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BOOK REVIEW

Plumbing the Plumbing

David Rosner

The Great Lead Water Pipe Disaster. Werner Troesken. x + 318 pp. The MIT Press, 2006. $29.95.

A few years after World War I ended, National Geographic magazine published a series of advertisements touting the value of lead in the newly developing consumer economy of the United States. One of these National Lead Company ads blared, "Lead helps to guard your health," illustrating this message with lead-containing objects from a modern bathroom, including porcelain tiles, sink, tub, water heater, paint and piping. Lead, the text maintained, was "invaluable in assuring comfort and proper sanitation" and, when used as an ingredient in paint, would prolong the life of a house. Another ad, which showed balls, bats, racquets, golf clubs, a fishnet with lead sinkers, toy soldiers, a doll and playhouse furniture, proclaimed, "Lead takes part in many games." Still another featured a motorcar, explaining that the radiator, storage battery and tires all contained lead. It would soon be found in the gas tank as well—tetraethyl lead was developed in the 1920s as a gasoline additive to prevent engine knock. But the industry's promotional campaigns over the decades failed to mention one important fact of which it was well aware: that lead is, as one company put it in 1904, "a deadly, cumulative poison."

The American love affair with lead firmly established it as a pollutant—one that we have been forced to address for decades and aren't finished with yet. Recent headlines have alerted us to the devastating consequences of lead poisoning among children exposed to lead paint on toys imported from China. But the single most important source of lead toxicity today is paint dust in homes built before 1978, when paint containing more than 0.06 percent lead was banned for residential use in the United States. Lead also continues to leach into drinking water from pipes.

In The Great Lead Water Pipe Disaster, historian Werner Troesken investigates water pipes as a major source of lead contamination, focusing on the second half of the 19th century and the early decades of the 20th. Starting 150 years ago, the rapid development of lead-pipe water-delivery systems in major cities of the United States and Great Britain, he argues, resulted in the insidious development of lead poisoning among quickly expanding urban populations. Troesken dissects vital records in those cities as well as clinical reports in the medical and public health literature of the era, looking for signs that lead was a serious problem. Using statistical and demographic techniques, which he explains in some detail in two appendices, he analyzes and reanalyzes data from a variety of cities, finding that those with lead piping experienced elevated rates of miscarriages, infant deaths and convulsive disorders, among other conditions. Lead water pipes weren't just a problem, they were a catastrophe—one of the greatest environmental disasters of the past 200 years, Troesken suggests, given that lead pipes have "killed or harmed many more people than were injured by events in Bhopal, India, or at Love Canal."

This is an interesting and impressive book that brings quantitative analysis to bear on some key historical questions. According to Troesken, the newness of his work rests in the methodology he uses to uncover what may not have been obvious without statistical techniques. Such conditions as miscarriages and infant deaths were not easily recognized at that time as symptoms of the larger problem of lead poisoning through municipal water supplies, he says; modern scrutiny of the historical evidence allows "a more rigorous and scientifically sound assessment" of lead piping as a source of danger. The importance of lead as a serious health hazard was missed due to a number of factors. First, it took a long time for symptoms of lead poisoning to appear. Second, the attention of public health departments and physicians in those days was focused overwhelmingly on acute infectious diseases and on adult health rather than infant mortality. Third, not every municipality with lead pipes had high levels of lead in its water; lead leached primarily from newer pipes and from those not exposed to hard water (since such exposure typically promoted the formation of a protective coating on the interior of pipes).

Most of the chapters begin with a clinical report or narrative description of a particular case from the era, in which lead in drinking water is a possible cause of an illness—typically eclampsia (coma or seizures in a pregnant woman with no prior history of such disorders), convulsions or infant death. After recounting the facts of the case, Troesken begins a statistical dissection of its basis, and by chapter's end we learn that lead piping was indeed the culprit.

The book builds on close examination of lead-poisoning research, previous histories of lead, and the vibrant literature describing efforts to merge historical narrative and quantitative evaluation. It is significant that the dust jacket includes endorsements from Herbert Needleman, one of the nation's foremost lead researchers; Dora Costa, an MIT professor of economics; and Stanley Engerman, an economist and historian who is a coauthor of Time on the Cross, perhaps the most controversial example of a book that addresses important historical issues through the use of quantitative methodology. The Great Lead Water Pipe Disaster is part of the same tradition, which some historians of the mid-1970s criticized because they were concerned about the reliability of historical statistics or because they were worried that important nuances of local conditions might be overlooked in attempts to reach sweeping conclusions from often inexact or partial data.

Troesken's book, which illustrates some of the best aspects of this tradition, is of enormous importance in documenting yet another way in which lead has polluted the environment and destroyed the lives and well-being of people around the world. Further, the book provides a window on the insidious nature of this poison, detailing its complex clinical manifestations, which throughout the 19th century confounded observers, who often mistakenly ascribed the symptoms to other causes. By the end, Troesken has left little question that lead has been and continues to be a serious public health threat—particularly to children and women.

But some aspects of the book are troublesome. First, the methodology at its center leads the reader to a needlessly reductionist conclusion: Not only was lead piping then a serious and overlooked problem, it was close to being the critical problem in urban settings. Troesken notes that other factors—including polluted water, inadequate sewerage, spoiled food, urban crowding and broad social and economic inequality—caused widespread outbreaks of infectious diseases (such as cholera, typhoid, typhus and, of course, tuberculosis), high rates of infant mortality (from diphtheria, diarrhea, fever and malnutrition) and disastrous rates of maternal mortality (from infections and sepsis following childbirth). But in much of his discussion, he ignores, downplays or even casts aside these factors. Sometimes his hypothesizing on the basis of scanty evidence leads to overly ambitious conclusions that overstep the limits of the data.

In such instances, the question of historical methodology becomes critical. Troesken maintains that health data from New England and Britain were "relatively complete." But how does he manage to get clean results from data that are only "relatively" complete?

This uncertainty is particularly critical, given Troesken's claim that his quantitative analysis is what makes this book valuable. Do we actually know that the incomplete data constitute a truly representative sample of what was really happening in the water supplies of the cities of Great Britain and the United States?

For example, in a section titled "Re­thinking Municipal Socialism," Troesken criticizes Glasgow and New York City for not paying attention to the threat of lead in their water pipes and thereby perpetuating a dangerous situation. He contrasts their performance with that of the Milford Water Company, a private enterprise in a small town in Massachusetts, which acted relatively quickly "to reduce the lead solvency of its water supply." His point, he says, is that "one should not blithely assume that public enterprises are above reproach, or necessarily superior to private organizations in the provision of public health." Troesken's agnosticism regarding the relative merits of public and private ownership of urban water supplies appears to be based primarily on findings in one small community (one in which high lead exposure was found in only 12 homes) and in two cities with extremely rich and complex social and public health histories. He is not necessarily wrong, but his massaging of incomplete or questionable data sometimes left me thinking that his reliance on quantification did not add much to his argument. For instance, in the first chapter, Table 1.1, "Lead pipes in the fifty largest American cities, 1900," appears to be based entirely on a single source, an 1897 publication of which we know little, The Manual of American Waterworks, by Moses Baker. Troesken is not naive about the limitations of his data; he does, after all, acknowledge the difficulty of comparing a small town to Glasgow and New York. But his claims that the use of statistics can be a means of achieving objectivity may be overstated.

Troesken's failure to provide detailed social histories of the communities he uses as examples left me wondering whether his implied conclusions about the failure of "municipal socialism" are justified. New York City's water supply, for example, has a long and interesting history: Private water companies were integrated into the municipal system as Brooklyn and Queens were integrated into the larger city, and a tremendously complex network of aqueducts and reservoirs was built up over the course of a century. It has been argued that municipal management there ultimately produced one of the purest and best-quality systems in the world, one that substantially reduced rates of infant mortality and infectious disease.

Troesken may be right in asserting that lead pipe was used throughout the system, but given the city's complex political history, I'd like to see more documentation than the few newspaper articles he cites. A close social history would have provided contradictory evidence. For example, although we learn little from Troesken about the construction of the water system in New York, other sources show that building codes there actually forbade the use of lead pipe in internal plumbing and restricted it for other uses as well. In 1919 the codes limited the use of lead pipe to "the short branches of the soil, and waste pipes, bends and traps" (Bulletin of the Board of Standards and Appeals of the City of New York, 1919, vol. 4). Although it's not clear to me exactly what that means, certainly the use of lead was not mandated. So the meaning of Troesken's Table 1.1 may be less than meets the eye. Without  a more exact historical understanding, it is impossible to know how important an issue the lead pipe was. This is particularly true given the many other sources of lead in the environment, including the mammoth problem of lead paint.

I also question the data on levels of lead in blood and water that Troesken uses in the quantitative parts of his study, given how difficult it was back then to isolate lead in the laboratory. As late as the 1930s, it took a trained laboratory technician two full days to measure the level of lead in the blood of a single patient.

These specific caveats aside, The Great Lead Water Pipe Disaster is a challenging and important contribution to our understanding of one of the great public health problems of the past two centuries—lead and its pollution of the environment. Troesken has provided us with new insights, and we should applaud him for it.

 

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