Document YGodM7aeLM2r5xvqZMYYdoRvN

E. C. Fis c h b e in , M. D. 620-630 F ID E L IT Y M E D IC A L B U IL D IN G DAYTON, OHIO A p r il 9 , 19oo D r.. Ilo b ert A. ehoe> U niversity of C in cin n ati, C ollege of m edicine, . C in c in n a ti, O hio. . " ly .d ear D octor E ehoe: Than-: you f o r y o u r l e t t e r o f A p ril 6 , - in w hich you c a l l my a t t e n t i o n t o y o u r f in d i n g s r e g a r d i n g th e t o n i c i t y o f t e t r a e th y l lead in th e q u a n titie s as o rd in a rily handled and th e r e la tio n o f th is to in d u s tria l poisoning. Vie, who do e x tra m u r a l p r a c t i c e i n c o n ta c t v .ith p a t i e n t s who m a n if e s t c l i n i c a l sym ptom s, c a n n o t depend e n t i r e l y on la b o r a to r y te c h n iq u e , and th e re a re tin e s trhen such a c t i v i t i e s a re q u its ' o u ts id e o u r f i e l d . T h ere a r e many c l i n i c a l symptoms w hich do n o t s l a v i s h l y depend upon la b o r a t o r y c o r r o b o r a t i o n . As yon know, t h e r e a re cases o f a tro p in and q u in in e p o iso n in g w ell known and c le a r ly defined occurring in su sc ep tib le in d iv id u a ls. 1 havs seen quinine p o is o n in g , i n p e rs o n s who hav e ta k e n two g r a i n s , t h r e e t i n e s a d ay , w here no la b o ra to r y c o rro b o ra tio n was a v a ila b le nor even needed; sim ply w ithdraw al of th e drug and th e subsidence of c lin ic a l symptoms b e in g s u f f i c i e n t to e s t a b l i s h th e c o n n e c tio n . I do n o t i n s i s t t h a t t h i s p a r t i c u l a r c a s e i s one o f te tr a e th y l lead p o iso n in g , b u t where th e re i s a c e rta in s e r ie s o f syhptom s, which have, in form er tim e s, been observed to occur in p o is o n in g by t h i s m a t e r i a l and t h e r e i s a t t h e sax' tim e a h i s t o r y o f exposure, no m a tte r to how l i t t l e o f th e drug, one cannot be considered e n tire ly unreasonable in c a llin g a tte n tio n to th is connection. 1 s h a ll read your pam phlet r a th g re a t in te r e s t, in f a c t I h av e r e a d some o f i t a l r e a d y . H owever, I f e e l t h a t C a n t. B ingnan, e v ery th in g co n sid e re d , w ill make an e f f o r t to e lim in a te th e use of th is m aterial a t the F ield as a reasonable precaution. I f th e nan makes a re c o v e ry l a t e r th e r e s t i l l w ill be room f o r d o u b t, and y e t one m ig h t f e e l t h a t th e i n t e r d i c t i o n o f th e d ru g may have played a p a rt in th e recovery. There i s a whole f ie l d o f m edicine in w hich th e re a re ill-d e fin e d syndromes, lo o se ly connected, w ith suspected id io sy n c r a s ie s , s u s c e p ti b ili tie s and a lle r g ie s which must be ta k en in to c o n s i d e r a t i o n by th o s e tvho do c l i n i c a l m e d ic in e , and t h e more one d o es, th e more one p r a c tic e s , th e more i s one in c lin e d to dicount, le a n in g h e a v i l y on t h e l a b o r a t o r y . I hav e n e v e r come t o t h e p o in t o f allow ing th e la b o ra to ry to assume th e m ajor ro le in d ia g n o sis, v a lu a b le a s t h i s s e r v i c e may b e . You c a n , o f c o u rs e ,- e a s i l y see t h e o u r p o in ts o f v ie w , p e r h a p s , d i f f e r s i n some r e s p e c t s . y. . .f - "uf? .;Y; :v oV*:- f ' - . 'y - ,`y X D r.ii.A .K . ,r2 A pril 9, 1935. # I s t i l l f e e l th a t th e use o f le ad g a so lin e should be fo rb id d e n and th a t t h i s nan shovild be removed from t h i s p a r ti c u la r job fo r a reasonable, le n g th -o f tin e , and th a t the lack of la b o ra to ry fin d in g s should not s e ttle th is n a tte r f in a lly . Y esterday I had a v i s i t from Dr. bchradin and h r. Hornan S ieb e n th ale r and I f e e l you are w ell re p re se n te d , as they p resen ted th e ir view of th e su b je c t in q u ite a se n sib le and reaso n ab le manner. 1 hope t h a t a t some f u tu r e t i n e , whoa you a re p erhaps i n v i t e d t o sp e a k to u s ag ain , i n D ayton on. some s u b j e c t o f i n t e r e s t to you, I m y have th e opportunity to discuss th is n a tte r w itlf you p erso n ally . I an Very s in c e re ly y o u rs , i'isc h b e in , h.D . Hi k/ f m i i .' O r -. . Y - ;,.v Y'Y r -*i