Always With Us?: The Lead Poisoned Child in America

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Carol Leonard
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1 Always With Us?: The Lead Poisoned Child in America Christian Warren New York Academy of Medicine

2 Introduction Origins of Brush With Death Regional Differences New England v. Florida, ca. 1987

3 Introduction Overview of Study Three Themes: Environmental Occupational Pediatric

4 Introduction Overview of This Talk Three Histories of Lead Poisoning Natural History Medical History Sociocultural History: the USES of a lead-poisoned child.

5 Natural History of Lead Poisoning? Left to Nature--little lead poisoning Galena Ore

6 Natural History of Lead Poisoning History of Exposure to Anthropogenic Lead

7 Natural History of Lead Poisoning History of Exposure to Anthropogenic Lead

8 Natural History of Lead Poisoning Routes of Direct Exposure, Pre-1900 Food and Water Contamination

9 Natural History of Lead Poisoning Routes of Direct Exposure, Pre-1900 Cosmetics

10 Natural History of Lead Poisoning Routes of Direct Exposure, Pre-1900 Medicinal Uses

11 Natural History of Lead Poisoning Routes of Direct Exposure, food adulteration

12 Natural History of Lead Poisoning Routes of Direct Exposure, food adulteration paint exposure

Natural History of Lead Poisoning Routes of Direct Exposure, 1900-1945 food

13 Natural History of Lead Poisoning Routes of Direct Exposure, food adulteration paint exposure air pollution from lead-bearing coal dust and industrial sources

14 Natural History of Lead Poisoning Routes of Direct Exposure, Car Exhaust Tetra-ethyl Lead Introduced in the 1920s

15 Natural History of Lead Poisoning Routes of Direct Exposure, Car Exhaust Tetra-ethyl Lead Lead Consumption Total For Batteries In Gasoline Year Introduced in the 1920s Takes off after World War II Happy Ending?

16 Medical History of Lead Poisoning Mortality 1953, Robert Kehoe: annual childhood fatalities at the minimum.

17 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

18 Medical History of Lead Poisoning Morbidity Late 19th Century Chronic forms implicated in other conditions: Gout

19 Medical History of Lead Poisoning Diagnosis in the 20 th Century From symptom without measurement to measurement without symptom

20 Medical History of Lead Poisoning Diagnosis in the 20 th Century Clinical Symptoms severe abdominal complaints Painter s colic, or the Dry Gripes

21 Medical History of Lead Poisoning Diagnosis in the 20 th Century Clinical Symptoms neurological symptoms: local paralyses: potter s foot; wrist-drop encephalopathy

22 Medical History of Lead Poisoning Diagnosis in the 20 th Century Clinical Symptoms (internal) Blood damage X-Ray evidence Post WWII: Measurement of Lead in Blood

23 Medical History of Lead Poisoning Treatment : Reliance on The Body s Beautiful Mechanisms Since 1945 : Chelation British Anti-lewisite or BAL CA-EDTA Succimer

24 Sociocultural History: The Uses of a Poisoned Child

25 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

26 Sociocultural History: The Uses of a Poisoned Child Aside: Why Was Pediatric Lead Poisoning Nearly Invisible? Special Susceptibilities Known 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

27 Sociocultural History: The Uses of a Poisoned Child The Lead Poisoned Child as Deviant 1920s to 1950s: Lead Poisoned Child Not Rare Percentage "Black" Percentage "White"

28 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

29 Sociocultural History: The Uses of a Poisoned Child The Lead Poisoned Child as Canary in the Urban Lead-mines 1940s- 1960s Health Departments

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

31 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

32 Sociocultural History: The Uses of a Poisoned Child A Success Story: Reductions in New Universal Exposures solder smelter emissions water fountains lead paint bans tetra-ethyl lead

33 Sociocultural History: The Uses of a Poisoned Child Son of Success Story:

34 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

35 Targeted Screening Two Examples from One Southern Town Son of lawyer in historic section Child in public housing

36 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

37 like the poor, lead poisoning is always with us.

Lead Paint Alliance Toolkit for Establishing Laws to Control the Use of Lead in Paint. Patrick Huber US Environmental Protection Agency

Lead Paint Alliance Toolkit for Establishing Laws to Control the Use of Lead in Paint Patrick Huber US Environmental Protection Agency 1 Outline Overview of the Toolkit Module Bi: Health impacts Module