Document OzDVZEmeNKL5mvxXORQwVzjOp

/ December 23, -1^65 Janies 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 you made, or which I thought you; made, at the Symposium on Lead in Washington, D.C. last weak. The point is of considerably more than academic importance, and therefore l'a like to be sure of my ground. For one thing, if it Has meant as I and others took it to mean, ' it. v/as a flat; contradiction of a. statement of mine made in an earlier1discussion 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 cither your statement or that of Harriet. I expected toj talk to you utter the cession, out chis -was not feasible.! T h e :point is this. You seem to have said that acute infections in childhood plumb ism ^resulted in the mobilization of lead and in the exacerbation of the illness of the child pith- lead poisoning. The question in my mind relates not tq the intensification of the illness of the sick child shilch 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 ijji 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 could be be applied to the urine and blood, and when the loss tfgl 00150E4 Uames 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 therefooiu 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 ox the distribution of isad in the tissues by any artifical means except one; namely - by the administration of certain chelating agents {TB/iL and iLTh) . T believe from certain reported facts that certain severe forms of skeletal disintegration, as osteoporosis, for -example, can relejasie significant quantities ox leaa from the skeleton. i:have no direct evidence that this is true However, ip a series of careful observation, we haye never seen,any quantitatively significant ksobilisatisan of lead" in association with acute infections in the adult or infant, nor have we found any such effects in alcoholic bouts, general anaesthesia, or acute toxic or infectious illness. V/hat I'd like to know, therefore, is whether you have real evidence that acute infections in childhood plumbisrn 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 or others, that tne distribution of lead in the body in altered under these cibcussfanc wtds* J. Uil lot arguing the case above, out am inquiring as to v/hat you said and believe to be true. Our experience may n o t ,have c overed all of the possible situations, and if it has not, I'd like to know more. did not say that ouch things ca m o t occur, hue than we haa nor observed any such thing aft r careful searca. 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) land 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 fraa (ionic) lead. KET 0015025 ?j\Ksnns DSGGiUDSr ^ 1965 Cordially yours. >eri a. Kehoe, MD. KH' 0150^6