restricted access Forum : "The Unbearable Heaviness of Lead": Comment
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Bulletin of the History of Medicine 78.1 (2004) 196, 198, 200

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John C. Burnham

A recent number of the Bulletin carries an essay about a book by Peter C. English, Old Paint: A Medical History of Childhood Lead-Paint Poisoning in the United States to 1980. 1 The essayist, Ellen Silbergeld, writes about the way in which a monolithic lead industry, to which she attributes anthropomorphized agency, managed a "successful manipulation of both history and science," including English's work. 2 She also maintains that English and another historian, Christian Warren, mistakenly deny the continuity of clinical plumbism with the subclinical syndrome of the post-1980 period. 3

English's book is a well-documented, carefully written, and nuanced narrative of a syndrome that has great interest for medical historians, without regard to the latter-day controversies on which the essayist spends most of her time. English, a very accomplished historian, is also a practicing pediatrician who has treated cases of childhood lead poisoning. His book makes two contributions. First, his is a history of medicine. And second, English puts the full record of published reports in the medical literature into the context of the time in which they were written. For medical historians, his is a particularly valuable addition to the historical literature, for it is quite different from other, more presentist accounts. [End Page 196] [Begin Page 198]

Anachronism and substantive misreadings distract Silbergeld from English's contribution. She treats children of all ages as equivalent, since lead was the poisonous substance, so that the clinical syndrome about which English writes is equated to that suffered by young people working in mines in the nineteenth century and to that of the children of five or six who were discovered to be victims in Queensland around the turn of the twentieth century. Indeed, the story of the Australian cases has a special literature, including a 1999 book by Allen Christophers that reinforces the point that those cases, for good reason, did not make much of an impact on American physicians dealing with very young children. 4 Or, again, the essayist cites a recent scientific publication on pica without indicating that quite independent research as late as the 1970s focused on behavioral patterns in ways that justified the opinions of informed clinicians of that day about the circumstances in which toddlers ingested lead. 5 Moreover, workers concerned with epidemiology raised serious questions about why people they identified by ethnic group suffered disproportionately, and a historian who today points out that people wrote about these matters in the past is not indulging in racism. Or to cite one more example of anachronism, the essayist perpetuates the confusing idea that labor legislation concerning lead paint was, in that day, consumer legislation.

An issue that Silbergeld does raise is whether or not historians can and should use evidence uncovered in the course of court proceedings. In the instance in hand, as far as I know, all such evidence becomes part of the public record accessible to all scholars. I cannot see that English has used any material not available to all of us, and in his diligent research he found a number of publications (always available) that previous scholars have not cited and that add depth to his analysis. The essayist also mistakenly suggests that Warren, in his book, was influenced when lawyers consulted him. In fact, the evidence and conclusions in his doctoral [End Page 198] [Begin Page 200] dissertation were only modestly sharpened, not reconceptualized, when it appeared as a book after he had spoken to lawyers. 6

I cannot match the high-quality scholarship of English's book with the rhetoric and tone of Silbergeld's essay. Examples abound on every page. English's explanatory diagrams for the novice reader are treated with inappropriate sarcasm. Associating the radical distinction between clinical and subclinical cases (made at the time) with antimedical social-constructionist controversies out of psychiatry, for example, is misleading. Similarly, it is gratuitous, as well as misleading, to line English up with Savanarola...