Document ym4J4R2G7gyRMwgxRew9p10N4

March 15, 1958 j M rs. Ana lourtallot A ssista n t to the E ditors , A T ex tb o o k o f M ed icin e . ,. 449 East Sixty-eighth Street New York 21, New York . , ; - ; m, i t .. . . r ... . ,-r 5 * : : .,, , . L j ,' M y d e a l A ir s. T p u r te llo t: . .. : . . ( ^ .. ; i attach h ereto a r ev ised lis t of. r e fe r e n c e s in com p lian ce with your note of M arch 11. Z sh ou ld a p p r e c ia te it i f you w ould b r in g th e fo llo w in g c o m m e n ts on the referen ces to the attention of D rs. C ecil and Loeb, sin ce they are en titled to som e doubts a s to why I did not include certa in r efer en ce s to the therapy of lead poisoning with edatham il in m y origin al lis t. I b eliev e the a rticle by v C hisolm and H arrison to be far the best d iscu ssio n of the c lin ic a l a sp ects of the m a tter, and so I include it without h esita tio n . I would have done so , on m y own in itia tiv e, but for the fa ct that th is a r tic le le a v e s certa in a sp ects of the m ech an ism , as w ell a s som e of the facts (with particu lar referen ce to the analytical data) in su fficien tly explored. N um erous other a r tic le s deal with certain item s of an alytical inform ation as though they w ere sufficient in th em selv es, and glo ss over the clin ica l observations, or m ake unwarranted assum ptions about them , forgetting,or perhaps not ra?Uzing, that m ost of the c a se s of industrial lead poisoning, of the type that are not s e r io u s ly d is a b lin g ,c le a r up s p o n ta n e o u s ly and s o m e t im e s w ith a s to n is h in g rap id ity, when ex p o su re i s term in a ted . In sh o rt, I v e ry m uch d isa p p ro v e of the la rg e portion of the ea rly crop of publications (e sse n tia lly u n critical ca se rep orts) on this subject for a num ber of both scien tific and practical reason s, and m any of the m ore recen t ones a re little b etter. The ground is covered , as w ell as it w ill be until a com prehensive, system a tic physiologic (m etabolic) exam ination of this subject has been m ade, by the one referen ce. C onsequently, I would u se th is r efe r e n c e , and then, p erh ap s, include the a r ticle by F orem an et a l, which I have listed for con sid eration , fo r the reason that it points out one of the dangers a sso cia ted with the uncontrolled and in d iscrim in ate u se of this agent. T his, I think, d espite the infrequency of difficulty, ju stifies som e attention. , A serio u s abuse is being perpetrated by certain physicians in the use of edatham il by mouth as a prophylactic procedure in substitution for apprppriate m easu res of industrial hygiene. I have spbken of this elsew here and, therefore HE 0020295 M r s . A nn T o u r te llo t - {Z} - M a rch 15, 1958 have om itted d iscu ssio n and reference,. H ow ever, because Belknap has reported certain attem pts of this type, calling them " em ergen cies, " and ap p aren tly not raco^ nirhip th at h is ...uts, as p u b lish ed , speak? le n d e r to m any d octors than does h is lip se r v ic e to good in d u strial h ygien e, 1 have been loathe to include h is clin ica l a r tic le am ong the r e fe r e n c e s, I reg ret the n ecessity of sneaking:of a p erson ality, but I cannot ignore the significance of an influence of this type. Unfortunately, there are sc o r e s of referen ces of a so rt, and the choice among them is d ifficu lt to make* I think, in th is situation it is n e c e ssa r y to provide either a very extensive list or a very sm all and non-controversial one. C ordially yours, HA it e f Enc. Robert A . Kehoe, M, U. KE 0020296 21, F ir st referen ce crossed out 1. C hisolm , J. J . , and H arrison , H. E . : The treatm ent of acute lead encephalopathy in children. P ed ia trics 19:1-20, 1957, (M ay he u sed if e d ito r s a g r e e , in -which c a s e the n u m b ers 2, 3 ,4 and 5 b eco m e 3, 4, 5 and 6. } 2. F orem an, If. , Finnigan, C ., and Lushbaugh, C. C. : N ephrotoxic hazard from uncontrolled edatha.m il-calciu m -d isod iu m therapy. J. A m , Med. A ssn. 160:1042-6, 1956. KE 0020297