uates of the University of British Columbia to stay 2 years behind the times in therapeutics. I believe he was simply telling us to use critical judgement in our assessment of any new knowledge. I believe he and Dr. Emanuel would agree that we should grow in clinical skills by a combination of continuing medical education and the cultivation of clinical judgement by self-evaluation and review of our everyday practice.
cian to comment on the number of acupuncture treatments a patient might need or the fee that should be charged for these treatments. C.G. WOOLFE, B SC PHM, CCFP
101 McBride Ave. Mississauga, Ont.
References 1. DOSCH P: Lehrbuch der Neuraitherapie nach Huneke. Ulm, Germany, Hang, 1966 2. TRAVELL .1, RINZLER SH: Scientific exhibit: myofascial genesis of pain. Posigrad Med 11: 425, 1952
A. 3. MACGREGOR, MD, CCFP
Director of medical education Victoria General Hospital Victoria, BC
Coccygodynia To the editor: From my limited experience with patients with coccygodynia I would support the views expressed by Cameron, Fornasier and Schatzker (Can Med Assoc J 112: 557, 1975). I was one of those physicians who tended to consider patients with this problem to be neurotic. Last year I attempted a follow-up of 23 patients operated on by 10 different surgeons in a local teaching hospital. I was unable to trace 3 patients and only 10 of the remainder replied to the questionnaire. All were completely or substantially relieved of their symptoms. Owing to the small numbers involved, one cannot draw very firm conclusions, but one can say that coccygectomy helped at least half of the patients. I am attempting to contact the nonrespondents as well as another group of 24 patients in order to obtain more useful figures. The best way for the patients to avoid sitting on the affected part is by the use of an inflatable air ring. The only 1 of the 10 respondents who had any relief preoperatively had used this simple device. I. HOLMES, MD
Department of anatomy Daihousie University Halifax, NS
The value of needling To the editor: It is quite correct for Dr. McKone to consider that his type of needling is not acupuncture (Can Med Assoc J 112: 558, 1975). It is a combination of modified neural therapy, as used by Huneke in Germany1 and Travell and Rinzler2 in the United States; "periosteal pecking", described by Felix Mann in his book "The Treatment of Disease by Acupuncture"; and treatment of trigger points, described by Louis Moss in his book "Acupuncture and You". These are but a small part of acupuncture. I do not believe, however, that a 1-day seminar and experience limited to treating 16 patients qualify a physi-
Therapeutic abortion To the editor: If therapeutic abortion in a healthy person presents a complex sociocultural problem, as Dr. Rapp claims (Can Med Assoc J 112: 682, 1975), the decision as to whether or not an abortion should be performed should be made by an expert in sociocultural problems, not by the patient and not by the physician. A physician could then perform the operation. Later, nurses could be trained to do it under supervision, and some time in the future special paramedics could do it. Then the back-street, unhygienic abortion will be gone. Without being a moralist or a cynic, I find it a little odd that there should be such a rush to import Vietnamese orphans while many Canadian fetuses have their biologic processes halted every day. A.C. HAYES, MB, MCH, BAO, DO
1812 - 4th St. SW Calgary, Alta.
We recognize the dangers associated with the use of alcohol, tobacco and illicit drugs; and also with the use of the automobile. We teach young people to avoid the first and how to use the second properly. We do not waste time on telling them how to smoke "safely" or how to drive when intoxicated. The "new morality" is simply the old immorality in disguise and, translated into "doctor language", is a serious and dangerous health hazard. If young Canadians could be taught to avoid sexual contact until they are mature, vast sums of money would be saved that are now spent on diagnosing and treating venereal disease and unwanted pregnancy; hundreds of neonates would be spared the unnecessary effects of syphilis, gonorrhea and herpesvirus 11; and thousands of Canadian parents would be spared the pain of having their daughters go through the trauma associated with unwanted pregnancy and abortion. The risks of being an adolescent and the importance of practising "defensive dating" must be given far greater emphasis. A fire marshall strongly discourages the practice of smoking in bed, not because smoking is naughty or expensive or corrosive to the lungs but because he is sickened every time he has to recover the charred remains of a human being from the smouldering ruins of his home. In a similar way I am sickened every time I discover venereal disease or unwanted pregnancy in a young patient. G.W. MURRAY, MD
814 Cook Rd. Richmond, BC
Control of venereal disease To the editor: I read with interest the article "MMA provides leadership in venereal disease control" by Steinberg and Deegan (Can Med Assoc J 112: 621, 1975). This article suggests how physicians can help to control the epidemic of gonorrhea that is sweeping the nation. I agree that screening for gonorrhea should be a prerequisite for obtaining a marriage licence and that good laboratory equipment should be made readily available to facilitate diagnosis. I am disappointed, however, that more stress is not placed on the most urgent need in the control of venereal disease (as well as unwanted pregnancy): a loud, clear declaration to the public that unbridled sexual self-indulgence is a very serious hazard to health and is to be avoided. Students should be taught this and special stress should be placed on the power and unpredictability of the basic sex drive. They should be given specific information on how to avoid circumstances in which instinct is likely to gain control over intelligence and good intentions.
1166 CMA JOURNAL/MAY 17, 1975/VOL. 112
Sick magazines To the editor: I would like to comment on Jane Somerville's admonition "Sick magazines need urgent treatment: why are they still in the waiting room?" (Can Med Assoc 1 112: 755, 1975). I subscribe to about 15 magazines, Canadian as well as American, for my office waiting room and they appear as described - but for a good reason. It has been my experience that any recent magazine is stolen within 2 days. As a result, I store my magazines fbr 2 to 3 months before placing them in the waiting room. I believe that old magazines are better than no magazines. Believe it or not, I am interested in my patients' comfort. I wish my patients were equally concerned with the well-being of each other with regard to waiting-room courtesies like smoking, eating and personal hygiene. M. Ross KNIGHT, MO, DMR, FRCP[C]
3025 Hurontario St. Mississauga, Ont.
cian to comment on the number of acupuncture treatments a patient might need or the fee that should be charged for these treatments. C.G. WOOLFE, B SC PHM, CCFP
101 McBride Ave. Mississauga, Ont.
References 1. DOSCH P: Lehrbuch der Neuraitherapie nach Huneke. Ulm, Germany, Hang, 1966 2. TRAVELL .1, RINZLER SH: Scientific exhibit: myofascial genesis of pain. Posigrad Med 11: 425, 1952
A. 3. MACGREGOR, MD, CCFP
Director of medical education Victoria General Hospital Victoria, BC
Coccygodynia To the editor: From my limited experience with patients with coccygodynia I would support the views expressed by Cameron, Fornasier and Schatzker (Can Med Assoc J 112: 557, 1975). I was one of those physicians who tended to consider patients with this problem to be neurotic. Last year I attempted a follow-up of 23 patients operated on by 10 different surgeons in a local teaching hospital. I was unable to trace 3 patients and only 10 of the remainder replied to the questionnaire. All were completely or substantially relieved of their symptoms. Owing to the small numbers involved, one cannot draw very firm conclusions, but one can say that coccygectomy helped at least half of the patients. I am attempting to contact the nonrespondents as well as another group of 24 patients in order to obtain more useful figures. The best way for the patients to avoid sitting on the affected part is by the use of an inflatable air ring. The only 1 of the 10 respondents who had any relief preoperatively had used this simple device. I. HOLMES, MD
Department of anatomy Daihousie University Halifax, NS
The value of needling To the editor: It is quite correct for Dr. McKone to consider that his type of needling is not acupuncture (Can Med Assoc J 112: 558, 1975). It is a combination of modified neural therapy, as used by Huneke in Germany1 and Travell and Rinzler2 in the United States; "periosteal pecking", described by Felix Mann in his book "The Treatment of Disease by Acupuncture"; and treatment of trigger points, described by Louis Moss in his book "Acupuncture and You". These are but a small part of acupuncture. I do not believe, however, that a 1-day seminar and experience limited to treating 16 patients qualify a physi-
Therapeutic abortion To the editor: If therapeutic abortion in a healthy person presents a complex sociocultural problem, as Dr. Rapp claims (Can Med Assoc J 112: 682, 1975), the decision as to whether or not an abortion should be performed should be made by an expert in sociocultural problems, not by the patient and not by the physician. A physician could then perform the operation. Later, nurses could be trained to do it under supervision, and some time in the future special paramedics could do it. Then the back-street, unhygienic abortion will be gone. Without being a moralist or a cynic, I find it a little odd that there should be such a rush to import Vietnamese orphans while many Canadian fetuses have their biologic processes halted every day. A.C. HAYES, MB, MCH, BAO, DO
1812 - 4th St. SW Calgary, Alta.
We recognize the dangers associated with the use of alcohol, tobacco and illicit drugs; and also with the use of the automobile. We teach young people to avoid the first and how to use the second properly. We do not waste time on telling them how to smoke "safely" or how to drive when intoxicated. The "new morality" is simply the old immorality in disguise and, translated into "doctor language", is a serious and dangerous health hazard. If young Canadians could be taught to avoid sexual contact until they are mature, vast sums of money would be saved that are now spent on diagnosing and treating venereal disease and unwanted pregnancy; hundreds of neonates would be spared the unnecessary effects of syphilis, gonorrhea and herpesvirus 11; and thousands of Canadian parents would be spared the pain of having their daughters go through the trauma associated with unwanted pregnancy and abortion. The risks of being an adolescent and the importance of practising "defensive dating" must be given far greater emphasis. A fire marshall strongly discourages the practice of smoking in bed, not because smoking is naughty or expensive or corrosive to the lungs but because he is sickened every time he has to recover the charred remains of a human being from the smouldering ruins of his home. In a similar way I am sickened every time I discover venereal disease or unwanted pregnancy in a young patient. G.W. MURRAY, MD
814 Cook Rd. Richmond, BC
Control of venereal disease To the editor: I read with interest the article "MMA provides leadership in venereal disease control" by Steinberg and Deegan (Can Med Assoc J 112: 621, 1975). This article suggests how physicians can help to control the epidemic of gonorrhea that is sweeping the nation. I agree that screening for gonorrhea should be a prerequisite for obtaining a marriage licence and that good laboratory equipment should be made readily available to facilitate diagnosis. I am disappointed, however, that more stress is not placed on the most urgent need in the control of venereal disease (as well as unwanted pregnancy): a loud, clear declaration to the public that unbridled sexual self-indulgence is a very serious hazard to health and is to be avoided. Students should be taught this and special stress should be placed on the power and unpredictability of the basic sex drive. They should be given specific information on how to avoid circumstances in which instinct is likely to gain control over intelligence and good intentions.
1166 CMA JOURNAL/MAY 17, 1975/VOL. 112
Sick magazines To the editor: I would like to comment on Jane Somerville's admonition "Sick magazines need urgent treatment: why are they still in the waiting room?" (Can Med Assoc 1 112: 755, 1975). I subscribe to about 15 magazines, Canadian as well as American, for my office waiting room and they appear as described - but for a good reason. It has been my experience that any recent magazine is stolen within 2 days. As a result, I store my magazines fbr 2 to 3 months before placing them in the waiting room. I believe that old magazines are better than no magazines. Believe it or not, I am interested in my patients' comfort. I wish my patients were equally concerned with the well-being of each other with regard to waiting-room courtesies like smoking, eating and personal hygiene. M. Ross KNIGHT, MO, DMR, FRCP[C]
3025 Hurontario St. Mississauga, Ont.
