The Story of a Laboratory, Chapter Four: Professor Hiscock and the Well-Rounded Laboratory

The field of public health became more professional and systematic in the interval between the two world wars.  For example, the State of Connecticut developed and published its first code of public health, the Sanitary Code of 1918.  It mandated the reporting of communicable diseases, demographic data and the public health capabilities of each town, among other things (Sanitary Code, 1918). Dr. Austen duly submitted counts of cases of disease, a description of the department’s services, and an ethnographic breakdown of the town’s population demonstrating that a significant percentage of Greenwich’s population was foreign born.  Italians were by far the majority of immigrants, and “Hebrews” were a major presence. There were seventy “colored” families living in the town in 1918 (Annual Report of Greenwich Health Officer to State Health Department, 1918).  Additionally, the Public Health Code required that laboratories be inspected and approved by the State Board of Health (Sanitary Code, 1918).  The Greenwich Department of Health Laboratory conformed to the standards of the Code, and was “expected soon to receive its certificate of approval” in 1918. This was apparently granted, since the laboratory continued to function (Annual Report, 1918).

Two years after the Sanitary Code was published, Dr. Ira Vaughn Hiscock joined the faculty of the Yale Department of Public Health (now the School of Public Health).  He became a major authority on public health administration, was a prolific researcher and author, and had a significant influence on the Greenwich Department of Health. 

In 1924, Dr. Hiscock presented a report on “Public Health Practice in Small Cities and Towns in Connecticut”, which examined the public health scene in smaller towns in the state.  He compared the health programs of twenty-one communities in Connecticut of less than 30,000 population, including Greenwich, in terms of organization, budget, milk and food issues, water supply, sanitary inspection, garbage and sewage disposal, communicable disease control, vaccination and laboratory diagnosis, industrial hygiene, school children, and public health nursing.  He found a wide variety of practice, and concluded that “public health work in these communities deserves more attention than it has previously received”.  Greenwich had an active Board of Health, which was not typical of these communities, and it spent about $1.25 per capita on public health services. (this calculation is based on data from the 1925 Annual Report of the Health Officer).   This was in the upper range of what the surveyed communities spent ($0.20 to $1.56), and well above the average expenditure of $0.61 per capita (Hiscock, Public Health Practice, 1924). 

Apparently they got good value for the money. Dr. Hiscock had based his research on performing in-depth studies of local health departments such as Fairfield and New Canaan.  In 1925, Dr. Austen invited him to do a similar study of the Greenwich Health Department.  Based on his observations and interviews, Dr. Hiscock concluded that Greenwich was, overall, a progressive town in terms of public health.  Its strong points were that it had good control of its milk and food supplies, it handled communicable disease well in many respects, it boasted a child welfare supervisor and a school inspector, and he praised the “unusual enterprise” of the nursing service.  The gaps he identified were: sewerage and garbage issues, the need for a communicable disease hospital, and that the situation regarding tuberculosis and “venereal disease” needed study (Hiscock, Survey of Greenwich, 1925).

Dr. Hiscock’s report described the laboratory in detail.  He stated that the laboratory, under the charge of a bacteriologist, routinely analyzed milk and drinking water, and performed diagnostic examinations for diphtheria, typhoid fever, malaria, and tuberculosis.  In 1924 it examined 507 specimens, of which 387 were clinical diagnostic specimens, 110 were    of milk, and only 14 for water.  This is the reverse of the laboratory’s work in the 21^st century; now the majority of specimens are for water analysis.  Some laboratory work was being done at Greenwich Hospital and some was referred out to private laboratories.  Dr. Hiscock stated that the laboratory’s “equipment and methods are modern,” and that “It is believed that a fuller use of a laboratory of this type might well be made in a community of 25,000 people” (Hiscock, Survey of Greenwich, 1925). 

Dr. Hiscock’s evaluation of the Greenwich laboratory might be placed in a context by referring to his paper on the public health procedures in towns similar to Greenwich.  This study did not include Connecticut’s large cities, all of which had health departments with their own laboratories. Of the twenty-two towns in his survey, most used the state laboratory for all their analyses, listing only Manchester, Middletown and Greenwich as having “excellent local facilities”.  Middletown and Greenwich were the only places where the milk was tested locally (Hiscock, Public Health Practice, 1924).  Dr. Hiscock also prepared a report on the laboratory services in 100 large American cities in 1925. Eighty-nine cities had their own laboratories, established more-or-less at the rate of two per year from 1895 to 1925.  Dr. Hiscock listed twenty-two types of tests offered by various laboratories.  In his vision of a “well rounded” laboratory program, most of the testing would involve diphtheria and sexually transmitted diseases, followed by analysis of milk.  Tuberculosis, typhoid fever, and water analyses would make up a smaller proportion of the work (Hiscock, Public Health Laboratories, 1925).  An analysis of the lab work performed in the Greenwich laboratory in 1924 is similar to this “well rounded” laboratory, but with more tuberculosis testing and less STD and water analysis (Annual Report, 1925).

Dr. Hiscock proposed a method to measure the effectiveness of a laboratory by comparing the number of tests performed to the number of diagnoses of disease.  He states that in the laboratories he studied, the ratio of laboratory tests to diagnoses was 19/1 for diphtheria and 7/1 for typhoid fever (Hiscock, Public Health Laboratories, 1925).  The ratios for Greenwich in 1925 were 17/1 for diphtheria and about 1/1 for typhoid fever, suggesting that the typhoid test was used more as a confirmation of suspected cases rather than as a diagnostic tool, as for diphtheria (Annual Report, 1925)

Dr. Hiscock was to return to present a paper at the Health Field Day celebration on September 16, 1937, on the occasion of the Town of Greenwich winning the first place award among cities in its population class in the City Health Contest sponsored by the American Public Health Association and the Chamber of Commerce.  The contest evaluated cities according to various indicators of health, and Dr. Hiscock outlined a 20-point program to guide Greenwich’s public health development in the future.  This included increasing the scope of the laboratory services (Hiscock, 20-Point Program, 1937)

A number of changes occurred in the Health Department Laboratory during this period.  Dr. Albert G. Bennett died suddenly in 1926 at 46 years old, leaving seven small children.  He was praised as someone who was always available to call on a sick person, and was generous in forgoing compensation for people unable to pay (Greenwich Press, November 11, 1926). He was eulogized by the Health Officer as “brilliant and gifted” in that year’s Annual Report.  Laboratory testing was then referred to Greenwich Hospital, under the direction of Dr. Louise Larrimore, the pathologist in charge of the laboratory.  Dr. Larrimore submitted annual laboratory reports for the town for six years.  She conducted research in endocrinology and was to win a prize in 1937 for the invention of a portable high-powered microscope (NYT, 1948).  On May 1, 1931, Mr. Frederick M. Remer was hired as bacteriologist, and the laboratory re-opened, this time close at hand in the Town Hall on Greenwich Avenue. Mr. Remer had attended the College of Bacteriology in Chicago and continued the study of chemistry in the Marine Corps in World War I.  In addition to his post as laboratory director in Greenwich, he was appointed State Chemist in 1931.  He maintained a state-certified diagnostic laboratory in his home.  His obituary states:  “In 1938, Mr. Remer was cited as one of the three men in the United States who could put a hair under a microscope and tell at once the sex, complexion, race, physical condition and approximate age of the person from whose head it came” (Greenwich Time, 1956).  Mrs. Nellie Reynolds was hired as a part-time assistant at this time, also.

 From 1931 to 1936, the types of tests performed as well as the number of specimens increased, and Mr. Remer’s annual reports always included requests for new apparatus.  After 1936 they included requests for help, that is, a lab assistant, which was not forthcoming (Annual Report: 1925, 1926, 1931, 1936).  He needed it, too.  Dr. Hiscock had reported that the average city laboratory performed 78 tests per 1000 population (Hiscock, Public Health Laboratories, 1925).  In 1925, Greenwich performed only 24 per 1000, but by 1940 it had grown to 90 per 1000.  And Dr. Hiscock’s well-rounded laboratory was staffed with a bacteriologist, a chemist, a full time lab assistant, and a clerk.  Remer, working alone with part time help from Nellie, was driven to say this in his 1941 annual report:

“Rather than repeat all recommendations previously made, attention is called to the words of the immortal Pasteur: ‘Take interest, I implore you, in those sacred dwellings which are designated by the expressive term LABORATORY.  Demand that they be multiplied, that they be adorned.  These are temples of the future- temples of well-being and happiness.  There it is that humanity grows greater, stronger, better.”

The laboratory was soon to be adorned with a new autoclave and a new analytical balance, which is still there (Annual Report: 1925, 1940, 1941).  Delivery of that analytical balance was to be delayed, however, due to extenuating circumstances.