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Title: Essentials of Human Anatomy


1
NEED OF ANATOMY IN UNDERGRADUATE COURSES
EXAMPLES FROM PRACTICE IN RELATION TO JOINTS AND
MUSCLES
DR V. K. CHAUHAN PRINCIPAL Dr. B.R.Sur
Homoeopathic Medical College, Hospital Research
Centre, Nanak Pura, New Delhi Email
vkchauhan2002_at_yahoo.com
2
MEDICAL SCIENCE
Medical Science (whether allopathic, ayurvedic or
homoeopathic) is the art and science of healing.
It encompasses a range of health care practices
evolved to maintain and restore human health by
the application of health science, biomedical
research, and medical technology to diagnose and
treat injury and disease, typically through
medication, surgery, or some other form of
therapy, prevention and treatment of illness.
3
HOMOEOPATHY
  • The word Homeopathy is derived from the Greek
    homoi similar, plus Pathos suffering.
  • In the early 19th century Dr. Samuel Hahnemann,
    developed a medical therapy, and put into words
    the basic principal Similia Similibus Curentur.
  • In the ear of 1850 Symptoms were the focus of
    study in in reference to diseasedisease

4
EDUCATIONAL NEEDS OF HOMOEOAPTHIC CURRICULUM
  • Homoeopathy is having a distinctly peculiar and
    individualistic approach to treat the sick.
  • Therefore its educational training needs are also
    distinctly different.

Ref http//cchindia.com/hdc4.htm
5
EDUCATIONAL NEEDS OF HOMOEOAPTHIC CURRICULUM
  • Keeping in mind the peculiar needs for the
    training of a homoeopathic physician CCH evolved
    a course curriculum for BHMS degree course.

Ref http//cchindia.com/hdc4.htm
6
EDUCATIONAL NEEDS OF HOMOEOAPTHIC CURRICULUM
  • It starts from the basic pre-clinical subjects
    and then encompasses the para-clinical followed
    by clinical subjects.

Ref http//cchindia.com/hdc4.htm
7
BHMS COURSE CURRICULUM
  • CCH Approved Subjects for study and examination
    for the B.H.M.S. (Degree) course are as under-
  • THE PRECLINCIAL SUBJECTS ARE TAUGHT IN FIRST
    YEAR
  • A . Core subject in Pre-Clinical Medicine include
    as
  • Anatomy
  • Physiology including Biochemistry.
  • B. The core subjects of homoeopathic speciality
    initiated and further followed up-till 4th BHMS
    include as
  • Organon of Medicine, Homoeo. Philosophy
    Psychology.
  • Homeopathic Pharmacy.
  • Homeopathic Materia Medica Therapeutics.

Here one finds Anatomyis one first and
foremostsubjects to start with.
Ref http//cchindia.com/hdc4.htm
8
BHMS COURSE CURRICULUM
  • CCH Approved Subjects for study and examination
    for the B.H.M.S. (Degree) course are as under-
  • THE PRECLINCIAL SUBJECTS ARE TAUGHT IN 2nd Year
    YEAR
  • A . Core Para clinical subject in Medicine
    include in 2nd BHMS study are as
  • Pathology and Microbiology.
  • Forensic medicine and Toxicology.

Ref http//cchindia.com/hdc4.htm
9
BHMS COURSE CURRICULUM
  • CCH Approved Subjects for study and examination
    for the B.H.M.S. (Degree) course are as under-
  • THE Clincial Subjects are taught in 3rd and
    4th year which essentially are applied part of
    basic preclinical disciplines and are as under
  • Practice of Medicine.
  • Surgery.
  • Obstetrics and Gynecology.
  • Community Medicine.
  • Case taking and repertory
  • During the course of Internship the final
    brushing and polishing is undertaken which
    incarporates all the areas of homoeopathic
    medical education undergone i.e., preclinical,
    paraclinical and clinical.

Ref http//cchindia.com/hdc4.htm
10
AIM OF BHMS COURSE CURRICULUM
  • Basic objectives of education and training in a
    Homoeopathic institution is to prepare competent
    Homoeopathic Physicians who are competent of
    functioning independently and effectively under
    Rural and Urban setups to meet the current
    medical needs of the country.
  • For this, the educational process shall be
    perceived as an integrated evolving process and
    not merely as an acquisition of a large number of
    data and facts.

Ref http//cchindia.com/hdc4.htm
11
ANATOMY
  • The first day that you look at or place your
    hand on a patient, you require a basic knowledge
    of anatomy to interpret your observations.
  • It is in the anatomy department that you learn
    the basic medical vocabulary that you will carry
    with you throughout your professional career and
    that will enable you to converse with your
    colleagues.
  • Anatomy can be a boring subject clinical anatomy
    is fascinating.........
  • ..........Richard S. Snell

12
ANATOMY THE LEVELS OF ORGANIZATION
  • Atoms are the simplest level.
  • Two or more atoms comprise a molecule.
  • Macromolecules are large, biologically important
    molecules inside cells.
  • Organelles are aggregates of macromolecules used
    to carry out a specific function in cell.
  • Cells are the basic living unit.
  • Tissues are groups of cells functioning together.
  • Groups of tissues form organs.
  • Groups of organs function together as organ
    systems.
  • Organ systems functioning together make up an
    organism.

Human body is sum of its parts at different
levels of organization.
13
ANATOMY AS BASIC FOUNDATION FOR PRACTICE OF
MEDICINE
  • Entire edifice of medicine rests on the
    understanding of four foundations, listed in
    descending order of importance
  • Structure of human body (Anatomy)
  • Function of human body (Physiology)
  • Disease processes that ravage structure and
    function (Pathology)
  • Intervention / means for preventing or treating
    disease (Medical / Surgical)

14
ANATOMY AND ITS MEDICAL DIMENTIONS
  • Anatomy is the study of the structure
    (morphology) of the body and the physical
    relationships involved between its parts, in
    other words, what are things called?
  • Physiology studies functions of these parts, in
    other words, how the parts of the body work and
    the ways in which they cooperate together to
    maintain life and health of the individual?
  • Pathology is the study of abnormalities and how
    they affect body structure and functions, often
    causing illness, in other words, it is abnormal
    anatomy and physiology.
  • Building on the normal and abnormal anatomy and
    physiology, relevant illnesses are assessed.

15
ANATOMY AND ITS MEDICAL DIMENTIONS
  • All disciplines are closely inter-related because
    the functional role of a part depends on how it
    is constructed.
  • To understand function, we must first comprehend
    structure. We cannot hope to unravel the effects
    of disease processes without first learning the
    structure and function of man.
  • Finally, our success in treating the patient is
    directly proportional to our mastery of all the
    four elements.

16
WHY STUDY ANATOMY?
  • Anatomy is obviously essential for surgeons but
    also has value for anyone who performs a
    procedure on a patient analyses radio-logical
    imaging performs a physical examination of a
    patient refers a patient to another doctor or
    explains a procedure to a patient. These tasks
    are common to all branches of medicine.
  • Provides an education rather than training, i.e.
    you can train a monkey to do surgery but the
    monkey cannot fix a problem when it arises.

17
INTERNATIONAL UNIFORMTIY OF COMMON ANATOMICAL
TERMS
  • It is essential that all medical professionals
    understand the terms used for describing the
    structure and function of different regions of
    gross anatomy.
  • Without these terms, it is impossible to describe
    in a meaningful way the composition of the body.
  • Moreover, the physician needs these terms so that
    anatomic abnormalities found on clinical
    examination of a patient can be accurately
    recorded.
  • Moreover we must understand the normal situation
    to be able to compare it with and recognize the
    abnormal.

18
INTERNATIONAL UNIFORMTIY OF COMMON ANATOMICAL
TERMS
  • The accurate use of anatomic terms by medical
    personnel enables them to communicate with their
    colleagues both nationally and internationally.
  • Without anatomic terms, one cannot accurately
    discuss or record the abnormal functions of
    joints, the actions of muscles, the alteration of
    position of organs, or the exact location of
    swellings or tumors.

19
WHAT IS MINIMUM BASIC ANATOMY FOR A PRACTICING
HOMOEOPATH
  • Basic anatomy is the study of the minimal amount
    of anatomy consistent with the understanding of
    the overall structure and functioning of the
    human body.
  • Anatomy should be studied in a way that so as to
    learn more of applied aspects than a multitude of
    minor anatomical details.
  • A minimum working knowledge should be that which
    enables an independent practitioner to practice
    safely, and to communicate with other medical
    professionals and patients effectively.

William BOERICKE(1849-1929, US)
20
RELEVANCE OF DISSECTION
  • The term Anatomy instantaneously brings to mind
    following things
  • Dissection
  • Skeleton
  • Mummified body
  • Study of the cadaver is only a
  • means to this end.
  • Much of that is at present taught by the
    dissection could be demonstrated as usefully
    through prepared dissected specimens, three
    dimensional models, plastination, virtual
    dissection, simulated surgery and multi-media
    classroom teaching.

21
RELEVANCE OF DISSECTION
  • Though dissection of the body is essential for
    the preparation of the student for his clinical
    studies, Major emphasis is placed on functional
    anatomy of the living subject and on general
    anatomical positions and broad relations of the
    vicera, muscles, blood-vessels, nerves and
    lymphatics.

22
RELEVANCE OF DISSECTION
The Anatomy Lecture of Dr. Nicholaes
TulpRembrandt van Rijn (Dutch, 1606-1669)1632,
Oil and Canvas, 169.5 cm by 216.5 cmMauritshuis,
The Hague, Netherlands
  • The purpose of dissection is not to create
    technically expert but to give an understanding
    of the body in relation to its functional, and
    the dissection should be designed to achieve this
    end.

23
CLINICAL ANATOMY
  • Clinical anatomy is the study of the macroscopic
    structure and function of the body as it relates
    to the practice of medicine and other health
    sciences.

24
CLINICAL ANATOMY
  • The pre-clinical subjects Anatomy and Physiology
    paves the way in a continuity, and in an
    evolutionary and progressive pattern to
    understand Para-clinical subjects like alteration
    in anatomy (Pathology) and alteration in function
    (Pathophysiology).

Wilhelm Heinrich Erb (November 30, 1840 - 1921)
was a German neurologist
25
CLINICAL ANATOMY
  • Anatomy is, and shall always remain the
    foundation on which the towering edifice of
    clinical medicine, in all its myriad forms, is
    built.

Bell's palsy
26
CLINICAL ANATOMY
  • What has changed, for the better, is its teaching
    methodology.
  • Today, the study of Anatomy is better integrated,
    both horizontally and vertically, not only with
    other basic sciences, but with clinical sciences
    as well.

27
MORBID ANATOMY
  • Morbid Anatomy, now called Pathology or
    Pathological Anatomy, refers to 'abnormal'
    structure and function.
  • As examples of relevance of Anatomy, reference
    is invited to all -graphies, -scopies, -centeses,
    -otomies, -ostomies, -ectomies, radical
    resections, endoscopies, biopsies, FNACs, Plastic
    and Reconstructive Surgery.

28
MORBID ANATOMY
  • Also, at another level, is exfoliative cytology
    (Pap. Smears), tissue culture and the entire
    Genetic Engineering Technology, PCRs, 'Blots' and
    Immunoflorescence techniques.
  • The scope of Anatomy in pathology is unending and
    all-embracing.

Exfoliative Pulmonary Cytology- ...
29
SURGICAL ANATOMY
  • Two living 18-month old miracles stand testimony
    to the relevance of knowledge of Anatomy in
    Surgery.
  • Dr. Keith Goh Dr. Chumpon Chan with their
    teams, in Singapore, performed a 99-hour
    operation, longest surgery in history, on Ganga
    and Jamuna, Nepali twins born with craniopagus or
    conjoined skulls, with entwinning brains, and
    successfully separated them. This involved months
    of studying three dimensional images of
    bewildering anatomy of their brains (Reader's
    digest, April 2003).
  • Would this have been possible without a thorough
    knowledge of Anatomy, first the normal, then
    recognizing the abnormal, and finally performing
    the miracle of restoring the normal?

30
APPROACHES TO STUDY OF ANATOMY
  • Systemic Anatomy
  • Study of one system at a time, e.g. osteology
    (all bones studied together), myology (all
    muscles studied together), splanchnology (study
    of viscera), etc.

31
APPROACHES TO STUDY OF ANATOMY
  • Regional Anatomy
  • All structures within a certain region are
    studied together, e.g. thoracic region, abdomen,
    head, neck, back, etc.

32
APPROACHES TO STUDY OF ANATOMY
  • Topographic Anatomy
  • Structures on the surface of the skin can be used
    to identify and locate deeper structures, organs,
    and tissues beneath the skin.

33
APPROACHES TO STUDY OF ANATOMY
  • Practical, Dissectional, Cross-sectional,
    Radiological, Artificial, Classic, Corrosion
  • Collectively, they give a three-dimensional
    orientation about the spatial organization of
    various body parts, and it is the visual images
    acquired during a study of these, that are
    crucial in the further understanding of diagnosis
    and treatment.
  • They are the traditional methods of study by
    prosections, aided by corrosion casts, charts,
    modes, and various imaging techniques.

34
APPROACHES TO STUDY OF ANATOMY
  • Minute, Histological, Microscopic
  • As one gains greater insight into the functioning
    of the body at cellular and sub-cellular levels,
    these aspects of Anatomy become more pertinent. A
    sound basis in microanatomy is essential for a
    clear understanding of the Pathology of disease.

ImageTesticle-histology-
35
APPROACHES TO STUDY OF ANATOMY
  • Morphological, Comparative, Ontogenic,
    Developmental, Embryological, Temporal (Tempus
    Time) and Phylogenetic
  • These include the time dimension, with reference
    to human evolution, life span of an individual
    and intrauterine growth and development.

36
HISTORICAL OVERVIEW
37
Pre-historic Medicine
  • Growth and evolution of anatomy as a science is
    an interesting story, it dates back to
    prehistoric age when primitive man lived for
    himself.
  • The fundamental urge was hunger and animals were
    killed for food. Thus it was necessary to know
    the vital parts of animals, that is heart area,
    liver area which they used to strike in order to
    kill the animals.
  • This laid the foundation of topographical
    anatomy.

38
Palaentological Medicine
  • Evidence for trepanning, the surgical procedure
    of cutting a hole in the skull, dates back 4,000
    to 5,000 years.
  • Some anthropologists speculate that Stone Age
    societies performed trepanning on people with
    mental illnesses to release evil spirits or
    demons from their heads.
  • In the absence of written records, however, it is
    impossible to know why the operation was
    performed.

39
Early Phase of Medicine
  • With the growth of civilization men became more
    conscious about their environment. They learned
    to live in society and to help each other in
    distress.
  • A class of people acquired art of healing which
    urged them to know about human body.
  • To start with it was for the people who used to
    detail out anatomical facts in relation to
    diseases and thus anatomy used to be learned as a
    by-product of clinical practice.
  • During this period there was no scope for
    studying human anatomy due to religious
    impositions and superstitious beliefs.

40
Primitive medicine
  • For the primitive man illness was due to the
    vagaries of Gods, demons and supernatural forces.
    The treatment was done by the medicine men called
    shamans through whom the spirits were believed
    to speak. The primitive society did not
    distinguish between magic, religion, and medicine
    or between the physical and psychological
    illnesses.

Shamanism in Siberiaexcerpts from Aboriginal
Siberia
41
Medicine in Dark ages
  • People used sacrificial animals and began
    experimenting on animals to learn anatomy.
  • Zeal for learning anatomy grew to such a
    magnitude that some inquisitives resorted to
    stealing dead body from graveyard or to commit
    murder for this purpose and thus purposeful
    anatomy came into existence.
  • The science developed slowly and a number of
    personalities came into prominence for their work
    on the subject, and Anatomy emerged from myths
    into a definite science.

42
"Anatomy is the foundation of medicine" the
classical Greek physician Hippocrates declared,
"and should be based on the form of the human
body Hippocrates is regarded as father of
medicine and founder of anatomy. His writings
contained directions for dissections and use of
scalpels. His study was based on human bodies
collected from battle fields.
43
The start of any medical career begins at the
dissecting table so it is fitting that medicine
itself began with the study of anatomy.
Galen practiced medicine in 3rd century and was
one of the most influential physicians of all
time. Many of his anatomic principles were based
on animal dissection with the liver felt to be
the seat of soul. His teachings remained the
foundation of medical care for almost 1500 years
known as Galenic Age.
44
  • According to Galen a Greek Physician who lived in
    2nd century AD the illnesses resulted from
    disequilibrium, in the body, of the distribution
    of one or more of the four humors or fluids,
    i.e. blood (from heart), phlegm (from organs),
    yellow bile (from liver), and black bile (from
    spleen).
  • The idea was derived from a philosophical notion
    that all matter was composed of earth, air, fire
    and water, and possessed the qualities cold, dry,
    hot and moist.
  • Blood was hot and moist,
  • phlegm cold and moist,
  • yellow bile hot and dry and
  • black bile was cold and dry.
  • When the humors were well blended the body was
    healthy.
  • However, an excess or deficiency of any one or
    more resulted in disease, e.g. excess of blood
    caused apoplexy (stroke), excess of yellow bile
    caused jaundice while excess of black bile
    brought out melancholia (depression). Too much of
    phlegm in the lungs caused consumption
    (tuberculosis) and too much in the bowels caused
    dysentery.

45
The Four Humors
  • Galen (130-201 AD) was the physician to Marcus
    Aurelius and became the heir to Hippocrates and
    one of the most influential physicians of all
    times.
  • He taught the importance of maintaining balance
    between the four bodily fluids, or "humors" (2)
    blood, phlegm, yellow bile, and black bile. Each
    fluid was associated with a specific personality
    characteristic.

2) Galen's Four Humors
                     
46
The Four Humors
  • Blood was associated with a sanguine personality,
    that is laughter, music, and a passionate
    disposition.
  • Someone with a phlegmatic personality was
    sluggish and dull,
  • Yellow bile represented an individual quick to
    anger or choleric (cholera meaning yellow as in
    yellow fever).
  • Lastly, black bile represented a melancholic or
    depressed personality, melan meaning black.

2) Galen's Four Humors
                     
47
Four Humors and Blood Letting
  • It was the job of the physician to restore
    harmony in those four humors by the use of
    emetics, cathartics, purgatives, and by
    bloodletting.
  • Bleeding was used to reduce excess circulation,
    to slow the pulse, and to "reduce irritation",
    all felt to be the cause of inflammation.
  • Dr. Benjamin Rush, a signer of the Declaration of
    Independence, was a major figure in colonial
    American medicine and was an important proponent
    of bleeding, though unfortunately he mistakenly
    thought that the body held 12 instead of 6
    quarts.
  • Shortly before his death, George Washington was
    bled 4 quarts in 24 hours for an infected
    throat and died not long after.

G. Washington After Being Bled
48
  • In the centuries that followed, there were few
    prohibitions to human dissection though specimens
    were hard to come by and preservation was
    inadequate.
  • Mondino de Luzzi was first to illustrate Galen's
    teachings by dissecting a human cadaver in 1315
    and produced first dissecting manual
    ANATHOMIA. His famous dissection in Bolognia
    remains a landmark.

49
  • Leonardo da Vinci (1452-1519) studied anatomy as
    an art form.
  • His drawings were designed to guide other artists
    and they marked the beginning of systemic study
    of the human body.
  • His were the first correct drawings of fetus and
    he first demonstrated the link between brain and
    peripheral nerves.

Da Vinci Foetus
Da Vinci Bones
Da Vinci Muscles
50
  • Da Vinci's sketches were on loose leaf and were
    the result of 30 careful human dissections.
  • Many of these works are present at Royal Library
    of Windsor.
  • Early anatomic investigation was opposed by many
    religious groups and da Vinci left Vatican to
    avoid prosecution.

"Dispel from your mind the thought that an
understanding of the human body in every aspect
of its structure can be given in words the more
thoroughly you describe, the more you will
confuse... I advise you not to trouble with words
unless you are speaking to blind men." ..........
Leonardo da Vinci
51
  • Andreas Vesalius 1514 - 1564 Father of modern
    anatomy remained a teacher and bachelor
    throughout his life. He did not accept anything
    left as a legacy of any previous worker without
    meticulous dissection.
  • He brought medicine into the modern era with his
    monumental work De Humani Corporis Fabrica Libri
    Septum (1543), now considered one of the
    greatest books in the history of medicine.

52
  • Andreas Vesalius contested the accepted teachings
    of Galen and started his independent studies in
    medicine, and indeed put scientific
    investigation, on the road that has led to
    today's incredible achievements.
  • The magnificent illustrations are classics in
    medicine.

Vesalius Muscleman
Vesalius, Skeleton
53
  • The next great landmark came in 1628 by William
    Harvey when he wrote Exercitatio Anatomica de
    Motu Cordis et Sanguinis in Animalibus.
  • He conducted experiment of movement of heart and
    blood in animals.

This study of circulatory physiology
revolutionized medical investigation by use of
scientific method and was major departure from
Galen, who taught that blood ebbed and flowed
throughout body, beginning in liver.
54
  • The finest anatomic work of 17th century was
    Anatomia Humani Corporis (1685) written by Govert
    Bidloo with 105 copperplate engravings drawn by
    Gerard de Lairesse.
  • These great examples of Dutch baroque art
    generated one of the most famous controversies in
    history of medicine when Bidloo accused William
    Cowper of plagiarism.
  • Original plates of Bidloo's figures found their
    way into Cowper's The Anatomy of Human Bodies in
    1698 after Cowper purchased those plates from
    engraver and reissued them under his own name.

55
  • Art of medical illustration reached its zenith
    with 11-volume compendium by Bourgery, Claude
    Bernard, and N.H. Jacob written between 1866 and
    1871.
  • The coloured illustrations of anatomy and surgery
    in Traite Complete de L'Anatomie de L'Homme are
    unsurpassed and are a necessary part of any
    medical art or instrument collection.

Bourgery, Face
Bourgery, Head
Musculature
Skeleton
Bourgery, Torso
Bourgery, Skull
Bourgery, Face
56
  • Dissection sets were made throughout 19th century
    and could be found at students' side as well as
    in hands of early pathologists.
  • Cadavers for dissection remained difficult to
    obtain and in fact families of deceased often had
    to pay for protection from "resurrectionists" or
    grave robbers, who supplied medical schools and
    anatomists.

Dissection Set
Autopsy
Post Mortem, Open
57
  • Italian craftsmen of 18th century created some of
    the finest wax anatomic models ever made and many
    of those works can now can be found on display at
    Museo di Zoologia, or "La Specola" of University
    of Florence.
  • Louis Auzoux (1797-1880) was a French medical
    school graduate and was the pre-eminent maker of
    paper mache models during 19th century, supplying
    medical schools in Europe, England, and U.S.

La Specola, Head
La Specola, Abdomen
58
  • Artisans turned elsewhere in 20th century when a
    growing population and economic pressures made
    anatomic study more available through mass
    production.
  • The artistry of wax and paper mache figures was
    lost forever, though many still try to recreate
    these beautiful forms of past.
  • "Flap" anatomic models were very popular as
    deeper and deeper structures were displayed by
    turning pages.

Auzoux, Female
Auzoux, Back
59
EXAMPLES FROM PRACTICE IN RELATION TO JOINTS AND
MUSCLES
60
Importance in Clinical Decision Making
Causes of Pain in around Joint 1. Muscular
pain 2. Bursitis 3. Stretching of joint
capsule 4. Synovial effusion. 5. Stretching of
synovial membrane 6. Ligament strain /
tendinitis 7. Periostitis 8. Destruction of
articular cartilage (causes no pain) 9. Raised
pressure in subchondral bone
7
1
2
8
3
4
5
9
6
61
DIAGNOSTIC IMPORTANCE
62
DIAGNOSTIC IMPORTANCE
63
IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
  • The self neglect occurs in food, clothing,
    cleanliness, and physical fitness. This lack of
    exercise and neglect in balanced and nutritious
    food results in feebleness of muscle tone and
    ligaments. The most commonly involved area is the
    vertebral column as long erector spine muscles
    and ligaments in the region of cervical and
    lumbar spine become lax.

Predominant psoric somatotype is ectomorphic. The
subject is lean, thin, tall usually engaged in
sedentary habits and as per his nature commits
self-neglect.
64
IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
  • Thus the periarticular components of the joint,
    getting weak and lax, cannot support the joint.
    The surfaces in mal-alignment further cause joint
    surface degeneration and osteoarthritic changes.
    These osteoarthritic changes more frequently
    affect the cervical spine and lumbar spine,
    leading to cervical spondylosis and lumbar
    spondylosis.

Such a subject is forced to adapt a poor posture
unknowingly while at work and otherwise during
the daily routine.
65
IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
  • These changes ultimately result in typical stoop
    shouldered deformity which becomes apparent in
    the predominantly psoric subject.
  • Surprisingly, such patients develop changes late
    in life and do not suffer more serious affections
    of degenerative arthrosis.

The most benign course of degenerative arthrosis
is seen in subject having preponderance of Psoric
miasm.
66
IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
  • Predominant sycotic somatotype is endomorphic,
    with poor musculature.
  • Such a constitution has overweight which causes
    stress on big weight bearing joints and bloated
    abdomen puts drag on lumbar spine leading to
    lumbar ligament strain and early degenerative
    changes.

Apart from constitutional predisposition, other
associated sycotic disorders as Diabetes
Mellitus, Hypothyroidism, Gout, will modify
onset, course and prognosis.
67
IMPORTANCE IN GENESIS OF DISEASEEXAMPLE OF
OSTEOARTHROSIS
  • Occupation plays a great role in the genesis of
    O.A., e.g. prolonged table work, working with
    computers, which cause strain to cervical and
    lumbar spine.
  • Occupations which involve repetitive joint
    strain, e.g. porter, labourers, sports also
    predispose to O.A.
  • Traumatised joint is most vulnerable to O.A.

Mesomorphic somatotype has well developed
muscular physique, along with an inborn liking
for strenuous physical activity which make them
prone to sports related injuries, development
of O.A.
68
IMPORTANCE IN DISEASE STAGING EXAMPLE OF
SPONDYLOSIS
1
1
1
2
2
2
Primary Stage
Secondary Stage
Tertiary stage
1. Loss of inter- vertebral space
1. Normal lordotic curvature
1. Loss of normal lordosis
2. Narrowed inter- vertebral space
2. Osteophyte formation
2. Encroachment of osteophytes in
Intervertebral foramen
69
Primary Stage
PROGNOSTIC IMPORTANCEEXAMPLE OF RHEUMATOID
ARTHRITIS
  • Pathology reversible.
  • Disease activity
  • mild to severe.
  • Primary sycotic
  • manifestations.
  • Therapeutic aim is to
  • Control disease activity
  • and progression.
  • Achieve remission.
  • Prevent relapse.

70
PROGNOSTIC IMPORTANCEEXAMPLE OF RHEUMATOID
ARTHRITIS
Secondary Stage
  • Pathology irreversible.
  • Disease activity
  • progressive.
  • Sycotic Syphilitic
  • (early) manifestation.
  • Therapeutic aim is to
  • Control disease
  • progression.
  • Preserve function.
  • Prevent complications.

71
PROGNOSTIC IMPORTANCEEXAMPLE OF RHEUMATOID
ARTHRITIS
Tertiary Stage
  • Pathology advanced.
  • Burnt-out phase,
  • Inflammation minimal.
  • Mixed syco-syphilitic
  • manifestation.
  • Therapeutic aim is to
  • Provide symptomatic
  • relief.
  • Minimise disability.
  • Rehabilitation.

72
IMPORTANCE IN MEDICINE SELECTION
  • Insertional
  • Affection at point of insertion of ligaments
    and tendons in bone.
  • e.g. Tennis Elbow, Golfers Elbow.
  • (Phyto., Ruta)
  • Synovial
  • Affection of synovial lining of bursae and
    tendon sheaths.
  • e.g. Housemaids knee, Olecranon bursitis.
  • (Apis, Bry., Phyto.)

73
IMPORTANCE IN MEDICINE SELECTION
  • Nerve Root Affection
  • Irritation to nerve root due to compression at
    intervertebral foramen.
  • e.g. Prolapse disc, C.S., L.S.
  • (Arnica, Gnaph., Hyper.)
  • Nerve Entrapment
  • Nerve compression subsequent in its course.
  • e.g. Carpal tunnel syndrome.
  • (Caust., Hyper., Phyto., Rhus tox.)

74
IMPORTANCE IN MEDICINE SELECTION
  • Degenerative arthrosis
  • Focal cartilage loss.
  • New bone formation.
  • (Ang. vera, Calc. fluor., Caust.)
  • Inflammatory Arthritis
  • Synovitis.
  • Synovial effusion.
  • (Apis, Bry., Form. acid, Form. rufa, Gaulth.)

75
PATHOLOGICAL IMPORTANCE EXAMPLE OF MUSCULAR
DYSTROPHY
  • Muscular dystrophy is a characterised by
  • Progressive muscle weakness loss of muscle
    tissue.
  • Muscle deformities.
  • Contracture deformities (clubfoot, clawhand,
    etc.)
  • Scoliosis.
  • Enlargement of calf muscles (pseudohypertrophy)
  • Because these are inherited disorders, risk
    include a family history of muscular dystrophy.

76
PATHOLOGICAL IMPORTANCE EXAMPLE OF MUSCULAR
DYSTROPHY
  • A positive Gower's sign reflects more severe
    impairment of lower extremities muscles. Child
    helps himself to get up with upper extremities
    first by rising to stand on his arms and knees,
    and then "walking" his hands up his legs to stand
    upright.

77
PATHOLOGICAL IMPORTANCE EXAMPLE OF MUSCULAR
DYSTROPHY
  • Creatinine Kinase (CPK-MM) levels in the blood
    stream are extremely high.
  • An electromyography (EMG) shows that weakness is
    caused by destruction of muscle tissue rather
    than by damage to nerves.
  • Genetic Testing can reveal genetic errors in the
    Xp21 gene.
  • Muscle biopsy or genetic test confirms the
    absence of dystrophin.

78
MEDICOLEGAL IMPORTANCE EXAMPLE OF RIGOR MORTIS
  • A few hours after a person dies, joints of body
    stiffen and become locked in place. This
    stiffening is called rigor mortis.
  • Depending on temperature and other conditions,
    rigor mortis lasts approximately 72 hours.
  • The phenomenon is caused by skeletal muscles
    partially contracting. Muscles are unable to
    relax, so joints become fixed in place.

Rigor mortis is used to estimate time of death.
Maximum stiffness is reached around 12-24 hours
post mortem. After 72 hours general tissue decay
leaking of lysosomal intracellular enzymes
cause muscles to relax.
79
MEDICOLEGAL IMPORTANCE EXAMPLE OF CADAVERIC
SPASM
  • Cadaveric spasm, also known as instantaneous
    rigidity, is a form of muscular stiffening that
    occurs at the moment of death and persists into
    the period of rigor mortis and can be mistaken
    for rigor mortis.
  • It is usually associated with violent deaths
    happening with intense emotion.
  • It may affect all muscles in body, but typically
    only groups, such as forearms, or hands.
  • It is seen in cases of drowning victims when
    grass, weeds, roots other materials are clutched,
    and provides proof of life at time of entry into
    water.

Cadaveric spasm often crystallizes the last
activity one did prior to death and is therefore
significant in forensic investigations, e.g.
clinging on a live electrical wire tightly.
80
LEGAL IMPORTANCE EXAMPLE OF JUDICIAL HANGING
  • Hangmans knot is a well-known knot most often
    associated with its use in hanging.
  • The knot of rope is typically placed under or
    just behind left ear.
  • As the blow when the condemned drops to the end
    of rope is supposed to break the neck (for modern
    "long-drop" hangings), this knot adds additional
    striking force against the head and neck.

81
LEGAL IMPORTANCE EXAMPLE OF JUDICIAL HANGING
  • When the body is released from a relatively high
    position, death is usually caused by the odontoid
    process severing the spinal cord between C1 and
    C2. High C1-C2 fracture has been called the
    hangmans fracture in medicine, even when it
    occurs in other circumstances.

The mechanical stimulation of the carotid sinus
in the neck brings on terminal cardiac arrest.
In the absence of fracture and dislocation,
occlusion of blood vessels becomes the major
cause of death, rather than asphyxiation.
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