1.ANATOMY AND MEDICINE. HUMAN ANATOMY DEPARTMENT OF TERNOPIL STATE MEDICAL UNIVERSITY. Presentation of the human anatomy department.

2. The main anatomical terms. The role of anatomy in the medical education. Planes, axes and surfaces. The bone structure. Periosteum. Trunk skeleton (general data).

3. Vertebrae (general data). Cervical, thoracic and lumbar vertebrae. Sacrum. Coccyx. THE VERTEBRAL COLUMN AS a WHOLE

Lesson # 1

Theme 1. ANATOMY AND MEDICINE. HUMAN ANATOMY DEPARTMENT OF TERNOPIL STATE MEDICAL UNIVERSITY. Presentation of the human anatomy department. The main anatomical terms. The role of anatomy in the medical education. DEPARTMENT of HUMAN ANATOMY

THE TERM human anatomy comprises a consideration of the various structures which make up the human organism. In a restricted sense it deals merely with the parts which form the fully developed individual and which can be rendered evident to the naked eye by various methods of dissection. Regarded from such a standpoint it may be studied by two methods: (1) the various structures may be separately considered—systematic anatomy; or (2) the organs and tissues may be studied in relation to one another—topographical or regional anatomy.

  It is, however, of much advantage to add to the facts ascertained by naked-eye dissection those obtained by the use of the microscope. This introduces two fields of investigation, viz., the study of the minute structure of the various component parts of the body—histology—and the study of the human organism in its immature condition, i. e., the various stages of its intrauterine development from the fertilized ovum up to the period when it assumes an independent existence—embryology. Owing to the difficulty of obtaining material illustrating all the stages of this early development, gaps must be filled up by observations on the development of lower forms—comparative embryology, or by a consideration of adult forms in the line of human ancestry—comparative anatomy. The direct application of the facts of human anatomy to the various pathological conditions which may occur constitutes the subject of applied anatomy. Finally, the appreciation of structures on or immediately underlying the surface of the body is frequently made the subject of special study—surface anatomy.

  SYSTEMATIC ANATOMY.—The various systems of which the human body is composed are grouped under the following headings:

Osteology—the bony system or skeleton.

Syndesmology—the articulations or joints.

Myology—the muscles. With the description of the muscles it is convenient to include that of the fasciæ which are so intimately connected with them.

Angiology—the vascular system, comprising the heart, bloodvessels, lymphatic vessels, and lymph glands.

Neurology—the nervous system. The organs of sense may be included in this system.

Splanchnology—the visceral system. Topographically the viscera form two groups, viz., the thoracic viscera and the abdomino-pelvic viscera. The heart, a thoracic viscus, is best considered with the vascular system. The rest of the viscera may be grouped according to their functions: (a) the respiratory apparatus; (b) the digestive apparatus; and (c) the urogenital apparatus. Strictly speaking, the third subgroup should include only such components of the urogenital apparatus as are included within the abdomino-pelvic cavity, but it is convenient to study under this heading certain parts which lie in relation to the surface of the body, e. g., the testes and the external organs of generation.

  For descriptive purposes the body is supposed to be in the erect posture, with the arms hanging by the sides and the palms of the hands directed forward. The median plane is a vertical antero-posterior plane, passing through the center of the trunk. This plane will pass approximately through the sagittal suture of the skull, and hence any plane parallel to it is termed a sagittal plane. A vertical plane at right angles to the median plane passes, roughly speaking, through the central part of the coronal suture or through a line parallel to it; such a plane is known as a frontal plane or sometimes as a coronal plane. A plane at right angles to both the median and frontal planes is termed a transverse plane.

  The terms anterior or ventral, and posterior or dorsal, are employed to indicate the relation of parts to the front or back of the body or limbs, and the terms superior or cephalic, and inferior or caudal, to indicate the relative levels of different structures; structures nearer to or farther from the median plane are referred to as medial or lateral respectively.

  The terms superficial and deep are strictly confined to descriptions of the relative depth from the surface of the various structures; external and internal are reserved almost entirely for describing the walls of cavities or of hollow viscera. In the case of the limbs the words proximal and distal refer to the relative distance from the attached end of the limb.

The Department of Human Anatomy of the Ternopil State Medical Academy was founded in 1957. At first it placed on the physiological building (today administrative building on the maydan Voli, 1). In that time the staff of department consists of the manager, two senior lecturers, four assistants, laboratory assistant and preparator. The students studied in one sectional hall, where six groups simultaneously could be placed, and for educational process anatomical models, 300 tables, and also stuffs of prosection separations of hospitals of city were used.

In August, 1959 department was transferred into modern morphological building on a street Ruska, 12. The educational rooms placed on the second level and actuated 2 sectional halls on 7 workstations. In a dextral wing of a building the main division of department was equipped room for cadavers. The students had a capability independently to make dispositions for practical classes using dry and wet preparations, the fund of the lecture tables was augmented, were built up a fundamentals for creation of an educational Anatomical Museum.

Senior lecturer A.О. Verisotskyy was first Head of Department in 1957. Professor М.Y. Polyankin has written above 100 scientific articles, the majority of which are dedicated to a circulatory system of the human and animal. He managed the scientific researches of influencing on an organism of gravitational overloading have begun. The pioneer of these researches was professor V.H.Коvеshnikov.

In 1972 department has headed MD Professor V.H. Коvеshnikov. During his management the exterior of department has changed, the Anatomical Museum has extended, there were inserted new training programs for the students. Professor V.H. Коvеshnikov carried out 6th Ukrainian Scientific Conference of anatomists, histologists, embryologists (in 1975) and Congress of sport morphologists (in 1980). Honoured Scientist Professor M.H. Prives, author of famous edition “Human Anatomy”, translated into English, Spain, wrote: “DEPARTMENT of HUMAN ANATOMY of Ternopil Medical Academy has modern equipment and design. Department meets requirements of modern anatomic science. It is the best department in the country. Especially I want to underline high qualification of staff and its devotion to educational business.”

The main scientific supervision on department was and there is an analysis of influencing external and internal environment at a skeletal system. For the initiatives Professor V.H. Коvеshnikov on the basis departments were conducted scientific conferences, workshops, congresses of the morphologists.

Since July, 1984 department has headed by professor Y.I.Fedonyuk. He is Honoured Scientist of Ukraine, Academician of New-York Academe of Sciences, Academician of International Academy of Integrative Anthropology, and Academician of Academy of National Progress. Professor Y.I.Fedonyuk prolongs the best traditions and scientific investigations. He has written above 550 scientific articles and books and five monographs. Under his management 15 candidate and 2 doctoral thesis realized. His name is in the brief biographic data are included in 24-those biographic issuing of the Cambridge International Biographic Centre (England). Main scientific field of Human Anatomy Department – morphology and development of tubular and plate bones of the skeleton during and after dehydration of organism, problems bound up with osteoporosis. Macro- and microstructure of the thyroid glands, spleen and kidneys are investigated. Scientists of Department took participated at national and international congresses: Timisoara, 1998, 2002 (Romania), Yerevan, 1998 (Armenia), Wroclav, 1999 (Poland), Beijing, 1999 (China). Professor Y.I.Fedonyuk is leader of scientific school that investigate problem “Influence of external and internal environmental factors to structure of the bone and internal organs and somatic proportions with different type of autonomic nervous system”.

Professor Y.I.Fedonyuk, associated professors – I.Y.Herasymyuk, B.V. Holod, А.М. Pryshlyak, B.Y. Reminetskyy, P.P. Flekey, O.M.Kyrychok, V.V. Buryy, I.I. Boymistruk, M.V. Yushchak, R.V.Hovda, M.V.Samborskyy work at the department. The staff of department participated in preparing the Ukrainian version of the Anatomical Nomenclature, from department sends to the public tutorials for the students of medical and nursing schools. Staff of the department develops new educational methods with using anatomical preparations and computer technique, including methods in English language medium.

Anatomy is the study of the structure of the body. Derived from the Greek to cut up: the Latin 'to cut up' gives us dissect. Anatomy has a very specialised vocabulary, much of it inherited from Latin, Greek. There is a standard list of terms, in Latin, which has the disadvantage that virtually no one uses it.

Major parts of the body

Anatomical usage follows general for most of the main parts, head neck, and trunk. The limbs are a little different. The Anatomist calls these the upper and lower limbs, and arm means between shoulder and elbow, and leg between knee and ankle. We subdivide the trunk into thorax, above the diaphragm and abdomen, below it.

The anatomical position

For descriptive purposes the body is always imagined to be in the anatomical position, standing erect, arms by sides, palms of hands facing forwards. In this position directions are given by superior, inferior, anterior, posterior. These are equivalent to the zoologist’s cephalic, caudal, ventral and dorsal. Thus the eyes are always superior to the mouth, even if the patient is lying down or standing on his head. These terms are not quite equivalent to above, below, in front of and behind. To a layman acrobats’ feet are above her head when she is dangling from a trapeze: to an anatomist they are inferior.

Theme 2. Planes, axes and surfaces. The bone structure. Periosteum. Trunk skeleton (general data)

Principal Axes Anterior view on left Horizontal (transverse) axis is perpendicular (at a right angle) to the longitudinal axis and runs from left to right. Longitudinal (vertical) axis, this is a vertical axis through the body in the upright position.

Lateral view on right The saggital (antero-posterior) axis runs from front to back which is why it is also know as an antero-posterior axis. This axis is perpendicular (at right angles) to the other 2 axes

Other dimensions are referred to the midline - median, medial or lateral, or to their closeness to the body surface, superficial or deep. In the limbs structures near the trunk are proximal, those further away are distal. We have a problem with the hands and feet: the palms of the hands resemble the soles of the feet and the thumb is equivalent to the great toe. But the palmar surface of the hand faces anteriorly and the back is dorsal. In the foot we defy logic and call the inferior surface plantar (equivalent to palmar) and the superior surface dorsal, even though it faces upwards. But we are still not out of the wood because the great toe is medial but the thumb is lateral. To get around this the term preaxial is often used to describe the thumb or great toe side. Postaxial is the little toe or little finger side. The axis referred to runs to the tip of the middle finger or the second toe.

The other small problem, the penis, is described in its erect position, so that its dorsal surface faces anteriorly and superiorly when detumescent.

We also need to define planes, mutually at right angles. The horizontal plane is clear enough: the other two are a little less so. The sagittal plane (L. sagitta, an arrow) probably refers to the sagittal suture which runs from anterior to posterior in the newborn skull, and has an arrowhead in the form of the frontal fontanelle. Coronal is also difficult since it means crown, and I always think of a crown as being horizontal. But this is an older usage, as in the crown of an arch or a tooth, or the road, meaning something more like a halo. Once again these refer to the anatomical position.

Now that we can describe the body at rest we can also deal with movement.

abduction is movement of any part away from the midline in the coronal plain
adduction is return to the midline flexion is moving anything in the sagittal plane
extension is straightening it again.
lateral flexion is bending in the coronal plane

opposition which brings its palmar surface in contact with the palmar surface of the fingers.
rotation occurs around a vertical axis, or the main axis of the limb. If we rotate the head to the right we end up facing right. For the limbs we still use the displacement of the anterior aspect i.e. lateral rotation moves the palm laterally. The shoulder is a good joint to illustrate movement because it is so free. The slide shows what we can do, and how we describe it.

VIDEO 1

VIDEO 2

VIDEO 3

Also see:

http://www.sohp.soton.ac.uk/biosci/anatomy2.htm

Hand and foot again pose problems because of their distinctive orientation. The hand has a rather unusual movement whereby the thumb can be brought to lie medially: in fact this crosses the bones of the forearm. The anatomical position of the hand is called supine, the reverse prone, so this movement is pronation reverse supination.

General anatomical terms:

Vertical Horizontal Median Frontal (Coronal) Sagittal Intermediate Medial Peripheral Radial Peroneal

Lateral Anterior Posterior Ventral Dorsal Frontal Occipital Axial External Internal Tibial

Superior Inferior Cranial Palmar Plantar Flexor Extensor Caudal Ulnar Fibular Proximal

Rostral Apical Basal Basilar Middle Transverse Longitudinal Superficial Deep Central Distal

In human body they distinguish some levels of the organization:

1. molecular level – object of the biochemistry

2. subcellular level – object of the histology

3. cellular level – object of the histology

4. tissues level – object of the histology

5. organs – object of the anatomy

6. systems – object of the anatomy

7. organism – object of the anatomy

connective tissue - less elasticity - wrinkles
cartilage - less elasticity - degenerative changes such as osteo-arthritis with associated changes. Costal cartilages often replaced by bone: bony spurs develop in unusual places.
bone - becomes brittle, reduced in size with less activity
muscle - ditto, plus deposition of fat.
heart and blood vessels - arteries become tortuous, walls become furred up with atheroma. Left ventricle is enlarged as consequence of load. Veins often varicose.
nervous system - Often small strokes will cause paralysis and reduction in size of some muscles
The human body is composed of 206 bones that perform five main functions:

1) support

2) protection

3) body movement

4) blood cell formation

5) storage of inorganic salts and lipid

II. Cells in Osseous tissue: osteocytes, osteoblasts, osteoclasts, osteoprogenitor, cells.

III. Cellular matrix - 1/ calcium hydroxyapatite, 2/ collagenous fibers

Long bone structure

Diaphysis -- shaft

epiphysis -- bone ends

epiphyseal line

nutrient foramen

medullary cavity

V. Types of bone:

a. lamellar or compact bone

1. contains osteons composed of concentric lamellae

2. each osteon has an osteonic canal (Haversian canal) which has blood vessels and nerves

3. osteocytes found within lacunae

4. canaliculi connect osteocytes and function to diffuse nutrition to the osteocytes

5. communicating (also called perforating or Volkman's) canals, connect adjacent osteons, and carry blood vessels.

6. the diaphyses, or shafts of long bones, are composed mostly of lamellar bone

b. Cancellous, trabecular, or spongy bone

1. does not contain haversian canal systems (osteons)

2. nerves and blood vessels run randomly through the loose meshwork of bone.

Structure and Physical Properties of the bone.—Bone is one of the hardest structures of the animal body; it possesses also a certain degree of toughness and elasticity. Its color, in a fresh state, is pinkish-white externally, and deep red within.

On examining a section of any bone, it is seen to be composed of two kinds of tissue, one of which is dense in texture, like ivory, and is termed compact tissue

The other consists of slender fibers and lamellae, which join to form a reticular structure; this, from its resemblance to lattice-work, is called spongious tissue. The compact tissue is always placed on the exterior of the bone, the cancellous in the interior. The relative quantity of these two kinds of tissue varies in different bones, and in different parts of the same bone, according as strength or lightness is requisite. Close examination of the compact tissue shows it to be extremely porous, so that the difference in structure between it and the cancellous tissue depends merely upon the different amount of solid matter, and the size and number of spaces in each; the cavities are small in the compact tissue and the solid matter between them abundant, while in the cancellous tissue the spaces are large and the solid matter is in smaller quantity.

Bone during life is permeated by vessels, and is enclosed, except where it is coated with articular cartilage, in a fibrous membrane, the periosteum, by means of which many of these vessels reach the hard tissue. If the periosteum be stripped from the surface of the living bone, small bleeding points are seen which mark the entrance of the periosteal vessels; and on section during life every part of the bone exudes blood from the minute vessels which ramify in it. The interior of each of the long bones of the limbs presents a cylindrical cavity filled with marrow and lined by a highly vascular areolar structure, called the medullary membrane.

Periosteum.—The periosteum adheres to the surface of each of the bones in nearly every part, but not to cartilaginous extremities. When strong tendons or ligaments are attached to a bone, the periosteum is incorporated with them. It consists of two layers closely united together, the outer one formed chiefly of connective tissue, containing occasionally a few fat cells; the inner one, of elastic fibers of the finer kind, forming dense membranous networks, which again can be separated into several layers. In young bones the periosteum is thick and very vascular, and is intimately connected at either end of the bone with the epiphysial cartilage, but less closely with the body of the bone, from which it is separated by a layer of soft tissue, containing a number of granular corpuscles or osteoblasts, by which ossification proceeds on the exterior of the young bone. Later in life the periosteum is thinner and less vascular, and the osteoblasts are converted into an epithelioid layer on the deep surface of the periosteum. The periosteum serves as a nidus for the ramification of the vessels previous to their distribution in the bone; hence the liability of bone to exfoliation or necrosis when denuded of this membrane by injury or disease. Fine nerves and lymphatics, which generally accompany the arteries, may also be demonstrated in the periosteum.

Marrow.—The marrow not only fills up the cylindrical cavities in the bodies of the long bones, but also occupies the spaces of the cancellous tissue and extends into the larger bony canals (Haversian canals) which contain the bloodvessels. It differs in composition in different bones. In the bodies of the long bones the marrow is of a yellow color, and contains, in 100 parts, 96 of fat, 1 of areolar tissue and vessels, and 3 of fluid with extractive matter; it consists of a basis of connective tissue supporting numerous bloodvessels and cells, most of which are fat cells but some are “marrow cells,” such as occur in the red marrow to be immediately described. In the flat and short bones, in the articular ends of the long bones, in the bodies of the vertebrae, in the cranial diploë, and in the sternum and ribs the marrow is of a red color, and contains, in 100 parts, 75 of water, and 25 of solid matter consisting of cell-globulin, nucleoprotein, extractives, salts, and only a small proportion of fat. The red marrow consists of a small quantity of connective tissue, bloodvessels, and numerous cells, some few of which are fat cells, but the great majority are roundish nucleated cells, the true “marrow cells” of Kölliker. These marrow cells proper, or myelocytes, resemble in appearance lymphoid corpuscles, and like them are ameboid; they generally have a hyaline protoplasm, though some show granules either oxyphil or basophil in reaction. A number of eosinophil cells are also present. Among the marrow cells may be seen smaller cells, which possess a slightly pinkish hue; these are the erythroblasts or normoblasts, from which the red corpuscles of the adult are derived, and which may be regarded as descendants of the nucleated colored corpuscles of the embryo. Giant cells (myeloplaxes, osteoclasts), large, multinucleated, protoplasmic masses, are also to be found in both sorts of adult marrow, but more particularly in red marrow. They were believed by Kölliker to be concerned in the absorption of bone matrix, and hence the name which he gave to them—osteoclasts. They excavate in the bone small shallow pits or cavities, which are named Howship’s foveolae, and in these they are found lying. but the great majority are roundish nucleated cells, the true “marrow cells” of Kölliker. These marrow cells proper, or myelocytes, resemble in appearance lymphoid corpuscles, and like them are ameboid; they generally have a hyaline protoplasm, though some show granules either oxyphil or basophil in reaction. A number of eosinophil cells are also present. Among the marrow cells may be seen smaller cells, which possess a slightly pinkish hue; these are the erythroblasts or normoblasts, from which the red corpuscles of the adult are derived, and which may be regarded as descendants of the nucleated colored corpuscles of the embryo. Giant cells (myeloplaxes, osteoclasts), large, multinucleated, protoplasmic masses, are also to be found in both sorts of adult marrow, but more particularly in red marrow. They were believed by Kölliker to be concerned in the absorption of bone matrix, and hence the name which he gave to them—osteoclasts. They excavate in the bone small shallow pits or cavities, which are named Howship’s foveolae, and in these they are found lying.

Vessels and Nerves of Bone. The bloodvessels of bone are very numerous. Those of the compact tissue are derived from a close and dense network of vessels ramifying in the periosteum. From this membrane vessels pass into the minute orifices in the compact tissue, and run through the canals which traverse its substance. The cancellous tissue is supplied in a similar way, but by less numerous and larger vessels, which, perforating the outer compact tissue, are distributed to the cavities of the spongy portion of the bone. In the long bones, numerous apertures may be seen at the ends near the articular surfaces; some of these give passage to the arteries of the larger set of vessels referred to; but the most numerous and largest apertures are for some of the veins of the cancellous tissue, which emerge apart from the arteries. The marrow in the body of a long bone is supplied by one large artery (or sometimes more), which enters the bone at the nutrient foramen (situated in most cases near the center of the body), and perforates obliquely the compact structure. The medullary or nutrient artery, usually accompanied by one or two veins, sends branches upward and downward, which ramify in the medullary membrane, and give twigs to the adjoining canals. The ramifications of this vessel anastomose with the arteries of the cancellous and compact tissues. In most of the flat, and in many of the short spongy bones, one or more large apertures are observed, which transmit to the central parts of the bone vessels corresponding to the nutrient arteries and veins. The veins emerge from the long bones in three places (Kölliker): (1) one or two large veins accompany the artery; (2) numerous large and small veins emerge at the articular extremities; (3) many small veins pass out of the compact substance. In the flat cranial bones the veins are large, very numerous, and run in tortuous canals in the diploic tissue, the sides of the canals being formed by thin lamellae of bone, perforated here and there for the passage of branches from the adjacent cancelli. The same condition is also found in all cancellous tissue, the veins being enclosed and supported by osseous material, and having exceedingly thin coats. When a bone is divided, the vessels remain patulous, and do not contract in the canals in which they are contained. Lymphatic vessels, in addition to those found in the periosteum, have been traced by Cruikshank into the substance of bone, and Klein describes them as running in the Haversian canals. Nerves are distributed freely to the periosteum, and accompany the nutrient arteries into the interior of the bone. They are said by Kölliker to be most numerous in the articular extremities of the long bones, in the vertebrae, and in the larger flat bones.

Transverse section of compact tissue bone

A transverse section of dense bone may be cut with a saw and ground down until it is sufficiently thin.

If this be examined with a rather low power the bone will be seen to be mapped out into a number of circular districts each consisting of a central hole surrounded by a number of concentric rings. These districts are termed Haversian systems; the central hole is an Haversian canal, and the rings are layers of bony tissue arranged concentrically around the central canal, and termed lamellae. Moreover, on closer examination it will be found that between these lamellae, and therefore also arranged concentrically around the central canal, are a number of little dark spots, the lacunae, and that these lacunae are connected with each other and with the central Haversian canal by a number of fine dark lines, which radiate like the spokes of a wheel and are called canaliculi. Filling in the irregular intervals which are left between these circular systems are other lamellae, with their lacunae and canaliculi running in various directions, but more or less curved ; they are termed interstitial lamellae. Again, other lamellae, found on the surface of the bone, are arranged parallel to its circumference; they are termed circumferential, or by some authors primary or fundamental lamellae, to distinguish them from those laid down around the axes of the Haversian canals, which are then termed secondary or special lamellae.

The Haversian canals, seen in a transverse section of bone as round holes at or about the center of each Haversian system, may be demonstrated to be true canals if a longitudinal section be made. It will then be seen that the canals run parallel with the longitudinal axis of the bone for a short distance and then branch and communicate. They vary considerably in size, some being as much as 0.12 mm. in diameter; the average size is, however, about 0.05 mm. Near the medullary cavity the canals are larger than those near the surface of the bone. Each canal contains one or two bloodvessels, with a small quantity of delicate connective tissue and some nerve filaments. In the larger ones there are also lymphatic vessels, and cells with branching processes which communicate, through the canalculi, with the branched processes of certain bone cells in the substance of the bone. Those canals near the surface of the bone open upon it by minute orifices, and those near the medullary cavity open in the same way into this space, so that the whole of the bone is permeated by a system of bloodvessels running through the bony canals in the centers of the Haversian systems.

  The lamellae are thin plates of bony tissue encircling the central canal, and may be compared, for the sake of illustration, to a number of sheets of paper pasted one over another around a central hollow cylinder. After macerating a piece of bone in dilute mineral acid, these lamellae may be stripped off in a longitudinal direction as thin films. If one of these be examined with a high power of the microscope, it will be found to be composed of a finely reticular structure, made up of very slender transparent fibers, decussating obliquely; and coalescing at the points of intersection; these fibers are composed of fine fibrils identical with those of white connective tissue. The intercellular matrix between the fibers is impregnated by calcareous deposit which the acid dissolves. In many places the various lamellae may be seen to be held together by tapering fibers, which run obliquely through them, pinning or bolting them together; they were first described by Sharpey, and were named by him perforating fibers.

The Lacunae are situated between the lamellae, and consist of a number of oblong spaces. In an ordinary microscopic section, viewed by transmitted light, they appear as fusiform opaque spots. Each lacuna is occupied during life by a branched cell, termed a bone-cell or bone-corpuscle, the processes from which extend into the canaliculi.

The Canaliculi are exceedingly minute channels, crossing the lamellae and connecting the lacunae with neighboring lacunae and also with the Haversian canal. From the Haversian canal a number of canaliculi are given off, which radiate from it, and open into the first set of lacunae between the first and second lamellae. From these lacunae a second set of canaliculi is given off; these run outward to the next series of lacunae, and so on until the periphery of the Haversian system is reached; here the canaliculi given off from the last series of lacunae do not communicate with the lacunae of neighboring Haversian systems, but after passing outward for a short distance form loops and return to their own lacunae. Thus every part of an Haversian system is supplied with nutrient fluids derived from the vessels in the Haversian canal and distributed through the canaliculi and lacunae.

  The bone cells are contained in the lacunae, which, however, they do not completely fill. They are flattened nucleated branched cells, homologous with those of connective tissue; the branches, especially in young bones, pass into the canaliculi from the lacunae.

  In thin plates of bone (as in the walls of the spaces of cancellous tissue) the Haversian canals are absent, and the canaliculi open into the spaces of the cancellous tissue (medullary spaces), which thus have the same function as the Haversian canals.

Chemical Composition.—Bone consists of an animal and an earthy part intimately combined together.

  The animal part may be obtained by immersing a bone for a considerable time in dilute mineral acid, after which process the bone comes out exactly the same shape as before, but perfectly flexible, so that a long bone (one of the ribs, for example) can easily be tied in a knot. If now a transverse section is made the same general arrangement of the Haversian canals, lamellae, lacunae, and canaliculi is seen.

  The earthy part may be separately obtained by calcination, by which the animal matter is completely burnt out. The bone will still retain its original form, but it will be white and brittle, will have lost about one-third of its original weight, and will crumble down with the slightest force. The earthy matter is composed chiefly of calcium phosphate, about 58 per cent. of the weight of the bone, calcium carbonate about 7 per cent., calcium fluoride and magnesium phosphate from 1 to 2 per cent. each and sodium chloride less than 1 per cent.; they confer on bone its hardness and rigidity, while the animal matter (ossein) determines its tenacity. Ossification.—Some bones are preceded by membrane, such as those forming the roof and sides of the skull; others, such as the bones of the limbs, are preceded by rods of cartilage. Hence two kinds of ossification are described: the intramembranous and the intracartilaginous.

According to their structure bones are dividing into long bone, short bone, flat bone, irregular bone, pneumatized bone, sesamoid bone. Bone is covered by periosteum. An individual bone is composed of bones tissue, cartilage, fibrous connective tissue, blood and nerve tissue. Because most of the bone is made of inorganic salts a bones seems nonliving, but the bone is a system of tissues that form together and the bones make the skeletal system.

Example of long bone.

Example of short bone

On long bones, such as those in the arms and legs the large expanded portions are called epiphyses. These are the regions of the bones that articulate with other bones. The shaft of the bones between the epiphyses is called the diaphysis. Except of the articular cartilage that covers the epiphyes the entire bones is covered in a tough, vascular tissue called periosteum. Periosteum fibres interlock with fibres of tendons and muscles that are connected to the bone. The wall of the diaphysis is composed of a strong, tightly packed, resistant to bending tissue called compact bone. The epiphyses, on the other hand, are formed mostly by spongy bone. Spongy bone is made of many small bone plates that have irregular interconnected spaces that help keep bones light but very strong. The compact bone in the diaphysis of long bones forms a tube or channel called the medullary cavity. This cavity is continuos through the length of the diaphysis and then fades into the spongy bone. The medullary cavity is filled with a special type of soft connective tissue called marrow.

Example of flat bones

Example of pneumatized bones

Bones usually developed from separate centers of ossification termed epiphyses, and consist of cancellous tissue surrounded by thin compact bone.

Example of sesamoid bone

The medullary canal and the spaces in the cancellous tissue are filled with marrow. The long bones are not straight, but curved, the curve generally taking place in two planes, thus affording greater strength to the bone. The bones belonging to this class are: the clavicle, humerus, radius, ulna, femur, tibia, fibula, metacarpals, metatarsals, and phalanges. Short Bones.—Where a part of the skeleton is intended for strength and compactness combined with limited movement, it is constructed of a number of short bones, as in the carpus and tarsus. These consist of cancellous tissue covered by a thin crust of compact substance. The patellae, together with the other sesamoid bones, are by some regarded as short bones.   6 Flat Bones.—Where the principal requirement is either extensive protection or the provision of broad surfaces for muscular attachment, the bones are expanded into broad, flat plates, as in the skull and the scapula.

Example of irregular bone

These bones are composed of two thin layers of compact tissue enclosing between them a variable quantity of cancellous tissue. In the cranial bones, the layers of compact tissue are familiarly known as the tables of the skull; the outer one is thick and tough; the inner is thin, dense, and brittle, and hence is termed the vitreous table. The intervening cancellous tissue is called the diploë, and this, in certain regions of the skull, becomes absorbed so as to leave spaces filled with air (air-sinuses) between the two tables. The flat bones are: the occipital, parietal, frontal, nasal, lacrimal, vomer, scapula, os coxae (hip bone), sternum, ribs, and, according to some, the patella.   7 Irregular Bones.—The irregular bones are such as, from their peculiar form, cannot be grouped under the preceding heads. They consist of cancellous tissue enclosed within a thin layer of compact bone. The irregular bones are: the vertebra, sacrum, coccyx, temporal, sphenoid, ethmoid, zygomatic, maxilla, mandible, palatine, inferior nasal concha, and hyoid.  Surfaces of Bones.—If the surface of a bone be examined, certain eminences and depressions are seen. These eminences and depressions are of two kinds: articular and non-articular. Well-marked examples of articular eminences are found in the heads of the humerus and femur; and of articular depressions in the glenoid cavity of the scapula, and the acetabulum of the hip bone. Non-articular eminences are designated according to their form. Thus, a broad, rough, uneven elevation is called a tuberosity, protuberance, or process, a small, rough prominence, a tubercle; a sharp, slender pointed eminence, a spine; a narrow, rough elevation, running some way along the surface, a ridge, crest, or line. Non-articular depressions are also of variable form, and are described as fossae, pits, depressions, grooves, furrows, fissures, notches, etc. These non-articular eminences and depressions serve to increase the extent of surface for the attachment of ligaments and muscles, and are usually well-marked in proportion to the muscularity of the subject. A short perforation is called a foramen, a longer passage a canal.  

Development of Bone

Bone formation is due to the osteoblasts which are specialized mesenchymal cells. Osteobiasts secrete an intercellular substance, the osteoid, which consists initially of soft around substance and collagen fibers. Osteobiasts develop into osteocytes, the definitive bone cells. At the same time multinucleated osteoclasts develop, cells connected with resorbing and remodelling bone. We distinguish direct or Intramembranous ossification from Indirect or chondral ossification.

Intramembranous ossification, osteogenesis membranacea is the development of bone from connective tissue. The latter contains many mesenchymal cells which develop via osteobiasts into osteocytes. At the same time osteoclasts develop and collagen fibers also appear. The original bone is fibrous and it is subsequently remodelled into lamellar bone. The skull cap, the facial bones and the clavicles develop as membranous bones. Preformed cartilaginous skeletal parts are necessary for chondral ossKlcatlon, osreogenesis cartilaginea when they become replaced by bone. Growth is possible only as long as cartilage still remains. The prerequisites for replacement bone formation are chondroclasts, differentiated connective tissue cells, which remove cartilage and enable the osteobiasts to form bone. Two types of replacement bone formation are recognized endochondral and perichondral.

Endochrondral ossification begins within cartilage, and occurs near the epiphyses. Just before ossification begins the mass is entirely cartilaginous, and in a long bone, which may be taken as an example, the process commences in the center and proceeds toward the extremities, which for some time remain cartilaginous. Subsequently a similar process commences in one or more places in those extremities and gradually extends through them. The extremities do not, however, become joined to the body of the bone by bony tissue until growth has ceased; between the body and either extremity a layer of cartilaginous tissue termed the epiphysial cartilage persists for a definite period.

The first step in the ossification of the cartilage is that the cartilage cells, at the point where ossification is commencing and which is termed a center of ossification, enlarge and arrange themselves in rows. The matrix in which they are imbedded increases in quantity, so that the cells become further separated from each other. A deposit of calcareous material now takes place in this matrix, between the rows of cells, so that they become separated from each other by longitudinal columns of calcified matrix, presenting a granular and opaque appearance. Here and there the matrix between two cells of the same row also becomes calcified, and transverse bars of calcified substance stretch across from one calcareous column to another. Thus there are longitudinal groups of the cartilage cells enclosed in oblong cavities, the walls of which are formed of calcified matrix which cuts off all nutrition from the cells; the cells, in consequence, atrophy, leaving spaces called the primary areolae.

At the same time that this process is going on in the center of the solid bar of cartilage, certain changes are taking place on its surface. This is covered by a very vascular membrane, the perichondrium, entirely similar to the embryonic connective tissue already described as constituting the basis of membrane bone; on the inner surface of this—that is to say, on the surface in contact with the cartilage—are gathered the formative cells, the osteoblasts. By the agency of these cells a thin layer of bony tissue is formed between the perichondrium and the cartilage, by the intramembranous mode of ossification just described. There are then, in this first stage of ossification, two processes going on simultaneously: in the center of the cartilage the formation of a number of oblong spaces, formed of calcified matrix and containing the withered cartilage cells, and on the surface of the cartilage the formation of a layer of true membrane bone. The second stage consists in the prolongation into the cartilage of processes of the deeper or osteogenetic layer of the perichondrium, which has now become periosteum. The processes consist of bloodvessels and cells—osteoblasts, or bone-formers, and osteoclasts, or bone-destroyers. The latter are similar to the giant cells (myeloplaxes) found in marrow, and they excavate passages through the new-formed bony layer by absorption, and pass through it into the calcified matrix. Wherever these processes come in contact with the calcified walls of the primary areolae they absorb them, and thus cause a fusion of the original cavities and the formation of larger spaces, which are termed the secondary areolae or medullary spaces. These secondary spaces become filled with embryonic marrow, consisting of osteoblasts and vessels, derived, in the manner described above, from the osteogenetic layer of the periosteum.

Thus far there has been traced the formation of enlarged spaces (secondary areolae), the perforated walls of which are still formed by calcified cartilage matrix, containing an embryonic marrow derived from the processes sent in from the osteogenetic layer of the periosteum, and consisting of bloodvessels and osteoblasts. The walls of these secondary areolae are at this time of only inconsiderable thickness, but they become thickened by the deposition of layers of true bone on their surface. This process takes place in the following manner: Some of the osteoblasts of the embryonic marrow, after undergoing rapid division, arrange themselves as an epithelioid layer on the surface of the wall of the space. This layer of osteoblasts forms a bony stratum, and thus the wall of the space becomes gradually covered with a layer of true osseous substance in which some of the bone-forming cells are included as bone corpuscles. The next stage in the process consists in the removal of these primary bone spicules by the osteoclasts. One of these giant cells may be found lying in a Howship’s foveola at the free end of each spicule. The removal of the primary spicules goes on pari passu with the formation of permanent bone by the periosteum, and in this way the medullary cavity of the body of the bone is formed.

  This series of changes has been gradually proceeding toward the end of the body of the bone, so that in the ossifying bone all the changes described above may be seen in different parts, from the true bone at the center of the body to the hyaline cartilage at the extremities.

  While the ossification of the cartilaginous body is extending toward the articular ends, the cartilage immediately in advance of the osseous tissue continues to grow until the length of the adult bone is reached.

  During the period of growth the articular end, or epiphysis, remains for some time entirely cartilaginous, then a bony center appears, and initiates in it the process of intracartilaginous ossification; but this process never extends to any great distance. The epiphysis remains separated from the body by a narrow cartilaginous layer for a definite time. This layer ultimately ossifies, the distinction between body and epiphysis is obliterated, and the bone assumes its completed form and shape. The same remarks also apply to such processes of bone as are separately ossified, e.g., the trochanters of the femur. The bones therefore continue to grow until the body has acquired its full stature. They increase in length by ossification continuing to extend behind the epiphysial cartilage, which goes on growing in advance of the ossifying process. They increase in circumference by deposition of new bone, from the deeper layer of the periosteum, on their external surface, and at the same time an absorption takes place from within, by which the medullary cavities are increased.

  The permanent bone formed by the periosteum when first laid down is cancellous in structure. Later the osteoblasts contained in its spaces become arranged in the concentric layers characteristic of the Haversian systems, and are included as bone corpuscles.

  The number of ossific centers varies in different bones. In most of the short bones ossification commences at a single point near the center, and proceeds toward the surface. In the long bones there is a central point of ossification for the body or diaphysis: and one or more for each extremity, the epiphysis. That for the body is the first to appear. The times of union of the epiphyses with the body vary inversely with the dates at which their ossifications began (with the exception of the fibula) and regulate the direction of the nutrient arteries of the bones. Thus, the nutrient arteries of the bones of the arm and forearm are directed toward the elbow, since the epiphyses at this joint become united to the bodies before those at the opposite extremities. In the lower limb, on the other hand, the nutrient arteries are directed away from the knee: that is, upward in the femur, downward in the tibia and fibula; and in them it is observed that the upper epiphysis of the femur, and the lower epiphyses of the tibia and fibula, unite first with the bodies. Where there is only one epiphysis, the nutrient artery is directed toward the other end of the bone; as toward the acromial end of the clavicle, toward the distal ends of the metacarpal bone of the thumb and the metatarsal bone of the great toe, and toward the proximal ends of the other metacarpal and metatarsal bones.

  Parsons groups epiphyses under three headings, viz.: (1) pressure epiphyses, appearing at the articular ends of the bones and transmitting “the weight of the body from bone to bone;” (2) traction epiphyses, associated with the insertion of muscles and “originally sesamoid structures though not necessarily sesamoid bones;” and (3) atavistic epiphyses, representing parts of the skeleton, which at one time formed separate bones, but which have lost their function, “and only appear as separate ossifications in early life.”

Epiphyses are found at the ends of long bones, whilst the shafts are called diaphyses. Pericnondrai ossification, which originates in the perichondrium. Is confined to the diaphysis. The epiphyslal disk (growth plate), which is necessary for growth in length, forms a layer between the epiphysis and the diaphysis. That part of the shall adjacent to the epiphysial disk is called the melaphysis and develops fiist on an endochondral basis. Within the epiphysial cartilage, the processes of ossification occur in separate zones. First, in the epiphysis is the zone of the capping, hyaline cartilaginous material, which has not been influenced by bone formation. Next to this area of 'resting cartilage' is the zone or cartilage cell columns, the growth zone. Here cartilage cells divide and so increase in number. The next layer, which lies nearer to the shaft, is the zone of large vesicular cartilage cells, in which calcification is occurring. This is contiguous with the zone of cartilage destruction, where cartilage is broken down by chondroclasts and replaced by bone-forming osteobiasts. A cartilage remnant persists, which enables endochondral bone and perichondral bone to be distinguished in the diaphysis. It Is secondarily replaced by perichondral bone. Endochondral bone is destroyed by the immigrant osteoclasts. In crease in thickness in the region of the diaphysis is brought about by deposition of new bony materal on the outer surface beneath the cellular layer of the periosteum. The bone marrow cavity becomes larger as a result of bone destruction. Hormones regulate all growth processes.

The bony aniagen in the epiphyses first aappear after birth, except for those in the distal femoral epiphysis and the proximal tibial epiphysis. In both of these epiphyses. and in the cuboid bone, osteogenesis begins just before birth in the tenth intrauterine month.

Bone and joint health is a concern for almost everyone over the age of 30. Studies show that bone density is determined by the mid-twenties for both men and women and that bone mineral loss occurs naturally as we age. This is also true for the “building blocks” that make-up our joints and connective tissue.

Flexibility: Stretching can increase flexibility. Bone strength: Weight-bearing exercise strengthens bones and helps prevent osteoporosis. Exercising on a regular basis can help build your bones, but the kind of exercise is what makes a difference. There are basically two kinds of exercise - aerobic and weight-bearing. Some aerobic exercises, like swimming and bicycling outdoors or on a stationary bike, are certainly good for you, but they don't do much for your bones.

The ones that help build and strengthen bone are the weight-bearing kind. Weight-bearing exercises, some of which can be aerobic, are those that force you to put weight, and therefore stress, on your muscles and bones. Weight-lifting walking, hiking, and step aerobic classes are all activities that require your muscles to work against gravity. For weights you can even use soup cans and water bottles.See the list below for more good examples of this kind of exercise. Weight-bearing exercises that may be right for you: gardening, stair climbing, chair exercises, tennis, walking, weight lifting erobics, dancing.

Ideally, you should do some kind of weight-bearing exercise on a regular basis. In addition, weight-bearing exercise stimulates the formation of new bone. Exercise strengthens the muscles that pull or tug on bones, an action that keeps bones strong. Exercise improves balance, strength, and co-ordination, which reduces the risk of falling and breaking a bone. Talk to your doctor about the best weight-bearing exercise for you. In general, exercise is a good thing. However, if you already have osteoporosis, or if you have any other medical conditions, some activities may not be good choices for you. Have a discussion with your doctor or other healthcare provider about the exercises and activities that would be best for you, especially before starting any new exercise programme.

When you start any new programme, start slowly and build gradually. If you develop any pain, check with your doctor or other health care provider immediately. Exercise to prevent falls. Exercise counts in fall prevention. You've probably heard about the benefits of exercise. It helps make your bones stronger, improves your overall health, and can even brighten your outlook. But did you know that exercise might reduce your risk of falling by improving your balance, muscle strength, and co-ordination? It may even help you avoid a serious injury if you do fall. Tips for developing an exercise programme that works for you

1. Talk to your healthcare provider before you start. While the right exercise program offers great benefits, the wrong exercises can lead to injury or serious illness. Discuss your exercise plan with your healthcare provider and keep in mind these special precautions:

2. Anyone more than age 40 should have a thorough medical exam before beginning an exercise programme. If a woman has a significant amount of bone loss, some exercises may actually increase her risk of fracture. For example, sit-ups and toe touches increase the risk of fracture in women with osteoporosis of the spine. A woman at high risk for heart disease may need a stress test before starting an exercise programme.

Tai chi (a popular exercise using gentle, slow movements to relax muscles): This improves balance, flexibility, and state of mind.

Weight-bearing, low-impact aerobic exercises such as walking, dancing, and climbing stairs: These increase muscle strength and co-ordination, improve balance, and make bones stronger, without putting too much stress on joints and muscles.

Consider one of the most natural forms of exercise - walking. This is an easy, effective way to strengthen muscles, increase bone strength, and improve overall health.

Theme 3. Vertebrae (general data). Cervical, thoracic and lumbar vertebrae. Sacrum. Coccyx. THE VERTEBRAL COLUMN AS a WHOLE

Osteology of the Vertebral Column
Bone	Description			Notes
vertebra one of a series of irregular bones that form the spine					a vertebra has two parts: the vertebral body and the vertebral arch; there are 33 vertebrae total: 7 cervical, 12 thoracic, 5 lumbar, 5 fused to form the sacrum, 4 coccygeal; features of a typical vertebra include: body, pedicles, transverse processes, laminae, articular processes, spinous process
vertebral body		the largest part of the vertebra			it is shaped like a short cylinder; adjacent vertebral bodies articulate through a symphysis
vertebral arch		the ring of bone formed by the paired pedicles and paired laminae of the vertebra			the transverse processes and spinous process are attached to the neural arch; the neural arch protects the spinal cord
pedicle		short strong process that extends posteriorly from the posterolateral surface of the vertebral body			paired; it connects the body with the transverse process; it is marked by superior & inferior vertebral notches;
transverse process		a lateral process the extends from the junction of the pedicle and the lamina of the vertebra			a site for muscle attachment and rib articulation
lamina		a broad flat plats of bone located between the transverse process and the spinous process of the vertebra			paired; it is flattened markedly in the anteroposterior direction; ligamenta flava span the interval between the laminae of adjacent vertebrae (Latin, lamina = thin plate)
articular processes			processed that project inferiorly and superiorly from the junction of the lamina and pedicle of the vertebra		two pair on each vertebra (superior and inferior); the superior articular processes of one vertebra articulate with the inferior processes of the adjacent vertebra through synovial joints
intervertebral notch			a notch on the superior and inferior surface of the vertebral pedicle		the superior intervertebral notch of one vertebra combined with the inferior intervertebral notch of the adjacent vertebra forms the intervertebral foramen
intervertebral foramen			an opening between the pedicles of adjacent vertebrae		adjacent intervertebral notches form the intervertebral foramen; an opening for passage of the spinal nerve
vertebral canal			the opening formed by the combination of the body and the vertebral arch		it contains the spinal cord, meninges, epidural fat and the internal vertebral plexus of veins
spinous process			a posterior midline process arising from the junction of the two laminae of the vertebra		it projects downward and inferiorly; it is an important site of muscle attachment; spinous processes of cervical vertebra 2-6 are bifid

Bones form the skeleton that they divide into bones of the trunk, skull, and limbs. Bones of the trunk include vertebrae, sternum and ribs.

Vertebrae

The vertebral column consists of 33-34 vertebrae: 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 4-5 coccygeal vertebrae. The sacral vertebrae fuse to form the sacrum and the coccygeal vertebrae fuse to form the coccyx. Thus the sacral and coccygeal vertebrae are false vertebrae while the others are true vertebrae.

Function of the vertebrae: 1) Supporting and amortisation; 2) Defense; 3) Motor; 4) Metabolic; 5) Hoemeopoetic.

Each vertebrae has a vertebral body and vertebral arch. They border vertebral foramen that forms the vertebral canal when vertebrae lay each other in backbone.

A typical thoracic vertebra, viewed from above.

Vertebral arch carries 7 processes: unpaired spinous process (projecting dorsally), paired transverse processes (for articulation with the ribs and attachment of muscles), the superior articular process and the inferior articular process processes (for articulation vertebrae each other). The vertebral notches, one caudal and one cranial, together form the intervertebral foramen which serves the passage of the spinal nerves.

Peculiarities of the III-VII Cervical Vertebrae

1. Transverse process possesses foramen transversarium.

2. Spinous process is bifurcated.

3. The transverse process has an anterior tubercle and a posterior tubercle, between them we find a groove, the sulcus for the spinal nerve.

4. Articular surfaces lay in horizontal plane.

1st Cervical Vertebra, the Atlas differs basically from the other vertebrae:

It has not any vertebral body. In the atlas we therefore describe a smaller anterior arch and a larger posterior arch. Both arches have small protuberances: the anterior and posterior tubercles. Lateral to the large vertebral foramen of the atlas lie the lateral masses, each of which has a superior and an inferior articular facet. On the inner side of the anterior arch is the articular facet for the dens, fovea dentis. From the foramen of the transverse process, which is located in the processus transversus, a groove, the sulcus arteriae vertebralis, extends across the posterior arch for the reception of the vertebral artery.

2nd Cervical Vertebra. The Axis carries the dens or odontoid process.

On the cranial surface of the body the axis carries a tooth-like process, the dens axis, which ends in a rounded point, the apex dentis. The surfaces of the dens have a the anterior articular facet and the posterior articular facet.

The anterior tubercle of the 6th cervical vertebra can be very large and is designated as the carotid tubercle.

The 7th cervical vertebra has a particularly large spinous process, which is usually the highest palpable spinous process of the vertebral column; it is therefore called the vertebra prominens.

Peculiarities of the Thoracic Vertebrae

1. Laterally, the vertebral body usually has two costal facets, each of which is half of an articular facet for articulation with the head of a rib.

2. Transverse processes carry a costal facet for articulation with the costal tubercle.

3. The spinous processes of the 1-st through the 9th thoracic vertebrae overlap each other like roof tiles.

4. Articular surfaces lay in frontal plane.

The 1^st thoracic vertebra has a complete articular facet at the cranial border of its body and a half facet at the caudal border. The 10^th vertebra has only a half articular facet, while the 11th has a complete articular facet at its cranial border. The 12th thoracic vertebra has the articular facet for the head of the rib in the middle of the lateral surface of the body. There may be an accessory process and a mamillary processor each side.

Peculiarities of the Lumbar Vertebrae

1. The bodies of the are much larger than those of the other vertebrae.

2. The spinous process is flat and is directed sagittally.

3. The flattened lateral processes of the lumbar vertebrae may be called costal processes, and since they originate from rib aniagen.

4. Articular surfaces lay in sagittal plane.

5. Arch carries the mamillar and accessory processes.

Peculiarities of the Sacral Vertebrae

The sacrum consists of the five fused sacral vertebrae. It has a concave anterior or pelvic surface and a convex dorsal surface. The sacrum has the base (with promontory) and the apex. The pelvic surface has four paired pelvic anterior sacral foramina and transverse lines. In the convex dorsal surface there are posterior sacral foramina and five longitudinal ridges, not always clearly developed, have their origin in fusion of the corresponding processes of the vertebrae (median sacral, intermediate sacral and lateral sacral crests). The sacral canal is located in bone and it terminate by the sacral hiatus, bounded laterally by the two sacral horns. Auricular surface for the articulation with the hip bone and sacral tuberosity can be seen in lateral parts.

Coccyx

The coccyx, which is usually formed from three to four vertebrae, has body and cornua or horns.

All vertebrae compose vertebral column, which has cervical and lumbal curves forward (lordosis), and thoracic and sacral curves backward (kyphosis).

Video 4

References:

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3. R.D. Lockhart, G.F. Hamilton, F.W. Fyfe. Anatomy of the human body. – Philadelphia.

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6. Lecture.

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