Document nN9MmpM1Bj20D5Zd3EOOJB8xa

B O T T RESEARCH L A B O R A T O R I E S f LABORATORI ES NORTH CHI CAGO, I LLI NOI S entofPbarmacpbgy ^1IDK.RICHARDS,M.D.,F.A.C.P. February 15, 1949 Robert A. Kehoe, M.D. University of Cincinnati College of Medicine Cincinnati 19, Ohio Dear Dr. Kehoe: This is to acknowledge with much thanks your letter of February 5th and the reprints which arrived just today. I am \ indeed much obliged to you for the time and effort you took to explain your present viewpoint on lead poisoning, and I am very happy to have the copies of the valuable \ publication which I am sure will greatly help me in my particular problem. I noticed with special interest the change in attitude regarding deleading. I have always been puzzled about the rather vacillating reports in the literature, with some people favoring and some relegating such a procedure. I hope that within the next few months I will find a chance to write up a rough draft of a recommended treatment for the book on therapy to which I have been asked to contribute. I would consider it a privilege to send you this outline with the ;hope that j^ou will criticize it and correct if you find it materially wrong. 3 Thank you again for your kindness and cooperation. Sincerely yours, R K. Richards, M.D. Director of Pharmacologic Research February 5# 1949 Dr. R. K. Richards, Director of Pharmacologic Research, The Abbott Research Laboratories, North Chicago, Illinois. Dear Doctor Richards: I fear 1 am tardy in replying to your letter*of January 18, but at least I have nearly caught up with an accumulation of corres pondency which came in during or shortly after a brief holiday vacation. i In response to your request I am sending you under separate cover a series of reprints, and one official report of the American Public ------ Essociation. I commend the latter report to your attention, for ever; a certain sense of modesty does not deter me from saying that it is much the best publication available in the E n g l i s h or any other language,on this subject. Within it you will find/rather large number of references which have been classified to a certain extent. You will find a limited number of references to the treatment of lead poisoning. There is only one additional bit of information that I would add on the problem of therapy, to that which is given in this report. Since this report was prepared, experimental observations of a very critical type have been carried out in a rather large series of cases of lead poisoning which came t o our attention fortuitously. I am now prepared to say without any qualification, that there is no point in even talking about "deleading.n The idea as originally advanced by Aub and his associates was a very interesting one, and from the physiological point of view very intriguing and satisfying. Unfortunately, there is nothing in it. Our observations over a period of years have shown clearly that the lead and calcium metabolism do not go along hand in hand, but, we think, diverge decidedly under suitable circumstances. Retention of lead in the skeleton is not influenced materially by the absorption of large quantities of calcium over considerable periods of time, while the limination of calcium from the body does not materially influence the loss of lead from the skeleton. The efforts made to influence the calcium metabolism are, therefore, without effect on the elimination of lead. The influence of the'administration of BAL is quite another thing. This agent brings about a very prompt release of lead from the erythrocytes, and permits a very high level of urinary excretion of lead, over a period of some hours the response is highly dramatic, and from the physiological point of view thi3 is a most interesting phenomenon. Here again, however, unfortunately the total effect i3 that of the elimination of a few milligrams of lead over a short period of time, and since this therapy cannot be maintained long enough to remove any considerable proportion of the lead from the body, it is unimportant therapeutically. Some means may be found for using this PrinCip3_e tn either the prophylaxis or. therapy, Department of Pharmacol RICHARD K.RICHARDS,M.D,F.A; CQ < CQ J <. I o Dr. R. K. Richards - (2j - February 5, 1949 providing a less toxic compound such as BAL glucocide can be shorn, to exert its effect over a longer period of time. At present, however, this is merely a hope. We expect to investigate it when the opportunity presents itself. The influence of BAL on the clinical symptomatology of lead poisoning, in our experience, is wholly negligible. Since we have treated about twenty cases by this means, ve are quite prepared to say at this point that results of such therapy are of scientific interest and are of no special value to the patient. In short, except for the treatment of symptom^ as they arise there is no useful therapy for lead poisoning beyond the complete interruption of lead exposure. I might say in addition that lead poisoning is essentially a self limited clinical syndrome. Except for rare instance-3 of irreversible damage to some part of the nervous system, the cure of the disease is spontaneous and complete The outcome is influenced vei--y little on a time base or otherwise by any known therapeutic procedure. Cordially yours, RAK ef Reprints under separate cover. Hotiert "A, aeiiGs , M.' B 7 ers , o. 1*4 QS er *se er Q e*&*i H * ? 3 P* %erP> o-o P> c* O' 4p B 2 * - ^ c+ o et %15P* gHO. C* , BOTT RESEARCH POCOr5&,art,orCt<iof^aEwig.SviotjAi.t'&fa^f*i'^o8Vl.is T LABORATORI ES V* fe*4 P o parimentofPharmacology URICHARDK.RICHARDS,M.D,f.A.C.P. NORTH c+ p LABORATORI ES CHI CAGO, I LLI NOI S Kettering Laboratory of Applied Physiology College of Medicine University of Cincinnati Cincinnati, Ohio Gentlemen: I am in the process of reviewing the field of lead poisoning in order to edit a chapter for a new textbook on thera py. I am aware of the excellent work which has been done in your institution, by Dr. Kehoe and other members of the staff on this subject and would appreciate any recent reprints or references on the treatment of acute and chronic lead poi soning which you may have available. Any assistance you can give me in this respect will be most gratefully received. Very truly yours, R. K. Richards, M.D. Director of Pharmacologic Research RKRran Coxa ( p 4 i a ff 1 f." 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