J. Julian Chisolm Jr., MD

James Julian Chisolm Jr. was born July 24, 1921, in Baltimore, the son of a doctor. He graduated from Princeton University in 1944 and earned his medical degree from Johns Hopkins University in 1946. He served in the Army Medical Corps from 1948 to 1950, discharged as a captain.

Dr. Chisolm joined the faculty at Johns Hopkins in the 1950s. In 1975, he became the director of the lead program at the Kennedy Krieger Institute, which is affiliated with Johns Hopkins, where he saw successive generations of Baltimore families treated for lead poisoning.

Dr. Chisolm is credited with saving the lives of hundreds of children with his introduction in 1968 of chelation therapy, which continues to be the primary way to remove lead from the blood in severe poisoning. In the treatment, chemical agents injected into the bloodstream bond with lead ions, forming a compound that can be excreted in urine.

As a pediatric intern at Johns Hopkins Hospital in the late 1940s, Dr. Chisolm was particularly horrified by the death of a girl shortly after her family moved into a house near the hospital. Within days of exposure to the house's peeling lead-based paint, she developed a brain fever. This experience shaped his lifelong crusade against lead poisoning.

In 1952, while at Baltimore City Hospitals, he started going door to door collecting stool samples of children living in East Baltimore to evaluate their exposure to lead. Four years later he published a study showing that the children had much higher levels of lead in their blood than had been suspected, because they had inhaled dust from crumbling paint or eaten paint chips. That study and others helped persuade cities, including New York in 1960, to ban the use of lead-based paint.

Dr. Chisolm also focused on prevention, testifying before Congress and other agencies against lead paint, influencing the passage of federal legislation in 1978 virtually banning the use of lead in paint and gasoline.

His work in helping devise a finger-stick test made it possible to diagnose the early stages of lead poisoning in children quickly and cheaply. As Dr. John F. Rosen noted: “His work was highly innovative in three ways: his use of chelating agents in treating children; his development with others of a single finger-stick test in screening for lead poisoning in the 1980s; and third was his persistent view that it was lead-based paint that was the overwhelming cause of lead poisoning in children, which continues to be true today.”

Dr. Chisolm served as the Principal Investigator at the Kennedy Krieger Institute clinical center in Baltimore and as a member of the TLC Steering Committee.

On November 23, 1992, Chisolm submitted KKI's Technical Plan to NIEHS in response to RFP NIH-ES-92-31.
Source: Featherstone v. Kennedy Krieger Institute, Exhibit 4.

On January 25, 1993, Chisolm wrote to Thomas R. Hendrix, Chair of the JHU School of Medicine IRB, regarding the protocol (RPN 92-11-19-01). In that letter, he noted that DMSA “is considered investigational” when used at lower blood lead levels, and that the protocol he submitted was “not likely to be the final protocol.” He also wrote: “In my view, the outcome of this study will not be determined by a single course of DMSA, but, rather, by the ability to suppress lead-bearing dust in the home over the long run.”
Source: Chisolm JJ. Letter to Thomas R. Hendrix, January 25, 1993. Featherstone v. Kennedy Krieger Institute, Document 28-32, Exhibit 28.

On February 9–10, 1993, the JHU IRB approved the protocol. Hendrix sent the approval letter to Chisolm.
Source: Hendrix TR. Correspondence to J. Julian Chisolm, February 10, 1993. Featherstone v. Kennedy Krieger Institute, Exhibit 12.

A KKI Lead Clinic progress note dated December 7, 1994, for a child referred to the TLC program states: “If she joins, that takes precedence over return to this regular Kennedy Lead Clinic.” The note is signed by J. Julian Chisolm, Jr., M.D.
Source: KKI Lead Clinic OPD Progress Note, December 7, 1994. Featherstone v. Kennedy Krieger Institute, Document 28-23, Exhibit 19.

In 2000, Chisolm published a study submitted to the FDA evaluating the safety and efficacy of DMSA in 59 children with blood lead levels of 25–66 µg/dL. The study reported that blood lead rebounded to a mean of 58% of pretreatment values after 26-day courses. Chisolm stated that “no conclusions can be drawn from this study regarding long-term beneficial effects, if any, of this drug on late neurocognitive outcome.”
Source: Chisolm JJ. Safety and Efficacy of Meso-2,3-Dimercaptosuccinic Acid (DMSA) in Children with Elevated Blood Lead Concentrations. J Toxicol Clin Toxicol. 2000;38(4):365-375.

Dr. Chisolm published extensively on lead poisoning treatment beginning in the 1950s. His 1968 introduction of chelation therapy for severe lead poisoning is credited with saving hundreds of children’s lives.

His clinical studies of DMSA (succimer) at Kennedy Krieger Institute were part of the FDA submission supporting the drug’s approval. The 26-day dosing protocol developed in those studies—1050 mg/m²/day for 5 days followed by 700 mg/m²/day for 21 days—was subsequently adopted by the TLC trial.
Source: Chisolm JJ. Safety and Efficacy of DMSA in Children. J Toxicol Clin Toxicol. 2000;38(4):365-375.

The clinical trials Chisolm submitted to the FDA included children with blood lead levels as low as 25 µg/dL (range: 25–66 µg/dL). All outpatient treatment required lead-safe housing; Kennedy Krieger Institute operated a rehabilitated mansion (“Safety House”) for this purpose.
Source: Chisolm JJ. Safety and Efficacy of DMSA in Children. J Toxicol Clin Toxicol. 2000;38(4):365-375, p. 367-368.

In a 1990 review, Chisolm demonstrated that DMSA produced comparable lead mobilization to CaNa2EDTA with negligible effects on zinc, copper, iron, and calcium excretion. He warned that “the potential benefits of even repeated courses of chelation therapy will be largely vitiated unless post-treatment exposure to environmental lead is drastically reduced.”
Source: Chisolm JJ Jr. Evaluation of the Potential Role of Chelation Therapy in Treatment of Low to Moderate Lead Exposures. Environ Health Perspect. 1990;89:67-74.