Document 2NbNGOO6pgjQrKkOx4XB9MOnN

Pebruary 27, 1031 Dr* Morris Pishbein, Editor, Journal Amer. Med, Assn*, 535 H. Dearborn Street, Chicago, ill. Dear Dr. Plshbeln: I aa taking the liberty of criticising rather severely a syndicated article which has appeared over your name in several newspapers, a copy of which was sent to me by a sun who Is familiar with the work which I and my associates have been doing and who felt that I might be Interested In the arti cle* I enclose a copy of It herewith* I do not ordinarily regard such articles very seriously, but 'since this one is given the authority of the Journal of the American Medleal Association it seems worth while to point out certain rather adsleadlng statements. I do this not in the inter est of obtaining any retraction, for in this I am not interested* It seems, however, that it is not wise to permit certain misunderstandings to contin ue in the minds of men whose influence is wide as that of important leaders of medical thought* There are three definitely misleading state ments in the article* The fourth paragraph makes the categorical statement that lead poisoning from anti-knock gasoline containing tetraethyl lead is one of the most serious forms* I and my associates, as well as certain members of the staff of the Unit ed States Public Health Service, have been studying this problem from the point of view of the publlo health and the health of gasoline handlers in the United States over some period of years* Every at tempt has been made to determine notoonly whether poisoning has resulted from this oauae, but also whether there is any evidence that men so engaged are absorbing appreciable quantities of lead* The evidence thus far has bn entirely negative* we have been unable to find cases of lead poisoning 6 E rV Lp' ( r I. i fro* this ca.ua, despite the existence of situations In whloh the prescribed precautions have In no way been carried out Our careful studies have further failed to shoe that men who are subjected to the most serious exposures of this sort are absorbing significant quantities of lead as a consequence of their occupation We have followed up numerous com plaints of injury, have investigated them carefully, and we see no evidence at this time to indicate that there have ever been any cases of lead poison ing as result of distribution of lead-containing gasolines We recognise that the matter has not been followed long enough so that It can be said with certainty that no danger exists Our feeling there fore, which is shared by the Public Health Service and also by various other persons whose experience and knowledge qualifies them to judge, is that the precautions which have been prescribed should be followed to every extent possible, while the investi gation of the matter continues to try to uncover the facts It is our further hope that continually call ing attention to these precautions will have a ten dency to educate the publio to regard all gasolines as s souree of danger. The inhalation of gasoline in high oonoentratlon is dangerous Gasolines in general are injurious to the skin and have a tendency to produce dermatitis* There are certain individuals unusually susceptible to gasoline, who have a consid erable difficulty with it as result of even s meagre exposure Pur thermo re, the fact that many gasolines contain bensol brings about another hazard of some consequence to gasoline handlers. Thus it is inad visable that gasoline handlers and ths public in gen eral, should believe that careless handling of gaso line or motor fuels is a safe proposition* It is partly for this reason that the precautions were issued in the form In which they now appear, and it should be understood that these precautions were a recognition of potential danger and not the result of actual experience with casee of lead poisoning* If any cases of real or presumed poisoning have es caped our attention and have come to your attention, I should deeply appreciate any information that will lead to the disclosure of further facts* The consequenoe of the above misinformation from the point of view of publio health is not as serious as that which is contained In a further para graph, which states that there is little lead hasard today in the painting industry. As a matter of fact -3- painters still contribute the largest number of eases of lead poisoning, and the serious and fatal cases of poisoning among them are all too numerous. The use of spraying methods has contributed considerably to this situation, and It may be safely said that spray painting Is today among the two or three most danger ous lead hasards In existence. This Is so much the case that where unions are strong, spray painting is speolfioally prohibited. Elsewhere, however, this practice continues, and takes a serious toll of life and health. It should be recognised by the lay indi vidual that painting is a dangerous occupation. It should also be recognised that some of the moat seri ous lead hazards in the community arise in connection with paint problems. Therefore, to advise the public Incorrectly in this matter is rather serious. I should take issue also with the last para graph of the article, which has a tendency to give a falae sense of security on account of the activities of industrial physicians. It le true that there are many industries in this country in which lead hasards are very well controlled. It le equally true that there are an enormous number of industries in which the hazards are glaringly large, and in which there is a very considerable inactivity both to recognise and to eliminate these hasards on the part of indus trial management, and equally on the part of indus trial physicians. That lead poisoning should still continue to be the moat frequent of industrial poi sons, la a very good index of the activity and knowl edge of present day industrial physiciana. There is no lead hazard known which cannot be controlled in such a way as to practically eliminate lead poisoning as an industrial disease. When this fact is known it is no leas than a social crime that there should be as much lead poisoning as there is. The situation exists by virtue of a placid attitude on the part of the publle, which la salved into the belief that preventive medielne is doing its job well in this regard. It is abetted by physicians who either do not know the facts, or are not very much interested in theai after they know them. I wish to assure you that there le nothing personal in the somewhat caustic remarks that I have made. I am assuming that the purpose of these arti cles Is to raise the educational level of the publlo in health matters. Such an article as this not only falls to do so, but defeats the purposes of education. I therefor feel Justified In criticising it as severely ae it deserves Very truly yours, RAK:EJ i 1 00655