Undiagnosed tetanus can be a rare cause of acute intestinal obstruction followed by respiratory failure after surgery and general anaesthesia. The anaesthetist should always read the general practitioner's referring letter (so should the surgeon). Equally, the general practitioner's letter should record normal physiological values for that patient, such as pulse rate and blood pressure. The current shortage of anaesthetists might partly be related to inadequate exposure of medical students to the specialty. The anaesthetist's prime task is the relief of a pain during surgery: but his contract might allow sufficient time outside the operating theatre for the nurture of diagnostic skills basic to clinical competence and survival of the patient inside the operating theatre.