tends to increase its durationand carries a greater risk than in any other condition except severe cerebral atherosclerosis. With cerebral vasospasm infarction is common7 but in Tomlinson’s8 experience thrombosis does not occur. There is no sure method of overcoming spasm, but very occasionally cervical sympathetic block may improve anastomosis from external carotid communications. A good airway, cooling, and correction of severe anaemia may, says Connolly, reduce the functional effects. Operation, if mistimed, can be disastrous, and in his series operation was delayed until the patient was reasonably alert and gross neurological signs due to ischxmia had cleared up. It may be found that in cases of cerebrovascular accident associated with arterial spasm, operation under deep hypothermia should be followed by less profound hypothermia for up to three weeks until the spasm has passed off. ELECTROCARDIOGRAPHIC CHANGES DURING EXERCISE
LONG-RANGE diagnosis by the Abrams box is not, perhaps, to be encouraged; and other methods are now available for making a diagnosis at a distance. Some years ago a transistor capsule was invented which passes through the gut and signals the intestinal pressures to a radio receiver as it goes.9 Now we can watch and record from a distance the electrocardiographic changes of patients during exercise. This has been made possible by the ingenuity of Dr. Bellet and his colleagues in Philadelphia in developing the radioelectrocardiograph. It consists of two electrodes, firmly attached to the skin of the fifth intercostal space, one in each axilla. These are connected to a small radiotransmitter in the patient’s pocket, and the broadcast electrocardiogram is received and recorded on an oscilloscope or conventional electrocardiograph. The resulting tracing is very like the V6 pattern of the standard electrocardiogram. Because no wires connect the patient to the electrocardiograph, records can readily be made while he takes any type of exercise, and such tracings have proved useful in the diagnosis of angina. Electrocardiograms taken immediately after exertion are generally expected to reveal any ischaemic changes which exercise may provoke; these enabled Wood et al. 11 to confirm the diagnosis of angina in 88% of their patients. Wood et al. also found that the ischaemic changes persisted for several minutes after the exercise had stopped; sometimes, fresh ischxmic changes (particularly T-wave inversion) appeared during the first few minutes of rest. The Philadelphia group, using the radioelectrocardiograph, obtained somewhat different results: they found electrocardiographic abnormalities during exercise in 37 (53%) of their 70 patients, while only 24 (34%) showed ischaemic changes immediately after exertion. The difference between the British and American findings may ’well reflect difference in techniques.12 The usual British test consists of maximal exertion, under close supervision by the doctor, until the patient is moderately dyspnoeic or feels the first twinge of angina. In America the patient Raynor, R. B., Ross, G. ibid. 1960, 17, 1055. Wilson, G., Riggs, H. E., Rupp, C. ibid. 1954, 11, 128. Tomlinson, B. E. J. clin. Path. 1959, 12, 391. Connell, A. M., Rowlands, E. N. Gut, 1960, 1, 226. Bellet, S., Eliakim, M., Deliyiannis, S., La Van, D. Circulation, 1962, 25, 5. Bellet, S., Eliakim, M., Deliyiannis, S., Figallo, E. M. ibid. p. 686. 11. Wood, P., McGregor, M., Madison, O., Whittaker, W. Brit. heart J. 1950, 12, 363. 12. Lancet, 1961, ii, 354. 6. 7. 8. 9. 10.
standard amount of exercise on a stepladder, the amount being determined by his age and body-build. The British test, more effective in the diagnosis of angina, is safe if carefully supervised and if those patients who show electrocardiographic abnormalities at rest are excluded. The radioelectrocardiograph should prove a useful research tool in assessing electrocardiographic changes during exertion. In the routine diagnosis of angina, however, a standard electrocardiograph is at least as effective when an exercise test is adequately and carefully performed.
LIFE FOR AFRICA
THE African Medical and Research Foundation (in association with the Flying Doctor Services of Africa and the Oxford Committee for Famine Relief) is launching a special appeal for funds to support its work over the next five years. The target is E2 million. Some of the work of the Foundation was described in London last week. The chairman of the appeal committee, Viscount Hambleden,
explained that the chief aim was to supplement and complement the medical services otherwise provided in East Africa. At present, practical work is done from a in Nairobi while boards in London and New York organise resources. The Foundation’s medical consultants include Sir John Boyd, F.R.S., Prof. Alexander Haddow, F.R.S., Prof. Hedley Atkins, Prof. George Macdonald, Prof. M. L. Rosenheim, Mr. H. J. Seddon, and Sir Brian Windeyer. The chairman of the British board, Sir Miles Clifford, told how the whole project began in 1957 when the late Sir Archibald Mclndoe and Dr. Thomas Rees visited Africa and were deeply impressed by the need to expand existing medical and health services. This Foundation, inspired by them, has now been at work for two years, and Mr. Ntiro, deputy High Commissioner for Tanganyika, spoke of the magnitude of the task it had undertaken. The Foundation, with limited personnel, is trying to provide specialist services over vast tracts of country. Emphasis therefore rests on improving communications and on practising " mobile " medicine. Already, one aeroplane has been equipped to carry doctors to outlying areas on special emergency missions, or to bring in seriously ill patients for treatment. Further, doctors and hospitals in remote areas are to be linked with the Foundation’s centre in Nairobi by radiotelephone so that calls for help need no longer depend on the present erratic communications. The Foundation has also set up mobile clinics (finding both staff and equipment) to tour remote areas; these provide treatment, and also instruct in matters of health. Medical fellowships have been established in Nairobi to attract specialists. On the research side, the Foundation has been promoting study of cancer in East Africa and of the possible aetiological roles of race, diet, and environment. At present there is no provision for radiotherapy in East Africa, but the Foundation plans to set up a centre to fill this gap in treatment. Besides this, future plans are concentrated on the expansion of health education and preventive medicine, the training of local personnel, and field research to assess disease patterns and the true needs of the country. Funds are urgently needed if these plans are to be realised. Contributions can be sent to: African Medical and Research Foundation, Strand House, Portugal Street,