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

Christian Warren. Brush with Death: A Social History of Lead Poisoning. Baltimore: Johns Hopkins University Press, 2000. xiv + 362 pp. Ill. $45.00 (0-8018-6289-2).

What will a history of public health look like when it departs from models forged on acute, infectious disease and takes on those conditions so prominent in post-World War II practice, when awareness of subclinical toxicity was combined with a sweeping sense of toxins' environmental spread? Brush with Death, our first book-length study of the health debates over lead in this country throughout the past century, lays open this new terrain. A well-written summary of the flurry of scholarship on controversies early in the century, Christian Warren's book follows these stories to their climax over the sixties and seventies. Rather suddenly, this age-old poison turned out to present a far greater health threat than most had assumed. Headlines about a "silent epidemic" blared, federal legislation and money for research and policy ensued, as did plummeting assessments of how much blood lead was safe. Why? Historians of medicine and public health are indebted to Chris Warren for the most thorough and convincing explanation yet.

His choice of topic serves Warren well. No single toxin offers a better window on this mid-century transformation of public health than does lead. The most widely recognized and studied of early-twentieth-century poisons, it provided the single most important template for a science and practice of "industrial hygiene" that shielded the lead industries from health concerns or regulation from the thirties through the fifties. Warren narrates the managerial awakening to the pervasiveness of occupational lead poisoning late in the Gilded Age, spurred by social and legal change as well as by the physician-reformer Alice Hamilton. The medicoscientific approach then crafted by industrial hygienists genuinely improved conditions in many factories, Warren judges, but it also supplied medical cover for a manyfold expansion of lead's uses--most dangerously, as a gasoline additive.

Brush with Death adds to these stories a parallel one about the slowly evolving awareness of childhood lead poisoning, as well as a new argument about what helped drive the pax toxicologica of compromises between health professionals and corporate officials in this time. As Warren puts it, we were a "nation of white-leaders," smitten with the virtues of lead paint (p. 44). Consumerism (at least as imagined by the period's organized elites) ruled. The dangers and sacrifices involved, so long as these were understood to be confined to lead workers and a handful of inner-city children, were deemed worth the price. Even those few lead workers who unionized--painters--offered a bulwark of support for continued use of the toxic pigment.

Conversely, after World War II, lead poisoning proved the perfect target for a succeeding medical and public health generation less dependent on corporate than on governmental funding. Over this second half, Warren's story comes more fully into its own, through a panorama of topics that others have broached only in articles. Once physicians and public health officials defined what was distinctive about childhood lead poisoning, active case-finding and screening in a few cities showed it to be far more widespread than previously imagined. Over this same period, Clair Patterson and other scientists suspicious about lead beyond industrial areas discovered ways of demonstrating that these "background" levels were not as "natural" as Robert Kehoe (and others) had asserted. Neither were they as harmless: subclinical effects turned up at ever-lower levels, even as federal funds and standard-setting emerged over the 1970s. Nowhere were the new conclusions more dramatic than in Herbert Needleman's influential studies of the detrimental impact on children's mental development. This trend was further spurred, somewhat paradoxically, by the population-wide declines in blood lead following the ban on leaded gasoline. By the end of the book, as proposals for...