IV. An apparatus is not essential, and ought not to be used, as, being made to fit the face, it must tend to produce a certain amount of asphyxia. Moreover, it is apt to take up part of the attention which is required elsewhere. In short, no matter how it is made it introduces an element of danger into the administration. A convenient form of inhaler is an open cone or cap with a little absorbent cotton inside at the apex.

V. At the commencement of inhalation care should be taken by not holding the cap too close over the mouth and nose, to avoid exciting struggling, or holding the breath. If struggling or holding the breath does occur, great care is necessary to avoid an overdose during the deep inspirations which follow. When quiet breathing is insured as the patient begins to go over, there is no reason why the inhaler should not be applied close to the face; and all that is then necessary is to watch the cornea and see that the respiration is not interfered with.

VI. In children, crying insures free admission of chloroform into the lungs; but as struggling and holding the breath can hardly be avoided, and one or two whiffs of chloroform may be sufficient to produce complete insensibility, they should always be allowed to inhale a little fresh air during the first deep inspiration which follows. In any struggling persons, but especially in children it is essential to remove the inhaler after the first or second deep inspiration, as enough chloroform may have been inhaled to produce deep anesthesia, and this may only appear, or may deepen, after the chloroform is stopped. Struggling is best avoided in adults by making them blow out hard after each inspiration during inhalation.

VII. The patient is, as a rule, anæsthetized and ready for the operation to be commenced when unconscious winking is no longer produced by touching the surface of the eye with the tip of the finger. The anaesthetic should never under any circumstances be pushed till the respiration stops; but when once the cornea is insensitive, the patient should be kept gently under by occasional inhalations, and not allowed to come out and renew the stage of struggling and resistance.

VIII. As a rule, no operation should be commenced until the patient is fully under the influence of the anesthetic, so as to avoid all chance of death from surgical shock or fright.

IX. The administrator should be guided as to the effect entirely by the respiration. His only object, while producing anæsthesia, is to see that the respiration is not interfered with.

X. If possible the patient's chest and abdomen should be exposed during chloroform inhalation, so that the respiratory

movements can be seen by the administrator. If anything interferes with the respiration in any way, however slightly, even if this occurs at the very commencement of the administration, if breath is held, or if there is stertor, the inhalation should be stopped until the breathing is natural again. This may sometimes create delay and inconvenience with inexperienced administrators, but experience will make any administrator so familiar with the respiratory functions under chloroform that he will in a short time know almost by intuition whether anything is going wrong, and be able to put it right without delay before any danger arises.

XI. If the breathing becomes embarrassed, the lower jaw should be pulled, or pushed from behind the angles, forward, so that the lower teeth protrude in front of the upper. This raises the epiglottis and frees the larynx. At the same time it is well to assist the respiration artificially until the embarrassment passes off.

XII. If by any accident the respiration stops, artificial respiration should be commenced at once, while an assistant lowers the head and draws forward the tongue with catchforceps, by Howard's method, assisted by compression and relaxation of the thoracic walls. Artificial respiration should be continued until there is no doubt whatever that natural respiration is completely re-established.

XIII. A small dose of morphia may be injected subcutaneously before chloroform inhalation, as it helps to keep the patient in a state of anesthesia in prolonged operations. There is nothing to show that atropine does any good in connection with the administration of chloroform, and it may do a great deal of harm.

XIV. Alcohol may be given with advantage before operations under chloroform, provided it does not cause excitement, and merely has the effect of giving a patient confidence and steadying the circulation.

The commission has no doubt whatever that, if the above rules are followed, chloroform may be given in any case requiring an operation with perfect ease and absolute safety, so as to do good without the risk of evil.

HYDERABAD, December 18, 1889.

EDWARD LAWRIE, (President.)
T. LAUDER BRUNTON,
G. BOMFORD,

RUSTOMJI D. HAKIM,

Members.

EDWARD LAWRIE, Surgeon-Major.

(True copy.)

INTERNATIONAL MEDICAL CONGRESS. The Tenth International Medical Congress assembled in Berlin on August 4th, and continued until the 9th, under the presidency of the illustrious Virchow, who made the opening address. In point of attendance this Congress far surpassed all its predecessors, having drawn together more than 6000 physicians representing nearly, or quite, every civilized country on the globeour own sending no less than 623. Some of our contemporaries have expressed the opinion that such assemblies are attended mainly by the small fry of the profession; but we are not disposed to sneer at the sky because all the stars in the firmament are not of the first magnitude, and we doubt if the history of the world can show such another concourse of illustrious names as are found on the roll of the Tenth International Congress. Even to enumerate the names of the men of eminence present-to many of whom humanity owes a debt beyond its power to repay-would occupy more space than we can at present spare. It may be true that gatherings which necessitate the employment of several languages are not well adapted to scientific discussion, but this will not affect the value of the papers presented, a large proportion of which will no doubt prove to be important additions to the general stock of professional knowledge. One great purpose of these international assemblies is to unite the medical world in the great contest with disease and death, and by this concentration of force to conquer or diminish the perils that threaten the human race.

The next Congress will be held in Rome in 1893.

THE next session of the Memphis Hospital Medical College will open on Monday, Oct. 27, observation during the past two years having shown that this arrangement is better suited to the student than the former custom of opening on Oct. 1. The renovation and improvement of the college building, including refitting with new and improved heating arrangements, are now in the hands of a committee and will be completed in ample time for the opening. The indications now are, that the attendance on the coming session will largely exceed that of any previous year.

BOARD OF MEDICAL EXAMINERS OF NORTH CAROLINA.-The annual session of the Board of Medical Examiners of North Carolina was held in Oxford, May 24th-29th, 1890. The Board consists of seven practitioners elected by the State Medical Society, each of whom conducts the examination of candidates in one of the seven grand divisions of medical science. That this Board is doing effective work in aid of the elevation of the standard of medical education may be inferred from the fact that of a total of 72 candidates at the examination for 1890 only 46 met the requirements and were licensed, and of a total of 398 applicants before this Board for the six years ending with 1890, one hundred and six failed to pass. This will prove interesting to undergraduates who slur their college work, and mayhap awaken them to the fact that State supervision of medical education is so rapidly extending that in the very near future only strict compliance with requirements that, in most colleges, are still too easy, will enable them to find a place in the profession.

CHOLERA ITEMS.-On August 20, an excitement was stirred up in London by the assertion that a sailor with cholera had arrived. It has since been found that he did not have cholera at all.

August 20, a death from cholera was reported on a British steamer at Malaga from Valencia. The disease was also stated to have appeared at Tortosa and Tarragona, and that there have been forty-eight deaths from cholera at the quarantine station at Eltor since the pilgrims were interred.

At Mecca, for the day before, ten deaths from cholera were reported, and at Jeddah nine deaths.

From Madrid it was reported, August 21, that the Government physicians had announced their refusal to serve any longer in the cholera infected districts, unless they were given a strong military escort. They declared that the peasants were opposing all attempts to institute sanitary precautions, and even resorting to force in order to prevent them from doing their duty, and that under these circumstances any abatement in the virulence of the disease was quite impossible. The city of Arges had been deserted by all the inhabitants,

only those who were down with the cholera and a few relatives who refused to desert them being left. The mayor, who was the only remaining official in the city, had buried his own son, all the grave-diggers having fled the city. Out of 123 people, who had been attacked with the disease, 44 had died during the last four days.

August 23, cholera was spreading steadily along the Mediterranean north of Valencia, where there were from ten to twelve new cases daily. The disease had appeared in several villages in the Province of Toledo, and suspicious cases had been discovered in Madrid.

There were eight deaths on board a coolie steamer which arrived from Madras at Durbin, August 24. The cause of death was given as diarrhoea, but the sanitary court declared that the deaths resulted from cholera and that Natal was an infected port.

Cholera was said to be spreading in the city of Toledo, August 25. Thirteen cases and five deaths were reported the day before. The Madrid Health Department had sent officers to Toledo to take sanitary measures.

The Government has established a second quarantine station at Rasmallag, on the Gulf of Suez, August 26. There were 13 deaths from cholera at Jeddah the day before. There were no deaths from the disease at Mecca.

In Toledo, August 27, eight new cases and four deaths were reported. The director of the military academy there had succumbed.

The Canadian Deputy Minister of Agriculture declares that Asiatic cholera will certainly visit Canada next year, and that in order to check its advance he proposes to establish quarantine stations in British Columbia on the same system as that at Grasse Isle.

Some excitement was caused in Vienna, August 29, by a report that a patient in the Central Hospital in that city was suffering with Asiatic cholera.—Med. and Surg. Rep., Sep. 6, '90.

STUDENTS entering the medical department of the University of Michigan after the class of 1893, will be required to attend four sessions before graduation.