Group Title: History of Medicine lecture series
Title: "Always with us" : the lead-poisoned child in twentieth-century America
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 Material Information
Title: "Always with us" : the lead-poisoned child in twentieth-century America
Series Title: History of Medicine lecture series
Physical Description: Book
Language: English
Creator: Warren, Chris
Publisher: College of Medicine, University of Florida
Place of Publication: Gainesville, Fla.
Copyright Date: 2005
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Bibliographic ID: UF00095033
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.

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'Always
The Lead Poisoned


With
Child in


Us'?:
America


Christian Warren
New York Academy of Medicine






Introduction

* Origins of Brush With Death

Regional Differences


New England v. Florida,


ca. 1987






Introduction


* Overview of Study
*Three Themes:
Environmental
Occupational
Pediatric






Introduction

* Overview of This Talk
*Three "Histories of Lead Poisoning"
Q"Natural" History
SMedical History
Sociocultural History:
"the USES of a lead-poisoned child."





Natural History of Lead
Poisoning?

* Left to Nature--little lead poisoning


SGalena Ore








"Natural" History of

Lead Poisoning

* History of Exposure to

Anthropogenic Lead


106


105i-


- ^


Discovery of Introduction
cupellation of coinage
Rise and fall
of Athens
.---^ K^_


5500 5000


Silver
production I
Exhaustion in Germany
of Roman Spanish pr
lead mines of sil
in New


Roman Rep
and Empi
I I


public
ire


I I


4500 4000 3500 3000 2500 2000 1500 1000 500
Corrected 14C (solar) years before present


104


103


102


101

. O


Industrial
'evolution

oduction
ver
World






"Natural" History of
Lead Poisoning

History of Exposure to
Anthropogenic Lead

0.20 -

0.16 -

0.12 -

< 0.08 -
-
0.04


I 800 1750 1800 1850 1900 1950
B.C. ----- A.D. 1-
AGE OF SAMPLES





"Natural" History of
Lead Poisoning


* Routes of Direct Exposure,


Pre-1900


+ Food and Water Contamination





"Natural" History of
Lead Poisoning


* Routes of Direct Exposure,
+ Cosmetics


Pre-1900





"Natural" History of
Lead Poisoning

* Routes of Direct Exposure, Pre-1900
*Medicinal Uses




,I yft l ll,>l ,/4I V

YSICIAN HOME REMEDIES


Sceta
=Xq ME:.. ~ r







"Natural" History of

Lead Poisoning

* Routes of Direct Exposure, 1900-1945


The Drip of Solder...
i -
A


03266


*food adulteration


Ni


that puts a Cow in your Kit.h,*, Cupboard


... .- ,- ;.

NATIONAL LEAD <..w


":" . JtJ. ''"S 'i
." .1 "" 7.d:-.


."" --: !

*_-_.:.&s





"Natural" History of
Lead Poisoning


* Routes of Direct Exposure,



*food adulteration
*paint exposure


1900-1945


,l T i: S1A V z,,,,,,,, ^i I M? M*.Jtl H 'ai tl ,&.MEl a fir t l aap i


IIIVIF~OYBIlIW I





"Natural" History of
Lead Poisoning


* Routes of Direct Exposure,


1900-1945


*food adulteration
*paint exposure
*air pollution from lead-bearing
coal dust and industrial sources







"Natural" History of

Lead Poisoning


* Routes of Direct Exposure, 1945-


-" -S ",A


* '-',.. 1-


+ Car Exhaust


I/h I t'i1m IS

SCOMhl'KRI )N
* rr ,

A. ., .I
bunion 1 1 I , .


h i-h. e .. 1 I .i L'r I r .- , .. ir I.

A, .. .. ...... .. ,
r .-. ". i '. i .. I .. i
l r r. ,r , ,,l r r ., i ,

hi hel r ,.. 1, .. ... . r '* ,
r .. .






ETHYL
GAS LINE
l;,j,,, . h I I, I. .


*Tetra-ethyl Lead


*Introduced in the 1920s


'I.






"Natural" History of
Lead Poisoning

* Routes of Direct Exposure, 1945-


+Car Exhaust

*Tetra-ethyl Lead

*Introduced in the 1920s
Total
For Batteries *Takes off after World War II
n GasolineHappy Ending?

......*Happy Ending?


1800
1600
1400
1200
- 1000
. . .


2 600
. 400
200
1935 1940 1945 1950 1955 1960 1965 1970 1975 1980 1985
Year





Medical History of Lead
Poisoning

Mortality
1953, Robert Kehoe:
250 300 annual childhood fatalities
"at the minimum."





Medical History of Lead
Poisoning

Morbidity

Late 19th Century
Many names and many
forms:
dry gripes
dry bellyache
wrist drop, foot drop
plague of the Guts




Medical History of Lead
Poisoning

Morbidity
Late 19th Century
S iChronic forms implicated
in other conditions: Gout




Medical History of Lead
Poisoning

Diagnosis in the 20th Century
From symptom without measurement
to measurement without symptom





Medical History of Lead
Poisoning

Diagnosis in the 20th Century
*Clinical Symptoms
*severe abdominal complaints
*"Painter's colic," or the Dry Gripes





Medical History of Lead
Poisoning

Diagnosis in the 20th Century
*Clinical Symptoms
neurological symptoms:
local paralyses: potter's
foot; wrist-drop
*encephalopathy






Medical History of Lead

Poisoning


Diagnosis in the 20th Century

1oo0
: Clinical Symptoms (internal)
, Blood damage
:X-Ray evidence



10 **
!,; .-' Post -VWWII:

10Measurement of Lead in Blood
a SYMPTOMATIC PLUMUtSM
ASYMPTOMATIC

20 100 1000
pg Pb/10OmI WHOLE BLOOD
Fig. 1. Relationship between blood lead concentration and
6-aminolaevulinate (ALA) excretion in urine (mg ALA-U/m2/24
hours) In children
In growing cNildrn. ALA.U is significantly related to body surface rea (m'), The
normal daily output is <2 mg ALA-U/m'124 h and it Increases quite sharply as
blood lead concentration Increases from 500 to 800 ng of Pb per lite. The data
g9erally conlorrm to the classical S-shaped dose response curve (From CN-
solm. J J.. Jr. Barrett, M B.. and Mellis. E. ., J. Pedatr 7, 1152. 1975)





Medical History of Lead
Poisoning

Treatment
1900-1945: Reliance on "The Body's
Beautiful Mechanisms"

Since 1945 : Chelation
*British Anti-lewisite or BAL
*CA-EDTA
*Succimer






Sociocultural History:
The Uses of a Poisoned Child

I"t "Mm *t IW fmo f e W"" ttIn pm ere








ALE
IHITCHOCKS

TECHNICOLIOaI*
O TMlr JE5M ATANDY
MIUA E PI.SHEITE -.-F1PHEDREH
uAI I -





Sociocultural History:
The Uses of a Poisoned Child


*The Lead Poisoned Child as Exotic

*Boundary Markers
*Philadelphia : Murder by Buns
*Australia: Murder by Tropics and Architecture
*Japan: Murder by Mom's Cosmetics






9D uLlinjrir rW1,y/
fi; Us J cH Ji P -J^ ]jj Dnih]

Aside: Why Was Pediatric Lead Poisoning
Nearly Invisible?
-..'Dutch Boy Paint
and Special Susceptibilities Known
Question Book
women and children; workplace restrictions
Pitching Lead Paint to Kids

Some Factors:
1. Over-simplified "Toxicity": either you're
classically sickened or completely well.
2. Domination of the Germ theory.
3. Pediatrics not yet fully into its own





Sociocultural History:
The Uses of a Poisoned Child

The Lead Poisoned Child as Deviant
1920s to 1950s: Lead Poisoned Child Not Rare


o 0


:145-0O





Sociocultural History:
The Uses of a Poisoned Child

The Lead Poisoned Child as Deviant
1920s to 1950s: Lead Poisoned Child Not Rare

Blame Culture and Personal Behavior
*Children got lead poisoning by eating
paint
*Lead Poisoning is "caused" by the
behavior, not the paint
*PICA: the Magpie





Sociocultural History:
The Uses of a Poisoned Child
The Lead Poisoned Child as Canary
in the Urban Lead-mines


) 1940s- 1960s Health Departments





Sociocultural History:
The Uses of a Poisoned Child
The Lead Poisoned Child as
Rooster:
Not Pica, but Poverty Kills






Sociocultural History:
The Uses of a Poisoned Child


The Lead Poisoned Child as
"Our" Child


*Universal Threats
*Clair Patterson: lead in the environment


*Herbert Needleman: risks of "low level"
lead exposures


100
90
80
70
60
50
40
30
20
10


U
50 60 70 80 90 100110 120130140 150
Verbal IQ Score
Figure 1. Distribution of Verbal IQ Scores in Subjects with High
Lead Levels and in Those with Low Lead Levels.


---High lead
--o- Low lead






Sociocultural History:
The Uses of a Poisoned Child


A Success Story:
Reductions in New Universal Exposures


*solder
110
Cn -16
S16 *smelter emissions
a 100 .
,.--A A Lead Used in Gasoline 15
rgo 9- / *water fountains
a) -14 0
a** G' V'
s0o 8- 3 *|lead paint bans
8O 13~

70 12e
S70 -12 tetra-ethyl lead
:3 Average Blood Lead Levels .-
S60 -11

50 -10
I I I I
1976 1977 1978 1979 1980
YEAR







Sociocultural History:
The Uses of a Poisoned Child


Son of Success Story:



NHANESII


NHANES III Phase 1


0.10 0.19 0.29 0.39 0.48 0.5E
(2) (4) (6) (8) (10) (12)


S0.68 0.77 0.87 0.97
(14) (16) (18) (20)


I !
1.06
(22)


1.16 1.25 1.35 �1.45
(24) (26) (28) (230)


Blood Lead Level, mol/L (gg/dL)


20-


Oi


20-
15-
10-
5-


0 -
0


Illlllllkkl..-





Universal Screening

Success Leads to Failure?

*Federal Laws in 1970s Support Idea
of Universal Screening
*PHS, ca 1982: Recommends
Universal Screening
*CDC 1985: concentrate on "high-risk
groups.
*CDC 1991: "our goal is that all
children should be screened,
unless...
*CDC 1998: "Targeted Screening"





Targeted Screening


Two Examples from One Southern Town
*Son of lawyer in "historic" section

*Child in public housing





Is Lead Risk Overblown?

As Lead Levels Fall:
*Harm at lower levels discoverable
*Identifying the "one source" harder
*Clear indictment of Pb harder to
establish in individual child
*Universality seems to disappear
*Bracketing of victims Reappears










"like the poor, lead
poisoning is always
us . "


with




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