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SUICIDE-RATE IN BRITAIN
899 tooth is drilled near the nerve and there is no pain. The patient feels everything that happens with normal full conscious sensation: he feels the probe going through the flesh, the pressure and speed of the drill--only pain is absent. Acupuncture analgesia differs from a local anaathetic, which reduces or abolishes all sensation. Dental acupuncture could be developed so that the hand manipulation of the needles is replaced by electrical or mechanical stimulation. This would enable one dentist to do the whole procedure by himself. Probably the method could be perfected, so that the induction period was only three minutes. The advantages of dental acupuncture are: the patient has no unpleasant numb feeling afterwards; there are no allergies to adrenaline or local anaesthetic, nor the mild nausea that some patients have with these drugs; the whole mouth is anaesthetised together (with a local anaesthetic only one tooth or at the most one quarter of the mouth can be anaesthetised. Hence a complete dental treatment can be done at one sitting (instead of several visits); only the sense of pain is affected. The other senses and presumably physiological functions are unaffected, thus minimising interference with normal function. The disadvantages of dental acupuncture seem to be: the degree of analgesia is usually not as deep as that of local infiltration, nerve-block, or a general anxsthetic (possibly this can be improved); and acupuncture does not invariably work (it is said in China that it is deep enough for major surgery in 80-90% of cases). The fourth patient was quite different. She had had a third lower molar removed a month previously, which required a minor operation on the jaw. Part of the inferior dental nerve was unfortunately interrupted, resulting in anxsthesia in the distribution of the mental nerve-the lower lip and chin. Some of the fibres of the inferior dental nerve must have been left intact, but in a hypersensitive state, since whenever the patient lightly touched her chin she had severe " electric shocks ". She was anaesthetised in the same way as the previous patients. After twenty minutes the " electric shocks" were " about 60 % gone". Then another needle " stomach 6 " at the angle of the jaw was stimulated to accelerate the process. After a total of 34 minutes anaesthesia was complete. The " electric shocks " returned after 12-20 hours. Normal acupuncture can at least be partly explained by the short segmental reflexes and the long intersegmental reflexes1 of Sherrington. Acupuncture anaesthesia can possibly be elucidated by a modification of the gate control theory of Melzack and Wall.2 Dental acupuncture analgesia will require considerable development and improvement before it can be applied in daily dental practice. To what extent it will prove to be a practical procedure remains to be seen.
or a
FELIX 15 Devonshire Place, London W1N 1PB.
MANN,
President of the
Medical Acupunture Society.
ARTERIAL CATHETERISATION a simplified method for percuarterial catheterisation. We have for the last four years used another modification.
SiR,—Koch 3 described
taneous
The artery is punctured with a disposable needle, 40 mm. 1-2 mm. outer diameter (Medeplast, Sweden). When the needle is advanced steadily and slowly only the anterior wall of the artery is punctured, and a free pulsating flow is seen. A standardNylon’ guideline (0-6 nun. diameter) is then inserted. If there is any resistance, the needle is gently rotated until the guideline can easily be advanced into the artery. The needle is
long,
1. 2. 3.
Mann, F. The Ancient Chinese Art of Healing. London, Melzack, R., Wall, P. D. Science, 1965, 150, 971. Koch, G. Lancet, 1971, i, 1166.
then withdrawn and a polyethylene or teflon catheter can be inserted in the usual way. This method has been used in about 400 cases of routineheart catheterisations via the brachial artery. The method is atraumatic. By not having the guideline inserted during the arterial puncture, there is no need for tape. Further, arterial puncture with a guideline in the needle might, in unexperienced hands, involve the small risk that the tip of the needle might cut off part of the guideline, should this be inserted too far.
University Hospital, S 750 14 Uppsala 14, Sweden.
INGEMAR CULLHED.
SUICIDE-RATE IN BRITAIN " SiR,—There is increasing emphasis on the " fact that the suicide-rate in Britain has declined over the past decade.1 Before such a fact is accepted, adequate data must be presented. To be sure, the suicide-rate has declined. But to show that this drop reflects a real reduction in the suicide-rate and not a change in the practice of certifying death, data are also needed on trends in the frequency of open verdicts and accidental deaths due to drugs. If these have increased, then the validity of the drop in the suiciderate could be questioned. Stockton State College,
Pomona, New Jersey 08240, U.S.A.
DAVID LESTER.
* ** In England and Wales between 1963 and 1970 the death-rate for suicide or self-inflicted injury fell by exactly a third from 120 to 80 per million. The increase in the death-rate from accidental poisonings by drugs and medicaments (from 6 to 11 per million) could not have contributed £ much to the decline in suicide-rate. " Open verdicts z (E980-989), recorded separately for 1967-70 only, were 23, 25, 29, and 23 per million, respectively.-ED. L. THE HOSPITAL CHAPEL
SiR,-In his address2 at the Hospital Centre, Dr. Michael Wilson raises a number of important issues, some of which were taken up by Mr. Leishman and Dr. Affleck (Feb. 19, p. 452) in describing the proposed use of a hospital chapel as a centre for " discussion, reflection,. research, and interdisciplinary study ". The need for such centres arises from our changing understanding of the nature of health, and can be further demonstrated by some surveys which I conducted from this hospital. In a random sample of patients on their first admission it was clearly shown that most families were involved to the extent of sharing and supporting, while many, though it was sometimes heavily denied, were more deeply involved in the sickness situation, and that the patient was presenting the group’s malaise. Hospital treatment still focuses largely on the individual, and care of the family must reside with professions in the community who do not always seem prepared for this role. A survey showed that the general practitioner, while fairly confident about caring for the patient with a mental or emotional problem, is much less confident about caring for the family. The mental welfare-officer sees his role with the patient often in crisis situations, and as an intermediary between hospital and family, but not in terms of group casework with them. The clergy surveyed saw health more in corporate terms and thought of using relationships, groups, and congregations. Family care would seem to be often an interdisciplinary matter involving hospital and community agencies in a particular area. The surveys showed much variation of
relationship between the community professions, significant areas of misunderstanding and lack of cooperation, and
1971.
1. See Lancet, 1971, ii, 1411. 2. See ibid. p. 1435.
or a
FELIX 15 Devonshire Place, London W1N 1PB.
MANN,
President of the
Medical Acupunture Society.
ARTERIAL CATHETERISATION a simplified method for percuarterial catheterisation. We have for the last four years used another modification.
SiR,—Koch 3 described
taneous
The artery is punctured with a disposable needle, 40 mm. 1-2 mm. outer diameter (Medeplast, Sweden). When the needle is advanced steadily and slowly only the anterior wall of the artery is punctured, and a free pulsating flow is seen. A standardNylon’ guideline (0-6 nun. diameter) is then inserted. If there is any resistance, the needle is gently rotated until the guideline can easily be advanced into the artery. The needle is
long,
1. 2. 3.
Mann, F. The Ancient Chinese Art of Healing. London, Melzack, R., Wall, P. D. Science, 1965, 150, 971. Koch, G. Lancet, 1971, i, 1166.
then withdrawn and a polyethylene or teflon catheter can be inserted in the usual way. This method has been used in about 400 cases of routineheart catheterisations via the brachial artery. The method is atraumatic. By not having the guideline inserted during the arterial puncture, there is no need for tape. Further, arterial puncture with a guideline in the needle might, in unexperienced hands, involve the small risk that the tip of the needle might cut off part of the guideline, should this be inserted too far.
University Hospital, S 750 14 Uppsala 14, Sweden.
INGEMAR CULLHED.
SUICIDE-RATE IN BRITAIN " SiR,—There is increasing emphasis on the " fact that the suicide-rate in Britain has declined over the past decade.1 Before such a fact is accepted, adequate data must be presented. To be sure, the suicide-rate has declined. But to show that this drop reflects a real reduction in the suicide-rate and not a change in the practice of certifying death, data are also needed on trends in the frequency of open verdicts and accidental deaths due to drugs. If these have increased, then the validity of the drop in the suiciderate could be questioned. Stockton State College,
Pomona, New Jersey 08240, U.S.A.
DAVID LESTER.
* ** In England and Wales between 1963 and 1970 the death-rate for suicide or self-inflicted injury fell by exactly a third from 120 to 80 per million. The increase in the death-rate from accidental poisonings by drugs and medicaments (from 6 to 11 per million) could not have contributed £ much to the decline in suicide-rate. " Open verdicts z (E980-989), recorded separately for 1967-70 only, were 23, 25, 29, and 23 per million, respectively.-ED. L. THE HOSPITAL CHAPEL
SiR,-In his address2 at the Hospital Centre, Dr. Michael Wilson raises a number of important issues, some of which were taken up by Mr. Leishman and Dr. Affleck (Feb. 19, p. 452) in describing the proposed use of a hospital chapel as a centre for " discussion, reflection,. research, and interdisciplinary study ". The need for such centres arises from our changing understanding of the nature of health, and can be further demonstrated by some surveys which I conducted from this hospital. In a random sample of patients on their first admission it was clearly shown that most families were involved to the extent of sharing and supporting, while many, though it was sometimes heavily denied, were more deeply involved in the sickness situation, and that the patient was presenting the group’s malaise. Hospital treatment still focuses largely on the individual, and care of the family must reside with professions in the community who do not always seem prepared for this role. A survey showed that the general practitioner, while fairly confident about caring for the patient with a mental or emotional problem, is much less confident about caring for the family. The mental welfare-officer sees his role with the patient often in crisis situations, and as an intermediary between hospital and family, but not in terms of group casework with them. The clergy surveyed saw health more in corporate terms and thought of using relationships, groups, and congregations. Family care would seem to be often an interdisciplinary matter involving hospital and community agencies in a particular area. The surveys showed much variation of
relationship between the community professions, significant areas of misunderstanding and lack of cooperation, and
1971.
1. See Lancet, 1971, ii, 1411. 2. See ibid. p. 1435.