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inspectors complain that they have too much to do: manyof them have to devote their Sundays to meat inspection,and until recently had no extra reward for it. To manyinspectors in rural districts where most slaughterhousesare sited it is an added grievance that their colleagues inthe towns are not allowed to give a helping hand, and therural ratepayer has some reason to grumble at having topay for the inspection of meat destined for the towns. Ontop of all this the public-health inspector has besidesmeat inspection many important duties which cannot beneglected. Until there are more inspectors, or until

slaughtering is centralised (or perhaps both), a proportionof meat in this country will not be inspected at all.

Complaints on this subject from several sources havebeen heard for some time, and the Government have nowtaken a practical step which will at any rate increase thenumber of inspectors. The Authorised Officers (MeatInspection) Regulations, 1960, made under the Foodand Drugs Act (1955), create a new type of official trainedand qualified for meat inspection only. The training willconsist of classes at technical colleges and practicalinstruction at slaughterhouses; the syllabus and examina-tion will be the responsibility of the Royal Society ofHealth. As an emergency measure this deserves a serioustrial. The obvious disadvantage is that it creates yetanother grade of official and at that an inferior one: theable or ambitious man is hardly likely to take up anoccupation which offers no vista but a long row ofcarcasses. It does not say much for the skill required formeat inspection or for its importance to public healththat it can be delegated to those unable or unwilling toqualify as public-health inspectors. There is more

promise in the concluding words which introduce thesenew regulations. The Ministers hope that this measure willresult in the inspection of all meat sold to the public,but go on to recognise that the standard of meat inspectioncould be raised and that antemortem examination of theanimal should be introduced as soon as possible.

Instead of this hand-to-mouth policy it might be wiseto look even further ahead. This is, we believe, the onlycivilised country where the veterinary surgeon plays littlepart in meat inspection and where his participation is

actively opposed by interested parties. If those respon-sible for the public health prefer rule-of-thumb diagnosisto the opinion of a man trained in pathology they mustaccept the responsibility for any accidents. (In the besthospitals necropsies are not delegated to the postmortemporter, however shrewd he may be.) Luckily we live ina country with high standards of animal health; but theannual reappearance of meat as the most importantsource of food-poisoning suggests that the theory andpractice of meat inspection might be re-examined. Ifthe antemortem examination of animals is introduced (asit should be) it is clear from the Veterinary Act that thiscan be done by a registered veterinary surgeon andno-one else. There are, at the moment, not enoughveterinary surgeons trained for this work; and, becausetheir training is a long one, now is the time to planfar ahead. Lastly it must be regretted that so muchvaluable material is wasted which might be used not onlyto fill our bellies but to increase the knowledge of

veterinary medicine. In these experimental days it is

easy to forget how much human medicine owes to themorbid anatomists, who showed that healing could befounded on something better than empiricism. Everyday all over the country thousands of carcasses are being

examined without contributing an iota to our knowledgeof veterinary pathology. To make use of some of thismaterial is more than an academic dream, because we areshamefully ignorant about such problems as the occur.rence of salmonella in seemingly healthy animals. Forthe sake of the public health and of the overworkedpublic-health inspectors we welcome these new regula-tions, but we hope that they are the first step to a morerational and efficient system of meat inspection.

STATUS ANGINOSUS

THE term " acute coronary insufficiency " is oftenapplied to increasing or recurring angina which comes onby night as well as by day, which is accompanied bypronounced RT-segment depression in the left ventricularleads of the electrocardiogram, and which often (but notinvariably) ends in cardiac infarction. This syndrome hasalso been termed occlusive 1 or preinfarction angina 2;and the use in this sense of " acute coronary insufficiency "has been criticised as inaccurate,3 particularly by Fried-berg,4 who believes it should never be used as a clinicaldiagnosis since it denotes an underlying physiologicaldisturbance which is undoubtedly chronic when caused bywidespread coronary-artery disease. Instead he recom-mends " subendocardial ischaemia or necrosis ". Pappand Shirley Smith 5 also deprecate the use of " acutecoronary insufficiency ", and prefer " status anginosus"as an accurate description of the clinical picture.They have studied 20 patients with status anginosus,

and present further evidence that the syndrome usuallyresults from widespread coronary atheroma causingsubendocardial ischaemia or infarction. All but 3 of their

patients gave a history of previous angina of effort orcardiac infarction. Yu and Stewart 6 have similarly noteda very high prevalence of antecedent angina in patientswith subendocardial infarction. Death followed status

anginosus in 9 of Papp and Shirley Smith’s patients,either suddenly soon after severe pain or as a result ofcongestive failure. Cardiac infarction developed in 10

patients after the onset of status anginosus: 3 of theserecovered and are still under observation. The 11 sur-

vivors have been followed for up to twelve years, and in 2

patients status anginosus has been present intermittentlyfor as long as seven and eight years. The characteristicelectrocardiographic change was found in 14 patients,consisting of considerable RT-segment depression in morethan two leads; this change was greatest in the lateralchest leads but was visible to a lesser extent in leads I andII and in the left-arm lead. The depressed segment wastypically square, resembling a positive response to theexercise or anoxia test, with a depth as great as 6 mm. insome cases. Although Q waves never developed as part ofthis pattern, reciprocal RT-segment elevation was con-

stantly found in the riglit-arm lead-a sign previouslydescribed by Levine and Ford in 6 cases of subendo-cardial infarction. In only 1 patient was pronounced RTdepression seen in the posterior leads-chiefly leads IIIand aVF-but in this case there was no reciprocal eleva-tion in aVR. Reversion of the electrocardiogram to

normal with improvement in the clinical picture was1. MacLean, K. S. Guy’s Hosp. Rep. 1950, 99, 1.2. Reeves, J. T., Harrison, T. R. J. chron. Dis. 1956, 4, 340.3. Scherf, D., Golbey, M. Amer. Heart J. 1954, 47, 928.4. Friedberg, C. K. Diseases of the Heart. Philadelphia, 1956.5. Papp, C., Shirley Smith, K. Brit. Heart J. 1960, 22, 259.6. Yu, P. N. G., Stewart, J. M. Amer. Heart J. 1950, 39, 862.7. Levine, H. D., Ford, R. V. Circulation, 1950, 1, 246.

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exceptional, occurring in only 2 patients: usually thechanges persisted or became worse, and if infarction

developed the typical changes were superimposed.Occasionally the picture reverted to that present beforethe development of status anginosus.The pathological findings in 3 patients confirm that the

clinical and electrocardiographic picture of status angin-osus is due to subendocardial ischasmia or actual infarction.In these 3 cases Papp and Shirley Smith found recentsubendocardial infarction, with involvement of the

papillary muscles in 2: furthermore the necrosis lay justbeneath the endocardium, affecting the inner shell of

myocardium but leaving intact a very thin layer of over-lying subendocardial muscle-a feature emphasised byFulton. How the pathological and electrocardiographicchanges arise is still uncertain. Fulton has demonstrated

by postmortem injection a dense network of anastomoticvessels in the subendocardium of patients with progressiveangina: in these cases the main coronary circulation wasdiffusely narrowed, and Fulton believes that the subendo-cardial areas are particularly vulnerable in these circum-stances, chiefly because they are farthest from the sourceof blood-supply.Horn et awl. point out that the intramural pressure

during systole may exceed the aortic pressure and so

jeopardise the nutrition of the subendocardium, where thecirculation is already reduced-a factor which may beparticularly important in hearts hypertrophied as a resultof hypertension and also affected by coronary-arterydisease. While earlier experimental observations 10 11

suggest that subendocardial injury causes RT depression inepicardial surface leads and RT elevation in direct cavityleads, Prinzmetal et al.12 have been unable to detect anyRT-segment shift using plunge electrodes inserted into thesubendocardium of dogs rendered hypotensive by bleed-ing ; but it is difficult to be sure how closely these experi-ments relate to disease in man. Levine and Ford 7

explain the characteristic RT elevation in the right-armlead by suggesting that this lead reflects the potential ofthe ventricular cavity. Whatever the mechanism, it seemsto be well established that status anginosus accompaniedby this characteristic electrocardiographic change indicatesunderlying subendocardial ischxmia or actual infarction.

THE BRITISH DIET IN 1958

THE latest report of the National Food Survey Com-mittee,13 like earlier ones,14 is based on analysis of a largenumber of log-books, each recording the food consumptionand expenditure of one household during one week. The8611 households were chosen by random selection from827 polling districts throughout the country. The resultsare presented in 67 tables with thoroughness and clarity,for which great credit is due to the secretaries of thecommittee, who have fulfilled their annual task withremarkable speed.The main conclusions are (1) that the diets of the

population as a whole are satisfactory, as judged by anyphysiological standard, and (2) that there is remarkably8. Fulton, W. F. M. Brit. Heart J. 1956, 18, 341.9. Horn, H., Field, L. E., Dack, S., Master, A. M. Amer. Heart. J. 1950,

40, 63.10. Pruitt, R. D., Valencia, F. ibid. 1948, 35, 161.11. Hellerstein, H. K., Katz, L. N. ibid. 1948, 36, 184.12. Prinzmetal, M., Goldman, A., Shubin, H., Bor, N., Wada, T. ibid.

1959, 57, 531.13. Domestic Food Consumption and Expenditure, 1958. Annual report of

the National Food Survey Committee. H.M. Stationery Office, 1960.Pp. 185. 10s.

14. See Lancet, 1958, ii, 254; 1959, ii, 798.

little difference between the food eaten by the rich andby the poor. The mean figures for consumption forhouseholds in class D (weekly income below E7 10s.) aresatisfactory, but they are based on an analysis of only1582 households (18% of the total). The report does notsay how many unsatisfactory diets are concealed in themean values, and, though the proportion of householdswhich do not get enough of the right foods is

obviously small, the absolute numbers might be quitelarge-perhaps running into tens of thousands in the

country as a whole. Since the National Food Survey isplanned to provide information not only for the Govern-ment but also for those concerned with the home marketfor food, it has to survey a sample which is a cross-sectionof the whole population and it cannot concentrate onclass D. Nevertheless many doctors and social scientistswould like to know more about class-D families; for meanfigures do not give the whole picture. Could the com-mittee next year provide a more detailed analysis of thisclass, perhaps using data obtained over several years ? Inthis report a detailed analysis of households dependenton widows and single women shows that these constitutea vulnerable group whose diet was marginal in bothprotein and calcium. This finding is a further argumentfor more detailed study of class D.

Taking all the households together, the weekly expen-diture on food was 28s. 5d. per head. In class A 1 (weeklyincome over E32 per head) it was 38s. 2d. In A 1 homes,weekly expenditures, expressed as a percentage of thenational average, were: milk 103, carcass meat 111,butter 101, margarine 104, sugar 108, fresh green vege-tables 111, other vegetables 112, fresh fruit 107. The

corresponding figures for class-D homes, whose weeklyexpenditure on food was 26s. 7d., are in no case below95. These differences are small and must represent aremarkable uniformity in the general pattern of the diet:indeed it is not clear how the wealthy spend their extra11 s. 7d. per head. An analysis of diets in relation tofamily size indicates that even families with four or morechildren somehow manage to feed them adequately.Since the figures for couples living alone with no childrenstrongly suggest that many of these are getting more foodthan they need, childless couples might be a good socialgroup in which to investigate diseases possibly arisingfrom overnutrition.

The report contains the usual list of remarkabledifferences in the food habits in different parts of the

country. Thus Londoners continue to eat large amountsof fresh fruit and vegetables, despite the high price theyhave to pay for them, while the Welsh are outstandinglythe greatest consumers of butter. The Scots buy themost shop cakes and biscuits, but home baking flourishesmost in Yorkshire and in the South West and least in the

Midlands, judging by the consumption of cooking-fat andflour. Meat consumption is high in London but low inScotland and the North Midlands. These regionaldifferences are set out at great length. It might be worthseeing whether they are correlated in any way with

regional differences in the incidence of disease, such asthe relatively high figure for deaths from ischxmic heart-disease in Scotland.

Air Vice-marshal Sir ALAN RooK, formerly of the medicalbranch of the Royal Air Force and latterly senior health officerof the University of Cambridge, died on Aug. 26.