Baltimore’s efforts were only successful in removing lead from a small number of buildings, but those efforts demonstrated that if you looked for lead poisoning among America’s urban children, you generally found it.14 Because of Huntington Williams’s efforts, Baltimore provided the nation’s most startling evidence on childhood lead poisoning. This in turn prompted Maryland to pass a Toxic Finishes Law in 1949, which, one LIA spokesman noted, “made it unlawful to sell toys and playthings, including children’s furniture, finished with any material containing ‘lead or other substance of a poisonous nature from contact with which children may be injuriously affected’ unless such articles are so labeled as to show that the finish contains lead or other poisonous substance.”15 The LIA subsequently lobbied state officials to repeal the law and soon claimed success in 1950 when the governor signed the repeal: “The campaign to remove this 1949 enactment from the statute books of the state was brought to a successful conclusion,” the association trumpeted to its members.16 The law imposed a burden on its affiliates, the organization said,17 while its health and safety director, Manfred Bowditch, complained privately that “these young Baltimore paint eaters were a real headache.”18 Not surprisingly, the lead industry favored placing the burden for preventing lead poisoning directly on the family. “The only seemingly feasible means of coping with the childhood plumbism problem is that of parental education,” the LIA argued.19 This ran counter to some of the oldest observations about childhood lead poisoning, dating at least to the first decade of the twentieth century when A.J. Turner, one of the first researchers to document childhood lead poisoning due to paint, argued that public health could not rely on parental education; legislation was needed to stem the epidemic.20
By the 1950s Baltimore institutions were dramatically affected by the ongoing lead crisis. Indicative is the experience at one hospital in Baltimore, as summarized by Mark Farfel: “Ninety per cent of the children between the age of seven months and five years seen at the hospital’s outpatient clinics in a one year period in the early 1950s had blood lead levels greater than 30 µg/dl [micrograms per deciliter].”21 In an attempt to curb the further spread of lead paint, Baltimore’s health commissioner issued a regulation in 1951 that it would take other communities at least a decade to replicate: “No paint shall be used for interior painting of any dwelling or dwelling unit or any part thereof unless the paint is free from any lead pigment.”22
Huntington Williams meanwhile had begun looking beyond the seizures and deaths of children to speculate that “unrecognized plumbism, lead poisoning, in children may explain many obscure nervous conditions and convulsions of undetermined etiology.” His (correct) conclusion was that “lead poisoning is cumulative.”23 Even the LIA, in 1950, recognized that new problems were on the horizon: “As our hygiene activities have expanded, the magnitude of our industry’s health problems become more and more evident.”24 In 1953, the LIA said it collected during the previous year “nearly 500 newspaper clippings featuring lead poisoning, often in sizable headlines,” indicative of the greater role the press was playing in bringing the severity of lead poisoning to the attention of the general public. Internally, the LIA admitted that “childhood lead poisoning continued to be a major problem and source of much adverse publicity,”25 yet it still opposed warning consumers of the danger its product posed to children.
The continual refrain from the lead industry—that childhood plumbism could only be addressed through the voluntary action of parents—quickly grew stale for anyone who routinely saw the effects of acute lead poisoning. J. Julian Chisolm, then a young physician associated with Johns Hopkins Hospital, had much firsthand experience with the group of children that by the mid-1950s were unfortunately labeled “lead heads” by the young residents at the hospital. Chisolm took issue with the industry’s casual attitude toward what was obviously a serious medical problem affecting Baltimore’s children. In a study of children at the Harriet Lane Home, he and his coauthor, Harold Harrison, had inspected sources of lead contamination in homes and found, like Henry Thomas and Kenneth Blackfan more than forty years before, that the prime “sources of lead were windowsills and frames, interior walls, including painted paper and painted plaster, door frames, furniture and cribs.” Throughout the “dilapidated dwellings” where young children lived, Chisolm observed that “flaking leaded paint is readily accessible.” He took umbrage that the industry blamed parents for the tragedy: “While the responsibility of parents to protect their children from environmental hazards is not denied, no mother can reasonably be expected to prevent the repetitive ingestion of a few paint chips when these are readily accessible.”26
THE GROWING EPIDEMIC: FROM BALTIMORE TO THE NATION
As early as 1951, the American Journal of Public Health acknowledged both the centrality of Baltimore and Johns Hopkins in the unfolding story of lead-poisoned children and the reality of lead poisoning as a nationwide problem. It chastised the public health profession for not recognizing the extent of lead poisoning, sarcastically asking “whether babies brought up in the shadow of ‘the Hopkins’ develop peculiar alimentary tastes not common elsewhere” and arguing that “if such is not the case, perhaps other health officers have been missing something.”27 This was indeed the case in Chicago, where Robert Mellins, a young Public Health Service officer, uncovered an epidemic of childhood lead poisoning in 1953. Mellins had been assigned to Chicago in response to the continuing polio epidemic that terrified the nation in the post–World War II era. His first day in Chicago, he learned from local health personnel about what they feared was an outbreak among the city’s children of St. Louis encephalitis, a serious mosquito-borne neurological disease. Having been a medical student at Johns Hopkins in the late 1940s and early 1950s, Mellins was aware that lead poisoning was often mistaken for encephalitis, which led him to question the diagnosis and suggest the children be reevaluated. What he had come upon was, in fact, the first epidemic of lead poisoning in Chicago that would be recognized as such.28
In an internal summary of his LIA activities in 1952, Manfred Bowditch once again used the image of a “major headache” in what was emerging as a major national tragedy. Calling childhood lead poisoning “a source of much adverse publicity,” he counted 197 reports of lead poisoning in nine cities, of which 40 were fatal, but acknowledged that this was an “incomplete” estimate, especially for New York City.29 Others also began to notice the scale of the epidemic. Between 1951 and 1953, according to George M. Wheatley of the American Academy of Pediatrics, as reported in the New York Times, “there were 94 deaths and 165 cases of childhood lead poisoning . . . in New York, Chicago, Cincinnati, St. Louis, and Baltimore.”30 By the standards of the time, these were of course only the most acute cases, often life-threatening; lead poisoning that caused lesser damage was neither the focus nor in many instances even attributed to lead.
The LIA was caught in a bind. On the one hand, it had in its possession numerous reports from health departments demonstrating the widespread nature of the lead paint hazard. On the other hand, the association was fighting a rearguard action hoping to convince officials and the public that the number of lead-poisoning cases was exaggerated. To continue in this fight, Bowditch confided to an industry colleague, would be “prohibitively expensive and time-consuming.”31 Bowditch did not dispute that childhood lead poisoning could come from ingesting lead-based paint. But rather than concentrate on how to prevent lead poisoning—toward which a first step would be the elimination of lead from interior paint—Bowditch believed the LIA should focus on “securing more accurate diagnoses of lead poisoning or face the likelihood of widespread governmental prohibition of the use of lead paints on dwellings.”32 Robert Kehoe, the longtime head of the Kettering Institute at the University of Cincinnati, a research center established and funded by the Ethyl and General Motors Corporations in the 1920s, admitted in 1953