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The DHEA-S loading test was used to evaluate fetoplacental function in 105 pregnant women. The test gave 84% correct results in the 43 cases of fetoplacental deficiency. However, in the control group of 62 subjects it gave only 42% correct results. Measurement of estriol excretion in maternal urine is one of the biochemical tests routinely carried out on pregnancies at risk. The prognostic value of the test is, however, restricted by the big daily fluctuations in estriol excretion. Fluctuations of between 60% and 140% have been reported (12). In addition to the routine determination of estriol levels, the following tests are of importance for the biochemical evaluation of fetoplacental function: 15α-hydroxyestriol (7), pregnanediol (8), placen-tal lactogen (8), heat-stable alkaline phosphatase (8, 14), and finally, the test discussed in this publication, the dehydroepiandrosterone sulphate (DHEA-S) loading test (4). The present investigation evaluated the usefulness of this test in the early detection of ...

Summary It would seem like stating the obvious to draw the following conclusions. 1 The eyes are not isolated organs, but rather they are very much an integral part of the total body system physiologically and immunologically. The inherent 2-way connections are seen in the general circulatory system and the 4 exit routes of drugs from the eye — the conjunctiva, the iris, the tear and aqueous drainage systems (Holden 1973). This is significant in the context of the multi-factor-etiology (genetic, infection, hapten, cross-sensitization, acquired metabolic disorders, and the environmental elements) for the general and ocular allergies. Primary and secondary ocular allergies are but a few of the many other indicators which point to the departure from good general health of the patient. 2 In the affluent and industrial societies one of the common economic-socio-medical aspects of life is typified by the circular connection of these phenomena: the massive supply of diverse range of drugs, the medication-conscious public that demands and consumes more and more drugs, which are ‘sometimes’ unwittingly prescribed (Pennington 1973). Therefore among the many exogenous allergens both ophthalmic and systemic medicines are likely to play an increasingly dominant role either in cross sensitization or in various forms of haptens. 3 More immunologic and clinical data should be published in optometry's literature, so that the profession may be better informed on the indications for referal. The external eye, especially the conjunctiva tissue, like any other mucous membrane, is a vulnerable site for contact dermatitis. 4 The future — optometry as one of the paramedical groups involved in community health care, should not be just an independent isolated profession, but should also be involved in multiprofessional communication. The vision of team-approach to public health, with optometry playing its unique role, such as early detection of ocular and some systemic pathologies, has been convincingly presented by Smith (1971). If Smith's enlightened ideal of mainstream public health prevails, optometry has no need to adopt a defensive attitude about being a relatively young profession; and — in theory — I see no reason why the older health professions should be hypersensitive about co-operating and communicating with optometry in the interest of the people and the society.

A new diagnostic instrument that can potentially affect the lives of hundreds of thousands of people has resulted from a collaboration among physicians, physicists, engineers and mathematicians. This article is the case history of the interdisciplinary study which culminated in the development of the urinary drop spectrometer, a painless instrument, now in clinical use, for the early detection of lower‐urinary‐tract abnormalities. As the name implies, this instrument analyzes the spectrum of drops into which the urinary stream breaks up. As the drop spectra carry a “memory” of the passage the fluid has traversed, their statistics may be used to map the delicate tubes of the urinary system. Figure 1 shows how the output of the spectrometer clearly distinguished output from patients suffering from two different disease conditions from each other and from that of a normal individual. We will see how these clearly distinguishable differences arise, and how they form the basis for medical diagnosis.

From 1965 to 1972 an annual detection screening program was carried out, as part of the Donolo Hospital Early Detection Clinic, on the over-35-year-old members of a stable agricultural population (kibbutz). The screened individuals were of equal socioeconomic status with excellent medical services. During this period 6859 examinations were carried out. The program covered all the physically accessible sites (no laboratory assistance), and the examinations took place in the medical centers of the settlements. All adults were examined at least once with the overall coverage being 58.7%. There were 103 cancer cases found over the eight year period, both by screening and the ordinary medical care service. This gave an approximate incidence 2.2 malignancies/1000 of all ages and 6.1/1000 adults aged 35 and over. The common cancers were of the skin, breast, and prostate while 70% of all cancers over the eight year period were in sites accessible to a simple clinical screening examination. It is stressed that a screening program should be an integral part of the medical care services round the primary or family physician.

The pneumoconioses develop as a result of deposition of dust in the alveoli and respiratory bronchioles. The harmful effects of the offending particles to begin with are limited to the lung parenchyma and small airways. Detection of functional impairment in the distal airways of the lung is technically difficult, and the usual tests of ventilatory capacity, that is estimation of airways resistance and the various derivatives of the forced expiratory volume manoeuvre, are of limited use for this. Several techniques have recently been introduced which it is claimed measure disturbed function in the small airways. At present, and despite the claims made on their behalf, the role of these newer techniques in the early detection of pneumoconioses and naturally occurring disease remains uncertain. The final verdict must await the results of long-term epidemiological studies.

Malignant hyperthermia is a pharmacogenetic disorder initiated by exposure to a variety of anesthetic agents. The reaction has assumed major importance to the otolaryngologic surgeon because: 1. approximately 20 percent of all reported reactions have occurred during anesthesia for ENT surgical procedures; 2. the disorder is being reported with increasing frequency; and 3. mortality associated with the reaction is greater than 60 percent. Susceptible patients appear to have a disorder of muscle, but because genetic penetrance and expression are limited, manifestations are often mild, and physical manifestations variably present. The authors suggest an approach leading to early detection of the susceptible patient.

Eighteen Peruvian children with protein-calorie malnutrition were studied to evaluate the usefulness of the limulus assay for endotoxin in detecting gram-negative sepsis. Nine of the children had at least one positive Limulus assay, and eight of this group had bacteriologic cultures indicative of gram-negative infection. Four of these nine children with positive Limulus assays died, whereas only one of the nine children with negative assays died. This preliminary study suggests the usefulness of the Limulus assay as an adjunct to bacteriologic cultures in the early detection of significant gram-negative infection in severely malnourished children.

This study was performed to establish a method for the early detection of hard—of—hearing children, using high—risk criteria. It was performed on children born in Gothenburg in 1970. 362 children were examined thoroughly because of the presence of a high risk history or suspicion of deafness. 10 hard—of—hearing children were found by the end of May 1973 (0.16%). One of the two maternity hospitals used a fixed routine with a written list of high risk criteria, as the basis for audiological examination. All hard—of—hearing children born at that clinic were diagnosed at the age of 9 months. The other clinic made an evaluation in each case, and 3 of the hard—of—hearing children were not diagnosed until the age of 22–33 months of age. All of these 3 children had a severe hearing loss. Nine of the 10 children with a hearing loss had one or more of the high risk criteria listed in Table II. This investigation indicates that by using high risk criteria it is possible to make an early diagnosis of deafness, but on...

Pure tone audiometry is the most widely used method of screening for hearing disorders in children. Unfortunately it does have a number of drawbacks that markedly diminish its utility especially when employed in testing young children with mild conductive losses. Secretory otitis is undoubtedly the commonest cause of such hearing losses and there is growing evidence that it may cause educational retardation. It is suggested that screening with an acoustic impedance instrument would facilitate the early detection of mild conductive hearing loss, and coupled with a simple pure tone screen would improve the efficiency of auditory screening.

Among the various efforts of the National Institute of Mental Health to utilize available manpower in the early detection and treatment of people with emotional disorder is the development of postgraduate educational programs for nonpsychiatrist physicians. In 1955 the first JAMA issue devoted to annual continuing education programs listed a total of 31 psychiatry courses available to nonpsychiatrist physicians in the United States. 1 Each subsequent annual issue has indicated that the number of psychiatry courses offered has exceeded the number offered by any other specialty, until 1970 when internal medicine closed the gap on psychiatry. 2 In its peak year, 1969, psychiatry offered 263 continuing education courses for nonpsychiatrist physicians, most of which were NIMH-supported. 3 The authors' own program is entering its 12th year. It extends into central and southern California as well as Arizona and lists 413 enrollees receiving almost 10,000 total instructional hours yearly. The trends in our own program may be applicable to newly emerging ones, and our experience should be of benefit to those program directors seeking some guidelines in overall planning, implementation, and evaluation.

Summary In a prospective study of 18 trauma cases we found that the fat embolism syndrome developed in eight (according to biochemical evidence), although only three of these patients showed clinical symptoms. Biochemical signs of fat embolism include disturbances in the clotting factors; fat excretion; changes in fat metabolism, and hypoxemia. The presence of any of these signs should alert the surgeon to the possibility of fat embolism and we recommend routine screening of all severely traumatized patients by hematologic tests, lipids investigation, blood gas measurements, as well as roentgenographic examination.

Cochcrane, G. M., Prieto, F., Hickey, B., Benatar, S. R., and Clark, T. J. H. Thorax , 29 , 389-393. Early diagnosis of airways obstruction. Three simple tests, maximum expiratory flow volume curve, maximum expiratory volume time curve and `closing volume9, were used to detect early airways obstruction in 21 smokers. A high proportion had abnormal values for MEF 75% , MEF 50% , and FET (86%, 71%, and 62% respectively) with a relatively normal FEV 1 . There was a good correlation between tests of small airways obstruction obtained from the forced expiratory manoeuvre. The measurement of `closing volume9 (phase 4/VC%) was less satisfactory as there were difficulties with interpretation of the records in half of the studies. We conclude that the forced expiratory manoeuvre can be used to detect early airways obstruction as well as providing FEV 1 and vital capacity. The importance of early diagnosis of airways obstruction is not yet clear and further information is required about its natural history, and its relation to smoking habits and to the more advanced and less reversible stages of airways obstruction. It may be possible to use early detection to prevent the development of disabling chronic obstructive bronchitis.

The increase in the number of children attending preschools or day care centers has provided an opportunity for early detection of emotional problems. However, few screening instruments have been standardized for children in this age group. A modification of Rutter's Children's Behaviour Questionnaire was standardized on a sample of 496 normal and 102 disturbed preschool children. The modified questionnaire (renamed the Preschool Behavior Questionnaire) was found to possess criterion validity and high interrater and test-retest reliabilities. Three factors were extracted and were labeled Hostile-Aggressive, Anxious-Fearful, and HyperactiveDistractible. The data indicated that the Preschool Behavior Questionnaire may be valuable in either clinical or research settings for the first step in early detection of emotional problems.

Congenital malformations are a leading cause of infant mortality and childhood morbidity1' 2 and their prevention is a major goal of child health specialists throughout the world. The recognition and investigation of an increase in the incidence of anomalies among newborns can be an important key to the determination of causes which may be amenable to preventive measures. As noted by Ingalls and Klingberg3 and Kallen and Winberg,4 the early detection of an increase in phocomelia could have greatly reduced the extent of the thalidomide tragedy in the early 1960s. In the United States the only routinely available information regarding the incidence of anomalies among newboms are the rates derived from birth certificates.

A group of 2684 women, selected as being at higher than average risk of breast cancer, has been screened by clinical examination, thermography, and mammography. The pickup rate for preclinical breast cancer is 19.3 per 1000. False positive and false negative rates are discussed. Cancer 33:1671–1679, 1974.

Herpes zoster and carcinoembryonic antigen serum analysis are of possible clinical value in the early detection of malignant neoplasia. The appearance of herpes zoster and a high serum level of carcinoembryonic antigen indicate immunologic alterations accompanying malignant neoplasia. An interesting case is presented in which the patient with herpes zoster and a positive carcinoembryonic antigen serum analysis eventually died of disseminated malignant disease.

We studied gas exchange in 19 children with cystic fibrosis in whom measurement of lung volumes, flow rates and airway conductance, diffusing capacity and mixing efficiency were normal. A significant decrease in arterial oxygen tension was found together with a significant increase in alveolar-arterial difference for oxygen and physiologic dead space/tidal volume ratio. These findings are consistent with evidence that early in cystic fibrosis the site of obstruction is in the small airways. It is also suggested from these data that blood gas abnormalities occur before other parameters of lung function become abnormal.

Utilizing the MEFR 25-75 and a clinical diagnosis as the standard for comparison, a 90 per cent level of sensitivity was achieved for the diagnosis of the obstructive ventilatory syndrome in men between 30 and 65 years of age. This measurement was obtained with the McKesson Vitalor in the homes of randomly selected subjects. The initial false positive rate of 45 per cent was reduced to 14 per cent by a validation examination using the same instrument without reducing the true positive rate. The McKesson Vitalor seemed suitable for a screening spirometric examination. Based on clinic studies, the best criteria for identifying patients with mild chronic obstructive ventilatory disease were: MEFR 25-75 less than 2.0 liters/second FEV 3 less than 90 per cent of FVC MEFR 75 less than 0.60 liters/second FEV 1 less than 70 per cent of FVC Other useful criteria were x-ray evidence of hyperinflation and any two of the following respiratory symptoms: shortness of breath, cough, production of sputum, or wheezing. A population survey for the prevalence of obstructive ventilatory disease should include a measurement of the forced expirogram (MEFR 25-75 ). A brief history and chest radiographs are desirable. Such a survey should include facilities for validation of "abnormal" field measurements and for evaluation of survey results. A group of men screened as abnormal can be expected to consist mainly of smokers who have a significant prevalence of cardiovascular disease.

The stresses unique to military retirement are described as a growing medical and social problem. in anticipation of or following retirement from the service, the retiree may develop psychiatric symptoms or experience an exacerbation of previously resolved medical problems. The authors stress the importance of early detection and treatment of retirement maladjustment.

Early roentgenologic recognition of left atrial enlargement is desirable, as diagnosis may depend upon this knowledge. Enlargement of the left atrium is an almost constant finding in disease of the mitral valve. This cham.ber may be the only one affected, at least at the early stages of this valvular lesion. Sosman considered dilatation of the left atrium as an indication of mitral stenosis even in the absence of typical auscultatory findings. The cardiac configuration in rheumatic mitral stenosis is, as a rule, sufficiently distinct in conventional roentgenograms to suggest the diagnosis. In the early stages of mitral valvular disease, however, the size and contour of the heart may appear normal on the postero-anterior roentgenogram, as the enlargement of the left atrium maybe hidden in the cardiac shadow. On the other hand, as Roesler points out, the term “mitral configuration” is purely descriptive and does not necessarily indicate that the mitral valves are affected. Such a configuration is seen physi...

Dr. James R. Marquis, Director of Pediatric Radiology at Children's Hospital of Newark, reviewed all of the films. R E F E R E N C E S 1. Berenberg, W., and Kevy, S.: Acute epiglottitis in childhood, N. EngL J. Med. 258: 870, 1958. 2. Rapkin, R. H. : Acute epiglottitis: Pitfalls in diagnosis and management, Clin. Pediatr. 10: 312, 1971. 3. Poole, C. A., and Altman, D. H.: Acute epiglottitis in children, Radiology 80: 798, 1963. 4. Baxter, J. D.: Acute epiglottitis in children, Laryngoscope 77: 1358, 1967. 5. Jones, H. M.: Acute epiglottitis and supraglottitis, J. Laryngol. Otol. 73: 932, 1958. 6. I-tolinger, P. H., and Johnston, K. C.: Factors responsible for laryngeal obstruction in infants, J. A. M. A. 143: 1229, 1950. 7. Dunbar, J. S.: Epiglottitis and croup, J. Can. Assoc. Radiol. 12: 86, 1961. 8. Rabe, E. F.: Acute inflammatory disorders of the larynx and taryngotracheal area, Pedlar. Clin. North Am. 4: 169, 1957.

1. The scope of the problem of the diagnosis of coronary artery disease is discussed. 2. The value and limitations of routine electrocardiography is outlined. 3. The Master “2-step” exercise test is described and the diagnostic value is stressed. 4. The ballistocardiogram is presented as a valuable means for early detection of coronary disease.

SummaryResults of treatment of bacterial endocarditis in the period from 1966 to 1972 are compared with previously reported results from the same institution for earlier time periods. The main differences between these two series was the greater emphasis on early detection and laboratory studies during treatment in the later period. Also, the development of cardiac surgery has led to the appearance of a great number of cases of infectious endocarditis in operated patients. Although the increased attention for the problems of infectious endocarditis was accompanied by a significant decrease in the mortality of patients which had not undergone cardiac surgery, the mortality in patients who have been operated remained frightful. In this latter series, the length of time which elasped between the operation and the development of endocarditis suggested that the infection did not occur at the time of operation in the greatest number of cases.

1. The results of the first 10 years of operation of a tuberculosis control program among patients in the institutions of the New York State Department of Mental Hygiene are reported. 2. This program consists fundamentally of the early detection and early segregation and treatment of cases of tuberculosis. 3. There has been a considerable decrease in morbidity and mortality from tuberculosis during the 10 years covered by this report, but the rates in the mental institution population are still higher than in the general population of the state.

In the previous papers, the oxidation mechanism of oxyhaemoglobin by sodium nitrite and the effects of various substances on the oxidizing reaction were investiga-ted. In the present paper, the effect of phenylhydrazine on the oxidation of oxy-haemoglobin was studied parallel with the haematological change. In the poisoned rabbits, the decrease of the red blood cells and the formation of Heinz-bodies were observed. At the same time, the oxidation rate of oxyhaemoglobin prepared from the poisoned rabbits was found to be notably reduced with increasing dose of the poison. The change of the oxidation rate was further ascertained by the experiments in vitro, although there were some differences between the results in vivo and in vitro.The measurement of the oxidation rate of oxyhaemoglobin prepared from the blood of animals exposed to poisonous substances, which cause the blood changes, seems to be useful for the early detection of the poisoning.

MAss SCREENING techniques like Mass Radiography and the School Health Service have been part of the social scene for many years, and it has not until recently beez~ suggested that screening might be potentially harmful by leading to a neurotic preoccupation with health matters. With the increasing use of these tcc, hniques and their application to an everwidening range of disorders and to an ever-enlarging population, it has been suggested by some that we may be doing psychological harm which outweighs any good which early detection of diseases may bring.

Customarily, differential diagnosis of congenital heart defects consists of correlating symptoms and signs with radiographic and electrocardiographic findings which belong to one isolated defect more than another. This approach, while academically interesting to the physician infrequently involved in cardiac problems, has proved to be unhelpful either in early detection of heart disease in the infant or in better management, once recognized. The approach presented in this review has intentionally avoided reference to specific anomalies in order to place emphasis where it is obviously needed— on functional assessment of the cardiovascular system rather than on clinical diagnosis of the anatomical defect. The plan of evaluation, if effective, would reduce prompt referral to a cardiac center of the healthy infant with a benign heart defect just as much as it would promote early referral of the infant with a morbid form of heart disease. The infant with heart disease has been featured since his problems are greater in number and complexity and because his nonverbalized complaints of cardiorespiratory distress are so frequently misinterpreted. The roles and competence of the several physicians who will be responsible for the infant with heart disease have been candidly discussed, since each has his function and his limitations in the total cardiovascular assessment. The first physician who sees the infant and is accountable for his overall care, has the most exacting assignment. It is for him that this plan is proposed, and it is to him that this article is very respectfully dedicated.

This commentary proposes that budding tumor cell projections from focally disrupted tumor capsules represent a most effective target for early detection and intervention of prostate tumor invasion. The rationale, supporting data, and clinical applications of the hypothesis are discussed.

47 high-achieving college students and 47 college dropouts were compared on the 24-item MMPI Underachievement Scale. The high achievers' mean score of 8.00 differed significantly ( p < .001) from the low achievers' mean score of 13.44. Probabilities of academic achievement level and score on the Underachievement Scale suggest that the scale may be useful in early detection of academic low achievement.

EXTENSIVE tiiscussions of chemodectomas reveal some unansweret! questions concerning their tliagnosis and treatment. The characteristic slow growth of these tumors, and their anatomic location adjacent to critical structures, result in surgical difficulties anti considerable morbidity. There are however, relatively’ few references, stressing the importance of angiography and tomography in the t!etection and evaluation of these uncommon tumors.

Unilateral hilar enlargement is often the first manifestation of primary carcinoma of the lung. Theoretically, it might be possible to establish certain criteria of measurement to differentiate the normal from the pathologically enlarged hilus. This study was undertaken to evaluate the usefulness of previously established criteria of hilar measurement in the detection of lung cancer. In a systematic review of the early roentgenograms of 50 cases of carcinoma of the lung, fortuitously made before the development of symptoms, Rigler, O'Lough-lin, and Tucker reported that the first roentgen evidence of tumor was unilateral hilar enlargement, a finding present in half of their cases at this early stage. Because this sign was frequently overlooked, they undertook to develop a method of measuring the transverse dimension of the hilar shadows, in an effort to improve the early detection of primary lung cancers by roentgen examination. They established the medial border of each hilus by drawing a vertical midthor...

In order to compare the plasma amino acid ratio recommended by Whitehead plasma tyrosine and valine levels and the Phe/Tyr ratio with those of healthy children, 24 subjects of 2-4 years old from 3 districts in Iwate Prefecture were selected. The children in these districts were in a sub-optimal state of protein nutrition as is evident from their detardation of growth, especially in Iwaizumi district where more than 15% were below the Japanese standard in body weight. A correlation between those estimations and the change in body weight was observed. The average amino acid ratio in Iwaizumi showed 2.1, whereas in case of healthy children the ratio was 1.7 in average and in the other 2 districts remarkable differences were not observed from that of healthy children.The amino acid ratio was found to be related to the change in body weight, with a coefficient of -0.75 while the Phe/Tyr ratio and valine content in plasma were somewhat less well correlated with the change in body weight, whereas the tyrosine content of the plasma was only slightly correlated.The results show that Whitehead's method is simple and widely applicable in field work and may be useful for the early detection of sub-clinical protein deficiency.

THE recent interest in metabolic screening in the newborn period stems from the belief that early detection of certain hereditary metabolic diseases provides the best opportunity to initiate treatment. It has been implied generally that identification of an aberrant biochemical phenotype is synonymous with disease; treatment ought, therefore, to be initiated to restore the normal phenotype in order to prevent harm to the patient. A practical application of this philosophy emerged in the case of phenylketonuria; a nation-wide alert to prevent mental retardation provided fertile ground for "phenylketonuria" screening programs to take root and appear abruptly in the mainstream of medical care. Many state legislatures were convinced that eradication of any cause of mental retardation was an important venture; thus, enabling or compulsory legislation was passed to achieve this end. How to interpret the "positive screening test" and how to divine its true significance has, therefore, become a problem which could face any pediatrician at any time in North America today. A recent editorial in Pediatrics commenting on neonatal screening programs noted that they may bring both good and harm. An accompanying article described the vicissitudes which beset several investigators of neonatal tyrosinemia. Early impressions suggested that infants would benefit from treatment of their tyrosinemia; however, the need for treatment in most infants with tyrosinemia was not substantiated after more detailed investigations had been performed. It is easy to see how harm might have been done in terms of quite unnecessary treatment for neonatal tyrosinemia, although at one point it seemed that it might be good to screen all infants for neonatal tyrosinemia.

In 500 Proben wurde die G-6-P-DH- und teilweise die 6-PG-DH-Aktivitat im Vaginalsekret untersucht. Die durchschnittliche Enzymaktivitat (Extinktion) gemessen anhand der Reaktion TPN→TPNH betrug bei gynakologisch Gesunden 0,0014, und der Normalbereich lag zwischen 0,0005–0,0068 (¯x±2 s). Einfrieren und Wiederauftauen der Sekretproben bewirkte einen Verlust der Enzymaktivitat. Die Enzymwerte im Scheidensekret von Schwangeren lagen unter dem Normalbereich. Erhohte Enzymaktivitaten wurden nicht nur im Vaginalsekret von Carcinompatientinnen (Carcinom-Ulcus an der Portio), sondern auch in den Proben von Patientinnen mit einer eitrigen Kolpitis, Endometritis und Portioektopie gefunden. Die erhohten Fermentaktivitaten im Wundsekret von Bauchschnittwunden, im Mastitis-Eiter sowie im Sekret bei Pyosalpinx- und Douglasabscessen zeigten deutlich, das es sich hier um eine unspezifische Fermentaktivitatssteigerung handelt. Es ist einleuchtend, das auch in einem carcinomatos zerfallenden Ulcus ebenfalls die Fermentaktivitat erhoht ist. Nicht zuletzt zeigen die erhohten Enzymaktivitaten nach einer Konisation, also nach einer Wunde an der Portio vaginalis uteri, das die Bestimmung der Enzymaktivitat nicht zur Erkennung von gynakologischen Krebserkrankungen geeignet ist.

Das 2 Std-Umwandlungsverhaltnis (conversion ratio) erganzt die Funktionsdiagnostik mit Radiojod in wesentlichen Punkten. Man versteht hierunter das Verhaltnis zwischen dem proteingebundenen und dem gesamten Radiojod im Serum 2 Std nach Verabreichung der Testdosis.

In a former paper two of the present writers described methods for increasing the diagnostic sensitivity of perimetry with the form field stimulus. It was pointed out that the methods described should be especially effective and feasible in that branch of field study that is commonly called scotometry. It is our purpose in the present paper to show with what success the methods may be used in the early detection of the Bjerrum and other scotomas. In the practice of scotometry with the form field stimulus, the means for increasing sensitivity are comparatively obvious. In order to pick up faint or incipient scotomas, it is necessary only to decrease by sufficient amount the visibility of the stimulus. The amount of increase in sensitivity that can be secured in this way clearly is limited only by the threshold of visibility. The three most important factors in the visibility of an

To the Editor:— In The Journal, Dec. 3,1960, page 1783, appears a report from the University of Minnesota Hospitals on the evaluation of annual examinations in the detection of cancer. On page 1786 (lower left) Jenson and co-workers state, "... visual inspection of the cervix, with biopsy of suspicious lesions, has proved the best means of early detection of cancer of the cervix." On page 1784 (upper left) the authors state that every woman receives a Papanicolaou smear. Can this mean that the latter method is inferior in competence, and that the expenditure of many millions of dollars in its promotion by the American Cancer Society and the U. S. Public Health Service has been ill advised?Dr. Jenson's answer to this question may be the same as my own, published first in the American Journal of Medicine (5:849 [Dec.] 1948). At that time I introduced the method of sponge