Document JrMNRbwrayjenNmnLp5eL2EKK

:'-T-v-x August 21, 1973 Ervin B Shaw, M.D. Departraent of Pathology Meuical University of South Carolina 80 Barr Street Charleston. South Carolina 29401 X r\L Dear Doctor Shaw: I hasten to answer your letter of August 17 - that is "hastening" by my own definition of the word, since time nas slowed up a bit for me in recent years. I am skeptical, in relation to your attitude toward the diagnosis of lead poisoning, following the death of an adult, in whose case no diagnosis has been arrived at during life. (Since you did not refer specifically to lead poisoning in earljr childhood, I assume, possibly erroneously, that you are speaking of the deaths of adults). Let me say, at the outset, that the diagnosis of lead poisoning in the ^dult is made not at the autopsy table, or only very very rarely, if at all. The reason is that fatal lead poisoning in the adult is a great rarity, and also that there are no pathological findings (other than chemical analyses) which are pathognomic or even suggestive of plumbism after death. Furthermore, as a former experienced pathologist, I would suggest to you that it is .highly unlikely that anJr such lesions will be found. Cerebral edema may well be associated with fa af lead poisoning in children and even in the adult, but it is also associa ed with many other things, and, hence, is not, in any sense, specific. Actually, the knowledge of the quantities of lead in the body and of their distribution in the body is indeed much the most valuable information to nave in connection with fatal lead poisoning - which is a very raie situation, except in the case of the infant of three years of age, or slightly more and very slightly less. The prodiem of diagnosis in lead poisoning has been investigated fairly thoroughly in the case of both infants and adults, and while it is not well recognized among clinicians.and pathologists generally, the facts are better understood in our time am<dng persistent students of the subject, than they have been at any prich time. > I'll be glad to supply you with references on the subject. It will take a bit oi time to do this, but I'll get suitable references together shortly and send them to you. I assume that you have access to a satisfactory medical library. I'll also send you a few of roy papers on the subject shortly. Sincerely yours, N6301 Robert A. Kehoe, M.D. Professor Emeritus of Occupational Medicine /MENT OF PATHOLOGY 92-3821 Medical University ofSduth Carolina 8 0 BARRE STREET / CHARLESTON, SOUTH CAROLINA 2 9 4 0 1 August 17, 1973 ,, Robert A. Kphoe, M.D. Kettering Laboratory, University of Cincinnati College of Jfedicine Cincinnati, Ohio 45219 Dear D r . Kehoe: Sow having worried over several such cases, I am trying to find out whether anyone has formulated criteria for the diagnosis of lead poisoning as a cause of death in those cases in which the diagnosis was not suspected during life. The tip-off to the pathologist may be the finding of cerebral edema or later discovery of "lead inclusions" in the tubular cells of kidney. It is my impression that the inclusions are very strong evidence that lead poisoning was a great factor in the death. In my experience, I have uncovered several possible cases of lead poisoning but blood lead levels were not definitely outside published normal limits. I have noted your mdy publications in this field. Has anyone, in your opinion, properly addressed the above problem? If they have and the work is published I would appreciate the reference. Otherwise I would like your comments about the problem and the possibility of my beginning some work to solve it. Sincerely, EBS:sk Enrin B. Shaw, M.D. Chief Resident in Pathology N6301.01 'No-2418