Piperazine.
THRUSH
Cause: Fungus Candida albicans.
Transmission: Fungus (Candida albicans) lives in alimentary tract and vagina; thrush arises when growth of fungus increases, in some cases following course of broad-spectrum antibiotics. Can be passed to baby at birth.
Characteristics: White patches in mouth or irritation of vagina.
Prevention: Avoidance of broad-spectrum antibiotics.
Treatment: Antifungals.
TUBERCULOSIS
Cause: Bacterium.
Transmission: Airborne; unpasteurized milk.
Characteristics: Bacteria inhaled into lungs cause a tubercle or lesion leading to fever, weight loss, coughing up blood. Bacteria from infected milk affect abdominal lymph nodes. Formerly often fatal.
Prevention: Immunization, pasteurizing milk.
Treatment: Antibiotics.
TYPHOID
Cause: Bacterium.
Transmission: Fecally contaminated food or water.
Characteristics: Infection of digestive system causing high fever, red rash, possible inflammation of spleen and bones. Formerly often fatal.
Prevention: Immunization.
Treatment: Antibiotics.
TYPHUS
Cause: Parasite Rickettsia, spread by lice, fleas or ticks.
Characteristics: Severe head aches, rash, high fever, delirium.
Characteristics: Infection of trachea and bronchi producing coughs followed by involuntary intakes of breath.
Prevention: Immunization.
Treatment: Rest.
TRANSMISSION OF
INFECTIONS
Airborne: Transmitted through infected droplets in the air from the nose, throat/lungs or saliva, or from dust particles from fallen skin.
Contamination: Contamination of food or water supplies usually by infected feces or urine.
Direct contact (contagion): Disease is caught from close contact with an infected person.
Sexual Transmission: Transmitted by vaginal or anal intercourse or oral sex. Use of condoms can reduce risk of transmission.
Blood borne: Transmitted by injection of contaminated blood or blood products or by improperly sterilized instruments. Common among hemophiliacs and intravenous drug users; occasionally from tattooing or acupuncture.
Animal carrier (vector): Injection of contaminated saliva as in malaria; flea bites as in bubonic plague.
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Surgery (page 1)
ftsTitle
The prosthesis (right) (an artificial replacement for a missing or malfunctioning part of the body) is a major part of medical technology. The picture shows an 'intelligent' prosthetic hand. Electrodes built into prosthetic hands can be activated by the patient's muscle contractions, and the electrical current generated by the contractions is amplified by electrical components and batteries to control movement.
* OPTICS
* MEDICAL TECHNOLOGY
* HISTORY OF MEDICINE
Surgery (1 of 4)
The practice of surgery is very old indeed. From the remains of skulls we know that the technique of trepanning - removing a disc of bone from the skull - was carried out about 10 000 years ago. This operation released the build-up of fluid in the skull, and may have been originally based on the belief that it let out an evil spirit. But it was only in the last century and a half that certain key events laid the foundations for safe, effective surgery as we know it today.
Landmark developments included the introduction of anesthesia; the acceptance of the germ theory of disease, which inspired measures to limit post-operative infection; the discovery of blood groups, paving the way for safe transfusions; and the development of techniques for surgical anastomosis - joining the severed ends of tubular structures such as blood vessels or the intestine.
Necessity or choice
At the beginning of the 20th century, two kinds of surgery began to emerge: elective and non-elective. Non-elective (often emergency) surgery is for the most part life-saving. Few people would question the need for the removal of an acutely inflamed appendix, amputation of a gangrenous limb or repair of a ruptured aorta. But with elective procedures there is often the element of choice: when to have the operation; which of several different techniques to choose; or whether to forgo surgery in favor of some other treatment.
The most notably successful elective procedure is hip replacement, which involves removing the diseased joint and inserting an artificial replacement or prosthesis. Degeneration of the hip joint due to age and arthritis can be overcome by this operation, freeing the patient from pain and restoring mobility.
The range of prostheses available includes the artificial pacemaker. This is an electronic device supplied to patients with a condition known as heart block, in which the conduction of the electrical impulses generated by the heart's natural pacemaker is impaired, slowing down the heart beat. The pacemaker stimulates the heart to beat at the desired rate.
A more recent innovation is the cochlear implant, also an electronic assembly, which restores hearing in some cases of deafness attributable to damage in the inner ear.
Spare-parts surgery also includes grafting of organic tissues - for instance, the corneal graft, in which diseased parts of the cornea are replaced by corneal tissue from a donor.
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Surgery (page 2)
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Louis Washkansky was the first man to have a heart transplant operation. He died 18 days after his operation, not of a failed heart but of pneumonia. He was given drugs to suppress his immunity system as it was feared that his body's defense system would reject the heart.
* OPTICS
* MEDICAL TECHNOLOGY
* HISTORY OF MEDICINE
Surgery (2 of 4)
Obsolete procedures
Some early operations, such as thoracoplasty (causing partial collapse of a lung) for pulmonary tuberculosis, have been replaced by more effective medical treatments. Psycho-surgery - surgical attempts to rectify mental disorders - has also become largely obsolete. For instance, leucotomy - an operation to sever connections to the frontal lobes of the brain - was pioneered in the 1930s for the relief of severe mental illness. It reduced severe anxiety, but often at the expense of personality and intellect. It came to be seen as inhumane, and was rendered superfluous by the advent in the 1950s of effective drug therapy.
More recently, the need for exploratory surgery has been lessened by the introduction of non-invasive imaging techniques, such as ultrasound, CT-scan and magnetic resonance imaging. Laparotomy - laying open the abdomen - was and still is the commonest exploratory procedure, but is now performed less frequently.
Keyhole surgery
Endoscopy - examination of the interior of the body by direct viewing - also provides a minimally invasive aid to diagnosis. Endoscopes are flexible viewing tubes fitted with a built-in fiber-optic light source and adapted for specific parts of the body. A bronchoscope, for instance, is used for viewing the bronchial passage, while the gastroscope allows the interior of the stomach to be seen. Tissue biopsy (the removal of a small piece of tissue for examination) and small, localized treatments can be performed by means of fine instruments introduced through the endoscope. This approach is known as keyhole surgery.
An operation in progress. Operating theaters are designed to ensure the maximum safety for the patient, especially by avoiding infection of the open wound. All utensils are sterilized, floors, walls and tables are washed daily, and bacteria counts are taken regularly. Forced ventilation with filtered air keeps out air contamination.
* OPTICS
* MEDICAL TECHNOLOGY
* HISTORY OF MEDICINE
Surgery (3 of 4)
Open-heart surgery
A major new development in the last quarter of a century has been open-heart surgery. This requires the heart to be stopped and the blood to be pumped by way of an extra-corporeal circulation (ECC), and had to await the advent of the heart-lung machine in the late 1950s.
In the 1970s, a significant addition to the heart surgeon's repertoire was coronary artery bypass grafting (CABG). This is an operation to replace sections of coronary arteries that have become severely narrowed by an accumulation of fatty deposits (plaque). Furred vessels are replaced by lengths of vein, usually taken from the patient's leg. The operation relieves the crippling pain of angina and restores an adequate blood supply to the heart muscle.
For some patients an alternative technique is available for dealing with blocked arteries - balloon angioplasty, developed in Switzerland in 1977. This involves passing a balloon-tipped catheter into a large artery in the groin and advancing it until the tip comes to rest in the narrowed coronary vessel. Here the balloon is inflated, compressing the plaque against the artery wall so as to re-establish an adequate channel for blood-flow to the heart. If balloon angioplasty fails, or - as often happens - the plaque recurs, the procedure can be repeated.
Balloon angioplasty is not without risk, but it is performed under local anesthesia and is quicker than the open-heart procedure. Another consideration is that it is a much cheaper option, entailing a hospital stay of only two to three days instead of the ten days or so required for CABG. However, the newer procedure may itself be improved (or even superseded) if current experimental work with lasers is seen to be more effective.
Bloodless surgery
Two areas where use of the medical laser has proved revolutionary are the treatment of cervical cancer (cancer of the neck of the womb) and eye problems such as glaucoma and diabetic eye disease. With fine precision, lasers can be made to cut, coagulate or vaporize body tissue. Tumors lying close to vital nerve fibers, bleeding gastric ulcers, some cancers, and even unsightly birthmarks can all be treated quickly and relatively painlessly. However, the full potential of 'bloodless surgery' has yet to be realized.
Safe anesthesia
It is often not realized to what extent successful surgery relies on competent anesthesia. Dramatic advances in anesthetic techniques over the last few decades have contributed to the development of high-profile surgery (such as transplants, etc.), as well as to cheaper, safer options for routine treatments. In particular, the versatility of anesthetic techniques underlies the growth of same-day surgery, which is increasingly popular with patients.
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Surgery (page 4)
ftsTitle
A Liver transplant operation at the University of Pittsburgh. This long and complicated surgical procedure becomes a necessity when a person's liver fails.
* OPTICS
* MEDICAL TECHNOLOGY
* HISTORY OF MEDICINE
Surgery (4 of 4)
ORGAN TRANSPLANTS
he first human organ to be successfully transplanted - in the 1950s - was a kidney. The fact that the donor and recipient were identical twins meant that there were no problems with rejection - normally a problem with such transplants because the body's immune system identifies the transplant as a foreign object and so sets about destroying it. It was another two decades, however, before organ transplants - kidney grafts in particular - began to be routinely employed to replace organs that had completely failed. Since then, the biggest single contribution to survival has been the discovery in 1978 of the drug cyclosporin, which suppresses the immune system and so prevents rejection.
Four major transplant procedures have moved from the experimental category to become treatments of choice: kidney, liver, heart and heart-lung. Kidney grafting is most in demand.
There is no mechanical support for the failing liver, and liver transplant - one of the most challenging of all operations - is increasingly sought. Children tolerate it slightly better than adults. However, because of the difficulty of finding suitably-sized organs, some younger children now receive segmental grafts fashioned from adult livers.
The fact that none of the first recipients of transplanted hearts (pioneered by Christiaan Barnard (1922- ) in South Africa in 1967) survived for long meant that this operation lost its appeal for some years. It came back into its own in the late 1970s, and now enjoys a one-year survival rate of 80%. Candidates for heart transplants include newborn babies with hitherto inoperable heart disease.
Heart-lung transplantations - technically more feasible than grafting the lungs alone - was developed for patients with severe lung disease, such as cystic fibrosis. Single lung transplants are rarely performed.
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Operation, liver transplant
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Medical Technology (page 1)
ftsTitle
A mobile magnetic resonance unit. The remarkable clarity of the information obtained with this technique can be seen in the screen image of the patient's head.
* ACOUSTICS
* OPTICS
* SURGERY
* HISTORY OF MEDICINE
* SEEING THE INVISIBLE
Medical Technology (1 of 4)
The practice of medicine is based on diagnosis and treatment. Diagnosis - identifying a disease or condition - depends on recognizing and assessing changes from normal function. With this information the doctor decides on the appropriate course of action. Increasingly sophisticated medical technology underlies both diagnosis and treatment.
The physician of a century ago could call upon few instruments to aid diagnosis. He relied on a stethoscope and percussion of the chest, a few urine and blood tests and, from the turn of the century, the sphygmomanometer to measure blood pressure, as well as the skillful observation of physical signs. The internal effects of the disease process could only be learned after death, by dissecting and studying the body (autopsy). And, while diagnosis became increasingly accurate, little could be done to influence the outcome of a disease.
Over the century, X-rays and penicillin perhaps represent medicine's most radical advances. Rontgen's mysterious rays first brought to light the secrets of the living body. Penicillin was the first of several drugs - the antibiotics - that have proved successful in treating an enormous range of bacterial infections. These early discoveries have since been joined by an array of technologies that have not only given clearer insights into the living body, but also provided increasingly diverse means of support for the sick.
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p242-2
ftsTitleOverride
Medical Technology (page 2)
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Magnetic resonance imaging is used to show a tumor inside a person's head. This non-invasive technique clearly can be used to diagnose health problems and determine proper medical care.
* ACOUSTICS
* OPTICS
* SURGERY
* HISTORY OF MEDICINE
* SEEING THE INVISIBLE
Medical Technology (2 of 4)
Medical imaging
Medical imaging has progressed far beyond the early days of still X-rays, although these are still an important diagnostic tool. Routine procedures now reveal organs and bones, joints in motion, blood flow through the heart and vessels, and cell activity at the molecular level.
Digital subtraction angiography (DSA) builds up multiple X-ray images by computer into a coherent digital picture. For instance, a radiograph (X-ray photograph) can be taken of a major blood vessel and radio-opaque dye (a dye that does not allow X-rays to pass through) then injected into a vein. A second radiograph is taken and the computer 'subtracts' the first image from the second, leaving only the differences between the two - in this case a clear outline of the blood supply to the brain, kidney or one of the limbs.
Ultrasound is best known for its role in providing images of the fetus in pregnancy, since it would be damaged by X-rays. Echocardiography, now an essential diagnostic tool for cardiologists (heart specialists), also uses ultrasound to study the heart in motion. Doppler ultrasonography translates blood flow into an image, using the Doppler effect. As blood passes through a narrowed vessel or damaged heart valve the changing sound of the flow is reflected to pinpoint the damage. This is proving of great value in the diagnosis of heart conditions in young children and babies.
Computerized Axial Tomography (CAT scanning) measures the attenuation of X-rays entering the body from different angles. The computer reconstructs thin sections or 'slices' of the interior of the body. The technique is valuable in that it allows images of soft tissues, such as the liver and kidneys, to be differentiated.
Magnetic resonance imaging (MRI) is a wholly new technique. Brief radio impulses, emitted within a very powerful magnetic field surrounding the body, cause the nuclei of atoms first to spin and then to emit signals as they realign themselves to the magnet. Each tissue gives off characteristic signals, which are converted by computer to produce startlingly clear images. For the first time it has become possible to observe degenerative conditions of the central nervous system, such as multiple sclerosis.
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Magnetic resonance imagingW
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p242-3
ftsTitleOverride
Medical Technology (page 3)
ftsTitle
A false-color ultrasound image of a human fetus in the womb after 7 months' development, showing the face and shoulders in profile.
* ACOUSTICS
* OPTICS
* SURGERY
* HISTORY OF MEDICINE
* SEEING THE INVISIBLE
Medical Technology (3 of 4)
Medical monitoring
The importance of physiological monitoring has been appreciated for many centuries. Recognizing that disease affects the way the body functions, early physicians felt pulses and tasted urine (for sugar in diabetes). Present technologies reflect the same principle: that every condition produces typical changes
that can be observed and measured. These findings are the key to diagnosing disease and to determining its treatment.
Electrocardiography (ECG) is a safe, non-invasive means of studying heart function. Electrical impulses generated by the heart are transmitted to an oscilloscope by means of electrodes placed on the skin. Abnormal rhythms and damage caused by a heart attack produce characteristic patterns that can be 'read' on the ECG tracing. A miniature ECG worn for 24 hours records heart activity throughout a routine day, while cardiac monitors used in hospital intensive care units provide a continuous picture of heart function in the critically ill.
A recent, non-invasive monitoring device, the pulse oximeter, measures oxygen concentrations in arterial blood. The probe, which simply clips on to a fingertip or ear lobe, detects pulsions of blood in the capillaries lying near the skin surface. It has two light-emitting diodes on one side - which flash up to 500 times a minute - and a photodetector on the other. The reading - based on the differing amounts of light absorbed by oxygen-carrying hemoglobin and hemoglobin without oxygen - gives a good indication of the blood supply to vital organs. A dangerous drop in oxygen can be detected - and treated - before damage occurs.
Physiological support
Before the invention of artificial respiration in the 18th century, the cessation of breathing meant the end of life. It is not surprising that the first resuscitation technique provoked a degree of hysteria: if the dead could be restored to life, who could say when a person was dead? Societies and ingenious devices sprang up everywhere to forestall the horrors of premature burial. The implications are no less problematic today. With the technology to support failing organ systems, how do we choose when to support and when to withdraw support?
Ventilators are used to maintain oxygen levels in the blood when unassisted breathing is inadequate. These machines - popularly known as 'life-support
machines' - deliver humidified gases to the lungs through a tube inserted into the trachea, either through the mouth or through a surgical incision in the throat. Modern ventilators control the proportion of oxygen, the pressure used to inflate the lungs and the rate of respirations. Some types initiate every respiration; others support the patient's own breathing.
Dialysis replaces kidney function in renal failure by removing toxic wastes from the blood. By means of diffusion across a semipermeable membrane, waste products and excess water are transferred to a dialysate fluid. For hemodialysis, the blood passes through a dialyser with membrane and dialysate, and is returned to the circulation.
Continuous ambulatory peritoneal dialysis (CAPD) uses the peritoneum (the membrane lining the abdominal cavity), which is about 2 m2 (21
sq ft) in area. Two liters of warmed dialysate are introduced into the abdomen through a catheter, left for several hours while waste products accumulate, and are then drained out. CAPD is carried out round the clock so that the patient is able to continue leading a normal life.
One of the foremost life-saving techniques is defibrillation. Each beat of the heart begins with electrical stimuli arising in the heart's own conductive tissue. In the condition known as fibrillation, the stimuli, and therefore the heart beat, become chaotic. Defibrillation uses a direct current shock to convert the twitching movement to normal rhythm. Two paddles, one negative and the other positive, are applied to the patient's chest, and the counter-shock delivered to the heart causes the myocardial cells to resume their proper electrical function.
This technique is being taken into the community to save the lives of people with heart disease. Defibrillators installed in ambulances either have a built-in computer or can be linked by telephone to the hospital. If a patient develops chest pains, the two paddles - which also take ECGs - are placed in position. If the machine has its own computer, this analyses the ECG and advises whether to defibrillate. Alternatively, the ECG can be relayed by telephone to a consultant, who can activate the defibrillator if necessary. Automatic battery-powered defibrillators that can be implanted in the patient's body are also available.
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p242-4
ftsTitleOverride
Medical Technology (page 4)
ftsTitle
A low-power red argon laser, directed through 4 fiber-optics wave guides to treat a cancerous tumor in the patient's throat. The low-power beams activate a drug previously injected into the patient - the drug does not affect normal cells, but is absorbed by cancerous ones. The products of the photochemical reaction initiated by the laser are toxic to cancerous cells.
* ACOUSTICS
* OPTICS
* SURGERY
* HISTORY OF MEDICINE
* SEEING THE INVISIBLE
Medical Technology (4 of 4)
Drug therapy
Drugs - the term includes any substance that acts on living cells - may treat or prevent a disease or condition, or may support a stressed or failing organ. The earliest effective drugs to be used - still of great value - include quinine, to treat malaria, and digitalis, to strengthen the weakened heart. Since the beginning of the 19th century, and particularly since World War II, drugs have been discovered and developed to treat every body system
and many diverse features within each system. Mentioned here are just some of the latest major developments.
Peptic ulcers occur when part of the lining of the digestive tract is digested by acid and the digestive enzyme pepsin. H2-receptor antagonists such as cimetidine and ranitidine, which reduce gastric acid secretion, have revolutionized treatment
of this potentially lethal condition. Management of ulcers was once limited to diet and major surgery; now most cases respond to a course of medication over 3-4 weeks. However, the ulcers may recur.
Thrombolytics are improving both short-and long-term survival after a heart attack. When a blood clot (thrombus) lodges in one of the coronary arteries, the heart muscle is deprived of blood and begins to die. Injected intravenously, preferably within the first few hours of the attack, both streptokinase and tissue plasminogen activator (t-PA) dissolve the thrombi effectively, preventing irreversible damage to the heart muscle.
Controversial though it may be, there has long been interest in an abortion pill to spare women the trauma of surgical termination. Developed in France, RU 486 is proving an effective abortion pill - 95% successful in terminating pregnancies of up to nine weeks. The embryo is implanted in the lining of the uterus, which is rich in blood vessels and maintained by the hormone progesterone. When progesterone is replaced by the synthetic hormone mifepristone (RU 486), the uterine lining and embryo are usually shed within 48 hours. Side-effects include moderate to severe pain and possible heavy bleeding.
INTENSIVE CARE
The intensive care unit is at the forefront of high-technology medicine. Here, a multitude of equipment and techniques are brought together to monitor, support and treat patients who are in imminent danger of death. Many of these devices have a vital preventive function, alerting staff to potentially fatal conditions before they become irreversible.
And yet the human element still prevails. Doctors must choose appropriate treatment and appreciate the consequences of each intervention. And it is nursing care and experience, not technology, on which the patient's life ultimately depends. Technology is a useful tool, but only in the right hands.
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Preventing Disease (page 1)
ftsTitle
Children are vaccinated against a variety of diseases, including polio, tuberculosis, diphtheria, tetanus, whooping cough and measles.
* FOOD, DIET AND DIGESTION
* THE IMMUNE SYSTEM
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* DRUG ABUSE
* POPULATION AND HUNGER
* THREATS TO THE ENVIRONMENT
* INDUSTRIAL SOCIETY (SOCIAL REFORMS)
Preventing Disease (1 of 4)
Methods of disease prevention range from simple precautions taken in the home - washing the hands, for example - to expensive international campaigns to eradicate illnesses. Until the 19th century there was little understanding of how disease was spread - earlier people often thought that diseases such as plague were a punishment from angry gods. We now know that plague is a possibly fatal infection passed to man from rat fleas.
Throughout history, sailors on long voyages suffered from scurvy, a disease characterized by bleeding gums and stiff limbs. The discovery in the mid-18th century that eating citrus fruits could cure these symptoms demonstrated the importance of diet in preventing disease, and ships began to carry supplies of limes. In the 20th century it was discovered that citrus fruits are particularly rich in ascorbic acid (vitamin C), and that it is a lack of this substance that causes scurvy. As our understanding increases, so we are better equipped to prevent disease.
Public health measures
Adequate housing is a basic human need and plays an important part in preventing disease. Overcrowded living conditions lead to the rapid spread of disease - for example, evidence of millions of disease-carrying parasites and worms have been found in human remains discovered by archaeologists in primitive settlements. Without toilets and drainage systems, such infestations are passed easily from one person to another. Two thousand years ago, Romans realized the importance of fresh water supplies and sewage systems, and the ruins of Pompeii include fountains, toilet areas and drains. Systems to cope with human waste are essential, since it is a common source of infection if not properly disposed of. Typhoid, for example, can be easily spread by a faulty sewer pipe leaking into the supply of drinking water. In London a cholera outbreak in 1854 was traced to a public well, the Broad Street Pump, which was being contaminated in this way.
Industrialization has brought new problems of pollution and waste disposal. Industrial accidents may also have major environmental effects, not ably accidents at chemical factories or nuclear power stations, and governments impose rigorous safety regulations to prevent these - although the disasters at the chemical factory in Bhopal in India in 1984 and at the nuclear power station at Chernobyl in Ukraine in 1986 show that such regulations are not always fool proof. The effects of radioactivity are particularly long-lasting, and may produce cancers years after the exposure to radiation. People working with dangerous substances such as radiation - for ex ample taking X-rays in hospital - have to take precautions to protect themselves and others.
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p244-2
ftsTitleOverride
Preventing Disease (page 2)
ftsTitle
A measles vaccination given to a small child in Peru. A nationwide epidemic of measles caused a vaccination program to be launched for all children. This prevented the epidemic from infecting more children.
* FOOD, DIET AND DIGESTION
* THE IMMUNE SYSTEM
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* DRUG ABUSE
* POPULATION AND HUNGER
* THREATS TO THE ENVIRONMENT
* INDUSTRIAL SOCIETY (SOCIAL REFORMS)
Preventing Disease (2 of 4)
International disease control
The World Health Organization in 1980 declared that smallpox, an often fatal disease, was officially extinct. This was the result of a successful worldwide vaccination program. It was hoped that the same success would be achieved with malaria, but unexpected difficulties have prevented the success of this program.
An older method of preventing disease from spreading from country to country - dating from 15th-century Venice - is quarantine. Quarantine (from the Italian quarantina, 40 days) is a period of isolation in which animals (and formerly humans) are detained before being allowed to enter a country - so allowing time for symptoms of a disease to develop before it can be transmitted. In this way, some countries have been successful in preventing rabies entering their territory. This serious illness is spread by animals, often foxes and rodents, but potentially also by domestic animals. In the United Kingdom strict quarantine arrangements for all animals entering the country have prevented the disease from becoming established.
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Vaccination: MeaslesG
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p244-3
ftsTitleOverride
Preventing Disease (page 3)
ftsTitle
Smallpox has now been completely eradicated as a result of worldwide immunization programs.
* FOOD, DIET AND DIGESTION
* THE IMMUNE SYSTEM
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* DRUG ABUSE
* POPULATION AND HUNGER
* THREATS TO THE ENVIRONMENT
* INDUSTRIAL SOCIETY (SOCIAL REFORMS)
Preventing Disease (3 of 4)
Immunization programs
Much protection from disease is given to children through immunization in the first year of life. This has greatly decreased the incidence of previously common illnesses. In the USA certain immunizations - against measles, for instance - are required before a child can be admitted to school.
Rubella (German measles) is a mild illness, but if caught by a woman in the first three months of pregnancy it can affect the developing fetus, resulting in permanent damage such as blindness and deafness. National programs exist in all developed countries to prevent this risk. Before the development of a vaccine many people died or were crippled due to poliomyelitis infection, but two drops of vaccine on the tongue can now provide effective protection for up to 10 years. Immunization is also standard in many countries against diseases such as tuberculosis, diphtheria and tetanus.
In addition to childhood immunization programs, immunization is available to the international traveler to prevent the risk of being affected by a wide range of illnesses.
Health education
Although much health education is undertaken by doctors, nurses, and health visitors, many people obtain health in formation from other sources. Magazines, newspapers and television carry increasing amounts of information on illnesses and their prevention. National campaigns to increase public awareness have been particularly successful.
In the UK, for example, widespread use of sophisticated advertising concerning the AIDS virus led to significant changes in public attitude. It is also thought to have contributed to a reduction in the spread of the disease. In Australia there is a high incidence of malignant melanoma - a skin cancer common in those exposed to strong sunlight. A media campaign has helped to save lives by providing information on early detection and on precautions that prevent melanoma from developing. In the USA the fictional character Superman has been enlisted in a television campaign to encourage people to check their blood cholesterol level. A high level may increase the risk of heart disease; cutting down on fats and eating unsaturated instead of saturated fats can help to reduce it.
Alcohol and tobacco
Cigarettes are known to cause cancer, lung disease and heart disease. Many governments impose restrictions on their advertising and sale, and increasingly on where they are smoked, since it is now recognized that it is possible to develop cancer from inhaling other peoples' cigarette smoke. Alcohol causes brain and liver damage and some types of cancer, as well as numerous accidents. Recent health campaigns have focused on the amount people can drink without risking these effects.
Health checks
In France the government links social security benefits to pregnant women to their attendance at antenatal clinics. This encourages attendance, which can lead to the early detection and prevention of diseases in the mother and the child.
Health-screening checks are used to detect various diseases, resulting in early treatment and fewer deaths. Finland and Scotland have succeeded, through regular screening, in reducing the number of deaths in women from cancer of the cervix. X-ray techniques that can detect breast cancer are now widely available. Blood pressure can be tested to make sure that it is not dangerously high, and diabetes can be detected by the presence of sugar in the urine. Blood tests can reveal the existence of many conditions, from anemia to the presence of the AIDS virus.
Although expensive to implement, health-screening checks - like other preventive measures - save money in the longer term on expensive treatments once diseases develop. They also save lives.
Overcrowded housing in the past contributed to the rapid spread of diseases such as tuberculosis, while poor sanitation was often a major factor in outbreaks of cholera and typhoid.
* FOOD, DIET AND DIGESTION
* THE IMMUNE SYSTEM
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* DRUG ABUSE
* POPULATION AND HUNGER
* THREATS TO THE ENVIRONMENT
* INDUSTRIAL SOCIETY (SOCIAL REFORMS)
Preventing Disease (4 of 4)
MALARIA
Every year in the tropics, more than 1 million people still die of malaria and 2 million new cases appear, despite worldwide effects to control the disease. The current situation is now more complex and difficult to solve than ever before.
All efforts at controlling the disease focus on the mosquito that is the carrier of the malaria parasite. A per-son catches malaria when bitten by a female mosquito. The parasite may then stay dormant in the human liver for months or even years before causing symptoms. There are different types of malaria, some more likely than others to be fatal.
Control of the mosquito population helps to control the disease. This is done by destroying breeding sites -still water such as ponds - through land drainage, treating water with chemicals to destroy mosquito larvae, and the use of insecticides to kill mosquitoes.
Drugs can be used to treat infected humans, and measures - such as the use of nets, repellents and suitable clothing - can be taken to prevent the mosquito biting.
Throughout the 1950s and 1960s the World Health Organization had enormous success in malaria eradication, particularly in the USA and Europe. The program also led to a 500-fold decrease in malaria in India. Unfortunately resistance of mosquitoes to the insecticide DDT then developed and in many areas in the 1970s the eradication began to falter. Some countries still have widespread malaria.
Travelers to areas where malaria is prevalent must take anti-malarial tablets before setting out, during their stay, and for at least four weeks after their return. The wide variety of drugs needed to prevent malaria reflects the emergence of the malaria parasite's resistance to certain drugs. This has further hampered control of the disease. Travelers must be careful to match their drug to the exact area they are traveling to in order to ensure its effectiveness.
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ftsTitleOverride
Drug Abuse (page 1)
ftsTitle
Sniffing cocaine can cause ulceration of the mucous membranes in the nose; death from respiratory arrest is
possible after high doses.
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
* MENTAL DISORDERS
* DEVIANCE, CRIME AND LAW ENFORCEMENT
* YOUTH MOVEMENTS
Drug Abuse (1 of 4)
People have been taking drugs for medicinal, spiritual or pleasurable purposes since the dawn of recorded history. Drug abuse is to be found among all known societies and cultures. Drug use is a subjective term implying dangerous use, usually of an illegal substance, and often reveals more about what is socially acceptable than what is truly harmful. In some societies heavy drinking and tobacco smoking are not generally considered to be drug abuse.
More precise terms have recently come into use: taking drugs for pleasure is referred to as recreational, as opposed to medical, use. Drug use which causes harm to the user is problem use, and can result from both medical and recreational use.
Physical and psychological dependence
Drug use can sometimes result in dependence, a craving to use again and again. This dependence may be physical, with unpleasant or dangerous symptoms when use of the drug is terminated, or psycho logical. Psychological dependence is often a greater problem than physical dependence and can occur with activities unrelated to drugs - gambling, for instance.
Such repeated activities can become harmful compulsions, especially if the person concerned faces problems such as lack of housing or employment, is susceptible to peer-group pressures, or is having difficulties with relationships.
Psychological factors can even influence the experience of physical dependence. The more a user fears withdrawing from a drug, the worse the physical withdrawal symptoms are likely to be. The dosage to which they have become accustomed is largely irrelevant. Regular sustained drug use can become an emotional crutch, with the routine of buying and taking the drug assuming a more important role than the physical effects.
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Drug Abuse (page 2)
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The injection-scarred arm of an intravenous drug user.
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
* MENTAL DISORDERS
* DEVIANCE, CRIME AND LAW ENFORCEMENT
* YOUTH MOVEMENTS
Drug Abuse (2 of 4)
Drugs and society
Different cultures use different drugs in different ways. For Sadhus - Hindu ascetics in India - cannabis is a sacred substance believed to assist the path to true understanding. The Christian world generally punishes cannabis use, but uses alcohol in religious services. Most Islamic societies ban both.
The social context in which drugs are taken influences how they are used. Alcohol is a physically addictive drug, dangerous by any standards, which causes immense harm when used excessively. Were it not for the fact that the majority of people drink without problems, most of the Western world would be facing widespread alcoholism and imminent social collapse. People have developed 'safe' drinking habits, reinforced by social pressures, such as not drinking alone, not drinking in the morning, or not drinking and driving. Other cultures control other drug use in similar ways.
Advertising, price structures, availability and the law all play a role in influencing who uses what drug, and how they use it.
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Drug Abuse (page 3)
ftsTitle
Prohibition, the illegal manufacture and sale of alcohol, was widespread in the USA during the 1920s. In this picture state troopers are unloading captured
alcohol in 1920.
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
* MENTAL DISORDERS
* DEVIANCE, CRIME AND LAW ENFORCEMENT
* YOUTH MOVEMENTS
Drug Abuse (3 of 4)
Legal and illegal drugs
Despite international statutes that prohibit or restrict production and sale of certain drugs, differing cultural attitudes to drugs remain partially reflected in different laws. Cannabis is still legally available in certain Indian states, and may be used in limited quantities in some European countries and American states. Public tobacco smoking is becoming increasingly restricted.
There is an important distinction between laws prohibiting drugs and statutes regulating their production, sale and public consumption such as the UK alcohol licensing laws. Prohibition forces production and consumption underground, creating rich illegal cartels as in the USA in the 1920s. The wealth and power of many organized criminal syndicates in the USA, now dealing in heroin and cocaine, grew from this era. Estimating the present size of world illicit markets is difficult, since these businesses tend not to publish their accounts. In Bolivia and Colombia the value of the illicit drug trade, largely cocaine, probably exceeds the combined value of all legal trade. In Europe, particularly the UK and Scandinavian countries, amphetamines are one of the most commonly used drugs and widespread domestic production generates huge sums.
There are no documented examples of prohibition eradicating the sale and use of an illegal drug. There are also many abused substances - such as lighter fuels, aerosols, cleaning fluids or the solvents in glue - which for practical reasons cannot be banned, although in some countries such as the UK and Eire retailers may not knowingly sell these for inhalation.
People are unlikely suddenly to stop using drugs, legal and illegal, and one proposed solution has been legal, strictly regulated supply and consumption of currently illegal drugs. However, it may be many years before legal consumption and supply curbs the power of illicit suppliers.
Nor is unrestricted legal supply a sensible solution. Restrictions controlling advertising, taxes to control relative price structures, and prescribing regulations making drugs such as heroin and amphetamines available to dependents are increasingly recognized as valid tools for minimizing problem drug use.
New Drugs
The quest for safe, non-addictive substitutes for commonly abused substances has been a long one. Heroin was advertised as a miracle cure for many diseases and as a non-addictive substitute for morphine and opium when it was first introduced in the late 19th century. Barbiturates were tried as a safe substitute for heroin, until they were found to be far more physically addictive, more liable to cause death through overdose and even capable - unlike heroin - of causing death during withdrawal. The benzodiazepines were in turn seen as a safe substitute for barbiturates until it was discovered, too late for many medical users, that they also induced both physical and psychological dependence.
Illicit chemists have been working for years on drugs similar in effect to banned substances, yet chemically distinct and therefore legal - until the law is changed. MDMA, known as XTC, ecstasy or adam, was one such drug, 'designed' as a substitute for LSD. It is now illegal in the UK.
Treatment
There is no single cure for problem drug use. Different treatments suit different people. It is generally accepted that withdrawing from physical addiction presents less of a problem than coping with psychological dependence. Successful treatment often has little to do with the drug itself, and may focus on personal counseling or practical assistance in finding work or a home. In recent years the concept of helping users learn safe drug use has become more acceptable as an option where total abstinence is unrealistic. Distributing clean syringes to combat HIV infection, prescribing opioids to maintain dependents on stable doses, and teaching sensible drinking habits are all examples of this approach.
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ftsTitleOverride
Drug Abuse (page 4)
ftsTitle
Intravenous drug users inject heroin to satisfy their addiction.
* RESPIRATION AND CIRCULATION
* THE NERVOUS SYSTEM
* MENTAL DISORDERS
* DEVIANCE, CRIME AND LAW ENFORCEMENT
* YOUTH MOVEMENTS
Drug Abuse (4 of 4)
TYPES OF DRUG
ALCOHOL
Short-term effects: Intoxication lasting several hours.
Long-term effects: Increased risk of liver disease, high blood pressure, diseases of the nervous system, strong physical and psychological dependence. Withdrawal after very heavy use can lead to delirium, which can be fatal. Regular heavy drinking during pregnancy can cause permanent damage to the baby.
BARBITURATES
Medical use: As hypnotics (sleep inducers).
Short-term effects: Drunkenness if sleep does not occur. Overdose deaths possible after less than 10 times usual dose. Extremely dangerous with alcohol. Effects last 3-6 hours.
Long-term effects: Chronic inebriation, respiratory problems. Risk of overdose death even when tolerance has built up. Strong psychological and physical dependence. Withdrawal can cause seizures and delirium, and can be fatal.
BENZODIAZEPINES
Medical use: As tranquilizers and hypnotics; include Valium, Librium, Ativan, Mogadon, etc.
Short-term effects: Relief from anxiety. Overdose death only possible with massive doses.
Long-term effects: Lethargy, physical and psychological dependence. Withdrawal causes anxiety, restlessness and tremors.
SOLVENTS AND GASES
Short-term effects: Immediate intoxication lasting 15-45 minutes. Deaths due to accidents, suffocation and heart failure possible.
Long-term effects: Impairment of mental and physical functions - clears up when sniffing stopped. Prolonged use can cause brain damage. Aerosols and cleaning fluids especially harmful.
OPIATES AND OPIOIDS
Opiates - natural derivatives of the opium poppy - include heroin and morphine. Opioids - synthetic drugs similar to opiates - include methadone and pethidine.
Medical use: Pain reduction
Short-term effects: Feeling of warmth and contentment lasting 3-6 hours.
Long-term effects: Psychological and physical dependence, respiratory problems, constipation, lack of sexual drive, instability of mood. Overdose death possible.
AMPHETAMINES
Medical use: Stimulation of nervous system.
Short-term effects: Increased alertness, mood elevation, diminished fatigue lasting 3-4 hours. After repeated doses and consequent sleep loss over several days, temporary psychotic state possible.
Long-term effects: Paranoid thinking and psychotic states, which clear up when use is stopped. Poor health due to lack of sleep and appetite. Withdrawal effects can be severe.
COCAINE
Short-term effects: Similar to amphetamines but lasting for shorter periods. Repeated use over several hours may lead to extreme agitation and paranoid states. Death from respiratory arrest possible after large doses. Cocaine freebase, which includes 'crack', gives more immediate and intense effects of shorter duration.
Long-term use: Short-lived 'high' is followed by extreme mood swings and eating disorders. Paranoid thinking and psychotic behavior possible. If sniffed, possible nose damage; if smoked, possible respiratory problems. Withdrawal effects less intense than with amphetamines but can be severe.
CAFFEINE
Short-term effects: Mild stimulant. After drinking, effects evident within an hour, lasting 3-4 hours. Overdose death possible after huge doses, but rare.
Long-term effects: Stomach irritation. Irregular heartbeat in susceptible people after high doses.
NICOTINE
Short-term effects: Mild stimulant, also felt to be relaxing by regular users. Inhaled in tobacco smoke. Almost immediate but rapidly declining effects.
Long-term effects: Other components of tobacco smoke can cause respiratory diseases, including lung cancer, and heart and circulatory disorders; at least 100 000 tobacco-related deaths in the UK alone each year. Smoking during pregnancy can cause premature birth and smaller babies. Strong psychological dependence.
Short-term effects: Major perceptual distortions, usually known to be unreal, which peak after 2-6 hours and fade after 12 hours. Hallucinations and usually temporary psychotic episode possible.
Long-term effects: Flashbacks (re-experiencing a small part of the episode later) possible. Prolonged psychotic episodes rare but may occur. No physical dependence. Further doses ineffective after several days' continuous use.
HALLUCINOGENIC MUSHROOMS
Short-term effects: Similar to mild LSD experience, but shorter (4-9 hours). Danger of mistakenly picking poisonous mushrooms.
Long-term effects: No physical or psychological dependence. Repeated doses ineffective after several days' continuous use.
CANNABIS
Short-term effects: Relaxed feeling, talkativeness, heightened perceptions. Perceptual distortions possible after high doses.
Long-term effects: Possible psychological dependence. Respiratory problems, including lung cancer if smoked.
PHENCYCLIDINE (PCP)
Medical use: As veterinary anesthetic.
Short-term effects: Unpredictable - stimulation or depression, hallucinations, distortion of time and space, paranoia. Higher doses can cause coma and death.
Long-term effects: Disorientation and severe depression, psychosis, possible physical and psychological dependence.
The information in this table is based on data provided by the Institute for the Study of Drug Dependence and reproduced with their permission.
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ftsTitleOverride
The History of Medicine (page 1)
ftsTitle
The first operation using anesthetic, carried out in 1846 at the Massachusetts General Hospital, USA. The operation - a tooth extraction - was performed by William Morton. The engraving shows sulfuric acid ether being administered to the patient through the mouth.
* HISTORY OF SCIENCE
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* SURGERY
* MEDICAL TECHNOLOGY
* PREVENTING DISEASE
The History of Medicine (1 of 3)
Disease is as old as life itself. Medicine, on the other hand, is of quite recent origin. In most early civilizations medicine was closely linked to religion. Diseases were believed to be caused by gods who might also effect cures, and treatment involved rituals and incantations. In ancient Egypt physicians were priests trained in special temple schools, and one famous physician, Imhotep (c. 2900 BC), was made a god of healing. >>Papyrus fragments such as the Ebers Papyrus show that Egyptian medicine was sophisticated in observation and diagnosis, if not in treatment. In ancient Babylon the Code of Hammurabi, the world's first legal code, contained laws regulating a large and well-organized medical profession.
The concepts of early Indian medicine are set out in sacred texts called the Vedas, which may date back to the 2nd millennium BC. Numerous herbal remedies are described.
Greek medicine
At its peak Greek medicine was rational, scientific and clearly separated from religion. The Greek philosopher Hippocrates of Cos (c. 460-370 BC) is regarded as the 'father of modern medicine'. His teachings were written down by his followers in a collection known as the Hippocratic Corpus. Hippocrates believed that moderation in all things is the key to health. He also set out a code of ethics for physicians, and the Hippocratic Oath, taken by doctors, is based on this code.
The Greek theory of the four elements and the four humors - which originated with the philosophers Empedocles (c. 490-430 BC) and Aristotle (384-322 BC) - influenced the shape of medicine for many centuries. At the time of the Roman Empire the Greek physician Galen of Pergamum (Latin name Claudius Galenus, AD 130-201) carried out dissections on animals but none on human specimens, and this led to many errors in his anatomical descriptions. Galen combined the theory of the humors with his own studies in anatomy and physiology to produce an erroneous system of medicine, which nevertheless lasted more than 1000 years.
Medieval medicine
As the Roman Empire declined and fell, civilization moved eastward. Greek learning was preserved and developed by Arab scholars such as Razes (Arabic name al- Rhazi, AD 860-932) and Avicenna (Arabic name Ibn Sinna, AD 980-1036), and from about AD 1000 ancient knowledge began to return to the West via centers such as the medical school at Salerno. Later, medicine was taught in new universities such as Montpellier in France and Bologna in Italy - two places where, in the 14th century, anatomy lessons included the public dissection of corpses. Because in this period a physician was expected to have had an academic schooling, he became known as 'doctor' - an academic title. However, the Church prohibited clerks from shedding blood and this meant that medieval universities did not teach surgery. In this field students had to be trained by a practicing surgeon. In general, medieval medicine was a mixture of ancient physiology, empirical knowledge of the effects of some drugs and superstitious incantation. By the 14th century thousands of hospitals had been founded in Europe.
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ftsTitleOverride
The History of Medicine (page 2)
ftsTitle
An engraving from the first edition of De Humani Corporis Fabrica by Vesalius, published in 1543.
* HISTORY OF SCIENCE
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* SURGERY
* MEDICAL TECHNOLOGY
* PREVENTING DISEASE
The History of Medicine (2 of 3)
The 16th century
Before this time individual doctors had frequently doubted Galen's authority on specific points, but it was only after the invention of printing that such doubts could become widely known. For example, in his book De Humani Corporis Fabrica ('On the Fabric of the Human Body') the Flemish anatomist Andreas Vesalius (1514-64) showed the inadequacies of Galen. It is the first accurate anatomy book, based on the dissection of human corpses, and laid the foundations of modern anatomy. Surgery was advanced at the same time by the Frenchman Ambroise Paru (1517-90), who opposed the use of cauterization (the application of red-hot irons or boiling oil) to treat wounds.
The Italian Girolamo Fracastoro (Latin name Fracastorius, 1484-1553) speculated that epidemic diseases might be caused by minute germs, invisible to the naked eye. He argued that germs are specific, i.e. that each kind causes a particular disease, but his theory was not proved until the 19th century. The idea that specific diseases required specific treatments was pioneered by a Swiss physician and al-chemist, Philippus Aureolus Paracelsus (real name Theophrastus Bombastus von Hohenheim, 1493-1541). He also introduced the use of chemicals into medicine, pioneering the use of mercury and laudanum.
The 17th and 18th centuries
The main medical event of the 17th century was the discovery by William Harvey (1578-1677), an English physician, of the true nature of the heartbeat and the circulation of the blood. His book De Motu Cordis ('On the Movement of the Heart') laid the foundation of all modern physiology - although Harvey did not realize why the blood circulates.
A further aid to the study of physiology - and to medical science generally - was provided by the invention of microscopes. The Dutchman Anton van Leeuwenhoek (1632-1723) showed the value of these fundamental research tools by using them to investigate blood cells, spermatozoa and even microbes.
During the 18th century a number of great medical schools, including Vienna and Edinburgh, were founded. Surgery was established on firm scientific principles by the Scot John Hunter (1728-93), who also proved the value of experimental surgery. The science of neurology was pioneered by the Swiss physiologist Albrecht von Haller (1708-77), with his theory that nerve fibers acted on 'irritable' muscle to produce movement.
Giovanni Battista Morgagni (1682-1771), an Italian anatomist, argued that disease is localized in parts of the body rather than spread throughout, while the invention of the stethoscope by the French physician Renu Thuophile Hyacinthe Laennec (1781-1826) was to prove a major aid in the diagnosis of disease.
Although the practice of medicine up to this point often did more harm than good to patients, one of the first scientific steps in preventing disease was the introduction of vaccination by the English physician Edward Jenner (1749-1823), when he discovered in 1796 that inoculation with the cowpox virus gives immunity to smallpox. Immunization against various other diseases was to be introduced over the next two centuries, and smallpox itself was finally eradicated from the world in the 1970s.
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The History of Medicine (page 3)
ftsTitle
Louis Pasteur (1822-95) in his laboratory. Pasteur's demonstration that many diseases are caused by specific microorganisms was a major breakthrough in medical science.
Pasteur also did important work on the micro-biology of fermentation.
* HISTORY OF SCIENCE
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* SURGERY
* MEDICAL TECHNOLOGY
* PREVENTING DISEASE
The History of Medicine (3 of 3)
The 19th century
The 19th century was the century of progress in medicine. One of the most important discoveries was the demonstration by the Frenchman Louis Pasteur (1822-95) and the German Robert Koch (1843-1910) that diseases such as rabies and tuberculosis are caused by microorganisms called bacteria . They showed precisely which bacteria cause which disease, and between 1875 and 1906 over twenty fatal diseases were understood and made preventable through immunization.
Although by the 19th century many kinds of surgical operation had been successfully carried out, patients died in large numbers from infections entering their bodies during operations or childbirth, or through wounds. They also had to endure the agony of being fully conscious during operations. Pain control by anesthesia (loss of feeling induced by drugs) was pioneered by the Americans Horace Wells (1815-48), using nitrous oxide, and William Thomas Green Morton (1819- 68), using ether. In Britain general anesthesia - rendering the patient unconscious - by means of chloroform was introduced by the Scottish surgeon Sir James Young Simpson (1811-70). In the 1840s the Hungarian Ignaz P. Semmelweiss (1818-65) showed the crucial importance of asepsis (a germ-free environment) in childbirth wards, and in 1865, following Pasteur's theory of bacterial infection, the Scottish surgeon Joseph Lister (later Lord Lister) (1827-1912) introduced antisepsis (the destruction of bacteria), spraying the area being operated on with carbolic acid.
The century also saw many measures introduced to improve public health. Chief among these were improved sewage and sanitary conditions, and such preventive measures improved the life expectancies of millions.
Finally, the century saw the emergence of modern nursing, largely due to the efforts of the Englishwoman, Florence Nightingale (1820-1910), who showed that good nursing had a dramatic effect on reducing death rates in hospitals.
The 20th century
The 20th century has been an era of technological innovation in medicine, particularly in diagnosis. In 1895 the German physicist Wilhelm Konrad Rontgen (1845-1923) discovered X-rays, the medical applications of which had been realized by the turn of the century. Other inventions of the early part of the century included the electrocardiograph (for measuring heart activity) and the electroencephalograph (for measuring brain activity). The introduction of ultrasound scanning in the 1970s allowed even more accurate pictures than X-rays, which cannot safely be used for long exposures or on pregnant women.
Work on the chemistry of nutrition by the German Emil Fischer (1852-1919) gave rise to biochemistry (the study of the chemistry of living organisms), and the chemical study of disease is now a basic medical approach. Out of Fischer's work came the discovery by the British biochemist Sir Frederick Gowland Hopkins (1861-1947) that certain substances - later called vitamins - are essential to the diet in minute amounts, and that disease occurs if these are absent.
Chemotherapy, treatment by chemicals that attack disease agents with minimum harm to the body, was pioneered by the German scientist Paul Ehrlich (1854-1915), who discovered that synthetic dyestuffs could kill bacteria. The sulphonamides, derived from dyestuffs and introduced in 1932, greatly reduced the number of post-operative infections. Ehrlich also initiated the study of the body's immune system. A large number of bacterial infections - many of which were previously fatal - were rendered curable by a new range of drugs, the antibiotics. These drugs were developed from the accidental discovery by the British microbiologist Sir Alexander Fleming (1881-1955) that a growth of penicillin mould had destroyed a bacterial culture he was working on.
Surgery has also been aided by technology, and now lasers are sometimes used for very precise work. The greater understanding of the immune system has led to the possibility of transplants of organs from one body to another. Kidney transplantation, first attempted in 1902, is now a well-established operation. Heart transplantation was first performed by the South African surgeon Christiaan Barnard (1922- ) in 1967.
ELEMENTS AND HUMORS
The ancient Greeks believed that everything was made out of combinations of air, water, earth and fire - and that these corresponded to four qualities - cold, wet, dry and hot. They thought that in the body the elements blend to form four humors : blood (hot and wet), yellow bile (hot and dry), black bile (dry and cold) and phlegm (cold and wet). Good mental and physical health was supposed to depend on the correct balance of the humors. This view of human physiology remained current until the 17th century, and is still preserved in words indicating a dominance of one humor, such as 'phlegmatic' (not easily excited), 'sanguine' (cheerful and confident, from the Latin sanguis, 'blood') and 'bilious' (irritable - yellow bile was supposed to cause anger, and black bile melancholy. In the 2nd century AD Galen refined the physiology of the Greeks with his early theory of circulation. The theory stated that nutriments from the stomach moved to the liver, where they were made into blood. Blood moved into the right side of the heart, and passed through the wall of the heart to the left side where it mixed with vital spirits from the lungs. Some now traveled to the organs and limbs, and the remainder went to the brain where animal spirits were formed.
It was this false physiology that Harvey replaced in the 17th century when he found that blood is pumped by the heart into the arteries and returned to the heart by the veins.
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Alternative Medicine (page 1)
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A Chinese model of an 'acupuncture man', showing the main energy lines and healing points.
* HOW PEOPLE MOVE
* THE NERVOUS SYSTEM
* THE BRAIN
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* MEDICAL TECHNOLOGY
Alternative Medicine (1 of 4)
Alternative medicine encompasses all the forms of healing that lie outside the sort of medicine people normally receive from a GP or hospital. It includes a wide variety of different therapies used by millions of people worldwide to treat every ill imaginable. That they appear to work in some cases is beyond doubt. How they work, however, is still to a large extent a mystery.
Medical science has made great advances and has long seemed to promise a 'pill for every ill'. Virtually every drug, however, has been shown to have some side effects and many patients have become dissatisfied with the inability of orthodox treatments to cure certain conditions - particularly chronic diseases such as arthritis. The common feature that seems to run through every one of the alternative treatments is the importance placed on the whole person, not just on specific symptoms - this is known as the holistic approach.
Herbalism
Herbalism is an ancient form of medicine. From the dawn of humanity, people have been using plants to cure their illnesses. From the Middle Ages, herbals - manuals listing the names of plants and what they could be used for - were widely used. In the 17th century Nicholas Culpeper (1616-54) combined herbalism with astrology in his Herbal. Herbalists today use the roots, leaves, stems, flowers and seeds of plants to produce medicines. A large number of orthodox modern medicines are also derived from plants - the heart drug digoxin is produced from the foxglove, and the group of painkillers known as opiates are derived from the opium poppy.
Once a diagnosis has been made, the herbalist will dilute a concentrated extract of a certain herb in water or mix it into a paste to form a cream or ointment.
Conditions such as arthritis, colds and coughs, skin problems, digestive disorders and minor injuries are regarded as the most likely to benefit from herbalism.
Homoeopathy
Homoeopathy was invented by a German doctor, Samuel Hahnemann (1755-1843). He reasoned that since many of the symptoms people suffer during illness - fever or pain, for example - are actually visible signs of the body's own defenses working against the disease, it would make sense to try to boost these defenses. He based his therapy on the principle that 'like cures like', giving patients tiny quantities of substances known to produce exactly these symptoms in healthy people. One homoeopathic remedy for fever, for instance, is sulfur, which produces a feeling of heat and promotes sweating if taken by mouth in larger doses.
Homoeopathy offers remedies for virtually every medical complaint, but it is less frequently used in acute or life-threatening illness. Homoeopathic remedies are prescribed by some GPs as well as by homoeopaths.
Aromatherapy
Aromatherapy is principally a massage technique in which essential oils derived from herbs, flowers and spices are rubbed into the skin and eventually inhaled. The natural fragrances these oils produce are said to be particularly effective for psychological complaints such as anxiety or depression, but are used to treat a range of conditions including skin disorders and burns.
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Alternative Medicine (page 2)
ftsTitle
An acupuncturist treating a patient for persistent headaches.
* HOW PEOPLE MOVE
* THE NERVOUS SYSTEM
* THE BRAIN
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* MEDICAL TECHNOLOGY
Alternative Medicine (2 of 4)
Acupuncture
Acupuncture originated in China over 5000 years ago. The technique uses fine needles inserted at specific points on the body in order to restore the balance of an inner 'life force' known as chi energy and believed to flow along a number of meridians or channels in the body. Each of the 12 main meridians is believed to have its own pulse - six in each wrist - and the acupuncturist checks these carefully in order to decide which points to stimulate.
The technique has been shown to be remarkably successful at stopping pain, and in China major operations have been carried out using only acupuncture for pain relief. Scientists have discovered that the needles appear to make the body produce its own natural painkillers, endorphins. Acupuncture is also claimed to be effective in treating a wide range of diseases, including respiratory, digestive, bone and muscle disorders.
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Alternative Medicine (page 3)
ftsTitle
A reflexology chart showing the areas of the feet that correspond to various organs, structures and systems of the body.
* HOW PEOPLE MOVE
* THE NERVOUS SYSTEM
* THE BRAIN
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* MEDICAL TECHNOLOGY
Alternative Medicine (3 of 4)
Reflexology
Like acupuncture, reflexology is based on the idea that the body contains channels of 'life force'. Reflexologists believe that this force exists in 10 'zones' of energy that each begin in the toes and end in the fingers.
By touching and feeling the toes and feet, reflexologists claim to be able to feel blocks in these channels of energy (they say these feel like crystals below the skin surface), and by manipulating and massaging the foot in a specific way they try to move the blockage, thus curing the illness. Like acupuncture, reflexology is used to treat most conditions.
Osteopathy
Osteopathy is a manipulative technique founded by the American doctor Andrew Taylor Still (1828-1917). Joints are pushed and occasionally pulled so as to restore them to their normal positions, thus relieving tensions on surrounding muscles, tendons and ligaments.
Osteopaths tend to concentrate their work on the spine since this contains the spinal cord and all the nerves that control the body. Back pain is the disorder most commonly treated by an osteopath.
Chiropractic
The central philosophy of chiropractic is that malalignments of the bones in the spine cause disturbances of the nervous and vascular systems leading to disease not only in the bones and muscles themselves, but in any organ of the body.
Chiropractitioners work with the help of X-rays to discover where the malalignments are and to identify 'intersegmental dysrelationships'. They then manipulate the bones using short, but very forceful thrusts to the joint, thus relieving the root cause of the problem. However, chiropractic should not be used in any case of bone malignancy (cancer) or where the spinal cord is compressed. The rapid, forceful thrusts can lead to fracture and paralysis in these cases.
The Alexander Technique
The Alexander Technique is a method of producing postural changes, which are claimed to relieve a number of physical disorders. The technique was developed in the 19th century by an Australian actor, Matthias Alexander (1869-1955). He realized that the position of his head and neck were the cause of his frequent loss of voice during performances, and found that by altering his posture he could cure himself.
During a series of lessons - 12 or more - the person 'relearns' how to use the body, breaking harmful postural habits. The technique is claimed to be beneficial for everyone, but in particular for those who have suffered long spells of general ill health - lethargy or poor sleeping, for example.
Biofeedback
Biofeedback is a technique used to help people learn to control physical phenomena governed by the autonomic nervous system, such as blood pressure, heartbeat and temperature. Electrodes placed on the body pick up electrical impulses produced by physical changes. The impulses are transformed by the biofeedback machine into an electronic sound, or shown by the rise and fall of a needle on a dial. The person concentrates on changing the tone of the sound or on causing the needle to move and in doing so learns, for instance, to lower the blood pressure or slow down the heartbeat.
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Alternative Medicine (page 4)
ftsTitle
In acupuncture, fine needles are inserted at specific points on the body in order to restore the balance of an inner 'life force'.
* HOW PEOPLE MOVE
* THE NERVOUS SYSTEM
* THE BRAIN
* NON-INFECTIOUS DISEASES
* INFECTIOUS DISEASES
* MEDICAL TECHNOLOGY
Alternative Medicine (4 of 4)
POTENTIZING OF HOMOEOPATHIC REMEDIES
In order to produce the tiny quantities that are needed for homoeopathic remedies, the active substance must be diluted. This process is known as potentizing. The active substance is diluted in proportions of 1 to 10, usually in distilled water, and this dilution is carried out six or more times in succession - the homoeopathic 'potency 6' is one million times diluted. Theoretically, with sufficient dilution, there can be none of the active substance left.
So how is it that these remedies can still work? The secret is claimed to lie in the rapid shaking or succussion that must be performed after each dilution. If the succussion is not carried out, the remedy is ineffective.
The explanation for this phenomenon is best given by comparing each molecule of the homoeopathic remedy, suspended in the dilution, to a person walking across a snow-field. Once the person has passed by, nothing physical remains, and only the footprints are left in the snow. Although there are few if any molecules of the active ingredient left, its 'footprints', thought to be produced by succussion, remain to do their work in the body.
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