Sunday, April 19, 2020

An Epidemiological Journey

Milton Werrin at his 20th St. veterinary practice


by Katja Lundgren
(excerpt from a paper presented to the Cincinnati Contemporary Club, March 2, 2020)

My veterinarian father, Milton Werrin, joined the Department of Public Health in Philadelphia in 1948.  The Department’s task was a complex one.  Philadelphia has always been a multi-ethnic, diverse city of approximately two million people.  And it has always been a city of immigrants.  Each community has its own churches, mosques, temples, synagogues, as well as restaurants, schools, foods, and manner of food preparation.  Professionals in the Department of Public Health have to know all about each community if they are to save lives or prevent illness. 
            Public Health doctors and veterinarians were informed of the occurrence of puzzling or unusual maladies by doctors or hospitals around the city.  An incident that was barely mentioned in the newspapers of the time but affected at least twelve families in a tragic way took place at Christmas time.  My father was the principal investigator during that week.  He started receiving  reports from various hospitals throughout the city noting that patients were exhibiting severe stomach cramps, paralysis, respiratory distress, and blurred vision  The patients lived all over the city but the one thing that they had in common was that they had all celebrated Christmas Eve dinner with friends and family members, as they did every year, at a single home in Little Italy. 
            My father visited  the home of the hostess.  She was horrified to think that her cooking may have caused such widespread havoc, and she willingly answered all questions and showed him her well stocked pantry.  She was asked what she had served; where she had purchased her ingredients; whether she had used anything different than in past years, whether her food preparation was different than in the past.  She answered all of the questions honestly and without qualms.  She even volunteered, with much pride, that this year she had used her very own home grown tomatoes that she had picked and canned from her Victory Garden.  She explained that she was planning to expand her repertoire to other vegetables, and her husband had already prepared a large patch of ground for next Fall’s crop. 
            The canned goods were taken back to the lab at City Hall for testing as were the leftover ravioli and other Italian delicacies that had been served Christmas Eve.  The shocking discovery revealed that the home canned tomatoes and tomato sauce in her pantry all tested positive for botulism.  The canning process she had used was defective.  Tragically, five people died, and the others had lingering, debilitating symptoms. 
Other public health problems continued to be tackled.  In Philadelphia there has always been a pigeon problem around City Hall.  Just to set the scene, City Hall is a huge, gray, Baroque building with turrets and tunnels topped by a wonderful, life-like sculpture of William Penn, the Quaker founder of the city.  The law used to forbid any building to be built taller than William Penn’s head but I’m sure that law has been changed by now. 
The plaza surrounding City Hall has always been filled with bustling human traffic and hundreds of pigeons.  They walked among the pedestrians, they flew around the turrets, they roosted on poor William Penn’s head, and they pooped everywhere and on everyone in their path.  It was a nightmare for anyone who had business in City Hall, and, of course, it was unsightly and unhealthy. 
The Department of Public Health started compiling statistics that indicated people within a certain radius of City Hall were developing Psittacosis — a rare flu-like disease also known as Parrot Fever.  There is a treatment for it today but in the 1950’s none existed.
Attempts at getting rid of the pigeons were tried, and my father used to come home at night and let us know the progress they were making (or not making) for the eradication of the pigeons.  As children we used to think his efforts were hysterically funny. The eradication of pigeons did not appear to be a serious  endeavor to the three of us. However, when we became older and were permitted to go downtown alone and walk around City Hall, we saw the damage and mess caused by the pigeons with our own eyes.
  Here are a few of the attempts used to rid the City Hall area of its pigeons:
(1) The city hired sportsmen snipers to shoot the pigeons at night when there were few pedestrians around.  Many died but they returned in droves.
(2) Poison was spread in crumb form all over City Hall Plaza for the pigeons.  Back they came.  Also, it was very unpleasant and unhealthy to have a plaza littered with dead pigeons.
(3) The city installed huge horns around William Penn’s head and randomly blasted the birds.  Unfortunately, the pigeons appeared to either ignore the noise or were deaf to the blasts.
(4) To my best recollection, the problem was partially solved in the 1960’s when the crumbs or food left for the pigeons contained birth control or sterilization medication.  The pigeon population diminished to a tolerable level.
The City of Philadelphia installed an enormous LOVE sculpture by Robert Indiana.  It seems to have remained clean and sparkling to this day.  The pigeons returned in fewer numbers, and even the returnees did not poop on the sculpture.  Make of this victory what you may.  Perhaps pigeons are art lovers.  
While the Public Health department concerned itself with pigeons, other investigations of even greater importance took place during the 1950’s and 60’s.  The discovery of the effect of lead in paint on Philadelphia children’s mental and physical development brought about the abolition of all paint containing lead, nationwide.  In addition, the Department of Public Health became increasingly involved in the detection of industrial hazards and the intersection of machinery, food preparation, and illness.
            My father would tell us about outbreaks of anthrax that occurred in particular tanneries and sheep farms.  Respiratory anthrax was not the form showing up among weavers or leather workers.  It was primarily the skin form with boils and rashes and terrible joint pain.  He became more and more convinced that the barrier between human and animal, viral and microbial, was becoming more transparent, and the need for public vigilance was becoming greater.
The whole field of public health was expanding at this time, and the field of Epidemiology was changing the understanding of how society and large urban populations became sick or stayed healthy.  The changing political climate under the aegis of the Charterite progressive party encouraged an increased professionalism among those who ran and worked in the public health field.  Epidemiology as an area of study and as the backbone of modern public health departments became the route by which my father’s life was to change, once again.
            In 1956, upon the urging of his very progressive boss, my father applied for and won a fellowship to the Harvard School of Public Health — considered the most prestigious school of public health at that time.  Its curriculum focussed  on human and veterinary epidemiology.  He went off to school the same year that his oldest child left for Antioch College.  It was a huge decision to make as he left behind my mother and two children under eleven.  It was also a decision he made with the enthusiasm and hope of expanding his professional and personal life at the age of forty-eight.   It proved to be the turning point of his life, and he embraced the new science of epidemiology wholeheartedly.           
            Harvard was the meeting ground for students from all over the globe.  Many of the graduates went back to their homes and became leaders and administrators of newly formed countries.  My father would write to me at Antioch, enthusiastically describing Friday night suppers with a colleague from Ethiopia.  Since there were no Ethiopian restaurants in Cambridge at that time, dinners were prepared at the student’s apartment.  “He cooked up a goat and we ate with our hands,” exclaimed Dad.
            When Dad returned home he was promoted to a new position — Head of the Veterinary Division of the Department of Public Health and Epidemiology.  During Lent of that year reports started to come in indicating that over a hundred Philadelphians had become ill from chemical and food poisoning.  Doctors and hospitals specifically named nitrite and fish as being the problem.  The number one Catholic tradition of eating fish during Lent meant that many hundreds of additional citizens were at risk of becoming ill.  This was the perfect case for the new Department of Epidemiology and Veterinary Medicine.
            My father and his colleagues went down to the wharves  and tested  the stalls of every fishmonger for excessive nitrite levels. They searched for any spoiled fish on the premises.  No evidence was found, and they began to think the fish might have come from out of state with the evidence long gone.  However, my father noticed that next to every fish stand there was a drain — necessary for the workers to clean up their day’s products.  As he described it, he got down on his knees and took samples from every drain.  Eureka — one drain in particular had excessive residues of nitrites and spoiled flounder.  Upon questioning, the vendor admitted that his flounder had gone bad, and rather than throw it out, he had packed it in large quantities of nitrites to give it the appearance of fresh fish.  The nitrite also removed the smell of  spoiled fish.   
The man was brought to trial, and, since there were five fatalities among the many very ill citizens, he went to prison.  The evidence was undeniable, and so was his confession.
            During the late 1950’s American taste in furniture changed from an interest in heavily upholstered sofas and chairs to cleaner lines, less stuffing, bare wooden or metal unadorned pieces that came primarily from Scandinavia or Asia.  Scandinavian furniture was usually made of light, streamlined teak, rosewood, walnut and leather.  Furniture coming from Asia (Hong Kong, China, Japan, the Philippines) was characterized by straight, unadorned lines and beautifully carved, black exposed wood with an occasional silk pillow for decoration or comfort.
            In 1961, several families in the Philadelphia Chinese-American community ordered several shiploads of very expensive and very beautiful furniture from Hong Kong and Singapore.  It arrived in time to celebrate the Chinese New Year. Reports started coming into the Board of  Health describing a virulent outbreak of  poison sumac that seemed to be targeting members of the Chinese-American community.            
             Since it was winter time and the Chinatown area was in the very urban downtown area of Philadelphia, it was unlikely that these patients were getting this rash from picnics in the park or from raking leaves and autumn foliage.  The Chinese New Year took place in January — not exactly a pastoral time of year.
            Investigating this outbreak revealed that these patients shared a common thread.  The  purchase of lovely black carved furniture from Hong Kong.  Remembering conversations he had had with Asian colleagues at Harvard regarding manufacturing techniques used in the furniture export business, my dad asked one of the homeowners if he could borrow one of the chairs to be examined in the Health Department laboratory.
            Chinese furniture manufacturers usually apply a lacquer to their furniture giving it a distinctive, shiny black look. The furniture that was tested revealed the presence of poison sumac in the black lacquer. Anyone who sat on this furniture, which was not covered in any manner, contracted the poison sumac rash on arms, legs, face, and scalp.  The furniture constituted a whole shipload from a specific factory in Hong Kong.  The rash spread throughout the Asian community as they visited family and friends during the Chinese New Year season.  My father had implemented the techniques and protocols which he had learned during his year at Harvard, and another award was earned by the Philadelphia Department of Epidemiology. 
            My father lived a professionally satisfying career.  From his struggling veterinary practice on 20th street, he managed to embrace and become part of a larger world.  He and my mother travelled extensively throughout the world after retirement. We received postcards and letters from India, China, the Middle East, Spain, Portugal, Italy, Greece, France, and Russia. My father would alway comment on the health conditions in every country visited.  However, in my mind’s eye, I still see a young girl, sitting on the windowsill of his veterinary hospital, doing her homework, and anxiously awaiting her father’s return so that they could begin the really exciting part of their life together.



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