AS one who campaigned long and hard against the historical situation of dental anaesthetics being given in dental surgeries and other premises without back-up facilities and by staff who were neither trained nor experienced in cardiac arrest procedures, I was stunned by the comments of David J Crawford (Letters, July 25).
Any surgery to the face, head or neck carries with it an inherent and increased risk of cardiac arrest, therefore dental anaesthesia is a specialised field. In the halcyon days Mr Crawford so fondly recalls, any passing doctor, GP or hospital doctor and not necessarily an anaesthetist, earned a couple of hundred quid on his day off by giving anaesthetics for dental extractions. The objection was not to where these procedures were carried out, but to the lack of emergency equipment and of trained staff who knew how to use it or what to do when a patient suffered a cardiac arrest. The prevalent attitude was: so what if the odd one dies? The existing system was cheaper than providing safe care for patients in an era when the motives and practices of medical professionals, doctors or dentists, were rarely questioned. When a patient arrested an ambulance had to be called to rush him or her to the nearest hospital, where a hapless cardiac arrest team waited, knowing there wasn’t a chance. Irreversible brain damage occurs after three minutes, but it was impossible to get patients to hospital in that time. I cannot recall a single instance where a dental patient was successfully resuscitated in these circumstances and I cannot understand why any dental patient should have been put in the position of needing it.
Mr Crawford talks of his experience. I speak from mine and those dead dental patients amounted to a great deal more than a single “unfortunate” child in Edinburgh. I can provide a roll call of similar “unfortunates”, all young, all dead by the time we got them, every one seared into the memories of those who desperately and vainly tried to breathe life back into them. With those patients in mind we used to say we should change our job description to Corpse Pummellers.
Good dental health is not just a case of extractions, but banning general anaesthetics for these cases unless the adequate equipment and trained, experienced staff were in place, was a huge step forward. Seeing very young children facing extractions for toothache, sometimes whole mouth extractions, is a disgrace that amounts to parental neglect at the very least, but a return to the days when children died, or risked dying, to have baby teeth removed is not the answer.
Meg Henderson,
c/o Bell, Lomax, Moreton,
131 Queensway, Orpington.
I WAS saddened, though not greatly surprised to read DS Blackwood's letter (July 24) regarding the progressive run-down of services at the Vale of Leven District General Hospital ("the Vale"). I was involved with the management of the hospital early in the 1970s and again for 10 years from the mid-1980s. During this time services at the Vale were strengthened and a small number of extra consultants appointed. By the end of this period the hospital was certainly a going concern, although many more improvements could have been made.
The summary execution of Argyll and Clyde Health Board early this century brought changes in management and it seems that the arrangements made for the running of the Vale did not adequately meet the needs of a hospital in its position. Mr Blackwood suggests that one solution might be to reinstate this board, but this would not be sensible – the boundaries of the Argyll and Clyde board, determined by the then Scottish Home and Health Department when boards came into being in 1974, made no sense and were in the long term unworkable. I think I am right in saying that the axe-wielding minister who abolished the board later acknowledged that its task was not sustainable.
Mr Blackwood is absolutely right in saying that it is the Scottish Government's responsibility to fix the problem and that reorganising areas of responsibility is the solution. In other contexts it has shown itself able to override vested interests and to impose its will; but with the ball in the court of the present Health Secretary it is unlikely that any effective solution will be found
Andrew A Reid,
75 Glencairn Drive, Glasgow.
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