ings and injections of local anesthetic or steroid fail to relieve the symptoms, then coccygectomy should be considered. H. U. CAMERON, MB CH B V. L. FORNASIER, FRCP[C] J. SCHATZKER, FRC5ICI Department of pathology The Princess Margaret Hospital Department of orthopedic surgery The Wellesley Hospital Toronto, Ont.
The value of needling To the editor: By Oct. 7, 1974 a 63-year-old patient of mine had been complaining for 2½ months about the constant, stinging, burning pain that extended along her midline sternal keloid. Three months previously she had had a mammary artery transplant. Four days previously I had attended a 1-day symposium and demonstrations on acupuncture. In jest I said "I have just attended a $50 1-day course on acupuncture. What I do will have to be called McKonapuncture because I really do not know enough to call it acupuncture but I am going to try it on you. I drove a 25-gauge needle attached to a 2-ml dry syringe with determination into the scar at its tenderest part. At 20-second intervals I withdrew it and reinserted it in 5 spots about 1 cm apart. Each insertion hurt her terribly but she made no move to stop me. However, she became a little pale and I discontinued the treatment. The total time taken was about 2 minutes and within another minute she accused me of injecting a local anesthetic. I pressed the scar and it no longer hurt her. I accused her of kidding me and she insisted I had frozen it. That night she thought the pain was going to return but during the next 4 days she had absolutely no pain. She went to Florida but 2 weeks after the initial needling she felt the pain returning. Her doctor there would not touch her because he did not believe in acupuncture. With this introduction to dry needling I tried it in a few specific conditions. My approach to patients varied from an attitude of joking to one of seriousness; sometimes I let the patient believe I was going to inject an anesthetic. The approach, however, did not seem to affect the results. Success was most likely to be achieved when the pain, stiffness or chronic discomfort had been present for months or even years. Many of these patients had had consultations, physiotherapy or chiropractic manipulation but still suffered in varying degrees. They included males and females, whose ages ranged from 20 to 96 years, housewives, breadwinners and retirees, tall, short, thin and obese. My dry needling was
not successful in patients with acute pain; treatment in these patients was more likely to be successful if a local anesthetic and a steroid preparation were used in addition. The needling lasted from 30 to 90 seconds; the warm, numbing sensation developing in the area was the indicator I used to withdraw the needle. In the successful cases the desired effect was evident within the next 60 seconds. Ten people who had stiffness and aching in the neck due to cervical disc disease, arthritis or fibrositis were needled over the right or left or both coracoid processes. The results were unexpectedly successful. I would never have believed it could happen as it did. In nine patients relief was complete within 3 minutes of commencing the needling. The 10th could not be quite sure what she felt. Three patients with chronic aggravating pain around the hip, extending to the greater trochanter and into the front of the thigh, were needled over their tender anterior superior iliac spines. Two of them have had no pain for over 100 days; the third was needled on both sides but the relief lasted only about an hour and the procedure was not repeated. Four patients with lumbosacral pain radiating towards the knees, or even down to the feet, had tender "nodules" over the sacroiliac joints and were needled at the tender spot or at the sacroiliac joint. Three had good immediate results. One was relieved for only 6 days; one was still free of pain after 40 days; one required needling on the 10th, 38th and 76th days, the first time into the sacroiliac joint and closely around it and the last three times at the tender "nodule". The fourth patient was an elderly woman who felt fine 45 days later but gave credit to many things other than the needling; I cannot give credit to the needling either. Over a span of 109 days, therefore, 16 patients had been needled a total of 24 times, with 1017 days of relief from pain. The average duration of relief was 42.3 days. Many of these patients might have had several weeks on narcotics, diazepam, phenylbutazone, chiropractic or physiotherapy treatments two or three times a week, or even acupuncture once or twice a week (for $15 or $20 a treatment). None of these patients were treated by the modern electroacupuncture technique lasting 15 to 60 minutes. From my very limited experience I have reached the following conclusions. The suggested fees of $15 and $20 for acupuncture are far too high. I do not believe that therapy at weekly or biweekly intervals is necessary. Continuation of therapy beyond the third
558 CMA JOURNAL/MARCH 8, 1975/VOL. 112
treatment without definite improvement is bordering on quackery. I am convinced that in some patients needling relieves pain. I hope that someone somewhere will find a "how and why" explanation that is acceptable. B. MCKONE, MD Peterborough, Ont.
Therapeutic abortion To the editor: I would like to respond to the comments of Drs. J.J. Krayenhoff and Heiko Baunemann (Can Med Assoc J 112: 25, 27, 1975). I regret that my previous letter (Can Med Assoc J 111: 900, 1974) did not make clear the distinction between people whose individual value system would not allow them to participate in abortion themselves and people who would prevent anyone from participating in abortion. I sincerely hope we never have laws that prevent the former from following the dictates of their own conscience; it was the latter group, those who believe that all women, once pregnant, should be compelled to remain pregnant and give birth, to whom I attach the label "crusaders for compulsory pregnancy Dr. Krayenhoff uses the phrase "helpless babies" to apply to embryos; he is entitled to call embryos anything he wishes. But those of us who call tadpoles "tadpoles" and not immature frogs, acorns "acorns" and not oak trees, prefer to call fetuses "fetuses". And I do not assign the same inherent value to a human fetus, a tadpole, an acorn or a malignant lung. With regard to Dr. Baunemann's letter, the persistent attempt on the part of the self-styled pro-life people to force an association between the Nazis and the advocates of abortion Jaw repeal is wearing a bit thin. Dr. Baunemann is actually incorrect as to his facts. Between the end of World War I and Hitler's rise to power in 1933 there was a growing movement in Germany to liberalize abortion laws. Hitler stopped all that and forced very strict antiabortion laws on the German people; in fact, death was the punishment for abortion, which Hitler saw as interfering with the future of the German nation. History shows that antiabortion laws (phenomenologically, compulsory pregnancy laws) were always introduced to stimulate population growth; and such policies of demographic aggression usually preceded acts of other kinds of aggression. Hitler was a fervent crusader for compulsory pregnancy. WENDELL W. WAlTERS, MD
Professor of psychiatry McMaster University Hamilton, Ont.
The value of needling To the editor: By Oct. 7, 1974 a 63-year-old patient of mine had been complaining for 2½ months about the constant, stinging, burning pain that extended along her midline sternal keloid. Three months previously she had had a mammary artery transplant. Four days previously I had attended a 1-day symposium and demonstrations on acupuncture. In jest I said "I have just attended a $50 1-day course on acupuncture. What I do will have to be called McKonapuncture because I really do not know enough to call it acupuncture but I am going to try it on you. I drove a 25-gauge needle attached to a 2-ml dry syringe with determination into the scar at its tenderest part. At 20-second intervals I withdrew it and reinserted it in 5 spots about 1 cm apart. Each insertion hurt her terribly but she made no move to stop me. However, she became a little pale and I discontinued the treatment. The total time taken was about 2 minutes and within another minute she accused me of injecting a local anesthetic. I pressed the scar and it no longer hurt her. I accused her of kidding me and she insisted I had frozen it. That night she thought the pain was going to return but during the next 4 days she had absolutely no pain. She went to Florida but 2 weeks after the initial needling she felt the pain returning. Her doctor there would not touch her because he did not believe in acupuncture. With this introduction to dry needling I tried it in a few specific conditions. My approach to patients varied from an attitude of joking to one of seriousness; sometimes I let the patient believe I was going to inject an anesthetic. The approach, however, did not seem to affect the results. Success was most likely to be achieved when the pain, stiffness or chronic discomfort had been present for months or even years. Many of these patients had had consultations, physiotherapy or chiropractic manipulation but still suffered in varying degrees. They included males and females, whose ages ranged from 20 to 96 years, housewives, breadwinners and retirees, tall, short, thin and obese. My dry needling was
not successful in patients with acute pain; treatment in these patients was more likely to be successful if a local anesthetic and a steroid preparation were used in addition. The needling lasted from 30 to 90 seconds; the warm, numbing sensation developing in the area was the indicator I used to withdraw the needle. In the successful cases the desired effect was evident within the next 60 seconds. Ten people who had stiffness and aching in the neck due to cervical disc disease, arthritis or fibrositis were needled over the right or left or both coracoid processes. The results were unexpectedly successful. I would never have believed it could happen as it did. In nine patients relief was complete within 3 minutes of commencing the needling. The 10th could not be quite sure what she felt. Three patients with chronic aggravating pain around the hip, extending to the greater trochanter and into the front of the thigh, were needled over their tender anterior superior iliac spines. Two of them have had no pain for over 100 days; the third was needled on both sides but the relief lasted only about an hour and the procedure was not repeated. Four patients with lumbosacral pain radiating towards the knees, or even down to the feet, had tender "nodules" over the sacroiliac joints and were needled at the tender spot or at the sacroiliac joint. Three had good immediate results. One was relieved for only 6 days; one was still free of pain after 40 days; one required needling on the 10th, 38th and 76th days, the first time into the sacroiliac joint and closely around it and the last three times at the tender "nodule". The fourth patient was an elderly woman who felt fine 45 days later but gave credit to many things other than the needling; I cannot give credit to the needling either. Over a span of 109 days, therefore, 16 patients had been needled a total of 24 times, with 1017 days of relief from pain. The average duration of relief was 42.3 days. Many of these patients might have had several weeks on narcotics, diazepam, phenylbutazone, chiropractic or physiotherapy treatments two or three times a week, or even acupuncture once or twice a week (for $15 or $20 a treatment). None of these patients were treated by the modern electroacupuncture technique lasting 15 to 60 minutes. From my very limited experience I have reached the following conclusions. The suggested fees of $15 and $20 for acupuncture are far too high. I do not believe that therapy at weekly or biweekly intervals is necessary. Continuation of therapy beyond the third
558 CMA JOURNAL/MARCH 8, 1975/VOL. 112
treatment without definite improvement is bordering on quackery. I am convinced that in some patients needling relieves pain. I hope that someone somewhere will find a "how and why" explanation that is acceptable. B. MCKONE, MD Peterborough, Ont.
Therapeutic abortion To the editor: I would like to respond to the comments of Drs. J.J. Krayenhoff and Heiko Baunemann (Can Med Assoc J 112: 25, 27, 1975). I regret that my previous letter (Can Med Assoc J 111: 900, 1974) did not make clear the distinction between people whose individual value system would not allow them to participate in abortion themselves and people who would prevent anyone from participating in abortion. I sincerely hope we never have laws that prevent the former from following the dictates of their own conscience; it was the latter group, those who believe that all women, once pregnant, should be compelled to remain pregnant and give birth, to whom I attach the label "crusaders for compulsory pregnancy Dr. Krayenhoff uses the phrase "helpless babies" to apply to embryos; he is entitled to call embryos anything he wishes. But those of us who call tadpoles "tadpoles" and not immature frogs, acorns "acorns" and not oak trees, prefer to call fetuses "fetuses". And I do not assign the same inherent value to a human fetus, a tadpole, an acorn or a malignant lung. With regard to Dr. Baunemann's letter, the persistent attempt on the part of the self-styled pro-life people to force an association between the Nazis and the advocates of abortion Jaw repeal is wearing a bit thin. Dr. Baunemann is actually incorrect as to his facts. Between the end of World War I and Hitler's rise to power in 1933 there was a growing movement in Germany to liberalize abortion laws. Hitler stopped all that and forced very strict antiabortion laws on the German people; in fact, death was the punishment for abortion, which Hitler saw as interfering with the future of the German nation. History shows that antiabortion laws (phenomenologically, compulsory pregnancy laws) were always introduced to stimulate population growth; and such policies of demographic aggression usually preceded acts of other kinds of aggression. Hitler was a fervent crusader for compulsory pregnancy. WENDELL W. WAlTERS, MD
Professor of psychiatry McMaster University Hamilton, Ont.
