for this decline, we believe it is due to discontinuance of sales by these two particular sublicensees of stabilized iodized salt for human consumption to the armed forces. The declined tonnage shown by these two sublicensees in 1946 as compared to 1945 aggregated between 11 and 12 percent of the total tonnage. Very truly yours, WISCONSIN ALUMNI RESEARCH FOUNDATION. NEW YORK DERMATOLOGICAL SOCIETY, Mr. W. G. WILCOX, Chairman, Standardization Committee, Salt Producers Association, Detroit 26, Mich. DEAR MR. WILCOX: At a regular meeting of the New York Dermatological Society held on November 25, 1947, Dr. Paul E. Bechet stated that a bill authored by the Honorable Frances P. Bolton was pending before Congress, proposing the compulsory use of iodized salt for everyone in the United States; the bill further provided that all salt used in the production of canned and packaged food must also be iodized. In view of the fact that if this bill was passed it would mean a tremendous increase of iodic eruptions of the skin, thereby causing much loss of time from work through serious illness, lasting sometimes for several months, and in a few instances even causing death; Dr. Bechet moved, seconded by Dr. Rulison, that the New York Dermatological Society express its complete disapproval of this bill, because of the risks of greatly increasing the incidence of iododermas, through sensitivity from the universal and continuous use of iodized salt. The motion was passed without a dissenting vote. At the request of Dr. Bechet I am mailing to you the above copy of this resolution. Sincerely yours, JOHN C. GRAHAM, Secretary, New York Dermatological Society Mr. W. G. WILCOX, AMERICAN ACADEMY OF DERMATOLOGY AND SYPHILOLOGY, Chairman, Standardization Committee, Salt Producers Association, Detroit 26, Mich. DEAR MR. WILCOX: I was glad to get your letter of November 7, 1947, and I can assure you that I am familiar with every phase of this subject. In June 1 had a letter from Mr. Kurt Borchardt asking my opinion of this legislation. I wrote to him on July 1, 1947, that so far as I knew, dermatologists generally were against this legislation. I told him that I would secure an expression of opinion by the entire society at our annual meeting in December 1947. On the date of July 21, 1947, I had another letter from Mr. Borchardt calling my attention to the fact that a new bill had been introduced by Mrs. Bolton and that under this bill no iodine-free salt would be available in packages under 3 pounds. This whole subject will be brought before the academy members in December, and I shall be happy to communicate to you regarding the decision of the academy. As far as I personally am concerned, I am absolutely against this type of mandatory legislation. While I am not against the sale of iodized salt as it is being done at the present time, I am strongly against the proposed bill by Mrs. Bolton. If you still feel that you would like to come down to Buffalo to talk to me about this, I shall be happy to see you, although I do not know what more can be done at the present time. I am sure all of the medical arguments will be presented in the proper manner. Very truly yours, EARL D. OSBORNE, M. D.. Secretary-Treasurer. Mr. ARTHUR D. CONDON, Suydam and Condon, PHILADELPHIA 4, PA., June 26, 1947. Attorneys at Law, Washington 6, D. C. DEAR MR. CONDON: Replying to your letter of June 23 with regard to H. R. 2717, requiring that all table salt be iodized, I express the following personal views with regard to this matter. There would appear to be to be no peremptory necessity for subjecting all salt consumed by the public to an iodine supplement. The purpose of iodine supplements in general in table salt is to make good deficiencies which occur in iodine content of food in parts of the country far removed from the seacoast and long out of the ocean, so to speak. I can understand therefore why a more or less routine use of iodized salt might be suggested in the Middle West but I can see relatively little occasion, if any, for such universal use of iodized salt along the coastal areas, which include a large part of this country. I would direct attention also to certain deleterious effects of iodization which are now quite commonly considered to exist, particularly in the field of dermatology which is my specialty. It is well known that the disease, dermatitis herpetiformis, is made markedly worse by the administration of even very minute amounts of potassium or sodium iodide, and iodized salt is routinely excluded from the diets of such persons in the hope of benefitting them. It has also for some time been considered that iodine, which is well known to produce in susceptible individuals, eruptive manifestations of pustular type, is undesirable at least in the form of added supplement in the diet of persons with acne vulgaris and pustular eruptions of various types. A number of observers in this country have subscribed to this view, particularly in the New York group, and it is now a routine point of inquiry in taking the histories of acne patients, and a more or less routine exclusion of iodized salt is prescribed. Acne is an extremely common disease, especially in young persons, and the volume of individuals affected by what amounts to a forced ingestion of supplementary iodine might be very large. Speaking to the point of the general status of medical law-making of this sort, I may say that legislation to force all sodium chloride for table use to be supplemented by potassium iodide appeals to me as one of the worst types of medical crankism. As long as iodized salt is available in unlimited quantities to all who desire it, and uniodized salt likewise, it seems to me that the problem is one of education and not of legislation. As the matter stands at the present time, it has been shown, I believe by a special inquiry, that the individual who purchases salt at a grocery, if he asks for nothing but salt, gets iodized salt three times out of five. If such is the case, he certainly need not suffer from an iodine deficiency that can be supplemented in table salt, and there is no reason to force his neighbor to take iodine in this fashion unless it is deemed advisable that he do so from the medical standpoint. There are innumerable agents, including drugs, that if this type of legislation once gains headway, might be added to foods in a plan of forced therapy that would be wholly unjustified. I would like to protest, then, the passage of such a bill as H. R. 2717 as contrary to a wise public policy, medical expediency, and the medical facts above cited. DEAR MR. WILCOX: I am sorry to learn that proponents for the use of iodized salt have seen fit to support contemplated legislation in making the addition of iodine to salt obligatory on the manufacturer or distributor. It is well known to dermatologists that iodine, even in minute amounts, is injurious to some people. It is necessary frequently to advise patients with skin diseases to avoid the use of iodized salt and to avoid medication containing iodine. Even though the content of iodine in iodized salt is very small it is still harmful to an allergic individual and it would seem to me unsound to force people to use salt containing iodine in their daily dietary since it is so easy for anyone to obtain iodized salt who requires it. Iodized salt should be looked upon as a medicament to be used only on the advice of a physician. For the reason stated I believe that I express the opinion of the majority, if not all the members, of the American Dermatological Association in opposition to any legislation of the nature discussed. I was interested in the letter written by Dr. Stokes and am glad to indorse his statements and recommendations without reservation. I consider the legislation proposed as likely to prove harmful if enacted and as unnecessary and unwarranted, and I trust you will vigorously oppose it. Very truly yours, HARRY R. FOERSTER, M. D. DALLAS, TEX., October 28, 1947. Mr. W. G. WILCOX, Chairman, Standardization Committee, Salt Producers Association, Detroit 26, Mich. DEAR MR. WILCOX: I have read your letter of October 24 with considerable interest and I know that the vast majority of dermatologists in this country will oppose the addition of potassium iodide to all table salt. We have found by years of experience that iodine aggravates and intensifies practically all acne cases and this disease is present in 40 to 60 percent of individuals between the ages of 14 and 20, so that this alone represents a major problem and I for one, would of necessity have to prescribe sodium chloride CP on prescription for these patients. I believe at present time 80 percent of table salt sold contains iodine. We all see an occasional eruption produced by the iodine in salt and there have been many articles in the dermatological literature discussing this subject since 1926. Dr. Bedford Shelmire reported one leg ulcer produced by iodine in salt, and all of us have seen it aggravate cases of dermatitis herpitiformis. There have been cases reported of hemorrhagic nephritis with deaths from relatively small amounts prescribed medicinally. I feel certain that the American Academy of Dermatology in its session in December, will unanimously oppose this legislation and I, as a member of the board of directors and immediate vice president, will see that this receives attention. I am enclosing an article, Fatal Iododerma, primarily for the listed bibliography. I feel that legislation requiring iodine to be added to all table salt will produce far more harm than the goiter cases it will prevent. Sincerely yours, EVERETT C. Fox, M. D. ELIZABETH, N. J., November 24, 1947. Mr. W. G. WILCOX, Chairman, Standardization Committee, Salt Producers Association, DEAR MR. WILCOX: In reply to your letter of October 31, I beg to state that the public health would be threatened by the compulsory and continuous use of iodized salt. This is not an opinion, but a definitely proven fact, which can be ascertained by the reading of my two articles on the subject, and the testimony of many of my fellow dermatologists. These two articles, the first one read at the fifty-sixth annual meeting of the American Dermatological Association, June 8, 1933, and published in the Archives of Dermatology and Syphilology, volume 29, pages 529-536 (April) 1934, and the second published last June at the request of Dr. Marian B. Sulzberger, editor of the Journal of Investigative Dermatology, volume 8, No. 6, pages 407-417. Both these articles are in your possession and you have my permission to turn them over to the congressional committee for their consideration. The occasional bad results following the long continued use of iodized salt are known by all dermatologists, but totally unknown by those outside the dermatologic fold. Iodine, either as a prophylactic or as a cure for certain types of goiter, is an extremely valuable and necessary drug, and I would be the last to see it abandoned in the treatment of thyroid disease; but to force its universal and continuous use for a lifetime in the form of iodized salt for every inhabitant of the United States, despite the fact that millions of them remain free of thyroidism is inviting a tremendous increase in the incidence of acne, a skin diseases marked by papules, pustules, comedos, and unsightly scars, thereby occasionally militating against high-class employment. A more serious result of the universal use of iodized salt would be the great increase of severe iododermas, at times causing hospitalization for several months, and even death, from induced sensitivity caused by iodine contained salt and suddenly manifested by submedicinal doses of iodine. Under these circumstances the passage of this bill would be detrimental to thousands of individuals who have never had thyroid disease. I sincerely hope that the congressional committee will not take decisive action on this bill without eliciting the views of some of the leaders in American dermatology. Sincerely yours, PAUL E. BECHET. AMERICAN ACADEMY OF DERMATOLOGY AND SYPHILOLOGY, Mr. W. G. WILCOX, Detroit, Mich. DEAR MR. WILCOX: At the recent meeting of the American Academy of Dematology and Syphilology, the question of the Bolton bill was fully considered by the board of directors. After long discussion, the vast majority of the board decided that dermatologists were in favor of: (1) the use of iodine for the prevention of goiter; and (2) That noniodized salt be made available to the public on the same basis as is iodized salt. Consequently the following resolution was adopted by the board of directors and subsequently by the entire membership present and voting at the first executive session on Monday morning, December 8, 1947: "Whereas it is proposed to legislate effective means to provide on a national scale the use of iodized salt as a measure of public health in the prevention of endemic goiter; Whereas it is recognized that certain diseases of the skin may possibly be precipitated or aggravated by the ingestion of iodine or its sales: Therefore, be it "Resolved, That the American Academy of Dermatology and Syphilology go on record as approving such legislation on general principles providing that socalled iodine free table salt be not excluded from the market but be made available for the use of such sensitive persons. Very truly yours, EARL D. OSBORNE, M. D., Secretary-Treasurer. BALTIMORE 2, MD., November 22, 1947. Mr. W. G. WILCOX, Detroit, Mich. DEAR MR. WILCOX: In answer to your recent communication concerning making all salts commonly used in the kitchen and on the table an iodized salt, I thoroughly agree with the opinion expressed by your committee and by the dermatologists quoted. We note that you left out several important papers. One by Paul Bechet, Journal Investigative Dermatology, volume 8, page 409 (June) 1947, who cited 15 deaths due to injection of iodides. In my practice I see cases made worse by iodized salt, they were principally iodized acne and dermatitis herpetiformis. As to testifying before the Congress investigative committee, I do not find that that is very convenient unless it is possible to select one's time, because I do work on appointments and going to Washington requires at least 3 hours traveling time leaving from Baltimore. I suppose you have already contacted such men in Washington as Dr. Lee McCarthy, Dr. H. F. Anderson, Dr. James Q. Gant, Jr., etc. The only convenient time for me would be some pre-determined Thursday at about 3 p. m. Very truly yours, FRANCIS A. ELLAS, M. D. Mr. W. G. WILCOX, WASHINGTON, D. C., November 21, 1947. Chairman, Standardization Committee, Salt Producers Association, Detroit 26, Mich. DEAR MR. WILCOX: I am in full agreement with the opinions of Dr. Harry R. Foerster, Dr. Everett C. Fox, and Dr. John H. Stokes; and I shall be very glad to cooperate with your committee for the purposes of disapproving the compulsory iodization of all salt. Sincerely yours, NAOMI M. KANOF, M. D. WASHINGTON 6, D. C., November 21, 1947. W. G. WILCOX, Chairman, Standardization Committee, Salt Producers Association, DEAR MR. WILCOX: My position on the question of compulsory iodization of all salt is identical with that of the other men from whom you had letters. I shall be glad to testify at the hearing on this bill. Very truly yours, F. J. EICHNEHLAUB, M. D. LOS ANGELES 5, CALIF., December 2, 1947. W. G. WILCOX, Chairman, Standardization Committee, Salt Producers Association, Detroit 26, Mich. DEAR MR. WILCOX: I received your letter of November 21, 1947, regarding the proposed legislation to enforce the iodinization of most of the table salt used in this country. There are several skin conditions familiar to all dermatologists which may be either initiated or aggravated by the ingestion of iodine, even in fairly small quantities. Some of these, such as certain forms of acne, although of considerable cosmetic importance to the patient, are not serious. Others, however, such as dermatitis herpetiformis and iododerma are quite serious and deaths have been reported. In the year 1946 I became interested in dermatitis herpetiformis and with particular reference to the value of the iodine patch test as a diagnostic criterion. As a result of research I did at that time I found that approximately 31 percent of a large series of patients who presented various skin diseases other than dermatitis herpetiformis exhibited positive patch tests to potassium iodide, an iodine salt. I conjectured that one factor in this high incidence was the ubiquitous use of iodized salt. I am strongly opposed to any legislation which would require the universal use of iodine by people who suffer from no lack of this substance and who would be constantly subjected to the possibility of developing dermatologic diseases, either directly due to or aggravated by iodine ingestion. My conclusions in studying this problem have already been made a matter of public record in the June 1947 issue of Journal of Investigative Dermatology. If my contribution to the cause of fighting this legislation would be of more value if I appeared in person before the future congressional hearings, in view of the fact that the work I did in this field dates back about 12 years, I shall be pleased to do so. I am writing the Williams & Wilkins Co. of Baltimore that they have my consent to furnish you as many reprints of my article as you may require, with the provision that no portion of it may be used or distributed for commercial purposes. Very sincerely yours, DAVID N. ALCON, M. D. NEW YORK 21, N. Y., November 20, 1947. W. G. WILCOX, Chairman, Standardization Committee, Salt Producers Association, Detroit 26, Mich. DEAR MR. WILCOX: I am grateful to you for writing me in regard to the proposed legislation on iodized salt. |