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physical treatment is more fully recognised than inthis country, the number of cases of marked scoliosisis comparatively rare and severe cases still rarer.

It is impossible to judge as yet whether this is thetriumph and vindication of preventive treatment ornot, but the presumption is that we, in this country,lag behind. This is not due to lack of effort, but thediscussion showed that much of this effort is mis-directed. At the conclusion of the discussion it wasproposed, from the chair, that the Council of theSociety of Massage and Medical Gymnastics beapproached to form a committee to discuss the wholesubject with representative medical men. Thisconference will be charged to estimate what is goodand what is bad in our present management of thesecases ; what physical treatment can accomplish as acurative, palliative, or preventive agency; how

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much of the training of the medical gymnast is faulty,both from the view of excess and omission; andwhat can be done to secure better cooperation betweenmedical men and the gymnasts to whom they deputetheir treatment. It is to be hoped that represen-tatives of the Ling Association may also be invited tojoin in this conference, which, if successful, shouldprove of high value. _____

KING EDWARD VII. SANATORIUM, MIDHURST.THIS sanatorium was founded by H.M. King

Edward VII. in 1903, with funds provided by the lateSir Ernest Cassel, part of which were reserved forendowment. It was built expressly for educatedpersons of limited means who are suffering frompulmonary tuberculosis in an early stage. TheCouncil, we are informed, believe that there are manyindividuals in the above class who do not availthemselves of the benefits of the institution, becausetheir medical advisers are not aware of the uniqueadvantages which it presents ; and it is felt to bevery desirable to enlist the cooperation of such prac-titioners, whose knowledge of their patients will enablethem to select the person3 socially as well as physicallysuitable for admission. The advantages of site, environ-ment, building, and equipment of the sanatorium,which is placed in one of the loveliest parts of Sussex,are probably well known to our readers. The medicalattendance and nursing organisation is thorough andefficient for an establishment of 104 beds. It consistsof a medical superintendent, two assistant medicalofficers, a pathologist, and a visiting dental surgeon,while the institution is supervised by a consultingstaff of London physicians, who visit it with regularity.Our readers should also note that a report of thecondition of each patient on admission and on dischargeis sent to the medical man concerned in the case, whoalso receives the annual report of the work of theinstitution. The inclusive charge for maintenance andtreatment is at present 4t guineas weekly. Applica-tion for admission should be made to the MedicalSuperintendent, King Edward VII. Sanatorium, Mid-hurst, Sussex, who will forward all particulars.

THE WASSERMANN TEST IN GENERALPRACTICE.

To what extent are modern laboratory tests madeuse of in general practice ? Much depends on thescientific keenness of the practitioner. We imaginethat in almost every case of suspected phthisis a

specimen of sputum is subjected to a bacteriologicalexamination, either by the practitioner himself or insome laboratory. But with that exception it isquestionable if full use is made of laboratory facilities.The statistical returns made by public laboratoriesup and down the country do not, for instance, suggestthat the general practitioner sends many specimensto be examined either for the gonococcus or thespironema of syphilis. It may be, of course, that,with centralisation of treatment in the free venerealclinics, the general practitioner is seeing less and lessof these diseases, and therefore does not need labora-tory aid for their diagnosis. But he must comeacross many cases of obscure disease in which an

examination of the blood by the Wassermann testwould be of assistance in helping him to a diagnosis.While it cannot be too often emphasised that a positiveresult from the Wassermann test does not necessarilvmean that the immediate affection from which a,patient is suffering must be syphilitic-the result ofthe test must be weighed carefully along with all theclinical symptoms and the details of the patient’shistory-nevertheless the result of the Wassermanntest may be the determining factor in leading thepractitioner to a correct conclusion.

These remarks are suggested by an interestingarticle in the January number of the EdinburghMedical Journal by Dr. Arthur Mills, of Dundee, onthe Wassermann Test in General Practice. Dr. Millspoints out a fact that is daily becoming more and moreappreciated by all hospital surgeons-viz., that a

child may be suffering from hereditary syphiliswithout exhibiting any of the classical stigmata ofthat disease. He further shows that inheritedsyphilis may manifest itself in a variety of conditionswhich have not been hitherto recognised as dependingupon hereditary infection, but which yield rapidly toantiluetic treatment. From his experience in generalpractice, where he seems wisely to have lost no

opportunity of having the blood of his patientssubjected to the Wassermann test whenever he deemedit necessary, he has gathered a valuable collection ofsuggestive facts. His observations indicate that allfamily physicians would be well advised to make fre-quent use of the serological examination. Its resultmay prove as valuable an aid to them as it has tohim, and enable them to decide upon a correct line oftreatment in cases where, but for the laboratory test,the precise diagnosis would have been uncertain. Theperusal of Dr. Mills’s article will repay all practitioners,and be of profit to more than one specialist.

HOLES IN THE MACULA.’ THE condition known as " hole in the macula isone of the rarer results of a blow on the eye. Occasion-ally it is found in the course of disease ; F. A.Williamson-Noble,1 making a pathological examinationof an eye excised for absolute glaucoma secondary to-thrombosis of the central vein, has found this con-dition. A cyst had been formed at the macula betweenretina and choroid and the retinal layers overlying this.cyst had completely atrophied. The condition was,attributed to a toxic influence acting on the macularchoroidal capillaries and causing oedema. Then,according to Williamson-Noble, the fluid diffuses intothe potential space between the rods and cones andthe pigment epithelium, preventing the access ofnutrient materials from the chorio-capillaris, so thatthe superjacent retina degenerates and forms a hole.Can traumatic cases be similarly explained ? Accord-ing to Menteith Ogilvie, who made a collection of thesecases in 1900,2 the injury is the result of " contrecoup,’the waves of force initiated by the blow on the frontof the eye meeting at the posterior pole. Williamson-Noble suggests that the effect of this may be to-cause oedema, with cyst formation and the appear-ance of a hole just as in non-traumatic cases. Aunique case is reported from China by T. M. Li, ofPekin, 3 in which not one but both eyes were similarlyaffected. The patient was a soldier of 22 and receivedthe injury when playing football, being struck fairlyin the face by the ball and made unconscious for aboutten minutes. Typical holes in each macula were found,with poor vision and relative central scotomata. Thecondition subsequently improved. The ophthalmo-scopic picture of these cases is very striking and iswell represented in the papers already quoted byOgilvie and Li. Its distinguishing feature is a roundor oval area at the macula, cherry-red in colour, as.in cases of simple retinal oedema, but, unlike these,sharply defined and on a deeper level than the adjoiningfundus.

1 British Journal of Ophthalmology, February, 1922.2 Trans. Oph. Society, vol. xx.

3 American Journal of Ophthalmology, January, 1922.