Document ymVzmZg0YgYyBXKB194o4kYdV

Ba l t imo r e Cit y Ho s p it a l s Fr e d e r ic G. Hu b b a r d d ir ec t o r 4940 EASTERN AVENUE BALTIMORE, MARYLAND 21224 February 2, 1966 JN REPLY REFER TO: Dr. Robert A. Kehoe Kettering Laboratory College of Medicine University of Cincinnati Eden Avenue Cincinnati. Ohio 45219 Dear Dr. Kehoe: Thank you so much for yourj letter of January 24. 1 do believe that we are sub stantially in agreement on the question of "mobilization of lead". I am enclosing a reprint of an article I recently prepared. This expresses my thoughts on some ideas that we have discussed recently* In particular, 1 should be most anxious to have your comments on the portion of the reprint on page 5 that I have marked in ink beginning with the sentence "This is because BAL but not EDTA removes significant amounts of lead from the red ce Is................". ! might add that I am trying this idea out at present and it does, indeed, appear to be possible to maintain blood le;ad concentrations within the normal range immediately following their recovery from acute lead encephalopathy At present, we are treating the acute episode with BAL-EDTA and immediately following it with the institution of long-term oral penicillamine therapy at a dosage of 250 to 500 mg daily. At the moment, am interested to see whether w e are going to encounter significant drug toxicity, So far this has not been a problem. Indeed, it seems in some patients we were able to maintain blood lead con entration at a subnormal level. I am wondering whether this might accelerate the mobilization excretion of excess body lead in comparison with the rate at whicjh this process occurs normally. If it does not appear that we will encounter sdrious drug toxicity we plan to commence a study of this problem in a more formal fashion in the summer of 1966. I should be most appreciative of any comments yo'u care to make on this point. Sincerely yours, AAS/ A/ ' /Os ,> /J ..A J. Julian Chisolm, Jr., M. t). ^Associate Professor of Pediatrics Johns Hopkins University School of Medicine