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The Legacy of Well-Water Methemoglobinemia

John N. Lukens, MD
JAMA. 1987;257(20):2793-2795. doi:10.1001/jama.1987.03390200133028.
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THE LANDMARK ARTICLE1 reprinted in this issue of The Journal was written by a pediatric resident, Hunter Comly, MD, who was encouraged by Robert Jackson, MD, to seek out the cause of cyanosis in two infants referred to Iowa City from the surrounding countryside. Central to the mystery's solution was a theory advanced by the father of the first patient that implicated well water in his daughter's recurrent episodes of cyanosis. Respecting Dr Jackson's "open minded attitude" toward the "cock and bull theory," the young Comly had water from the suspect well analyzed and in so doing demonstrated that well-water nitrates were a cause of methemoglobinemia in infants. A survey of the nitrate content of water from Iowa wells clearly demonstrated the public health dimension of the problem. Neither Comly nor Jackson pursued their interest in methemoglobinemia: Comly became a child psychiatrist, while Jackson distinguished himself as a pediatric


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