FIGURES 3A.Children at risk, 1960s. During the War on Poverty, peeling and chipping paint became a symbol of urban blight and social inequality. Community activists and housing reformers were critical in pressing for improved conditions. Source: (a) Chicago Tribune, February 3, 1966, reprinted with permission;
FIGURES 3B.Continued_(b) New York City Housing Authority, Wagner Archives, reprinted with permission.
Community groups such as the Young Lords in New York (a largely Latino organization), the Citizen’s Committee to End Lead Poisoning in Chicago, the Black Panthers in Boston and Oakland, and the Harlem Park Neighborhood Council in West Baltimore, as well as others around the country, seized on this devastating disease, seeing it as a representation of the ills of a culture rather than as a product of nature. These groups began agitating for more testing of children, better enforcement of existing housing laws, poisoning surveillance and prevention programs by departments of health, and new laws to hold landlords accountable for lead hazards.74 Sometimes, the lead tragedy actually led to civil disobedience, as it did in New York City in 1970 when the Young Lords seized unused mobile testing vans and began door-to-door screening for lead poisoning while others staged sit-ins at the Department of Health.75 In 1969, Jack Newfield, an influential writer for the Village Voice, picked up the story and wrote a series of articles about lead poisoned children who had suffered irreversible brain damage, thereby putting enormous pressure on the city to strengthen housing codes against flaking and peeling paint.76
Community activism played an important role in bringing attention to lead poisoning and reducing its impact on poor communities, as Mark Farfel wrote in 1985, a few years before he would codirect the Kennedy Krieger Institute study: the “Great Society programs, including Medicaid, urban renewal projects, and food stamp and food supplement programs,” led to the identification and amelioration of lead poisoning in subtle ways that were “difficult to quantify.” Building on the public health model of an earlier time, in which social reform was viewed as essential to effective public health efforts, Farfel noted that “improved nutrition, access to medical care and new housing” were critically important in reducing risk to children. “Even the civil rights movement may have reduced risk for toxicity among blacks by opening some doors to better housing.”77
Indeed, public health activists embraced numerous social causes in the mid-1960s and mid-1970s, building on the older tradition of allying with community organizations and consumer groups to effect changes in the delivery of services and health care. In New York City, the Health Policy Advisory Committee (Health PAC) gave young professionals both in and out of government a means of linking movements to combat poverty, poor housing, lead poisoning, racism, and other social ills to health and their professional identities. For at least a decade, Health PAC and other health professional organizations and other groups in the American Public Health Association—such as the Medical Committee for Human Rights, Physicians Forum, and Physicians for Social Responsibility—helped to build community health centers in poor neighborhoods in northern cities and southern rural communities, achieved a partial atomic test ban to reduce strontium 90 and other radioactive exposures, developed programs to improve housing condition in poor communities around the country, and pressured governments to organize services for the poor on Indian reservations and in urban neighborhoods.78
Throughout the country, large city health departments were pressed by community groups and concerned professionals to expand surveillance efforts and screening programs, which brought greater awareness of the extent of lead exposures and concern that Clair Patterson and Harriet Hardy were accurate in arguing that lead poisoning was a much more serious problem than previously assumed. According to one government expert, by the late 1960s several large cities, including Chicago and New York, “reported that 25 to 45 percent of one- to six-year-old children from high-risk areas had blood lead levels exceeding 40 µg per 100 ml.”79
As doctors became more alert to the possibility of lead poisoning, the numbers of those acknowledged to be affected naturally increased. But the fatality rate didn’t. In Chicago, in 1966, for example, a study of more than 60,000 children showed “a marked rise in cases reported [compared to the 1950s] and a sharp decrease in fatality rate.”80 In New York, like Chicago, the fatality rate among those diagnosed with lead poisoning declined from 27 percent in the 1950s to 1.4 percent in 1964.81 Such drops in the fatality percentage were in part a function of increased surveillance and a lower threshold used to trigger a diagnosis of lead poisoning, which increased the pool with which the percentage was calculated but not the fatalities. But beyond that, it was widespread use of chelating agents that was responsible for this remarkable decline. An early champion of chelation therapy was J. Julian Chisolm, who would years later be the co-principal investigator of the KKI study so excoriated by the Maryland Court of Appeals.
As a young physician in the 1950s, trained at Johns Hopkins and at Princeton before that, Chisolm was in his generation almost unique in his ongoing professional focus on lead poisoning, particularly among African American children. In the early 1950s he received a fellowship to study the breadth of lead poisoning among Baltimore’s children. He visited homes, collecting stool samples of young children to analyze their lead content, and found that the City had been grossly underestimating the extent of the problem. He recalled that his “first findings . . . were that children who ingested paint were getting more lead than even heavily exposed industrial workers.”82
FIGURE 4.J. Julian Chisolm examining a child, ca. 1972. Chisolm was one of the early pioneers who called attention to the lead-poisoning epidemic, and throughout his life he treated thousands of lead-poisoned children in Baltimore. Source: Baltimore Sun, March 14, 1972, reprinted with permission.
Chisolm’s own background, perhaps, stimulated his commitment to and concern for African American children. Ironically, he came from a long line of southerners whose roots were in the South Carolina planter class. His great-great-great uncle, also named J. Julian Chisolm, was the leading surgeon for the Confederacy during the Civil War and author of the primary text for Confederate army surgeons.83 That Chisolm moved to Baltimore after the Civil War, established the Presbyterian Eye, Ear and Throat Charity Hospital, and became professor of ophthalmology and dean at the University of Maryland School of Medicine in Baltimore.84 J. Julian Chisolm Sr. (our J. Julian Chisolm’s father), himself the son of a Presbyterian minister who presided over a Natchez, Mississippi, segregated congregation of African American and white parishioners, received his medical degree from Johns Hopkins early in the twentieth century and taught at the medical school there for many years.85
J. Julian Chisolm Jr., who died in 2001, was a tall, large man with “a round face and sort of wispy hair that wasn’t very well combed,” according to Ellen Silbergeld, his student and protégé. He was mild mannered “in a kind of old Maryland gentleman way,” she remembers, and he “always wore a bow tie as the pediatricians in his day did,” so that young children couldn’t grab his tie. He could also be “very acerbic” to those who denied the importance of issues he cared deeply about. That the poisoning of African American children was one of these, Silbergeld said, “probably inhibited his promotion at Hopkins . . . to full professor until he was almost dead.” His commitment to the children he treated from the neighborhood around Hopkins was unquestioned by his students and colleagues. He once told Silbergeld that he saw racism inherent in the society’s lack of response to lead poisoning. “If this was a disease of white children,” he told her, “we would have done something about this a long time ago.” From these experiences came a life-long passion to address the effects of lead paint as the primary source of danger to children.86
Chisolm was working against the ingrained segregationist culture of Baltimore and Johns Hopkins at this time. Like other medical schools, Hopkins was an institution dominated by relatively wealthy, white, overwhelmingly male doctors and trustees.