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Toxic SHOCK; Twenty five years ago a disease that many thought was dead and gone reared its head in Birmingham: smallpox. Campbell Docherty and Caroline Foulkes look back at the 1978 outbreak and ask if it could ever happen again.

Byline: Campbell Docherty and Caroline Foulkes

It was a phone call that killed Janet Parker. Somewhere between dialling the number and putting down the receiver, her fate was sealed.

But the conversation had nothing to do with it.

So when she got a bit of a cold a few days later, she thought nothing of it.

The cold turned into flu. Again, nothing unusual, but flu in August? A bit odd.

Then she broke out in a rash. The doctor thought it was chickenpox. Mrs Parker took to her bed.

That was on August 11, 1978. A month later, Mrs Parker was dead and Birmingham was in panic.

It wasn't flu. It wasn't chickenpox. Janet Parker died of smallpox, a disease more associated with the Indian subcontinent than leafy suburbia.

Yet she wasn't its first victim. The smallpox virus Mrs Parker contracted hadn't come from another country. It had come from a lab, the one directly below the room from which she had made her phone calls in the Anatomy Department of the University of Birmingham's Medical School. A lab that was run by Professor Henry Bedson.

'Henry was the kind of man who got quite involved in his work,' says bacteriology expert Professor Hugh Pennington.

'A determined man, who would just sort of get on with things. He was very committed to what he was doing.'

What Professor Bedson was committed to doing was finding out more about the smallpox virus and its variants, including white pox and monkey pox.

In 1978 it seemed smallpox, a disease that had been rampaging across the world for centuries infecting rich and poor alike, was on the brink of extinction. The last recorded case was that ofAli Maow Maalin, cook at the hospital in Merca, Somalia, and sometime vaccinator in a World Health Organisation (WHO) smallpox eradication team. He survived, but as a now famous photo of him shows, he bore the scars of the disease for the rest of his life. After Maalin, WHO were ready to pronounce the virus dead and buried.

Then Janet Parker got sick. There was a subtle difference between her illness and Maalin's though. His smallpox was a 'natural' case. Hers was not.

Professor Bedson had been working on the smallpox virus for a number of years, and was part of what Professor Pennington calls the 'Liverpool University school' of smallpox researchers.

Ten years prior to the 78 outbreak, he and another Liverpool colleague, Professor Keith Dumbell, had begun producing hybrid pox viruses. He was on the verge of what colleagues described as an 'important breakthrough' when WHO inspectors came to check the lab. They were not entirely happy with what they found.

'Henry dedicated himself to looking at whether these variants were going to present a problem after the eradication campaign had worked,' says Professor Pennington.

'It was a loose end which was possibly not important but which needed to be tied off. Henry's experience made him the ideal person for it. But he was in a Catch-22 situation, because WHO wanted him to continue his work but were not happy with the state of the lab, yet because it was due for closure in six months there was no way he would get any money for it. So he just had to get the work done more quickly, which meant using more samples in the lab, and the more samples you have, of course, the more likely it is that something will happen.'

Back then restrictions and guidelines for handling viruses were nowhere near as stringent as they are now. After visiting the lab in the '70s, Pennington vaccinated himself thoroughly to prevent any risk of infection. If anyone was going to pick up the virus, it would be more likely to be someone actually working with it, someone who had been in the lab rather than someone like Janet Parker. No one ever thought that the virus might find another way out.

But it did.

On July 24 and 25 a strain of smallpox known as Abid was being handled in the lab. It travelled in air currents up a service duct which led directly to the room where Janet Parker was using the phone.

Seventeen days later, on August 11, she fell ill. By August 20, smallpox had been diagnosed and she was placed in Catherine-de-Barnes isolation hospital, near Solihull. All the people with whom she had recently had contact, some 500 in total, were placed in quarantine. Professor Bedson and his family were also quarantined at their home in Cockthorpe Close, Harborne. As the story of the smallpox outbreak came to light, the press began to ask questions. Exactly what happened inside the Bedsons' house will never be known, but it became clear to all that Henry Bedson felt under increasing pressure.

'It was a terrible business when the whole thing broke,' says Professor Pennington.

'I think everyone felt dreadfully sorry for Henry and his family because he was responsible for the lab and he was the kind of guy who took his responsibilities very seriously. He wasn't a happy-go-lucky type who was cutting corners. He wasn't doing anything that other smallpox investigators hadn't been doing for the past hundred years. So there was this feeling from everyone else in the field that he was unlucky. A feeling of 'there but for the grace of God go we'.'

The pressure became unbearable. On September 1, while his wife, Ann, was on the phone to a friend, Henry Bedson went to the garden shed and cut his throat. Five days later he became the first fatality of the smallpox outbreak, killed not by the virus itself but by the panic it had generated. In a suicide note, he apologised to his family, friends and colleagues for the strain he had put them under: 'I am sorry to have misplaced the trust which so many of my friends and colleagues have placed in me and my work and above all to have dragged into disrepute my wife and beloved children. . . I realise this act is the last sensible thing I have done, but it may allow them to get some peace.'

'It was tragic for everyone involved,' says Professor Pennington.

'My own feeling is that Henry would feel terribly guilty about what happened. For someone to die and for him to have had a hand in it. . . if he hadn't committed suicide he would have had this on his conscience for the rest of his life.'

If Henry Bedson had lived, it seems likely that what followed would have affected him even more deeply. On September 5, Mrs Parker's father, Fred Witcomb, died of a heart attack at Catherine-de-Barnes: he and his wife had been transferred there after being placed in quarantine. Six days afterwards, Janet Parker died.

The deaths provoked further panic. Yet this was not the first time there had been a smallpox outbreak in the city.

In May 1966, while working in the same lab later used by Mrs Parker, a photographer called Tony McLennan caught smallpox. A doctor who examined him told him he had a 'sweat rash' and advised that he should 'have a bath, go out and enjoy himself'. During the eight weeks that followed the virus moved swiftly yet randomly around the community before one woman who fell ill happened to see a foreign doctor. He recognised the disease from his own country, and the outbreak was tackled.

On that occasion, Birmingham was lucky. The virus contracted by Tony McLennan was much milder than that caught by Mrs Parker. Yet Professor Pennington feels more lessons could have been learned.

'People's attitude towards outbreaks like smallpox at that point was that there were a lot of people coming into the country from the Indian Subcontinent, so it was likely that it had come in that way. The photographer who caught smallpox in Birmingham in 1966 had a very varied social life and mixed with people from different ethnic backgrounds, so that was thought to be one way he might have caught it, rather than in the lab.

'There were a lot of red herrings like that around the '66 outbreak which obscured where the whole thing had actually come from. People always like the worst case scenario in things like this when in fact there was a simple explanation -it had escaped from a lab. It's like SARS.

'That was a lab infection, but everyone imagined it was this virus that had come lurching out of the jungle or something.

'Lessons were not learned from 1966 because the outbreak was not pinned down to the lab or any arrangements in the medical school. Maybe if it had been, then Janet Parker would not have died'.

When it came out that Bedson had been testing the hybrid viruses in his lab, suspicion fell on them as the cause of Mrs Parker's death. This was later disproved by Professor Dumbell, who found that the virus she was carrying differed from common strains of smallpox but was not one of the six.

The way smallpox was handled changed dramatically after the 1978 outbreak. Not only were laboratory regulations tightened up, all samples of the virus, which WHO declared eradicated in 1980, were committed to just two sites, the Center for Disease Control and Prevention in Atlanta, Georgia, and the State Research Centre of Virology and Biotechnology (known as Vector) in Koltsovo in the Novosibirsk region of Russia.

Yet we still fear this virus. In the aftermath of the break-up of the Soviet Union, fears were expressed that samples of smallpox from Vector might have fallen into the hands of terrorists for use as weapons. Although this has never been categorically proven, it was enough to spark renewed concern in the wake of the September 11 attacks.

In April this year a series of Health Protection Teams (HPAs) were set up across Britain to help provide a fast response in the event of bioterrorist threats from viruses like anthrax, SARS and. . . smallpox.

Brian McCloskey, regional head of the West Midlands HPA says that part of the problem is that because smallpox is now officially extinct it would be difficult to identify it in the event of any potential bioterrorist-led outbreak.

'It doesn't exist so people don't know what it looks like. Many doctors today would find it difficult to diagnose because they've never seen it. The other thing is that it starts off like a lot of infections, with people feeling unwell and getting a temperature, which could be anything'.

He adds that though there is a potential risk of smallpox virus being used as a bioterrorist weapon, it would not be particularly effective killer.

'It's not hugely infectious and it doesn't spread as quickly as influenza, but it is a threat. It is easy to grow in a lab but hard to spread: if you put it into a bomb the heat would kill it off. If you got people to infect themselves with the virus by the time they were contagious they would be too ill to pass it on -they would just want to be at home in bed.'

'The thing with smallpox is that the fear associated with it is not justified,' says Professor Pennington.

'Yes it will kill a few people, but it is the panic that comes with it that makes it such an effective tool.

'It's not a weapon of mass destruction, it's a weapon of mass panic.'

He points to the outbreak of monkeypox, a smallpox variant, in the USA earlier this year as evidence of that panic.

'The virus came from a giant Gambian rat that someone had bought and kept with some prairie dogs. The prairie dogs were taken to a convention in Milwaukee where they were bought and swapped. People then got monkeypox. Now some would interpret that as smallpox returning and that's the kind of thing which could cause a panic.

'Henry's work was about identifying whether these things were a risk and trying to stop them and the panic that goes with them. It was about trying to understand the smallpox family of viruses'.

The bad reputation of smallpox persists, though. The reason there was so much fear around both the 1966 and 1978 outbreakswas because of the decline in vaccination rates. Today, because it no longer officially exists, it is not considered necessary to vaccinate people against smallpox.

Although this makes it more likely that the disease could spread if it ever did get out, vaccination in itself is dangerous: during an outbreak in Britain in 1962, many more people than necessary were vaccinated due to public demand. Vaccine complications killed around 15.

There have been arguments over the years as to whether the smallpox samples in Atlanta and Vector should be destroyed. At the moment, they are still in existence. But even if they were eliminated tomorrow, it seems our fear of a virus that has been extinct for 23 years would persist.

The Post approached The University of Birmingham during the course of the story but they declined to comment.

Sue Primmer, spokesman for the University of Birmingham, said 'The University chooses not to discuss this well documented episode out of respect to those who died, their family and friends.'

Post-viral infection halted

August 24, 1978, was a busy day for Leslie and Dorothy Harris.

They had spent 11 years of their working lives waiting for this moment, one they thought, hoped, could never happen.

Eleven years of cleaning, checking, preparing. And waiting.

Then, all of a sudden, in a rush, in a panic, the moment arrived, sometime around midnight.

It arrived in an ambulance, in a hurry. It arrived in the form of Janet Parker. The Harrises were the only resident staff at Catherine-de-Barnes Isolation Hospital, Solihull. For 16 years, apart from that brief period in 1978, they spent their days alone, getting ready for an outbreak that everyone prayed would never occur.

The hospital, located in Henwood Lane, was built in 1907 by Solihull and Meriden councils. It was constructed with a main block housing individual one bed wards and several separate bungalow style buildings -enough to house ten staff and 16 patients. The object was, of course, to isolate the patients.

Such places were often known as 'fever hospitals'. During the earlier part of the 20th century diseases such as diphtheria, typhoid fever and smallpox were still quite common. When the risk began to decrease in the 1950s, the hospital became a convalescent maternity hospital.

Following the building of the maternity block at Solihull it reverted to an isolation hospital and was mothballed.

Yet it had to be ready at one hour's notice to receive patients with highly dangerous diseases. No one could set foot inside the 20 acre grounds without wearing protective clothing and being inoculated. The Harrises had to follow all the rules, even when entering the grounds or hospital from their house.

The ward in which Janet Parker died was still sealed off five years after her death, all the furniture and equipment inside left untouched.

In 1981 the Department of Health and Social Security decided to close six other isolation hospitals around the country and spend pounds 150,000 on maintenance at Catherine-de-Barnes. But keeping the unit running at a cost of some pounds 38,500 a year was seen as an expensive precaution at a time when the NHS was financially pressed.

In 1985 plans to burn the hospital down, thus ridding the land of any last traces of the disease, were mooted.

The following year the disinfected hospital was sold to a building company who converted it into houses and flats with the name of Catherine's Court.

Timeline

May 4, 1978 World Health Organisation Inspectors visit Professor Henry Bedson's lab at the University of Birmingham. Despite being unhappy with the arrangements, they allow him to continue, with minor improvements due to the importance of his work and the fact the lab is due for closure in six months.

July 24/25, 1978 An air current carries a virus of the smallpox strain Abid into a service duct from the smallpox lab into a room in the medical school's anatomy department that was used for telephone calls. It infects Janet Parker, departmental photographer, who had been busy placing telephone orders.

August 1, 1978 Regulations recommended by the government's Genetic Manipulation Advisory Group come into force, stating all genetic experiments must be approved by the Health and Safety Executive. They did not apply to Bedson and Dumbells' hybrid viruses as they had been created ten years earlier and were made by a rare naturally occurring process rather than by genetic manipulation.

August 11, 1978 Mrs Parker falls ill. She is diagnosed with flu, then chickenpox, once spots start to appear.

August 20, 1978 Mrs Parker admitted to East Birmingham Hospital at 3pm. By 10pm she is on her way to Catherine-de-Barnes isolation hospital near Solihull. By 11pm all her close contacts, including her parents, Frederick and Hilda Witcomb, are being placed in quarantine. MR and Mrs Witcomb are later transferred to Catherine-de-Barnes.

August 21, 1978 All work on smallpox stops at Professor Bedson's lab.

August 26 1978 Janet Parker tells nurses at Catherine-de-Barnes Isolation Hospital she is 'feeling chirpier after a comfortable night.'

Health officials fumigate her home and car at Burford Park Road, Kings Norton.

August 28 1978 Five hundred people placed in quarantine for two weeks.

August 30, 1978 Holidaymakers told to get vaccinations before going abroad.

August 31 1978 Prof Bedson announces that work on infectious strains of smallpox is unlikely to restart after three teams are set up to investigate how Mrs Parker caught the virus.

September 1978 University accused of failing to comply with health and safety regulations in research lab. Shooter Inquiry into the outbreak announced.

September 1, 1978 Professor Bedson found in his garden shed with his throat cut. He is rushed to hospital and put on life support.

September 5, 1978 Mrs Parker's father dies of a suspected heart attack. No post-mortem is carried out because of the risk of smallpox infection.

September 6 1978 Professor Bedson's life support turned off.

Mrs Parker's husband, Joseph, a Post Office engineer, released from quarantine along with several others.

September 7, 1978 Two families placed in quarantine forced to leave isolation after officials fail to bring them food. Rachel Andre, her son Nigel, her friend Susan Jacobs and her son Romi became smallpox risks after Romi was treated for gastroenteritis at East Birmingham Hospital, in a ward above the one where Mrs Parker had been.

September 8, 1978 Coroner Richard Whittington holds an inquest into Professor Bedson's death, reading out his suicide note. Ann Bedson tells the court her husband was hounded by the press at the time of his suicide. Inquest also opened into the death of Mrs Parker's father, Fred Witcomb.

September 10, 1978 Mrs Parker's husband reveals she was due to attend a week-long course at Nottingham University shortly after she contracted the virus, but decided not to go because she broke out in a rash -the first visible sign of smallpox. Had she attended she would have come into contact with some 3,000 or more people whom she could have infected.

September 11, 1978 Mrs Parker dies at Catherine-de-Barnes.

September 22, 1978

Prof Keith Dumbell is asked by WHO if it would be possible to continue Bedson's work with the deep frozen white pox and smallpox viruses.

October 10, 1978 Final suspects released from quarantine.

October 17, 1978 Smallpox outbreak officially comes to an end.

October 19, 1978 Claims by Clive Jenkins, general secretary of the Association of Scientific, Technical and Managerial Staffs (ASTMS), that Mrs Parker died from a virus created by unauthorised experiments dismissed as 'science fiction' by Birmingham University.

October 22, 1978 Report in The Times reveals that Bedson was testing man-made viruses created more than ten years previously. After taking the six hybrid viruses out of storage in the summer, he began a new series of experiments aimed at identifying different kinds of smallpox. Report quotes Dumbell as saying Mrs Parker was not infected by one of these viruses. The virus she carried differed from common strains of smallpox but was not one of the six.

November 12, 1978 Birmingham University claims it is being made subject of malicious claims that Bedson's lab was not safe.

'This river of hate that someone is pouring out is absolute nonsense,' says press officer Martin Cheesewright.

December 1, 1978 Health and Safety Executive announces it is to prosecute university over smallpox outbreak.

January 4, 1979 Joseph Parker says he wants a pounds 100,000 payout for the loss of his wife. Shooter report leaked to the press by Clive Jenkins, leader of ASTMS. It reveals that research on viruses was carried out, unsupervised, by PhD student Linda Harper.

May 18, 1979 Formal claim for damages lodged by ASTMS against Birmingham University for the relatives and colleagues of Mrs Parker.

October 4, 1979 University agrees to fumigate Medical School East Wing where outbreak occurred.

October 23, 1979 Health and Safety Exec case comes to court. Claims are heard that the lab ignored the risk of smallpox infection, despite a 1974 summons by HSE.

October 24, 1979 Linda Harper, now a doctor, appears in court saying Bedson was a 'perfectionist' and would not have allowed lab standards to slip. Her evidence is backed up on Oct 25 by Jennifer Durham, research assistant.

November 6, 1979 Birmingham Medical Officer Dr William Nicol tells court he 'warned people in high places' that Professor Bedson would commit suicide days before he cut his throat.

November 7, 1979 Court clears Uni of blame for Mrs Parker's death.

August 6, 1981 Joseph Parker receives pounds 26,500 payout for death of his wife.

October 1986 Catherine-de-Barnes isolation Hospital sold to company which converts it into luxury flats.

CAPTION(S):

Above, Janet Parker who was infected by a smallpox strain carried on a breeze into the phone room at the University of Birmingham Medical School; left, the microscopic smallpox virus; below, a technician handles a phial of the disease; Left, scientist Henry Bedson who committed suicide after test viruses in his lab infected Janet Parker with smallpox; top, Ali Maow Maalin who survived being infected by the disease and brought the World Health Organisation close to declaring the disease eradicated; above, smallpox lesions on the skin are shown in this photograph taken in 1973 in Bangladesh
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Title Annotation:Features
Publication:The Birmingham Post (England)
Date:Oct 4, 2003
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