Document 99MR3p3XEBnZod7mgX7zQxzX6

January 31, 1957 A ir M ail D r. D . Karr Grant 231 M acquarie S treet Sydney, A ustralia D ear D octor Grant: " You a r e rig h t, 1 think, in you r d e c is io n to obtain the eq u ip m en t fo r c o lle c t in g s a m p le s -of b lo o d fr o m th e B e c to n , D ic k in s o n C o m p a n y , and I b eliev e that our b est se r v ic e to you, in addition to the inform ation w hich you req u est, would be to send you a package containing som e of th is equipm ent. Since 1 am ju st about to depart on a trip to the W est C oast, 1 shall ask M r. Cholak to look after th is fo r you. You can r eim b u rse us for th is equipm ent w henever and how ever th is can be done m ost conveniently. In a n sw er to the q u estion in you r p rev io u s le tte r , 1 sh a ll d e s c r ib e the procedure which we have ad vised and w hich is being follow ed by the h osp ital sta ff. On confirm ation of the d iagn osis by an alytical m ean s, or p rio r to so doing, if the urgency of the c a se dem ands avoidance of d elay, E datham il C alcium -D isodium is ad m in istered fo r 5 days or perhaps fo r a w eek. About 2 w eeks la ter (after the distu rb ed m etab olism has sta b iliz e d som ew h at, fu rth er a n a ly se s a re m ad e. If the blood le v e l Is then above the danger point - 0 .0 8 M g. or m ore per 100 gram s of w hole blood, as determ ined by our m ethods of an alysis - a secon d cou rse of therapy is in stitu ted . The procedure continues in th is m anner until tht blood le v e l is at 0, 05 m g . o r la s s p er 100 g ra m s of olood , and until it rem ain s at or below this le v el a fte r a s e r ie s of check a n a ly ses at in tervals o f 3 o r -i w e e k s . ( T h is p r o c e d u r e i s to e s t a b lis h toe f a c t th a t th e "body burden" of lead has been low ered to the point at w hich the lead m etab olism w ill not perm it the lead content of the soft tis s u e s (including the blood) to r e a c h s ig n ific a n t l e v e l s o f c o n c e n tr a tio n . In th is c o n n e c tio n I m u s t c o r r e c t your b elief that the "m etabolism of stored lead" is influenced by acute toxic or febrile disease " M obilization ," so called , does not occur under th ese conditions. This idea, developed o rig in a lly by Aub and his a sso c ia te , a t H arvard has been exploded c o m p letely . It a r o se out of m is interpretations of analytical evidence at a tim e when our analytical p recisio n was inadequate to in v estig a te blood con cen tration s and u rin ary lea d e x cr e tio n . The seq u en ce . of event3 in a sso c ia tio n w ith EDTA th erapy r e v e a ls the in c o r r e c tn e ss of that id e a . When th is agen t is em p lo y ed , th e wit t is s u e s a r e fr e e d r a p id ly of N22321 t . e 1 00354 D r . D . K err Grant - (2) - January 31, 1957 th eir lead content to d ecreaain gly low le v e ls a s the therapy p ro ceed s. The sk eleton is la rg ely unaffected. H ow ever, in the period after therapy the lea d in the sk eleto n slo w ly reg a in s its equilibrium with the so ft tis s u e s , a s show n m oat read ily by the return of the blood le v e l to a higher point, if th e burden inthe sk e leto n is sig n ifica n tly high We have been unable t o influence the lead m etab olism in a sign ifican t m anner (i. e. to m ore than a v ery slig h t and p h y sio lo g ica lly unim portant exten t) by any oth er procedure than th^t o f using BAD or ED TA. A ctually an in crea se in the w ater throughput influences the lo ss of lead from the body m ore e ffe ctiv ely than does any other procedure em ployed with the two excep tion s referred to above. . R epeated co u rses of E datham il, w ith due care not to give over d osage, and with carefu l clin ica l and analytical su p ervision a r e , th erefore, in m y opinion, the proper procedure, until the blood le v el reach es a safe lev el and rem ain s th ere. This procedure follow ed up w ill also in su re that no recu rren ce of the exp osu re returns the child to his form er state. 1 tr u s t th at th e se r e m a r k s and our e ffo r ts o th e r w is e w ill aid you in yq.ur w ork. " '> Sincerely yours, / , RAK ef Robert A . Kehoe, M . D. , D ictated but not read. P . S. I have been in touch with the rep resen tative o f B ecton, D ickinson Com pany who w ill ad vise in about a w eek how the m atter of getting the equipm ent to you, b illin g , etcy When I h ea r, I w ill ad vise you. H ow ever, I have ordered 1 dozen each of V acutainer N eedles N o. 3200N, V acutainer P la stic H olders N o. 3200H, and Steri-tu b es and 100 V acutainer T ubes N o. L 3208 w ith sto p p ers, fo r b illin g d ir e c tly to y o u . E nclosed are "D irections for U se of B-D V acutainer." EF