In June 1895 Joseph Priestley (1859 -1928) took up the post of medical officer of health (MoH) for the district of Lambeth. Although Lambeth was a large borough, Priestley had just left the Leicester where as the MOH and Public Analyst since 1892 and formed ideas about the control of infectious disease. Leicester had been experiencing a large outbreak of smallpox and Priestley disagreed with the Sanitary Authority over who should be vaccinated1.
In July 1898, the London County Council sent a letter to all London Vestries and Districts seeking opinion on the level of uptake that could be expected if a central bacteriological laboratory was built to offer municipal bacteriology for all medical officers of health and general practitioners across London. Priestley wrote to his Borough Sanitary Committee (Committee Minutes 28 Nov 1898) asking for 12 month’s funding for a trial of bacteriological analysis to detect the Klebs-Loeffler bacillus in throat swabs from uncertain cases of diphtheria. Priestley argued for a local rather than central laboratory for the following reasons
- Less expense compared with sending samples to independent labs.
- ‘more expediency in the examination of samples’
- ‘medical men more likely to take interest’.
Priestley points out that ‘’…13 of the 42 sanitary authorities have already made the necessary local arrangements with one or other of the well-known and efficient bacteriological laboratories at present’’. The proposal for a local laboratory in Lambeth would involve each medical practitioner in Lambeth provided with a ‘diagnostic outfit at a cost of 6d or less’ and the necessary laboratory equipment to cost £50. Although the initial request was to see if having bacteriological confirmation of diphtheria would be of value, what Priestley obtained was a full proposal to establish a bacteriological laboratory. The Sanitary Committee approved and, notwithstanding a delay due to a plasterer’s strike, in January 1st, 1899 Priestley’s municipal laboratory was opened. The laboratory was created in a room in the borough Disinfecting Station which sat in the garden of Arlington Lodge, Wanless Road. The house had been purchased by the Vestry in 1896 and handed to the Sanitary Department in 1897. After an especially constructed brick wall to surround the premises was in place (insurance of the bacteriological lab itself was £500 per annum in 1903), the SuperIntendent of the Disinfecting Station was able to move in to rooms within the Lodge in order to keep an eye on the Disinfecting equipment and the Bacteriology Laboratory since ‘’the apparatus of which requires constant supervision.’’ The success of the laboratory would depend on the patronage of the general practitioners and other medical men to submit samples. Pleasingly for Priestley, he received over 900 specimens received in the first 18 months.
Thus, whilst not the first borough to seek bacteriological confirmation of diphtheria, typhoid fever and tuberculosis, Lambeth was the first in London to establish their own bacteriological facility and the his Annual Report for 1900 (p15) Priestley points this out, as do the Lancet (1900, ii 1821), the Nursing Record and Hospital World (1901), all giving leader space to cover the results. So much so that again in 1903 the Lancet uses Lambeth as poster boy, stating ‘We have advocated the foundation of municipal bacteriological laboratories like that at Lambeth’ (Lancet 1903 i 118). In addition to being useful and popular to clinicians locally the laboratory was cost effective. In 1903 Priestley calculates the Borough had saved £128, based on the cost of sending the samples to a private laboratory. The materials needed to run the laboratory were still less than £50 per annum in 1906. The costs did not include the man hours but by 1906 with approximately 700 samples a year this would mean that Priestley was analysing no more than 2 specimens a day on average.
Over the course of the next 27 years the number of samples crept upwards with an average of over 900 specimens per annum and all were processed by Priestley himself. Only with his retirement in 1927 was a full time Bacteriological Assistant to the MOH employed. That person was Frances May Speakman. Not medically qualified, but Diploma of the Society of Apothecaries, Speakman was working in the Council’s Central Tuberculosis Dispensary (73 Eccles Road, Brixton) where she was staining 1000 sputa for tubercle a year. Prior to that she had learnt bacteriology under Richard Tanner Hewlett at King’s College and had laboratory experience working in several laboratories in various London hospitals. The fact that Speakman was not a clinician and the lab remained under the charge of the MOH reflects the trajectory of medical bacteriology. Whilst important, it was not something that was central to a doctor’s career in public health.
Up until 1914, Bermondsey (1902), Lewisham (1902) and Stepney (after 1904) were the only other London boroughs to establish their own bacteriology laboratories, the other boroughs choosing to send the samples away to independent laboratories. The reasons must surely lie with the motivation of the MOH. It is well documented that bacteriology was not universally accepted as progress, with concerns expressed over the validity of the results. Analysis of the bacterial content of the water supply in the preceding 10 decade had highlighted the limited understanding of the science and the rudimentary techniques, mostly unable to differentiate the pathogenic organisms from the harmless (see Hamlin 1990). Probably the more serious objection was that bacteriology was diminishing the clinicians central place in making the diagnosis. Whatever the reasons, most boroughs contracted out their bacteriology and some London boroughs appear to have barely engaged with the concept (the roaring silence is shown in the contemporary Annual Reports of Health for the City of London, Hammersmith, Hampstead and Kensington).
Whilst pleasing to note he was a descendent of the great chemist himself, it is not clear where this Priestley picked up his interest in bacteriology. As public analyst for Leicester, working in the borough analyst’s laboratory housed in rooms in the Town Hall Priestly examined food samples for chemical adulteration and samples of the local water supply for total bacterial contamination. He also was doing some diagnostic bacteriological work there as well, for example, bacteriological examinations of food and detecting anthrax bacilli in the spleens of dead animals. In 1894 Priestley was already recommending Leicester carry out bacteriological analysis of diphtheria cases (Leicester Ann Report of MOH 1894, p26-27). The following year, when Priestley left Leicester, the Leicester Bacteriological Institute opened, a privately-sponsored company offering a bacteriological service to the area (Lancet 1895 i 1003) given that alternatives for such analyses were restricted to a few large cities with appropriate university departments. The most important dedicated facility at the time was the British Institute of Preventive Medicine (subsequently renamed the Lister Institute) in London which had opened in 1891 and indeed Priestley was a lecturer in Hygiene there and would know of the bacteriological service they offered to boroughs across the country.
Having retired in 1927, Priestley died in December the following year. His obituary gives some idea of the industrious nature of the man who was an important figure in the Society of Medical officers of Health. His achievements in bacteriology, of course, are not mentioned.
- It is tempting to think he left Leicester after only three years because of this (see Fraser SM 1980).
References
A Science of Impurity: Water Analysis in Nineteenth Century Britain. C Hamlin 1990 Adam Hilger, Bristol
Fraser SM 1980 Med Hist. 24 315-332
Obituary (Joseph Priestley) BMJ 1928 ii 1200