Brush with Death: A Social History of Lead Poisoning (review)

Christian Warren. Brush with Death: A Social History of Lead Poisoning. Baltimore, MD: Johns Hopkins University Press, 2000. 362 pp. $45.00 cloth.

Christian Warren begins his fine work on lead in America with the fact—startling only because we often lose sight of it—that the United States is lead poisoned. Particularly the built environment is loaded with lead, from paint that continues to coat older buildings and from dust still contaminated from the days of leaded gasoline. Even with the chronic underreporting of lead-related diseases, it is clear, as Warren states, "Lead-induced brain damage killed or maimed untold thousands in the twentieth century" (13). Uncounted thousands of others lived lives with needless pain and metal impairment.

Brush with Death is the first general history of lead in American society. A revised version of his Brandeis dissertation, the book combines stories that have long influenced our understanding of the past from the occupational lead poisoning at the turn of the century, the rise of leaded gasoline in the 1920s, and the discovery of the juvenile lead poisoning epidemic in the 1960s. But this work is much more than the sum of these parts. With the disparate aspects of the lead story combined here, Warren can effectively argue that the lead industry, particularly in its ability to control research, "silenced by design" reporting about a century of poisoning (12). The industry's object, of course, was to ensure that Americans would continue to dwell on the utility of lead rather than on its toxicity.

Warren is a social historian, interested in changes in medicine, business, and technology, but primarily in the changing attitudes toward "health, safety, and risk" (2). Indeed, this project appears to have been inspired and guided by our current culture of risk aversion and specifically the relatively recent heightening awareness about the lethal qualities of lead. Although Warren hopes to shed light on broader changes in the society by tracing changing attitudes, his primary task is to explain how a well-known and widely used toxicant only gradually attracted adverse attention and only belatedly earned sufficient regulation.

Warren limits his attention to the twentieth century, noting that "lead did not attain popular notice or sustain professional concern in the United States before 1910" (8). Despite a focus on "America's leaden century" (26), Warren includes a brief but helpful deeper history of lead use. He particularly relies on Jerome O. Nriagu's (1983) Lead and Lead Poisoning in Antiquity and, like Nriagu, Warren emphasizes the utility of lead. Early users of the metal appreciated its toxicity even to the point of devising medical uses that relied on physiological reactions to lead. Warren also makes good use of Richard P. Wedeen's (1984) Poison in the Pot: The Legacy of Lead. A physician whose research helped spur stronger lead regulation, Wedeen focused on lead and renal disease, his specialty, but he also produced a history with much wider implications. Indeed, Wedeen's work and Nriagu's are part of that great social reaction against lead poisoning in the 1970s. Their work helped describe the long, international complacency concerning lead poisoning and the institutional resistance to change, even, as Wedeen has argued, among physicians (Sheehan and Wedeen 1993). Warren's work, on the other hand, can be seen not as a part of the broad social movement to reveal and diminish lead exposure but as a reaction to the strength of that effort and as an attempt to explain its timing.

Fittingly, Warren divides his attention along modes of exposure: occupational, pediatric, and environmental. Warren has a difficult task in weaving together three rather distinct narratives, in what he calls a "braided narrative," but despite the topical jumps the monograph maintains its integrity. Pediatric lead poisoning is perhaps the most important topic covered here. The first chapter on this issue is rife with unfortunate chronological skipping...