Dr. Leonard Morse, MD: Sherlock Holmes Meets Public Health

Cameron G. Thompson, MD, BS

Leonard Morse is well known as a leader in medicine having served as president of both the WDMS and MMS, as well as Commissioner of Public Health of Worcester. However, there is another side of Leonard Morse, whose clinical and deductive skills rival those of Sherlock Holmes.

As an infectious disease expert, Dr. Morse was drawn to investigating outbreaks of unusual infectious diseases. One such investigation, for instance, piqued his interest when 16 UMass Memorial Hospital employees and patients developed Salmonella gastroenteritis. He observed that those affected had either recently eaten or worked in the hospital cafeteria, so he reviewed the daily lunch menus for a potential source. His investigation led him to discover that the cafeteria workers customarily enriched the ice cream with frozen, unpasteurized egg yolks, which, upon culturing, were found to be massively contaminated with numerous disease-causing bacteria, including Salmonella. Per Dr. Morse’s request, the hospital mandated rectal cultures of all hospital employees and patients and found that 167 individuals were primarily infected by the soiled ice cream. In his case report detailing the outbreak, Dr. Morse emphasized the importance of pasteurizing all dairy products, a controversial idea at the time.

Another case involved six ICU patients who simultaneously developed Klebsiella septicemia. He cultured every surface imaginable and found that the hand lotion in the unit was overwhelmingly contaminated. To his horror, he discovered providers inadvertently spread Klebsiella to the sickest patients, one of whom ultimately died. In his concise yet effective case report, he discussed the dangers of hospital-acquired infections and emphasized the need for appropriate antisepsis.

His masterful detective work also led him to discover several new conditions, such as the transmission of paralytic polio from a recently vaccinated newborn to his unimmunized mother. Although the live-attenuated oral polio vaccine was associated with rare cases of the vaccine-acquired disease, this marked the first time this unique mode of transmission was described, illustrating the need for vaccinating all those at risk.

The case of Dr. Morse’s career that garnered the most attention involved the Holy Cross football team. Returning from a disappointing 3-6-1 season, the 1969 Crusaders were determined to improve their record. Despite a strong preseason, the team suffered sluggish losses in their first two games. When several players complained of weak legs, and one even vomited at the line of scrimmage during the second game, it was clear something was wrong. The Crusaders canceled their remaining eight games and called in Dr. Morse to investigate. Easily observing jaundice amongst several players, he speculated that more than just the visibly sick were affected and requested blood samples from all players and coaches. Of the 97 samples collected, 90 returned positive for elevated bilirubin, indicating hepatitis. His suspicion was correct, and he set out to find an explanation.

Dr. Morse visited the Holy Cross practice fields. Acute hepatitis has about a 30-day incubation period, so he had to look back in time. One possible culprit was the team’s water supply. Before practice, water was collected into large metal vats from a spigot adjacent to the fields. Tracing the pipe back to its origin, Dr. Morse observed that six subsurface faucets came off the line to irrigate the fields. Neighborhood children played in the fields’ sprinkler system, and Dr. Morse learned that four of them had been sick that summer. It was reasonable to think that the children shed an infectious agent into the field while they played, but how did that infected water enter the drinking supply? The last part of the puzzle required a review of the city’s records.

On a particularly hot summer day, the city fire department battled a raging house fire in the surrounding residential neighborhood. When the nearby fire hydrants were opened, Dr. Morse speculated that the water table under the field experienced negative pressure, which sucked the infected groundwater into the drinking line through the sprinkler faucets. To test his hypothesis, he spread a water-soluble dye across the practice fields and had the fire department open the hydrants. Sure enough, the dye was easily detected in the Crusaders’ drinking water. His experiment proved that the team’s season was doomed an entire month before they even played their first game.

Today, we know of the five distinct forms of viral hepatitis, but comparatively little was known about acute hepatitis in 1969. The hepatitis A virus was not discovered until 1979, so Dr. Morse impressively established a diagnosis using only knowledge of probable exposure, length of the patient’s incubation period, and basic, liver-associated labs. Interestingly, later testing on the original blood samples confirmed that hepatitis A was the cause of the outbreak.

Although the Crusaders missed out on the remainder of their season and were required to quarantine in their dorm rooms for the entire school semester, all team members fully recovered. Because of the unusual circumstances leading to the dramatic infection rate, the story gained significant attention. Through local and national news coverage, Dr. Morse advocated for improved drinking water systems. Additionally, his descriptive scientific publications about the outbreak significantly contributed to understanding the viral hepatitides, and the Holy Cross outbreak is still referenced in the medical literature today.

A brilliant detective, clinician, and leader in medicine, Dr. Morse significantly improved the health and safety of the Worcester community and beyond over the course of his nearly five-decade-long career. Each case tested his cleverness, but he always found a concise and satisfying explanation that furthered the understanding of infectious disease. His scientific articles all share an unconventional theme: the methods section is the most enjoyable part to read. Through his descriptive narration, he takes the reader on an illustrative journey through his skillful deduction.

Now 92 years old, he and his beloved wife, Maxine, live near one of their four children in Virginia. As a Worcester resident for 88 years, Dr. Morse still feels a strong connection to the city and continues to read the Worcester Telegram daily.

References:

1. Morse LJ, Rubenstein AD. A food-borne institutional outbreak of enteritis due to Salmonella blockley. JAMA. 1967;202(10):939-940.

2. Morse LJ, Williams HL, Grenn Jr FP, Eldridge EE, Rotta JR. Septicemia due to Klebsiella pneumoniae originating from a hand-cream dispenser. New England Journal of Medicine. 1967;277(9):472-473.

3. Morse LJ, Rubin HE, Blount RE. Vaccine-acquired paralytic poliomyelitis in an unvaccinated mother. JAMA. 1966;197(12):1034-1035.

4. Morse LJ, Bryan JA, Hurley JP, Murphy JF, O’Brien TF, Wacker WE. The Holy Cross college football team hepatitis outbreak. JAMA. 1972;219(6):706- 708.

5. Wacker WE, Riordan JF, Snodgrass PJ, et al. The Holy Cross hepatitis outbreak: Clinical and chemical abnormalities. Archives of Internal Medicine. 1972;130(3):357-360.

6. Friedman LS, O’Brien TF, Morse LJ, et al. Revisiting the Holy Cross football team hepatitis outbreak (1969) by serological analysis. JAMA. 1985;254(6):774- 776.

7. Koff RS. Feinstone SM, Kapikian AZ, Purcell RH. Hepatitis A: detection by immune electron microscopy of a virus like antigen associated with acute illness [Science 1973; 182: 1026–1028]. Journal of Hepatology. 2002;37(1):2-6.

8. Sherlock S. Landmarks in viral hepatitis. JAMA. 1984;252(3):402-406.9. Neagle ME. 1969: The Missing Season. In: Holy Cross Magazine; 2004.

10. Toland J. 1969 Holy Cross football team members reflect on 50th anniversary of hepatitis outbreak that canceled games, ended careers, made national headlines. The Worcester Telegram. 2019.

11. The ACP Commitment to Being an Anti-Racist, Diverse, Equitable, and Inclusive Organization, 10/21/20, www.acponline.org