The Story of a Laboratory, Chapter Two: The Bacteriological Revolution and a Modern Health Department

The closing decades of the 19^th century witnessed a major development in the diagnosis and treatment of disease, which was the rise of bacteriology as a scientific discipline.  This was a true revolution in mindset and not just a change of scientific technique, because it demonstrated that diseases had single, specific causes, and that other persons as well as the environment could be sources of disease.  This implied that public health practices must focus on the health of the individual as well as environmental sanitation, and it encouraged the development of both laboratory science and epidemiology (the tracking of the movement of diseases through a population) (Future of Public Health, 1988).  This had major implications for the practice of public health in Greenwich.

Beginning in the 1870s, the pioneering work of Louis Pasteur in France and Robert Koch in Germany resulted in the discovery of many disease-causing bacteria, as well as effective methods to observe, culture and study them in the laboratory.  1n 1884 in Germany, Loeffler isolated Corynebacterium diptherae, the bacteria that causes diphtheria, which was a deadly childhood disease producing a membrane in the throat and causing death by suffocation.  His experiments suggested that the disease was caused by a toxin secreted by the bacteria, not the bacterium itself.  In 1889, Pasteur’s protégés Roux and Yersin isolated the toxin by filtering a bacterial culture through an unglazed porcelain filter through which bacteria cells could not pass.  Koch’s protégés Behring and Kitasato isolated a toxin from Clostridium tetanae, the bacteria which causes tetanus, in a similar manner.  They were able to isolate an antitoxin produced by horses injected with the toxin, which they used to successfully immunize animals against tetanus.  Using this technique with antitoxin produced against Corynebacterium diptherae, the first attempt to cure a human being of diphtheria was performed- successfully- in Berlin in 1891 (Barry, 2004, p70). In 1894, Herman Biggs, the director of the bacteriological laboratory for the New York City Board of Health (i.e., Health Department), sailed for Europe to investigate this new treatment.  When he telegraphed home the news, his laboratory immediately began synthesizing (and improving) the antitoxin, and distributing it to clinics around the city.  The use of this antitoxin resulted in an immediate and dramatic drop in the incidence of diphtheria in New York City (Protecting the Public Health, 2005). 

These developments must have been on the mind of Dr. Alvin W. Klein when he took over as Health Officer of Greenwich in 1908.  He reported epidemics of measles and scarlet fever, diphtheria and whooping cough, and cases of smallpox in the next few years.  By 1911 he was reporting the use of antitoxin to control diphtheria in the schools, and in 1912 stated that diphtheria was now “well controlled” by this treatment.  Malaria was present “to an alarming degree” in 1912, and he urged that the Health Officer be allowed to enforce drainage of swamps and inspection of premises.  Rabies was very prevalent, and he ordered the muzzling of all dogs.  Two residents of Greenwich were bitten by rabid dogs that year; they were given the rabies treatment developed by Pasteur and recovered Annual Report, 1908, 1911, 1912). 

As of 1908 Dr. Klein was sending samples of milk, sputum and blood to the state laboratory, which had relocated to Wesleyan University in Middletown (Mickle, 1928), and he expected this to be a “valuable service.”  In his 1913 report, he described the water supply as plentiful and good, subject to occasional pollution, and added: “…this can only be detected by frequent bacteriological examination.  When we have the facilities for making these exams, any dangerous conditions showing in the water can be immediately reported and remediated.”  Also that year, the Town of Greenwich undertook a major project to deal with malaria, which was endemic (widespread) in the town.  The town government and private donors raised $10,000 for mosquito extermination, and a private contract was awarded to drain swamps in the south part of the town and to oil the surfaces of 150 swamps in the north.  Dr. Klein commented that “this immense amount of work was made necessary by the totally inadequate provision for public health in the past.”  Perhaps as a result of this effort, by the fall of 1912 the public realized the need for a modern health department.  In April 1913 the town government approved the necessary funding, and in March of 1914 the Greenwich Department of Health was inaugurated, including a state-of-the-art laboratory (Annual report, 1913, 1914).  The next year, on May 15, the Board of Health was given the legal power to make and repeal regulations and ordinances (Annual Report, 1915).

The new Department was fully staffed with Dr. Klein as the Health Officer (paid $2500 annually), a District Nurse, Miss Eva Ryan ($900), an Assistant Sanitary Inspector, Mr. T. J. Murray ($1200), a veterinarian, Dr. Earl A Schofield (no salary recorded), and a stenographer, Miss Edith Smith ($500), replacing the first one who quit after a month.  The Sanitary Inspector was Dr. Albert G. Bennett ($1500), who was experienced in bacteriology and research and had taught Hygiene and Sanitation (Annual Report, 1914).  He had graduated from the College of Physicians and Surgeons of Dublin University in Ireland and upon coming to the United States worked for the New York City Department of  Health (Greenwich Press, November 11, 1926).  He was to run the laboratory and inspect milk, food and water.  There was an obvious advantage to having the same person be the sanitary inspector and bacteriologist, as he would know exactly when, where and how a sample was taken, and how it was analyzed.  The department had

offices in the Maher Building, “where the laboratory was set up.” It was open daily from 8:30 AM to noon, and 1:00 to 5:30 PM, and its telephone number was 1086 (Annual Report 1914).

Dr. Klein worked to publicize the Department, and to assure that its functions were understood by the community.  He wrote an article published in the Greenwich Graphic on March 20, 1914, describing the need for a Health Department and its planned activities.  Among these he described the laboratory, which was to monitor water and milk supplies and perform bacteriological tests as a service to physicians, and for public health disease control.

The laboratory appears to have had a positive impact on the Greenwich community from the start.  There was good cooperation from farmers and dairies in town in providing monthly samples of milk for analysis, after some initial questioning of the accuracy of the laboratory results (which has a familiar ring to laboratorians today) (Annual Report 1914).  The water distribution system was monitored monthly, and drinking water wells serving tenements and boarding houses were routinely monitored.  The public also made use of the laboratory: “Quite a number of people have sent samples from their own private well for examination.”  An example of a new service the laboratory could now provide may be seen in the protocol for dealing with suspected cases of diphtheria.  Dr. Bennett would visit the patient and take a throat swab.  If C. diptherae was present on examination under the microscope (the “direct smear” technique), he prescribed the antitoxin.  If the patient was a schoolchild, the whole class would be examined and their throats cultured, and any carriers of C. diptherae would be quarantined until their throats cleared.  To be released from quarantine, two consecutive throat cultures had to be negative (Annual Report 1915).

Dr. Klein resigned in 1918.  Dr. Frank Brooks was appointed interim Health Officer, and he wrote: “The Town owes to Dr. Klein the reorganization of the Health Department and it is to him largely that the department has attained its present excellent standard.”  Dr. Klein was to be replaced by Dr. A. E. Austin, who did not take office until 1919, as he was on active duty with the army in World War I (Annual Report, 1918 & 1919).  If Dr. Brooks expected a quiet term as interim Health Officer, he was in for a surprise.