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to outside reviewers, including J. Julian Chisolm, and then published it. That became Lead Poisoning in Children, a widely circulated 1967 government booklet that was instrumental in drawing the attention of Congress and the public to the lead problem.⁴

      It also attracted the attention of the lead industry. “When my booklet came out in 1967,” Lin-Fu recalled, “the lead industry wanted to reprint it [with a gloss of their own accompanying it], and they hired Hill & Knowlton to contact me. . . . The industry found my early work useful because it emphasized that the [main] problem was lead paint, not all the other [lead-related] environmental issues [such as lead in gasoline, then the dominant interest of the lead industry]. . . . The lead industry kept sending public relations representatives to me to be my friend. They would call to chat and have lunch with me. They would be friendly and try to keep track of my work.”⁵ While the federal government distributed more than 28,000 copies of Lin-Fu’s pamphlet, this effort, as historian Christian Warren puts it, “paled next to the efforts of the Lead Industries Association which distributed 61,000 copies [of Lin-Fu’s work]. . . as part of its free booklet, ‘Facts about Lead and Pediatrics.’”⁶

      Lin-Fu’s publication reflected the prevailing view of the time that lead poisoning was a problem mainly limited to “slums” and poor children, largely ignoring lead in gasoline, which exposed all children, rich and poor, urban, suburban and rural. People in public health and community organizations such as the Young Lords and the Black Panthers helped bring this scourge to public attention.⁷ But even so, many practitioners simply did not recognize lead poisoning because the symptoms were nonspecific except in extreme cases. Others thought lead poisoning “went away” when titanium oxide replaced lead as the major pigment in interior paint in the 1940s.⁸

      Arthur Lesser, a well-respected federal public health official who was director of the Maternal and Child Health Program in the Children’s Bureau, said to Lin-Fu one day, apparently exasperated by her insistence about the lead issue, “You did not discover anything. We know lead poisoning was there, but this is a housing problem, not a public health problem. You screen children, diagnose them, treat them and send them home to eat lead paint again. Are you going to fix their houses and remove the lead paint? Obviously not. This is a housing problem—what do you want us to do?”⁹

      THE EMERGENCE OF “UNDUE” LEAD ABSORPTION

      While Lin-Fu remembers herself as naïve, someone who just tried to do the right thing, ignorant of the bureaucratic and political workings of the White House and Congress, she was in fact a very effective political infighter. Although she did not have a public health background, Lin-Fu saw lead poisoning from the position of a pediatrician and a mother of young children. In contrast to the kind of bureaucratic view Lesser expressed, she did not see why a housing problem causing such serious lead poisoning in children was not also a public health problem. As she put it, “It was a football bounced between housing and public health so it went into no-man’s land.”¹⁰ This kind of tension over which agency should deal with childhood lead poisoning would continue to plague policy makers and advocates alike for decades.

      Lin-Fu’s pamphlet and her subsequent work on lead poisoning became the basis for the first statement on the subject by the surgeon general of the Public Health Service, Jesse L. Steinfeld. Lin-Fu remembers, “When we finally finished the draft of the guidelines [in the fall of 1970 for childhood lead-poisoning programs] and sent them downtown [to the Department of Health, Education and Welfare secretary’s office], the surgeon general was on duty that weekend, responsible for signing important papers for the DHEW secretary’s office. He signed the paper and saw the significance of the draft, and it became the [basis for the] surgeon general’s policy statement.”¹¹ In November 1970, Steinfeld announced “guidelines for a nationwide campaign against lead poisoning” because “as many as 400,000 children” were estimated to have blood lead levels above 40 micrograms per deciliter—in 1970, a shocking number of children.¹² At the time, children were considered poisoned if their blood lead levels were over 60 µg/dl. This was the level at which many children, though not all, showed classic acute symptoms of lead poisoning—convulsions, coma, permanent neurological damage, and even death. According to the New York Times, Steinfeld recommended screening programs for “all children under six years of age living in old and poorly maintained houses.”¹³

      The surgeon general’s policy statement was important, Lin-Fu recalls, “because a new concept of lead poisoning was contained in the document—that of ‘undue lead absorption,’ which was [seen as] an intermediate problem that preceded clinical symptoms. The document challenged the old concept and definition of lead poisoning—those with overt symptoms of profound neurological damage—and introduced the concept of finding children at the phase of undue lead absorption, defined at blood lead levels of 40 µg/dl and over.”¹⁴

      The federal government’s acknowledgment that “undue” lead absorption was a danger to children was an important breakthrough. But it was not achieved without a struggle. The ad hoc committee that drew up the DHEW guidelines for lead poisoning, in case impending legislation became a reality, had included Jane Lin-Fu and other DHEW staff along with outside experts, including Julian Chisolm. “Chisolm opposed me [Lin-Fu] on this, as did the chairman of the committee. . . . He and Chisolm thought that I was being too aggressive and impractical to implement screening and follow-up, as New York City was finding 45 percent of its sampling above 40 micrograms.” The chair challenged Lin-Fu: “How are you going to tell local public health officials that they have a lead problem in half of their kids?” And she answered: “That’s their problem. Our job in the government is to tell them the scientific facts, the truth.”¹⁵ It was Chisolm who had originally written a paper stating that the upper limit of “normal” blood lead should be 40 µg/dl, she pointed out.¹⁶ “When he refused to back up his own statement at the meeting, she recalls, “I knew that DHEW’s committee would not let me say [in the draft guidelines] that the upper level of normal should be 40.”¹⁷

      

      As a compromise, Lin-Fu drafted a statement proposing that in cities with overwhelming lead-poisoning problems priority should be given to children whose blood lead levels were more than 60 µg/dl, followed by those with levels between 40 and 60, and then those with levels less than 40. Children of one to three years should be given priority over those of three to six years, and so forth. At the next meeting, Lin-Fu spread copies of the document around the table and said, “This is what I propose.” Chisolm said, “If we include this statement on priority, then dropping to 40 µg/dl in the statement is OK.” But the chair angrily said it was too radical: “I am leaving the government in three months and I don’t really care what happens with this document. If you insist on the 40 µg criteria, after that statement is released, and when all the letters start coming in to the secretary’s office, you will have to deal with this and answer those letters.” “I will,” Lin-Fu said without hesitation. “Deal,” the chairman said, and the final draft included Lin-Fu’s triage concept of dealing with lead poisoning and dropped the upper limit of what was considered the “normal” blood lead level from 60 to 40 µg/dl, with children having levels above 40 considered at risk from undue lead absorption.¹⁸

      While Lin-Fu was fighting within the federal bureaucracy to convey a better understanding of and more action on low-level lead poisoning, a few senators and representatives were also trying to address the emerging lead-poisoning epidemic. Responding to pressure from community organizations in New York, Boston, and around the country and from local public health officials, Congressman William Ryan (D-NY) and Senator Ted Kennedy (D-MA) cosponsored bills in 1969 and 1970 to authorize $30 million in federal grants to combat lead poisoning. The Ryan-Kennedy Bill was passed on December 31, 1970, and signed into law as the Lead-Based Paint Poisoning Prevention Act by President Nixon in mid-January 1971. The act was composed of three parts: the first “empowered HEW [the Department of Health, Education and Welfare] to prohibit the use of ‘lead-based paint’ [paint with more than 1 percent lead pigment] in federally constructed or rehabilitated housing” but left unregulated the private housing stock; the second authorized the Department of Health, Education and Welfare “to make grants to cities establishing lead-abatement programs and . . . to establish

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