Old Paint: A Medical History of Childhood Lead-Paint Poisoning in the United States to 1980 (review)

Since Dr. Alice Hamilton's work in the early part of the twentieth century, lead-poisoning issues have been on the cutting edge of industrial medicine and health concerns in the United States. Peter English examines a century of lead-paint poisoning cases in a study that combines medicine and history to explore this disease that especially impacted children. He traces the "social construction of disease, technology and the definition of disease, therapy, and the effect of various public health measures: education, voluntary industry bans, labels, local bans, and federal laws" (p. 3). The resulting study is of interest to health-care professionals, to historians, and to a larger audience concerned with the ways in which technology can shape our perceptions of disease and its treatment.

English, a physician and a historian, focuses on two areas. First, he outlines the public's and the medical community's changing attitudes toward childhood lead poisoning. His idea that diseases evolve in accordance with developments in technology and science is of considerable interest. Before 1920, physicians reported few cases of childhood lead poisoning, and these were noteworthy for the symptoms the victims exhibited, including abdominal cramping, numbness or paralysis, anemia, seizures, even death. During the early part of the twentieth century, physicians paid more and more attention to domestic lead poisoning, particularly disease that was a result of children gnawing on cribs and other surfaces covered with lead-based paint. It soon became obvious that the solution to this problem was to keep lead paint away from children.

During the early 1950s there was, according to English, a "sea change in how pediatricians, public health officials, industry, and politicians thought about childhood lead poisoning" (p. 91). Social implications were evident as it became apparent that the "urban ecology" was changing. The most dangerous urban residences for children in terms of lead-paint exposure were those where previous middle-class occupants had replaced wallpaper with paint in an effort to achieve a more sanitary environment. Lead-based paint was viewed as a superior finish (the U. S. government recommended lead paint in its own buildings until after World War II) and was not dangerous so long as there was regular upkeep or repainting. After World War II, however, when many middle-class urbanites moved to the suburbs, their old residences were converted into multiple units for rental, and landlords were less likely to repaint on a regular basis. Many of the new occupants were African-Americans who had migrated from the South, where they had had no experience with lead paint because housing for poor blacks was "rarely painted" (p. 108).

In the 1950s lead poisoning became a treatable disease through drug therapy. More sophisticated testing enabled physicians and public-health officials to identify potential health problems related to lead-paint poisoning even when no specific symptoms were in evidence. Because of the combination of better testing and a renewed understanding of the sources of lead-paint poisoning, in the late 1960s "childhood lead poisoning exploded as a major national epidemic" (p. 151).

English's second area of emphasis involves the role of the lead industry, and he puts forth an interpretation that is in sharp contrast to those advanced by Christian Warren, in Brush with Death (2000), and Gerald Markowitz and David Rosner, in "'Cater to the Children': The Role of the Lead Industry in a Public Health Tragedy, 1900-1955," American Journal of Public Health (2000). In English's view, the lead industry was quick to recognize the effects of lead paint on children and acted swiftly to counteract them. He emphasizes the pivotal role of Robert Kehoe at the Kettering Laboratory for Applied Physiology in Cincinnati. With his close ties to the Lead Industries Association (LIA...