When I was a pediatric house officer at a university hospital, my colleagues and I saw and treated about 20 cases of severe lead poisoning each year. When we examined these children on the ward, many had brain swelling severe enough to produce coma and convulsions. Most left profoundly brain damaged and handicapped. Some died. Now at most major teaching centers, pediatric residents usually finish their training without ever seeing a case of brain swelling due to lead.
This decrease in lead encephalopathy and death is a public health triumph. Because of projected budgetary changes, it may be short-lived. One of the prominent reasons for the decline in severe lead poisoning has been the activity of the Center for Disease Control's Environmental Health Services Division. This federal program collaborates with local officials in the health screening of children, educating physicians and health officials and advancing the technological level of lead measurement and control.
CDC undertook the lead program in 1974 and transformed it from one of minor consequence to a model of preventive practice. Each year 500,000 American children under age six have their fingers pricked and their lead exposure evaluated. In the process, neighborhoods and entire cities become more aware of the hazard of lead, and the incidence of toxicity drops accordingly. In cities of under 200,000, three years after a lead-screening program begins, the proportion of tested children with excess exposure usually drops to one third of the starting level, as children with high exposure are found and treated, and the community learns of the threat.
While the incidence of reported deaths and lead encephalopathy has decreased, lead toxicity continues to be one of the most important public health problems for American children, exceeded in significance only by undernutrition. Of the half-million children screened last year, 30,000 were found to have lead toxicity. CDC epidemiologists estimate that 150,000 children under age six, or 1 percent of the population at risk, are intoxicated. This is a bona fide epidemic in which most of the cases go unrecognized. Lead's symptoms, in its milder forms, are headaches, malaise and irritability. None of these complaints carry the label of lead poisoning, and most children with them do not see a doctor.
Even at these lower doses, lead continues to do its quiet mischief. Children with high levels of lead in their teeth (and by inference in their brains), but who have not come to medical attention, are less able intellectually, less attentive and more disturbed. Teachers who are unaware of a child's lead burden report more distractibility and poorer classroom function in those children with high tooth lead. Epidemiologists have estimated that as much as 43 percent of overall classroom functioning in some areas may be attributed to lead exposure.
The current OMB plan calls for the reduction of the slim federal lead budget of $10.5 million by 25 percent, and then, as with other preventive medical programs, the return of these funds to the states by the block grants mechanism. CDC's central lead office will wither in the process.
As one who has spent considerable time educating pediatric specialists and politicans about lead's continuing threat, I am doubtful that many governors will be sensitive to the problem. Certainly 50 state offices as informed and motivated as the CDC central lead program cannot be developed and maintained.
Stripped of central coordination, education and quality control, lead screening and public awareness will slowly slip back to where they were in the '50s and '60s. This may have one educational effect that is not without irony. Pediatric house officers may again be seeing the classic picture of lead-caused brain swelling in the cribs of our children's hospitals.