C. Alan B. Clemetson

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C. Alan B. Clemetson, MD
Born 1923
Died 2006

C. Alan B. Clemetson MD, F.R.C.O.G., F.R.C.S.(C), F.A.C.O.G. (31 October 1923 – 30 August 2006) was a medical doctor, scientist and researcher. Throughout his life, he made numerous important scientific and medical discoveries and contributions, including publishing over 48 medical papers and a three-volume monograph on Vitamin C.

Dr. Clemetson was born in Canterbury, England, attending schools in England and graduating from Oxford University in 1948 with a Bachelor of Medicine & Bachelor of Surgery (B.M., B.Ch) degree. After graduation, he became a Royal Air Force medical officer for two years, and then returned to Oxford University in 1950 for a MA degree. In 1950, as a research assistant in Obstetrics, he started to pursue research into preeclamptic toxaemia and started to publish medical papers in 1953. In 1951-1952, he was named a Nichols Research Fellow of the Royal Society of Medicine. From 1952 through 1956, he served at various hospitals in England as the House Surgeon of either Obstetrics or Gynecology, and, in 1956, became a lecturer in Obstetrics and Gynecology at London University.

Dr. Clemetson immigrated to Saskatoon, Canada (1958 -1961), becoming an assistant professor of Obstetrics and Gynecology at the University of Saskatoon. Then, in 1961, he moved to California and assumed a position as an assistant professor of Obstetrics and Gynecology at the University of California Medical Center in San Francisco, and a lecturer in the Department of Maternal and Child Health with the University of California, Berkeley.

In 1967, he assumed a teaching position (1967–1972) as an assistant professor of Obstetrics and Gynecology with the State University of New York, Brooklyn. He also became the Director of the Obstetrics and Gynecology Department (1967-1981) at the Methodist Hospital of Brooklyn, New York. In addition (1972-1981), he served as a professor in the Department of Obstetrics and Gynecology at the Downstate Medical Center of the State University of New York, Brooklyn, New York.

Dr. Clemetson in 1981 moved to New Orleans, Louisiana, and became a professor of Obstetrics and Gynecology at Tulane University School of Medicine, and the Director of Obstetrics and Gynecology at the Huey P. Long Memorial Hospital, Pineville, Louisiana. He also became a consultant in Gynecology for the Department of Surgery, Veterans Administration Hospital, Pineville, Louisiana.

Upon his retirement in 1991, as a Professor Emeritus, Tulane University School of Medicine, Dr. Clemetson, with his experience and knowledge of vitamin C and histamine, devoted his remaining years to writing and publishing medical papers concerning the “Shaken-Baby Syndrome.”

Contents

[edit] Medical hypotheses

In 1964, Dr. Clemetson conducted and published the first studies[1] concerning ascorbic acid (vitamin C) metabolism and depletion in preeclampsia. Additional studies concerning the oxidative stress in the pathogenesis of preeclampsia have also been published, noting that ascorbate concentrations were 50% lower in preeclampsia relative to normal pregnancy plasma.[2] Preeclampsia is a toxic disorder producing high blood pressure, bloating, weight gain, vision changes, nausea or vomiting, and protein in the urine that typically occurs only during pregnancy and the postpartum period; and affecting the mother and the unborn baby. Preeclampsia and other hypertensive disorders of pregnancy are a leading global cause of maternal and infant illness and death. Preeclampsia usually occurs after 20 weeks' gestation during the middle or late stages of pregnancy. Preeclampsia, Pregnancy Induced Hypertension (PIH), and toxemia are closely related conditions. HELLP Syndrome and eclampsia, which cause seizures, are other manifestations of the same syndrome. [3]

After Dr. Clemetson’s retirement from teaching in 1991, he conceived and published four medical hypotheses. In 1999, he published “The Key Role of Histamine in the Development of Atherosclerosis and Coronary Heart Disease;”[4] in 2002, he published “Barlow's Disease;”[5] and in 2004, he published "Capillary Fragility as a Cause of Substantial Hemorrhage in Infants," [6] and also published “Elevated Blood Histamine Caused by Vaccinations and Vitamin C Deficiency May Mimic the Shaken Baby Syndrome.”[7]

In 1980, [8] he became the first person to conduct human studies on the relationship of histamine and vitamin C. This study demonstrated an inverse relationship of blood histamine levels with the levels of ascorbic acid in the human body. Two additional human studies in 1992 [9] and 1996 [10] not only confirmed Clemetson’s findings, but also determined that the consumption of 2,000 mg/day of vitamin C for two weeks was needed to significantly reduce the histamine level about 40% below the base line value. However, 500 mg of vitamin C daily, a level 4 to 7 times the most recent adult RDA[11][12] and still attainable in a carefully planned diet, does not alter blood histamine levels in healthy adults.

Clemetson in 1989 wrote and published a monograph consisting of three volumes entitled Vitamin C, including thirteen chapters involving histamine. [13] With the publication of his three-volume set on Vitamin C, many considered him an authority and expert on vitamin C. A study based on Clemetson’s 1999 hypothesis,[4] concerning histamine in the development of atherosclerosis and coronary heart disease, was published in 2002. [14] In conclusion, we found evidence that high total blood histamine is associated with confirmed CAD (coronary artery disease) and subsequent acute cardiac events and may prove to be a single excellent marker for atherosclerosis and coronary events.

The second hypothesis, published in 2002, concerned the “shaken-baby syndrome” as a variant of Barlow’s Disease, [5] or infantile scurvy -- with bruises, broken bones, and sores that will not heal. Barlow’s disease was a well-recognized condition in the first 75 years of the 20th century. Sir Thomas Barlow, MD, in 1883,[15][16] established the true nature of infantile scurvy. By postmortem studies (after death), Barlow established that subperiosteal hemorrhage (hemorrhage under the skin of the bone) was the anatomic basis for limb affliction in infantile scurvy.[17] To this day, Barlow's clinical description of infantile scurvy, with the appropriate pathologic correlation, remains a classic. Barlow stated that the extreme pain and tenderness seen in cases of infantile scurvy reflected bone pathology. Clemetson published additional papers concerning infantile scurvy, or a "variant of Barlow’s Disease", caused by toxic levels of histamine, and producing a weakness of the retinal vessels and the bridging veins and venules between the brain and the dura mater in infants, [18][6] and also published “Elevated Blood Histamine Caused by Vaccinations and Vitamin C Deficiency May Mimic the Shaken Baby Syndrome.” Clemetson points out that in early papers describing shaken baby syndrome, reference is made to the possibility of infantile scurvy. We now know that capillary fragility, so characteristic of scurvy, is the result of elevated blood histamine levels, which occur with even mild ascorbate depletion, as shown both in guinea pigs [19] and in human subjects. [13] The probability of Barlow’s disease can be increased by maternal malnutrition, by hyperemesis gravidarum (excessive vomiting in pregnancy), and by bacterial or viral infections in the mother or the infant. The retinal hemorrhages of severe hyperemesis gravidarum are a manifestation of vitamin C deficiency and are similar to petechial hemorrhages seen elsewhere.

Early electron microscope studies in 1961 by Majno and Palade [20][21] and by Gore in 1965 [22] demonstrated that toxic levels of histamine in the blood cause openings in the tight junctions between the vascular endothelial cells (lining of blood vessels), leading to extravasation (the forcing of liquid from a vessel out into surrounding tissue) of blood. The leakage of rat blood vessels occurred within minutes after the intravenous injection of histamine. Leakage of blood into the tissue slowly leads to local hemolysis, and also leads to local ascorbate depletion.

In 2004, Clemetson published two hypotheses. After reviewing Fung et al., [23] concerning the case review of nine infants, he states that Fung and her colleagues found no history of shaking or physical abuse of the patient, or in the infant's family, of the subdural hematomas reviewed. Clemetson questioned the causes of the cerebral hemorrhages, lesions, and delayed development, and published "Capillary Fragility as a Cause of Substantial Hemorrhage in Infants." [6] Based on his prior medical experience of 50 years in Obstetrics and Gynecology and his previous work with capillary strength, he states subdural hemorrhages can sometimes be detected by ultrasound examination before birth and even before labor. Never assume that bruises and broken ribs, or other broken bones, must always indicate trauma, because variants of infantile scurvy (or Barlow's disease) still occur today. No blood coagulation defect was found in any of the infants, so one has to consider capillary fragility as a possible cause.

The second hypothesis published in 2004 concerned "Elevated Blood Histamine Caused by Vaccinations and Vitamin C Deficiency May Mimic the Shaken Baby Syndrome." [7] A combination of ascorbate depletion and the injection of foreign proteins can cause a very high blood histamine level, leading to capillary fragility and venular bleeding. In 2006, he published another paper, [24] reviewing Caffey’s 1946 paper, [25] and found In addition to the long-bone fractures and subdural hematomas, other clinical signs consistent with infantile scurvy were evident in most of Caffey’s six cases. Another review of the early "shaken baby" literature was also conducted and published, finding that the bone pathology and subdural hematomas associated with Caffey's theory of the "shaken baby syndrome" are in fact typical scurvy fractures and bleedings.[26] Dr. Clemetson cautions the use of radiographs to determine scurvy: Although osteopenia and contrasting white lines of healing are said to be characteristic radiological features of classical scurvy, absence of these findings on radiographs does not rule out a scorbutic state. The precise time course of increased susceptibility to fractures and the development of osteopenia and white lines of healing seen on radiographs is not known. Bones may be vulnerable to fracture because of proline and lysine hydroxylase deficiencies (dependent upon vitamin C) affecting chondroblasts and osteoblasts before these classic radiological signs appear, especially if scurvy develops rapidly at an early age.[24]

Dr. Clemetson also based his vitamin C / histamine hypotheses concerning “the shaken baby syndrome” on bioengineering studies that have demonstrated since 1943[27] inflicted brain injury by manual shaking could not occur, before the appearance of cervical spine and neck injuries. A recent bioengineering study was published in 2005, [28] finding that forceful shaking can severely injure or kill an infant; this is because the cervical spine would be severely injured and not because subdural hematomas would be caused by high head rotational accelerations. Furthermore, shaking cervical spine injury can occur at much lower levels of head velocity and acceleration than those reported for the SBS. These findings are consistent with the physical laws of injury biomechanics as well as our collective understanding of the fragile infant cervical spine from (1) clinical obstetric experience, (2) automotive medicine and crash safety experience, and (3) common parental experience. We have determined that an infant head subjected to the levels of rotational velocity and acceleration called for in the SBS literature, would experience forces on the infant neck far exceeding the limits for structural failure of the cervical spine.

Although a Barlow’s disease variant may be the most common disease, other diagnoses such as fragile bone disease, hemorrhagic disease of the newborn (vitamin K deficiency), and glutaric aciduria type 1 must also be considered. Dr. Clemetson continues: No one should ever be accused of inflicting shaken-baby syndrome unless analyses for ascorbic acid and blood histamine have been performed and can be placed in evidence. To reduce the risk of Barlow's disease, we should consider the following: (1) Postponing inoculations for infants who are premature or ailing in any way, even with an upper respiratory infection; (2) reconsidering the wisdom of giving as many as six inoculants, all at once, to infants at eight weeks of age; (3) administering 500 mg of vitamin C powder or crystals, in fruit juice, to infants before inoculation; and (4) giving additional ascorbic acid by injection to any infant showing a severe reaction such as convulsions or a high-pitched cry.[6][29]

[edit] Published letters

The following Letters are highlights of the many eLetters Dr. Clemetson had published. See his Curriculum Vitae. for an extensive listing.

C. Alan B. Clemetson, M.D., et al. (2004) Re: “The evidence base for shaken baby syndrome” eBMJ 6 Apr 2004

  • "Shaken Baby", or Barlow's Disease Variant? 19 June 2004
  • "Toxic histaminaemia" 28 September 2004
  • “Subdural haematomas in infants” 22 October 2004
  • “Errors in the diagnosis of child abuse” 21 December 2004

C. Alan B. Clemetson, M.D., et al. (2004) Re: "The sudden death of a child" eBMJ 17 July & 26 July 2004

C. Alan B. Clemetson, M.D., et al. (2004) Re: "Review of Hear the Silence: Public needs to know why adverse reactions to vaccines occur." "The prevention of vaccine reactions." eBMJ 15 November 2004

C. Alan B. Clemetson, M.D., (2000) "The prevention of vaccine reactions." eJECH June 2000; 54:402-403

[edit] Achievements

Dr. Clemetson had a long and distinguished academic career as a medical doctor, scientist and researcher. During his forty year professional career, he implemented numerous scientific studies and was instrumental in furthering scientific knowledge. The following listed achievements are highlights of his life’s work that are contained in his extensive Curriculum Vitae.

Dr. Clemetson's most notable medico-legal achievement was as the father of the “Motherhood Bill”, which requires that all medical insurance carriers in the State of New York include coverage for pregnancy and complications of pregnancy. This so-called Donovan Bill rapidly spread to all 50 states.

    • University College Hospital – London – 1950-1952 / 1956-1958
      • Demonstrated the effects of cord around the neck and of preeclampsia on the oxygen saturation of newborn infants.
      • Published the first study of “small-for-dates” infants in his studies of “the difference in birth weight of human twins.”
      • Demonstrated impaired active transfer of amino acids from mother to fetus in preeclampsia.
      • Demonstrated aortic hypoplasia in some patients following severe early preeclampsia.
      • Performed and published successful open cardiac massage outside of hospital.
    • University of California Medical Center – San Francisco – 1961–1967
      • Bioflavonoids and catechins - Solved the old “Vitamin P” problem, by showing that bioflavonoids with certain structural characteristics act as indirect antioxidants for Vitamin C. See: Plant Polyphenols Monograph in New York Academy of Sciences.
      • Preeclampsia - Demonstrated a disturbance of ascorbic acid metabolism in preeclampsia and in abruptio placentae.
    • Methodist Hospital of Brooklyn – New York – 1967–1981
      • Developed a new method for measuring the bilirubin content of amniotic fluid.
      • In collaboration with the Department of Anesthesiology, he showed an improved oxygen saturation in the umbilical cord of blood of babies delivered by Caesarean Section under spinal anesthesia when the mother is placed in a left-side-down tilt position.
      • In collaboration with Drs. Mallikarjuneswara and Moshfeghi, he was able to measure the electrical charge on fertilized rat ova, and this was the first time that anyone had ever measured the electrical charge on any mammalian ovum.
      • He showed conclusively that women on the pill need more Vitamin C than usual, and, as a result of this, a special vitamin formula called “Feminins” was developed and marketed for women on the pill.
      • His research on the uterine luminal fluid in the rat showed that estrogen causes secretion and progesterone causes reabsorption of uterine luminal fluid.
      • In collaboration with Dr. J.K. Kim and others, he showed that the luteal phase of the human menstrual cycle is the reabsorptive phase, and not the secretory phase.
      • In recent research, he has shown that people with low vitamin C levels have very high blood histamine levels.
      • He was able to relate the above observation to abruptio placentae, as women with low ascorbate (Vitamin C) and high histamine levels are prone to develop premature separation of the placenta.
    • Tulane University School of Medicine 1981–1990
      • Wrote three-volume monograph on Vitamin C, published by CRC Press in 1989.

[edit] Work cited

Commission on Life Sciences - National Academies Press (USA)

[edit] Publications

Books

  • Vitamin C, Volumes I, II, III. Monograph by C.A.B. Clemetson, 1989 CRC Press, Boca Raton, Florida, ISBN 0-8493-4841-2

Journal articles

[edit] Past memberships in learned societies

  • Member of the British Medical Association
  • Fellow of the Royal Society of Medicine
  • Member of the New York Academy of Sciences
  • Member of the New York Obstetrical Society
  • President of the Brooklyn Gynecological Society
  • Member of the Medical Society of the County of Kings and Academy of Medicine of Brooklyn
  • Fellow of the American College of Obstetricians and Gynaecologists
  • Fellow of the Royal College of Surgeons of Canada
  • Fellow of the American College of Nutrition

[edit] Footnotes

  1. ^ Clemetson CA, Andersen L (Nov 1964). "Ascorbic Acid Metabolism In Preeclampsia.". "Obstet Gynecol" 24: 744-82. PMID 14227609. 
  2. ^ Hubel, CA (Dec 1999). "Oxidative stress in the pathogenesis of preeclampsia.". "Proc Soc Exp Biol Med." 222 (3): 222-35. PMID 10601881. 
  3. ^ Preeclampsia. Baby Center (March 2005).
  4. ^ a b Clemetson CA (Apr 1992). "The key role of histamine in the development of atherosclerosis and coronary heart disease.". "Med Hypotheses" 52 (1): 1-8 Review. PMID 10342662. 
  5. ^ a b Clemetson CA (Jul 2002). "Barlow's Disease.". "Med Hypotheses." 59 (1): 52-6. PMID 12160680. 
  6. ^ a b c d Clemetson CAB (Jul 2004). "Capillary Fragility as a Cause of Substantial Hemorrhage in Infants."" (PDF). Medical Hypotheses And Research 1 (2/3): 121-129. 
  7. ^ a b Clemetson CA (2004). "Elevated blood histamine caused by vaccinations and Vitamin C deficiency may mimic the shaken baby syndrome.". Med Hypotheses. 62 (4): 533-6. PMID 15050101. 
  8. ^ Clemetson CA (Apr 1980). "Histamine and ascorbic acid in human blood.". J Nutr. 110 (4): 662-8. PMID 7365537. 
  9. ^ Johnston, C.S. (1996). "Chapter 10) The Antihistamine Action of Ascorbic Acid", Ascorbic Acid; Biochemistry and Biomedical Cell Biology. Plenum Press, page 189. ISBN 978-0-306-45148-5. 
  10. ^ Johnston C S, Martin L J, and Cai X (Apr 1992). "Antihistamine effect of supplemental ascorbic acid and neutrophil chemotaxis.". J Am Coll Nutr 11 (2): 172-6. PMID 1578094. 
  11. ^ Higdon J. Vitamin C Micronutrient Information Linus Pauling Institute Micronutrient Information Center. 2006
  12. ^ Hampl JS, Taylor CA, and Johnston CS. (2004). "Vitamin C Deficiency and Depletion in the United States: The Third National Health and Nutrition Examination Survey, 1988 to 1994". American Journal of Public Health 94 (5): 870-875. PMID 15117714. 
  13. ^ a b Clemetson CA (1989). "V III Chapter 1-13", "Vitamin C" Histamine Metabolism. CRC Press Boca Raton, Fla. ISBN 978-0-306-45148-5. 
  14. ^ Clejan S, Japa S, Clemetson C, Hasabnis SS, David O, Talano JV. (Dec 2002). "Blood histamine is associated with coronary artery disease, cardiac events and severity of inflammation and atherosclerosis.". J Cell Mol Med. 6 (4): 583-92. PMID 12611642. 
  15. ^ Barlow T (1883). "I. On cases described as `acute rickets' which are probably a combination of scurvy and rickets, the scurvy being an essential, and rickets a variable, element.". Chir Trans (London) 66: 159-220. 
  16. ^ (December 17, 1983) "“Medical History - Infantile scurvy: the centenary of Barlow's disease”" (PDF). British Medical Journal 287. 
  17. ^ Rajakumar K (2001). ""Infantile Scurvy: A Historical Perspective”" (PDF). Pediatrics 108: 76. 
  18. ^ Clemetson CA (2004). "Was it "shaken baby" or a variant of Barlow's disease?" (PDF). J Am Phys Surg" 9: 78-80. 
  19. ^ Subramanian N, Nandi BK, Majumder AK, Chatterjee IB (Jul 1973). "Role of L ascorbic acid on detoxification of histamine.". Biochem Pharmacol 22 (13): 1671-1673. PMID 4147115. 
  20. ^ Majno G, Palade GE (Dec 1961). "I. The effect histamine and serotonin on vascular permeability. An electron microscopic study." (PDF). J Biophys Biochem Cytol 11 (3): 571-605. PMID 14468625. 
  21. ^ Majno G, Palade GE, Schoefl GI. (Dec 1961). "II. The site of action of histamine and serotonin along the vascular tree: a topographic study." (PDF). J Biophys Biochem Cytol 11 (3): 607-626. PMID 14468625. 
  22. ^ Gore I, Fujinami T, Shirahama T. (Oct 1965). "Endothelial changes produced by ascorbic acid deficiency in guinea pigs.". Arch Pathol 80 (2): 371-376. PMID 5319838. 
  23. ^ Fung ELW, Sung RYT, Nelson EAS, Poon WS (Jul 2002). "Unexplained subdural. hematoma in young children: is it always child abuse?". "Pediatr. Int." 44 (1): 37-42. 
  24. ^ a b Clemetson CA (Spring 2006). "Caffey Revisited: A Commentary on the Origin of "Shaken Baby Syndrome."" (PDF). J Am Phys Surg 11 (1): 20-1. 
  25. ^ Caffey J (1946). "Multiple fractures in the long bones of infants suffering from chronic subdural hematoma.". Am J Roentgen Rad Ther 56: 163-173. 
  26. ^ Scheibner V (Aug 2001). "Shaken Baby Syndrome Diagnosis on Shaky Ground."" (PDF). “Journal of the Australasian College of Nutritional and Environmental Medicine” 20 (2): 5-8,15. 
  27. ^ Uscinski R (Fall 2004). "The Shaken Baby Syndrome" (PDF). J Am Phys Surg 9 (3): 76-7. 
  28. ^ Bandak F (Jun 30 2005). "Shaken baby syndrome: a biomechanics analysis of injury mechanisms.". Forensic Sci Int 151 (1): 71-9. PMID 15885948. 
  29. ^ Clemetson, CAB (3rd Q 1999). "“Vaccinations, Inoculations and Ascorbic Acid”" (PDF). “The Journal of Orthomolecular Medicine” 14: 137. 

[edit] See also

[edit] External links

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