Voluntary Subscription. Moreover, They Antenatal Screening for Syphilis Must Continue

expense and have acceptably low revenue implications. Disturbances of cardiac rhythm are common in general practice,68 and Shaper was able to show electrocardiographic evidence of ischaemic heart disease in 15% of a large sample of men aged 40-59.9 Perhaps most tellingly, home care of patients with acute myocardial infarction cannot be contemplated without establishing the diagnosis. More recent entrants to general practice have some familiarity with electrocardiography; and there are specific courses in interpreting electrocardiograms and an increasing volume of educational material. There are also semiautomatic "intelligent" instruments with inbuilt interpretation and reporting. Though it is true that thrombolytic treatment has abolished the days of the leisurely diagnostic process based on serial electrocardiograms and measurements of enzyme concentrations, Gordon's group in Scotland achieved an impressive diagnostic accuracy based on electrocardiographic evidence before starting streptokinase treatment at home or in a general practitioner hospital. 11)-13 At Chequers in 1936 Evans's diagnosis produced immediate anxiolysis, and subsequent events proved his prognosis to be correct. The increase in ischaemic heart disease since then, coupled with our increased understanding of the pathophysiology of heart disease, should strengthen our resolve to improve the use of electrocardiography in general practice. All general practitioners should aspire to own and be able to use an electrocardiograph. ARWYN DAVIES General Practitioner, Ruperra House, Bredon, Powys LD3 7AA