The Last Smallpox Death: Birmingham, 1978

3 Oct

In the summer of 1978, the World Health Organization was close to announcing the greatest achievement in the history of medicine. For the first time, a human disease had been hunted to extinction. Smallpox, which had killed kings and peasants for thousands of years, had not been seen in the wild for almost a year. The paperwork for victory was being prepared.

In Birmingham, England, a medical photographer named Janet Parker was ordering film.

She worked on the second floor of the University of Birmingham Medical School. One floor below her, in a small laboratory, live smallpox virus was being grown for research. Within weeks the virus would be inside her. Within two months three people would be dead, hundreds would be in quarantine, and one of Britain's most respected virologists would be destroyed by guilt and cut his own throat.

The clock had started. Nobody yet knew it was running.

The oldest enemy

Smallpox was not simply a disease. It was one of the great constants of human history.

Marks resembling its pustules have been found on the mummified face of the Egyptian pharaoh Ramses V, who died more than 3,000 years ago. It killed Queen Mary II of England, the Holy Roman Emperor Joseph I, the young Tsar Peter II of Russia and King Louis XV of France. Elizabeth I survived it. Countless ordinary families did not. When Europeans carried it to the Americas, it swept through Indigenous populations with no immunity and helped bring down entire civilisations.

In the twentieth century alone, smallpox is estimated to have killed around 300 million people. For comparison, historians generally put the combined death toll of the century's wars at somewhere between 100 and 200 million.

The disease was spread by the breath of the infected and by their bedding and clothes. After about twelve days of silent incubation came a savage fever, a splitting headache and crippling back pain. Then the rash: first in the mouth, then across the face and limbs, then onto the palms of the hands and the soles of the feet. The spots swelled into blisters, and the blisters hardened into deep, pea-like pustules. The more severe form, variola major, killed roughly three in every ten people it infected. Many survivors were left scarred for life. Some were left blind.

There was no cure. There was only one defence, and for most of history, people were afraid of it.

A bomb through the window

The first defence was inoculation, or variolation: deliberately infecting a healthy person with material from a smallpox sore, producing a milder illness and lifelong immunity. It had been practiced for centuries in Africa, India and China. In 1721 it arrived, controversially, in both London and Boston.

In London, Lady Mary Wortley Montagu, who had seen the technique in Constantinople and survived smallpox herself, had her young daughter inoculated. Condemned prisoners at Newgate were offered pardons if they submitted to the procedure. In Boston, the minister Cotton Mather learned of it from Onesimus, an enslaved West African man in his household, and persuaded a physician, Zabdiel Boylston, to begin inoculating the town during a savage epidemic.

Boston was outraged. Many believed that deliberately spreading smallpox was madness, or an affront to God. In the early hours of one November morning, someone threw a lit grenade through Mather's window. The fuse came loose and it failed to explode. Tied to it was a note: "Cotton Mather, you dog, dam you: I'll inoculate you with this; with a Pox to you."

In 1796 the Gloucestershire doctor Edward Jenner made a safer breakthrough. He took material from a cowpox sore on the hand of a milkmaid, Sarah Nelmes, and inoculated an eight-year-old boy, James Phipps. Weeks later he exposed the boy to smallpox. James did not fall ill. Jenner called the technique vaccination, from vacca, Latin for cow, and published his results rather than profiting from them.

The public was not immediately grateful. Cartoonists mocked the idea of injecting people with matter from animals; in James Gillray's famous 1802 print, newly vaccinated patients sprout cows from their faces and arms. When Britain made infant vaccination compulsory in 1853 and began penalising parents who refused, anti-vaccination leagues spread across the country. On 23 March 1885, a vast crowd, estimated by contemporaries at up to 100,000, marched through Leicester in protest, carrying banners, burning copies of the Vaccination Acts and executing an effigy of Jenner.

Yet the evidence kept mounting. Wherever vaccination took hold, smallpox retreated. Over the following century, the disease that had once been an ordinary part of childhood slowly became something that happened elsewhere.

The last campaign

By the 1950s smallpox had been driven out of Europe and North America, but it still killed millions every year across Asia, Africa and South America. In 1967 the WHO launched an intensified global eradication programme under the American epidemiologist D.A. Henderson.

The odds looked poor. The campaign had to reach remote villages, cross borders and work through civil wars, floods and famine. Its breakthrough was a change of tactics. Rather than trying to vaccinate everyone, teams tracked down each new case, isolated the patient and vaccinated everyone around them, closing a "ring" the virus could not escape. Rewards were offered for reporting cases. Vaccinators travelled on foot, by boat and by bicycle, and many worked in places where the disease was still raging.

One by one, countries fell silent. The last natural case of the deadly variola major was a young girl, Rahima Banu, on Bhola Island in Bangladesh in 1975. The last natural case of any kind was Ali Maow Maalin, a hospital cook in Merca, Somalia, in October 1977. He recovered.

After Maalin, smallpox existed only in laboratory freezers. The WHO began the long process of confirming that the disease was truly gone. The champagne, figuratively speaking, was on ice.

Birmingham, 1978: the floor below

One of those freezers was in Birmingham.

Professor Henry Bedson, head of medical microbiology at the university's medical school, was a respected virologist and the son of a distinguished one. His small smallpox laboratory studied "whitepox" viruses, close cousins of smallpox that some scientists feared could lurk in animals and one day undo the eradication campaign. In other words, the work was meant to protect the victory.

But the WHO wanted as few laboratories as possible holding live smallpox. In 1977 it rejected Bedson's bid to become an official collaborating centre, partly over safety. His smallpox work would have to end by the close of 1978. Bedson pushed to finish before the deadline, and the volume of work in his laboratory went up, not down.

The building also had a history that should have given everyone pause. In 1966, a medical photographer at the same medical school, Tony McLennan, had caught a mild form of smallpox. It went undiagnosed for weeks and led to further cases across the West Midlands. No formal inquiry into its source was ever held.

Twelve years later, another medical photographer was working directly above the laboratory.

Janet Parker was 40. She had spent several years as a police photographer before joining the Anatomy Department, and lived in Kings Norton with her husband, Joseph, a Post Office engineer. Her days were spent in a darkroom that smelled of developer and fixer, printing images of specimens and patients under a red safelight, cataloguing, ordering supplies. It was careful, unglamorous work. She had last been vaccinated against smallpox in 1966.

24–25 July: The exposure

In the laboratory below, staff were working with a strain of variola major called Abid. It had been isolated years earlier from a three-year-old Pakistani boy and named after him. It was one of the most dangerous organisms on earth, and on 24 and 25 July it was out of the freezer.

On 25 July, Janet Parker spent longer than usual in a small room upstairs that was used for telephone calls. The financial year was about to end, and there were photographic materials to order before the budget closed.

It was the most ordinary of working days. Beneath the floor, a network of service ducts linked the laboratory to the rooms above. Later, an official inquiry would decide that this was how the virus reached her: carried on currents of air, up through a poorly sealed duct and into the room where she sat making phone calls.

That conclusion would not survive. But nobody was asking the question yet.

11 August: A headache

Seventeen days later, Janet Parker felt unwell. She had a headache and aching muscles. It looked like flu.

Then came spots. Her doctor thought they were a harmless rash, perhaps chickenpox. It was an understandable mistake. Smallpox had not been seen in Britain for years, and very few doctors practicing in 1978 had ever seen a case.

For nine days the most feared disease in history went unrecognised in a Birmingham suburb. Every day that passed gave the virus new chances to escape.

20 August: The diagnosis

On the afternoon of Sunday 20 August, Parker was admitted to East Birmingham Hospital.

The rash now covered her whole body. It had spread to her palms and the soles of her feet. On her face the pustules had run together.

The consultant in infectious diseases, Dr Alasdair Geddes, took one look.

Variola major.

By 10pm she was in an ambulance bound for the Catherine-de-Barnes Isolation Hospital near Solihull. By 11pm her close contacts, including her mother and father, were in quarantine.

The next day, fluid from her blisters was placed under an electron microscope. The brick-shaped particles of a poxvirus were unmistakable.

The man looking down the microscope was Professor Henry Bedson. The virus had come from his own laboratory.

Late August: A city holds its breath

Birmingham now faced something no British city had dealt with in years: a case of the deadliest form of smallpox, with nine days of unknown contacts behind it.

The response was swift and sweeping. Dr Surinder Singh Bakhshi, the city's medical officer of environmental health, led a painstaking hunt for everyone Parker might have met. Some 260 people were quarantined almost immediately, including the ambulance driver who had carried her. More than 500 were vaccinated. On 26 August, health officials fumigated her house in Kings Norton and her car. Hundreds more were confined to their homes for two weeks, waiting to see whether a fever would come.

The news travelled fast. It led television bulletins and filled the front pages. A disease the world had been told was finished was suddenly loose in the Midlands.

At Catherine-de-Barnes, an old isolation hospital set apart from the town, Janet Parker lay behind closed doors. Staff who entered her room did so under strict barrier precautions. Her illness grew worse. Her parents were brought to the same hospital, in quarantine.

On the floor below her darkroom, the laboratory's smallpox work had stopped. And across the city, in his home in Harborne, Henry Bedson was also in quarantine, with nothing to do but wait.

1 September: The professor

Bedson had spent his career trying to understand smallpox. Now reporters were camped outside his home, and the question in every newspaper was whose fault this was. The answer seemed obvious. It was his laboratory. It was his virus.

On 1 September, while still in quarantine, Henry Bedson attempted to take his own life. He was taken to hospital, where he died on 6 September. He was 48.

He left a note. In it, he said he was sorry "to have misplaced the trust" that so many friends and colleagues had "placed in me and my work."

His colleagues saw him differently. His obituary in the Royal College of Physicians' Munk's Roll, written by the virologist Peter Wildy and Sir Gordon Wolstenholme, blamed a relentless hunt by journalists for a villain. They called him "a victim of his own dedicated conscientiousness."

5 September: The visit

The day before Bedson died, the tragedy took another turn.

Frederick Witcomb, Janet's 71-year-old father, was in quarantine at Catherine-de-Barnes, close to his gravely ill daughter. On 5 September, after visiting her, he suffered a cardiac arrest and died. Because of the risk of infection, no post-mortem was carried out.

Two days later, her mother Hilda developed smallpox, despite having been vaccinated on 24 August. Hers was a mild case. She would survive, and be discharged later that month. She was the outbreak's only other case.

On 7 September, as television sets across Britain carried a broadcast from the Prime Minister, James Callaghan, announcing that there would be no autumn general election, a mother in a Solihull isolation hospital had lost her husband, was ill herself, and was waiting on news of her daughter.

11 September: The last death

Janet Parker died at Catherine-de-Barnes on 11 September 1978.

Even then, the virus dictated what happened next. The coroner refused an autopsy. Her body was not kept in a mortuary fridge for fear the virus might survive the cold, but sat in a sealed bag on the floor of a garage. Ron Fleet, who collected it for a Solihull funeral director, remembered it years later: "The body was covered in sores and scars – it was quite horrific."

Burial was ruled out. Her hearse travelled with an escort of unmarked police cars. She was cremated at the Robin Hood Crematorium, every other funeral that day was cancelled, and the building was cleaned from top to bottom afterwards.

The ward where she died was sealed. Five years later, its furniture and equipment were still inside, untouched.

Birmingham was declared free of smallpox on 16 October 1978. The outbreak was over. The reckoning was about to begin.

Winter 1978: The leak

The government appointed an inquiry under the microbiologist Professor Reginald Shooter, with observers from the WHO, the Health and Safety Executive and the Trades Union Congress. It worked quickly. By December its report was finished.

It was scathing. Bedson had not told the authorities about changes in his research that affected safety. Some laboratory staff had received no special training. The facilities fell well short of legal requirements, yet the official advisory group had twice inspected the laboratory and allowed the work to continue. The report concluded that Parker had been infected by air carried up the duct from the laboratory to the telephone room.

On 1 December the Health and Safety Executive announced it would prosecute the university. That meant the report could not be published. It was supposed to stay quiet.

It did not.

Clive Jenkins, the combative general secretary of ASTMS, the union Janet Parker had belonged to, received a copy. He gave it to the press.

Its findings made headlines. Writing in Science in 1979, Nigel Hawkes called it "one of the most damning documents ever produced by an official enquiry in Britain."

On 24 January 1979, the Secretary of State for Social Services, David Ennals, rose in the House of Commons. He announced that the old voluntary safeguards for dangerous pathogens would be replaced by legal regulation and licensing. "No system of control and no safety arrangements can be 100 per cent. fool-proof," he told MPs. From the opposition benches, Patrick Jenkin pointed to the cruelty of the timing: the deaths had come just as smallpox was "being eradicated from the face of the earth." Jeff Rooker, a Birmingham MP, paid tribute to "the hundreds of citizens in Birmingham who co-operated with the quarantine regulations."

October 1979: The duct on trial

The case against the university came before Birmingham Magistrates' Court in October 1979. At its centre was the Shooter report's explanation of how the virus had travelled.

The defence called some of the most eminent smallpox experts in the world, among them Kevin McCarthy, Allan Watt Downie and Keith Dumbell. One by one, they took the duct theory apart. By their calculations, at the rate the laboratory had been working, it would have taken around 20,000 years for a single virus particle to drift up to the telephone room. The poorly sealed duct that had so troubled the inquiry turned out to have been damaged after the outbreak, by engineers fumigating the laboratory.

The university was found not guilty.

That left a question nobody could answer. If the virus had not come to Janet Parker, how had she come to the virus? The university's barrister, Brian Escott-Cox QC, put it plainly in an interview with the Birmingham Mail in 2018: the only inference left was that "Janet Parker must, in some way or other, have come to the smallpox."

Mark Pallen, the microbiologist who wrote the definitive history of the outbreak, The Last Days of Smallpox: Tragedy in Birmingham, has said the duct theory "was not really believed by anyone in the know." He suggests Parker may have gone into the laboratory itself, perhaps seeking advice on photographic materials or offering staff discounted film. It has never been proven.

In August 1981, Joseph Parker was awarded £25,000[i] in compensation. How his wife caught smallpox remains unknown to this day.

May 1980: The celebration

On 8 May 1980, the World Health Assembly formally declared that smallpox had been eradicated. It was the first human disease ever wiped from the planet, and it remains the only one. The disease that had killed pharaohs and emperors, and some 300 million people in a single century, was gone.

The declaration came twenty months after Janet Parker's death. In the wake of Birmingham, laboratories around the world destroyed their stocks or handed them over. Today live smallpox is officially held in just two places: the Centers for Disease Control and Prevention in Atlanta, and the VECTOR institute in Koltsovo, Russia.

The ironies are hard to escape. The long war against smallpox was won in the villages of Bangladesh and Somalia, only for the final death to occur in a university building in England's second city. The research that caused it was intended to protect the eradication campaign. The laboratory was months from closing. The man who confirmed the diagnosis was the man who would be blamed for it. And the victim was a photographer at the same medical school where a photographer had caught smallpox twelve years before.

There is one more. Since 1980, generations have grown up never having seen a smallpox scar. The disease that terrified every family in history has become a line in a textbook. It is an extraordinary gift, and it has made it easy to forget what vaccination actually accomplished. Somewhere between Cotton Mather's grenade and a social media feed, the argument has come full circle. People who owe their unmarked skin to the vaccinators now doubt the vaccines, and diseases once thought beaten, such as measles, have found their way back in communities where vaccination has fallen.

No words of Janet Parker's own appear in the public record. She is remembered mostly through inquiry reports, court records and the recollections of the people who dealt with her illness. But her death is a reminder of what smallpox was, and what it cost to beat. The monster did not go quietly. Its last act was to reach up through the floor of a Birmingham medical school, at the very moment the world was preparing to celebrate its end.