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Credit: Cardio-splanchnic phenomenon of Abrams / by Albert Abrams. Source: Wellcome Collection.
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![Haclere emt SORRESP 1348 [JUNE 3, rorr. ae ONDENCE. about infection by the Bacillus paratyphosus A (para- typhoid fever) than any one in Europe. We are hopeful that when their work is made public the present ambiguities may be removed —I am, etc., Simla, May 4th. R. H, Fiera, Col.,/R.A.M.C. THE PREVENTION OF MALARIA. Sir,—In your interesting and impartial roview (May 13th) of the Prevention of Malaria, by Professor Ross, C.B., you suggest that a school is “ arising in India” which, although ‘‘not openly hostile,” nevertheless would oppose the views advanced by that authority. Your reviewer has probably assumed that, as a\result of prolonged experience in that country, there is a tendency to adopt opinions that are not held in other parts\of the world. Deductions formed and due weight would be given them by sanitarians. from, no better practical experience than that afforded by Mian Mir, the financially starved efforts of 1904, and the outspoken criticism by Professor Ross. In the interval no practical effort has been made which would justify the medical profession in India in relying “for the country at large” solely upon quinine prophylaxis. The recent appearance of increased vitality in this policy is in reality due to the scheme by which “ The Committee for the Study of Malaria in India’”’ (they having modestly renounced the title of the Scientific Committee” with which they were formerly credited) have been endowed by the Govérnment of India with the power to ‘ direct and co-ordinate” investigations as to malatia, throughout the one and three-quarter millions of square miles of India. As this decision was communicated by the Govern. ment of India at the Antimalaria Conference in 1909, the natural inference has been that the members ‘proposed this’ autocratic method of administration, and endorsed the peculiar views of the officers already selected for the purpose. The conference was, however, given no option in the matter. Sanitary Commissioners with Local in the hands of a committee with a predetermined policy, | ‘their diplomatic skill would be weak indeed if they were not able to guide the sanitary ship in the route they would desire. But consultation with all medical representatives of Local Governments at this conference left no doubt in my mind that professional opinion in. India—as elsewhere—whilst recognizing quinine prophylaxis as a desirable adjuvant, where appropriate and practicable, would rely upon minor and major works directed towards “ mosquito reduction” as of prime importance where permanent results are desired.—I am, etc.., W. G. Kine, Colonel, I.M.§. (ret.). CARDIO-SPLANCHNIC FHENOMENON OF ABRAMS. | Sir,-—Dr. Gordon! seeks to deny the existence of this phenomenon, and he proceeds to fortify his contention by percussion of the right heart border, and the theoretic observation that the posture of the ‘heart must he influenced by gravity. The phenomenon, in brief,? is as follows: If the lower sternal region—that is, the part of the sternum con- tiguous to the heart—is first percussed in the erect posture, the sound elicited is one of resonance or hyper- resonance, but when the patient assumes the recumbent position a dullness supplants the resonance. This is the attitudinal cardio-splanchnic phenomenon. It is present in health, but absenf when the splanchnic vasomotor mechanism is defective. In describing the phenomenon the undersigned empha- sized the importance of employing palpatory percussion. The determination of the right heart border is neither a positive nor a negative evidence of this phenomenon. Per- cussion of the right heart border is difficult, and the results are often in accord with the prejudiced preconception of the observer. Again, by the time the right border is per- cussed the phenomenon has disappeared (2¢ is very limited im duration), for the reason that a vigorous right ventricle 1 British MEDICAL JOURNAL, March 25th, 1911. mmediately disposes of the augmented quantity of blood ‘which has been conveyed to it by the change in posture. The writer has sought to simplify the percussion of the i/heart by a recently described method,’ and if Dr. Gordon | will execute this method he will find decided discrepancies i Q ‘Hin his results, although the delimitation of the heart has '| absolutely no bearing on the phenomenon. | The latter fact is emphasized in my original contribution | by the following quotation : ‘ | I have endeavoured by means of the Roentgen rays to deter- ' mine whether any of the manoeuvres already suggested for pro- |, voking the cardio-splanchnic phenomenon in any way influence f de cardiac diameters, and my investigations show that they de not. ) As for the contention that the: heart must be influenced (| by gravity, my skiascopic findings to the contrary permit me to say that the situs of the heart is maintained by pulmonary suction.—I am, etc. : San Francisco, May 5th. ALBERT ABRAMS. CONGENITAL APHASIA IN CHILDREN. Sir,—The descriptions of defective children in Miss McCall's article, under the heading of “Two Cases of Congenital Aphasia in Children” (in the Journat for May 13th, p. 1105), are no doubt of interest The first case, however, is not one of aphasia, congenital or other- wise, neither is the other if the epithét of “ word-deaf- ness” applied to. it ‘is correct. are examples of defect in the receptive. centres—in one case for written and in the other for phonated words—and to such’ condi- tions the term “ aphasia,” catrying with it the significance of imperfection in some-patt of the central neuromotor apparatus for language; is quite inapplicable. Congenital aphasia is distinctly rare and is\apt to be confused with deaf-mutism by Ahe unwary ; Sas ager word-blindness, on the other hand, is a condition the existence of which even schoolteachers, who are as a ease perhaps among the most conservative and unreceptive section of the community, are beginning to realize.—I am, etc., Renfrew, May 15th. . W. J. Rournerrurp, M.D. ENUCLEATION OF THE TONSIL. S1r,—I would be glad of the opportunity of making some remarks on the discussion that took place at the last Annual Meeting on the anatomy of the tonsil. I wish to thank Dr. William Hill for remembering my papers sent to the two previous meetings, in which the claim was made that the so-called supratonsillar fossa was absolutely an, intratonsillar space. The reason for the delay in this letter is that I have been trying to find refer- rence by Mr. Seccombe Hett in the Journal of“Anatomy, in which he stated that he had drawn attention to the intratonsillar position, of the fossa. I have been unable to get access to it, but I am almost sure that it was sub- sequent to my first, if hot my second, paper, as Dr. Hill says, “no one had been \willing to give Mr. Hardie Neil the slightest support.” In act, the punishment meted out tome by Dr. D. R. Paterson very severe, but, in the light of the now universal recognitign “of the truth of my con- tention, it contained a fine cOmpliment—namely: ‘He traverses in detail views now/gekerally accepted and suf- ficiently established to hayé found their way into most modern textbooks.” A perusal of his letter (October 10th, 1908) will give a clue to the method’, by which he found “that there could be no question of its\{the supratonsillar fossa] being outside the tonsil.’ His researches could not, surely, have been done on either humah or mammalian tonsils. His denial of the existence of the capsule is simply inexplicable. However, the newer do the subject justice, and consign the statements about the supratonsillar fossa going beyond the tonsil up i soft palate and down outside the tonsil to the level of the angle of the jaw, to the oblivion suitable to them, statements, I think, retarded the proper surgery of the tonsil for years. Photomicrographs of tonsils, fetal, adult, and animal, were sent with my paper in 1908 to the Annual Meeting. Some may be seen in the Royal College of Surgeons and Melbourne University. As to the surgical anatomy of peritonsillar abscess, a 8 La presse médicale, December 14th, 1910.](https://iiif.wellcomecollection.org/image/b33449363_0002.jp2/full/800%2C/0/default.jpg)
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