572 
CHLOROFORM ANASTHESIA.* 
THE administration of chloroform is a subject that is of 
personal and direct interest to everyone in this present 
age of civilisation. Sooner or later either we ourselves or 
those dear to us gladly accept the relief from suffering that 
is offered, and that chloroform shall be given so that no 
unavoidable risk is run is a necessity that forces itself on 
our attention. i 
That much remains to be done in the direction of safety 
is only too evident. We confess to perusing the diagram 
of the yearly increasing death-rate from chloroform on p. 14 
of Dr. Waller’s lecture with a feeling of horror, and that 
is deepened when we read the instances given of such 
deaths, and supplemented by others which have come to our 
knowledge independently, where chloroform has been given 
for a trifling operation to an otherwise healthy patient, and 
where the phrase ‘‘ Death from cardiac syncope ’’ has 
acted as an anaesthetic to the conscience of the ignorant and 
careless anzesthetist. It is plain that some vital factor in 
the problem of safe chloroform administration has been 
overlooked, and what this consists in is readily seen when 
it is pointed out tous. The student of anzsthetics is taught 
to regard most carefully the minor details of the process; 
the observation of the state of the pulse and the condition 
of the conjunctival reflex is reduced to a fine art, but the 
most important detail of all, the amount of chloroform 
administered, is dismissed with the remark, made in our 
hearing by a professional anesthetist, ‘‘ I judge of the dose 
of chloroform by the effect* on the patient’’!!! Yet if 
strychnine or arsenic were given without a measured dose, 
the folly of the proceeding would be manifest, and the 
possibility of such a remark, made by one who had spent 
some time in the study of the subject, shows at least that 
this study had been misapplied. 
To replace ignorance of knowledge it is, however, 
necessary to do more than talk, and the lecture now under 
review gives an outline of the research that has been carried 
on in the physiological laboratory of the University of 
London on chloroform anzsthesia. It was apparent that 
there was a great lack of quantitative measurement in the 
process, and the first step consisted in obtaining a ready 
and accurate method for the estimation of the percentage 
of chloroform in air, and this was accomplished by the 
““densimetric ’? method. It then became possible readily to 
ascertain :— 
(1) What percentage of chloroform in the inspired air 
was sufficient to cause anzsthesia. 
(2) What percentage of chloroform caused death. 
(3) How this death was brought about. 
(4) By taking the percentage of chloroform in the expired 
air as well as in the inspired, together with the amount of 
air breathed, to measure the total quantity of chloroform 
used in any experiment. 
Proceeding in this quantitative way, it was found that 
though death from too much chloroform can occur in either 
of two ways, yet, so far as the experiments lead us, neither 
way can occur when chloroform is given regularly in a per- 
centage not greater than 2, and so before we can claim 
that a healthy patient has died from ‘* idiosyncrasy ’’ or 
““ cardiac syncope ’’ it is incumbent on us to show that we 
have not given him too much chloroform, and to ascertain 
that the cause of death (in at least the great majority of 
cases) arises from this easily remediable source, and not 
from some mysterious accident, is a very great advance 
towards safety. 
We shall await the results of further observations on the 
human subject with interest, as well as the records of the 
use of the Dubois apparatus, which appears to be well 
adapted for clinical use. But meanwhile the facts here 
recorded merit the most careful consideration, and clearly 
point out the lines on which further research must be carried 
out. 
1 A Lecture on the Administration of Chloroform to Man and the Higher 
Animals, Delivered in the University of London on October 3, 1903, by 
A. D. Waller, M.D., F.R S. 
2 By a curious mental process this anasthetist, when the patient dies, 
does not consider that too much chloroform has been given, but that death 
has occurred from ‘‘ idiosyncrasy"’! 
NO. 1798, VOL. 69] 
NATURE 
[APRIL 14, 1904 
THE FIRST INTERNATIONAL CONGRESS 
FOR SCHOOL HYGIENE. 
HAT it should be possible to hold an international 
congress on a subject which a few years ago had 
but little attention paid to it shows the enormous strides 
which have been made in the knowledge of the hygiene of 
children attending schools. 
The first International Congress of School Hygiene was 
held at Nuremberg from April 4 to 9, and the credit for 
starting the congress must be given to Prof. Griesbach, the 
president of the ‘‘ Allegemein deutschen Vereins fur Schul- 
gesundheitspflege.’’ The energy and determination with 
which Prof. Griesbach overcame all obstacles are proved by 
the fact that every European country, except Italy and 
Turkey, was represented at the congress, and in addition 
to these European countries America and Japan were also 
represented. 
The congress was opened formally by Prince Ludwig 
Ferdinand of Bavaria, and the work of the congress was 
carried on in sections. How extensive the work of the 
congress was may be gathered from the fact that there were 
seven sections. The first dealt with school buildings and 
the furnishing of the school-room, the second with the 
hygiene of residential schools, with the methods of hygienic 
investigation and research in schools, and with the physi- 
ology and psychology of educational methods and work. 
The third section dealt with instruction in hygiene for 
teachers and scholars, the fourth with physical education 
and training in personal hygiene, the fifth with contagious 
diseases, ill-health, and conditions affecting attendance at 
school. The sixth section dealt with special schools, in- 
cluding those for the feeble-minded, the blind, deaf, dumb, 
cripple, invalid and exceptional children, and the seventh 
with out of school hygiene, holiday camps and schools, the 
relation of the home and the school, and the hygiene of the 
teaching profession. 
The sectional meetings were held in the Royal Industrial 
School, a building well adapted for such a purpose. An 
exhibition of apparatus necessary for school purposes was 
held in the same building. Excellent arrangements had 
been made for the accommodation of those attending the 
congress, and also for obtaining information. Nor had the 
social side of the congress been neglected, and every facility 
was given to visitors to see those things in which they took 
the greatest interest. 
Great Britain was represented by a committee with re- 
presentatives from various societies interested in education 
and hygiene, with Sir Lauder Brunton as president. 
The next International Congress of School Hygiene will 
be held in London in 1907, and Sir Lauder Brunton has 
been elected president of that congress. 
UNIVERSITY AND EDUCATIONAL 
INTELLIGENCE. 
Ar the graduation ceremony at the University of Edin- 
burgh on April 9 the honorary degree of LL.D. was con- 
ferred on Prof. Alexander Macalister, F.R.S. 
Dr. Roser, H.M. Consul at Stuttgart, continues his 
account of German technical education in No. 603 of the 
miscellaneous series of the diplomatic and consular re- 
ports issued by the Foreign Office. The recent report is on 
technical schools for special branches of the metal industries. 
Dr. Rose finds that in Germany for certain special branches 
of the metal and other industries the practical instruction 
given to apprentices in the workshops of factories is often 
incomplete and not progressively arranged, and the theo- 
retical instruction given in evening and Sunday continu- 
ation schools is generally insufficient and not even obligatory 
in all cases. At the special technical schools for these 
industries the instruction is complete and _ progressively 
arranged, practice and theory being carefully and judiciously 
combined. As the schools, moreover, are situated in the 
midst of the industries they are intended to promote, they 
are kept in the closest possible touch with the actual and 
progressive requirements of factory methods and processes. 
The report gives full accounts of the courses of instruction, 
the hours, the preliminary knowledge expected of students,. 
