Document mbdBZjpB88aBGxqjewXnRr6Gd

Pebruary 27, 1031 Dr* Morris Fishbeln, Editor, Journal Amer. Med. Assn*, 535 H. Dearborn Street, Chicago, 111. Dear Dr. Plahbein: 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 man 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 misleading 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 oause, but also whether there is any evidence that men so engaged are absorbing appreciable quantities of lead. The evidence thus far has been entirely negative. We have been unable to find cases of lead poisoning te n N 4042 -6** fro* this cause, despite the existence of situations In vhloh the prescribed precautions have in no way bean carried out. Our careful studies have further failed to show 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 publlo to regard all gasolines as a source of danger. The inhalation of gasoline in high oonoentratlon la dangerous. Oaaollnee in general are injurious to the akin 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 evsn s meagre exposure Furthermore, the fact that many gasolines contain banco! brings about another hazard of some consequence to gasoline handlers. Thus it is inad visable that gasoline handlers and the public In gen eral, should believe that careless handling of gaso line or motor fuels is a safs 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 theae precautions were a recognition of potential danger and not the result of actual experience with cease of lead poisoning. If any cases of raal or presumed poisoning hewe es caped our attention and have coaw to your attention, I should deeply appreciate any Information that will lead to the disclosure of further faots. The consequenoe of the above misinformation from the point of view of public health is not as serious as that which la contained in a further para graph, which states that thsre is little lead hasard today in the painting Industry. As a matter of fact n 006 7 II painter* 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 specifically 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 dangeroua occupation. It should also be recognised that some of the moet seri ous lead hasards in the community arise in connection with paint problems. Therefore, to advise the publio 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 false sense of security on account of the activities of industrial physicians. It is true that there are many industries in this country in which lead hasards are very well controlled. It is 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 hazards 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, is a very good index of the aotlvity and knowl edge of present day industrial physicians. 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 aalved into the belief that preventive medicine is doing its job well in this regard. It is abetted by physicians who either do not know the feots, or are not very much interested in them after they know them. I wish to a satire you that there is nothing personal in the somewhat cauetio remarks that I have made. I am assuming that the purpose of these arti cle* Is to rales the educational level of the publio in health matters. Such an article as this not only fails to do so, but defeats the purposes of education. I therefor* feel justified in criticising it as severely as It deserves. Very truly yours. RAX:EJ ter 1 00655