In 1954, Frank Bozza, director of the Greenwich Department of Health Laboratory from 1946 to 1966, reflected on the mission of the laboratory in his annual report for that year. He said that the purpose of a laboratory was the control of infection, elimination of disease and the promotion of public health. He felt that the laboratory’s function was shifting from diagnosis and control of disease (although still its main function) to playing an important part in investigations that prevent outbreaks. He stated that in the period from 1930 to 1950 there was a great reduction in communicable disease, and he attributed this development to the education of people in prevention and personal hygiene, and the advent of sulfa drugs and antibiotics (Annual Report, 1954).
Mr. Bozza was commenting on a period that was indicative of the general pattern of the 20th century, and which continued as the century wore on. This period was marked by a sharp drop in infant mortality and a great decrease in communicable disease. In 1900, 30.4% of all deaths in the United States occurred in children less than five years old (MMWR 1999). In Greenwich, 22% of the deaths were in this age group in 1914, and 18% in 1915. Today that rate is less than 1% (Annual Report: 1914, 1915, 2010). In the early 1900s, 30% of all deaths nationally were from pneumonia, tuberculosis, and enteritis, and 40% of these deaths were in children less than five years old (MMWR 1999). In Greenwich, about 16% of all deaths were from these three causes in the ten years for 1905 to 1914 (Annual Report, 1905-1914). Today, fewer than 4.5% of all deaths nationally are attributable to infectious disease, including influenza and HIV (MMWR 1999).
Sulfa drugs were developed in the 1920s; a paper on their use was presented at the Greenwich Health Field Day in 1937 (Burgdorf, 1937). Penicillin was discovered fortuitously during this decade as well. Having fewer side effects than sulfa drugs, it was developed and first widely used during World War II. Penicillin and related antibiotics, as well as drugs developed to treat parasitological, fungal and viral diseases, provided a way to deal with previously incurable diseases (MMWR 1999).
Vaccines are substances that induce the human body to produce antibodies, which are proteins that ward off infectious disease-causing organisms. Smallpox vaccine has a venerable history, having been used since the 17th century. By 1900, however, vaccines were generally little used in this country, although five were known (rabies, typhoid, cholera, plague and smallpox). In Greenwich during the 1920s, about 150 vaccinations for smallpox and diphtheria were administered annually by the bacteriologist (Annual Report, 1921). Health Officer Thomas J. Bergin directed a major smallpox vaccination program carried out in 1946. He estimated that 10,000 vaccinations were given, based on the number of units of vaccine distributed to pharmacies (Greenwich Time, 1949). A combination of the diphtheria and tetanus toxoids with the pertussis (whooping cough) vaccine was licensed in 1949, and many state and local health departments began systematic vaccination programs (MMWR 1999). A “diptussis” vaccination program was instituted in Greenwich at this time, and in 1958 the Health Officer, Dr. Coffey, stated that there had been no cases of diphtheria, smallpox or typhoid fever in town for the last several years, due to the use of vaccines. He lamented that there were no vaccines for German measles or chickenpox. Greenwich had participated in national field trials of the Salk polio vaccine in 1954, and began vaccinating all its school children the next year, essentially eliminating polio by 1958 (Annual Report: 1949, 1954, 1958). Measles vaccination became available and was put to use in the Greenwich Department of Health’s well baby clinics by 1964 (Annual Report, 1964).
Antibiotics and vaccines did not directly figure in the work of the Greenwich Department of Health Laboratory, but they affected it nonetheless. A much smaller percentage of the tests performed were clinical microbiological diagnoses, and the majority of testing was for milk, water and cultures of utensils from public restaurants. Additionally, the laboratory began testing urines for glucose levels as part of the National Diabetes Week in 1950, and this program continued annually. This marks the beginning of a shift in the laboratory’s’ work from concern with treating acute, infectious diseases to preventing chronic conditions. Mr. Bozza summarized his thoughts about this development in his 1954 report by saying that the lab is moving from diagnostic work to prevention and control (Annual Report: 1950, 1954).