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

Warren’s study of lead poisoning serves as a window through which a major cultural shift in attitudes toward health, safety and risk can be viewed and analyzed. This shift “transformed medicine and health care and gave purpose and power to modern environmentalism,...altered jurisprudence” and profoundly affected social behavior. (p.2) Throughout the book, Warren places the various conflicts and debates in a social and political context, which serves well to highlight prevailing ideology and changing cultural values. More than a social history and cultural analysis, which almost get lost in the book, however, Brush with Death serves as an excellent historical policy analysis that could serve to inform current policy makers dealing with environmental threats to health. Warren uses a plethora of varied primary and secondary sources in this well researched study. In order to establish his analytical framework, Warren utilizes three major modes of exposure: occupational, pediatric and environmental. Limited to the twentieth century and a focus on lead-based paints and tetraethyl lead in gasoline, the study is divided into three parts. Part one (chapters 1–3) provides a general history of mankind’s use of lead and its production process worldwide as well as the symptomatology, pathophysiology, long term effects and treatment of lead poisoning while also tracing the role of environmental activists and changing interests of the American medical profession. Occupational exposure is the subject of the second (chapters 4–7) while the third section is devoted to pediatric and environmental lead poisoning.

One of the major themes, implicit in the second section, is the issue of industrial control over occupational health and its clear attempts to thwart government intervention. Warren identifies the cultural factors at the turn of the century that “pushed aside long-standing traditions about accepting risks and side-stepping responsibility” (p.66), forcing industry to address the problem. Those cultural values were manifested in the demands of social scientists, muckrakers and labor organizations that pressured for legislative action and greater industrial responsibility for occupational health. The result was the development of workmen’s compensation laws, ultimately placing the control of the industry in the hands of the insurance companies, thus avoiding government control. Although changing cultural values drove individuals demanding occupational health standards, it was industry’s concern for economic solvency that led to self-imposed regulations. Many of the improvements in occupational safety and health were due to the growing numbers of industrial physicians. Research conducted by industrial medicine professionals, funded by the lead paint industry, provided the scientific basis for industry’s claims that it could protect its own. Occupational health improved in the lead paint and leaded gas industries, but largely due to industry’s controls, not external mandates.

In the last and longest section, Warren discusses pediatric and environmental lead poisoning. By the 1930s lead poisoning had become associated with poverty, but after World War II, when people began to realize that what is unseen can kill, public health professionals and community activists had become increasingly concerned about lead poisoning. By the mid-1960s lead-using industries could no longer direct research and publicity as they had in the 1930s since industry outsiders provided additional scientific studies, bringing industries’ research into question. As a result, legislation passed in the 1970s that restricted lead based paint and leaded gasoline usage.

The study of lead poisoning illustrates an epidemiologic transition that shaped public health in America. In the early twentieth century emphasis was on acute and epidemic diseases with singular causes, based on the germ theory. That, as well as attitudes toward children in general, indicate that a changing paradigm of disease was crucial before environmental toxins would be recognized as a causal factor in children’s illnesses. Gradually those attitudes gave way to a focus on chronic endemic health problems that are multi-causal and associated with lifestyle diseases. Indeed, a new disease paradigm did draw attention to plumbism.

The strength of this book is...