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American community, recalls Connie Nathanson, now a professor of sociomedical sciences at Columbia, who worked in pediatrics at the Hopkins medical school from the late 1950s until 2002.⁸⁷ In the postwar period, plans were developed for 178 garden apartments for African American families who were being displaced by the urban renewal project close to the Hopkins medical school campus. Those same plans included housing for residents and staff at the university. As social scientist Stephanie Farquhar documents, the “planned 178 garden apartments for blacks were never built . . . though the garden apartments for Hopkins married staff and the residence hall for Hopkins’ unmarried staff and students were.”⁸⁸ Nathanson recalls that the “housing for residents and interns [was] surrounded by wire fencing that segregated it off” from the surrounding community.⁸⁹

      By 1969 the combined use of the two chelating agents, BAL and EDTA, according to Chisolm, “apparently reduce[d] the mortality from acute lead encephalopathy to 5%.” It was a pyrrhic victory, though, for “the incidence of severe, permanent brain damage among survivors of encephalopathy continues to be 25% or more,” he said. And “if survivors of an initial attack of acute lead encephalopathy are re-exposed to abnormal lead exposure the incidence of severe permanent brain damage is increased to virtually 100%.”⁹⁰ Chisolm clearly understood the critical connection between treatment of children and the need to rehabilitate the housing where they lived. “The cornerstone of our current therapeutic program,” he argued, “is prompt termination of environmental exposure to lead: no child with an increased body burden of lead is ever returned to a leaded home.” Although it is not clear how often this was accomplished or who paid for this service, Chisolm wrote that after chelation therapy, children at Johns Hopkins clinics were either placed in suitable new housing or their homes were abated of lead. Chisolm understood that children having to be poisoned before remedial action was taken was both destructive for the child and expensive for society. “How much more intelligent it would be,” he commented, “to spend our effort and substance on the systematic elimination of environmental lead exposure associated with old dwellings. Were this to be done, childhood lead poisoning could be largely eradicated in the United States.”⁹¹ Although the solution was obvious, the means of attaining it were not. In the late 1960s there were, for example, thirty million housing units nationwide still in use that had been built before 1950; of these, at least 90 percent were polluted by lead.⁹²

      3Peeling the Onion

      New Layers of the Lead Problem

      The worth of the human brain is incalculable. The value we assign to it will be defined by the intensity with which we pursue or avoid the protection of its optimum development. Excess lead in the human environment is man-made and is, therefore, preventable by man.

      HERBERT NEEDLEMAN, 1977

      Prior to 1970 and the establishment of the Environmental Protection Agency, the federal government rarely regulated environmental toxins. But by the late 1960s and early 1970s, environmentalists and public health officials were advocating such regulation to protect the food supply and improve air and water quality. The Food and Drug Administration had begun to expand its role in regulating foods and additives after a weed killer, aminotriazole, feared as a carcinogen, was found in cranberries just before the 1959 Thanksgiving holiday. Environmental activists and the broader public also joined together to press for greater regulation following publication of Rachel Carson’s Silent Spring in 1962, with its vivid account of the devastating effects of DDT and other pesticides on birds and other wildlife, and then the revelation in 1966 that PCBs and other chlorinated hydrocarbons were accumulating in animals—including Homo sapiens—at the top of the food chain. Similarly, Congress began to pay more attention to pollutants following passage of the first Clean Air Act in 1963.

      By the late 1960s, environmentalists, politicians, community activists, conservationists, scientists, and public health officials understood that lead was one pollutant that challenged them all. It was in the air people breathed and, as the previous decade had made clear, it was on the walls of the nation’s housing. With the new decade, physicians were more effectively treating the symptoms of acute lead poisoning, public health personnel were active in establishing more lead-screening programs to identify children most at risk, and community groups and others were calling for stronger housing codes and more effective enforcement for existing ones. But as they seemed on their way to solving one problem, all through the 1970s they would discover new ones that were in some ways ever more troubling, uncovering literally millions of children at risk of developing life-changing neurological and behavioral problems from the slightest exposure to this devastating metal, while intense resistance from the lead industry continually tried to discredit the new research.

      AN INADVERTENT ADVOCATE

      Within the government, a federal official played an instrumental role in getting Washington to acknowledge the importance of childhood lead poisoning. Jane Lin-Fu came to her work by a circuitous route. Born in Singapore of Chinese parents, Lin-Fu spent her early years in Shanghai, where her father, a teacher educated in China and the United States, joined his brother Lin Yutang, then a rising journalist, to work as a journalist at China Critic, an English-language periodical. Her father, a Quaker, had a strong sense of social justice, and she still remembers how upset he was by the British treatment of Gandhi. Her mother was well-educated, pragmatic, a strict disciplinarian and a devout Christian. Jane was raised to believe she shouldn’t worry what others thought as long as she was doing the right thing before God. “This upbringing molded me to be the free spirit who would take up social justice issues like lead poisoning, speak the truth about lead as I saw it, and not be intimidated by bureaucratic or academic authorities,” she believes.¹

      In 1937, when the Japanese Army invaded China, her parents fled with her to the Philippines, where Jane later attended medical school before coming to the United States in 1955. She accepted an internship, followed by a pediatric residency, at Brooklyn Jewish Hospital, an institution that served many children from the impoverished neighborhoods nearby—in what was later referred to as the “lead belt.” One summer, a two-year-old came to the clinic with a stomachache and vomiting. The physician thought the boy had summer flu but admitted him because he was quite dehydrated. On the ward, the child began convulsing and the attending doctor mentioned it might be lead poisoning. The event made a lasting impression on Lin-Fu.²

      In the early 1960s her husband joined NASA and they moved to the Washington, D.C., suburb of Bethesda. She was a board-certified pediatrician, but she wanted a part-time job with the federal government so she could spend time with her children. In November 1963, just after John F. Kennedy’s assassination, she was hired by Alice Chenoweth at the Maternal and Child Health Program in the Children’s Bureau.

      When Kennedy became president, the plight of his sister Rosemary led him to make a concerted effort to focus the nation’s attention on the study and treatment of mental retardation. The Children’s Bureau, a beneficiary of the subsequent funds appropriated by Congress for that purpose, helped develop statewide screening programs for phenylketonuria (PKU), a genetic disorder that causes mental retardation. Newborn PKU screening was a particularly exciting area then because, for the first time, severe mental retardation in children who suffered from this genetic disorder could be prevented through large-scale screening, early diagnosis, and dietary treatment.

      When a colleague happened to ask Lin-Fu in 1965 what she knew about lead poisoning as a cause of mental retardation, the question triggered a flashback to that little boy who had convulsed from lead encephalopathy in Brooklyn Jewish Hospital a few years earlier. As she looked into the issue she was horrified to realize that her own training had not included lead poisoning, even though research indicated the prevalence of the problem in old, poor neighborhoods like the ones surrounding the hospital where she had done her residency. She was also deeply troubled that the Maternal and Child Health Program in the Children’s Bureau, which was so active in preventing mental retardation caused by the PKU condition, was not doing anything about lead poisoning so common in young children living in dilapidated dwellings. “This is really unfair because poor children have no voice in society,” she recalls thinking at the time. She could not understand how “we could ignore such a simple and readily preventable issue.”³ By December 1965, she had reviewed the existing literature on childhood

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