On Which Cannibal The Clever Rhetoric of Montaignes On the Cannibals - Literature Essay Samples

â€Å"What does sadden me is that, while judging correctly of their wrong-doings we should be so blind to our own† (235). Montaigne’s essay â€Å"On the Cannibals† is a criticism on how the ‘civilized’ man passes judgment too harshly upon others while disregarding their own actions. This is especially apparent, as he has read the accounts by the conquests in the New World. He expresses this idea through his presentation and use of evidence, rhetoric, and thoughtful structure of his essay. Known for his idiosyncratic examples and anecdotes, Montaigne also proves to be an adept rhetorician; in particular, he evinces an ability to anticipate his readers points of preconception or resistance, and to maneuver around these impediments to persuasion. Montaigne always seems to place the correct evidence with the idea at hand in order to craft the reader’s mind toward his main idea. His brother lives on the coast and is facing a retreating coastline; this fact is crafted to fit Montaigne’s idea of changing boundaries affect how people interact and view each other, but how valid is the example? â€Å"The locals say that the sea has been thrusting so hard against them for some time now that they have lost four leagues of land.† This is not a concrete piece of evidence, but Montaigne recognizes when to use more subjective evidence to explain a topic and when to give factual information like the battle of the Spartans or the many wives of Jacob in the Bible. What this does though, is create a sense of security with the facts and information given by Montaigne so all examples that are given are held to the standard of its most supported example given. This evidence being an example from the Bible, the rest of the ev idence is held to the same esteem. Not to say that is a bad thing. For his idea to come across as clear as he intended, you must â€Å"go along for the ride.† This ride being a sarcastic, skeptical, and cynical one through the human condition. The tone of one’s work sets the mood for how well received it is by the reader. â€Å"I fear that our eyes are bigger than our bellies, our curiosity more than we can stomach. We grasp at everything but clasp nothing but wind† (229). Montaigne self-identifies with the group he is criticizing in an effort to bring the reader into the argument, assuming the people reading his work fit the bill of western European culture. A break in the text allows for a moment of reflection and impact that the reader will remember. Montaigne adds these to separate his main ideas and to add a little flair, be it publisher’s choice or not, the breaks are written in the original language in which they were intended. As noted by this publication with a [B], many of these quotes were written before his death in a revision of his essays. With the interruptions and frankness behind his work, a bit of comic relief helps keep the reader engaged. Montaigne’s casual nature can also be detrimental to his main idea. The predominant idea is that the western culture is too judgmental on new and different cultures that they cannot see the problems within their own society. He employs quotes from two natives brought back to Europe that he had spoken to, but prefaces the information with an apology for not remembering all three points the natives spoke about. This discredits Montaigne slightly as an accurate teller of information. While Montaigne’s lack of solidarity in his interview with the natives is concerning, the way he approached it was quite unique. More often then not, writers would rather have a third idea splashed within the paper to satisfy rhetoric and their main thesis. This is not the case for Montaigne, and while it may slightly discredit the information he has given thus far, I think it helps â€Å"pack a punch† with the evidence he does bring forward. The frankness he holds is impressive and quite risky. Having brought up the fact that he should satisfy rhetoric in the rule of three and that the natives did, in fact, share more than memory serves draws the readers attention to the information that follows. Montaigne stopped the flow of his argument to point out he has forgotten a point to sort of ground the reader and draw his attention to the new topics he brings up. This is a powerful tool that Montaigne uses in his favor toward the end of his essay. Another rhetorical device he uses is the over-arching metaphor of the criticism on cannibalism being the same mindset western Europeans approach new societies in general. Taking a very grotesque and foreign example to headline his essay draws the reader in, continually keeping the example on their mind. Montaigne uses this as the basis for the rest of his argument against societal judgments. Marriage, battle, honor, daily life, and dress are all topics with the same division as cannibalism, both being present yet different in each society. Montaigne is a thoughtful writer, as he does not explain the cannibalism argument right away. There is a thoughtful structure behind his support. At first, the reader is slightly confused as Montaigne talks about boundaries occurring between people, natural or artificial, and the validity of the accounts he has read about. The flow of consciousness is effortless though as Montaigne is a great writer when it comes to cognitive ideas leading to a well-developed thought. He keeps this line of thought fairly unbiased as we have identified his main idea, being that people judge others for things they themselves do and cannot see. His bias does take over slightly, but to his benefit. â€Å"Not at all bad, that. – Ah! But they wear no breeches . . .†(241). This is the quote that ends the essay. Up to that point, the majority of points Montaigne made could have supported either side toward being the â€Å"cannibal.† The balance within the essay is very well maintained, as Montaigne criticizes both sides to the same extent. Maybe not the same voice throughout, but most definitely in content. For example, the cannib alism, where the reaction from the European conquistadors who see the natives killing their own and roasting them like a pig for food, or similarly after a battle to signify the ultimate victory. The same practice is seen in the European camps to prisoners being burned alive and tortured. Also, it is seen again in the medical field where the dead are used to cure the living. The balance of ideas whether it be in quantity or breadth, Montaigne maintains very well. What makes his idea so strong though is the subtlety behind his stance. After long flowing paragraphs, wordy explanations, and seemingly irrelevant tangents, he states his idea with a sassy one-liner to cap off the essay. That is powerful. Indeed, Montaigne’s unusual delivery craftily expresses his criticism of Western European judgments being worse than those that, as he expresses, naturally follow divisions of people, whether naturally or artificially occurring.

Neurologic aspects of pain - Free Essay Example

Sample details Pages: 28 Words: 8358 Downloads: 9 Date added: 2017/06/26 Category Biology Essay Type Argumentative essay Did you like this example? 1. Neurologic Aspects of Pain 1.1. Functional Properties of Nerve Fibres 1.1.1. Properties of Peripheral Somatic Nerves Peripheral somatic nerves consists generally of somatic-motor, autonomic-motor and sensible fibres. 1.1.1.1. Somatic-motor fibres for the striated musculature The cell bodys of somatomotor fibres for the striated musculature are always lying in the brainstem (12 pare cerebral nerves) or the fore horn of the whole spinal medulla. The stimulus runs from central to peripheral (efferent). The lateral cutaneous femoral nerve consists of sensible fibres and no motor fibres. The shiatic nerve consists of 20% motor fibres, 30% sensible, and 50% sympathetic fibres. The gluteal nerves consist of pure motor fibres, sympathetic fibres and no sensible fibres. 1,2 Don’t waste time! Our writers will create an original "Neurologic aspects of pain" essay for you Create order 1.1.1.2. Autonomic-motor fibres for the smooth muscles of blood- and lymphatic vessels The autonomic-motor fibres for the smooth muscles of the blood and lymphatic vessels are of sympathetic origin. Venes are not innervated. They function by the musculare pump system and in some cases by valves. The cells bodies of the autonomic-motor fibres are situated in the lateral horn between C8-L2. They are termed: the centro-ganglionar neurons. All motor neurons, situated in the spinal medulla go via the fore horn to the peripheral nerve. It must be mentioned that all smooth muscles can contract without external innervation (for example: heart, gut). This is due to the intrinsic nerve system with is influenced by the sympathetic and parasympathetic nervous system. 3-5 1.1.1.3. Sensible fibres for somatic structures The sensible fibres for somatic structures originate from muscles, tendons, capsules, joints, ligaments and bones. Their cell bodies are lying in the spinal ganglions of the corresponding nerve (= afferent). 2,6 1.1.1.4. Sensible fibres for autonomic structures: blood- en lymphatic vessels The cell bodies of the sensible fibres for autonomic structures are situated in the spinal ganglions of the segments where the sympathetic neurons start (SI-joint: T11-L1). The peripheral autonomic nerve contains generally autonomic-motor and sensible fibres and serves for the innervation of organs. Glands are always dubble innervated (sympathetic and parasympathetic), except for the adrenals. 2 Examples: The femoral arterie contains sensible fibres which go to the spinal ganglions and arrive in the dorsal horn where connections exist, via intercalar neurons, with the origins of the sympathethic fibres of the levels T10-T11. Knee joint: is sensible innervated via the sciatic nerve (posterior side of the knee), but in the knee capsule, sensible fibres exist which connect via the femoral arterie the levels T10-T12. 1.1.2. Properties of Peripheral Autonomic Fibres Peripheral autonomic nerves consist of autonomic-motor and sensible fibres. They innervate organs and glands. 1.1.2.1. Viscero-sensible fibres The cell bodies of viscero-sensible nerve fibres are situated in the spinal ganglions of those segments from where the sympathetic and parasympathetic neurons start. Example: the pelvis organs: S2-S4 and/or TLJ (= thoracolumbar junction). The TLJ receives a lot of information. Some of those stimuli go via the nervous supply in the blood vessel wall. 2 1.1.2.2. Motor fibres for smooth muscles The parasympathetic primary cells are situated in the brain stem to the level of C2 and the lateral horn of S2-S4. The sympathetic origin is situated in the lateral horn of C8-L2. 2,7,8 1.1.3. Axoplasma Flow of the Axons Materials and substances are moved within the cytoplasm of all cells. In the axoplasm (= cytoplasm of neurons), structures such as the smooth endoplasmic reticulum, ribosomes, microtubules and neurofilaments likely take part of the axoplasmic transport mechanism. Perhaps the human movement plays a role in this intracellular motility 9. In the cytoplasm of nerve fibres nutrients and transmitters are moved. At the nerve ends vesicles are located, that continue the transport into the gap junction. The transport in the axoplasma is termed antidrome and orthodrome transport. Antidrome (antegrade) transport occurs from central to the periphery and orthodrome (retrograde) transport in the opposite direction.1,10,11 For the sciatic nerve the antidrome transport is rather fast (12 hours), the orthodrome transport is slower (48 hours). 1.1.3.1. Signal transfer of the peripheral nerve fibres Ion-channels and receptors play an important role in the signal transfer of the peripheral nerve fibres. The ion-channels are located on the extremities of the fibres. They make the transport for the neurotransmitters possible. Receptors are specified. Every cell has  ± 1 million receptors. The gates of the ion-channels (mostly proteins) can be inhibitory or excitatory. The Swann-cells are spread over the axon and form de myelin sheet. The myelin sheets are interrupted by the knots of Ranvier. In the CNS they are termed glial cells. The glial cells have several functions. The myelin sheets have a certain thickness. Unmyelinated axons have Schwann-cells as well. In myelinated axons the stimulus progresses salutatory and in unmyelinated axons the stimulus progresses slowly. The signal transfer of the peripheral nerve fibres has 3 kinds of stimulus progress being chemical transport, electric stimuli progression and axoplasm flow. Chemical transport occurs at the nerve ends, and consists of neurotransmitters. The transport depends of the kind of ion-channel, the neurotransmitter and the receptor. Electric stimuli progress over the axon and occur by opening of the ion-channels stimulation the own nerve ends due to production of the neurotransmitters. The speed of transmission depends of the presence of a myelin sheet and the diameter of the fibres. The axoplasm flow of the neurotransmitter in axoplasma (= chemical) occurs in 2 directions. Sometimes the pain can occur 24 hours after injury! It can also be very slow (up to 48 hours) and be resposible for the à ¢Ã¢â€š ¬Ã…“delayed onset of painà ¢Ã¢â€š ¬?. 1,11 1.1.3.2. Morphologic and functional classification of nerve fibres: Understanding pain phenomen the morphologic and functional properties of nerve fibres is important. In time several classification systems have been investigated and proposed. 1.1.3.3. Classifying axons according to their conduction velocity In the 1920s and 1930s, there was a virtual use of classifying axons according to their conduction velocity 13. Three main categories were discerned, called A, B and C fibres: C fibres are the smallest and slowest. Mechanoreceptors generally fall in category A. The A group is further broken down into subgroups designated: the a fibres: the fastest the b fibres the d fibres: the slowest The muscle afferents axons are usually classified into four additional groups: I: the fastest II, III and IV: the slowest, with subgroups designated by lower case roman letters. 1.1.3.4. Properties of the A-d, A-b sensors or type I en II fibres The A-a and A-b fibres have low threshold properties. They are low threshold afferents/efferents, they have a quick adaptation, are bi- or monosynaptic and unimodal (= mechanosensors: only sensible for mechanical stimuli). They cross the midline in the spinal medulla. The A-b provides information about normal pressure or strain tension and the A-a provides information about position changes of joints in space. They give information about the smooth touch and kinesaesthesis in the skin. 1.1.3.5. Properties of the A-d and C sensors or type III en IV fibres 1.1.3.5.1. The A-d sensors or type III fibres The A-d or type III fibres are selective and have a slightly higher threshold than the A-a and the A-b sensors. They have a longer adaptation time. After a pin prick the pain keeps going on for a time which is a specific property of the A-d sensors. They are multisynaptic and cross the midline in the spinal medulla. A-d sensors are polymodal. They provide information about mechanical stretch and pressure forces from normal to noxious. They give information about temperature from normal to noxious stimuli. From 36,5 °C tot 42 °C especially C-fibres are involved. From 36,5 °C tot 38 °C the A-d fibres are responsible. A quantity of those fibres is noxious. They are termed: à ¢Ã¢â€š ¬Ã…“nocisensorsà ¢Ã¢â€š ¬? but not all. Some measure only normal temperatures and they become nocisensors in case of tissue injury. 11 1.1.3.5.2. The C sensors or type IV fibres The C or type IV fibres are selective and have a high till very high threshold. They are slow to very slow with a long adaptation time. They have tonic and continuous activity properties. They cross the midline in the medulla medulla and are polymodal. The C fibres measure the chemical consistence of tissues from normal to noxious. They measure temperature from normal till abnormal (= noxious). Some of those fibres are nocisensors but not all of them. Example: the sensibility of the knee consists of 80% normal sensibility sensors and 20% nocisensors. 11 1.1.3.5.3. Difference between à ¢Ã¢â€š ¬Ã…“nocisensorà ¢Ã¢â€š ¬?- stimulation and à ¢Ã¢â€š ¬Ã…“painà ¢Ã¢â€š ¬? A nocisensor measures the damage of injured tissue. A nocisensor can but must not necessarily provoke pain. A part of the A-d and C-fibres are nocisensors. They measure the damage or the almost-damage (mechanic, temperature, chemical). Their noxious stimulation does not always lead to pain perception. Here fore the stimulus must attain the thalamus and cerebral cortex, otherwise there is no pain sensation. Not all nociceptory stimuli rise so high to the midbrain or cortex. A lot of stimuli à ¢Ã¢â€š ¬Ã…“extinguishà ¢Ã¢â€š ¬? in the spinal medulla, the ascending pathways or in the brainstem. The stimulus attains the à ¢Ã¢â€š ¬Ã…“pain centresà ¢Ã¢â€š ¬? when the intensity of one stimulus is sufficient or when summation occurs of several stimuli in parts of the dorsal horn. As well reflectory (unconscious) as cognitive (conscious) reactions occur and the nocisensors will provoke à ¢Ã¢â€š ¬Ã…“painà ¢Ã¢â€š ¬?, in case of severe damage. Thus, not all nocisensors provoke pain but they can be considered as normal pain fibres. It is logic that if a nocisensor is sufficiently stimulated it will provoke the sensation of pain. A-d en C fibres can give pain thatà ¢Ã¢â€š ¬Ã¢â€ž ¢s not only caused by the damage itself, but as a result of the damage as well. A pain feelin which is more intense than normally expected is termed hyperalgesia. For example, when ice is applied on the skin it à ¢Ã¢â€š ¬Ã…“hurtsà ¢Ã¢â€š ¬? but ice applied on a burned skin does hurt even more. When punctuated stimuli are applied on the course of the sciatic nerve it à ¢Ã¢â€š ¬Ã…“normallyà ¢Ã¢â€š ¬? hurts but in case of sciatica it hurts even more (= hyperalgesia). Hyperalgesia is hypersensitivity on a stimulus that normally hurts, due to over stimulation of the nocisensors. The A-a and A-b fibres normally do not give pain, because they are not nocisensors. They register only à ¢Ã¢â€š ¬Ã…“normalà ¢Ã¢â€š ¬? values. Under certain circumstances they provoke pain. This happens in ca se of injured tissues or nerves or when the nocisensors become active. When nocisensors already give pain as a result of a decreased threshold, then the A-a and A-b fibres become sensitive as well. A light pressure on the pain area will also be painful. A low pressure- or strain force on the skin, tendons or muscles normally provoke no pain, but in case of damage it will well provoke pain. This is termed allodynia. Allodynia is pain that is caused by a stimulus that normally doesnà ¢Ã¢â€š ¬Ã¢â€ž ¢t hurt due to an increased sensitivity of the the A-a and A-b fibres. This phenomon gives an opportunity to test the pain perception of the nervous system by use of pricking or brushing tests on the painfull area. There is a difference between nocisensor stimulation and the pain interpretation. 11 Table 5: Difference between nocicensor stimulation and pain. By use of selective stimulation the A-a and A-b fibres can be stimulated without that the A-d and C-fibres become active. This is caused by the low threshold of the A-a and A-ÃÆ'Ã… ¸ fibres compared with the A-d and C-fibres. A-d en C-fibres canà ¢Ã¢â€š ¬Ã¢â€ž ¢t be stimulated selectively by use of mechanical stimuli because at the moment those fibres are stimulated; already the A-a and A-ÃÆ'Ã… ¸ fibres are active. When those become active, all fibres were stimulated. Also in case of nociception all those fibres are active. Selective stimulation can be used during TENS application or during active en passive mobilisations applied under the pain threshold level. 11 1.1.4. Hierarchy of the Nervous System The information processing in the nervous system happens on 4 levels. As well as the peripheral nerve ends, the dorsal horn, the brainstem and sub cortical and cortical levels are involvend. 1,7,11 1.1.4.1. The peripheral nerve ends The peripheral nerve ends are responsible for the uptake of information. The receptors are modulated by the state of surrounding tissue and the condition of the peripheral nerve. 1.1.4.2. The dorsal horn of the spinal medulla The dorsal horn modulates the incoming signals and is influenced by the state of the dorsal horn and the quantity and kind of gathered stimuli. 1.1.4.3. The brainstem The brainstem provides the primary responses with autonomic and hormonal modulations as a response to stimulation. 1.1.4.4. Sub cortical and cortical levels The sub cortical and cortical area provides the conscious cognitive and psycho-emotional modulation. The processing of the information and response on stimulation depends on the hierarchic manner, but always occurs with a total integration of the whole nerve system. 1.1.4.5. The Archi-, Paleo- and Neo level of the nervous system The nervous system can be ordered depending on a hierarchic manner in an archi, paleo and a neo level. 7 1.1.4.5.1. The Archi level The archi level consists of the gray matter (dorsal horn) of the spinal medulla, the ascending multisynaptic pathways in and around the gray matter, the medial pathways of the anterolateral quadrant, the mid part of the cerebellum and the brainstem (reticular formation). It is responsible for the à ¢Ã¢â€š ¬Ã…“most automatic movementsà ¢Ã¢â€š ¬? after Hughlings Jackson. 7 1.1.4.5.2. The Paleo level The paleo level consists of the ascending pathways of the anterolateral quadrant, the descending pathways in the ventro-lateral quadrant, the hormonal and vestibular nuclei in the brainstem, the hypothalamus, certain parts of the cerebellum and the limbic system. Humoral influences from the liquor can influence (endofins) the sensibility of the pain system. 7 1.1.4.5.3. The Neo level The neo level consists of the dorsal ascending pathways, the dorso-lateral and ventral descending pathways, the cerebellar cortex, the lateral thamalus nuclei and the cerebral cortex. It is responsible for the cognitive mental processes, accurate skills and à ¢Ã¢â€š ¬Ã…“least automatic functionsà ¢Ã¢â€š ¬?. 7 1.1.4.6. Phylogenetic development of the nervous system The phylogenetic development of the nervous system differs in time for the different levels. The archi-system is the oldest and is identical to that of the lower vertebrates. It is completely developed when born. The paleo-system is younger than the archi-system. It is identical of that of the lower vertebrates but only half developed when born. The neo-system is het youngest system in the phylogenetic evolution. It is much more developed than that of the lower vertebrates and not developed when born. 7 1.1.4.7. Functional properties of the different hierarchic systems of the nervous system Specific properties can be indicated to the different hierarchic levels of the nervous system. 1.1.4.7.1. Functional properties of the Archi level The archi level consists of C and A-d fibres. It is a relatively slow and tonic (continuous) working system that stands for the basic needs of life e.g.: à ¢Ã¢â€š ¬Ã…“basic survivalà ¢Ã¢â€š ¬? or à ¢Ã¢â€š ¬Ã…“most automatic movementsà ¢Ã¢â€š ¬? and autonomic functions such as basic tonus regulation in the brainstem and medial cerebellum. It is responsible for primary pain modulation e.g.: redraw reflex and increased tonus. 1.1.4.7.2. Functional properties of the Paleo level The paleo level consists especially of A-d, A-b, and C-fibres as well. It is a relative quicker system but also has tonic activity properties. The paleo level supports the archi-level by use of hormonal adaptation and psycho-emotional adaptation. It takes part of the autonomic function (hormonal function), fight/flight reactions in case of stress and pain and posture regulation (static posture balance). 1.1.4.7.3. Functional properties of the Neo level The neo level consists especially of A-a and A-b fibres and is very quick with phasic responses on stimulation. It analyses the information of the archi- and paleosystem and is guided by use of cognitive responses. The least automatic movements are à ¢Ã¢â€š ¬Ã…“guidedà ¢Ã¢â€š ¬? and à ¢Ã¢â€š ¬Ã…“consciousà ¢Ã¢â€š ¬? movements. It regulates the dynamic posture balance and automatisation of movements. It is responsible for the organ sense perception and dissociated movement. 1.1.4.7.4. Interaction and control of the different hierarchic systems in the nervous system General principles of interaction among the different hierarchic systems in the nervous system can be summarized as follows. The paleo-system controls the archi-system and guides it. The neo-level controls the archi- and paleo system and guides both. The neo-level surrounds literally the archi and paleo level. The grey matter is situated medially in the nervous system medial in spinal medulla, the white matter laterally. The neo-system keeps the paleo-level and archi-level à ¢Ã¢â€š ¬Ã…“in harnessà ¢Ã¢â€š ¬?. The hierarchic construction of the nervous system can be seen as a gate control system that exists on all levels. 7 1.1.4.7.5. Gate-control in the peripheral nerve fibres Axo-axonal connections between lower and higher fibres exist. The A-a and A-b fibres give off collaterals in the dorsal horn. The A-a and A-b attain the spinal medulla faster and à ¢Ã¢â€š ¬Ã…“prepare ità ¢Ã¢â€š ¬? for the arrival of A-d and C-stimuli. Selective stimulation of higher fibres (A-a and A-b fibres) inhibits the working of the fibres of lower order (A-d and C-fibres). 1.1.4.7.6. Gate control in the dorsal horn At the level of the dorsal horn interaction and control mechanisms exist and this phenomen known as à ¢Ã¢â€š ¬Ã…“Gate-control in the dorsal hornà ¢Ã¢â€š ¬? is also known as the gate theory of Melzack en Wall. The outlets of the A-a en A-b neurons shunt on the outlets of the A-d and C-neurons and their neurotransmitters close the ion-channels of these. The descending pathways of the paleo- and neosystem do the same and work on the interneurons and inhibit the A-d and C-neurons. 11 1.1.4.7.7. Gate-control in the brain The cortical pathways control the sub cortical pathways. They inhibit the brainstem reflexes. à ¢Ã¢â€š ¬Ã…“Consciousà ¢Ã¢â€š ¬? movements and intentions inhibit à ¢Ã¢â€š ¬Ã…“unconsciousà ¢Ã¢â€š ¬? tonic reflexes (Example: relaxation). The cortical and sub cortical pathways regulate a directed and conscious life. The brainstem provides the autonomic support. This is all controlled by neurotransmitters. The perception of nociceptive pain not only involves the sensation transmitted and regulated by peripheral and central neurons, but is also affected by higher brain functions. 11 1.1.4.7.8. The uptake of nociception information A-d and C-fibres are the only fibres that can registrate nociception. The A-d fibres are quicker and give à ¢Ã¢â€š ¬Ã…“epicriticà ¢Ã¢â€š ¬? pain when the stimulus is attaining the pain centres. Epicritic pain means precise localisation with immediate redraw reflexes. The kind of pain is described as stabbing, boring, tearing or pulling. The impulses of the C-fibres attain the pain centres much later. They give à ¢Ã¢â€š ¬Ã…“protopathicà ¢Ã¢â€š ¬? pain, which is a continuous pain. That pain is not precisely located. Protopathic pain is burning, booring of a kind and continues much longer. It goes together with autonomic reactions, for expample: oedema. 11 1.1.5. The dorsal horn of the spinal medulla 1.1.5.1. General survey of the classification of the grey matter of the spinal medulla The grey matter is divided in the 10 layers of Rexed. This system is named by Rexed who discovered that the neurons in the dorsal horn where organised in à ¢Ã¢â€š ¬Ã…“layersà ¢Ã¢â€š ¬? depending on their function. Every layer is present in different segments and forms rostro-caudal nuclear columns. The counting happens from the dorsal horn to the anterior horn. Every layer is in contact with another by interneurons and dendrites. Layer I and II: nocisensory outlets of both: musculo-skeletal and visceral structures Layer III: intersegmental ascending pathways (dorsal proprium tract) and outlets to the spinothalamic tract (anterolateral quadrant) Layer IV: exclusive nocisensors from the musculoskeletal system Layer V-VI: fibres arriving from the nocisensors of the skin and viscera Layer VII: lateral horn: interneurons and sympathetic neurons Layer VIII en IX: motoneurons for musculoskeletal system Layer X: hormonal neurons In all levels descending pathways arrive from diverse levels of the brain. 1.1.5.2. Somatotopic ordering of nocisensors in the dorsal horn In layer I-II the nocisensors of viscera and musculo-skeletal structures are laying next to each other. They are ordered in a sagittal way from medial to lateral. The medial structures project medial and lateral structures project laterally. In layer V the nocisensors of certain skin areas are lying next to the nocisensors of viscera. Those are ordered in à ¢Ã¢â€š ¬Ã…“horizontalà ¢Ã¢â€š ¬? layers. For example: the organ-nocisensors under the level of the diafragm are lying next to the skin sensors from Th7-Th10. 1.1.5.3. Segmental interactions in the dorsal horn Normal reactions in musculo-skeletal influence the nocisensoric function. Outlets of nocisensors stimulate interneurons. There exists interaction with the spinothalamic tract and interaction with motoric anterior horn cells (somato-somatic relation). Normal reactions in musculo-skeletal nocisensoric function and influence the outlets of nocisensors stimulate the interneurons causing interaction with spinothalamic tract and with the sympathetic lateral horn cells (viscero-visceral relation). 11 Abnormal reactions can occur when the outlets of nocisensors à ¢Ã¢â€š ¬Ã…“infectà ¢Ã¢â€š ¬? the other nocisensors. Those react in turn causing interaction between motoric and visceral responses. This results in a somato-visceral relation, a somato-sympathetic relation and a viscero-somatic relation. 1.1.5.4. The Importance of Wide Dynamic Range Neurons In layer III, wide dynamic range neurons (WDR-neurons) exist. 21 Those WDR-neurons are interneurons that connect all the A-d en C-fibres from the dorsal horn. They project on the spinothalamic tract (antero-lateral quadrant). The ventral pathways go to the reticular formation, medial thalamus and the medial limbic system. The lateral pathways go to the lateral thalamus and cortex. They connect all visceral and motoric stimuli (= summation) with as consequences that motoric and visceral stimuli are sent together to the brain. The brain receives à ¢Ã¢â€š ¬Ã…“segmentalà ¢Ã¢â€š ¬? information and no à ¢Ã¢â€š ¬Ã…“individualà ¢Ã¢â€š ¬? information. The brain can project pain to segmental connected structures. This is termed à ¢Ã¢â€š ¬Ã…“referred painà ¢Ã¢â€š ¬?. Examples are: the stomach ulcer can provoke inter scapular pain or cardiac complaints and can give ulnaris nerve pain. Pain does not always indicate the exact location and origine. Anamnesis, assessment and clinical rea soning are very important. 1.1.5.5. Inhibition and excitation of the dorsal horn Inhibition and excitation of impulses in the dorsal horn can be caused by outlets of peripheral nerves. For example the A-a and A-b can inhibit the A-d and C fibres (pre-synaptic inhibiton). The outlets of the descending pathways can influence the the nerve ends and the interneurons (postsynaptic inhibition/excitation). The interneurons themselves can cause pre- or postsynaptic inhibition/excitation. Summation of stimuli defines the state of the dorsal horn. If a segment is excited or inhibited depends on the som of stimuli. Nocisensory impulses of the peripheral nerves always excite the dorsal horn. Summation of exciting nocisensoric impulses is defined by à ¢Ã¢â€š ¬Ã…“spatialà ¢Ã¢â€š ¬? and à ¢Ã¢â€š ¬Ã…“temporalà ¢Ã¢â€š ¬? facilitation. Temporal facilitation means the timing; spatial facilitation, the diverse structures that are involved. Impulses of A-a and A-b neurons act à ¢Ã¢â€š ¬Ã…“generallyà ¢Ã¢â€š ¬? inhibiting. The impulses from the descending pathways can act i n both ways. They are also regulated by temporal and spatial factors. The sum of stimulating and inhibiting stimuli defines the state of the dorsal horn. An excitated dorsal horn provokes a lot of irradiating pain. 1.2. Assessment of Primary and Secondary Hyperalgesia 1.2.1. Definition of primary hyperalgesia à ¢Ã¢â€š ¬Ã…“Changes in the local sensibility of the afferent neurons as a result of a lesion in the peripheral tissues are termed hyperalgesiaà ¢Ã¢â€š ¬?. In case of an increased sensibility of the A-a and A-b fibres the primary hyperalgesia is termed allodynia. In case of an increased sensibility of the A-d and C fibres the primary hyperalgesia is termed hyperalgesia. The lesion in the peripheral tissue can be of inflammation or neurogenic origin. 22 1.2.1.1. Pathophysiology of primary hyperalgesia In case of tissue injury bradykinin and ATP is produced at the site of lesion. Those mediators stimulate the blood- and lymphatic vessels, the mast cells and nociceptors. In the circulation inflammatory mediators are released aswell as histamine, serotonin, NGF, leucocytes, trombocytes and others. C-fibres released neuropeptides such as SP and CGRP. Those modulate and stimulate the release of other inflammatory mediators aswell. All those mediators are termed the à ¢Ã¢â€š ¬Ã…“inflammatory soupà ¢Ã¢â€š ¬?. Those mediators also stimulate the C-fibres which causes a vicious circle. The sympathetic nerve terminals are stimulated by inflammation and release noradrenalin which also stimulates the C-fibres. The à ¢Ã¢â€š ¬Ã…“sympathetic couplingà ¢Ã¢â€š ¬? between C-fibres and sympathetic end neurons occurs. The presence of inflammatory mediators decreases the threshold of all types of endneurons with as a result local allodynia and hyperalgesia. The allodynia and hyperalgesia can sp read in the surrounding tissue, by stimulating the surrounding neurons. This is termed the flair zone. 22,23 Figure 16: Consequences of tissue injury: the inflammatory soup. 14 1.2.1.2. Primary hyperalgesia and the dorsal horn The A-d mechanoreceptors and nociceptors, and C-nocisensors stimulate the dorsal horn of somatic connected segments. As a consequence a temporary wind-up can occur. A wind-up is an over stimulation that can hold on for 72 hours. A refectory muscular reaction occurs around the lesion aswell. As a result the stimulation via the ascending pathways (antero-lateral quadrant) to the brain increases. Protopatic pain (quick, stabbing pain) followed by epicritical pain (boring, continuous pain) occurs. The brainstem regulates the autonomic reactions further such as sympathetic, hormonal, and emotional. The C-nocisensors give stimuli to the sympathetic connected segments. As a result the sympathetic system stimulates the C-endneurons (= sympathetic coupling) and vasoconstriction on the arterioles and lymphatic vessels. 20,24 1.2.1.3. Primary hyperalgesia and nerve injury When compressed inflammation occurs as prescribed above. In case of long standing injury, an ectopic injury occurs. This can be located on different locations on the peripheral nerve with the result that hyperalgesia and allodynia occurs on the course of the nerve, the connected dermatomes and this from the nerve root! In the spinal ganglion of the nerve, the sympathetic endneurons grow round the nerve cells with the occurrence of basket formations as a result. Consequently sympathetic maintained pain (SMP) occurs, also termed causalgia. This phenomon can continue for 7 to 10 weeks after the lesion but can also continue afterwards. 10 25 To summarize we can state that inflammation provokes a à ¢Ã¢â€š ¬Ã…“localà ¢Ã¢â€š ¬? hyperalgesia and allodynia, which spreads over the flair zone. Locally a vicious circle between the inflammatory soup and C-fibres takes place and sympathetic coupling between sympathetic end-neurons and C-fibres occurs. This continues until the tissue heals. Normally the medulla reacts with a temporary wind-up and a normal stimulus-response reaction. In case of neurogenic injury, causalgia may occur and sensitisation of the dorsal horn is possible. 22 1.2.1.4. Clinical pain assessment in case of primary hyperalgesia During the pain assessment, in case of primary hyperalgesia, when brushing or by use of punctuate stimuli the following properties are local allodynia and hyperalgesia restricted to the flair zone. In case of a nerve injury the flair zone is restricted to the course of the nerve root. Local sympathetic reactions occur when inflamed but are restricted in time. In case of allodynia and hyperalgesia when brushing and applying punctuated stimuli on the course of the nerve or a part of it, sympathetic reactions in the dermatome of the nerve can occure aswell. 22 1.2.2. Definition of Secondary Hyperalgesia à ¢Ã¢â€š ¬Ã…“An increased sensibility of all types of nerve fibres that continues outside the flair zone of the original lesion, linked to the course of the hyperalgesia and allodynia around the tissue, is termed secondary hyperalgesiaà ¢Ã¢â€š ¬?. 22 1.2.2.1. Pathophysiology of secondary hyperalgesia When tissue is injured, nociceptors stimulate the interneurons by use of neurotransmitters such as SP, CGRP, NO, Ca, etc. The A-a and A-b neurons provide inhibiting neurotransmitters and the descending pathways give exciting or inhibiting mediators. The WDR-neurons receive al those impulses and send them to the spino-thalamic tract. WDR-neuron receptors differ. Some open ion-channels using inhibiting neurotransmitters, others open ion-channels using exciting neurotransmitters depending on the kind of receptor. If the stimulus acts inhibiting or exciting depends on the quantity of the opened inhibiting- or exciting ion-channels. In case of secondary hyperalgesia, more excitatory stimuli exist and insufficient inhibiting ways are activated. The WDR-neurons will work exiciting as well because of the fact they do not only activate the spino-thalamic pathways but also on the incoming stimulating neurons. As a result a vicious circle occurs in the dorsal horn. This provokes a decreased thr eshold of the present neurons. The sensors are also stimulated by the dorsal horn and not only by the local lesion. They become sensitized over their whole course with the consequence that the central hyperalgesia is linked to the lesion. When the local lesion is healing, the central allodynia will also disappear. Hyperalgesia is not as much linked to the course of the lesion but can last longer. Its origin is mostly caused by temporal and spatial summation of exciting stimuli. 22 1.2.2.2. Clinical pain assessment in case of secondary hyperalgesia During the pain assessment, when touching (brushing) and applying punctuate stimuli local hyperalgesia en allodynia and extending hyperalgesia and allodynia can be observed. When the pain occurs outsite the spinal column area the touching (brushing) and applied punctuate stimuli starting from the lesion and over the dermatome near by. The application must be enlarged to the neighbouring dermatomes and also to the corresponding segments of the spine. Always compare with the opposite side. Differentiate allodynia and hyperalgesia. 22 In case of primary hyperalgia the allodynia and/or hyperalgesia is restricted to the lesion area and flair zone. The allodynia disappears before the hyperalgesia when healing. In case of secondary hyperalgesia the allodynia and or hyperalgesia is present in several dermatomes and sometimes occurs up to the spinal segments. The allodynia disappears sooner than the hyperalgesia when healing. When the pain occurs at the level of and around the spine, the touching (brushing) and applying punctuate stimuli must first be applied on the painful segments and continued to higher and lower segments. The findings in the different segmental zones must be compared with each another. The conclusions are identical as case of peripheral pain. 22 1.2.3. Sympathethic maintained pain 1.2.3.1. Definition of sympathetic maintained pain: à ¢Ã¢â€š ¬Ã…“Pain, which is maintained by local or central over stimulation of the sympathethic nervous system, is termed sympathetic maintained painà ¢Ã¢â€š ¬?. Sympathetic maintained pain can occur as a consequence of local maintained inflammation and provoke phenomons such as sympathetic reflex dystrophy or complex regional pain syndrome (= CRPS). 26-28 1.2.3.2. Pathophysiology of sympathetic maintained pain In case of sympathetic maintained pain, local inflammation is maintained by local sympathetic coupling. This can be caused by a continuous stimulation of the secondary neurons in the lateral horn. This stimulation can be the result of stress situations or local input from organs. In pain physiology sympathetic reflex dystrophy (CRPS) is described as CRPS type I of II. CRPS I is the classic algoneuro dystrophy and CRPS II is the earlier described causalgia. Both types have a different pathophysiology. CRPS I is caused by a continuous sympathetic coupling as seen in maintained inflammation. The CRPS II is caused by the presence of basket formations in the spinal ganglion in case of a nerve lesion. Sympathethic maintained pain can be mild to extreme. In both cases of pain, the sympathetic system is involved. It depends from case to case, if its role becomes dominating. 26-28 1.2.3.3. Clinical pain assessment of sympathetic activity When assessing patients with chronic pain it is important to evaluate the sympathetic activity. This can be done with superficial observation and palpation of the skin. Herefore the therapist strikes softly over the skin of the back with the dorsal side of the hand. Look for colour changes, connective tissue abnormalities (strings), sweaty skin, pilo erection (chicken skin reaction). Afterword the Kibler-skin roll test can be applied. Hereby the skin is taken up between the thumb and index or mid finger. Lift and roll out the skin softly while proceeding in the paravertebral area over the whole spinal column. This must be repeated about 4 times. During the assessment; special attention must be made for possible presence of adhesions, the elasticity and dampness of the skin. Pain and red colouring may occur. The Headsche zones can be disturbed. Deep irritation of the skin can occure accompanied with muscular tension (McKenzie zones). To assess deeper tissues, enforced circularly frict ions around the paravertebral musculature can be applied over the whole spine and repeated sufficiently. When palpating for hypertonic paravertebral musculature, also look for sweat reactions, the red colour and Headsche zones, pain, hypertonia (Mc Kenzie zones). Sometimes the Headsche zones and the Mc Kenzie zones can correlate and indicate an underlying pathology. 7,26-28 1.2.3.4. Clinical neurodynamic pain assessment During clinical pain assessment special attension must be made for peripheral nerve lesions. While neurodynamic testing, the à ¢Ã¢â€š ¬Ã…“mobilityà ¢Ã¢â€š ¬? of the peripheral nerve is assessed when elongated. The sensibility or à ¢Ã¢â€š ¬Ã…“irritabilityà ¢Ã¢â€š ¬? of the peripheral nerve must be evaluated and the involvement of the peripheral nerve in case of a locomotoric lesion must be investigated. The neurodynamic testing involves à ¢Ã¢â€š ¬Ã…“mobilityà ¢Ã¢â€š ¬? or sensibility assessment of the dura mater aswell. The sympathetic chains must be must also been assessed. More details are described in literature 10,29-35. 1.2.4. Organisation of the Sympathetic Nervous System The functional properties of the sympathetic- en parasympathetic system are the regulation of the physiological basic functions such as: blood pressure, heart- and lung function, energy regulation and the functioning of organs. The function of the exo- and endocrine glands are regulated. The autonomic nervous system plays an important role regulating the the balance of the à ¢Ã¢â€š ¬Ã…“milieu interneà ¢Ã¢â€š ¬? (homeostasis). 2 Table 6: Organisation of the autonomic system. 1.2.4.1. Sympathetic nervous system: musculo-skeletal distribution 1.2.4.1.1. Primairy or first order neurons The primary or first order neurons are situated in locus coerolus (b-fibres) and in the reticular formation. The axons or first order neurons attain the whole spinal medulla and have collaterals to the dorsal horn. They produce catecholamine provoking inhibition. They have collaterals to cells in the lateral horn between C8-L2 as well. The first order neurons are stimulated by the limbic system, the cerebellum and the hormonal system. 22,36 1.2.4.1.2. Secondary or second order neurons The secondary or second order neurons are situated in the lateral horn (intermedio-lateral tract (ILT)) between C8-L2 (b-fibres). The axons go externally via the ventral horn together with the spinal nerves through the intervertebral foramen attaining the paravertebral ganglions. The secondary neurons are stimulated by the first neurons, the interneurons from the dorsal horn and from impulses of visceral or motoric origin. Before they attain the paravertebral ganglia, the second order neurons go as close as possible to the target tissue. 24,37 This phenomen can be summerized in 3 golden rules. Figure 7 Musculoskeletal distribution of sympathetic origin: 3 golden rules. 1.2.4.1.3. Tertiary or third order neurons The tertiary or third order neurons are situated in the paravertebral ganglia. They go direct to the target tissue. They are postganglionic end neurons (C-fibres). The teriary neurons go from every ganglion fibre back to the spinal channel (recurrent nerves). From every ganglion fibres go back to the spinal ganglion. Tertiary fibres follow the local blood- and lymphfatic vessels: radical arterial nerves. They follow peripheral nerves to muscles, joints and skin aswell (grey rami communicantes). 2 1.2.4.1.4. Functions of the sympathetic system on somatic structures The general action occurs from the locus coerulus. It is responsible for the activation of the alert state. Those conditions are also termed: fight/flight reactions. A sympathetic state also provokes an increased basic-tonus, vasodilatation of the large arteries, except for the vertebral arteries, an increased heart beat (tachycardia), increased respiratory volume, and increased adrenaline- and cortisol levels. It inhibits the digestion, provokes pupil dilation (mydriasis), constriction of the arterioles and lymphatic vessels and stimulates sweat- and talg glands. Sympathetic facilitation provokes segmental or general reactions on the skin, in general: on the pilomotoric stimulation (chickenskin reaction), sudomotoric stimulation (sweating) and vasomotoric (vasoconstriction: pale skin). The clinical signs at rest or when touched softly are: pale skin, chickenskin reaction and sweating. When stimulated a red skin, swelling and sweating occurs. By working on the musculature (segmental or general) the Headsche areas can be palpated. Ischemic contractures can appear (Mc-Kenzie areas). 7,38-43 1.2.4.2. Autonomic Nervous system: anatomical considerations The nervous system can be devided in a somatic and autonomic nervous system. Both systems have afferent and efferent properties. The autonomic nervous system receives afferent information of all kind. The efferent part of the autonomic system consists of sympathetic and parasympathetic division. The answer on stimulation depends of the tuning of the nervous system itselve. 7 Table 8: Classification of the nervous system. 1.2.4.3. Anatomical difference between the somatic and autonomic nervous system 1.2.4.3.1. The origin of the somatic and autonomic nervous system in the CNS The peripheral part of the somatic nervous system starts over the whole length of the spinal medulla and medulla oblongata. The peripheral origine of the autonomic nervous system differs for the sympathetic and parasympathetic division. The sympathetic division originates in the medullar segments from C8 to L2 and the parasympathetic division originates in the medulla oblongata and the medullar segments of the sacral medulla. 2,7 1.2.4.3.2. The configuration of the reflex bow The configuration of the reflex bow differs in the somatic and autonomic nervous system. In the reflex bow of the somatic nervous system there exist an afferent and an efferent neuron. The traject of afferent viscerosensible pathways differs from the traject of the somatic sensible pathways. For both systems the perikarion is situated in the spinal ganglions. The autonomic nervous system has a receptor neuron, a centroganglionar neuron and an effector neuron in its reflex bow. The centroganglionar neuron is situated between the receptor and effector neuron. The centroganglionar neurons originate in the lateral horn. It synapses with the effector neuron outside the CNS. The effector neuro connects the centroganglionar neuron with smooth muscles, glands or organs. 2 The receptor neuron or afferent neuron is the same for both divisions of autonomic nervous system. 1.2.4.3.3. Anatomical differences between the sympathetic and parasympathetic nervous system 1.2.4.3.3.1. Position of centroganglionar neuron The centroganglionar neuron is the second autonomic neuron which does not exist in the somatic nervous system. In the sympathetic division, the origin of the centroganglionar neuron is situated between C8-L2 in the lateral horn (intermedio lateral and medial nucleus). 2 In the sympathetic division the origin of the centroganglionar neuron is situated cranial and sacral. The cranial parasympathetic origin is situated in the medular levels C3-C4 of the medulla oblongata and consists of the accessory (Edinger-Westphal) nucleus of the ocullomotor nerve (CN III) (visceral motor), the superior (CN VII) and inferior (CN IX) salivatory nuclei, and the posterior (dorsal) vagal nucleus (CN XI). The sacral parasympathetic origin is situated in the medullar segments S2-S3-S4 of the medio-ventral grey matter of the sacral medulla. 1.2.4.3.3.2. Difference in position of the ganglion or synapse between the 2nd and 3rd autonomic endganglion In the sympathetic division the synapse (ganglion) between the 2nd and 3rd neuron can be situated close to the spinal medulla in the sympathetic chain, or halfway between the spinal medulla and the end organ (splanchnic ganglia, celiac plexus, hypogastric plexus), or close to the organ (parenchymatic gangliae). In the parasympathetic division the synapse (ganglion) between the 2nd and 3rd neuron is never situated in or around the sympathetic chain. Fibres of the parasympathetic system even do not go through the sympathetic chain. The synapse between the preganglionar and postganglionar neuron is situated halfway between the CNS and the target organ (for example: the cardiac, pulmonar, celiac, mesenteric or hypogastric plexus). Mostly the synapse between the 2nd and 3rd neuron is situated close to or into the target organ. All those are parasympathetic exept for the adrenals. Therefore the sympathetic division has typical short preganglionar neurons and long postganglionar neurons. The parasympathetic division has an opposite configuration with long preganglionar neurons and short postganglionar neurons. 2 The grey rami communicantes exist at every medullar level. The white rami communicantes are situated at the level of C8-L2. Sympathetic efferent impulses that must attain higher or lower areas follow the sympathetic chain to their target. The fibres follow the wall of blood vessels. The sympathetic chain attains cranial structures via the internal carotic arterie that enters the skull via the carotic formamen in the temporal bone. 1.2.4.3.3.3. Neurotransmitter properties of the autonomic nervous system The sympathetic neurotransmitters are adrenalin, noradrenalin, amfetamin, dopamine etc. The parasympathetic neurotransmitter is acethylcholin. At the end of the postganglionar neurons of the autonomic nervous system, a different neurotransmitter is used. The postganglionar parasympathetic nerve fibres secrete acethylcholine; the postganglionar sympathetic nerve fibres secrete noradrenalin. In the synapse between the 2nd and 3rd autonomic neuron for both systems acethylcholine is secreted. Therefore the sympathetic nervous system is termed adrenergic and the parasympathetic nervous system is termed cholinergic. 1.2.4.3.4. The sympathetic division The cell bodies of the sympathetic nerves are situated in the lateral horn of the thoracal and upper part of the lumbar medullar segments. The axons leave the spinal medulla via the anterior roots together with the efferent nerves from the somatic system. They connect the the sympathetic chain. The connections between the spinal nerve and the sympathetic chain are termed: the white rami communicantes. The preganglionar fibres can connect the second on different locations. They can connect the 2nd neuron in the sympathetic chain. After synapsing they follow the peripheral nerves of the somatic nervous system. The connections between the sympathetic chain and the peripheral nerve are termed the grey rami communicantes. In the white rami communicantes myelinated fibers are present. In the grey rami communicantes the fibres are unmyelinated. When the preganglionar fibres attain the sympathetic chain they can attain higher or lower medullar segments where they synapse in higher or lower sympathetic chain ganglions. From there they connect the peripheral nerve via the grey rami communicantes. The second neurons can follow the wall of bloodvessels aswell in the periphery. Preganglionar fibres can go through the sympathetic chain without making any synapse to attain the preganglionar plexusses e.g.: the celiac, mesenteric or hypogastric ganglions situated in the prevertebral plexus where they synapse. The sympathetic division provides the cardiac and pulmonary plexus from the medullar levels T1-T6. Via the celiac plexus (T5-T9) the stomach, liver, gallbladder, spleen, kidney (T10-L1), adrenals (T11) and a part of the duodenum and pancreas is supplied. The superior mesenteric plexus (T10-T12) supplies a part of the pancreas and duodenum, the jujenum, ilium, the colon ascendens and the proximal 2/3rd of the transverse colon. The inferior mesenteric plexus (T12-L2) supplies the distal 1/3rd of the transverse colon, the colon descendens, sigmoid and rectum. The hypogastric plexus (T12-L2) supplies the distal 1/3rd of the colon, the colon descendens, sigmoid, rectum, bladder and gender organs. 2,8,43-45 From the level of T5-T9 the n. splanchnicus major occurs and supplies the upper gastrointestinal tract, the duodenum and pancreas via the celiac ganglions. The minor splanchnic nerves occur from the medullar levels T10-T11. Via the superior mesenteric plexus they supply the intestinum tenue, the right colon, the adrenals, the testes, ovaria, kidney, and upper half of the ureters. The nervus spanchnicus minimus occurs from T12 and joins the lumbar splanchnic nerves (L1-L2) in the inferior mesenteric plexus to supply the left colon, the lower half of the ureters, the pelvis, the bladder and gender organs. The sympathetic supply for the arterial blood vessels of the upper limb is provided from the medullar levels T2-T6 and for the lower limb from T11-L2. 1.2.4.3.5. The parasympathetic division The parasympathetic division of the autonomic nervous system originates from fibres that start from the brainstem and the sacral medullar segments. The parasympathetic fibres are joining the cranial nerves such as the occulomotory nerve (III), the fascial nerve (VII), the glossopharyngeal nerve (IX) and the vagal nerve (X). The vagal nerve is considered to be the most important parasympathetic nerve but is discussed further. The parasympathetic preganglionar fibres are long, the postganglionar fibres short because the ganglions where they synapse are situated close to the target organ in the cranium. The parasympathetic fibres that originate from the brainstem and join the cranial nerves (III, VIII, IX) serve the supply for the innervation of the pupil and the glands in the cranium. 2,8,43-45 1.2.4.3.5.1. The ciliar ganglion The ciliar ganglion is situated in the orbital fossa between the lateral rectus muscle and the optic nerve. The preganglionar fibres occur from the autonomic accessory nucleus (nucleus of Edinger Westphal) in the brainstem. They join the occulomotory nerve to the ciliar ganglion where they synapse. From the ciliar ganglion the ciliar breves nerves occur that go through the sclera to the constrictor pupillae muscle and the ciliar body. The sympathetic fibres originate form the cavernous plexus and innervate the dilatator pupillae muscle. 2,8,43-45 1.2.4.3.5.2. The pterygopalatinum ganglion The ganglion pherygopalatinum is situated in the fossa pterygopalatinum under the maxillar part of the trigeminal nerve. The preganglionar fibres originate from the superior salivatory nucleus, which is part of the fascial nerve nucleus. The fibres attain the pterygopalatinum ganglion via major petrosus nerve and the canalis pterygoideal nerve (Vidian nerve). The postganglionar supply the mouth, nose cavities and pharynx. 2,8,43-45 1.2.4.3.5.3. The otic ganglion The otic ganglion is situated medial of the mandibular nerve. The preganglionar fibres occur from the inferior salivatorius nucleus and attain the otic ganglion via the minor petrosus nerve. Theire most important supply is the parotis gland. 2,8,43-45 1.2.4.3.5.4. Submandibular ganglion The submandibular ganglion is situated near by the tube of submandibular gland. The preganglionar fibres occur also from the superior salivatori nucleus. The fibres join the fascial nerve (intermedius n.) and leave it with taste fibres in the tympanic chord. From here they go via the lingual nerve to the base of the mouth where they become a ganglion. They supply the submandibular and submaxillary glands and the anterior part of the tongue. 1.2.4.3.5.5. The vagal nerve The vagal nerve leaves the skull via the jugular formamen and goes through the cervical area near by the oesophagus and provides supply for the heart and lungs. Together with the oesophagus they go through the respiratory diaphragm into the abdomen. Under the diaphragm the vagal nerve joins the celiac plexus and goes via the mesenteric plexus to its target organs. 1.2.4.3.5.6. The pelvic nerve The sacral part of the parasympathetic division exists of branches from S2-S3-S4 that form the pelvic nerve that supplies the pelvis organs. It provides the vesical and uterovaginal plexus. 2,8,43-45 1.2.5. References Loeser JD, Butler SH, Chapman CR, Turk DC. 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In: McMahon SB, Koltzenburg M, eds. Wall and Melzacks Textbook of Pain. 5th ed. Philadelphia: Elsevier Churchill Livingstone, 2006: 721-709. Korr IM. The emerging concept of the osteopathic lesion. 1948. J Am Osteopath Assoc 2000;100(7):449-60. Korr IM. The spinal cord as organizer of disease processes: III. Hyperactivity of sympathetic innervation as a common factor in disease. J Am Osteopath Assoc 1979;79(4):232-. Korr IM. The spinal cord as organizer of disease processes: II. The peripheral autonomic nervous system. J Am Osteopath Assoc 1979;79(2):82. Willard FH, Patterson MM. Nociception and the Neuroendocrine-Immune Connection. International Symposium 1992 1992: 327-1. Patterson MM, Howell JN. The Central Connection: Somatovisceral/Viscerosomatic Interaction. International Symposium 1989 1989: 298-1. Ward RC. Foundations for Osteopathic Medicine. 1st ed. Baltimore: Williams and Wilkins, 1997. Quaghebeur J. Neurologie van het visceraal systeem. FICO. Antwerp, 2006. Bonica JJ, Loeser JD. Applied Anatomy Relevant to Pain. In: Loeser JD, ed. Bonicas Management of Pain. 2th ed. Philadelphia: Lippingcott Williams Wilkins, 2001: 196-191.

Up From Slavery 18th Century Colonial America Under The...

In the documentary, Up from Slavery: 18th century Colonial America Under the Rule of the British Empire, the story of slavery begins on the coast of West Africa where thousands of African people are unceasingly enslaved and placed upon overcrowded ships on which they must endure the cruelest of conditions. Many did not live through the journey due to disease, malnutrition, or in some cases murder, such as the Zong Massacre where 132 slaves were thrown overboard in a monstrous act committed by the captain all for the sake of an insurance claim. Out of the 12 million slaves who endured the grueling Middle Passage, only about 5,000 were transported to the United States. However, by the time of the Civil War, that number increased to 4 million†¦show more content†¦Oftentimes, due to the strenuous labor required to work the plantations, southern plantation owners used mostly male slaves. The lack of female slaves caused a lower reproduction rate and required more importation of s laves. Lastly, the North constituted a third type of system. With an unsuitable climate for the large cultivation of a single crop, the North put slaves on small farms or to work in the household. Despite the idea that the North resisted slavery, places such as Massachusetts, New York, and Rhode Island served as centers for the North American slave trade. Not only was slavery divided up into different systems, but the roles of the slaves varied greatly. Field slaves were subjected to strenuous labor and strict overseers. They usually worked from dusk until dawn without receiving a day off. On the other hand, household slaves took care of the children, chores, and food and were sometimes seen as part of the family. There is a misconception that household slaves had an easier life than those working in the fields. However, regardless of whether or not someone was a household slave or a field slave, they were slaves nonetheless. 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Calcium Element Essay Example For Students

Calcium Element Essay Calcium Element symbolCA Atomic weight40.08 Element number20 Number ofprotons20 Number of electrons20 Number of neutrons20 Density at68? FBoiling point2,264?F Melting point1,562?F Calcium was discovered by SirHumphrey Davis in 1808. Calcium is a mineral found in abundance in the Earthsouter crust. It is the fifth most abundant mineral in the Earth crust. Calciumis considered a major mineral because it is found in large quantity in the body. Milk also has a high amount of calcium and it is the best way to get calcium. Daily dietary requirements exceed over 100 mg. Calcium forms and maintainsteeth, it helps with blood clotting, it helps build cell membranes, helpscontract muscles, helps nerve transmissions and if the bones did not get calciumthey would not grow properly. Plants also need calcium to grow because withoutand adequate supply of calcium to enrich the soil they would die. Calcium isnever found as a pure element in nature. It is found as calcium hydroxide,calcium oxide (also know as lime(lime stone)), chalk, Iceland spar, coral,pearls, egg shells and calcium carbonate which makes up marble and gypsum. Limestone and marble are used for buildings and building. Gypsum is found inplaster, when in crystal form it is called alabaster which is used by sculptorsto carve, it is also found in cement.

Why God Cannot Exist Using Descartes Arguements Essays -

Why God Cannot Exist Using Descartes' Arguements Philosophy 300 Sam Black God Cannot Exist Using Descartes' Argument Steve Cara JIBC/SFU Cohort #1 May 25th, 2000 Descartes sets about proving the existence of God through his meditations on knowledge in an effort to prove the skeptics of his time wrong. He first determines that human knowledge is based entirely too much on unproved presuppositions. He argues that this makes it difficult to distinguish between truth and error, since we cannot recognize true knowledge. Descartes proposes that the quest for knowledge must be based upon universal doubt. Specifically, he proposes the following in relation to his universal methodic doubt: 1. In order to seek truth, it is necessary once in the course of our life, to doubt, as far as possible, of all things. 2. We ought also to consider as false all that is doubtful. 3. We ought not meanwhile to make use of doubt in the conduct of life? 4. Why we may doubt of sensible things. 5. Why we may also doubt of mathematical demonstrations. 6. We cannot doubt of our existence while we doubt, and this is the first knowledge we acquire when we philosophize in order. Descartes proceeded to strip away his knowledge base in order to determine the one indubitable fact, Cogito, ergo sum. From this absolute knowledge of his own existence, he set about deducing the existence of God through ontological argument. ? In our minds, the idea of God is one of an infinitely perfect Being ? An infinitely perfect being must have existence, otherwise it would not be infinitely perfect. ? Therefore, God exists. In proving the existence of God, Descartes set the groundwork for determining that God created man. He further postulated that God, being infinitely perfect and not a deceiver, could not have provided man with the deceptive powers of knowledge. Therefore, man's mental faculties are determined to be trustworthy provided we separate what there is of clear and distinct in the knowledge from what is obscure and confused. Using this reasoning, man must discard all previous knowledge which is doubt-ridden, all sensory-based knowledge (as perceptions can be misleading), and all intellection. As a result, skepticism is removed and valid knowledge possible. Descartes primary purpose was the defense of human knowledge against the attacks of the skeptics. He was justified in excluding preconceived notions, presuppositions, and traditions in determining the limits of knowledge. Descartes discarded the ability of the mind to know truth and the human abilities of contradiction and sufficient reason. In doing so, he made a solution to the problem impossible. As it relates to his theory of the existence of God, Descartes universal doubt refutes his own conclusion as to God's existence. Descartes formed an idea of God as an infinitely good being. He would have had to discover this idea within his own mind. According to his principle of universal doubt, he cannot simply know whether his conception of God is correct or incorrect. He would have, as a matter of his own principle, considered it as false until proven otherwise. Therefore, since the idea of God is in doubt, the trustworthiness of man's reasoning must also be doubtful and Descartes cannot escape his own real doubt. Descartes uses a process of reasoning, a mathematical formulae, in attempting to demonstrate God's existence. If his reasoning is of demonstrably doubtful validity, how can Descartes demonstrate God's existence? The validity of Descartes reasoning is supposed to flow as a consequence of the infinite perfection of God; and God's infinite perfect is made certain through Descartes' reasoning powers before he has even proven that these reasoning powers are valid and trustworthy. Descartes assumes the very thing beforehand which he intends to prove afterwards. (Begging the question). Descartes accepts the trustworthiness of his faculties in demonstrating the existence and infinite perfection of God, and that is illegitimate. A doubtfully valid faculty will produce a doubtfully valid argument which will, in turn, produce a doubtfully valid conclusion. The entire argument for God's existence is therefore nullified by a suspect reasoning process. Since he proves the reliability of his reason and process by means of God's veracity, the proof of his reliability cannot be established beyond doubt. Thus, Descartes attempt to vindicate the validity of human knowledge failed, because, by rejecting the reliability of his own powers

Free Essays on Abraham Lincolna And Abolition

The Role of Abraham Lincoln in the Abolition of Slavery I am going to analyze the essay, â€Å"The role of Abraham Lincoln in the Abolition of Slavery.† This was written by James M. McPherson, and he tries to let the reader understand what Abraham Lincoln had to do with the abolition of slavery. McPherson wants the reader to understand that Abraham Lincoln was a crossbreed between a conservative and a revolutionary thinker. He wants the reader to know that the slaves would not have been freed if it were not for Lincoln, but that he was not the sole factor in the event. The emancipation proclamation shows Lincoln’s push for this to happen, and the fact that it worked gives him a placed in history forever. The author wants to make clear that even though Lincoln was a large part of freeing the slaves that it was not his intent as president or for the war. The author states that although this revolutionary achievement was made, it was not part of Lincoln’s war aims. This gives Lincoln some conservative credibility, which is a great tactic to use to persuade the audience that Lincoln is not a full breed revolutionist. Another point that McPherson makes to prove his argument that Lincoln is a conservative is when he points out that Lincoln stated, â€Å"I am naturally anti-slavery. If slavery is not wrong, nothing is wrong.† Then follows it up by saying that Lincoln’s conflict was that as president he could not act officially on his private judgment concerning the moral issue of slavery. McPherson relies upon quoting Lincoln for most of his argumentative evidence. There is no quantitative evidence, nor does there need to be. Also, there are very little generalizations. He uses specific statements and political beliefs of the time period to persuade the reader that Lincoln was a conservative revolutionary. For example, when explaining how Lincoln wanted Congress to endorse his plan for gradual emancipation... Free Essays on Abraham Lincolna And Abolition Free Essays on Abraham Lincolna And Abolition The Role of Abraham Lincoln in the Abolition of Slavery I am going to analyze the essay, â€Å"The role of Abraham Lincoln in the Abolition of Slavery.† This was written by James M. McPherson, and he tries to let the reader understand what Abraham Lincoln had to do with the abolition of slavery. McPherson wants the reader to understand that Abraham Lincoln was a crossbreed between a conservative and a revolutionary thinker. He wants the reader to know that the slaves would not have been freed if it were not for Lincoln, but that he was not the sole factor in the event. The emancipation proclamation shows Lincoln’s push for this to happen, and the fact that it worked gives him a placed in history forever. The author wants to make clear that even though Lincoln was a large part of freeing the slaves that it was not his intent as president or for the war. The author states that although this revolutionary achievement was made, it was not part of Lincoln’s war aims. This gives Lincoln some conservative credibility, which is a great tactic to use to persuade the audience that Lincoln is not a full breed revolutionist. Another point that McPherson makes to prove his argument that Lincoln is a conservative is when he points out that Lincoln stated, â€Å"I am naturally anti-slavery. If slavery is not wrong, nothing is wrong.† Then follows it up by saying that Lincoln’s conflict was that as president he could not act officially on his private judgment concerning the moral issue of slavery. McPherson relies upon quoting Lincoln for most of his argumentative evidence. There is no quantitative evidence, nor does there need to be. Also, there are very little generalizations. He uses specific statements and political beliefs of the time period to persuade the reader that Lincoln was a conservative revolutionary. For example, when explaining how Lincoln wanted Congress to endorse his plan for gradual emancipation...

The Nature Of The Human Soul Term Paper Example | Topics and Well Written Essays - 1750 words

The Nature Of The Human Soul - Term Paper Example type of approach used 2. mortality status 3. purpose 4. knowledge 5. types or parts of the soul 6. distinguishing characteristics 7. relation between body and soul 8. origin Plato takes a spiritual approach to understanding the nature of the soul. He sees the soul as an immortal being, whose origin is in a spiritual world of perfect forms. He contrasts this with the physical world, which is a mere imitation of this perfection (Page, 2003). There are three phases of the soul, relative to humans. There is a prenatal phase, the embodiment phase, and a postmortem phase. Plato believes that reason, emotion and desire comprise the soul (Velitchkov, 2009). They function with sequential differences from the womb, through life and after death. The purpose of the soul, from Plato’s perspective, is to carry knowledge to the body, but its duration there is of little meaning, since true meaning can only be in the spiritual world of perfect forms, not in this imitation world. In fact, Plato feels that the soul is distinct from the body, pre-dates and outlasts it, is imprisoned by the body, and achieves liberation only at death. Conflicts arise among human thoughts (connected to upper body tension), spiritual experience (connected to the chest area), and desires or appetites (connected to the lower region of the body) (Page, 2003). Knowledge is not so much transmitted as it is remembered, since the soul carries knowledge from one incarnation to the next, Plato’s version of anamnesis (Kowalczyk, n.d.). I support Plato’s spiritual approach. The soul cannot be measured by science, as it is apparently not bound by the laws of physics, the way the body and physical world are. I also support Plato’s theory that the soul is immortal, that it belongs to a world of spiritual perfection, of which our physical reality is a substandard imitation. At night, when I dream, I experience myself flying and changing physical reality with focused intention. I do not c onsider this to be my imagination, but rather my soul’s memory and deeper understanding of reality and thought. I believe that experience of freedom from the body is real, more real than body reality. Not only in dreams, but also in hypnosis, or with the inspiration of hallucinogens, or in a near-death experience, or other out of body experience, one can remember and appreciate freedom from the body. I support Plato’s contention that the soul carries all knowledge across incarnations, and brings it to the body in each current incarnation, so that it must be remembered and not re-learned (anamnesis) (Kowalczyk, n.d.). I believe this because of my own experience. For example, sometimes a friend or even a stranger approaches me and begins to outline a deep problem or confusion they are struggling with. I cannot possibly have all the answers, based solely on current life experience and education. Yet, once a deep rapport is established, my soul speaks. Of course the sound is my voice and comes from my body, and what I say is embroidered with my own thoughts. But the essence that flows freely is my soul, and not my body. Of this I am certain. I have had the experience of driving a car and becoming lost in thoughts, having no knowledge of where I am, passing my destination by miles. At such times, it seems clear to me that I am not in a safe state to be driving, since I am