Document p2gnV71LX7nz81nZLR09d189w

November 1*5, 1941 Dr. Morris Fishbein Journal of American Medical Association 535 Horth Dearborn street Chicago, Illinois Bear Doctor Plshbein: I as writing :/ou about the paper ''Tetraethyl Load Poison ing, with Report of Cases" by Philip Work and Pagnar J. Neas, Denver, Colorado that you accepted for publication recently, and am communicating with you at the suggestion of Dr. J. F. Hammond, vdth whoa I discussed this matter last week in your absence from Chicago. ISy reasons for commenting upon this paper are three-fold: (1) There is a certain amount of misinformation in the paper that should be corrected; (2) Certain data of mine and Pr. Kehoe*s were used without our consent or acknowledgment and more importantly, without our comment upon them and our interpretation of their meaning; (3) The inferences that were drawn from our data are, I believe, erroneous and since our own data was misused in this fashion, I feci that the matter definitely culls for some comment and action. For your information, I will outline the manner in which we became interested in these cccea and the way In which the present situation arose. In February 1941, w were called by Dr. H. J. Hess of Denver, for advice on the treatment of a case of tetraethyl lead intoxication which was presumed to have arisen during the course of operations involving the blending of tetraethyl lead with gasoline. tr have had responsibility for the hygienic supervision of men engaged in blending operations and have previously reported (in the Journal of Industrial Hygiene) on the state of health of over 2,000 men so engaged. Since there has never been a case of lead poisoning or even 0021311 Dr, Morris Fishbeln - (2) November 15* 19^1 a measurable increase In lead excretion la that group of man, we were very such Interested in tabat seemed to be an unusual oircujMstance and went to Denver for the purpose of assisting With this case and of ascertaining the facts* While there, wo learned that this case of poisoning had coca# about a a the result of the operation of a small boot leg manufacturing plant and that a number of other individuals hud boon exposed during its operation* We arranged to examine the remainder of the employees, which examination 1 carried out in Dr* Hess* office* To my knowledge, Dr. Work did not see these cases, although he was the neurologic* consultant on the original case und assisted Dr. Bess In that patient*c management throughout the course of his illness. Following jay return to Cincinnati, Pr. Haas expressed the wish to present those c&aes to the students at the Medical dehool m& to the County Medical society. We were heartily in accord with this idea end sent Dr* Bess all of our clinical records and analytical data, together with certain interpretations* Since the case reports and analytical data wore our own, we expressed our desire at that tine to see and review any material that might be prepared for publication* After the materiel hud been used for presentation by Dr* Ness, it was some time later turned over to Dr. Work, who prepared the paper that you now have. We did not see this paper, nor to my knowledge did Dr* Hess see it in its finished form until a copy was sent him after it had been accepted for publication. I mention this latter fact to you merely to point out that though Dr* Hess* name is on the paper, what X have to say both above and subsequently ought not be taken as criticism or reflection In any way upon Dr. Hess* position in this matter* He has been and is moot cooperative, and in fact placed in our hands his copy of the paper as soon as feasible after receiving it* You can see that the manner in which this thing developed has created a very unfortunate situation* It is not the matter of credit that concerns us, but I li&ve a very strong reaction against what is obvious misuse of data* There are minor paints of error* The principal aberration which may be of significance, particularly from the medicolegal point of view, is the last conclusion in which the statement is made that organic lead intoxication may produce permanent clinical residua. Setting aside for Kf 0021312 Dp . Morris Fishbein - (31 - November 15* 19M the moment the origin of date in the paper, X 3hould like to point out that the patient was discharged from the hospital, improved, but not recovered, in April, and that Dr. Work's last examination vras in July* Considering the seriousness of the man's illness and the nature of his exposure, it would not be expected that he would make a clinical recovery in that short period of time. By no stretch of reason would one be justified in considering any lesion or functional disturbance that persisted for only four months after a serious illness as being, of necessity, a permanent clinical residuum* Our experience has shown that clinical symptoms may persist until the lead content of blood end excreta have resumed substan tially normal levels* In point of fact,, I examined this patient in company with Dr. haso on Tuesnay, November h, ana found no evidence of organic residua or of mental impairment* We are at the present time securing samples from this man find will have further information on the extant of his recovery cheaioally. Without regard to any of the foregoing const derations, a further point that must be made, namely, that the exposure of this patient was not due to organic lead com pounds alone, but there was in addition, oerious and significant; load exposure to Inorganic lead compounds In the form of dust and. lead fumes* While one could not say that these alone would be adequate to cause an encephal opathy, yet the sever exposure to inorganic lead com pounds made this case atypical in its behavior, as was noted on our examination records. It is well established that permanent residua my follow encephalopathy from inorganic lead compounds, but in none of our cases of organic load intoxication have there been organio sequelae. Since this patient had both types of exposure of considerable magnitude, it is quite apparent that some type of logical tour de force is necessary to permit of the last conclusion* I have labored these points and gone into the faetB with considerable frankness since wo feel it is proper to call upon you for advioe as to procedure. Were this entire difficulty merely a matter of interpretation of previously published results, it would not"be tit all difficult to express our opinion in the form of a letter that could appear at the time of publication of the article* Kfc 0021313 Dr. Morris Fiahbein - (4) - November 15, 1941 It is not so simple, however, and 1 believe you o&n wall realise that the scope of any letter that included all of the facts would of necessity have to involve soiae state ment thrt would tond to reflect rather seriously upon the authors. 1 would .not like to do that if e better way can be found. It occurs to us that since the paper has not yet hoen printed, it nay be possible to get the opinion of a reviewer personally acquainted with tills type of intoxication who could reconsider this paper in light of the ooratsent a that wo have made. \fe would Ilka vary nuoh to be apprised of your reaction. It is noossaary for " to be in Chicago from tirso to fciad and if you or Or. Hammond feel that anything oun be gained by further discussion, I shall nafco it a point to be there sose tim when you are available, Tory truly yours, ?y.:vr Tl'Iiard "'ifelchls H,,"ST 0021314