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Impetigo is a skin disorder characterized by weeping sores that crust over with a hard, yellow-brownish coat. Pus and fluid often accumulate underneath. The skin area surrounding is often inflamed, and may be tender. This is common about the lips, on the face, and on the fingers and hands. The germ is usually caught from others, commonly at school where one infected child can infect an entire school. The lymph glands in the surrounding areas are usually swollen and tender.

Impetigo is an onslaught of the child’s skin by a family of germs called the streptococcus, or occasionally by its friend, the staphylococcus. I might add that it has always been regarded as an “onslaught” because the term comes from the old Latin word impetus, which means attack.

I think mother would like to know what happens after the attack. Germs are often conveyed home from a school, and for this reason are more Impetigo or “school sores,” caused by a streptococcal infection, is highly contagious.

It is probable in children of that age group than babies – but junior may readily infect brothers and sisters from a common source at school. Very rapidly the germs multiply and cause a pus-filled, discharging sore commonly on the face around the lips, chin, but also hands and knees. Any part of the body may be involved, but these are the most common.

They are brownish, ugly, very obvious, and the discharging fluid sets to form a brown crust. But underneath the infection continues unabated. Often the lymph glands nearby, commonly under the jaw or in the armpits or groin with limb infections, swell and become very tender as they produce special cells aimed at quelling the invaders. The germ is highly contagious, and several other skin areas may be infected from the original sore.

Impetigo Treatment

Simple bathing of the parts with a weak Condi’s crystal solution (pink only) helps. Gently remove the scabs with bathing. Application of an antiseptic cream helps (although antibiotic creams from the doctor are often superior).

Single sores may be covered with band aids. Painting surrounding areas with spirit or spirit-based lotions and tinctures may help prevent spread to other parts. Severely infected children should be kept home from school to avoid contaminating many other children.

Simple bathing of the infected areas with a weak Condi’s crystal solution is often a good start. Make this a light pink only – not dark crimson or black. Bathe away the scabs and the underlying pus and debris.

This in itself often kills off germs. But applying an antibiotic cream or ointment from the doctor will frequently clear the sores within two or three days. Keep them covered to prevent spreading, both to the child’s skin as well as to others.

Paint methylated spirits around the surrounding skin; this also helps check spreading. Cover the sore for the same reason. Large areas may need a dry dressing and bandaging.

See the doctor for further advice and perhaps more medication. Also, I think the child should be kept home until the sores have healed to check spreading. The germs are extremely contagious and can cause similar sores on others. Also, you can give your child the task of bathing the sores and removing the scabs. This gives the patient something to do, for a child often makes a good nurse!

Impetigo, a bacterial skin infection, is spread by contact, and is common, among children. Adequate attention to underlying causes. Attention to diet and general health is desirable, especially if these bouts are recurrent.

Attention by the doctor may be required if simple measures do not bring a quick response. Other measures available include: Antibiotic applications. The broad spectrum antibiotics, when applied as creams or ointments, usually bring spectacular results. A large number arc available and the doctor will write a prescription for your particular needs (e.g. Soframycin, Neomycin etc).

Antibiotics orally. These may be needed in severe cases, but with local treatment are usually not required. General measures. If severe recurring bouts arc taking place, the doctor will seek underlying causes of general ill health and aim treatment at this.

Boils (Furuncle; Folliculitis). This is a painful infection of a hair root. It usually takes several days to develop. Starting from an area of redness and general discomfort, it can rapidly progress. The infected part swells, becomes hot, red, later tense and a lump develops. This is usually due to localized inflammation of the surrounding skin, and the collection of pus. Then a “core” develops, and this finally points and discharges. it is formed of a yellow plug of tenacious pus-filled material. Once this is removed, the pain Boils are hard, red and painful swellings resulting from an infection of the hair roots by the germ Staphylococcus aureus.

• Mice and rats belong to a group of 1,800 species of small mammals called rodents. The group also includes squirrels, voles, lemmings beavers, porcupines and guinea pigs.
• All rodents have two pairs of razor-sharp front teeth for gnawing nuts and berries, and a set of ridged teeth in their cheeks for chewing.
• A rodent’s front teeth, called incisors, grow all the time. Only gnawing keeps them the same length.
• Rats and mice are by far the most common rodents – they have adapted well to living alongside humans.
• Brown and black rats carry germs for diseases such as food poisoning, plague and typhus.
• Rabbits and hares look like rodents but they belong to another group of mammals called lagomorphs or ‘leaping shapes.’
• Rats and mice have long thin tails, pointed noses, beady black eyes and four very sharp front teeth.
• Hares live above ground and escape enemies through sheer speed. Rabbits live in burrows underground.
• Baby hares are born above ground, covered in fur and with their eyes open. Rabbits are born naked and blind in burrows.
• Rabbits breed quickly – a female can have 20 babies every month during the breeding season, and her babies will have their own families after 6 months.
• One single rabbit could have more than 33 million offspring in just 3 years, if they all survived to breed.
• A single mouse can produce up to 34 young in one litter.

• Gulls are big sea birds that live on coasts all around the world, nesting on cliffs, islands or beaches.
• Gulls are related to skuas and terns.
• Skuas have hooked claws and sharp bills, which they use to attack other birds and force them to disgorge (throw up) their food – which the skua then eats.
• Skuas are such good acrobats that they can catch the disgorged meal of another bird in mid-air.
• The great skua often pounces on seagulls, drowns them, and then steals their chicks.
• A wandering albatross can glide for hours without a single flap of its huge wings. It glides quite low, usually less than 20 m above the waves, where rising Iv/Ms keep it aloft.
• Wandering albatrosses are the biggest of all sea birds, with white bodies and dark wings.
• The wandering albatross has the biggest wingspan of any bird – 3.7 m across.
• An albatross will often follow a ship for days without stopping to rest.
• Wild albatrosses may live for more than 50 years.
• Herring gulls watch ducks diving for fish and then steal it when the ducks resurface.

What is Cholesterol?

Cholesterol is a white, fatty substance manufactured mainly by the liver.

It is involved in a number of important bodily functions, including the formation of vitamin D and some hormones.

Particles known as lipoproteins circulate cholesterol to all parts of your body via your blood. At this stage it is called blood cholesterol. Scientific evidence shows that above-normal amounts of cholesterol in the blood increases the risk of atherosclerosis – the condition that can lead to heart attack or stroke.

There are a number of factors that influence the level of cholesterol in your blood. For most people the cause is diet-related. A high-fat diet is the main reason why high blood-cholesterol levels are so common. Rarely is it a hereditary condition.

Your doctor will tell you if the level is too high and if dietary changes are necessary. The National Heart Foundation’s publication Healthy Eating for the Heart will give you more details.

High blood cholesterol can be prevented. Most people can avoid ever having high blood cholesterol if they follow the right diet and start young enough. Most people who do have a high blood-cholesterol level can lower the level by dietary means.

Follow these guidelines:

• Maintain a healthy weight. If you are overweight now set about losing approximately 1 kg a week by changing your eating habits and increasing your physical activity (see the National Heart Foundation booklet The Weight Loss Guide).
• Limit your total intake of fat. You may need to reduce the amount of fat and fatty foods you eat, or substitute with polyunsaturated fats and oils or cut back on certain foods high in cholesterol. More foods rich in dietary fiber and starch may need to be included. (Remember that cholesterol present in foods and ingredients of animal origin is only one influencing factor on blood-cholesterol levels; the main dietary factor is fat.)
• Take a good long look at what you eat now. There is probably room for some improvement.

Often the following changes are all that are necessary:

• Always trim fat off meat.
• Browse through the butchers or supermarket for the meat with the least fat marbling.
• Always discard fat and skin on chicken.
• Experiment with low-fat dairy foods.
• Include at least one vegetarian meal per week based on dried beans, peas or lentils such as soya bean casserole, lentil patties.
• Avoid deep-fried and fatty takeaway foods.
• Try low-fat salad dressings and sauces.
• Switch to whole meal bread.
• Try brown rice and pasta instead of white.
• Limit high-cholesterol foods such as egg yolks, offal products, prawns, fish roe and squid.
• Avoid packet snacks and biscuits between meals.
• Ensure vegetables and fruit feature on your daily menu.
• Drink more water.
• Increase physical activity (get off the bus one stop early, swim three times a week, walk to the local shops instead of driving).
• When you buy supermarket foods, always check the label – if fat, shortening or oil is high on the list of ingredients, look around for an alternative.
• Use the Heart Foundation cookbook Guide to Healthy Eating.

Meal Suggestions

Breakfast

• Have wholegrain breakfast cereal such as rolled oats, untoasted muesli, commercial whole-wheat cereal and switch to skim milk. Include fruit or juice.
• If you like something hot, how about mushrooms on toast or grilled tomato or asparagus or baked beans?
• Try tasty whole meal bread or enjoy the texture of wholegrain types. Switch to easily spreadable polyunsaturated margarines and use just a little.

Lunch

• Whole meal sandwiches or rolls made with lean meat, salmon or cottage cheese and lots of salad makes a convenient lunch. If buying at the sandwich shop, ask for no butter or salt.
• Fill up with nonfat yoghurt and fresh fruit.
• On a cold winter’s day, warm up with a mug of hot homemade soup.

Dinner

• Enjoy fish more often or experiment with an occasional vegetarian meal. Eat only lean meat and lean poultry and have plenty of vegetables – hot or cold. Use recipes from the Heart Foundation cookbooks Guide to Healthy Eating or Harvest Cookbook.
• For dessert try your own combinations of fruit – fresh or cooked – with ricotta topping.

Snacks

• Try not to snack but if you must make your own and keep it small. Convenience and fast foods are often high in fat. Have a crusty bread roll stuffed with bean sprouts and mushrooms.
• Munch a crunchy apple or enjoy a few dried fruits, nuts and seeds. If overweight is not a problem, make your own cakes and loaves using skim milk, a little polyunsaturated margarine and egg whites instead of full-cream milk, butter and whole eggs. Carrot, pineapple, apple or zucchini are useful additions in cakes.

Triglycerides

Triglycerides are also an important type of fat. They are found in food and in most of the body’s fat tissue. The level in the bloodstream rises with overweight and dietary factors. As with blood cholesterol, a high level can increase the risk of heart disease, although a high triglyceride level is not considered as important a risk factor as high blood cholesterol.

• Fertilizers are natural or artificial substances added to soil to make crops and garden plants grow better.
• Natural fertilizers such as manure and compost have been used since the earliest days of farming.
• Manure comes mostly from farm animals, though in some countries human waste is used.
• Manure contains the chemicals nitrogen, phosphorus and potassium plants need for growth. It is also rich in humus, organic matter that helps keep water in the soil.
• Artificial fertilizers are usually liquid or powdered chemicals (or occasionally gas), containing a mix of nitrogen, phosphorus or potassium. They also have traces of sulphur, magnesium and calcium.
• Nitrogen fertilizer, also called nitrate fertilizer, is made from ammonia, which is made from natural gas.
• The first fertilizer factory was set up by Sir John Lawes in Britain in 1843. He made superphosphate by dissolving bones in acid. Phosphates now come from bones or rocks.
• Potassium fertilizers come from potash dug up in mines.
• The use of artificial fertilizers has increased in the last 40 years, especially t h roughout the developed world.
• Environmentalists worry about the effects of nitrate fertilizers entering water supplies, and the huge amount of energy that is needed to make, transport and Apply them.
• Fertilizers are natural or artificial substances added to soil to make crops and garden plants grow better.
• Natural fertilizers such as manure and compost have been used since the earliest days of farming.
• Manure comes mostly from farm animals, though in some countries human waste is used.
• Manure contains the chemicals nitrogen, phosphorus and potassium plants need for growth. It is also rich in humus, organic matter that helps keep water in the soil.
• Artificial fertilizers are usually liquid or powdered chemicals (or occasionally gas), containing a mix of nitrogen, phosphorus or potassium. They also have traces of sulphur, magnesium and calcium.
• Nitrogen fertilizer, also called nitrate fertilizer, is made from ammonia, which is made from natural gas.
• The first fertilizer factory was set up by Sir John Lawes in Britain in 1843. He made superphosphate by dissolving bones in acid. Phosphates now come from bones or rocks.
• Potassium fertilizers come from potash dug up in mines.
• The use of artificial fertilizers has increased in the last 40 years, especially throughout the developed world.
• Environmentalists worry about the effects of nitrate fertilizers entering water supplies, and the huge amount of energy that is needed to make, transport and apply them.

Fitting new internal doors can go along way towards giving the home a completely new look. A new door maybe fitted for purely cosmetic reasons, because the existing one is out of style with the room’s décor, or because the old one is warped or damaged. Whatever the reason, there is a huge selection of replacement doors available, made from hardwood or softwood in styles ranging from plain flush doors to highly ornate ones with solid or glazed panels. Glazed doors are ideal for admitting extra light to darkrooms or passageways, but national building regulations or local building code requirements must be followed in the choice of glass. Reinforced (safety) glass may be required if there is any danger of an accident.

When replacing a door, it is generally advisable to fit new hardware, hinges and latches especially. Door handles and knobs can be removed and replaced if they must match others in the room. In countries where wood frame construction is the norm, pre-hung doors complete with frame and architrave (trim) are widely available. These are very convenient, as to fit them is all that is necessary is to set the unit in the opening, using wood shims to get it plumb, and then nail it into position ready for the trim moldings to be attached. The door is even pre-bored to accept the new lock or latch.

1. Remove the old door and use it as a guide to marking the hinge 1/MI11011S on the edge of the new door. Square the lines across it with a T-square.
2. Set a marking gauge to match the width of the hinge, and scribe a line parallel to the door edge between those made in step 1.
3. Use a chisel and mallet to cut into the door along the marked lines and then to chop a shallow recess to match the thickness of the hinge leaf.
4. Hold the hinge in position in the recess, and mark the positions of all the screw holes on the door edge with a pencil or bradawl.
5. Drill pilot holes into the door edge at each of the marks. Check that they are at right angles to the door edge. If not, the screws will be crooked.
6. Screw the hinge to the door with marching screws. Drive them fully home and check that the screw heads sit square and flush in the countersinks.
7. If reusing the hinge recesses, screw the door to the frame using screws one size up from the originals. If cutting new recesses, then prop the door in the opening and, with a pencil, mark the hinge positions. Remember to lift it a little clear of the floor to allow for easy opening and shutting
8. Square lines across the frame at the marks, then measure the width of the hinge length and mark the width of the recess required on the frame.
9. Cut along the marked lines with a sharp chisel, then carefully cut out the recess to the required depth. Take care not to let the chisel slip.
10. Prop the door back in position and mark the hinges new positions. Drill pilot holes, then drive in the screws to secure the hinges to the door frame.

DOOR SIZES

Doors are made in a range of standard sizes. If the old door is a standard size, buying the correct replacement is simple; but if it is not, a door in the next largest size will need to be sawn or planed down as required. Bear this in mind when deciding on the style of your door. Paneled doors can be reduced in size more easily (and by more) than flush ones. However, doors cannot be cut down excessively or they come apart: do not cut away the tendon joints in the corners, nor remove too much of the edge wood on a flush door.

TIP

If the door binds on the hinge side and will not close properly, the hinge recesses are too deep. Unscrew the hinges and insert cardboard pecking pieces.

• Orchids are a group of over 20,000 species of flower, growing on every continent but Antarctica.
• In the moist tropics many grow on the trunks and branches of trees and so are called epiphytes.
• A few, such as the Bird’s nest orchid, are saprophytes, living off rotting plants in places where there is no light.
• Some species are found throughout the tropics, such as Ionopsis utricularioides. Others grow on just a single mountain in the world.
• Orchids have a big central petal called the lip or labellum. It is often shaped like a cup, trumpet or bag.
• The fly orchid of Ecuador has a lip shaped like a female tachinid fly so as to attract male flies.
• To attract male bees, the bee orchid has a lip that looks just like a female bee.
• The early purple orchid was said to have grown beneath Christ’s cross and the red spots on its leaves were said to be left by falling drops of Christ’s blood.
• The flavor vanilla comes from the vanilla orchid.
• Ancient Greek couples expecting a baby often ate the roots of the early purple orchid. They believed that if the man ate the flower’s large root the baby would be a boy. If the woman ate the small root, the baby would be a girl.
• In Shakespeare’s play Hamlet, the drowned Ophelia is covered in flowers, including the early purple orchid, famous as a love potion. Hamlet’s mother says that ‘cold maids’ call the flowers ‘dead men’s fingers.

Garden lights not only make your garden look more dramatic as dusk falls, they also extend the hours during which you can enjoy it. If you like entertaining in the garden on summer evenings or just want to sit and relax, lights will add another dimension to the space. When illuminating your garden you are not attempting to fill the entire garden with floodlights, but rather to use spotlights to pick out a particular tree, highlight a semi hidden ornament, or bring to light the droplets of a cascade or fountain.

You don’t need elaborate main lighting. Low voltage lighting supplied from a transformer indoors is perfectly adequate for most lighting jobs in a small garden. Low voltage lighting is designed for DIY installation, but main voltage requires a professional.

Lighting beds

Summer bedding looks good with pools of light thrown downwards onto the beds. If you find the lights obtrusive during the day, choose a low voltage type that is easy to move around. Simply push the spiked supports into the bed when you want to use the garden in the evening.

Picking out plants

Use a spotlight to pick out one or two striking plants that will form focal points in the evening. The white bark of a birch tree, perhaps under planted with white impatiens, the tall ramrod spikes of red hot pokers (kniphofias), or a spiky yucca, make excellent focal points picked out in a spotlight. Tall feathery plants, such as fennel, also illuminate well.

Spotlighting ornaments

Ornaments and containers full of plants also make striking features to pick out in a spotlight and are easy ways of creating a dramatic impact. Before highlighting an ornament, try moving the beam around. Quite different effects can he achieved by directing it upwards or downwards, and side lighting creates a very different effect to straight on illumination.

Illuminating water

Underwater lighting is popular and you can buy special sealed lamps designed to be submerged or to float, but the effect can be disappointing if the water is murky or if algae grows thickly on the lenses. A simple white spotlight is often the most effective. Ordinary terracotta pots, gilded and filled with candle wax, offer the most enchanting outdoor lighting.

Thinking of the neighbors

When using garden lights in a small garden, you have to consider neighbors. It is unsociable to fix a spot where the beam not only illuminates your favorite tree but also falls on the windows of your neighbor’s house, if you direct beams downwards rather than upwards, the pools should not obtrude. If using candles, flares or underwater lighting, never leave it unattended and keep them out of the reach of children and animal.

Many rural families have found that it is worthwhile to include a few geese amongst farm animals since they require little attention, virtually no housing and find their own. Besides, roast goose is a delicious and different Christmas or Thanksgiving treat.

Breeds

The Toulouse goose has a broad, deep body, is a fair layer, has on average about 25 to 40 or more eggs per year, and is a good market bird. However, its dark pinfeathers make it less attractive market prospect than the Emden.

Emdens grow well, are fairly good layers, producing 35 to 40 or more eggs a year, and fare at the market better than Toulouse geese.

Chinese geese come in white and are better layers, averaging 40 to 60.5 or more eggs. While the Toulouse or Emden weighs 12 to 20 pounds, Chinese geese weight up to 12 pounds. Crosses with the Emdens and Toulouse are also available.

Other varieties of geese include Pit, which have the advantage of being naturally sexed, the adult gander is white and the goose is gray. African geese are attractive gray birds with a brown shade. There are also Canadian geese, the American wild goose; the Buff, Egyptian, and the Sebastapol.

Housing

Except in extremely cold weather, mature geese need no shelter and hardly ever use a house. Open shelters shades are provided on range to give protection from the sun. In the North, a barn can be left open for the geese so they can move inside during cold weather.

Starting with Geese

The best way to start is to buy day-old goslings from a hatchery. Goose eggs do not incubate as well as hen’s eggs so it is inadvisable to begin with fertile eggs.

Don’t order goslings until the weather allows for it. If the outside temperatures are low, the eggs must be kept warm. Start them inside a brooder of 90°F (32.22°C.) and gradually reduce the heat over a period of ten days to two weeks, depending on outside temperatures.

Goslings can be fed wetted regular chick whole-grain bread soaked in milk or water, or cooked oatmeal covered with water. Supply tender, chopped greens at all meals to the goslings three to four times a day. After two weeks, reduce the grain supplement to only two- a day and offer more greens. At three weeks of age, cut the geese down to one pound of grain per day and provide greens and other feedings.

Water and fine grit should be available at all times. Provide water in a chick feeder and with pebbles in the trough so that the cannot get their whole bodies into the water.

At four weeks of age the goslings can be outside and will support themselves well on the range. Provide a shelter in case of rain and enclosed on the sides and top within wire. After a few days they can tolerate several hours of freedom a day, and back to their coop at night by a late on feeding of grain. Be sure that litter in the coop is clean and dry. At six weeks they sleep outside at night except during lengthy days of chilling rain, and by eight weeks can take care of themselves.

Feeding

After goslings are six weeks old they can be raised on pasture alone, but enough growing mash may be provided to keep them steadily growing. Pasture grasses, clover and alfalfa make fine pasture, and an acre of good pasture can support 15 to 25 geese. Poor pasture can be supplemented by cut fresh greens.

Geese may be used to weed strawberry beds until the plants are nearly ripe. Feed a pound of grain per five geese daily, and change location of this feeding and their waterers every few days so the geese range over the en-tire patch. After the strawberries are picked, geese can be turned back into the patch to handle late summer and fall weeding. In the garden, however, geese will supplement their pasture by feeding on your ripening vegetables, even onions. If you have a roaming flock of geese, keep them out of your garden with a heavy wire fence.

Geese need a constant supply of fresh, clean water. A waterer such as a hog fountain is excellent since geese cannot get into the water container. Like all poultry, they need a constant source of oyster shell or other in-soluble grit.

Geese should be fattened before slaughtering. This is best done in cool weather. Geese are ready to fatten when fully feathered or when the long wing feathers reach the tail when folded. They are usually five to six months old and weigh from 11 to 15 pounds, depending on breed.

Feed birds a crumbly mash three times daily, or twice daily with a feeding of whole grain. They should be allowed little exercise and confined or permitted limited range. Unlimited water should be provided, but the geese should not be able to fit into their water dispensers. If confined, plenty of clean, dry bedding should be available.

Geese must be starved for 12 hours before slaughtering, but should have water available.

Breeding geese kept over winter should have grain, laying mash and roughage. Oats Mixed with corn, wheat or barley are a good feed. Geese can be fed whole corn, and should be given clover or alfalfa hay as roughage.

Breeding

Geese mate permanently in pairs. Breeders should be selected from medium-sized, vigorous and well-developed birds that grow rapidly and have compact, meaty bodies. A gander may be mated with up to five geese, but pair and trio matings are most common. Mature ganders have a longer neck and head than females and have a higher pitched voice; the female is smaller, less coarse and has a deeper cry.

Most breeds lay in the early spring, the Chinese somewhat earlier. Laying mash is fed once a day in December or January to encourage egg production. Farmers with just a few geese can use regular hen laying mashes. Broodiness in geese can be checked by confining the broody goose in sight of but away from the gander. Geese will continue to lay until mid-June if not allowed to set, so collect the eggs regularly to encourage egg production. Geese kept outside can use nesting boxes made of old packing crates inverted on the ground and with a hole cut in one end. Fill the boxes with clean straw.

Eggs for hatching should be collected twice daily until March 1. Geese eggs do not hatch as well as hen’s eggs in an incubator, so you may want to use a hen or a Muscovy duck to set the eggs. Hens must be watched, how-ever, since the goose eggs hatch a week later than hen’s eggs. Eggs should be turned once a day, and should be sprinkled with lukewarm water daily during the last two weeks of hatching.

Newly hatched goslings should be to the geese to mother, if possible, and be to the geese to mother, if possible, and confined indoors until they are two cold. Even at that age, goslings should not be -allowed to get wet-even by walking through wet grass. Goslings are commonly not to swim until they have begun to feather.

Slaughtering

Kill geese the same way other poultry is killed. Goose down is a valuable by-product of raising and if down is desired, the bird should be dry-picked. Since geese have tend, be careful not to bruise the bird if you plan to market it. Semi-scalding makes picking easier. Dip the goose into almost-boiling water for two to 21/2 minutes until feathers pull easily. If desired, detergent may be added to the water. After picking, geese should be cooled in water or in the refrigerator, and then packed for shipping or storage, or bagged and frozen.

Feathers can be saved from dry geese. Flesh should be cleaned from any remains after picking and the replaced in a burlap or cheesecloth bag. Wash with soap and warm water and allow to dry in the shade or in a well-ventilated room.

The features of a heart attack are often obvious and quite straightforward. It is vital that a possible attack be recognized, and that treatment be started immediately. The quicker this can be arranged, and the patient transported to a place where expert attention is available, the greater are the chances of recovery.

Often in smaller heart attacks, the symptoms are not so apparent. However, the same precautions hold. It is far better to assume a heart attack has taken place and see that proper treatment is given, rather than the reverse.

Chest Pain

This is the most prominent symptom and occurs in practically every case of heart attack. (The term cardiac infarction is the one most used these days. It is the same as coronary occlusion. It means a narrowed coronary artery has been blocked with a clot or thrombus.)

The pain varies greatly, and it can come on suddenly. It may occur at any time of the day or night, although it is claimed to be a little more common in onset in short, obese men during winter.

It takes place without any apparent exciting cause. Maximum pain is soon reached. It usually is situated over the front of the chest, mostly over the breastbone (sternum). From here it tends to spread into the chest, particularly the left-hand side.

The pain has often been described as a constricting sensation or a pressure, rather than pure pain. It tends to spread into the lower part of the neck, probably the jaws, and into the left arm. The pain may also be present between the shoulder blades, and also in the pit of the stomach (the epigastrium). The distribution of the pain and its nature are very similar to that occurring in angina, but there has not been the exercise- induced cause as usually occurs with angina.

However, as opposed to the pain of angina, an infarct pain gradually or rapidly increases in intensity until a maximum has been reached. In some people this pain is excruciating, and is among the worst a person has ever experienced. Often the discomfort is not as severe as this, however, and the person tends to be active and quite restless.

Many instances have been recorded where patients think they have a bad attack of indigestion. They feel the more they move and exercise, the quicker it will disappear. A multitude of instances are on record of people going outside and digging the garden, doing exercises or attending the local gym and vigorously exercising. Of course, none of these activities can have any beneficial effect, and indeed they may jeopardize the person’s life.

Painless infarction is almost totally unknown. Cases have occurred during sleep, causing the patient’s death, but these are not usual.

Prodromal Symptoms

Some patients notice brief attacks of chest pain occurring during the 24-72-hour period before the true commencement of symptoms. These are referred to as prodromal symptoms.

There may be a general feeling of malaise, feeling off-color, and generally in indifferent health, often for no outward, obvious reason. Bouts of pain may take place, coming then going.

Patients who have known angina may realize all is not well by the apparent frequency and recurrence of their chest pains. But they may recognize this as something more than their usual anginal attacks. The pains may be more frequent, and persist for longer periods of time. This could herald the onset of an infarct, and a patient is wise to seek medical attention promptly.