It happens an average of three times a day in Baltimore -- an urgent phone call or knock at the door, a fearful dash to the doctor's office, followed by a lifetime of worry.
"Your baby has been lead-poisoned."
Almost 27 years ago, that baby was Barbie Kress.
Today, she is a walking exhibit of the ravages of lead poisoning. Brain-damaged, unable to keep a job and prone to explosive outbursts, she is the face of an affliction that strikes about 1,200 children every year in what the U.S. Department of Housing and Urban Development ranks as one of the most toxic cities in America.
"I'm so tired of going to court," she sighs. "I'm so afraid of going to jail, scared of losing my kids, scared of losing my life. But when I get to beefing with people, it's like something goes off inside me. ... I just lose it."
She is 5-foot-4 and weighs only 105 pounds. But her periodic rages are so intense that she is virtually unstoppable. She has knocked out a cousin's front teeth, carved up her husband's arm with a broken bottle, beaten him with a shower rod, punched out his ex-girlfriend, and, in a neighborhood dispute, pummeled a woman senseless and trashed her house after being blasted in the face with pepper spray.
"It's not that I'm a bad person," says the 31-year-old mother of two, brushing aside a wisp of brown hair and squinting through the smoke from a Marlboro Light. "Or maybe I am. Sometimes I just don't know no more."
This much her doctors do know: Her terrible temper, her long history of run-ins with police and her years of drug abuse had their beginnings in a massive dose of lead paint that nearly killed her when she was 4 years old. The poison left her with a condition her doctors call "bilateral frontal lobe and cortical dysfunction." A scrambled brain. And a very short fuse.
Her symptoms were readily apparent even as a child, and may have been worsened by later addiction to alcohol and mood-altering drugs.
Now her baby is poisoned, too.
Little Casey, the angel-faced redhead that everyone calls "Roo," for her favorite Winnie the Pooh character, has been loaded with lead paint for so long that she can barely speak an intelligible word at the age of 3. Says Barbie: "I'm the only one that can understand her most of the time."
They live in a rental rowhouse near Patterson Park in the 1900 block of E. Lombard St., in the shadow of the bell tower of St. Michael's Church.
Inside their red-brick, three-story home, levels of lead paint dust in places are more than 250 times the state standard. In the room where Casey sleeps, the paint on the window frame near her bed contains 80 times more of the toxin than is allowed by federal regulations.
The paint, tests show, is nearly 40 percent raw lead.
"Most of the readings are off the chart," says Shannon Cavaliere of ARC Environmental Inc., a Baltimore lead-testing company that surveyed the house under a contract with The Sun. "Unfortunately, it's not a lot different than what we see in older rental neighborhoods all over the city. With a few exceptions, it's fairly typical."
But the exceptions in this case are telling. In a city where hundreds of kids are exposed to dangerous levels of lead paint every year -- usually through the indifference of scofflaw landlords who control Baltimore's three worst slum enclaves -- Barbie Kress and her children live in a neighborhood far outside any recognized hot zone. On a block where no child has ever been reported poisoned before. In a house owned by a man with no prior history of lead violations, Health Department records show.
Rather, Casey is the victim of a renovation project undertaken with the best of intentions by her father, a self-taught carpenter who knew little about the hazards of lead poisoning when he gutted the third floor of his landlord's house and sent plumes of toxic dust billowing through the halls.
Theirs is a cautionary tale about an unseen threat that lies in nearly every home in Baltimore.
For little Casey, who has been carrying poisonous levels of lead in her bloodstream for three years, it may already be too late. Born to a mother whose brain was damaged by lead paint, she now faces a similar fate. Barring a miracle, Casey will likely struggle for the rest of her life.
Already, according to U.S. government estimates, she is five times more likely to fall behind in school, seven times more likely to drop out. A recent university study suggests that Casey may well spend some time in jail.
For the sake of other children like her, Casey's parents desperately want her story to be told.
Barbie Kress herself fits into what nationally known lead researcher Dr. Herbert L. Needleman calls "a classic profile" for victims of high-level lead poisoning. Abysmal school performance. Trouble adapting to stress. Drug addiction. Violence.
A growing body of research -- more than 30 studies in five countries -- has shown that lead increases the tendency of laboratory animals to react aggressively to slight provocation. At least nine other studies have established that the toxin increases tolerance for alcohol, cocaine, morphine and methamphetamine.
In humans, the toxin appears to have similar effects, depending on dosage and duration of exposure, researchers say.
Scientists note, however, that lead poisoning seldom occurs in isolation. A broad range of factors such as poverty, family instability, drug abuse and poor nutrition can exact mental and emotional tolls of their own -- making it difficult to identify the exact cause of a victim's troubled behavior.
This much is clear: For Barbie Kress and others like her, lead can severely limit their ability to cope with even minor strains.
The phenomenon is just beginning to come to the attention of the courts, as defense attorneys explore lead poisoning as a possible explanation for the sudden bursts of rage experienced by many victims as they age to adulthood.
"Over the past 10 years, lead poisoning has certainly become an integral part of background investigations in death penalty cases," says Frank Draper, a capital punishment lawyer with the Maryland Office of the Public Defender. "And it's probably just a matter of time before defense attorneys start raising it in other kinds of cases.
"At high enough doses, you can make an unequivocal case that a defendant's violent actions are explainable by his lead poisoning. Their brains are broken. They just can't control themselves."
High score, grim future
"You have 30 minutes to get your daughter to the hospital."
"What are you talking about?"
"She's badly lead poisoned. She could die. If you won't take her, I have the authority to do it for you."
The conversation took place nearly 27 years ago, on Sept. 21, 1973. But Barbara Richter, 53, remembers it as if it were yesterday.
She was lying on the couch in her rundown rented rowhouse in the 200 block of S. Pulaski St., with its chipped woodwork and peeling walls, and plaster that crumbled like old chalk.
She was watching a soap opera and recovering from surgery. Her daughter Barbie was playing nearby, giggling and jabbering and fussing the way babies do.
She remembers the knock at the door. Standing on the steps was a sanitarian from the Baltimore Health Department, holding a sheet of paper that bore the results of Barbie's latest blood test and emphatic instructions on what her mother was to do next.
"Your daughter has a 107," the sanitarian said. "You need to get her to the hospital immediately."
The score on Barbie's annual checkup at Bon Secours Hospital held no significance for Richter then. It was just a number -- a measure of the micrograms of lead in a deciliter of her baby's blood. She knew nothing of the scientific research behind that number, or the fact that doctors automatically report such high lead readings to city health officials.
By the current standards of the U.S. Centers For Disease Control and Prevention in Atlanta, Barbie's blood contained 10 times more lead than is considered safe -- enough, in fact, to poison three children.
"All I knew then was that Barbie could die," Richter recalls.
The sanitarian gave her cab fare and stood by with Barbie in the living room as Richter ran to get dressed. Within the hour, they walked into the Kennedy Krieger Institute on Broadway, bypassed normal check-in procedures and were whisked by a waiting nurse into the Krieger lead clinic.
"That's the day we met Dr. Chisolm," Richter recalls. "He told me Barbie had lead in her brain, in her bones, in her kidneys. He told me her brains were swelled up inside her head from all the lead, and if we waited much longer she could have died. Her brains could have been squashed inside her skull."
Dr. J. Julian Chisolm Jr. was by then one of the world's leading authorities on lead poisoning in children. Over the preceding 17 years, he had published at least 22 scientific papers on the subject. Among these was a groundbreaking study in 1956 which revealed that children in the slums of East Baltimore had up to six times more lead in their systems than severely exposed industrial workers who handled the substance for a living.
The study also firmly established that the poisoning of Baltimore's kids was caused primarily by dust and chips from old lead paint in their homes, rather than lead fumes in the environment or some other source.
In the 1950s, Chisolm had pioneered a safe treatment for severely poisoned children that saved the lives of hundreds worldwide. Using two chemical agents, one of which had been developed by British scientists during World War II as a nerve gas antidote, doctors were able to flush the lead from children's bodies.
The treatment has two drawbacks. In addition to lead, one of the chemicals also flushes out vital minerals such as iron, zinc, magnesium and calcium, leaving patients weak. And it requires a form of ritual torture: a dozen or more deep muscle injections every day for up to a month.
"They would stick four needles in her at a time," Richter recalls. "In her arms, her heinie, her thighs, her legs. Pretty soon, they were running out of places to stick them. She was there three weeks, and by the end they were sticking them in her neck."
The children in the lead treatment clinic at Kennedy Krieger called it "hurty time."
"We'd see them nurses coming with the medicine trays and we'd scatter," Kress remembers. "We'd hide under our beds or lock ourselves in the bathroom. They had this phone booth on the ward -- the old kind with the folding doors -- and I used to run in there and sit on the floor with my feet against the door so they couldn't get me.
"But you had to come out sooner or later, and when you did they'd drag you into the playroom for your shots so the other kids on the ward wouldn't have to see you cry."
Afterward, Dr. Chisolm would appear in a bow tie and a white lab coat and round glasses -- a balding, grandfatherly man with a boyish grin. He would examine them and chart their progress on a clipboard, dispensing small comforts and jokes and stories.
"Some of my first memories are about that man," Kress says. "All us kids loved him, maybe because he weren't the one giving us the needles. He was always nice to us. And we always laughed at his bow ties. A lot of us, he saved our lives. Me, for sure."
Today, at 79 years old, Dr. Chisolm still recalls Barbie Kress.
"There's not much question, at blood levels that high, that the child would need assistance for the rest of her life," he says. "We now know that kids can suffer lifelong damage at levels far less than that. And those kinds of cases are still happening in Baltimore. Even with everything we know about the conditions that cause lead exposure, it continues to happen."
About 1,200 children a year are poisoned in Baltimore, according to the U.S. Centers For Disease Control and Prevention.
Research shows that most will suffer what Chisolm calls "dumbing effects." Many will become hyperactive, unable to concentrate for more than a few minutes. And the damage, more often than not, is irreversible.
"As with any epidemic," Chisolm says, "some patients will recover for reasons that may not be clear. But it is fairly well established in the literature ... that the damage from lead poisoning is permanent, or at least highly persistent."
The causes are at least threefold. At the critical time when young nervous systems are still forming, lead blocks the absorption of essential minerals -- deforming children's nerve endings and jamming their brains with scrambled impulses that researchers have variously described as "static," "noise" and "racket."
Recent research at Kennedy Krieger has found that the toxin stunts growth in the part of the brain that translates these nerve signals. So, poisoned children not only receive a flood of garbled messages from their senses, they may also have less ability to process the information.
Finally, lead disrupts the normal release of a powerful chemical called dopamine that enables the brain to turn sound, sight and touch into thoughts, decisions and actions.
The overall result is a persistent state of mental confusion that causes children with lead poisoning to behave in strange and sometimes frightening ways.
"When you see the grief it brings into their lives, and into the lives of their families, it's unconscionable that we've let this problem go on as long as we have," Chisolm says.
The grief is considerable, and the children are not the only ones who suffer. In cities and towns across America, researchers say, society is paying a heavy price for the epidemic of lead poisoning that strikes about 1 million children annually.
A dose of anger
For more than 20 years, Dr. Herbert L. Needleman has been at the forefront of research into the disturbing phenomenon of violence among poisoned children.
A pediatrician at the University of Pittsburgh Medical School, he is widely recog- nized as the leader of a national movement of doctors and scientists who say that even relatively small doses of lead can stunt children's intelligence and make them volatile well into adulthood.
"Anyone who doubts it need only talk to the parents of these children," Needleman says. "It wasn't doctors or neurologists who discovered this. It was the mothers who have been walking into clinics for decades reporting this problem. There is a nearly universal profile, a sameness to the reports, that is very impressive. And at higher doses, it's almost beyond debate at this late date that lead makes kids unstable."
As early as 1943, researchers at Boston Children's Hospital noted in a study of 20 kids with serious lead poisoning that 18 later had "extremely poor" school records, poor coordination and a striking tendency to be impulsive, cruel or overly aggressive.
One boy stabbed a kindergarten classmate in the face with a fork. Another set fires in school. A little girl tortured animals. Frustrated teachers reported that most of the kids were all but uncontrollable in class.
Building on this early research, Needleman sought to prove that even minuscule doses of lead might have similar effects. Using previously untried methods -- and test equipment of his own design -- he found himself at the center of a roaring professional debate.
His harshest critics accused him of deliberately misrepresenting his findings in a 1979 intelligence study to make the toxin appear more dangerous.
Dr. Chisolm, a contemporary who was publicly skeptical of Needleman's early work, says: "I must say that I'm now moving more and more to his point of view.
"The controversy back then had a lot to do with the fact that he was using new methods and new equipment that perhaps were not as precise as they could have been. Over the years, as his data has gotten more refined, he has continued to win more people over."
Chisolm also notes that Needleman's studies have been bolstered by other researchers who have replicated his findings.
In more than 60 controlled animal studies and long-term tracking projects involving thousands of poisoned children in Australia, New Zealand and the United States, scientists have verified Needleman's early observations that lead appears to blunt kids' learning potential and make them increasingly unstable the longer they are exposed.
In a nearly three-decade career of provocative work, Needleman's most recent study may be his most startling. In a random sample of 216 juvenile offenders in Allegheny County, Pa., Needleman found that they were almost twice as likely to have suffered lead exposure as a comparable group of Pittsburgh teens who had never committed a crime.
The study suggests that up to 37 percent of youth offenders might have been exposed to lead as toddlers.
Needleman presented his findings to the U.S. Department of Justice and the Pediatric Academic Societies. He is well aware of the broader implications. "It may well be," he says, "that in places like Baltimore, Philadelphia, Milwaukee and Newark, N.J. -- where the rate of exposure is worse than it is in Pittsburgh -- that you might find an even greater incidence of lead-related delinquency."
From more than 50 years of accumulated scientific studies, this much is clear, he says: As dosages of lead increase in a given child, or a given population of children, so does the potential for uncontrollable violent outbursts.
And in children as severely stricken as Barbie Kress, aggressive behavior may become more likely than not.
Upon reviewing her records, the first thing that came to Needleman's mind was a name.
"Lavar Bryant's file," he says, "looked a lot like this."
Like Barbie Kress, Bryant was severely stricken by lead paint as a child. His medical records show that he suffered an 83-microgram dose when he was 1 year old. Almost from the moment he began to crawl, he picked up on his hands and clothes and toys the toxic lead paint chips and dust that pervaded his mother's rented tenement. So much lead got into his system that he remained poisoned for six years.
Like Kress, Bryant went on to experience severe learning disabilities, problems with drugs and trouble with police.
One attorney who represented him calculated that Bryant had been involved in more than 100 incidents of truancy, fighting and petty crime by the day he finally made the news on Aug. 4, 1995.
It was shortly after his 18th birthday when he appeared in the parking lot of a state office building on a steamy afternoon in Columbia, S.C. and broke into a truck.
At that moment, Mike Suber left his desk at the state Department of Health and Environmental Control to run some lunchtime errands. As Suber approached his truck, he noticed the lanky teen emerging from the cab with something in his hand.
The 45-year-old photographer hardly hesitated. "What are you doing?" Suber demanded.
"Nothing," Bryant replied.
In a signed confession after his arrest the next day -- after he tried to commit suicide by guzzling from a bottle of brake fluid -- Bryant admitted that he had turned on Suber and lashed at him with a screwdriver. Three times Bryant jabbed the tool at Suber's chest before punching through to his heart.
"I was afraid, so I grabbed the man and we started fighting," Bryant told police. "I stabbed at him ... and he started gasping."
In June 1997, it took a jury less than three hours to convict Bryant of murder. Remarkably, the jury refused a prosecutor's request to give Bryant the death penalty, choosing instead to hand down a life sentence.
"In South Carolina, in a case like that, with a black defendant, it was a small miracle that they spared his life," says Frank Draper, who assisted in Bryant's defense before coming to Baltimore as a public defender. "And it had everything to do with Lavar's lead poisoning."
At his penalty hearing, jurors were told of Bryant's inability to concentrate in school, his impulsiveness, his explosive temper and his long history of petty violent crimes that often lacked a motive. Tests revealed that he was mentally retarded.
Appearing as an expert witness, Dr. Needleman told the jury that such a massive dose of lead would have made Bryant prone to uncontrollable aggression long after he was exposed.
"He has significant organic brain damage due to lead poisoning," Needleman told the jury. "Children who have recovered from lead poisoning ... have trouble controlling their impulses, which means they don't think through what they're going to do before they do it. And ... they're often aggressive."
Prosecutor Knox McMahon suggested that not all lead poisoning victims turn violent, not all become criminals, and that Bryant's drug and alcohol abuse might have contributed to his troubles.
Needleman agreed, then added: "Part of the boy's reason for doing this terrible thing was that he was lead poisoned. His brain was compromised."
"He's very damaged," McMahon said. "He's very dangerous also?"
"Yes," Needleman replied.
Bryant's temper flared during the trial -- resulting in him watching much of it unfold on closed-circuit TV from a holding cell after he repeatedly lunged from his chair during prosecutors' remarks.
"This was a guy who was capable of boiling over at the slightest provocation," recalls Draper. "It was almost fortunate for Lavar that he was as badly poisoned as he was as a kid, because it meant he had to be admitted to a hospital, where they keep very good records. If it weren't for those records, he'd probably be sitting on death row right now."
John Blume, a Cornell University law professor and opponent of capital punishment who assisted in Bryant's defense, has been citing the case in seminars for defense attorneys ever since.
"I don't think there's any doubt that there's a lot of undiscovered lead poisoning lying in the background of a lot of capital murder cases," he says. "You can take one look at some of these guys and know something is up.
"A lot of them have all the tell-tale signs -- grossly diminished IQ, long histories of petty violence and misdirected anger, and episodes of impulsive behavior that make absolutely no sense. That's when I advise defense attorneys to start asking about lead poisoning."
Especially if the circumstances of the case suggest that a killing resulted from a spontaneous rage or overreaction to minor provocation, lead poisoning is at the top of Blume's checklist, he says.
"Basically, to condemn a defendant, a jury is supposed to find that he exercised free will and committed a deliberate act," Blume says. "In cases of serious lead poisoning, it's doubtful that any of them fit that definition."
Barbie Kress calls it "zapping out." And it's been happening for a long time.
By age 10, medical records show, she had become a one-girl wrecking crew, fighting with classmates, getting into scrapes with police over petty acts of vandalism and nearly getting kicked out of special education classes at two schools.
"Barbara's mother called today to request a psychiatric referral for her daughter," one nurse noted in her file on Oct. 3, 1979. "Barbara has been having quite a bit of trouble in school and at home and has been involved with the police on several occasions. She is presently in the fourth grade on a trial basis, but [her] mother feels that if her behavior worsens she will be expelled altogether."
Doctors noted that Barbie's fragile mental state was not helped by instability at home. Her parents' marriage was torn by violence. After a bitter divorce, her mother was forced to move four times through a succession of rental houses as she struggled to complete an associate's degree while caring for two little girls on her pay as a bookkeeper.
Five years later, shortly after beginning her freshman year at Southern High School, Barbie Kress dropped out -- never again to endure the jeers of classmates who called her "retard" and "psycho" and "nut case."
"My math is OK, except when I get up into fractions and big numbers," Kress says. "It's really my reading where I have problems. Sometimes I need to read the words three or four times to get it, and sometimes I don't get it at all."
On a battery of tests in 1991, Kress scored at a fifth-grade level in math, less than a third-grade level in reading and in the range of mild retardation on general intelligence.
"This young woman with a history of lead poisoning produced a set of test [results] indicating longstanding dysfunction," wrote one psychologist who evaluated her. "These symptoms are consistent with research findings attributing the destruction of brain tissue ... to lead toxicity."
"I learnt myself to get by, I guess," Kress says. "I've had jobs and all. Problem is, I don't have them very long before somebody pisses me off and I zap out."
A paltry settlement
Three years after dropping out of school, Barbie gave birth to her first child, a daughter, Erica, in June 1987.
Three years later -- after losing a succession of menial jobs washing dishes and toilets and other people's laundry in a string of hotels and restaurants -- she saw something on television about children with lead poisoning. She thinks it was an advertisement, but she can't remember.
She went to the law offices of Saul E. Kerpelman, a young attorney who had filed more lawsuits on behalf of lead-poisoned children than any other lawyer in Baltimore.
Kerpelman remembers Barbie Kress as one of the "worst cases I have ever seen ... with absolutely horrible consequences for this young woman. I've seen a lot of victims, and I guess I'm fairly numb at this point," Kerpelman says. "But I have children myself, and every so often I get a case that makes me angry. This case made me angry."
As is so often the case in Baltimore's slums, however, the property management company that owned the house on Pulaski Street where Kress was living when she was poisoned was all but defunct.
Rowhouses controlled by Maryland Mortgage and Investment Co. and two subsidiaries had been implicated in the lead poisoning of at least 10 children between 1964 and 1979, city Health Department records show. Not only was the company uninsured, its total assets were valued at zero, according to the firm's tax returns.
"Without sounding sarcastic," an attorney representing the company wrote to Kerpelman's firm on March 24, 1993, "I would like to know from whom you think the money to settle this case will come."
Ultimately, Kerpelman settled the lawsuit for $3,105. After expenses, Kress got $771.50, records show.
Barbara Brown, an attorney representing Milton Sommers, the management company's owner, notes that the case never came to trial and that her client continues to deny responsibility for Kress' childhood poisoning.
"There is absolutely nothing in the record, beyond the plaintiff's assertions, that he was responsible in any way," Brown says. "There was a complete denial of liability on his part, and there is no indication that the court found otherwise."
Years of conflict
But for luck, Kress now admits, she might easily have killed several people in the years that followed. It was a period in her life she would rather not talk about. But she says it's important that people understand those like her.
"It ain't no fun being this way," she says. "You never know what could happen. And then you see what you did and you can't believe it was you that did it, you know?
"Does that make sense? 'Cause that's the part that people have to get. You know you're doing it, right? But, like, you can't stop yourself. It's like you're watching yourself do these really bad things and you can't believe you're doing them. But you can't stop."
From age 22 until Casey was born three years ago, Kress describes her life as a blur of jail cells and flying fists and waking up bloody in the morning. Judges were patient, sentencing her to a string of probations and home detentions and suspended sentences. Most of the charges eventually were dropped.
In June 1993, she got into an argument with a neighbor on Hanover Street after hearing rumors that the woman had accused her of cheating on her boyfriend.
"I heard she was ... spreading rumors all over the neighborhood," Kress says. "So I got in her face, and we got to beefing."
The rumor was untrue, but Kress didn't discover that until she had smashed through her neighbor's screen door, toppled her TV onto the floor, flipped over a table and doused her with pepper spray.
In the brawl that ensued, she drenched herself with the caustic spray as well. But unlike her adversary, who was gasping on the floor as Kress punched and kicked her, Kress was little deterred by the chemical.
"I was totally out of control," she admits. "By the time it was over, I trashed her place pretty good."
The incident is indelibly marked in the mind of Dawn Rutherford, 29, both for the fury of the confrontation and the fact that Kress was among her best friends at the time -- and still is.
"I've known Barbie since junior high school, and I love her like a sister," says Rutherford. "But she was a wild person that morning, totally out of her mind. I have bronchial asthma, so I could have died, and she knew that."
But Rutherford quickly forgave her friend.
"She's very different from other people," Rutherford says. "She's been through hell. She goes up and down, and she has for years. If someone would ever piss her off, even over something small, she would just go off. And it would take a lot to bring her back down -- hours sometimes."
Kress was charged with battery, malicious destruction of property and using a weapon with intent to cause injury. But prosecutors dropped the charges when Kress agreed to obey a restraining order.
Similar scenes were played out repeatedly over the next few years, with similar results, as Kress was charged in three separate batteries, three cases of malicious destruction, assault, disorderly conduct and harassment. In all, she has been the subject of five restraining orders.
During this period, she admits having used PCP -- a powerful animal tranquilizer popular in the white, working-poor neighborhoods of South Baltimore and known to induce unpredictable and sometimes violent behavior. She also consumed crack cocaine, marijuana and oceans of beer.
Chuck Hause, her husband and father of her children, recalls that during her worst period in the mid-1990s, Kress could "drink a roomful of grown men under the table."
She was drunk the night she attacked him with a metal shower rod and on the night she slashed his right arm with a broken bottle.
"A few inches higher and Chucky might be dead right now," Kress recalls. "It wasn't like I was aiming at his arm or nothing. He was just lucky."
Her court records contain a dry recitation of charges and dispositions and dates and places. Not once, in 11 trips through Baltimore's clogged and chaotic court system, was her devastating childhood lead poisoning noted in her files.
Not once did anyone plead in her defense that science had a possible explanation for her seemingly inexplicable behavior and her capacity for mind-boggling doses of drugs.
Dr. Jack R. Nation has seen it before.
For 15 years at Texas A&M; University, the toxicologist has been studying the peculiar tendency of animals with lead poisoning to consume large quantities of alcohol and drugs.
While he is not certain that lead makes them crave intoxicants, his research shows that poisoned rats, given the choice, will consistently consume greater quantities -- 20 percent or more -- than normal rats.
Nation first reported on this increased "self-medication" in the journal Behavioral Neuroscience in 1986. Since then, his group at A&M; has produced six other studies that have yielded even more pronounced results with cocaine and opiates. Scientists in India, Argentina and Britain have announced similar findings over the past decade.
The precise reasons for the phenomenon are not clear, but researchers theorize that lead-poisoned animals consume drugs to reduce the chronic stress and anxiety wrought by the toxin's ravages on their nervous systems.
"We now know that lead-poisoned animals, given a choice of drugs, tend to choose the most potent thing available," Nation says. "In the inner city, where drugs are amply available and where lead exposure is a constant, this research has serious implications. Lead appears to affect not only the drugs people will choose to use, but also the amount they will use."
He calls lead poisoning "a hydra-headed issue," a hidden epidemic that causes a cascade of expensive social problems.
"From the standpoint of drug rehab," Nation asks, "where do you even begin treatment when the thing that is motivating the drug abuse is a physiological condition that's irreversible? Our research ... is very clear on that point: The condition is permanent."
Barbie Kress readily admits that she continues to use drugs -- marijuana and alcohol mostly, but also powerful prescription painkillers such as Tylox and Percocet that she buys on the street.
She insists that she stopped using PCP and cocaine in September 1996. That's when she learned she was pregnant with Casey.
Her husband had left her years before, securing custody of their first child after Kress was busted in 1993 for possession of PCP. At the time, she was sharing a house in Locust Point with members of a drug ring known in South Baltimore as the "Green Monsters" for the color of their product.
Prosecutors eventually dropped the charge in her case. But by the time Kress got her day in court, she had already spent months in the Baltimore City Detention Center.
"I was a mess," she recalls. "My family would see me coming down the street, boy, they'd just shut the doors."
Destitute, with an eighth-grade education and a drug record, she finally broke down and called her estranged husband.
By then, Chuck Hause was living in a rundown three-story rowhouse at 1921 E. Lombard St. that was owned by his boss, a Harford County contractor named Paul D. Rogerson who specializes in buying distressed Baltimore dwellings and renovating them for resale.
In exchange for Hause doing carpentry work on the property, Rogerson charged him only $65 a month rent -- a common arrangement in the construction trades.
"I was just starting to gut the third floor when Barbie moved in," says Hause, 35. "And it wasn't long after that when we found out she was pregnant again."
Hause was unaware that renovation work is a common cause of severe childhood lead poisoning. He was unaware that the dust from demolishing old plaster and sanding old paint and tearing out old woodwork is loaded with lead -- enough to poison a child many times over.
Most important, he did not know that the toxin can poison a fetus in its mother's womb.
"At least 30 percent of the kids we treat have some sort of improper renovation in their background," says Dr. Cecilia T. Davoli, director of the Kennedy Krieger Lead Poisoning Prevention Clinic. "And it's the main source of exposure in the upper-income families we see. Even parents who are aware of the dangers of lead poisoning will make the mistake of assuming they can pull off a renovation without hurting their kids. They just don't understand how pernicious this stuff is once it's mobilized into the air in dust."
While lead paint chips can be dangerous to children if eaten, fine particles of lead dust are much more readily absorbed through the intestines, into the bloodstream, then to the brain.
The dust is also much more difficult to avoid, as it clings to toys, clothes and horizontal surfaces, and is readily consumed through any hand-to-mouth contact.
In pregnant women, studies show, the toxin moves with ease from a mother's bloodstream into her fetus through the umbilical cord.
In short, Casey was in peril before she was even born.
It wasn't until Casey's first birthday, in April 1998, that anyone had proof that something might be wrong.
She had been born two months prematurely and was a cranky infant who often kept her parents up half the night with squalling in her crib. But the symptoms looked like garden-variety colic -- until blood test results came in from her annual checkup at Kennedy Krieger.
Before she began to crawl, Casey had taken in a 27-microgram dose of lead, nearly twice what the state deems hazardous.
The next year, her lead level was 25, and again the year after that. Last month, a follow-up test showed that she was back up to 27.
While Casey has never reached the critical point of 35 -- the level at which treatment becomes mandatory -- chronic exposure over such an extended period can cause long-term damage, doctors at Kennedy-Krieger say.
Social workers at the institute have been advising the family to move for more than a year, as Casey's mental and behavioral problems have grown increasingly apparent.
"She never has settled down," Kress says. "There are nights when she'll stay up till 2 or 3 in the morning. Sometimes, she'll be bouncing off the walls all day on three hours' sleep. I don't know how she does it."
At 3 years old, she still drinks a bottle, still can't talk beyond a mash of unintelligible syllables as she teeters down halls dusted with lead paint, babbling to herself and bobbing her flame-red ponytail.
"Bu, bu, bu," she squeaks, tugging her mother's shirttail.
"I already gave you a bottle, Roo," Kress says. "Whatya do with it?"
On July 20, the city Protective Services office determined that conditions in the house were so dangerous that Kress and her husband should be ordered to remove Casey and her older sister from the address. Otherwise, the girls would be taken into custody.
While Erica, 13, has never tested positive for lead -- and has reached the age when the brain-damaging effects of the toxin are reduced -- she still could suffer kidney problems from prolonged exposure.
Almost 27 years after her daughter nearly died from lead poisoning, Barbara Richter agreed to take her grandchildren into her home for the time being. "It brings back a lot of bad memories," she says. "It's like history repeating itself. First Barbie, now Casey."
Three days before social workers ordered the children out, Hause and Kress received another blow when the Coalition to End Childhood Lead Poisoning, a nonprofit group with a long record of helping families clean and repair tough poisoning hazards, declared the house "beyond our capacity" to fix.
"We really believe this family needs to move," says Ruth Ann Norton, the group's executive director. "This is why housing relocation is such a huge issue. There are virtually no resources in the city right now to help families that are facing hazards like this."
Rogerson, the landlord, has refused to help with the cleanup, saying that his employee agreed to be responsible for any injuries that result from the renovation work.
He declined repeated requests for an interview, but sent a three-paragraph letter by fax, which said Hause "has a land installment contract with me for the purchase of this property. This was made known to the appropriate city agencies, who have been assisting Chuck, as owner."
Such contracts are supposed to be filed in the city deed room, but records show that Rogerson has yet to record any such agreement on the Lombard Street house. He used the contract, however, to persuade the city Health Department to quash a violation notice against him for Casey's poisoning and transfer it to her father.
To date, Rogerson remains listed as the owner in both city and state property records -- as he has since he bought the house in 1993.
As for Hause, he says the only assistance he has received from the city is an order to clean up the property or face possible prosecution. And he says Rogerson -- who has employed him as a carpenter's assistant since he was a teen-ager -- never provided him with a copy of the agreement.
"It's all just starting to sink in," Hause says. "It would cost $65,000 to make this place safe for my kids to live in, and I don't have 65 bucks in my pocket. Nobody seems interested in helping us out. It's like the city and everybody else is just piling on."
Kress sits on the threadbare couch in their poison-filled rowhouse, rocking back and forth with her arms around a pillow, weeping and shaking and blowing her nose.
Casey's toys sit idle in the dining room -- a mound of stuffed bears, a kid-sized broom, a pink Barbie play set. But for Kress' sobbing and the low drone of the TV, the house is quiet.
"It's all a mess, things just coming apart," she gasps. "I ain't seen my kids in two days."
One more time, she describes how sick she is of the pills and the violence and the joblessness and the lack of hope, the constant chaos and confusion that is her life.
She applied for a drug treatment program the day before Protective Services came for her daughters, she says, but backed out after the latest calamity at home.
"I'm losing it," she says. "I can't seem to keep nothing straight in my head no more."