Hektoen International

A Journal of Medical Humanities

“Rich man, poor man”: A history of lead poisoning

Mariel Tishma
Chicago, Illinois, United States

Comfort in the Gout. Thomas Rowlandson. 1802. The Metropolitan Museum of Art.

The history of lead poisoning is the history of human industry. For unmarked time, lead has been around causing abdominal pain, constipation, nausea, and irritability, as well as conditions like heart disease, kidney disease, reduced fertility, and gout.1

Many say that the first description of the symptoms of lead poisoning can be credited to Nicander of Colophon.2, 3 The oldest lead mines can be dated back to 8000-6500 BC.4 The lead industry, though, did not truly begin until after about 3500 BC, when a new method of extracting silver from lead ore created a surplus.5

Knowing what we know now—that no amount of lead is safe and small amounts can build up to produce long term problems6—it is certain that lead poisoning often occurred, unknown and untreated.

The rich man’s table

Lead was everywhere for the elite in ancient Rome, with the empire at its peak using around 80,000 tons of lead per year.7 Lead could be found in utensils, cosmetics, medicines, wines, and even the food of the upper class.8 Extremely popular at the time was a method for sweetening and preserving food and wine using lead acetate. Occasionally lead acetate—or lead sugar—was sprinkled directly onto food. More often, grape concentrate was boiled down in lead pots producing a syrup called sapa, which was then added to wine.9 Later examination of storage vessels suggest “that wine stored in them had a considerable lead content,” and further studies of Roman patrician (elite) and slave skeletons “show a much higher bone lead content among the patricians.”10

The pipes in Rome’s plumbing system were made of lead. In fact, plumbing derives from Latin for lead—plumbum. Lead is a water soluble metal, and so it is likely that some people were exposed to lead this way.11 However, when water is high in certain other minerals, as it was in Rome, it forms a crust coating on the inside of pipes that prevents contact with the lead and left the water “wholly safe to drink.”12

With so much lead in the cups of the upper class, it has been suggested that the madness of some Roman emperors can be attributed to lead. Many of the upper class turned to adoption as they were unable to concieve.13 Infertility is a notable symptom of lead poisoning. Lead poisoning is also associated with gout and kidney disease, as well as depression, irritability, mood disorders, and forgetfulness—which emperors such as Claudius, Nero, and Caligula suffered from.14

Later, lead continued to cause problems. In 1703, England signed a treaty allowing the importation of fortified wines such as port, which were notoriously high in lead.15, 16 Interestingly, elsewhere in Europe wine sweetened with sapa had been prohibited in the early 1400s.17 But this did not extend to brandy and the other liquors added to fortified wines, which may have been produced in lead containing vessels or aged in lead caskets.

The influx of port changed the drinking habits of the English nobility, as their formerly preferred wine was no longer available. Combining the increased lead consumption with the heavy, rich, and expansive meals of the time resulted in a high incidence of gout due to lead’s impact on kidney function.

Lead’s harmful effects were identified early on, but often disregarded. Even after its association with diseases like gout became clear, it was considered a mark of success—something caused by the richness of life—at least until it began to permeate industry and the lives of common people.

The poor man’s house

Lead poisoning was well known among artisans because of white lead paint, and was often referred to as “painter’s colic”18 though it popped up among potters19 and other artisans such as tin workers.20, 21

In the 1920s “in almost every hospital and dispensary painters make up the large majority of the cases of lead poisoning.” Painters were hesitant to leave their industry due to the skilled nature of the work, and many may not have been aware they were being poisoned, as lead poisoning was diagnosed only by doctors who had previous experience with lead. 22

Once lead was on the walls, the problem escalated. Children experience more severe symptoms at lesser exposure than adults, and it was children who were surrounded by lead painted walls, toys, and furniture. In 1913, for example, a young boy was admitted to Johns Hopkins Hospital with lead poisoning. He had been chewing on the painted bars of his crib. At the time, no treatment for lead poisoning was available, and the connection between the lead paint and his condition was not made.23

Modern studies have shown that ingesting lead chips repeatedly over a three month period can produce clinical symptoms, and produce a lethal body burden of lead in children.24 As this became obvious, international labor conferences convened, and between 1920 and 1929 at least eight countries passed bans on lead paint, specifically white lead.25 The United States was not one of these countries.

Lead manufacturers in the United States “fiercely marketed” their products as central to the narrative of American growth and prosperity.26 This put lead based paint in-demand for anyone who could afford it, and especially difficult to regulate.

Causing further difficulty was the “Depression disease” of 1930s America caused by inhalation of fumes from burning battery casings in winter when no other fuel was available. Lead manufacturers twisted Depression disease to reinforce that lead itself was not the source of the problem, making the story one of improper consumer use, particularly among the poor and outsiders.27, 28

By 1970, only four states had laws prohibiting lead paint. Finally in 1972 federal legislation prohibiting white lead paint was passed.29

It is hard to say how many subclinical cases of lead poisoning snuck through, as it was not until the 1970s in the United States that cases with more minor symptoms were recorded as poisoning.30 Today, even the mildest cases have been recognized as clinical, and rightly so.31 However, this is not the end of the story.

The introduction of tetraethyl lead (TEL) into gasoline in the US meant many children were exposed to lead during the 1940s and 50s. The effects of that exposure created a ripple, and research suggests that the wave of violent crime between 1960 and 1980 was caused by lead. Exposure to lead in childhood may cause loss of gray matter in the parts of the brain associated with aggression and emotional regulation.32 The exposure was and is compounded with the disparity caused by poverty, and children under these conditions may not be able to bounce back from lead exposure.

Thankfully as more and more was revealed about the toxicity of TEL, lead levels in gasoline were slowly reduced and eliminated beginning in 1978.33

Between 1967 and 1991, many patients in Alabama presented with symptoms of gout and were found to have elevated blood lead levels. The cause was moonshine, or illegal whiskey, distilled in either lead bearing car radiators or stills with lead solder and pipes.34, 35 This echoes both the lead induced gout of the English aristocracy, and the Depression disease of 1930s America.

The most recent widespread and well known outbreak of lead poisoning in the US was the water crisis in Flint, Michigan.

In 2016, the city of Flint, Michigan switched its water source to the Flint River. This water was not properly treated for corrosion and soon after residents began to complain about the quality of their water.36 These concerns were largely dismissed, and the city attempted to convince its people that the water was safe to drink.37 However, the water was contaminated with lead after the sediment crust inside the pipes eroded. This protection was the same employed by ancient Rome, but without a natural source of minerals as Rome had, the water in Flint leached lead and other contaminants from the pipes. Conditions grew so bad that a General Motors plant stopped using the water to avoid corrosion of their steel parts.

As a result, the residents of Flint, including many children, were exposed to lead and other contaminants. In areas with the highest concentrations of lead in the water, around 10% of children had elevated blood lead levels.38 In Flint, as elsewhere, many of the children affected “already suffer(ed) from risk factors” such as poor nutrition which increased lead’s effects.39

In the aftermath, crews began installing replacement pipes across the city. However, as of August, 2019, residents are still advised to filter their water while the replacement is underway.40 Many of the water crisis’ effects will not be known until the children affected by it grow and their development and success can be assessed.

Similar lead water events occurred in the mid 2000s and early 2010s as any change in water quality—such as changing water sources, disinfectants, or corrosion reduction agents—could potentially trigger water contamination.41, 42 Old lead pipes and lead solder remain an understood but brushed aside risk in many homes, and those most at risk due to other factors are largely unable to pay the price to replace the pipes.

Lead has worn many masks. This has allowed it to slip by undetected, seen as an unfortunate side effect of wealth, or else as a consequence for those believed too foolish to know better.

End notes

  1. Center for Disease Control., “Lead: Health Problems Caused by Lead – NIOSH Workplace Safety and Health Topic,” S. Department of Health & Human Services, Last Reviewed June 18, 2018, Accessed September 5, 2019, https://www.cdc.gov/niosh/topics/lead/health.html.
  2. Michele Augusto Riva, Alessandra Lafranconi, Marco Italo D’orso, and Giancarlo Cesana, “Lead Poisoning: Historical Aspects of a Paradigmatic “Occupational and Environmental Disease”,” Safety and Health at Work 3, no. 1 (March 8, 2012): 11, Accessed September 5, 2019, https://doi.org/10.5491/SHAW.2012.3.1.11.
  3. Julio Montes-Santiago, “Chapter 9 – The lead-poisoned genius: Saturnism in famous artists across five centuries,” Progress in Brain Research 203,(2013): 224, Accessed September 5, 2019, https://doi.org/10.1016/B978-0-444-62730-8.00009-8.
  4. 223.
  5. Nriagu, Jerome O, “Tales Told in Lead,” Science281, no. 5383 (1998): 1622, Accessed September 5, 2019, http://www.jstor.org/stable/2896365.
  6. Mayo Clinic Staff, “Lead Poisoning – Symptoms & causes,” Mayo Foundation for Medical Education and Research, Published December 06, 2016, Accessed September 5, 2019, https://www.mayoclinic.org/diseases-conditions/lead-poisoning/symptoms-causes/syc-20354717
  7. FP Retief, and L Cilliers, “Lead Poisoning in Ancient Rome,” Acta Theologica Supplementum 7 Vol 26, No 2 (2006): 149, https://www.ajol.info/index.php/actat/article/view/52570/41176.
  8. 156.
  9. 149-151.
  10. Milton A. Lessler, “Lead and Lead Poisoning from Antiquity to Modern Times,” The Ohio Journal of Science 88, no. 3(June, 1988): 80, Accessed September 5, 2019, http://hdl.handle.net/1811/23252.
  11. Michele Augusto Riva, et al, “Lead Poisoning: Historical Aspects of a Paradigmatic,” 12.
  12. Trevor Hodge, “Vitruvius, Lead Pipes and Lead Poisoning,” American Journal of Archaeology85, no. 4 (1981): 488-489, Accessed September 5, 2019, doi:10.2307/504874.
  13. Michele Augusto Riva, et al,, “Lead Poisoning: Historical Aspects of a Paradigmatic,” 12.
  14. Shom Bhattacharjee, “A brief history of gout,” International Journal of Rheumatic Diseases 12 (2009): 62, Accessed September 5, 2019, https://doi.org/10.1111/j.1756-185X.2009.01381.x.
  15. Milton A. Lessler, “Lead and Lead Poisoning from Antiquity to Modern Times,” 80.
  16. Richard P. Weeden, “Irregular Gout: Humoral Fantasy or Saturnine Malady,” Bulletin of the New York Academy of Medicine 60, no. 10 (December, 1984): 975, Accessed September 5, 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911803/.
  17. Milton A. Lessler, “Lead and Lead Poisoning from Antiquity to Modern Times,” 80.
  18. Jan Dequeker, “Medicine and the artist,” Age and Ageing37, no. 1 (January 2008): 4, Accessed September 5, 2019, https://doi.org/10.1093/ageing/afm154.
  19. Scott Fields, “Exposing Ourselves to Art,” Environmental Health Perspectives105, no. 3 (1997): 286, Accessed September 5, 2019, doi:10.2307/3433264.
  20. Julio Montes-Santiago, “Chapter 9 – The lead-poisoned genius”: 229.
  21. Alice Hamilton, “Lead Poisoning in American Industry,” The Journal of Industrial Hygiene 1 (April, 1920): 1, Accessed September 5, 2019, https://hdl.handle.net/2027/chi.17209657.
  22. 13
  23. Christian Warren, Brush with Death: A Social History of Lead Poisoning, (Baltimore: The Johns Hopkins University Press, 2000), 27-28.
  24. Julian. Chisolm, “Lead Poisoning,” Scientific American224, no. 2 (1971): 21, Accessed September 5, 2019, http://www.jstor.org/stable/24927721.
  25. Sven Hernberg, “Lead Poisoning in a Historical Perspective,” American Journal of Industrial Medicine 38 no. 3 (September, 2000): 256-249, Accessed September 5, 2019, https://doi.org/10.1002/1097-0274(200009)38:3%3C244::AID-AJIM3%3E3.0.CO;2-F.
  26. Laura Bliss and Citylab, “An American History of Lead Poisoning,” The Atlantic, published February 12, 2016. https://www.theatlantic.com/health/archive/2016/02/an-american-history-of-lead-poisoning/462576/.
  27. Christian Warren, Brush with Death,” 142-143.
  28. Laura Bliss and Citylab, “An American History of Lead Poisoning.”
  29. Sven Hernberg, “Lead Poisoning in a Historical Perspective,” 246.
  30. 245-246.
  31. 250.
  32. Kevin Drum, “Lead: America’s Real Criminal Element,” Mother Jones January/February 2013 Issue, https://www.motherjones.com/environment/2016/02/lead-exposure-gasoline-crime-increase-children-health/.
  33. Herbert Needleman, “Lead Poisoning,” Annual Review of Medicine 55 (February 2004): 212, Accessed September 5, 2019, doi: 10.1146/annurev.med.55.091902.103653.
  34. GENE V BALL, “Two Epidemics of Gout,” Bulletin of the History of Medicine45, no. 5 (1971): 404-405, Accessed September 5, 2019, http://www.jstor.org/stable/44447458.
  35. “Elevated Blood Lead Levels Associated with Illicitly Distilled Alcohol — Alabama, 1990–1991,” Morbidity and Mortality Weekly Report41, no. 17 (1992): 294-295, Accessed September 5, 2019, http://www.jstor.org/stable/23300153.
  36. Mona Hanna-Attisha, Jenny LaChance, Richard Casey Sadler, and Allison Champney Schnepp, “Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response,” American Journal of Public Health 106 no. 2, (February, 2016): 283, Accessed September 5, 2019, doi: 10.2105/AJPH.2015.303003.
  37. Paul Mohai, “Environmental Justice and the Flint Water Crisis,” Michigan Sociological Review32 (2018): 1. Accessed September 5, 2019, https://www.jstor.org/stable/26528595.
  38. Emma Winowiecki, “Does Flint have clean water? Yes, but it’s complicated.,” Michigan Radio, Published August 21, 2019, Accessed September 5, 2019, https://www.michiganradio.org/post/does-flint-have-clean-water-yes-it-s-complicated.
  39. Terese M. Olson, Madeleine Wax, James Yonts, Keith Heidecorn, Sarah-Jane Haig, David Yeoman, Zachary Hayes, Lutgarde Raskin, and Brian R. Ellis, “Forensic Estimates of Lead Release from Lead Service Lines during the Water Crisis in Flint, Michigan,” Environmental Science & Technology Letters 4, no. 9 (Jul7 2017): 356, Accessed September 5, 2019 DOI: 10.1021/acs.estlett.7b00226.
  40. Michael Wines and John Schwartz, “Unsafe Lead Levels in Tap Water Not Limited to Flint,” The New York Times, February 8, 2016, https://www.nytimes.com/2016/02/09/us/regulatory-gaps-leave-unsafe-lead-levels-in-water-nationwide.html?_r=1.URL.

References

  1. Ball, Gene V. “Two Epidemics of Gout.” Bulletin of the History of Medicine 45, no. 5 (1971): 401-08. http://www.jstor.org/stable/44447458.
  2. Bhattacharjee, Shom. “A brief history of gout.” International Journal of Rheumatic Diseases 12 (2009): 61-63. https://doi.org/10.1111/j.1756-185X.2009.01381.x.
  3. Bliss, Laura and Citylab. “An American History of Lead Poisoning.” The Atlantic, published February 12, 2016. https://www.theatlantic.com/health/archive/2016/02/an-american-history-of-lead-poisoning/462576/.
  4. Center for Disease Control. “Lead: Health Problems Caused by Lead – NIOSH Workplace Safety and Health Topic Department of Health & Human Services. Last Reviewed June 18, 2018. Accessed September 5, 2019. https://www.cdc.gov/niosh/topics/lead/health.html.
  5. Childs, Julien R. “Sir George Baker and the Dry Belly-Ache.” Bulletin of the History of Medicine 44, no. 3 (1970): 213-40. http://www.jstor.org/stable/44449974.
  6. Chisolm, J. Julian. “Lead Poisoning.” Scientific American 224, no. 2 (1971): 15-23. http://www.jstor.org/stable/24927721.
  7. Dequeker, Jan. “Medicine and the artist.” Age and Ageing 37, no. 1 (January 2008): 4–5. https://doi.org/10.1093/ageing/afm154.
  8. Drum, Kevin. “Lead: America’s Real Criminal Element.” Mother Jones. January/February 2013 Issue. https://www.motherjones.com/environment/2016/02/lead-exposure-gasoline-crime-increase-children-health/.
  9. “Elevated Blood Lead Levels Associated with Illicitly Distilled Alcohol — Alabama, 1990–1991.” Morbidity and Mortality Weekly Report 41, no. 17 (1992): 294-95. http://www.jstor.org/stable/23300153.
  10. Fields, Scott. “Exposing Ourselves to Art.” Environmental Health Perspectives 105, no. 3 (1997): 284-89. doi:10.2307/3433264.
  11. Gearing, Mary. “The Deadly Biology of Lead Exposure.” SITNBoston – Harvard University. Published June 27, 2016. Accessed September 5, 2019. http://sitn.hms.harvard.edu/flash/2016/deadly-biology-lead-exposure/.
  12. Hamilton. Alice. “Lead Poisoning in American Industry.” The Journal of Industrial Hygiene 1 (April, 1920): 8-21. https://hdl.handle.net/2027/chi.17209657.
  13. Hanna-Attisha, Mona, Jenny LaChance, Richard Casey Sadler, and Allison Champney Schnepp. “Elevated Blood Lead Levels in Children Associated With the Flint Drinking Water Crisis: A Spatial Analysis of Risk and Public Health Response.” American Journal of Public Health106 no. 2, (February, 2016): 283-290. doi: 10.2105/AJPH.2015.303003.
  14. Hernberg, Sven. “Lead Poisoning in a Historical Perspective.” American Journal of Industrial Medicine 38 no. 3 (September, 2000): :244-254. https://doi.org/10.1002/1097-0274(200009)38:3%3C244::AID-AJIM3%3E3.0.CO;2-F.
  15. Hodge, A. Trevor. “Vitruvius, Lead Pipes and Lead Poisoning.” American Journal of Archaeology 85, no. 4 (1981): 486-91. doi:10.2307/504874.
  16. Kennedy, Chinaro, Ellen Yard, Timothy Dignam, Sharunda Buchanan, Suzanne Condon, Mary Jean Brown, Jaime Raymond, Helen Schurz Rogers, John Sarisky, Rey de Castro, Ileana Arias, Patrick Breysse. “Blood Lead Levels Among Children Aged <6 Years — Flint, Michigan, 2013–2016.” Morbidity and Mortality Weekly Report 65, no. 25 (July, 2016): 650-654. http://dx.doi.org/10.15585/mmwr.mm6525e1.
  17. Lessler, Milton A. “Lead and Lead Poisoning from Antiquity to Modern Times.” The Ohio Journal of Science 88, no. 3 (June, 1988): 78-84. http://hdl.handle.net/1811/23252.
  18. Mayo Clinic Staff. “Lead Poisoning – Symptoms & causes.” Mayo Foundation for Medical Education and Research. Published December 06, 2016. Accessed September 5, 2019. https://www.mayoclinic.org/diseases-conditions/lead-poisoning/symptoms-causes/syc-20354717
  19. Mohai, Paul. “Environmental Justice and the Flint Water Crisis.” Michigan Sociological Review 32 (2018): 1-41. https://www.jstor.org/stable/26528595.
  20. Montes-Santiago, Julio. “Chapter 9 – The lead-poisoned genius: Saturnism in famous artists across five centuries.” Progress in Brain Research 203, (2013): 223-240. https://doi.org/10.1016/B978-0-444-62730-8.00009-8.
  21. Needleman, Herbert. “LEAD POISONING.” Annual Review of Medicine 55 (February 2004): 209–222. doi: 10.1146/annurev.med.55.091902.103653.
  22. Nriagu, Jerome O. “Tales Told in Lead.” Science 281, no. 5383 (1998): 1622-623. http://www.jstor.org/stable/2896365.
  23. Olson, Terese M, Madeleine Wax, James Yonts, Keith Heidecorn, Sarah-Jane Haig, David Yeoman, Zachary Hayes, Lutgarde Raskin, and Brian R. Ellis. “Forensic Estimates of Lead Release from Lead Service Lines during the Water Crisis in Flint, Michigan.” Environmental Science & Technology Letters 4, no. 9 (Jul7 2017): 356-361. DOI: 10.1021/acs.estlett.7b00226.
  24. Phillips, Charles Robert. “Old Wine in Old Lead Bottles: Nriagu on the Fall of Rome.” The Classical World 78, no. 1 (1984): 29-33. doi:10.2307/4349661.
  25. Retief, FP and L Cilliers. “Lead Poisoning in Ancient Rome.” Acta Theologica Supplementum 7 Vol 26, No 2 (2006): 147-164. https://www.ajol.info/index.php/actat/article/view/52570/41176.
  26. Riva, Michele Augusto, Alessandra Lafranconi, Marco Italo D’orso, and Giancarlo Cesana. “Lead Poisoning: Historical Aspects of a Paradigmatic “Occupational and Environmental Disease”.” Safety and Health at Work vol. 3 no. 1 (March 8, 2012): 11-16. https://doi.org/10.5491/SHAW.2012.3.1.11
  27. Torrice, Michael. “How Lead Ended Up In Flint’s Tap Water.” Chemical & Engineering News. Published online February 11, 2016. , Accessed September 5, 2019. https://cen.acs.org/articles/94/i7/Lead-Ended-Flints-Tap-Water.html.
  28. Waldron, H. A. “Lead Poisoning in the Ancient World.” Medical History 17, no. 4 (1973): 391–99. doi:10.1017/S0025727300019013.
  29. Warren, Christian. Brush with Death: A Social History of Lead Poisoning. Baltimore: The Johns Hopkins University Press, 2000.
  30. Weeden, Richard P. “Irregular Gout: Humoral Fantasy or Saturnine Malady.” Bulletin of the New York Academy of Medicine 60, no. 10 (December, 1984): 969-979. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911803/.
  31. Wines, Michael and John Schwartz. “Unsafe Lead Levels in Tap Water Not Limited to Flint.” The New York Times. February 8, 2016. https://www.nytimes.com/2016/02/09/us/regulatory-gaps-leave-unsafe-lead-levels-in-water-nationwide.html?_r=1.
  32. Winowiecki, Emma. “Does Flint have clean water? Yes, but it’s complicated..” Michigan Radio. Published August 21, 2019 Accessed September 5, 2019. https://www.michiganradio.org/post/does-flint-have-clean-water-yes-it-s-complicated.

MARIEL TISHMA currently serves as an Executive Editorial Assistant with Hektoen International. She’s been published in Hektoen International, Bloodbond, Argot Magazine, Syntax and Salt, The Artifice, and Fickle Muses. She graduated from Columbia College Chicago with a BA in creative writing and a minor in biology. Learn more at marieltishma.com.

Highlighted in Frontispiece Volume 12, Issue 1 – Winter 2020

Summer 2019

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