may also cause
pain as they enlarge in size and press
and the ribs.
Pain in the centre of the chest may
be due to a heart disorder. The common
that may spread from the chest to the
throat, jaw, or arms. It is caused by an
inadequate blood supply to the heart,
commonly due to
coronary artery disease
(heart attack) causes
a sim ilar pain to angina but is usually
more severe and is not relieved by rest.
(inflammation of the
membrane covering the heart) produces
severe pain that may be relieved slightly
when the person leans forwards.
may cause sharp pain,
usually on the left side of the chest.
Chest pain may also be a result of
and emotional stress (see
ventilation; panic attack
The treatment of chest pain depends on
may be given for chest
pain due to pneumonia, and surgery is
needed to treat some lung tumours or
some cases of coronary artery disease.
A first-aid technique that is used to
unblock the airway of a person w ho is
Chest thrusts involve standing
behind the casualty, reaching around
his or her chest, and placing one fist,
breastbone. The fist is then grasped
w ith the other hand, and the casualty’s
chest w all is thrust sharply inwards
and upwards up to five times. The
pressure simulates the coughing reflex
and may expel the obstruction.
For an infant, the technique involves
the first-aider laying the baby face-
upwards and head downwards along
his or her forearm, placing two finger-
tips of the other hand on the baby’s
lower breastbone, and giving up to five
sharp thrusts into the chest.
One of the most frequently performed
medical tests, usually carried out to
examine the heart or lungs. Chest X-
rays are used to confirm diagnoses of
heart disorders, such as enlargement of
a heart chamber, or lung diseases, such
as tuberculosis or lung cancer. They
may also be used to examine the ribs
after an injury. The procedure is simple,
quick, and painless. (See also
An abnormal pattern of breathing in
w hich the rate and depth of respiration
vary rhythmically. Cheyne-Stokes res-
piration is characterized by repeated
cycles, each lasting a few minutes, of
slower and shallower and then stops for
between 10 and 20 seconds.
The pattern of Cheyne-Stokes respir-
ation may be due to a malfunction in
of the brain that
breathing (as occurs in some cases of
It may be due to
or occur in healthy people
at high altitude, especially during sleep.
A common, m ild infectious disease,
also called varicella, most often occur-
ring in children. Symptoms are a rash
and slight fever. In adults, chickenpox
is uncommon but usually more severe.
An attack gives lifelong immunity, but
the causative virus remains dormant in
nerves and may reappear later in life to
CAUSE AND SYMPTOMS
Chickenpox is caused by the varicella
zoster virus, w hich is spread in air-
develops two to three weeks after infec-
tion and consists of clusters of small,
red, itchy spots that become fluid-filled
blisters within a few hours. After several
days, the blisters dry out to form scabs.
Scratching the blisters can lead to
secondary infection and scarring. In
adults, or in anyone whose immune
system is suppressed by drug treatment
or illness, serious complications invol-
ving the lungs can occur.
People with chickenpox are highly
infectious from about two days before
the rash appears to about a week after-
wards. Nonimmune pregnant women
should be particularly careful to avoid
children with chickenpox or anyone
with shingles, because the disease may
be serious in pregnancy and newborn
babies could suffer a severe attack.
In most cases, no specific treatment is
lotion may be used
to relieve itching. Anyone at high risk
who has been exposed to the virus may
be given treatment with
w hich may prevent the condition from
developing. In severe cases of chicken-
(an antiviral drug) is given.
A painful, itchy swelling, about the size
of a pea, caused by a sand flea that lives
in sandy soil in Africa and tropical
America. W hen stepped on, the flea
penetrates the skin of the feet and lays
eggs. Chigoe fleas should be removed
with a sterile needle, and the wounds
treated with an antiseptic.
An itchy, purple-red swelling, usually
on a toe or a finger. Chilblains are
caused by excessive constriction (nar-
rowing) of small blood vessels below
the surface of the skin in cold weather.
They are most common in young chil-
dren and elderly people, and women
are more susceptible to them. They
generally heal without treatment.
Maltreatment of children. Child abuse
includes physical injury,
emotional mistreatment, and/or neg-
lect; it occurs at all levels of society.
Child abuse can cause severe physical
and psychological damage in the vic-
tims. In addition, being deprived or
ill-treated in childhood may predispose
some affected people to repeat the pat-
tern of abuse w ith their own children.
The event during w hich a baby leaves
the m other’s
(womb) and enters
childbirth, known as labour, normally
takes place between
of pregnancy, as timed from the moth-
er’s last menstrual period.
For most women w ho receive a high
standard of medical care during preg-
) and delivery,
childbirth presents no serious prob-
lems. The development of specialized
equipment and the availability of
made childbirth much safer for both
mother and baby. In developing coun-
tries, however, the number of women
w ho die from childbirth remains high
ONSET OF LABOUR
It is often difficult to determine pre-
cisely when labour has started. During
the last three months of pregnancy, the
uterus begins to contract in preparation
for the birth. Such contractions, called