Document DvGExR5ZMenD17RZLKa3nDz5a

December 23, 1565 James J. Chisolm, Jr., M.D. Johns Hopkins Hospital Baltimore, Maryland 21205 Dear Doctor Chisolms 1 am writing to ask a question concerning a statement which yon made, or which I thought you; made, at the Symposium on Lead in Washington, D.C. last week. The point is of considerably more than academic importance, and therefor. I'd like to be sure of my ground. For one thing, if it was meant as X and others took it to mean, it v/as a flat; contradiction of a. statement of mine made in an earlier1 discussion in the same symposium. This, in itself, is not unduly disturbing, but it was taken up fairly sharply by Harriet Hardy. X didn't think it directly relevant to the specific matters under discussion, and therefore X did not inquire of you at the time or take issue with either your statement or that of Harriet. I expected to Italic to you after the session, out this -was not feasible.! The;point is this. You seem to have said that acute infections in childhood plumbism Desalted in the mobilization of lead and in the exacerbation of the illness of the child With-lead poisoning. The question in my mind relates not tq the intensification of the illness of the sick child whijeh is altogether reasonable, but 'whether there is a recurrence of lead poisoning in the fully recovered child, and/Whether there is evidence that this may be due to the release of lead from its points of deposition or bonding in the! body. You are aware, no doubt, of the concept advanced by Aub and his associates at Harvard that the metabolism of lead is disturbed bir a variety of factors including infections and disturbances isk the metabolism of calcium and in the acid base equilibrium, etc. You may or may not be aware that this concept had its origin at a time when the analytical methods :culd be be applied to the urine and blood, and when the loss names J. Chisolm, Jr -2~ December 23, 1965 of lead from the living body could be followed only by analysis of the feces. The facts so obtained were misinterpreted and to make a long story short - the hypothesis chat arose therefoom has since been s hewn to be untune in practically all. respects, as 1 stated at the Symposium, we have not found it possible to cisturb the pattern of the distribution of lead in the tissues by any artifical means except one; namely - by the administration of certain chelating agents (Bflliand DDTA} t believe from certain reported facts that certain s evere forms of skeletal disiintegratioin, as OjSteoporosi s, . for example, can relieve significant quantities os lead. from' the $keleton. j. have no direct evidence that this is true, however, ip a series of careful observation, -we have never seen,any quantitatively significant "mobilisation of lead" in association with acutie infections in the adult or infant, nor have we found any such elects in alcoholic bouts, general anaesthesia, or acute toxic or infectious illness, dhat I'd like to know. It Ilt arefore, is Whether you have real evidence that acute infections in childhood plumbism affect the metabolism of- lead. That the course of illnessris altered, I do not aoubt, but is it fact or assumption based on the assumptions of others, hat the distribution of lead in the body is altered unoer these ccuastancesi \ 1 'Civ lot arguing the caste above, owe am inquiring as to v/hat you said and believe to be true. Our experience may not,have c overed all of the possible situations, and if it has not, I'd like to know more. 1 did not say that ouch things ca.unot occur, hue than we hda nor observed any such thing at or careful searon. valid answers cannot be given except c a the oasis of sound data. So far as I know, there are no s uch data in the literature. I shall be most grateful to you if you will let me know your views. I am entirely confident that these are certain obscuria biochemical phenomena, probably intracellular in character, that covert essentially inert (or inactive) laad into active(i.e., toxic) lead, and that this can occur with little or': no changes in the distribution of lead in the tissues, t have no idea what mechanism is involved in this, beyond the likelihood that bound lead ..becomes free (ionic) lead. KET i)015025 o ciints s CT * Chi ;olm, Jr. sinner ?65 With kindest regards Cordially yours. RBKsrras .cohort B Kehoe, HD 0150^6