s arrived at the conclusion that competition must
be checked, and has lately brought into force two drastic measures
calculated to attain this object; one is the lengthening of the course
to five years, and, more recently, the abolishing of the unqualified
assistant. The medical profession of America is quite as conscious of
the disastrous results of competition as are its fellow practitioners
on the other side, and should use every legitimate means to sweep away
the evils of the present system.--Medical Record.

* * * * *

DEATHS UNDER ANAESTHETICS.

On December 17, 1897, a fatality occurred during the administration of
ether. The patient, a woman aged forty-four years, who suffered from
"internal cancer," was admitted for operation into the new hospital
for women, Euston Road. It was considered that an operation would
afford a chance of the prolongation of her life. At the time of
admission the patient was in a very exhausted condition. Mrs. Keith,
the anaesthetist to the hospital, administered nitrous oxide gas,
followed by ether, which combination of anaesthetics the patient took
well. After the expiration of thirty minutes and while the operation
was in progress the patient became so collapsed that the surgeon was
requested by the anaesthetist to desist from further surgical procedure
and she at once complied. Resuscitative measures were at once applied,
but the patient died after about ten minutes from circulatory failure
arising from surgical shock and collapse. We have not received any
particulars as to the means adopted to restore the woman or whether
hemorrhage was severe. In all such cases posture, warmth and guarding
the patient from the effects of hemorrhage are undoubtedly the most
important points for attention both before and during the operation.
The fact is established that both chloroform and ether cause a fall
of body temperature, and so increase shock unless the trunk and limbs
are kept wrapped in flannel or cotton-wool. The fall of temperature
under severe abdominal and vaginal operations again is considerable. A
profound anaesthesia allows of a considerable drop in arterial tension,
which has been shown to be least when the limbs and pelvis are placed
at a higher level than the head. Again, saline transfusion of Ringer's
fluid certainly lessens the collapse in such cases when the bleeding,
always severe, has been excessive. We do not doubt that such a sever