Chapter XII.
PUBLIC HEALTH LABORATORY SERVICE.
With the cooperation of Ira V. Hiscock, Assistant Professor of Public Health,
Yale School of Medicine.
1. General Facilities. A well organized public health laboratory is one of the foundations of effective health work and is an invaluable means of coordinating health activities. The health department laboratory, until the summer of 1927, was located on the third floor of the building occupied by the Police Department on Court Street, in crowded quarters, which distinctly handicapped effective service. The laboratory is now located at 212 Orange Street, and is more accessible for physicians and others who use it. The quarters are considerably more spacious and better adapted for the types of work performed. The staff consists of a director, a technician, a stenographer, and a helper.
2. Services Provided. In addition to the facilities offered by the City Laboratory, New Haven has at its disposal the resources of the State Department of Health Laboratory at Hartford, to which certain types of examinations are referred; and also those of the excellently equipped Brady Laboratories of the Yale School of Medicine and those of the laboratory at Grace Hospital.
The city laboratory renders the following services:
The diagnostic aid afforded to local physicians and to the health department epidemiologist by the laboratory has undoubtedly been an important factor in the control of communicable diseases. Outfits for collecting specimens are supplied to physicians, and laboratory procedures correspond with accepted practice.
Among the special activities of the year, reference may be made to the septic sore throat outbreak in the fall of 1926. Cultures were examined for the presence of Streptococcus hemolyticus, a total of 115 examinations having been made with 22 positive findings. Swabs routinely submitted with cultures to be examined for diphtheria have also been scrutinized for detection of the presence of Streptococcus hemolyticus, 1,388 such examinations having been made.
The facilities of the laboratory have not been adequate for carrying out Wassermann tests for syphilis, and consequently such examinations have been made in the State laboratory in Hartford or in local hospital laboratories. Likewise, virulence tests of diphtheria bacilli have been made for the local department by the State laboratory. Al1 morphologically positive diphtheria cultures are sent to the State laboratory for this purpose, 205 such cultures having been submitted in 1926, of which 110 were positive.
For the past two years, special examinations have been made of persons engaged in the oyster shucking industry. Only persons from whom negative results are obtained from urine and feces examinations are issued certificates.
While the number of cultures submitted to the laboratory for diphtheria diagnosis has fallen off during recent years, more time-consuming work has been undertaken. Three hundred and fifty-eight specimens of feces and urine were examined to determine whether or not the persons from whom the specimens were obtained were typhoid carriers. Almost of these specimens were from persons engaged in the oyster shucking industry, among whom one carrier was found in 1926. Permits were issued to 109 persons engaged in this work. Two other persons were found to be typhoid carriers during the year.
The city water is tested daily for bacterial content at the laboratories of the New Haven Water Company, where chemical analyses are also made monthly. In addition, as we have seen, the city laboratory makes bacteriological tests twice each month as an added control. Neither of these laboratories has however been using the new standard methods promulgated in 1923, and further modified in 1925.
An effort is made to test samples of milk from each dealer at least four times every three months. The regular bacteriological and chemical analyses of milk of the many dealers supplying New Haven and the publication of results, quarterly, have been important factors in the improvement of the milk supply. The establishment of their own control laboratories by certain of the large dealers has materially aided in this campaign. One of these private laboratories has already been placed on the list of "approved laboratories of the State Department of Health" and it seems highly desirable that others should apply for this recognition.
All biological supplies are obtained from the State Department of Health and are distributed by the local laboratory. These supplies consist of diphtheria, scarlet fever and tetanus antitoxin, smallpox and typhoid vaccine, Schick test outfits, and toxin-antitoxin.
During the year 1926, the laboratory examined a total of 8,191 specimens for diagnostic purposes, in addition to 200 samples of water and 1,629 samples of milk. A total of 14,476 examinations were made of these specimens and samples because certain types of samples, as milk, require more than one kind of examination. This is an increase in total examinations over the previous year of 930.
3. Appraisal of Laboratory Service. The Appraisal Form allots 70 out of the 1,000 total points for a perfect score on laboratory service. Applying the service rendered in New Haven by the health department and other laboratories used, a total score of 67.0 points is obtained. The score is distributed as follows: (a) Dipetheria: 20 points; Standard, 250 examinations per annual death. In 1926 there were 4,263 examinations with only one resident death; hence the full score of 20 points was obtained. (b) Typhoid: 7 points; Standard, 75 examinations per annual death. In 1926 there were 781 examinations with 4 deaths; hence the full score of 7 points was obtained. (c) Tuberculosis: 8 points; Standard, 5 examinations per annual death. In 1926 there were 471 examinations by the local laboratory and 26 by the state, in addition to those made in hospita1 laboratories. There were 97 deaths; hence the full score is allowed. (d) Syphilis: 5 points; Standard, 12 examinations per case reported. There were 205 cases reported. In the State laboratory, 2,620 examinations were performed, while an even larger number of examinations (approximately 6,000) were made in the Brady Laboratory of the New Haven Hospital and in the Grace Hospital Laboratory (1,017 examinations). The State laboratory figures are adequate, however, to give full score for this item. Thus while New Haven is well above its quota and receives full score, it is observed that the examinations were made in laboratories other than that of the local health department. (e) Gonorrhea: 5 points; Standard, 5 examinations per ease reported. There were 244 cases reported, and 1,138 examinations were made in the health department lahoratory alone, with 6 in the State laboratory, giving a full score, in addition to several hundred analyses made in the hoslpital laboratories. (f) Milk: 15 points; Standard, 100 analyses per 100,000 gallons of milk distributed. During the year 1926 there were made 6,359 examinations on approximately 8,212,500 gallons (city's annual milk consumption). Thus, New Haven's quota was 8,212 examinations. A score of 12 (77%) of the 15 points is allowed. (g) Water: 10 points; Standard. 1 examination daily. As daily examinations of the water supply are made hy the New Haven Water Company, a full score is given.
4. Summary and Recommendations. The laboratory work carried on by the health department is essentially of a routine character. In general, Standard Methods are employed although the procedure used in water analysis has only been brought up to date in the course of the survey.
Most city laboratories in communities of the size of New Haven make their own Wasserman tests and the possibility of expansion in this direction might well be considered. The city should also in the future be able to make its own diphtheria virulence tests by the use of the new Falk electrophoretic method if experience elsewhere justifies present hopes. We would urge that the laboratory initiate the typing of pneumonia cultures as a part of the comprehensive campaign which we have suggested for the control of this disease. It seems most important that the examination of milk samples should be considerably extended to cover examinations of raw milk before pasteurization with special emphasis on those dealers who now fall below standard. The laboratory force should also have opportunities for the study of the research problems which constantly arise in the course of their work for a wholesome spirit can scarcely be maintained in a laboratory where only routine work is done.
The 1928 Budget of the Health Department wisely makes allowance for an additional bacteriologist and a new technician, which will bring the staff and budget nearer to the level of standard procedures. We would merely suggest as
Recommendation 30. That when the two much needed additions are made to the staff of the City Laboratory there should be a considerable increase in milk examinations (including examinations of samples of raw milk before pasteurization) with special attention to dealers producing high count milk; while consideration should be given to the desirability of making diphtheria virulence tests; typing pneumococci; perhaps making Wasserman examinations; and to research.
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