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could permanently damage children was put to rest as researchers at Harvard documented continuing mental and neurological disorders among those ostensibly “cured” of acute lead poisoning, which was most often diagnosed after children showed a variety of symptoms, such as convulsions, muscle paralysis, “mental lethargy,” vomiting on eating solid food, and dizziness. For generations it was well recognized that workers in lead-based industries suffered severe neurological damage from lead poisoning, and by early in the twentieth century women and children were often barred from working in the areas of pigment and paint factories where lead was used. Beginning in the early twentieth century recognition grew that children outside the factory were also at risk because of contact with lead paint in their homes. As the nation’s cities grew exponentially following the Civil War, so too did the danger from lead paint that was used in and on the new houses.

      By the 1920s physicians were remarking on the fact that children “lived in a lead world,” and by the 1940s a huge literature had emerged that detailed the horrifying effects of this metal on children. But for both children and adults prior to the 1940s, the assumption had been that if the overt symptoms of lead poisoning passed, there would be no residual effects. During World War II, the two Harvard researchers—Randolph Byers and Elizabeth Lord, a pediatrician and psychologist, respectively, at Boston’s Children’s Hospital—documented the long-term effects of acute lead poisoning even after a child had ostensibly “recovered.” From a group of 128 patients ranging in age from about ten months to four years who had been admitted with acute symptoms of lead poisoning over the span of a decade, the researchers followed twenty children who still lived in the Boston area. All but one of the children who had returned home with no clinical symptoms of cerebral damage still suffered in “both the intellectual and emotional spheres” in school over the course of the study. These children’s motor coordination was abnormal and their general intelligence appeared to have been permanently affected. A few of the children suffered “recurrent convulsions.” One child at the end of first grade had “not learned to write or print his name or recognize any figure.” Another six-year-old was described as “cruel, unreliable [with] impulsive behavior; runaway; unable to get on with other children or adults; excluded from school because of behavior.”¹ In the decades since, researchers and clinicians have documented the huge numbers of children at risk, now with the understanding that lead causes permanent damage.

      As the seriousness of this epidemic became increasingly apparent in the 1950s, public health officials in Baltimore, New York, Chicago, Cincinnati, Boston, and other large cities began to follow the scientific and medical literature on the effects of lead paint poisoning. Many cities passed ordinances that required warnings on containers and restrictions on the sale of lead paints for use on walls, woodwork, and other surfaces accessible to children. But their actions were piecemeal and uncoordinated.

      Historically, health departments in the United States were local operations whose administrators rarely harmonized responses with each other, even in the face of the most dire public health threats. In the case of childhood lead poisoning, very few city administrators as late as the 1950s were even aware of the national scope of the problem, much less how colleagues in other communities were coping with it. While some of the larger cities began to establish registers to document the extent of the problem within their jurisdiction, there was no central source for information outside of the Lead Industries Association (LIA), the trade association of the lead industry. Nor did public health officials generally remember the controversy that arose about the potential hazards from lead when it was introduced into gasoline in the 1920s.

      Since its creation in 1928, the LIA had downplayed health concerns for fear that they might undermine business, but that had not stopped the organization from tracking reported cases in the medical literature of death and disease among children exposed to lead paint. In the 1950s the LIA bragged that it possessed the most extensive archive of newspaper articles, reports, and general information on this toxic metal.² Though the U.S. Public Health Service (PHS) was nominally responsible for addressing the health effects of toxic metals, at the time this agency was largely focused on the problems of infectious epidemic diseases and their threat to the nation as a whole. The modern federal institutions that potentially might coordinate a national effort to inform local agencies of toxic threats and to coordinate remedial action were just being born. The U.S. Department of Health Education and Welfare, the predecessor to the current U.S. Department of Health and Human Services, which today oversees the PHS and the National Institutes of Health, was only established by Congress in 1954.

      In the absence of federal and local knowledge and coordination on lead issues, from the 1930s through the 1950s the LIA assumed a central role in funding research on lead-related illness and framing national policy regarding childhood lead paint poisoning. The trade group resisted efforts by cities and states to regulate lead pigments in paint. Instead, in the 1950s it called for the establishment of limited, voluntary agreements among paint manufacturers to cap the amount of lead used in paints intended for indoor use. These recommendations the LIA misleadingly called “standards,” and both the lead and paint industries hoped they would thereby inoculate pigment and paint manufacturers from state and local regulatory action. The lead industry, through the LIA, in effect set the agenda that public health officials and lead researchers would live by for the foreseeable future: and the LIA of course did not advocate the removal of lead paint from the walls of homes. Rather, from the 1950s onward it promoted the view that lead poisoning was a virtually insoluble problem, largely limited to black and Puerto Rican children living in slum dwellings, and that the elimination of childhood lead poisoning was a utopian dream.

      Before the mid-1950s, the one exception to general ignorance about the extent of lead poisoning was in Baltimore, where in the 1930s the Department of Health had begun to track and even treat lead-poisoned children who appeared in its clinics. Baltimore was the first and only American municipality before the 1950s to develop, according to the pioneering research of historian Elizabeth Fee, “an extensive public health program on childhood lead paint poisoning.”³ The City organized health education campaigns, housing inspections, and lead-abatement programs, and it passed some of the nation’s first paint-labeling laws. Baltimore’s visionary commissioner of health, Huntington Williams, appointed in 1931, was instrumental in bringing the city’s lead problem to the forefront of public health knowledge. Baltimore’s early recognition of the issue’s seriousness may also be traced to the identification of fifty-nine cases of lead poisoning among poor African Americans who had burned battery casings to keep warm in the early years of the Depression.⁴ According to Fee, “Several patients developed acute encephalitis while others experienced headaches, vomiting, and dizziness.”⁵ The Baltimore American, too, described cases of lead poisoning and its dangers and communicated Health Department warnings about ingesting lead paint. “Parents should be on the lookout and remember that paints often contain large quantities of lead compounds and that the eating of considerable amount from paint materials may result in lead poisoning,” read one such alert from the 1930s.⁶

      By 1935, the Health Department had begun to offer free laboratory diagnostic tests to doctors who suspected that their patients were suffering from lead poisoning.⁷ Department inspectors visited homes, took samples of loose paint, and tested them for lead. When lead was found, the agency ordered the paint removed.⁸ During the first three years of the program, fifty-seven cases of acute lead paint poisoning in children were confirmed. Throughout the 1930s, the department documented paint as a prime source of childhood lead poisoning and used the new medium of radio to warn local residents of the often dire, even fatal effects of lead poisoning.⁹

      The dedication of Williams and the Baltimore Department of Health to uncovering lead-poisoned children was quite remarkable, given the enormous effort such an undertaking required. It was nearly impossible to get children tested for suspected lead poisoning for several reasons: legal restrictions limited testing to occupational, not environmental, exposures; the tests themselves were difficult to carry out; and only a limited number of laboratories were capable of performing the extraordinarily time-consuming analysis needed.¹⁰ As late as the 1950s, one technician could typically analyze only eight tests per day.¹¹

      By the early 1940s, it was abundantly clear to Baltimore’s health officials that children were the prime

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