Letters Received to H.H. Barker, December 13, 1934

THE UNIVERSITY OF WISCONSIN SERVICE MEMORIAL INSTITUTE MADISON, WISCONSIN ERNST A. POHLE, M. D., PH. D. PROFESSOR OF RADIOLOGY December 13, 1934 Mr. H. H. Barker c/o Robert Treat Hotel Newark New Jersey Dear Mr. Barker: I got on the train yesterday and also made connections in Chicago. On the way home I did a little thinking concerning some of the questions which were asked and of course being alone and in a quiet place I could analyze some of the things far better than while on the witness stand. The first thing I am doing, therefore, after I reached my office is to write you some of the results of my deliberations. You remember that among other things "histocytes" were said to be in the gastro-intestinal tract and take up some of the foreign bodies and carry them in the lymphatic vessels to be deposited then in liver, spleen or bone marrow. Granted that this is possible we should think of the analogy with the insoluble barium salt. Thousands of patients have been examined by x-rays after they swallowed barium salt and it stands to reason that barium being insoluble and acting like a foreign body should also be taken up by the histocytes and deposited in the 3 organs mentioned above. Many patients have numerous examinations while following up, for instance, the progress made in the treatment of a gastric or duodenal ulcer. There is no doubt that barium sulphate is radiopaque and there is also no doubt that radiologists would then detect these faint opaque shadows on a film. In other words when films are taken following gastro-intestinal examination one would expect small shadows in either spleen or liver representing small particles of barium sulphate carried there by the histocytes from the gastro-intestinal tract. Since there is no case on record and since we are looking for such minute shadows representing small kidney stones, small calcifications within the retroperitoneal glands or phleboliths (calcifications in veins), I believe it is obvious that if barium is at all taken up by the histocytes it is taken up in such minute quantities as to be insighificant. You know it does not take much barium sulphate to cast a shadow on an x-ray film. May I also mention in this connection that very often examinations are made with suspensions of barium sulphate for the very purpose of outlining the entire surface of the gastro-intestinal mucosa. We call this a relief picture. Mr. E. mentioned that if a suspension of that nature carrying an insoluble radium salt would thus be brought into contact with a larger surface of the mucosa of the gastro-intestinal tract a greater amount of resorption sould be expected. Since we see no barium shadows after the use of this method it stands to reason that the same conclusion must be drawn as from the swallowing of a larger quantity of barium sulphate. If Dr. Schlundt has not been called or has not finished his testimony I would recommend that you take this matter up with him and use it.