the possibility that John suffered from lead poisoning, encephalitis, and secondary anemia. He had apparently been eating plaster for the past six months, and his mother reported that “he has been eating paint that peels off from window sills.” The blood work showed 390 micrograms of lead per deciliter of blood—almost eighty times the level considered by the CDC to be dangerous for children seventy years later20 and at the time clearly a cause of acute poisoning. The social worker in charge of the case noted that “because the landlord refused to make any repairs in this home, the family pooled their money and bought some paint which they have used all over the home.” When told that paint from the windowsills was dangerous, his mother said she had not realized its danger and had “caught him on frequent occasions with a mouth full of paint chips.” She promised that in the future “she would make every effort to keep the child away from the paint.” She had “a large play pen and from now on the child [would] be kept there. It gives him adequate room to move about and have a good time,” the social worker wrote, “and will make it impossible to get to the window sill and eat more paint.”
In mid-June 1941, after more than a month in the hospital, John’s symptoms subsided and he was sent back home. But two months later the mother was back at the social service department. In the words of the social worker, the family had “contacted the real estate agency several times about repair work but with no success”; there continued to be problems of “loose plaster throughout the home in spite of their efforts at repair.” The social worker contacted the health department, which promised to investigate the home conditions, but we know neither the results nor what befell John in subsequent years.
What did and did not occur in response to the plight of John’s family is telling. At the time, Johns Hopkins was the lone institution and Baltimore the lone city in the country that was systematically trying to identify and treat large numbers of children affected by the increasing tonnage of lead polluting the nation’s housing. Baltimore and Hopkins had been the epicenter of this issue ever since the area’s rapid growth at the turn of the century had created a huge housing boom and, with it, the use of lead-based paint throughout the central city. The first American case of poisoning due to lead paint ingestion was also documented here, in 1914, by Henry Thomas and Kenneth Blackfan at the very same Harriet Lane Home where John was treated. And Baltimore’s Department of Health was the first local health agency to mount a campaign to protect a city’s children from the effects of lead. In fact, in the 1930s it used the new medium of radio to broadcast public service announcements warning its residents about lead’s dangers: “Every year there are admitted to the hospitals of Baltimore a number of children with lead poisoning caused by eating paint. Most of these children die,” listeners were told, “but those who live are almost equally unfortunate because lead poisoning leaves behind it a trail of eyes dimmed by blindness, legs and arms made useless by paralysis, and minds destroyed even to complete idiocy.”21
The response of Johns Hopkins to the epidemic was, however, fraught with practical and institutional problems emblematic of a larger crisis over lead poisoning and other ubiquitous toxic pollutants that continue to plague us today. Lead poisoning was both a medical and a social problem of inordinate proportions. Hopkins could treat the problem by allowing children who came to its attention a brief respite from the environmental assault on their bodies and brains, but such respites were typically just that, and not adequate to stop these assaults. John was returned to his home following the acute episode of lead poisoning that had nearly paralyzed him. But Hopkins, in no position either to compel the landlord to repair the home or to provide the family with a lead-free house, had no answer to the problem of how to protect John from further lead dosings other than to have his desperate mother promise to keep him pent up in a playpen, away from what was assumed to be the major sources of lead.
We may look back on John’s treatment and the “discharge protocol” as inadequate (although in many ways it is similar to what occurs in numerous localities today). And we may assume that John would have likely returned to the hospital with a fresh, and possibly fatal, episode of lead ingestion: despite the well-intentioned advice to his parents, no well-functioning toddler could remain for long in a four-by-four pen. But we would be wrong to write off the John Hopkins’s effort as an anomaly or proof of special inadequacy of the medical and social service system of the time. True, unlike the Harriet Lane Home, which generally saw its responsibility as treating the acute symptoms of lead poisoning as best it could, the Kennedy Krieger Institute, facing similar problems in serving Baltimore’s children a half century later, took as its responsibility finding the means to protect children from lead exposure, treating them when evident symptoms began to appear and planning for their return to a safe environment. But, in the end, despite this wider purview, KKI, like its predecessor, could not overcome the huge social and economic issues that frame the long, troubling, and desperate history of lead poisoning in Baltimore, and in the nation.
The story of John and the public health response to cases such as his are indicative of the entire history of lead poisoning in particular and the crisis of environmental and industrial pollution in general. The root of John’s disease lay in the physical conditions in which he and his family lived—poor housing whose walls were covered with a poison. But the only response was from the public health and medical professions, and they could only provide medical care to the individual child. That was important, of course, but the broad social problems that affected huge numbers of children living in similar conditions were left unaddressed, virtually guaranteeing that there would be many more children like John in urgent need of help. John was suffering from more than an environmental exposure to a known neurotoxin, caused by shoddy landlords and peeling paint. He suffered from a social and economic system that condemned his family to poverty and racial discrimination, as well as to the urban decay that put him in harm’s way. John’s parents could hardly be blamed for the constraints he and his entire family were forced to endure in, for example, the limited choices in housing they would have had. And even vague attempts to “explain away” John’s situation by pointing to his color and poverty could not counter the observations that his mother was a hard-working, sincere, and dedicated parent who, according to the social worker at Harriet Lane, was “genuinely interested and concerned about the children” and, using the racist language of the period, “more intelligent than the average negro.” Nor could John’s well-educated and industrious father be blamed for the family’s economic plight and thereby somehow explain away the disease as a family failing. Public health agencies, without such traditional explanations for the diseases of poverty to fall back on—and with no ability to confront the socioeconomic relationships among lead producers, paint manufacturers, housing officials, and landlords that had produced the epidemic of lead poisoning—lacked the tools and the will to control the epidemic effectively as well as the clout to effect much change.
The good doctors of the Harriet Lane Home faced an impossible situation. On the one hand their responsibility was to treat disease and they did so to the best of their abilities. But, in the context of such a glaring threat—children being poisoned by a toxin in their home—one would hope they would have gone beyond that role to advocate more forcefully for housing reforms and rehabilitation as a means of prevention. Public health administrators, advocates, and policy-oriented academics, though, faced a classic dilemma: how does one prevent disease and premature or unnecessary death when the means of effecting such prevention are controlled by a political and economic system over which one has limited influence and that profits from the existing social relationships that produce disease? In this respect, the public health problems of the 1940s are no different than what we face today, though the political climate is quite different. In fact, given the growing attention to the impact of chronic illnesses and low-level environmental exposures to a host of toxic chemicals and industrial products whose chemistry, much less whose health effects, is largely not understood, the problem is only magnified.22
Acute lead poisoning, the kind of poisoning John suffered, perhaps the oldest and best understood environmental disease, has been for the most part successfully contained in the United States over the past half century through judicial, legislative, and regulatory decisions as well as scientific discoveries and medical interventions. Removing some of the most obvious
