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 LONDON, NEW YORK, MUNICH, MELBOURNE, DELHI

Dr Ian Bogle
Dr W J Appleyard
Sir Anthony Grabham

Tony Smith MA BM BCH, Sue Davidson MB BS MRCP MRCGP DRCOG

Sir Peter Beale KBE FRCP FFCM FFOM DTM&H, Peter Cantillon MSc MRCGP,
Mark Furman MRCPCH, Stephen Hughes MRCPCH, Warren Hyer MB ChB MRCP MRCPCH,
Penny Preston MB ChB MRCGP, Andrew Shennan MB BS MRCOG MD,
Frances Williams MA MB BChir MRCP DTM&H MRCPCH

Andrea Bagg
Marianne Markham
Mary Atkinson, Nicki Lampon, Andrew Macintyre
Jolyon Goddard, Katie John, Janet Mohun, Teresa Pritlove, Hazel Richardson
Janice English, Chris Walker Sara Freeman Julian Dams, John Goldsmid,
Jason Little, Louise Paddick Marie Osborn Michelle Thomas
Nicola Erdpresser
Martyn Page
Louise Dick
R Bryn Walls

Prita Maitra
Shuka Jain
Atanu Raychaudhuri Chandana Chandra, Sudhanshu Gupta
Sabyasachi Kundu Sukanto Bhattacharjya
Jacob Joshua Shailesh Sharma
Anita Roy

The British Medical Association New Family Doctor Home Adviser is not a substitute for medical diagnosis.
You are advised always to consult your doctor for specific information on personal health matters.
The naming of any organization, product, or alternative therapy in this book does not imply BMA endorsement;
the omission of any such names does not indicate BMA disapproval.

First published in Great Britain in 1986 by Dorling Kindersley Limited, London

First published in paperback in 1989, reprinted 1990
Second edition 1992, reprinted 1992, 1994, 1995, 1996, 1997
Third edition 2001

Published in the United Kingdom by Dorling Kindersley Limited

80 Strand, London WC2R 0RL
A Penguin Company
4 6 8 10 9 7 5 3
Copyright © 1986, 1992, 2001 Dorling Kindersley Limited, London
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording,
or otherwise, without the prior written permission of the copyright owner.
A CIP catalogue record for this book is available from the British Library.
ISBN 0-7513-2168-0
Colour reproduction by Colourscan, Singapore
Printed and bound in Spain by AGT, Toledo

see our complete catalogue at

www.dk.com
FOREWORD
Attitudes to illness have changed enormously in recent years. People now
expect that treatment of even the most serious disorders is likely to be
successful. In general, people are more knowledgable about health. When
they or their children become ill, they want to know the likely cause of
their symptoms and how quickly they may expect to get better.

At the same time, we are now more self-reliant. Most of us realize that
the majority of common, minor illnesses such as a cold or an attack
of diarrhoea do not need expert medical assessment or complex drug
treatments. These disorders are self-limiting – we can expect to get
better, even if no treatment is given.

The problem for people without medical training is that some symptoms
such as a headache or a cough may be the first warning of a serious illness.
Few events can be more alarming or make a parent feel more helpless than
the sudden illness of a child – especially in children too young to describe
their symptoms clearly. For how long does a sensible person deal with
the problem at home? When should you call your doctor or talk to an
information service such as NHS Direct? And when do you need to make
an urgent visit to the hospital’s accident and emergency department?

Following the easy-to-read charts in this book will help you to tell the
difference between minor problems and conditions that need immediate
medical attention. No book can teach you how to make a medical
diagnosis, and this is not a guide to being your own doctor. What it does
do, however, is to tell you when and for how long you may safely wait for
things to get better naturally. It gives practical advice on the use of home
remedies and over-the-counter drugs and so encourages self-reliance when
that makes sense. If you do need to see a doctor, the charts tell you whether
you need emergency help, an urgent appointment, an appointment within
24 hours, or just a routine one. This book will give you the information
you need to make the best use of your doctor.

The charts in this book have been developed by doctors and reviewed
by medical experts. We hope that this book will make an important
contribution to giving people more control over their own health.

&
MEDICAL EDITORS
CONTENTS

CONTENTS
......................... 8 30 Hearing problems.......................... 104
SYMPTOM CHARTS 31 Runny or blocked nose............... 106
43–288 32 Sore throat......................................... 107
YOUR BODY AND HEALTH 33 Coughing........................................... 108
.................. 44
9–42 34 Breathing problems....................... 110
System-by-system chartfinder.................. 46
35 Mouth problems............................. 112
Symptom-by-symptom chartfinder....... 48
................................................... 10 36 Teeth problems................................ 114
Skeleton.............................................................. 10 37 Eating problems.............................. 116
Muscles............................................................... 11 CHARTS FOR CHILDREN 38 Vomiting in children..................... 118
Cardiovascular system................................ 12 49–144
39 Abdominal pain.............................. 120
Respiratory system....................................... 13 Contents............................................................. 49 40 Diarrhoea in children................... 122
Nervous system.............................................. 14 41 Constipation..................................... 124
The senses......................................................... 15 ........................................... 50–65 42 Abnormal-looking faeces........... 125
Digestive system............................................. 16 1 Sleeping problems in babies........ 50 43 Urinary problems........................... 126
Endocrine system.......................................... 17 2 Excessive crying................................ 52 44 Toilet-training problems............. 128
Lymphatic system.......................................... 17 3 Fever in babies................................... 54 45 Genital problems in boys........... 130
Urinary system................................................ 18 4 Vomiting in babies........................... 56 46 Genital problems in girls............ 132
Male reproductive system......................... 19 5 Diarrhoea in babies......................... 58 47 Painful arm or leg.......................... 133
Female reproductive system..................... 20 6 Feeding problems.............................. 60 48 Joint and back problems............ 134
Conception and pregnancy....................... 21 7 Slow weight gain............................... 62 49 Foot problems................................. 136
The newborn baby....................................... 23 8 Skin problems in babies................. 64 50 Limping.............................................. 138
The growing child......................................... 24
.................... 66–138 ....... 139–144
Growth charts................................................. 26
9 Feeling generally unwell................ 66 51 Adolescent weight problems..... 139
10 Tiredness............................................... 68 52 Adolescent behaviour
........................................ 28
problems............................................. 140
A healthy diet.................................................. 28 11 Sleeping problems in children.... 70
53 Problems with puberty
Exercise.............................................................. 29 12 Growth problems............................. 72
in boys................................................. 142
Alcohol............................................................... 30 13 Excessive weight gain..................... 74
54 Problems with puberty
Tobacco.............................................................. 31 14 Fever in children............................... 76 in girls.................................................. 143
Drugs................................................................... 31 15 Rash with fever................................. 78 55 Adolescent skin problems.......... 144
Sex and health................................................ 32 16 Skin problems in children............ 80
Stress................................................................... 32 17 Hair, scalp, and nail problems... 82
GENERAL CHARTS FOR ADULTS
Safety and health........................................... 33 18 Itching.................................................... 84
145–240
19 Lumps and swellings....................... 85
.............. 35 20 Dizziness, fainting, and Contents.......................................................... 145
Healthcare throughout life....................... 35 seizures.................................................. 86 56 Feeling unwell.................................. 146
Visiting your doctor..................................... 35 21 Headache.............................................. 88 57 Tiredness............................................ 147
Health checks and screening................... 36 22 Confusion and/or drowsiness..... 90 58 Loss of weight................................. 148
Immunization.................................................. 37 23 Clumsiness........................................... 92 59 Overweight........................................ 150
24 Speech difficulties............................. 93 60 Difficulty in sleeping.................... 152
.......................................... 38 25 Behaviour problems........................ 94 61 Fever..................................................... 154
Testing samples.............................................. 38 26 School difficulties............................. 96 62 Excessive sweating......................... 156
Physiological tests......................................... 39 27 Eye problems...................................... 98 63 Headache........................................... 158
Imaging tests.................................................... 39 28 Disturbed or impaired vision... 100 64 Feeling faint and passing out... 160
Endoscopy......................................................... 42 29 Painful or irritated ear................. 102 65 Dizziness............................................ 162

6
 CONTENTS

66 Numbness and/or tingling......... 163 110 Painful joints.................................... 228 142 Weight problems and
67 Forgetfulness and/or 111 Painful shoulder............................. 230 pregnancy.......................................... 279
confusion............................................ 164 112 Painful arm....................................... 231 143 Vaginal bleeding in
68 Twitching and/or trembling...... 166 pregnancy.......................................... 280
113 Painful leg.......................................... 232
69 Pain in the face................................ 167 144 Abdominal pain in
114 Painful knee...................................... 234
pregnancy.......................................... 281
70 Difficulty in speaking................... 168 115 Swollen ankles................................. 235
145 Skin changes in pregnancy........ 282
71 Disturbing thoughts and 116 Foot problems................................. 236
feelings................................................. 169 146 Swollen ankles in pregnancy.... 283
117 Back pain........................................... 238
72 Depression......................................... 170 147 Back pain in pregnancy.............. 284
118 Painful or stiff neck...................... 240
73 Anxiety................................................ 172 148 Recognizing the onset of
labour.................................................. 285
74 Lumps and swellings.................... 174
149 Breast problems and
75 Itching................................................. 175 CHARTS FOR MEN
pregnancy.......................................... 286
76 Hair and scalp problems............ 176 241–254
150 Depression after childbirth....... 288
77 General skin problems................ 178 Contents.......................................................... 241
78 Skin problems affecting 119 Bladder control problems
the face................................................ 180 in men.................................................. 242 FIRST AID
79 Skin discoloration and 120 Problems with the penis............. 244 289–302
moles.................................................... 182 121 Erection difficulties....................... 246
80 Rash with fever............................... 184 122 Ejaculation problems................... 247 ...................................................... 290
81 Nail problems.................................. 185 123 Testes and scrotum ABC of resuscitation................................. 290
82 Painful or irritated eye................ 186 problems............................................ 248 Action in an emergency........................... 291
83 Disturbed or impaired 124 Painful intercourse in men........ 249 Recovery position....................................... 292
vision................................................... 188 125 Low sex drive in men.................. 250 Artificial respiration.................................. 293
84 Hearing problems.......................... 190 126 Fertility problems in men.......... 252 Choking.......................................................... 294
85 Noises in the ear............................ 192 127 Contraception choices Cardiopulmonary resuscitation
86 Earache............................................... 193 for men................................................ 254 (CPR)............................................................ 296
87 Runny or blocked nose............... 194 Shock................................................................ 298
88 Sore throat........................................ 195 Anaphylactic shock................................... 298
89 Hoarseness or loss of voice....... 196 CHARTS FOR WOMEN Severe bleeding............................................ 299
255–288 Severe burns.................................................. 299
90 Wheezing............................................ 197
91 Coughing............................................ 198 Contents.......................................................... 255 Unconsciousness.......................................... 300
92 Shortness of breath....................... 200 128 Breast problems.............................. 256 Major seizures.............................................. 300
93 Chest pain......................................... 202 129 Bladder control problems Spinal injury.................................................. 301
94 Palpitations....................................... 204 in women........................................... 258 Fractures......................................................... 301
130 Absent periods................................ 260 Swallowed poisons.................................... 302
95 Teeth problems............................... 206
131 Heavy periods.................................. 262 Bites and stings............................................ 302
96 Mouth problems............................ 208
132 Painful periods................................ 263
97 Difficulty in swallowing............. 209
133 Irregular vaginal bleeding.......... 264
98 Vomiting............................................ 210 DRUGS GUIDE AND
134 Abnormal vaginal discharge..... 266
99 Recurrent vomiting....................... 212 USEFUL ADDRESSES
100 Abdominal pain.............................. 214 135 Genital irritation............................ 268
303–313
101 Recurrent abdominal pain........ 216 136 Lower abdominal pain
in women........................................... 269
102 Swollen abdomen.......................... 218 ............................................. 304
137 Painful intercourse in
103 Wind.................................................... 219 How drugs affect you............................... 304
women................................................. 270
104 Diarrhoea.......................................... 220 Using drugs safely....................................... 304
138 Low sex drive in women............ 272
105 Constipation.................................... 221 A–Z of drugs................................................. 305
139 Fertility problems in women.... 274
106 Abnormal-looking faeces........... 222
140 Contraception choices ................................. 311
107 Anal problems................................. 223 for women......................................... 276
108 General urinary problems......... 224 141 Nausea and vomiting
109 Painful urination............................ 226 in pregnancy..................................... 278 ..... 314

7
HOW TO USE THIS BOOK

HOW TO USE THIS BOOK

The major part of this book consists of 150 question-and- healthy precedes the charts, and, after them, you can find
answer symptom charts, which help you determine the information on dealing with major emergencies. The book
possible cause of a symptom and what to do. Background concludes with useful information on drugs and how to
information on how the body works and how to keep it contact support groups or find further health information.

Your body and health Y O U R B O D Y A N D H E A LT H

HEALTHY
A healthy diet
LIVING
Diet has a major influence on health. It can affect your risk of
Meat, fish, and nuts are rich in protein,
essential for building and repairing cells,
and provide B vitamins and minerals such
as iron. They can also be high in fat, so
Fruit and vegetables are high
in fibre (which aids digestion),
natural sugar, and water. Aim
to eat at least five portions a
Assessing your weight
To avoid diseases associated with being overweight or underweight,
you need to maintain your weight within the range considered normal
for your height. To find out if you are within this range, you can use
a height and weight chart such as the one shown below. You can also
assess your weight by calculating your body mass index (BMI). To do
this, divide your weight in kilograms by the square of your height in
metres. A BMI figure under 20 indicates that you are underweight,
Planning an exercise routine
Y O U R B O D Y A N D H E A LT H

For exercise to be beneficial, it has to be regular. The recommended

amount is at least 30 minutes of moderate exercise, such as a brisk
walk, on at least 5 days of the week. To become fitter or lose weight,
you will have to exercise harder. You need to do activities that work
the heart and lungs (build stamina), improve joint mobility (increase
flexibility), and increase muscle strength. If you have never exercised
regularly before, or if you have any health concerns, consult your
Y O U R B O D Y A N D H E A LT H

MEDICAL
Testing samples
TESTS
Tests that are carried out on samples of body fluids, such as
Tests on body fluids
Tests may be performed on body fluids from wounds or abnormal
areas of skin, from mucous membranes such as those of the nose and
Physiological tests
Certain investigations that do not involve testing samples
(opposite) or imaging internal structures (see IMAGING TESTS,
right) can be performed to assess the function of organs or
systems. These physiological tests are commonly used to assess
vision and hearing, the nervous system, and the heart and lungs.
Imaging tests
Y O U R B O D Y A N D H E A LT H

In imaging tests, energy is directed at or introduced into body

tissues and detected by machines to produce images of internal
structures. Many tests use X-rays; these tests range from
conventional X-ray procedures to the computerized technique
of CT scanning. X-rays carry the risk of exposure to harmful
radiation, so some tests are available that use other forms of

You will find general information about

developing many diseases; for example, a high-fat diet increases doctor before starting an exercise routine.
your risk of heart disease. It is also crucial in weight control.
eat them only in moderation day; examples of one portion
include one medium-sized
while a figure over 25 shows that you are overweight. blood or urine, are often the first investigations requested by throat, or from internal areas such as the inside of a joint or around Vision and hearing tests energy. For example, MRI uses magnetism and radio waves,
fruit, such as an apple, or
a doctor before making or confirming a diagnosis. Samples of the brain and spinal cord. The tests may involve looking for infectious
The most common vision tests measure the ability to focus (see VISION and ultrasound scanning uses sound waves. Other imaging
For a balanced diet you need the correct amounts of Height/weight graph for men and women urine and faeces can usually be collected easily by the patient, microorganisms, abnormal cells such as cancerous cells, or abnormal
one dessert bowl of salad lb kg Fitness benefits of different activities levels of certain chemicals. Other tests involve assessing cells or other
TESTING, p.189, and VISION TESTING IN CHILDREN, p.101). Another test tests include radionuclide scanning, PET, and SPECT, which
carbohydrates, fats, proteins, vitamins, and 100 and blood samples by the doctor in his or her surgery. Some defines the visual field (the area that each eye can see independently).
substances that are normally found in the fluid, such as sperm in a use radioactive substances introduced into certain tissues.
minerals. Eat plenty of high-fibre foods, 210
OVERWEIGHT samples, such as cell and tissue samples and certain body There is a range of tests for hearing.
90 Activity Fitness benefits sample of semen. Some samples, Test bowl Controls and
limit foods with a high fat or sugar 190
Stamina Flexibility Strength
fluids, may need to be collected during a hospital procedure. such as saliva, can be collected Tongue depressor Some show how well sound is touch-screen X-rays
content, and avoid large amounts 80 The results of tests on body samples can provide information Swab conducted through the ears; others display

the body and health in this highly illustrated

WEIGHT
170 by the individual; others by a X-rays are a form of radiation that can pass through body tissues
of salt, alcohol, and caffeine. In Aerobics HHHH HHH HH on the function of certain organs, such as the liver or kidneys, measure how well sounds of varying
150 70 doctor. The samples are to leave an image on photographic film. The ability of the rays to
addition, water is vital for life, HEALTHY WEIGHT Basketball HHHH HHH HH or reveal the presence of abnormal substances or abnormal pitch and volume can be heard or,
then usually sent to a penetrate tissues depends on the density of those tissues. Solid, dense
and you should aim to drink at 60 in children, show the ability to
HH HHH
130 Cycling (fast) HHHH levels of normal substances, such as hormones, in the body. laboratory for analysis. tissues such as bone let few rays through and appear white on the
hear speech (see HEARING
least 8 glasses (2 litres) a day. 110 50 UNDERWEIGHT Climbing stairs HHH H HHH In addition, some tests can reveal the presence of disease- image. Muscular organs, such as the heart, appear grey. Tissues
TESTS, p.190, and HEARING
Dancing (aerobic) HHH HHHH H causing microorganisms. Most tests on body samples are containing air, such as the lungs, and fluid-filled areas, such as the
90 40 TESTS IN CHILDHOOD, p.105).
144 150 156 162 168 174 180 186 192 carried out in a laboratory, but some may be performed in Fluids from wounds or bladder, let most of the X-rays through and appear black on the
H
cm
Golf HH H
from body cavities, Response button film. X-ray images are often used to assess bone injuries such as

section, which is divided into four parts.

Milk and dairy foods provide 57 59 61 63 65 67 69 71 73 75 77 in
Hiking HHH H HH
a doctor’s surgery or even at home. fractures or disorders such as arthritis. The images can also show
protein, calcium, and certain HEIGHT such as the mouth, are
Jogging HHHH HH HH usually collected with a disorders in some soft tissues, such as infection in the lungs, and
vitamins, such as B2, B12, and D.
They can form a fairly large part Swimming HHHH HHHH HHHH
Blood tests swab – a sterile cotton
This test is used to map the
breast X-rays are used to screen women for breast cancer (see
visual field. You are asked to
of your diet, but try to choose
low-fat varieties so that you Exercise Tennis HH HHH HH
Blood tests can be used to find information about the blood itself and
to assess the function of other parts of the body, such as the liver.
bud on a plastic stick.
look at a screen and press a
button when you see flashes in
MAMMOGRAPHY, p.257). X-rays may also be used in other imaging
techniques, such as bone densitometry (p.239).
maintain a healthy weight H HH H H
Y O U R B O D Y A N D H E A LT H Most people know that exercise is an important part of a Y O U R B Walking
O D Y(briskly)
A N D H E A LT Y O U R B O D Y A N D H E A LT H The samples are usually taken from a vein, but may also be taken Tests on faeces different areas of the screen. Y O U R Hollow
B O D YorAfluid-filled
N D H E Astructures
LT H do not show clearly on plain
healthy lifestyle. Regular exercise protects physical and Yoga H HHHH H from capillaries (tiny blood vessels) by a finger prick or occasionally X-rays but can be imaged by introducing a contrast medium into
Samples of faeces may be tested for infectious microorganisms or for
from an artery. The most common blood tests performed are blood

Your Body shows how major body systems

the area before taking the X-ray. The contrast medium blocks
mental health. It can also reduce your risk of developing evidence of digestive disorders. One common test is the faecal occult Nervous system tests
YOUR Muscles
PROFESSIONAL
This pie chart shows the five
Types of muscle Safety in the sun cell tests and blood chemistry tests.with Blood cell tests
stressful include try
situations, measuring
to Helmet X-rays and makes the area appear white on the image. Types of

BODY
long-term disease, increase your life expectancy, and improve blood test, which can reveal
head tiny amounts of blood invisible to the
main food groups and the
proportion of your diet that
each group should form.
Foods in the larger segments
Bread, potatoes,
and pasta are high
Muscleswhich
Fatty foods,
are are
in energy,
maintain
fibrous
its and
your quality of life in later years.
high bundles of tissue that move the body,
The When
part of your daily routine, youmoves
sugary and work internal
posture, organs such as
you of
three types make
the skeleton;
will probably
heart; and smooth
exercise
muscle
cardiac
find
muscle,
a
are skeletal
KEY
muscle,
muscle, which forms
that you
found
which coversGood
H Small HH
and
effect the walls effect
of the
H H H Very good
effect
H H H H Excellent
effect the long term, serious problems such asand
the numbers of red and white blood
Overexposure to the sun may lead to sunburn,
help blood
skin
heatstroke,
cancer.
blood
and, incarries if
to clot). Blood
You aretests
chemistry
many
at can measure
cells these
resolve

affectthe
and ofproblems,
substances
necessary,
your
platelets or
before
levels
apart
(cells
theyfrom
that
seek
to
of these substances.
health.
help
startcells,
shields
naked eye. This from
test may
debrisbe carried out if the doctor suspects that
there may be bleeding in the digestive tract. The test may also be
used to screen for colorectal cancer. Tests on samples of faeces are
HEALTHCARE
Some tests are used to establish whether nerves are able to conduct
impulses normally. Abnormalities may be the result of something
compressing a nerve or a disease such as diabetes mellitus. Another
contrast X-ray include barium contrast X-rays (p.40), used to image
the digestive tract; angiography (p.40), which shows blood vessels;
and intravenous urography (p.227), which shows the urinary tract.
in fibre, starches, and foods, which can have a lot more energy for ordinary daily activities such as in the walls of the digestive tract, especially high risk if you have red or blond
These hair
testsand
are green
used toordetect
blue kidney,Manyliver, types
and muscle
of manualdamage,
work are Ear test, known as EEG, records the electrical activity produced in the
of the chart should form a the heart, intestines, and bladder. These functions are the blood vessels, and the genital and urinary tracts. Each type of usually carried out in a laboratory.
Skeleton greater part of your diet than
those in the smaller slices.
some vitamins and minerals,
Types of joint
so can form a large proportion
of Joints
your diet limited
cause tooth decay, shopping, housework, child care,
performed by three different types of muscle (right), of
amounts
should be eaten in
and gardening. Exercising safely
muscle has a different function and consists of fibres of a particular
eyes because your skin contains a low level
that absorbs ultraviolet light. To minimize
of bone
certain melanin,
the riskthe
to measure of sun
a pigment
disorders, and inflammation.
leveldamage,
dangerous.
of cholesterolorinheavy
One
the blood.
type is with
Working
objectsIn may
carried
addition,
out
machinery
blood
put you at risk
Cell and tissue
protectors
cut out
tests
Healthcare throughout life Visiting your doctor
brain and is useful for the diagnosis of disorders such as epilepsy.
X-ray
are formed where two or more bones meet. Different types shape. Skeletal muscle, which moves theTo limbs and body, is formed loud noise
Heart and lung testsBefore your first appointment with a new doctor, you may

function, and also covers pregnancy, birth,

which skeletal muscle makes up theHowgreatest exercise
bulk. benefits health avoid overexertion or injury, start by setting realistic goals. If everyone should stay out of the sun in chemistry
the middletests of the
areday. If you to see
performed if a gland,
of injury. Many such as the thyroid
chemicals are toxic Looking after your health involves not only following a healthy
Fibula
be machine
The skeleton provides form, support, and protection for the of joint allow for differing degrees of movement. A few joints, such of long, strong, parallel fibres. This typeyou of muscle
are notisfit,able to contract are outdoors, make sure to protect your skin inand
Muscles are controlled by signals from the nervous system. begin exercising slowly and build up gradually. Take gland theeyes.
neck,Wear a wide- abnormal
is producing or have amounts
other harmfulof a hormone.
effects such Microscopic studies of individual cells, or of a larger sample of tissue
lifestyle but also making effective use of the
Heart healthcare
rhythm and ratesystem. asked by
can be monitored to tests
fill in
in a questionnaire
which the electricalabout your health and lifestyle.
body. It consists of 206 bones, with further support from as those in the skull, are fixed. Semimovable joints, such as those Regular exercise benefits most of quickly
care and powerfully,
not to overexertbut can so that you are in pain or feel ill.
yourself brimmed hat, a long-sleeved shirt, and long trousers or skirt. Use a containing a varietyGloves helpcan give a definitive
of cells, diagnosis for many
Skeletal muscle can be controlled consciously, while the other the Long, parallel fibres to as burning the skin. Some forms of Doctors and activity workers
in the heart muscle is recorded: electrocardiography
On your first visit, your(p.203),
doctor will ask further questionsFracture
and
cartilage (a tough, fibrous material).Vitamins and –minerals or other
screen professional healthcare provide
The axial skeleton the in the spine, provide stability and some flexibility. The majority of the body’s systems, especially The supply of blood work at maximum
sure that strength onlycorrect protective equipment, clothing, to reduce
skull, spine, and ribcage – consists of joints, known as synovial joints, move freely. The main types of
types work automatically. Most skeletal muscles connect
cardiovascular, musculoskeletal,
Make you use the
the brain is increased, for short periods of time. Heart Urine tests
sunscreen with a suitable sun protection factor (SPF); the higher the dust, such as silica (found in sand disorders. Tests on cells are often used to diagnose
effects of
cancer
treatment when ambulatory
you are ill and are also involved electrocardiography
in some (p.205),
check ifandyou exercise
are upECG (below).
to date with immunizations and screening.
The80body
bones and protects
requires a range of vitamins two adjacent bones. One end of theand muscle is attached byIt can thus promoting mental and footwear for your sport. Every time you exercise, start with a factor, the greater the protection it gives you.
tested forand some of rocks) andtract
asbestos, can for genetic disorders. Cells may be obtained from
vibration body fluids such Lung function can be tested in various ways. The visits,
simplest is measuring
the brain, spinal cord, heart, and lungs. The appendicular synovial joint, and their planes of movement, are illustrated below. respiratory systems.
alertness, and chemical muscle pumps blood
warming-up routine around
and finish with a cooling-down routine to Apply it 15–30 Urine
minutes is most
before commonly
you go outside evidence urinary infections
as sputum (fluid coughed up from the lungs) orimportant elements
scraped from tissue of preventive healthcare. These include During later the doctor will add notes to your medical
and minerals because these substances Good sources of vitamins and minerals a flexible cord of fibrous tissue called alsoa benefit
tendon; the other
mental healthisby changes occur that the prevent
body. It muscle
comprises short,
cramps and stiffness and minimize the risk of injury. and re-apply itorevery
diabetes,
2 hours. can also be used todamage
and Sunglasses the lungs
assess kidney if inhaled.
function. MostOther
urine
surfaces such as the cervix (see CERVICAL SMEARhealth education,
TEST, p.264).
peak flow rate (p.197), which is the maximum rate at which you can
Cellscheckups during childhood and later in life, records, which are transferred if you change to another GP.
Tibia
(shinbone)
skeleton has 126 bones and consistsplay of the
vitallimb
roles bones,
in growth and metabolism providing pleasure, reducing testsBritish
are dipstick tests, hazards
which involve include
dipping loud noise
a chemically and
treated breathe out. More complex tests show how quickly the lungs fill and
attached by a tendon or by a sheet of connective tissue. The improve mood branching,
These typesinterlinked
of routinefibres that gentle
involve should have Standard mark may also be withdrawn from the body using a screening needle andtests
syringe. You have thecapacity
right to(tosee your
collarbones, shoulder blades, and bones of the pelvis.
(the chemical processesAllthat occur in the extreme temperatures. Your employer to identify risk factors and (to
early signs of disease, forown or your child’s records.

and child development. In Healthy Living,

Vitamin or RDA Food sources Necessary for skeletal muscles not only move parts stress,
of theandbody
producing
but also form a network within theaswalls stickgive
intomaximum
a sample protection
of urine to show the presence or concentration empty detect narrowed airways), show lung check
aerobic exercise, such slow jogging, BS2724 and This process, called aspiration, is often used to and takeimmunizations
cells from the to help prevent certain Duringand a visit, do not hesitate
bones are living tissue with cells that are constantly
body). Vitamins D replacing
and K can be made in of specific should orinform you ofof any risks and disordersinfectious
that causediseases.
the lungs to shrink), measure blood levels to ask questions about your
mineral
help to maintain the posture when physical
a person changes
is that
standing, of the heart. by
followed Thisa type ofofmuscle
series movements to from ultraviolet light.substances, such as glucose,supply
the presence
protective
infectious
lungs, thyroid gland, or breasts (see ASPIRATIONTo OF A BREAST LUMP, X-RAY OF last
LOWER LEG minutes. X-rays
old bone with new material. Bones the body, but the other vitamins, and all Vitamin A 1 mg Eggs, carrots, liver Eyes, hair, skin, bones or lying down. The names of improve mood. canstretch
work continually
your muscles. without
Two typical organisms. Dipstick tests are usually performed in aequipment. If you
doctor’s office. get the most from what professional healthcare
of oxygen has to BLOOD health
(see MEASURING OXYGENand treatments. Most appointments
, p.201). 7–10
minerals, must comeSkull from food. In sitting, some muscles suggest are self-employed, find out about p.256).
When usingTissue
toolstests
suchare
as used to detect areas of abnormal tissue such
a drill, offer, you need to be aware of the options for you and your
contain a soft, fatty material tiring. Smooth
stretches aremuscle
showncarries
here. Keep your If the test
Apply sunscreen to suggests an infection, the sample may be sent to a laboratory
as Blood pressure
affluent countries such as the UK, most PIVOT JOINT Vitamin B1 1 mg Meat, peas, grains, cereals, breads Energy production,
theirnervous system Extensors straighten joints, flexors bend
functions. The heart uncoveredtoareas
grow and identify the microorganism. possibleA risks to protect
specific test for yourself
a hormone and youcirrhosis of theand
need clothing liver or tumours. Samples are taken by biopsy, in
equipment family and to learn how to make the best use of the services
called bone marrow; this is Blood pressure is reduced,
becomes out functions such as moving back straight which a small piece of tissue is removed from parts of the body such Provide your GP with
Electrical signals from your
cuff
people’s diets supply the recommended
Jawbone Vitamin B2 1.5 mg Eggs, meat, dairy products, leafy
BALL-AND- Nervous system,joints, adductors move limbs towardsandthe
muscles thisbody, abductors
decrease helps while you produced in pregnancy is the basisensure of thethat
urine you conformtest,
pregnancy to safety
which that protect you from noise,
that doctors and other healthcare professionals canareprovide.
surrounded by spongy bone, (mandible)
daily allowances (RDAs) of vitamins and greenSOCKET JOINT
vegetables stronger and food through the digestive Rest yourtract.
hands
regulations for your work. as the skinand
vibration, (seeflying
SKINdebris.
BIOPSY, p.183) or the liver (below). heart recorded as youaccurate
do information
pull limbs outwards, and erectors raise or hold
to lower upofparts of
the risk
can pump It is composed of short, on your knee to
spindle-
move your can be performed at home (see HOME PREGNANCY TEST, p.260).
which is in turn surrounded by cardiovascular disease about symptoms, and
increasingly intense exercise.
minerals, but certain people may need Vitamin B3 15–20 mg Fish, whole grains, peanuts, peas Energy production, skin
the body. Some of the main skeletal muscles are illustrated more blood shaped fibres that are steady yourself
connected
hips Babies and children are at high
Healthcare providers

you can find out how to stay healthy and

denser compact bone. The feel confident about
marrow in the bones of the
supplements. For example,
Collarbonepregnant Vitamin B6 1.5 mg Meat, fish, whole grains, bananas Blood formation, nervous
below. system muscles are shown on the left of each image
Deeper with every
to form sheets, and can work for
The intensity
risk
shows theskin.
of each
of sunburn colour
because
concentration
of their
of out Safety on the road Under local anaesthesia, a hollow needle
Most disorders ECG traceasking questions.
can be diagnosed and treated by general practitioners
Electrode
women need extra(clavicle)
folic acid for the heartbeat delicate Keep babies
is inserted into the liver through a small
Vitamin B12 1 µg Milk, fish, meat, eggs, yeast andnervous
Blood formation, the more
system superficial muscles are shown on the right. SKELETAL MUSCLE prolonged
Kneel, thenperiods.
put one foot on the a certain substance
of the sun, and ensure that The chart In the UK, road traffic accidents result in (GPs). GP practices provide a range of services, including antenatal
spine, skull, ribs, and pelvis health of the fetus, and vegans need
The lungs can take in shows possible
thousandsWhen
of deaths and is
injuries each year. incision between the right lower ribs, and
Vitamin C 40–60 mg Many fruits and vegetables Body’s use of iron, immune system floor in front of you. Push your young children wear protective a dipstick put into care and clinics for immunizations and for minor surgery such as wart
manufactures blood cells. extra vitamin B12 because they do not eat Occipitofrontal more oxygen from each
Temporoparietal Temporoparietal test results a core of liver is removed. You will then
Vitamin D 5 µg Dairy products, oily fish Teeth and bones hips down and forwards to clothing and sunscreens. Nearly alla accidents
urine sample,are chemicals
due to human
in error removal. Some large practices also have other healthcare providers
meat or other animal products (the usual breath and supply more need to stay in bed for up to 6 hours.
Shoulder blade source of this vitamin). Do not take SADDLE JOINT
Vitamin E 10 mg ELLIPSOIDAL
Vegetables, JOINT
eggs, fish, margarine Orbicular
Maintaining cell of mouth
membranes oxygen Splenius
to the body
How muscles
stretch work
the back thigh. rather than
themechanical
squares along faults. A major cause
the stick including practice nurses, dentists, physiotherapists, and some
(scapula)
more than the recommended amounts Vitamin K 70 µg Leafy green vegetables, formed by Blood clotting, bone formation
Orbicular of eye of head Semispinalis of head Repeat for the other thigh. Safety at work of errors in drivers
react
causes include
is alcohol
and cause
lack
abuse; other
a colour
of square
experience,
practitioners of complementary therapy, such as osteopaths. In Treadmill
of vitamins A, D, E, and K, because the bacteria in intestines
Smaller pectoral Movement occurs when signals Both office work and manual jobs can involve certain risks to change. Each on theuse of addition, theneedle
Biopsy NHS helpline, NHS Direct, provides advice on health

minimize the risks of common disorders.

Muscles become stronger medications, Mobile table
stickand
teststiredness.
Breastbone (sternum) Greater pectoral Erector Trapezius from the nervous system cause by telephone or on the internet (see USEFUL ADDRESSES, p.311).
body stores these substances and they and more efficient so health. It is wise to find out about any potential risks associated for a different
Folic acid 200 µg Leafy green vegetables, organ meats, Internal
Fetal nervous system, keeping of that
spine Kneel, sitting on your heels. Stretch These factors can delay
can become toxic if excessive amounts whole grains, breads, nuts intercostal
cells and blood healthy they can work for longer muscles to contract. Conscious with your work and take action to prevent them. If necessary, ask chemical. After a specified The usual way to obtain hospital care is by referral from a GP.
your arms above your head, bend
Humerus build up in body tissues. In addition, Calcium at least Dairy products, eggs, peas, dry beans, Bones, teeth, muscles,
Deltoid
periods of time Deltoid movements of the body are
forwards, and put your hands your employer for help in minimizing these hazards.
reactions amount
and impair drivers’
of time, the colours However, if you have a severe accident or a serious problem such as Your medical history You are positioned on or against a Control
Externalnervous Bones maintain produced judgment. Drivers should heavy bleeding, you should go straight to an accident and emergency
pregnant women should avoid foods 800 mg edible fish bones system intercostal Latissimus on thebyfloor.
their strength and skeletal
the interaction
Keep your of Office work rarely poses risks to your physical safety, but it can of the squares, which
ensure that they are not tired When you first visit a doctor, you will special
be questioned about your
table or surface that allows panel
that contain high levels of vitamin A dorsi muscles,
arms, head, bones, and give rise to various health problems. Two of the most common indicate the concentration department in a hospital for treatment. If your injury or symptoms present and past health; treatments thatX-rays
you are having
to pass or have
through it tohad;
a cassette
Iron 14 mg Eggs, meat, dairy products, Red blood cell formation, muscles Joints become stronger and density so that they or under the influence of Drawer
Rib are not severe, you should consider waiting to see your GP or
because of potential harmful effects PLANE JOINT HINGE JOINT
leafy green vegetables more
Bicepsflexible and mobile as are less prone to joints. andMost
bodymuscles connect one physical conditions are lower back pain, due to poor posture while of substances in the urine,
alcohol, and check that any disorders that could run in your family;ofand aspects
film. of your
You have lifestyle,
to keep still during the containing
on the developing fetus. aofresult
arm of exercise damage and diseasebonealigned.
to another and cross a joint. sitting at a desk, and repetitive strain injury (RSI), a type of muscle are compared to a chart. contact NHS Direct. Hospital clinics for the treatment of sexually procedure
such as diet and exercise. The information so that
gathered fromthethese
image will be clear. film cassette
medications they are taking A car seat for a child should cushion transmitted infections, called STI clinics or genito-urinary medicine

What to expect when you see your doctor

When a muscle contracts, it pulls strain caused by repetitive movements such as typing. Another questions is known as a medical history. If you then visit your doctor
Spine The spine Deep
flexor of
Triceps
of arm on the bones to move them. common problem is psychological stress (p.32), which may be due
will not cause them to feel the child from possible injury and clinics, are also run on the basis of self-referral. with a disorder or unexplained symptoms, your medical history can
28 Cervical 29 drowsy. Every occupant of a should allow the seat belt to fit
The spine, also known as the vertebral fingers Many muscles are found in pairs, to factors such as demanding situations38 or poor relationships with help him or her to reach a diagnosis. In addition, if there is evidence 39
Ulna vertebrae
(7 bones) column, maintains the body in an Extensor one on each side of a joint, and colleagues. To avoid physical problems, you should make sure that
car should wear a seat belt. correctly across his or her body. Choosing a doctor that you are at risk of developing certain disorders, your doctor will
upright position, supports the head, and Young children should have
of fingers produce opposing movements. your work space is well ventilated and is well lit. Sit with your back If you are looking for a new GP, you can obtain a list of doctors in suggest preventive measures or screening to detect early signs.
Radius
encloses and protects the spinal cord. It Gluteus car seats that are appropriate for their size and weight.
For example, in the upper arm the straight and feet on the floor. If you do a lot of typing, make sure your area from your Community Health Council or local library;
minimus Motorcyclists and cyclists need helmets and clothing that will
Wrist bones consists of 33 bones called vertebrae.
Joints and discs of fibrous tissue between Ulnar
triceps contracts to pull that your wrists are supported while you work. If you are faced protect them from adverse weather conditions and injury. They
you could also ask friends and neighbours if they can recommend Having a physical examination
(carpals) Quadrate the arm straight and anyone. When you find a likely practice, ask about their opening

and other healthcare professionals is covered

extensor Computer monitor is should ensure that their lights work properly, and wear reflectors When you see your doctor, you may have a physical examination to
most of the vertebrae make the spine of thigh the biceps contracts Open window hours and how long, on average, you will have to wait for an
of wrist level with line of sight or bright clothing to make them visible to other road users. assess your state of health, look for abnormalities, or confirm or rule
Hand bones flexible, while ligaments and muscles to bend the arm. provides appointment that is not urgent. In addition, ask whether the practice
(metacarpals) Thoracic ventilation Pedestrians should use pavements or footpaths, and should cross out a diagnosis. The examination usually begins with a check of
vertebrae
stabilize it and control movement. offers home visits, advice over the telephone, services provided by
roads at pedestrian crossings. If there is no path, they should walk external areas, such as the eyes, ears, skin, and nails, and a test of
Finger bones (12 bones) other healthcare professionals such as nurses, and special services,
(phalanges) Triceps contracts on the same side of the road as oncoming traffic. Anyone who has nervous reflexes. In some cases, the doctor can gather information
Pelvis Upright seat such as family planning clinics. You may also wish to ask if you
Internal young children should ensure that Bright clothing
about other areas apart from the one being examined; for example,
back aids can choose a female doctor rather than a male doctor (or vice versa),
Kneecap oblique of Biceps relaxes posture they learn about road safety. makes cyclists a pale-coloured tongue may be a sign of anaemia. He or she may also
(patella) if you have a strong preference in this matter.
Femur abdomen
Abductor clearly visible to check for abnormalities by listening to organs with a stethoscope

in Professional Healthcare. Finally, Medical

Soft Fibrous Cycle helmet protects
core of finger Gluteus head from impacts other road users (auscultation), by feeling
covering
Long maximus Shoulders relaxed (palpation), or by
Fibula Lumbar adductor and not hunched If you are new to an
Compact Spongy Bone vertebrae SECTION OF INTERVERTEBRAL DISC Sartorius area and need to register tapping areas and
marrow of thigh Tyres should
bone bone (5 bones) STRAIGHTENING THE ARM Cyclists should wear listening to the sounds
Biceps be inflated with a GP, you may be
Tibia Intervertebral disc helmets to protect the skull produced (percussion).
Popliteal of thigh Foam-rubber rest to the right able to find out about
Gracilis Rectus supports the wrists and fluorescent or bright
Triceps relaxes pressure local practices by
of thigh Gastrocnemius for typing clothes to make them easily
Vertebra looking on
Ankle bones Gastrocnemius visible. Lights must be The doctor uses a
the internet.

Tests covers procedures that doctors may

(tarsals) Anterior Soleus used at night. Always stethoscope to listen
tibial Posterior
Areas maintain your to sounds within the
Long extensor tibial Achilles
where ribs Arrange your desk and bicycle in good chest, such as those
of toes tendon
Foot bones are attached
Long equipment so that they working order. made by the heart and
(metatarsals) Sacrum Short extensor Short
of big toe
flexor of are positioned correctly lungs. A stethoscope is
(5 fused big toe extensor
of toes Biceps contracts for you. Sit in a position Brakes must also used to listen to
bones) Ligaments Abductor that maintains good be checked sounds made by the
Toe bones Coccyx of big toe BENDING THE ARM posture and enables you to Feet rest flat regularly for intestines or by blood
THORACIC

use to diagnose and assess disorders.

STRUCTURE OF BONE (phalanges) (4 fused bones) VERTEBRAE FRONT VIEW BACK VIEW use the keyboard comfortably. on the floor wear and tear flowing through vessels.

10 11 34 35

Symptom charts A D U LT S : G E N E R A L

117 Back pain

Most people have at least one episode of back pain during
their lives, and they usually recover without needing medical
help. Back pain is often due to poor posture. However, it
cartilage in the spine, in many cases as a result of tasks such
as lifting excessively heavy weights. Severe back pain may
be due to pressure on a nerve or, rarely, it may be due to a
Continued from
previous page Are you over 50?
NO
YES SELF-HELP
back pain
A D U LT S : G E N E R A L

Relieving

Most back pain is the result of minor sprains

or strains and can usually be helped by
A D U LT S : W O M E N

128 Breast problems

For breast problems during pregnancy or after giving birth,
see chart 149, BREAST PROBLEMS AND PREGNANCY (p.286).
Although the majority of breast problems are not serious,
breast cancer can often be successfully treated. It is therefore
important to familiarize yourself with the look and feel of
your breasts (see BREAST SELF-AWARENESS, below) so that you
Mammography
Mammography uses X-rays (p. 39) to detect
abnormal areas of breast tissue. It is used as a
screening test to detect signs of breast cancer
X-ray
machine
Compressed breast

X-ray
A D U LT S : W O M E N

Plastic cover

The Symptom Charts are grouped according

X-rays
simple measures. Try the following: and is also carried out to investigate breast machine
may be a sign of damage to the joints, ligaments, or discs of problem with an internal organ such as a kidney. POSSIBLE CAUSE You may have ankylosing breast cancer is one of the most common cancers in women. will be able to detect any changes. If you do find a change in
spondylitis (inflammation of the joints between lumps. Mammography is offered every 3 years
• If possible, keep moving and carry out Rarely, it also occurs in men. If diagnosed early enough, your breast, you should seek medical advice immediately.
the vertebrae, resulting in the spinal column your normal daily activities. from age 50 to 65. The breast is positioned in
gradually becoming hard and inflexible). This the X-ray machine and compressed so that the Technician
Has your • Rest in bed if the pain is severe, but do
YES is especially likely if you are between 20 and 40. breast tissue can be easily seen on the X-ray.
back gradually Consult your doctor.
not stay in bed for more than 2 days.
START Did the pain Are any of the danger WA R N I N G become stiff as • Take over-the-counter nonsteroidal anti- Two X-rays are usually taken of each breast. X-ray plate
YES YES
follow an signs in the warning ACTION Your doctor will examine you and inflammatory drugs. START Are both Is your period due The procedure is uncomfortable but lasts only POSITION OF BREAST
HERE well as painful
within the next 10 days? YES
DANGER SIGNS Call an ambulance if you YES POSSIBLE CAUSE Breast pain before a period
injury, fall, box (right) present? arrange for you to have a blood test and X-rays breasts tender a few seconds. If an abnormality is detected,

to age and/or sex – there are charts for

have back pain or have recently injured your over a period of (p.39) of your back and pelvic areas. If you
• Place a heating pad or wrapped hot-water HERE may be due to changes in hormone levels.
or violent months or years? bottle against the painful area. or painful? In some cases, it is associated with other you will need further tests such as aspiration Your breast is compressed between the plastic
NO back and you develop problems with either are found to have ankylosing spondylitis, NO
movement? bladder or bowel control. Rarely, damage to you will probably be given nonsteroidal anti- • If heat does not provide relief, try using symptoms of premenstrual syndrome, such (see ASPIRATION OF A BREAST LUMP, opposite) to cover and X-ray plate. X-rays pass through
NO determine the cause of the abnormality. the breast tissue onto the plate.
the spinal cord may be the cause. NO inflammatory drugs. You will also be referred to an ice pack (or a wrapped pack of frozen as mood changes and bloating.
NO
a physiotherapist, who will teach you exercises peas); place it over the painful area for ACTION The self-help advice for premenstrual
to help keep your back mobile. These mobility 15 minutes every 2–3 hours. syndrome (opposite) may reduce breast
exercises are an essential part of the treatment If your backache is severe or is no better tenderness. Otherwise, consult your doctor. Continued from
for this disorder and can be supplemented by SEE YOUR DOCTOR WITHIN previous page POSSIBLE CAUSE AND ACTION Some POSSIBLE CAUSES A change in a nipple may
within 2 days, consult your doctor.

children of different ages, charts for all adults,

POSSIBLE CAUSE AND ACTION You have probably other physical activities, such as swimming. 24 HOURS women have lumpier breasts than others. be a sign of breast cancer. However, normal
Once your back pain has cleared up, you Do you have a tender, Lumps are usually more obvious before aging may also cause a nipple to become
t
bruised or strained your back. Follow self-help EMERGENCY!
should take steps to prevent a recurrence by red area in one breast? YES a period. If you are particularly worried, indrawn. Consult your doctor.
measures for relieving back pain (opposite). If CALL AN AMBULANCE POSSIBLE CAUSE AND ACTION Mastitis,
your pain is severe or if it has not improved following the self-help advice for taking care which is inflammation in the breast, is consult your doctor, who will examine
within 48 hours, consult your doctor. POSSIBLE CAUSE You may have damaged your Did the pain of your back (opposite). NO likely. This condition is usually due to
POSSIBLE CAUSE AND ACTION Breast tenderness
your breasts to make sure that there
ACTION Your doctor will examine your
come on may be the first sign of pregnancy. If there breasts and will probably arrange for tests
spinal cord. Try to keep completely still while infection and is rare in women who are is a chance you might be pregnant, carry are no individual lumps that require
Do you have waiting for an ambulance. suddenly after SEE YOUR DOCTOR WITHIN 24 HOURS Do both your such as mammography (above) to exclude
not breast-feeding. Non-breast-feeding out a home pregnancy test (p.260). If you YES investigation. Naturally lumpy breasts
breasts feel lumpy? a problem deeper in the breast.
pain in one side ACTION In hospital, you will be examined and an extended women who are affected are usually are not pregnant, a serious cause is unlikely, do not require treatment and do not
YES POSSIBLE CAUSE You may have a crush fracture Do you have a single increase the risk of breast cancer.

and charts specifically for men and women.

of the small of YES CALL YOUR DOCTOR NOW will probably have tests such as CT scanning stay in bed or of a vertebra as a result of osteoporosis, in which POSSIBLE CAUSE Osteoarthritis of the spine YES
smokers, and they tend to have repeated but you should consult your doctor. NO
lump in a breast?
m m
your back just (p.40) to look for the site and extent of any confinement to episodes. Your doctor will probably
POSSIBLE CAUSE Pyelonephritis, a bacterial infection of bones throughout the body become thin and is probably the cause of your symptoms. In
prescribe antibiotics to treat infection.
above the waist, a kidney, may be the cause of these symptoms.
damage. In some cases, surgery to stabilize the a wheelchair, or weak. Osteoporosis is symptomless unless a this condition, joints between the vertebrae in NO Recurrent mastitis may need surgical
and do you spine may be required. are you over 60? fracture occurs. The disorder is most common the spine are progressively damaged. This is
ACTION Your doctor will examine you and arrange for in women who have passed the menopause. particularly likely if you are over 50 and you
treatment to remove affected milk ducts. Has this developed
feel generally recently? YES
a urine test. If an infection is confirmed, you will be NO However, a prolonged period of immobility will are overweight. Consult your doctor.
unwell with a prescribed antibiotics. You may also need to have an also lead to the development of osteoporosis.
S E L F - H E L P Breast Is one of your nipples POSSIBLE CAUSE AND ACTION If your nipple has
Continued on YES NO
temperature of abdominal ultrasound scan (p.217) or a contrast ACTION Your doctor may arrange for blood next page self-awareness drawn into the breast? always been drawn in, this is not a cause for
38°C (100°F) ACTION Initial treatment for the pain is with tests and an X-ray (p.39) to confirm the Are you aged under 20? YES

The charts help you find a possible cause of

X-ray of the kidneys (see INTRAVENOUS UROGRAPHY, concern, although it may make breast-feeding
p.227) to look for an underlying cause. SELF-HELP Taking care of painkillers. Your doctor may also request bone diagnosis. Over-the-counter painkillers should NO difficult. Wearing a nipple shell inside your
or above? densitometry (below). Specific treatment for help to relieve your symptoms. If you are If you examine your breasts regularly, you
NO bra during pregnancy may help to draw the
your back osteoporosis depends on the underlying cause. overweight, it will help to lose weight (see HOW will become familiar with their normal
NO
However, in all cases, it is important that you TO LOSE WEIGHT SAFELY, p.151). Your doctor
Aspiration of a breast lump appearance and feel and find it easier to
nipple out in preparation for breast-feeding.

Improving your posture and taking care to try to remain active and take weight-bearing may refer you for physiotherapy to help you notice changes. Look at your breasts in a
Does the pain prevent lift heavy objects safely can help you avoid Are you female exercise, such as walking. strengthen the muscles that support the spine. Aspiration involves removing cells or liquid mirror, checking for changes in the size or
YES from a breast lump using a needle and Do you have a discharge
you from moving, back problems. Stand up straight, and avoid and pregnant? shape of your breasts, changes to your YES POSSIBLE CAUSES Nipple discharge is usually
YES syringe. If the lump is solid, cells will be POSSIBLE CAUSES A noncancerous growth from a nipple? due to hormone changes and is no cause
and/or does it shoot wearing high-heeled shoes. Be aware of your SELF-HELP Premenstrual

many symptoms that may affect you or your

nipples, or dimpled skin. Then, while lying
NO collected in the needle. These cells are then or cyst are the most likely causes of NO for concern. In rare cases, a cancerous or
down one leg? posture when sitting at a desk (see SAFETY AT or standing, put one arm behind your head, syndrome
WORK, p.34), in a car, or at home. You should
Bone densitometry sent to a laboratory to be examined under breast lumps. However, breast cancer is
and feel the breast on that side with firm,
noncancerous growth affecting a milk duct
NO a microscope. This technique can identify a possibility that needs to be ruled out. is the cause. Consult your doctor.
have a supportive mattress on your bed. Consult your doctor. small circular movements. Feel around the
This technique uses low-intensity X-rays (p.39) to measure whether or not the lump is cancerous. If fluid ACTION The doctor will examine your breasts Premenstrual syndrome is a group of
Regular gentle exercise may strengthen your whole breast, including the nipple and
Did the pain abdominal and back the density of bone. X-rays are passed through the body, The X-ray generator and detector move is withdrawn into the needle instead of cells, ACTION Your doctor may arrange for you
armpit. Repeat the process with the other
and may arrange for mammography (above) symptoms, often including bloating, mood
YES to have either mammography (opposite) to exclude an abnormality in the underlying
come on after muscles and help and their absorption is interpreted by a computer and along the length of the spine, and the lump can be diagnosed as a breast cyst. breast. If you discover a lump or any changes
swings, and breast tenderness, that some
lifting a heavy POSSIBLE CAUSE AND ACTION You have probably information is displayed on a monitor. The procedure is painful, but it usually takes or ultrasound scanning (p.41) and breast tissue. Treatment is often not necessary, women experience in the days leading up to
displayed as an image. The computer

t
Upper body you lose any in the breast, consult your doctor.
aspiration (see ASPIRATION OF A BREAST but occasionally affected milk ducts may need

child and tell you what steps you should take,

object or after strained some of the muscles and/or ligaments in straight calculates the average bone density and less than a minute to carry out. a period. The following measures may help
your back. Follow self-help measures for relieving excess weight. CONSULT YOUR DOCTOR IF YOU X-ray detector LUMP, left) to rule out breast cancer. to be removed surgically.
undertaking compares it with the to prevent or relieve your symptoms:
back pain (opposite). If pain is severe or no better ARE UNABLE TO MAKE A DIAGNOSIS Treatment of noncancerous lumps is
an unusually within 48 hours, consult your doctor. FROM THIS CHART AND YOUR BACK normal range for the Breast lump often unnecessary. However, in some • If possible, keep stress to a minimum.
strenuous PAIN IS SEVERE OR IF THE NATURE person’s age and sex. cases, removal of the lump is advised. Keeping your fingers Does the skin around a • Try relaxation exercises (p.32) or take up
Bend your knees Monitor flat, feel around the nipple look abnormal? YES an exercise such as yoga.
exercise? OF LONG - STANDING BACK PAIN The procedure takes
when you pick Needle whole breast and armpit
up an object,
SUDDENLY CHANGES . about 20 minutes NO
• Eat little and often, including plenty of
NO area in small circles. carbohydrates and fibre.
and keep your and is painless.
Press gently POSSIBLE CAUSES You may have a skin • Reduce your salt intake.

whether it involves professional help or self-

back straight with the pads AREA TO BE condition, such as eczema. However, Paget’s
SEE YOUR DOCTOR WITHIN 24 HOURS while lifting it. Knees raised of your fingers
EXAMINED • Do not eat fried foods or excessive
POSSIBLE CAUSE The lump is probably a disease, a rare form of breast cancer, is a amounts of chocolate.
to keep the fibroadenoma, which is a noncancerous Raise arm possibility. Consult your doctor.
POSSIBLE CAUSE AND ACTION You may have a slipped spine flat growth. Consult your doctor. • Avoid drinks containing large amounts
disc (a ruptured disc of cartilage between the vertebrae) ACTION Your doctor will examine your of caffeine, such as coffee, tea, and cola.
that is irritating a nerve where it leaves the spinal cord. Object ACTION Your doctor will examine you and breasts. If you have a skin condition, you • Try taking the recommended daily
X-ray beam
Your doctor may recommend either physiotherapy or directly in will probably arrange for tests such as may be prescribed corticosteroid creams. If allowance of a vitamin B6 supplement.
front of you A fine needle is attached to a syringe and
manipulation of the spine. If the pain is severe, you may ultrasound scanning (p.41). Small lumps your doctor suspects Paget’s disease, you will
have MRI (p.41) to confirm the diagnosis. In some Go to chart 147 X-ray generator inserted into the breast lump. Cells or fluid
may not need treatment; larger lumps may CONSULT YOUR DOCTOR IF YOU ARE UNABLE TO probably be referred for tests such as • Try taking evening primrose oil, particularly

help. At the start of the charts section, there

Continued on are then carefully withdrawn. in the days before your period.
next page cases, surgery may be needed. (p.284) be surgically removed. MAKE A DIAGNOSIS FROM THIS CHART. mammography (above).

238 239 256 257

are detailed instructions on how to use the

charts, along with two types of “chartfinder”
to help you find the most appropriate chart
for a particular symptom.

First aid FIRST AID

Recovery position Artificial respiration

Finding information
The recovery position is a secure position in which to place a
person who is unconscious but breathing. If an unconscious
victim is left lying on his or her back, the tongue may block
the throat and prevent air from reaching the airways to the

Here you will find step-by-step instructions

lungs. This situation is life-threatening because the breathing

WA R N I N G
You can find the information that you need
for dealing with major emergencies, ranging
If you suspect a spinal injury (p.301), do not
move the victim unless the breathing is
impeded or the person is in danger.

2 With one hand, bring the arm farthest

from you across the victim’s chest, and
place the back of the victim
from this book in several ways:
from giving artificial respiration to someone
CONTENTS LISTS The comprehensive
who has stopped breathing to how to staunch
4 Lift your mouth
contents (pp.6–7) lists every symptom chart
severe bleeding. Techniques are described for
away, keeping
your hands in place to
maintain the victim’s
head position. Glance
at the victim’s chest;

as well as the main headings in the other

you should see the
chest fall as air leaves
the lungs. Take a
3 Continue to pull the

treating babies, children, and adults. To help

breath yourself, then
upper leg so that the give another 11⁄ 2-
victim rolls on to his or her second breath.
side. If necessary, support
the body with your knees so
Infants

sections of the book. In addition, at the start

that the victim does not roll
too far. Leave the victim’s
hand supporting his or her
head, and tilt the head so

you find the first-aid information quickly,

that the airway stays open.

of each group of charts, there is a contents

all the pages in this section have a red bar
list of the charts in that group.
running down the edge. 292

CHARTFINDERS The system-by-system

chartfinder (pp.46–47) groups the charts by
body system or process, and the symptom-
Drugs guide and U DD
by-symptom chartfinder (p.48) alphabetically
useful addresses D G G D lists all the symptoms and can direct you to
The Drugs Guide tells you how drugs work the appropriate chart.
and how to use them safely and includes CROSS-REFERENCES Throughout the
concise profiles of over 35 major drug groups, book, there are cross-references to take you
including their main side effects. Useful to pages with further information.
Addresses provides addresses, telephone INDEX If you still cannot find what you
numbers, and online sites of support groups need, the index (pp.314–319) covers every
for different conditions and sources for subject within the book.
additional health information.

8
 Y O U R B O D Y A N D H E A LT H

YOUR B ODY
& H EALTH
Understanding how your body works and
how to look after yourself are essential if you
want to stay healthy. This section starts by
explaining the structure and function of the
major body systems. It then looks at how you
can modify your lifestyle to prevent health
problems from developing. The final parts of
the section describe how you can make the
best use of the help that health professionals
offer and how medical problems are
investigated should they occur.

9
Y O U R B O D Y A N D H E A LT H

YOUR BODY
Skeleton Types of joint
Joints are formed where two or more bones meet. Different types
The skeleton provides form, support, and protection for the of joint allow for differing degrees of movement. A few joints, such
body. It consists of 206 bones, with further support from as those in the skull, are fixed. Semimovable joints, such as those
cartilage (a tough, fibrous material). The axial skeleton – the in the spine, provide stability and some flexibility. The majority of
skull, spine, and ribcage – consists of 80 bones and protects joints, known as synovial joints, move freely. The main types of
the brain, spinal cord, heart, and lungs. The appendicular synovial joint, and their planes of movement, are illustrated below.
skeleton has 126 bones and consists of the limb bones,
collarbones, shoulder blades, and bones of the pelvis. All
bones are living tissue with cells that are constantly replacing
old bone with new material. Bones
Skull
contain a soft, fatty material
PIVOT JOINT
called bone marrow; this is BALL-AND-
Jawbone
surrounded by spongy bone, (mandible) SOCKET JOINT
which is in turn surrounded by
denser compact bone. The Collarbone
marrow in the bones of the (clavicle)
spine, skull, ribs, and pelvis
manufactures blood cells.
Shoulder blade ELLIPSOIDAL JOINT
SADDLE JOINT
(scapula)

Breastbone (sternum)

Humerus

Rib
PLANE JOINT HINGE JOINT

Spine The spine

Cervical
vertebrae
The spine, also known as the vertebral
Ulna
(7 bones) column, maintains the body in an
upright position, supports the head, and
Radius
encloses and protects the spinal cord. It
Wrist bones consists of 33 bones called vertebrae.
(carpals) Joints and discs of fibrous tissue between
most of the vertebrae make the spine
Hand bones flexible, while ligaments and muscles
(metacarpals) Thoracic
vertebrae
stabilize it and control movement.
Finger bones (12 bones)
(phalanges) Pelvis

Kneecap
(patella)
Femur Soft Fibrous
core covering
Lumbar
Compact Spongy Bone Fibula SECTION OF INTERVERTEBRAL DISC
vertebrae
bone bone marrow (5 bones)
Tibia Intervertebral disc

Vertebra
Ankle bones
(tarsals)
Areas
where ribs
Foot bones are attached
(metatarsals) Sacrum
(5 fused
bones) Ligaments
Toe bones Coccyx THORACIC
STRUCTURE OF BONE (phalanges) (4 fused bones) VERTEBRAE

10
 Y O U R B O D Y A N D H E A LT H

Muscles Types of muscle

The three types of muscle are skeletal muscle, which covers and
Muscles are fibrous bundles of tissue that move the body, moves the skeleton; cardiac muscle, which forms the walls of the
maintain its posture, and work internal organs such as heart; and smooth muscle, found in the walls of the digestive tract,
the heart, intestines, and bladder. These functions are the blood vessels, and the genital and urinary tracts. Each type of
performed by three different types of muscle (right), of muscle has a different function and consists of fibres of a particular
which skeletal muscle makes up the greatest bulk. shape. Skeletal muscle, which moves the limbs and body, is formed
Muscles are controlled by signals from the nervous system. of long, strong, parallel fibres. This type of muscle is able to contract
Skeletal muscle can be controlled consciously, while the other quickly and powerfully, but can
Long, parallel fibres
work at maximum strength only
types work automatically. Most skeletal muscles connect
for short periods of time. Heart
two adjacent bones. One end of the muscle is attached by muscle pumps blood around
a flexible cord of fibrous tissue called a tendon; the other is the body. It comprises short,
attached by a tendon or by a sheet of connective tissue. The branching, interlinked fibres that
skeletal muscles not only move parts of the body but also form a network within the walls
help to maintain the posture when a person is standing, of the heart. This type of muscle
sitting, or lying down. The names of some muscles suggest can work continually without
their functions. Extensors straighten joints, flexors bend tiring. Smooth muscle carries
out functions such as moving
joints, adductors move limbs towards the body, abductors
food through the digestive tract.
pull limbs outwards, and erectors raise or hold up parts of It is composed of short, spindle-
the body. Some of the main skeletal muscles are illustrated shaped fibres that are connected
below. Deeper muscles are shown on the left of each image to form sheets, and can work for
and the more superficial muscles are shown on the right. SKELETAL MUSCLE prolonged periods.

Occipitofrontal Temporoparietal Temporoparietal

Orbicular of mouth
Splenius How muscles work
Orbicular of eye of head Semispinalis of head
Smaller pectoral Movement occurs when signals
Greater pectoral Erector Trapezius from the nervous system cause
Internal of spine
intercostal muscles to contract. Conscious
Deltoid Deltoid movements of the body are
External produced by the interaction of
intercostal Latissimus
dorsi skeletal muscles, bones, and
joints. Most muscles connect one
Biceps
of arm bone to another and cross a joint.
Deep When a muscle contracts, it pulls
Triceps
flexor of of arm on the bones to move them.
fingers Many muscles are found in pairs,
Extensor one on each side of a joint, and
of fingers produce opposing movements.
Gluteus For example, in the upper arm the
minimus
triceps contracts to pull
Ulnar the arm straight and
Quadrate
extensor
of thigh the biceps contracts
of wrist
to bend the arm.

Triceps contracts
Internal
oblique of Biceps relaxes
abdomen
Abductor
of finger Gluteus
Long maximus
adductor
of thigh Sartorius
Biceps STRAIGHTENING THE ARM
Popliteal of thigh
Gracilis Rectus
of thigh Triceps relaxes
Gastrocnemius
Gastrocnemius
Anterior Soleus
tibial Posterior
Long extensor tibial Achilles
of toes tendon
Long
Short extensor Short
flexor of
of big toe extensor
big toe
of toes Biceps contracts
Abductor
of big toe BENDING THE ARM
FRONT VIEW BACK VIEW

11
Y O U R B O D Y A N D H E A LT H

Cardiovascular system Structure of the heart

The heart is a double pump consisting mainly of muscle called
The cardiovascular system transports blood around the body, myocardium. On each side, blood flows through veins into an upper
taking oxygen and nutrients to body tissues and removing chamber (atrium), then passes into a lower chamber (ventricle),
waste products. The heart is a hollow, muscular organ that which pumps the blood into the arteries. Blood flow through the
pumps all the body’s blood – roughly 5 litres (9 pints) – chambers is controlled by one-way valves. The right side of the heart
around the body about once pumps blood into the pulmonary arteries and so to the lungs, and
Jugular vein the left side pumps blood into the aorta and around the body.
a minute and faster during
exercise. Blood flows through Common Ligamentum Coronary
carotid artery arteriosum artery
a network of vessels that Aorta
reaches all parts of the body. Superior vena cava
Superior
Arteries carrying blood from Aorta vena cava
the heart branch into
Pulmonary
smaller vessels and then artery
into capillaries, which Pulmonary
Brachial
in turn join a network vein
arteries BLOOD SUPPLY
TO THE HEART
of veins that return
Heart
blood to the heart. Pulmonary
arteries
Hepatic Pulmonary
Pulmonary vein vein veins Pulmonary
veins
Renal
Brachial artery vein
Left atrium
Hepatic artery Common
Right Aortic
iliac vein
atrium valve
Renal artery

Mitral
Radial artery Pulmonary valve
valve
Inferior vena cava
Tricuspid Left
Femoral valve ventricle
Common iliac artery
vein
Inferior
Femoral artery Great saphenous vena cava Heart muscle
vein (myocardium)
Descending aorta Right ventricle
Popliteal artery Popliteal vein

Anterior
Blood circulation
Anterior tibial artery
tibial vein The heart pumps blood into two linked circuits: the pulmonary and
the systemic. The pulmonary circuit takes deoxygenated blood to the
Peroneal artery Posterior lungs, where it absorbs oxygen and releases carbon dioxide (a waste
tibial vein
gas) through a network of capillaries; the oxygenated blood is then
Posterior tibial artery
returned to the heart. The systemic circuit takes oxygenated blood to
Small saphenous
vein body tissues, where it releases oxygen and nutrients through capillary
Dorsal artery walls; carbon dioxide and other wastes pass from the tissues into
of the foot the blood, and the deoxygenated blood is returned to the heart.
Dorsal vein
of the foot
Deoxygenated blood Oxygenated blood going
coming from the to the upper body
Arteries and veins upper body Oxygenated
blood coming Capillary
Arteries have thick, muscular, elastic walls to withstand the high Deoxygenated blood from the network
pressure of blood pumped out of the heart. Veins return blood to the going to the lungs lungs in lungs
heart. They have thinner walls that stretch easily, allowing them to
expand and hold large volumes of blood when the body is at rest.
The linings of many large veins have folds that act as one-way valves
to stop blood from flowing the wrong way.

Thick, Elastic One-way Thin, muscular

muscular layer layer valve layer

Deoxygenated
blood coming Oxygenated
from the blood going to
ARTERY VEIN lower body Heart the lower body

12
 Y O U R B O D Y A N D H E A LT H

Respiratory system How breathing works

Breathing is the act by which the body takes in and expels air. The
Respiration is the process by which the body obtains oxygen, flow of air in and out of the body occurs because air moves from
which it uses to produce energy, and expels carbon dioxide, areas of high pressure to areas of low pressure. To breathe in (inhale),
the main waste product. Air breathed in through the nose or the diaphragm and the muscles between the ribs contract, causing the
mouth passes down the trachea (windpipe) into the bronchi chest to enlarge. As a result the air pressure in the lungs decreases so
(lower airways), then into bronchioles (smaller airways) in the that it is lower than the atmospheric pressure, and air is drawn into
lungs. The bronchioles end in sacs called alveoli, which are the lungs. To breathe out (exhale), the muscles relax, decreasing the
volume of the lungs. The air pressure in the lungs becomes higher
surrounded by blood vessels. Here, oxygen passes into the
than that in the atmosphere, causing air to leave the body.
blood and carbon dioxide enters the lungs to be breathed out.
Breathing is powered by the diaphragm (a muscle) and the
intercostal muscles. The respiratory system also includes the
Lung
pharynx (throat), larynx (voicebox), and epiglottis. The tonsils
and the adenoids in the pharynx help to fight infection. The Air flow
larynx contains the vocal cords, which vibrate to produce Flattened
sounds. The epiglottis seals the trachea during swallowing. Each lung diaphragm
increases in
Blood vessel Alveolus volume as
X-RAY OF CHEST
the ribcage DURING INHALATION
Bronchiole Adenoids expands

Tonsil The ribs rise

and swing
Pharynx outwards
The
diaphragm
Epiglottis contracts and The intercostal
moves down muscles, between
the ribs, contract
ALVEOLI Vocal cords
BREATHING IN

Nasal cavity Larynx

Lung
Air flow
Mouth Heart
Domed
Trachea Lung diaphragm
Each lung
Bronchus decreases in
volume as
the ribcage X-RAY OF CHEST
becomes DURING EXHALATION
smaller

The ribs move

down and
Rib inwards
The
diaphragm
relaxes and The intercostal
moves up muscles, between
the ribs, relax

Bronchiole Diaphragm Intercostal muscle BREATHING OUT

Gas exchange in the body Oxygen is released and

passes into the body cells
The body’s tissues constantly take up Alveolus Oxygenated
oxygen from the blood and release blood travelling
via heart
carbon dioxide back into the blood.
Oxygen leaves
Oxygen is breathed into the lungs, the alveolus Red
and passes from the alveoli (tiny sacs) to bind with Plasma blood
into blood vessels called capillaries, haemoglobin cell
where it binds to a substance called in red blood
haemoglobin in the red blood cells. cells
At the same time, carbon dioxide Capillary
passes from the blood plasma (the Red blood cell
fluid part of the blood) into the Deoxygenated
alveoli to be breathed out. In the blood travelling Waste carbon
Carbon dioxide GAS EXCHANGE GAS EXCHANGE dioxide leaves
capillaries in tissues, the red blood IN LUNGS via heart IN BODY CELLS
passes from the the body cells
cells release oxygen, while carbon plasma into the and dissolves
dioxide is absorbed into the plasma. alveolus in the plasma

13
Y O U R B O D Y A N D H E A LT H

Nervous system White matter

of cerebrum
Meninges
Cerebral cortex
(grey matter)
Cerebrum
The nervous system gathers, analyses, stores, and transmits
information. It controls vital body functions and interacts with
Vein Skull
the outside world. There are two parts: the central nervous
system, which comprises the brain and spinal cord, and the
peripheral nervous system, which is made up of nerves that
branch from the brain and spinal cord to all areas of the body.
Signals, in the form of tiny electrical impulses, are transmitted
through the nervous system from the brain to the rest of the
body and vice versa. The brain controls almost all activities –
both conscious activities, such as movement, and unconscious
functions, such as maintaining body temperature. It also
receives information from the nerves about the environment
and the condition of other parts of the body. For example, Corpus
callosum
the nerves leading from the eyes register visual information
and nerves beneath the surface of the skin transmit sensations Pituitary gland
such as pain. In addition, the brain is capable of complex
processes such as learning, memory, thought, and emotion, and Hypothalamus
can instruct the body to act on the basis of these processes.
Brainstem Cerebellum
Structure and function of the brain CROSS SECTION OF THE BRAIN
The brain is the most complex organ in the body. It has more than
100 billion nerve cells and billions of pathways. The largest part of
the brain is the cerebrum. It is divided into two halves (hemispheres),
Organization of the nervous system
which are connected by a bundle of nerve fibres called the corpus The central nervous system, comprising the brain and spinal cord,
callosum. The outer layer (cerebral cortex) consists of tissue called grey processes and coordinates nerve signals. The spinal cord forms the
matter, which generates and processes nerve signals. The inner layer link between the brain and the rest of the body. Motor pathways,
consists of white matter, which transmits the signals. The cerebrum which carry messages from the brain,
controls conscious thought and movement and interprets sensory descend through the spinal cord, while Brain
information; different parts govern specific activities such as speech sensory pathways from the skin and
and vision. A structure at the base of the brain called the cerebellum other sensory organs ascend through
controls balance, coordination, and posture. The brain is connected to the spinal cord carrying messages
Cervical
the spinal cord by the brainstem, which controls vital functions such to the brain. A network of Spinal nerves
as respiration. Just above the brainstem is the hypothalamus, which peripheral nerves reaches all cord
links the nervous system and the endocrine system and helps to parts of the body. Each nerve
regulate body temperature, sleep, and sexual behaviour. The brain is formed from hundreds of
is protected by the skull and by membranes called meninges. Clear nerve fibres, which project
cerebrospinal fluid cushions the brain and spinal cord from injury. from nerve cells, grouped in
bundles. Thirty-one pairs of
Voluntary movement is Sensory information is nerves branch off the spinal
controlled in these areas processed in these areas
cord. These divide into smaller
Visual
information and smaller nerves throughout
Speech is is processed the torso and the limbs.
controlled in these areas
in these
areas
Thoracic nerves

Lumbar nerves

Sacral nerves

MAJOR SPINAL NERVES

Grey matter Structure of the

Various spinal cord
aspects of White The spinal cord is made
Spinal matter
behaviour and
nerve
up of grey matter, which
personality are contains nerve cells and
controlled here supporting cells, and
Information from the white matter, which
ears is processed here contains nerve fibres.
The cord is enclosed by
Brainstem Cerebellum protective membranes
EXTERIOR OF THE BRAIN Meninges called meninges.

14
 Y O U R B O D Y A N D H E A LT H

The senses Smell

Smells are detected by specialized receptor cells in the roof of the
Our senses enable us to monitor all aspects of our environment. nasal cavity. These receptor cells detect odour molecules in the air
The eyes provide visual information; the ears detect sound and convert the information into tiny electrical impulses. These
and also aid balance; the nose and tongue respond to different impulses are transmitted along the olfactory nerve to the olfactory
smells and tastes respectively; and the sensory nerves in the bulb (the end of the olfactory nerve) and then to the brain, where
skin allow us to feel physical contact (touch), changes in they are analysed. The human sense of smell is highly sensitive,
temperature, and pain. In each case, information about the allowing us to detect more than 10,000 different odours.
environment detected by the sense organs is transmitted by Olfactory Nasal Nerve fibre Support cell Receptor cell
nerves to the brain, where it is then analysed. bulb cavity
Smell receptors
When odour molecules
Vision Sclera (white enter the nose, they
of eye) stimulate cilia (tiny hairs)
The organs of vision are the
Lens Choroid attached to receptor cells
eyes. Light rays entering each
eye are focused by the cornea Cornea in the roof of the nasal
Retina
and the lens so that they fall cavity. The receptors
LOCATION
on the retina, producing an transmit signals via nerve
Cilia fibres to the olfactory
upside-down image on it.
bulb, which passes the
Cells in the retina convert this Mucus signals to the brain.
image into electrical impulses
that pass along the optic
nerve to the brain, where they Taste
are decoded to create vision. Tastes are detected by the taste buds. These structures are located
The iris alters the size of the in the mouth and throat, with most – about 10,000 – on the upper
Optic
pupil to control the amount nerve surface of the tongue. They can distinguish only four basic tastes:
of light reaching the retina. Pupil sweet, sour, salty, and bitter. Each taste is detected by taste buds
Blood vessels in the retina Retinal in a specific area of the tongue: bitterness is registered at the back,
and a layer called the choroid Iris blood vessel sourness at the sides, saltiness at the front, and sweetness at the tip.
supply the eye with nutrients. CROSS SECTION OF AN EYE It is our sense of smell, in combination with these four basic tastes,
that allows us to differentiate a great range of more subtle flavours.
Optic Blood
disc vessel Tongue Taste hair Tongue surface
View of the retina
The cells in the retina register colour
and light intensity. At the back of the
Taste bud structure
Substances in the mouth
retina is the optic disc, where nerve
come into contact with
fibres converge to form the optic nerve
tiny hairs projecting
and where blood vessels enter the eye.
LOCATION from taste buds in the
The disc contains no light-sensitive
tongue. These hairs
cells and is called the “blind spot”.
generate nerve impulses
This photograph was taken through an Receptor cell
that travel along nerve
ophthalmoscope, which magnifies and
fibres to a specialized
illuminates the inside of the eye.
Nerve fibre area of the brain.
Hearing and balance
The ear is concerned not only with hearing but also with balance. It Touch
has outer, middle, and inner parts. The outer ear directs sound waves The sense of touch includes sensations such as pain, pressure,
to the eardrum, causing it to vibrate. The bones of the middle ear vibration, and temperature. These sensations are detected by two
transmit these vibrations to the inner ear, where they are converted types of receptor under the surface of the skin: free (uncovered)
into electrical signals. The signals pass along nerve cells to the brain, nerve endings, and enclosed nerve endings called corpuscles.
where they are analysed. The inner ear also contains structures that Different types of nerve ending or corpuscle monitor particular
aid balance by detecting the position and movements of the head, sensations. The number of receptors varies around the body:
allowing us to stay upright and move without falling over. for example, the fingertips are highly sensitive and have many
receptors, whereas the middle of the back has fewer receptors.
Structure of the ear Outer Middle Inner
The outer ear comprises ear ear ear Touch receptors Free nerve Merkel’s Skin
the pinna (the visible part) Touch is detected by ending corpuscle surface
and the ear canal, which Pinna various receptors at
leads to the eardrum. different levels within the
The middle ear contains skin. Free (uncovered)
Meissner’s
three tiny bones that nerve endings, near the corpuscle
connect the eardrum to a skin surface, respond to
membrane separating the Ear touch, pain, pressure,
middle and inner ears. canal and temperature.
The inner ear houses the Merkel’s and Meissner’s
cochlea, which contains corpuscles detect light Pacinian
Eardrum
corpuscle
the sensory receptor for touch, and Pacinian
hearing, and structures Nerve corpuscles detect deep
that regulate balance. Cochlea pressure and vibration.

15
Y O U R B O D Y A N D H E A LT H

Digestive system Stomach

Food moves down the oesophagus into the stomach. There, it may
The digestive system consists of the digestive tract and its spend up to 5 hours being churned and partially broken down by
associated organs. The digestive tract is a convoluted tube digestive juices until it becomes a semi-liquid substance called
about 7 m (24 ft) long through which food passes while it is chyme. Swallowed fluids, such as water and alcohol, pass straight
being broken down. The tract consists of the mouth, pharynx through the stomach and into the intestine in a few minutes.
(throat), oesophagus, stomach, small and large intestines,
rectum, and anus. The associated digestive organs include Small intestine
three pairs of salivary glands, the liver, the pancreas, and the Chyme enters the duodenum (the first part of the small intestine)
gallbladder. The digestive system breaks down food into and is further broken down by digestive juices from the liver and
simpler components that can be used by the cells of the body pancreas. The final stage of digestion takes place in the rest of the
and eliminates the remaining substances as waste. small intestine. Here, digestive juices released from the intestinal walls
split nutrients into chemical units small enough to pass through the
Large wall of the intestine into the surrounding network of blood vessels.
intestine
Mouth
Pancreas Large intestine
Tongue Peritoneum After nutrients have been absorbed in the small intestine, the
remaining material passes into the large intestine. Most of the water
Teeth Small content is absorbed back into the body, and the semi-solid waste
intestine
Salivary that remains is called faeces. It moves down into the rectum, where
glands Pharynx it is stored until it is released through the anus as a bowel motion.
Oesophagus

A folded membrane
Liver, gallbladder, and pancreas
called the peritoneum The liver, gallbladder, and pancreas all help to break down food
lines the inside of the chemically. The liver uses the products of digestion to manufacture
abdominal wall and proteins such as antibodies (which help to fight infection) and blood
covers all of the clotting factors. It also breaks down worn-out blood cells and excretes
digestive organs. the wastes as bile, which is stored in the gallbladder and plays a part
in the digestion of fats. The entry of food into the duodenum (the
Liver first part of the small intestine) stimulates the gallbladder to release
the bile into the duodenum via the bile duct. The pancreas secretes
Gallbladder powerful digestive juices, which are released into the duodenum
when food enters it. Together with digestive juices produced by the
Stomach intestinal lining, they help to break down nutrients into substances
that are absorbed into the blood and carried to the liver.
Pancreas
Liver Bile duct Oesophagus
Small intestine Stomach
Large intestine

Appendix The liver, gallbladder, and

pancreas, in the upper
Rectum
abdomen, secrete digestive
Anus juices into the duodenum.
Bile from the liver and
gallbladder passes down the
Mouth and oesophagus bile duct, and pancreatic
The process of digestion begins in the mouth. The action of the juices are released directly
teeth and tongue during chewing breaks food into small, soft pieces Gallbladder Duodenum Pancreas into the duodenum.
for swallowing, while substances in the saliva start to break down
carbohydrates in the food. When you swallow, the tongue pushes
the mixture of food and saliva, known as a bolus, down the throat
Peristalsis
into the oesophagus. At the same time, the soft palate closes off the
nasal cavity, and the epiglottis, a small flap of cartilage at the back Food is propelled along the digestive tract Contracted
of the tongue, moves to close off the larynx. by a continuous sequence of muscular muscle
contractions known as peristalsis. The walls
Food bolus Tongue Tongue Soft palate raised of the digestive tract are lined with smooth
Soft palate muscle. To move a piece of food (bolus) Direction
Food bolus forwards, the muscle behind the food of food
contracts while the muscle in front relaxes. movement
Epiglottis
Epiglottis lowered
Relaxed
Larynx To move pieces of food through the muscle
Larynx closed off digestive tract, the muscles in the walls
contract and relax in a sequence known Bolus of
Oesophagus Oesophagus as a peristaltic wave. food
BEFORE SWALLOWING DURING SWALLOWING

16
 Y O U R B O D Y A N D H E A LT H

Endocrine system the development of certain male sexual characteristics. The medulla
secretes epinephrine (adrenaline) and norepinephrine (noradrenaline),
The endocrine system produces hormones – chemicals that are which increase the heart rate and blood flow to the muscles in
response to stress (a reaction called the “fight or flight response”).
carried in the bloodstream and control processes in other parts
of the body. Such processes include metabolism (the chemical
reactions constantly occurring in the body), responses to stress, Pancreas
growth, and sexual development. The pancreas lies behind the stomach. It produces digestive juices
Hypothalamus that help to break down food. It also releases the hormones insulin
The system comprises glands
and glucagon, which play an important part in regulating the level
and other hormone-producing Pineal gland
of glucose, a sugar that forms the body’s main energy source.
cells. Glands, such as the
pituitary, adrenal, and thyroid Pituitary gland

glands, are organs whose

Ovaries
Thyroid and The ovaries lie on either side of the uterus. They release eggs and
only function is to produce parathyroid
glands produce the female sex hormones progesterone and oestrogen,
specific hormones. Other which regulate the menstrual cycle. Oestrogen also encourages
organs and tissues, such the development of some female sexual characteristics, such as
as the ovaries, testes, enlargement of the breasts.
heart, and kidneys,
also contain hormone- Testes
producing cells. The testes hang in a bag of skin and muscles called the scrotum. They
produce sperm and secrete the male sex hormone testosterone. This
Adrenal gland hormone is responsible for the onset of puberty and the development
of male secondary sexual characteristics, such as facial hair.
Pancreas
Testis
Ovary
Lymphatic system
The lymphatic system consists of
a network of lymph vessels that Cervical
runs throughout the body, clumps lymph nodes
of bean-shaped lymph nodes
(commonly called lymph glands),
the spleen, the thymus gland, and
MALE
other areas of lymphatic tissue,
such as Peyer’s patches in
the wall of the intestine. The
Pituitary gland and hypothalamus lymphatic system helps to
Lymph
vessel
The pituitary gland lies at the base of the brain. It is known as the defend the body against Axillary
“master gland” because it produces hormones that stimulate and
infection and also to maintain lymph
control endocrine tissue in other glands and organs. It also secretes nodes
hormones that control growth, the volume of urine passed, and the the balance of body fluids.
Thoracic
contraction of the uterus during labour. The hypothalamus is a part
of the brain that is linked to the pituitary gland. It secretes hormones Vessels and nodes duct

called releasing factors that control the function of the pituitary, and Lymph vessels carry a fluid Thymus
also acts as a link between the nervous and endocrine systems. gland
called lymph around the body.
Lymph helps to maintain the Spleen
Pineal gland body’s fluid balance by collecting
The pineal gland is situated deep inside the brain. Its precise function excess fluid from the tissues and Peyer’s
has yet to be clarified. However, the gland is known to produce a returning it to the bloodstream. patch in
hormone called melatonin, which is thought to be associated with It also carries white blood cells, intestine
the daily cycle of sleep and waking. which fight infection. Lymph nodes,
situated at junctions between lymph
vessels, filter infectious organisms Deep
Thyroid and parathyroid glands from the lymph. They are packed with inguinal
(groin)
The thyroid gland, in the neck, produces hormones that control lymphocytes, a type of white blood lymph
metabolism. Some thyroid cells also secrete the hormone calcitonin, cell. Clusters of nodes are found in nodes
which lowers the blood level of calcium. The four parathyroid glands, many parts of the body, including the
behind the thyroid, produce a hormone that controls blood levels of neck, armpits, and groin.
calcium and phosphate. Calcium is vital for healthy bones and, with Popliteal
phosphate, plays an important part in nerve and muscle function. Spleen and thymus lymph
nodes
The spleen and the thymus gland produce
Adrenal glands certain types of lymphocytes (white blood
The adrenal glands lie on top of the kidneys. Each gland has a cortex cells). These cells produce antibodies,
(outer layer) and a medulla (core). The cortex produces corticosteroid which help to destroy infective
hormones, whose roles include helping to regulate blood levels of salt organisms. The spleen also breaks
and glucose, and tiny amounts of male sex hormones, which promote down worn-out red blood cells.

17
Y O U R B O D Y A N D H E A LT H

Urinary system Structure of the kidney

Inside the kidney, there are three regions: the cortex (outer layer),
The urinary system filters wastes from the blood, eliminating the medulla (middle layer), and the renal pelvis (inner region). The
them together with excess water as urine. It also regulates cortex contains functional units called nephrons. Each nephron
body fluid levels and maintains the body’s acid–alkali balance. consists of a glomerulus, a cluster of specialized capillaries in which
The system consists of a pair of kidneys; the bladder; the the blood is filtered, and a renal tubule, through which the resulting
ureters, which connect each kidney to the bladder; and the waste fluids pass as they are turned into urine. The medulla consists
of groups of urine-collecting ducts. Urine from these ducts passes
urethra, the tube through which urine leaves the body. The into minor calyces and then into major calyces, which open into the
kidneys are red-brown, bean-shaped organs lying at the back renal pelvis. From here, the urine is funnelled into the ureter.
of the abdomen, one on either side of the spine. They contain
units called nephrons that filter the blood circulating through Podocyte, a special Nephron
cell involved in
the kidneys and produce urine, which then passes down the filtration Glomerulus Renal
ureters into the bladder. The bladder is kept closed by a ring of tubule
muscle (a sphincter) around its lower opening. This muscle can
be relaxed voluntarily to allow urine to be expelled through Proximal
convoluted
the urethra. The male urethra is longer than the female urethra tubule
and also provides an outlet for semen (fluid that contains
sperm and that is released during sexual activity). Because the
Cortex
female urethra is shorter and opens close to the vagina and
anus, women are more prone to urinary infections than men. Capillary

Adrenal Cortex of
gland the kidney
GLOMERULUS
Medulla of
the kidney Nephron
Kidney
Peritoneum
(membrane Medulla
lining the Renal artery
Renal abdomen)
artery
Ureter
Renal vein
Renal Bladder
vein Renal pelvis

Ureter

Bladder

Ureter
Prostate
gland Urethra
FEMALE
Major calyx

Urethra Protective
Minor calyx capsule

How urine is made

Urine is composed of substances that have been Filtrate Urine-collecting duct
filtered from the blood in the nephrons. A kidney Blood
has about a million nephrons. Each consists of a entering the Secretion of
cluster of tiny capillaries called a glomerulus and a glomerulus unwanted
substances
tube called the renal tubule. This has three parts:
the proximal convoluted tubule, the loop of Henle, Water and
substances filtering
and the distal convoluted tubule. Blood first passes out of blood Urine from a number
through the glomerulus. The capillary walls have of nephrons passing
Reabsorption of to the renal pelvis
pores that allow water and small particles (such as water and nutrients
salts) to pass through, while retaining larger particles,
Blood
such as proteins and red blood cells. The fluid that Proximal flow
has been removed from the blood, called filtrate, convoluted tubule Distal
enters the renal tubule, where water, and other Reabsorption of convoluted
Loop of Henle water and salts tubule
useful substances such as glucose and salts, are
reabsorbed into the bloodstream as necessary. URINE FORMATION IN A NEPHRON

18
 Y O U R B O D Y A N D H E A LT H

Male reproductive system Changes in boys during puberty

The male reproductive system produces sperm – cells that can
fuse with eggs from a woman to form offspring. It also makes Puberty is the period during which sexual characteristics
the male sex hormones needed for sperm production and for develop and sexual organs mature. In boys, puberty
sexual development at puberty. The male genitals consist of usually begins between the ages
Facial
the penis, the testes, and the scrotum, in which the testes are of about 12 and 15 and lasts hair
for 3–4 years. The pituitary
suspended. Each testis is packed with seminiferous tubules,
gland, at the base of the
which make sperm. The sperm are stored in the epididymis, a brain, starts to secrete Chest
coiled tube that lies behind each testis. Another tube, the vas hair
hormones that stimulate the
deferens, connects each epididymis to an ejaculatory duct, testes to produce the male
which in turn is connected to the urethra. Three glands – a sex hormone testosterone. Pubic
pair of seminal vesicles and the prostate gland – secrete fluids This hormone stimulates hair
to transport and nourish the sperm; the secretions and sperm changes such as enlargement Enlarged
form a fluid called semen. During sexual activity, the erectile of the genitals and the genitals
tissue in the penis fills with blood, making the penis lengthen growth of body hair, and,
Developed
and stiffen in order to enter the woman’s vagina. At orgasm, later, sperm production muscles
and increased sex drive.
muscular contractions force semen along each vas deferens, BEFORE PUBERTY AFTER PUBERTY
down the urethra, and out of the penis.

Prostate Artery Vas

gland deferens
Bladder

Epididymis
Urethra
Erectile
Vas tissue
deferens Penis

Urethra
Scrotum Testis Seminiferous
FRONT VIEW SECTION THROUGH THE PENIS
tubule

Ejaculatory Seminal Prostate Pubic Vas

duct vesicle gland cartilage deferens CROSS SECTION OF A TESTIS

Sperm production
Once puberty has been reached, sperm
are manufactured continuously in the
testes at a rate of about 125 million
each day. The sperm develop around the
walls of the seminiferous tubules; their
tails, which enable them to swim, point
towards the centre of the tubules.
Mature sperm are stored in a coiled tube
called the epididymis, situated behind
Erectile each testis. The sperm are eventually
tissue
ejaculated during sexual activity or are
Penis reabsorbed into the body.

Developing
sperm

Sperm
tails

Tubule
wall

Rectum Centre of
tubule
SPERM INSIDE A
Foreskin Urethra SEMINIFEROUS TUBULE
Anus Muscle Scrotum Epididymis Testis

19
Y O U R B O D Y A N D H E A LT H

Female reproductive Changes in girls during puberty

system Puberty is the period during which sexual
characteristics develop and sexual organs Armpit
The internal structures of the female reproductive system –
mature. In girls, puberty begins hair
the ovaries, fallopian tubes, uterus, and vagina – lie in the between the ages of about 10 and
lower third of the abdomen. The ovaries contain follicles that 14 and lasts for 3–4 years. The Enlarged
store eggs, cells that can fuse with sperm from a man to form breasts
pituitary gland starts to secrete
offspring. Each month an egg matures and is released from an hormones that stimulate the Wider
ovary; the fimbriae guide the egg into a fallopian tube, which ovaries to produce the female hips
propels it towards the uterus. The vagina, a passage with sex hormones oestrogen and
muscular walls, connects the uterus to the outside of the progesterone. These hormones Pubic
body. The external structures, collectively known as the vulva, prompt physical changes such as hair
include the sensitive clitoris and folds of skin called the labia, enlargement of the breasts and
hips and the growth of pubic and Thicker
which protect the entrances to the vagina and the urethra. Just thighs
underarm hair. Later, they stimulate
inside the vaginal entrance lie the Bartholin’s glands, which
ovulation and menstruation. BEFORE PUBERTY AFTER PUBERTY
secrete a fluid for lubrication during sexual intercourse.

Fallopian Uterus
Fimbriae tube
Fallopian
tube
Ovary
Ovary

Cervix
Uterus
Bladder
Vagina
FRONT VIEW

Immature
Cervix Pubic egg
cartilage Blood
follicle
vessel

Empty
Vagina Clitoris
follicle

Labia Mature
Rectum egg follicle

Pelvic floor Egg

muscles CROSS SECTION OF AN OVARY

The menstrual cycle

During the menstrual cycle, a woman’s body
is prepared for the possibility of pregnancy. Changes during the menstrual cycle
The cycle is regulated by four sex hormones.
MENSTRUATION PREOVULATION OVULATION POSTOVULATION
Follicle-stimulating hormone and luteinizing
hormone, which are secreted by the pituitary
Egg Developing Mature Egg released Empty Shrinking Dying
gland, cause an egg to mature in a follicle
CHANGES IN

egg egg
THE OVARY

growing in from follicle follicle follicle follicle

and be released. The egg and its follicle follicle
secrete oestrogen and progesterone, which
make the uterus lining thicken. If an egg is
fertilized, it embeds itself in the lining. If it
is not fertilized it passes out of the body,
together with blood and cells from the Unfertilized
Unfertilized Thickened egg
lining, during menstruation. The cycle lasts egg Endometrial lining
CHANGES IN THE
ENDOMETRUM

about 28 days but this can vary from month Blood vessels glands enlarge
to month and from woman to woman. Shed lengthen
blood
and cells

The chart shows changes that occur in the

endometrium (uterus lining) and the ovary
during a menstrual cycle. The egg can be 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28
fertilized by a sperm at ovulation, the DAYS
time when it is released from its follicle.

20
 Y O U R B O D Y A N D H E A LT H

Role of the breasts

Breasts play a part in sexual arousal, but their main role is to produce
Conception and pregnancy
milk for babies. During puberty the hormone oestrogen causes the All organisms reproduce. In human beings, reproduction
breasts to grow and develop. During pregnancy, hormonal changes involves two types of cell: sperm, produced by the testes in
make the breasts enlarge further and, in late pregnancy, stimulate men, and eggs, produced by the ovaries in women. These cells
milk production in glands called lobules. These glands are connected each contain half a set of DNA (genetic material). They are
to ducts that lead to channels called ampullae, which open on to the brought together by sexual intercourse; if a sperm penetrates
surface of the nipple. The rest of the breast tissue is mostly fat, with a and fertilizes an egg, the man’s and woman’s DNA combine
small amount of connective tissue, which helps to support the breasts.
to form new cells. Conception occurs when these cells embed
themselves in the uterus. During pregnancy, which lasts for
about 40 weeks (9 months), the cells develop into a baby.
Rib
Fertilization Tail of
sperm
Head of
sperm
Surface
of egg
During sexual intercourse,
Muscle
sperm are expelled into the
woman’s vagina, then swim up
AREA OF through the uterus and into the
BREAST TISSUE Blood fallopian tubes. If the sperm
vessel
meet an egg, they try to pierce
its coating. If a sperm succeeds,
Areola
it sheds its tail and fuses with
the nucleus of the egg, while
chemical changes in the egg
Ampulla stop any more sperm from
entering. In this way a new cell The head of the sperm pushes
is formed, combining DNA through the egg’s outer coating
Nipple from the man and the woman. in order to reach the nucleus.

Beginning of pregnancy
Milk duct
The cell produced by the fusion of the egg and sperm is called a
zygote. Within 2 days of fertilization, the zygote starts its journey
Lobule along the fallopian tube towards the uterus, propelled by the
muscular action of the tube’s walls. At the same time, the zygote
divides itself repeatedly to form a cluster of cells, which is called
a morula. After 5–7 days, the cell cluster reaches the uterus. It
The breasts consist mainly of embeds itself securely in the endometrium (the lining of the uterus)
lobules and milk ducts, together and continues to grow. From this moment onwards, the pregnancy
with fat and connective tissue. Fatty
tissue is properly established. One part of the cell cluster grows into the
Milk is released through the endometrium and becomes the placenta, which
nipple. The dark area surrounding will nourish the developing baby. The rest of
the nipple is called the areola. Lung
the cells, from which the baby will grow,
become an embryo.
The menopause
The menopause is the time when menstrual cycles cease. It usually The zygote The cluster of An embryo
begins to dividing cells, starts to form
occurs between the ages of 45 and 55. The ovaries stop responding
divide soon called a morula, once the cluster
to follicle-stimulating hormone and produce less of the female sex LOCATION
after it has grows as it of cells has
hormones oestrogen and progesterone. As a result ovulation and A single cell been formed travels along embedded itself
menstruation end, and once a woman has reached the menopause she called a zygote is the fallopian in the lining of
is no longer fertile. In the years just before and after the menopause, formed if an egg tube the uterus wall
fuses with a
hormone changes produce symptoms such as mood swings, hot sperm
flushes, vaginal dryness, and night sweats. The menopause may also
result in long-term physical changes, such as osteoporosis.

Thin, brittle bone Fallopian

tube

An unfertilized
The sex hormone egg is released
oestrogen is needed to from an ovary Ovary
give bones strength. Low
oestrogen levels after the
menopause can result in As the cells passing along the fallopian
Lining of
osteoporosis, a condition tube divide, their number doubles every the uterus
in which the bones lose 12 hours. When the cell cluster reaches
density and may become the uterus, it contains hundreds of cells.
thin and brittle, as shown Once embedded in the uterus lining, the
in this microscopic image. cells start developing into an embryo.

21
Y O U R B O D Y A N D H E A LT H

How the baby is nourished Changes in the mother’s body

An unborn baby depends on its mother to supply it with oxygen, Pregnancy is divided into three stages (trimesters), each about 3
nutrients, and antibodies against infection, and to remove its waste months long. During pregnancy, the mother’s body undergoes major
products. These substances pass between the mother’s blood and the changes. The most noticeable are the swelling of the abdomen as the
baby’s blood inside the placenta, an organ that is attached to the baby grows and the enlargement of the breasts as they prepare to
uterus lining and is connected to the baby by the umbilical cord. In produce milk. In addition, specific changes occur in each trimester.
the placenta, the mother’s and baby’s blood supplies are brought In the first trimester, there are few visible changes. However, the
close together, although they do not actually mix. mother’s heart rate increases by about 8 beats per minute in order to
increase the blood circulation. Changes in hormone levels may cause
The mother’s The mother’s Placenta
veins carry
symptoms such as nausea. During the second trimester, the mother
arteries provide
oxygen, nutrients, wastes away may begin to experience backache due to the weight of the fetus.
and antibodies for from the fetus Umbilical Her appetite may increase. By 18–20 weeks the fetus starts to make
the fetus cord noticeable movements, producing fluttering feelings in the mother’s
abdomen. In the third trimester, the mother rapidly gains weight as
Mother’s
blood the fetus undergoes a growth spurt. The uterus eventually becomes
Fetus
so large that the top reaches almost to the mother’s breastbone. In
Substances
the last weeks the fetus changes position so that it is lying with its
LOCATION OF head pointing downwards, ready for birth.
transferred PLACENTA
to fetus
Substances The mother’s breasts are tender and
Where the blood vessels from
transferred
to mother the umbilical cord meet the the areola (the area that surrounds the
placenta, they form structures nipple) darkens. The enlarging uterus
Chorion called villi. The villi extend into may press on the mother’s bladder.
areas containing blood from Areola
Villus the mother. They are enclosed Enlarged milk-
by the chorion, a membrane producing lobule
Umbilical through which nutrients and Milk-
cord other substances pass. producing
lobule

The baby’s development

The baby develops in a sac in the Developing
uterus. It is cushioned by amniotic head Uterus
fluid and nourished by blood from
Fetus
the umbilical cord. In the first Umbilical
8 weeks, the baby is known as stalk
an embryo. During this time the Fetus
limbs, head, and facial features Developing
appear, most of the organs form, arm
and the heart begins to beat. From
Developing Bladder
week 8, the baby is called a fetus. leg
The body structures continue to 4 WEEKS
Uterus Compressed
develop throughout the pregnancy. 7 mm ( 5⁄ 16 in) long lung
Ear Amniotic
Eye with Face fluid
eyelids Ear around
fetus
Hand
Arm Cervix Bladder
Developing
toes The mother’s abdomen starts to
Developing
swell as the fetus and uterus grow.
fingers
Umbilical The milk-producing lobules in the
Leg cord Foot breasts enlarge, and there may be
8 WEEKS 12 WEEKS discharge from the nipples.
2.5 cm (1 in) long 6 cm (21⁄ 2 in) long
Sense of Compressed intestine
hearing is Fetus can
developing suck its Umbilical
thumb Fetus’s head positioned
cord
just over cervix
Fingers
are fully Compressed bladder
developed Protective
layer of fat
has formed
under skin Compression of the lungs, stomach,
Umbilical intestines, and bladder can cause symptoms
cord 16 WEEKS 28 WEEKS such as mild breathlessness, heartburn, and
18 cm (7 in) long 30.5 cm (12 in) long a need to pass urine frequently.

22
 Y O U R B O D Y A N D H E A LT H

The newborn baby

A newborn baby has to cope with dramatic physical changes Many babies are The head may be
as it leaves the total protection of the mother’s uterus. In born with hair. temporarily misshapen
The skin may be The baby’s
Premature babies due to pressure on the
particular, the baby’s body has to adapt in order to breathe blotchy. It may hands may
may be covered skull bones during
also be covered be clenched
air and function independently of the mother. The body with a greasy into fists
with downy hair birth. There are
systems can carry out the basic functions necessary for life, called lanugo hair, several soft areas
substance called
which disappears called fontanelles,
but they continue to develop and mature vernix, which
after about a month which are gaps
protected the
throughout childhood. A newborn baby’s skin in
between the bones
baby also shows certain basic patterns the uterus
of behaviour that aid his or her
survival, such as finding the mother’s
breast, sucking, responding to
stimuli such as noise, and crying
to gain attention and care.

The nails may be

long, and the ends
may flake off by The genitals The eyelids
themselves Babies born in are large in Right after delivery, are puffy. The
hospital are proportion to the umbilical cord is The edges of the baby can see, but
fitted with an the rest of the clipped and cut to lips may develop only to a distance
identification body, and may leave a small stump. white blisters due of 20–25 cm
bracelet also appear red The stump falls off to vigorous sucking (8–10 in)
and swollen within 10 days as the baby feeds

Reflex actions and movements The heart before and after birth
Babies are born with certain automatic patterns of behaviour. Some In the fetus, the task of adding oxygen to the blood and filtering out
of these activities are involuntary actions, such as breathing and waste gases is done by the placenta, but at birth the baby has to start
passing urine and faeces, and others are reflex actions, instinctive breathing, obtaining oxygen from the lungs. Before birth, the fetus’s
movements designed to protect and to aid survival. Some reflex heart pumps blood around the body and to the umbilical cord, but
actions, such as sucking and “rooting” (searching for the mother’s most of the blood bypasses the pulmonary arteries (the vessels leading
breast), obviously aid survival. Others may be relics from a more to the lungs) by flowing through two special openings in the heart.
primitive stage of human evolution; for example, the grasp reflex is With a baby’s first breath the lungs expand and take in air; this
thought to have originated with our ape ancestors, whose babies had triggers changes in the heart and circulation, causing the two openings
to cling to their mothers as they were carried. The reflex actions, and in the heart to close so that all blood from the rest of the body then
involuntary actions such as passing urine, are eventually replaced flows through the pulmonary arteries to the lungs to be oxygenated.
by voluntary, controlled actions as the baby’s nervous system and
muscles mature. Two typical reflex responses are shown below. Deoxygenated Oxygenated blood Closed ductus Oxygenated
blood from to upper body arteriosus blood to upper
upper body
Open ductus Deoxygenated
body
If a newborn baby is held arteriosus blood to
upright with the feet on a Pulmonary lungs
firm surface, he or she artery
will make movements Closed
that resemble stepping Blood foramen
or walking. from lungs ovale
Minimal
blood to
lungs Oxygenated
blood from
Open lungs
Arms and foramen
hands are ovale
Deoxygenated
stretched
Oxygenated Oxygenated blood from Oxygenated
open
blood from blood to lower body blood to
placenta lower body lower body
If a baby is startled, a
protective movement An opening called the foramen The foramen ovale and ductus
Legs make occurs in which the baby ovale and a channel called the arteriosus close, so that all blood
“stepping” flings the arms wide and ductus arteriosus divert most blood from the heart passes to the lungs
motion stretches the legs out. away from the pulmonary arteries. to be oxygenated.

23
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