mates who are at the same level of fitness. Their coach is a cardiologist. AMJA pathologists expect not only a decrease in the incidence of coronary heart disease, but also, because of the teetotaling life style, fewer cases of cirrhosis, carcinoma of the lung, emphysema and generalized arteriosclerosis. Such programs may give us the increase in life expectancy of which McIntosh speaks. Thomas J. Bassler, MD Centinela Valley Hospital Inglewood, Calif. References

Cardiol 34: 127,

1. McIntosh HD: President’s page: life expectancy. Am J 2. Bssskr TJ: Lonpdistance runners. Science 182:113. 1973


REPLY Intuitively, I believe that a well planned jogging program is important as both a prophylactic and a rehabilitative measure. Yet I believe that the data that prove this hunch correct are not yet available. I hope that the role of exercise in the treatment and prevention of coronary artery disease will be clarified soon. I hope, too, that Dr. Bassler will not continue to refer to AMJA pathologists who “expect not only a decrease in the incidence of coronary heart disease; but because of the teetotaling life style, they also expect to see fewer cases of cirrhosis, carcinoma of the lung, emphysema and generalized arteriosclerosis.” I hope that the pathologic data that become available to the American Medical Joggers Association will be examined by pathologists without preconceived ideas. Whether or not jogging increases life expectancy and reduces the progression of coronary artery disease, I, for one, can attest to the fact that it improves the quality of life. I do not believe, however, that one has to be a marathon runner to enjoy the benefits of reconditioning or to remain in good physical condition. I cannot emphasize strongly enough that the middle-aged, obese, smoking, sedentary male should not embark on a self-designed exercise program. He should have a careful physical examination with stress testing to be sure that if he does have ischemic heart disease that he is well aware of the limits to which he can exert without developing the process. Finally, Dr. Bassler’s enthusiasm is gratifying and I am sure infectious. I hope that he will always separate intuition from facts and so inform his listeners. Henry D. McIntosh, MD, FACC Department of Medicine The Methodist Hospital Houston, Texas



I read with great interest Dr. Katz’s account of acupuncture anesthesia for open heart surgery. I too was a doubting Thomas about the much acclaimed wonders performed by our Chinese colleagues using acupuncture anesthesia in heart surgery until May 1972 when I visited the People’s Republic of China and observed several closed mitral commissurotomies performed under acupuncture anesthesia and July 1973 when I returned there to witness several open heart operations performed under acupuncture anes-

thesia. It was only after I had seen with my own eyes, as Dr. Katz has with his, that I became convinced that indeed it was, is and will be possible to do open heart operations using the technique of total cardiopulmonary bypass under acupuncture anesthesia. Dr. Katz’s account of operative repair of a ventricular septal defect in a youngster under acupuncture anesthesia is identical to what I saw being successfully accomplished in the same hospital and by the same surgical team, many members of which were my former schoolmates and classmates. For documentary purposes, I had the entire operation filmed through the courtesy of the Shanghai Branch of the Chinese Medical Association. More than 100 open heart operations have been performed under acupuncture anesthesia in that hospital since its first on April 19,1972, with a success rate of over 90 percent. The types of congenital heart disease so treated included ventricular septal defect, atria1 septal defect, pulmonary stenosis, trilogy of Fallot, tetralogy of Fallot and ruptured aortic sinus of Valsalva with ventricular septal defect. The youngest patient was 10 years of age and the longest period of extracorporeal circulation was 121 minutes. My Chinese colleagues neither considered acupuncture anesthesia to be a panacea for all open heart operations nor claimed perfection with this technique. Three “castles” or hurdles still remain in acupuncture anesthesia: incomplete relief of painful sensations during closure of median sternotomy, incomplete muscular relaxation during abdominal operations and uncomfortable sensation during mesenteric traction of gut handling. However, my Chinese colleagues are determined to lick these problems. Physicians in the western world tend to be somewhat critical of happenings that cannot be explained on a “scientific” basis. In fact, some even called acupuncture anesthesia a form of hypnosis. Such an attitude reflects ignorance and mulishness. I suggest to some of my American colleagues that we keep our mouths closed but our eyes open for further progress and development emanating from the medical horizons in the People’s Republic of China. Tsung 0. Cheng. MD, FACC Division of Cardiology Department of Medicine The George Washington University Medical Center Washington, D. C. Reference 1. Katz AM:

Acupuncture anesthesia for open heart surSery. A C~SB report. Am J Cardial 34:250-253. 1974



Medical journals should publish reports of clinical studies of methods that seem unlikely to be successful by our previous experience; there would be no progress otherwise. But this report of Dr. Katz is, in the language of the courtroom, hearsay evidence. Katz was not the physician in charge; he was not the surgeon; his closest contact to the patient was observation in the operating room. There is no evidence that he examined the patient beyond his observations in the operating theater. I doubt that you would publish a case report submitted by an observer, however interested, whose evidence consisted of the material presented here.

September 1975

Reuben Berman, MD Editor Minnesota

The American Journal of CARDIOLOGY


Volume 36


Letter: Acupuncture anesthesia for open heart surgery. I.

LEllERS TO THE EDITOR mates who are at the same level of fitness. Their coach is a cardiologist. AMJA pathologists expect not only a decrease in the...
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