claim that later deliveries would reap the advantage of the enlarged pelvis has not been borne out by experience. Even after a strikingly successful operation and uneventful immediate recovery, the condition of the patient is not always enviable, especially in those compelled to return to their duties after a short convalescence. Thrombosis, prolapse, and sacral pain drag on indefinitely although the gait is relatively seldom disturbed. Since eighty per cent of deliveries with contracted pelves are spontaneous if left to nature, and if hebosteotomy is not performed till the child is in danger, the goal of the operation, namely, a living child, is uncertain, and the mother incurs a great risk. To insure a living child the operation should be performed early in labor. As the benefit for future labors. is uncertain, it has no advantages over Cesarean section. Cesarean section in equally skilled hands has never shown such a list of disasters. To avoid these disasters the cases have to be so carefully selected that the field for hebosteotomy must remain a narrow one, namely, multipara, with a conjugate of not less than seven and five-tenths centimeters in a flat, or eight centimeters in a generally contracted pelvis. Even in these cases Cesarean section will be considered by many to hold the field.

DERMATOLOGY.

WILLIAM FLEMING BREAKEY, M. D.

CLINICAL PROFESSOR OF DERMATOLOGY IN THE UNIVERSITY OF MICHIGAN.

JAMES FLEMING BREAKEY, M. D.

ASSISTANT IN DERMATOLOGY IN THE UNIVERSITY OF MICHIGAN.

G. K.

THE INDIA INK METHOD FOR SPIROCHETES. VOLUME LV, Number XXII, of the Journal of the American Medical Association, contains a timely article by Joseph H. Barach, entitled a "Warning Against the India Ink Method for the Spirocheta Pallida."

After calling attention to the changes in the methods of treatment in the past few years, all dependent upon the diagnosis being made upon the presence of spirochetes, he warns against insufficient or uncertain methods being used in the search for them. Various staining methods are in vogue and vary in their popularity, with the ease or difficulty of carrying them out. The India ink method became rapidly popular on account of the simplicity of the technic.

Doctor Barach discovered that the detection of spirochetes in large. numbers from specific lesions was easy. He then found similar bodies in lesions where the diagnosis was in doubt. He then examined the ink alone and found the same bodies. These are wavy fibers which were exhibited to a number of laboratory workers. All of these men agreed that the noncritical or inexperienced worker might easily mistake these wavy fibers for spirochetes.

The ink first used was Higgin's India ink, but experiments were later carried out with other inks, all of which gave forms easily confused with spirochetes, cocci, streptococci, and bacilli.

A culture of Higgin's ink after seveny-two hours was negative.

J. F. B.

MEDICAL NEWS.

THE PASSING OF A DISTINGUISHED PHYSICIAN.

THE American medical profession certainly suffered a great loss by the death of Doctor Aloysius O. J. Kelly, which occurred in Philadelphia some time ago. While only forty-one at the time of his passing, deceased

had rendered valuable service to medicine in various capacities. He was born in the City of Brotherly Love on June 13, 1870, and concluded his earthly career on February 23, 1911. At the age of twenty-one he

graduated from the medical department of the University of Pennsylvania, and after serving awhile as interne at Saint Agnes' Hospital, he pursued further study at London, Dublin, and Vienna. On his return to Philadelphia he became successively physician to Saint Agnes' Hospital; pathologist to the German Hospital; instructor in physical diagnosis in the University of Pennsylvania, and later instructor in clinical medicine, while still later came the promotion to assistant professor of clinical medicine in the same institution. The Woman's Medical College of Pennsylvania elected him to the clinical professorship of pathology in 1897. He also held the chair of theory and practice of medicine in the University of Vermont. Doctor Kelly was not only a physician and teacher but earned the title of literateur as well, having contributed much to the literary side of medicine. He was author of a "Practice of Medicine;" coeditor with Doctor Musser of a "System of Therapeutics;" editor for a number of years of "International Clinics;" and since 1906 occupied the tripod. of the American Journal of the Medical Sciences.

RECENT PUBLICATIONS.

REVIEWS.

DISEASES OF THE BONES AND JOINTS.*

THESE clinical studies are of absorbing interest and merit careful reading and thoughtful consideration. A chapter of more than thirty pages is required for the description of methods of physical examination in joint disease and is one of the noteworthy features of the book. Numerous clear, carefully described figures and illustrative cases contribute greatly to the effectiveness of the work. Special chapters are devoted to the operative treatment of joint tuberculosis, to the operative technic and mechanical treatment of tuberculous and chronic nontuberculous joint disease and to the use of plaster of Paris in orthopedic surgery.

N. N. W.

*By Joel E. Goldthwaite, Charles F. Painter, and Robert B. Osgood. Cloth; 683 pages, with 287 figures. Published by W. M. Leonard, Boston.

SURGICAL ANATOMY.*

THE title of this work is a faithful index of its character and value. As a practical anatomist and surgeon, the author fully appreciates the importance of the correlation of anatomic facts and has brought together in this book a digest of available data in a way both acceptable and calculated to develop the "anatomic mind." It is by no means a textbook of anatomy but rather a commentary and withal so comprehensive that no portion of the human body is neglected. It is confidently recommended to the thorough anatomist and surgeon as an efficient aid. F. B. W.

*By William Francis Campbell, M. D., Professor of Anatomy at the Long Island College Hospital. Second edition revised. Octavo of 675 pages, with 319 original illustrations. Cloth, $5.00 net; half morocco, $6.50 net. Philadelphia and London: W. B. Saunders Company, 1911.

CAMPHORIC ACID AND ITS RELATION TO THE NIGHT SWEATS OF TUBERCULOSIS.*

GEORGE B. ROTH, M. D.

INSTRUCTOR IN PHARMACOLOGY AND THERAPEUTICS IN THE UNIVERSITY OF MICHIGAN.

THE use of camphoric acid in the treatment of the night sweats of tuberculosis dates back to the researches of Fürbringer and Wittkowski several decades ago. Immediately following their announcement that it possessed antihydrotic properties many clinicians investigated it and found. it to be one of the most useful drugs in combating this symptom.

Chemically camphoric acid is the oxide of camphor and by some authorities is said to have an action similar to that of its parent substance. By others it is believed to further possess a paralyzing action on the nerve terminations in the sweat glands. Adherents of the former view support the idea that the sweats of phthisis are asphyxial in origin being due to a depression of the respiratory center. Therefore any drug which stimulates this center will be effective in stopping the sweats.

The more recent clinical and experimental work on this drug would seem to throw considerable doubt upon its supposed physiologic action.

Experimentally the work has been meager. The first work of this kind was done by Wagener who concluded that the action was similar to that of camphor. Stockman found in addition that it paralyzed the nerves to the sweat glands. Dreesman duplicated the work of Stockman and came to opposite conclusions.

The experimental researches of Fugitani and Tyrode which were carried out within the last few years were more extensive than any previously reported. Fugitani, using the sodium salt, produced a gradual depression in frogs, and in mammals an increase in respiration and a rise in blood *Read before the Clinical Society of the University of Michigan, April 5, 1911.

pressure. He was unable to stop the sweating induced in cats by electric stimulation of the sciatics. From this he concluded that the nerve ends in the sweat glands were unaffected.

Tyrode, working independently, reported his results at about the same. time and concluded that the drug had no well marked physiologic properties other than those possessed by any salt whose ions exerted no specific effect.

In my own work the sodium salt of camphoric acid (sodium camphorate) was used throughout, being made by neutralizing the acid with sodium hydroxid or sodium carbonate. Three specimens were used, all of which were tested as to purity, and met the requirements of the "United States Pharmacopeia," eighth revision.

In the frog with doses up to .010 gram, per gram of body weight, no especial symptoms were produced other than a noticeable increase in respiration. With doses as large as .025 gram, per gram of body weight, the animals would sink into a state of general depression very quickly and in from five to forty minutes muscular twitchings would appear. In some cases tonic convulsions and an increase in reflexes were observed. The death of the animal usually followed in from one to several hours. An investigation of the depression showed it to be central. The twitchings never appeared in curarized animals and so were not muscular in origin. The effect upon the frog's heart was studied in the intact animal and upon the isolated organ perfusing it with Ringer's solution. A decrease in rate and a decline in efficiency was observed by either method when large doses or strong solutions were used but with small doses or weak solutions no changes were noticed.

When the drug was given to cats or rabbits subcutaneously in doses of 1.3 gram, per kilogram of body weight, no unusual effects were observed, but if given intravenously to rabbits a marked increase in respiration would occur about an hour and a half after its administration. Clonic convulsions would follow later but an increase in reflexes was never obtained. The pupils were very much contracted and remained so for several hours. Death occurred several days after the injection, the animal being apparently normal until the day of its death.

In order to determine whether the drug exerted a specific action upon the kidney, solutions of sodium chlorid and sodium camphorate were made isotonic with the blood and the urinary flow observed following the injection of equal amounts of each solution. The urinary flow caused by both solutions was practically identical, so any diuretic effect which the drug possesses is due entirely to salt action.

The effect upon the salivary secretion was studied in dogs by observing the flow of saliva coming from the submaxillary duct. No secretion was observed after as much as five grams of sodium camphorate.

Upon the circulation the result was in a general way the same in cats, dogs, and rabbits, producing with either small or large doses a small but constant rise in pressure, the extent of rise depending upon the depth of anesthesia. When isotonic solutions of sodium chlorid and sodium camphorate were used the extent of rise was the same, from which we