Document p2gJ9Kj47NQrVKjRzK1GqYp3k

B a l t im o r e C it y H o s p it a l s Fr e d e r ic G. Hu bba r d d ir e c t o r <4940 EA ST ER N A V EN U E BALTIMORE. MARYLAND 2 1 2 2 4 May 12,1969 IN REPLY REFER TO: D r, Robert A , Kehoe K ettering Laboratory College o f M edicine Eden Avenue C in cin n ati, O hio 45219 Dear Dr. Kehoe: As you a re doubtless a w a re, there Is considerable ferm ent and a ris in g demand fo r large scale screening o f young ch ild re n for e a rly d e te c tio n o f lead poisoning in the urban slum areas. It is th is and some o f the associated problems th a t prompts my le tte r to yo u at th is tim e . 1 am about to undertake an e va lu a tio n o f the various techniques w hich in c lu d e blood lead d eterm ina tio n , co nce n tratio n o f S -a m in o le v u lin ic a cid in urine and lead in h a ir. It is my personal opinio n th a t blood lead determ inations must remain the cornerstone o f any screening program designed for young c h ild re n . 1 b e lie v e th a t the e vid e n ce supports this p o s itio n . H ow ever, the re are some p ra c tic a l lim ita tio n s w h a ith is is a p p lie d on a la rg e -s c a le basis in young c h ild re n . The main fie ld problem , o f course, is the problem o f o b ta in in g adequate samples o f venous blood in ve ry young c h ild re n . This o fte n requires Jugular or fem oral p uncture w h ic h are o b v io u s ly im p ra c tic a l. There is also the p o s s ib ility o f resistance on the part o f the p op u la tio n to be screened by sam pling o f b lo od . W ith respect to the u rin a ry A L A test, a ll the evidence is not in but i t is e n tire ly possible that th is may be no more sensitive than a u rin a ry coproporphyrin test when a pp lie d to a random sample o f u rin e . W e hope to have the answers to these questions a t the co n clu sio n o f th is study. From the p o in t o f v ie w o f ease o f sam pling in the fie ld , the d e te rm in a tio n o f lead in h a ir seems most a ttr a c tiv e . From th e m e ta b o lic p o in t o f v ie w , how eve r, I kn o w th a t yo u have grave reservations w ith respect to the in te rp re ta tio n and meaning o f lead in h a ir. To d a te , the reported studies on lead in h a ir do not appear to be a d e q u a te ly c o n tro lle d . The procedure recommended is th a t o f K o p ito and Shwachman. They suggest th a t h a ir can be cleansed by b o ilin g and th a t i f the one or tw o centim eters closest to the scalp are taken for analysis, then the problem o f external contam ination can be m inim ized, i f not co m p le te ly e lim in a te d . I should g re a tly appreciate your thoughts on these problems and in p a rtic u la r, your thoughts w ith respect to the dete rm ina tio n o f lead in h a ir. K 0020251 _,jerf A . Kehoe 7 12, 1969 There may be some e vid e n ce on th is th a t I am n o t aware o f. I spoke b r ie f ly w ith D r. H a rrie t Hardy about lead in h a ir. She also has reservations about the v a lid it y and in te rp re ta tio n o f lead in h a ir. As I see i t , a mass screening program should be d ire c te d a t the e a rly d e te c tio n o f a m inim al increase in body lead burden. That is, d e te ctio n p rio r to the appearance o f e v i dence o f t o x ic it y . So the question is does lead in h a ir p ro vid e a sensitive e a rly in d e x o f the increase in body lead burden. I t w o u ld seem to me th a t w h a t we re a lly need is th e a b ilit y to determ ine lead in blood w ith reasonable accuracy on ve ry small samples, possibly obtained by c a p illa ry puncture. Y our thoughts on these questions w ould c e rta in ly be g re a tly a pp re cia te d . I lo o k forw ard to seeing yo u , perhaps a t some m eeting in the near fu tu re . Yours very sincerely, JJC iov J. Ju lia n Chisolm, J r ., M. D. KE 0020252