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in which the authors state that my report of experience with 2 patients "appears to have been unduly alarming."Our 2 patients, both maintained at hypoprothrombinemic levels within the range recommended by Dr. Wright, underwent dental extraction performed by the chief of the dental service of a VA hospital. In both our patients, bleeding could only be controlled by returning the prothrombin level to normal by the use of vitamin K1 oxide. In view of a fall in the hemoglobin level from 14.0 to 7.1 gm. per 100 cc. before appropriate therapy was instituted, we feel that 1 patient might have died of exsanguination. It should be emphasized that this same patient who hemorrhaged profusely following 2 separate extractions under hypoprothrombinemia had no difficulty after a third similarly performed extraction with normal prothrombin levels.We have since observed a third patient with similar results.Our findings prompted us to suggest that longterm anticoagulant therapy be discontinued briefly at the time of oral surgery. We recognize the danger of embolism, but this has not been reported in the short period during which we advocate stoppage.The above comment was referred to the authors of the article cited, and they have submitted the following reply.To the Editor:\p=m-\Inthe interim since the preparation of the paper referred to, we have continued to conduct dental extractions while patients have been under therapeutic levels of anticoagulant drugs. This markedly decreases the risk to many patients suffering from thromboembolic conditions. This procedure has been carried out in approximately 50 additional patients without complications. In our paper we described the control of the therapy and surgical techniques which has proved to be safe. We recommend that others adopt this approach. The fact that the conclusions of Ziffer et al. have been requoted and "condoned" by others has not contributed new knowledge. On the other hand, the original paper and the recent letter of Dr. J. M. Askey (JAMA 176:746 [May 27] 1961) are based on actual experience with this problem.This technique is now being widely adopted in leading medical centers.To the Editor:\p=m-\Whena 64-year-old male notices gradual onset of moderately severe, continuous, deep-seated, pressure-type substernal pain which lasts several hours and is associated with pallor, air hunger, and weakness, attention naturally centers on the heart. But, when physical examination, electrocardiogram, and other laboratory tests are negative for cardiac involvement, it may be well to inquire into the patient's gardening activities immediately preceding onset of symptoms. Such a case recently came to my attention. Onset of symptoms began about 3 hours after the patient had spread calcium arsenate (crabgrass deterrent) on his lawn. Blood arsenic level was 330 mg.%. (The normal level is variously given as from 0 to 60 mg.%.) Arsenic was also present in the urine. Approximately 32 hours after exposure to the arsenic compound, slight nausea occurred followed by 3 loose, watery stools....