Document e1mmze5kXBEe2rZvkKewpXL2e

M ar ch 23, 1953 D r . PI. B r ie g c r P r o fe sso r of In d u str ial M edicin e an d D irector of the D ivision Th e Je ffe r so n M ed ical C o llege of P h ilad e lp h ia 1025 W alnut St r e e t P h ilad elph ia 7, P en n sylvan ia . Dear Doctor Brieger: I h ave been m o r e th an n egligen t, it w ould se e m , w ith out an y su ch in ten tion , in ackn ow ledgin g or com m en tin g on th e m an u sc r ip t an d oth er it e m s of in form ation on th e exp o su r e w h ich you an d your a sso c ia t e s h ave h ad w ith V e r se n a t e . C e r t ain ly I am gr at e fu l for the opportun ity of seein g th is m at e r ial. It is m ore than in t e r e st in g. Certain , asp e c t s of th e m at ter ar e open to qu estion in m y m in d , but your con tribution to the facts of the m atter ar e m uch m ore sign i fican t tlian an y o th er s th at h ave co m e to m y atten tion . I do n ot qu estion th e d ata p r e se n t e d , an d I th in k th at th ey ough t to be p u b lish ed . One tilin g th at b o th er s m e about th e situ ation is the sp eed w ith w h ich th e -lead in th e blood an d u r in e r e ach ap p ar en t ly n o r m a l , e v e n su b - n o r m a l l e v e l s {e . g . C a s e E ) . C o n sid e r in g t h e q u an tities of le ad th at ar e av ailab le u su ally , in c a se s of le ad poison in g, and the len gth of tim e r eq u ir ed n or m ally to elim in ate th ese q u an tities, the tim e se e m s e xce ssiv e ly sh ort. I h ave not m ade an y c a lc u la t io n s t o t h r ow ligh t on t h is p o in t , but I w ou ld e x p e c t , in m an y in stan ces, th at th ese le v e ls w ould sh ift b ack v ir t u ally to th e in itial h igh v alu e s, afte r th e ce ssat io n of t h e r ap y . The co m p ar iso n h e r e b e t w e e n t h e e ffe c t s o f t h is t h e r a p y an d t h a t o f BAL. sh o u ld be en ligh ten in g in d eed , an d I sh all be v e r y m uch in t e r e st e d in th is asp e c t of th e su b je ct . C e r t ain ly th e tim e fa c t o r s ar e d iffe r e n t , and I su sp ect th at the en tire p r o c e ss is d ifferen t. I am a lso in t e r e st e d in th e ap p a r e n t c lin ic a l b e n e fit s ac h ie v e d b y tire ap p lication of th is th erap y . I am n ot w h olly con vin ced by th e effect in du ced in th e c a se of th e blin d ch ild , sin ce r ath e r b iz a r r e clin ical b e h av io r , i .e . su d d en n ess of d r am at ic ch an ge, am on g ch ild r e n , in r elatio n to th is d ise a se , o ccu r s n ot too in frequ en tly. H ow ever, the ou tlook is fav o r ab le, an d th e t h er ap y sh ou ld ce r t ain ly be em p loy ed . Tim e w ill te ll the sto r y as adequate n u m bers of patien ts ar e tr eated . Th e fa c t t h at tw o o f th e t h r e e c h ild r e n d id n ot sh ow m u ch in w ay of p er m an en t b en efit, in th at th e se q u e lae w er e se r io u s, is n ot alto geth er u n exp ected in an y type of th er ap y . KE 0008633 * N9776 D r . H . Br ie g e r - 2 - M arch 23, 1953 One of m y a sso c ia t e s (D r. Ja m e s P . H u gh es) who r e a d th ere T ap e r s h as m ad e p en ciled n otation s at v ar io u s p oin ts in th e m an u scr ip t . I did n ot ask h im to do t h is, but it w as done fo r m y b en efit, an d I h ave n ot e lim in a t e d an y o t h e se n o t a t io n s, k n ow in g t h a t t h e y w e r e m a d e in en tire good faith and believin g th at th ey m igh t be u se fu l to th e au th or s. O b viou sly, I do n ot assu m e , for m y se lf or fo r ou r st aff,e d it o r ial p r iv ile g e s, and t h e r e fo r e I t r u st th at n eith er you n or th e au th or s w ill ob ject to th ese n otation s. I h ave u se d you r m a n u sc r ip t s to in fo r m c e r t ain of m y c o lle a gu e s in the p ed iatr ic se r v ic e s of th e C h ild r en 's H osp ital and the Cin cin n ati G e n e r al H o sp it al, in o r d e r to en cou r age th em to em ploy t h is t h e r a p eu tic agen t, d e sp it e som e u n fortu n ate e xp e r ie n ce w ith it in tw o in st an ce som e tim e ago. Th e se aso n is approach in g when we can exp ect to see so m e c a s e s , an d .1 h op e v e r y m u ch t h a t w e sh a ll b e a b le t o t e s t th e e fficacy of the agen t and so to add to the sto r e of evid en ce. In ciden t o ily , in n otin g th at th e ch ild fir st d e sc r ib e d b ecam e co m at o se du rin g the secon d p er iod of th er ap y , I can n ot fail to c a ll atten tion to th e fac t th at a ch ild t r e a t e d h e r e w ith th e V e r se n at e faile d to r e c o v e r after developin g som e com p arab le situ ation . W as th is a reaction to the th erapeu tic agen t? It is d ifficu lt to avoid th at con clu sion at p r e se n t. I retu rn th e m an u scr ip t , sin ce I su sp e ct th at you w ish m e to do so , alth ough you did n ot say so . If you in ten ded m e to keep th em for the p r e se n t , I 'll be glad to h ave th em b ack , alon g w ith an y oth er .in form ation now av a ila b le . P le ase accept m y th an ks for your cou rtesy . Sin cerely y ou rs, AAK ef Enc . Robert A. Keh oe, M. D.