Document r47MJ1O0pr71kOQrq1pv3rEv

February 27, 1931 Dr* Morris Fishbein, Editor, Journal Amer. Med, Assn*, 555 H, Dearborn Street, Chicago, 111* Dear Dr, Fishbein: I am 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 X 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 Medical Association it seems worth while to point out certain rather misleading statements, I do this not in the inter est of obtaining apy 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 pojnt of view of the public 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 froze this cause, but also whether there is any evidence that men so engaged are absorbing appreciable quantities of lead. The evidence thus far has bees entirely negative. We have been unable to find cases of lead poisoning 2 from this cause, despite the existence of situations in which the prescribed precautions have in no way been 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 complaints 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 chat the precautions which have been prescribed should be followed to every extent possible, while the isvsstlgetion of the matter continues to try to uncovers the facts. It is our further hope that continuallycall ing attention to these precautions will have a ten dency to educate the puolic to regard ell gasolines as a source of danger* The inhalation cf gasoline in high concentration is dangerous* Gasolines in general are injurious to the skin and heve a tendency to produce dermatitis* There are certain individuals unusually susceptible to gasoline, who nave e consid erable difficulty with it as result of van a meagre exposure* Furthermore, the fact that many gasolines contain benzol brings about another hazard cf some consequence to gasoline handlers* Thus it is inad visable that gasoline- handlers and the public in gen eral, should believe tbst careless handling of gaso line or motor fuels is 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 cf potential danger and not the result of actual experience with capes of lead poisoning* If any cases of real or presumed poisoning have es caped our attention and have come to your'ettentlon, I should deeply appreciate any information tbst will The consequence of the above misinformation from the point of view of public health is not as serious as that which is contained In a further para graph, which states that there is llfttle lead hazard today in the painting industry, mb a matter of fact 3- painters still contribute the largest number of cases 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 hazards 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 recognized by the lay indi vidual that painting ia a dangerous occupation. It should also be recognized that some of the most 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, vrtiich has a tendency to give a false sense of account.of the activities of industrial physicians* It $e trueare many industries In this country In wh|^|i|l|e!||i'"hazards are very well controlled. It f|:s equfe||il|||||.'' there are an enormous number of Indus ||`lri|, M which the hazards are glaringly large, end |h there' is a very considerable inactivity bot|^0tif;#|ttihize to eliminate these hazards bn tkep&j of trial management, and equally on the part ofindus- physicians. That lead poisoning should]'till! continue to be the most frequent of Induetrialpoi- eons, Is a very good Index of the activity aai IklJOWl- edgeof present day industrial physicians. There is nbrlied hazard known which cannot be control!", te: sucha way as to practically eliminate lead poisoning ae on Industrial disease. \hen this fact is known It Is nb lees than e social crime that there should be . as much lead poisoning as there is* The situation exists by virtue of a placid attitude on the of the public, which Is salved Into the belief preventive medicine ia doing its job well regard. It is abetted by physicians who either do not know the facts, or are not ?ery much interested in them after they know them. I wish to assure you that there is nothing personal.in the somewhat caustic remarks that 1 have made. I am assuming that the purpose of these arti cles is to raise the educational level of the public in health matters. Such an article as this not only fails to do so, but defeats the purposes of education. |^1 0 4 3 16 -4 I therefore feel justified in criticising it &s severely as it deserves. Very truly yours RAK:EJ 'l l.: . iJ `J i ... .. 5. i* li \ 'I 0431