May 9, 2025 • 37 mins
In 1978 the world is on the brink of declaring victory over smallpox. No cases have been seen for months, and it looks like the end for a deadly, painful disease. When a photographer in Birmingham begins to feel ill, doctors are mystified: it looks like smallpox, but how could she have caught it? As they try to contain the outbreak, questions about blame and lab safety erupt in a media frenzy, questions that remain today.
For a full list of sources, see the show notes at timharford.com.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:15):
Pushkin a warning before we start. This cautionary tale discusses
death by suicide. If you're suffering emotional distress or if
you're having suicidal thoughts, support is available, for example, from
the nine eight to eight Suicide and Crisis Lifeline in
the US. Funeral director Ron Fleet is driving his van
(00:42):
to a hospital in Catherine de Barnes, a quiet village
in the countryside near Birmingham, England. Catherine de Barnes is tiny,
just a few dozen houses and a nineteenth century pub.
To get to the hospital, you drive half a mile
out of the village down a narrow lane flanked by
hedgerows and fields. The hospital is a big, old building
(01:05):
and twenty acres of grounds. The year is nineteen seven eight.
You might expect this to be a journey. Ron Fleet
knows well. Funeral directors do tend to become familiar with
their local hospitals. But no. The hospital in the village
of Catherine de Barnes hasn't seen a death for years.
(01:25):
It hasn't seen a patient for years. It's an isolation hospital,
kept empty but ready just in case someone gets some
appalling infectious disease that requires them to be confined safely
away from the public. Year after year after year, the
(01:45):
hospital's husband and wife caretakers have kept award with sixteen
beds on constant standby, ready for patients who mercifully never came.
But now they have had a patient and she's died.
(02:05):
Ron Fleet assumes that the body he's come to collect
will be in a morgue or a fridge. It isn't.
He's directed to a garage some distance away from the
main hospital building. In the garage, he finds a transparent
body bag. It's clear that this woman must have suffered terribly.
(02:30):
Her body and face are covered with saws, scars, and
fluid filled pustules, and the body's on the floor, not
a trolley. How's he going to get it into his van?
He goes back to the main building to ask someone
to help him. Nobody seems keen. Fleet opens the back
(02:52):
doors of his van and heaves the body inside. Some
kind of liquid sloshes around inside the transparent body bag.
I really hope this bag doesn't split, thinks ron Fleet.
I'm Tim Harford, and you're listening to cautionary tales. By
(03:40):
the nineteen sixties, smallpox had become rare enough in England
that when someone got it, it was often misdiagnosed. In
nineteen sixty six, for example, a young man called Tony
became ill with what seemed like flu. Tony called in
sick to his job as a medical photographer at the
University of Birmingham and spent a few days in bed
(04:03):
with aches and a fever. Then came the rash, when
he thought he'd better get a doctor to look at it.
Maybe a sweat rash, said the doctor. You'll have been
sweating with that fever, or it could be a reaction
to the medicine you've been taking. Anyway, nothing to worry about.
(04:24):
Tony starts to feel better, well enough to resume his
social life. He needs to freshen up a bit, so
he borrows his dad's raisor to shave. He's got to
be careful as he's still got that rash on his face,
and he accidentally slices through one of the pustules. He
(04:44):
goes to the pub with his dad and his girlfriend.
The barman winces sympathetically nasty attack of acne. A week
and a bit later, Tony's dad gets a spot on
his face where he's nicked himself with the razor Tony borrowed.
He then gets a fever and more spots. An old
(05:06):
man who'd been drinking in the pub gets hilled too,
who he infects his teenage grandson, who infects a hitchhiker
he meets at a roadside cafe while on a trip
to the beach. A couple of hours drive away. The
hitchhiker gets home to another part of the country and
infects his mum. Various people go to doctors who say,
(05:28):
probably flu or that looks like chicken pox. It's eight
weeks before someone sees a doctor who seen smallpox before
and says, hmm, let's test for that. There are two
types of smallpox. Veriola major was the one you really
(05:50):
didn't want. It killed about thirty percent of those it infected.
Veriola minor was much less serious, but still no joke.
Its fatality rate was one percent, comparable to COVID. Once
the tests confirmed that Variola minor is at large, the
medical authorities start to put the pieces together. They find
(06:14):
seventy three people who've been infected. Luckily, nobody's died. The
medics trace back the roots of infection, and they seemed
to converge on young Tony. But where had Tony got it? Well,
smallpox might have been rare in England at the time
that it was still common enough in the Indian subcontinent.
(06:38):
The last outbreak of small pox in Britain four years
earlier turned out to have started with people recently arrived
from Karachi. Birmingham had a high rate of immigration from
the subcontinent. Tony enjoyed a varied social life with friends
from all backgrounds. It was perfectly possible, as Tony's own
(06:58):
case showed, to go out on the town while not
realizing you're infectious with a mild case of Veriola minor.
Most likely Tony had picked it up from someone he
had met at a party. The building at the University
of Birmingham where Tony worked as a medical photographer, also
housed a laboratory that did research on smallpox. The lab
(07:23):
was run by a man called Henry Bedson, a well
respected smallpox expert. Bedson had been cultivating strains of Variola
minor just over a week before Tony's symptoms started. The
incubation period for smallpox is typically between a week and
a fortnight. Quite a coincidence. Was it just a coincidence?
(07:50):
Nobody seemed too worried. At the time, the university didn't
feel the need to hold an investigation. Tony's office wasn't
even on the same floor as the smallpox lab, and
everyone knew smallpox didn't spread that easily. It needed both
close personal contact and a dose bad luck. Think about
(08:11):
the outbreak Tony started. Yes, it passed it on to
a few people, but he met many more who didn't
get infected. In eight weeks, only seventy three people had
picked it up. The idea that virus particles might have
found their way out of Bedson's lab and wandered around
the building, missing everyone else, until they met Tony on
(08:34):
the floor above seemed fantastical. Still, the coincidence was striking.
It occurred to Bedson's boss, the head of the department,
that he should probably get an outside opinion. He asked
another smallpox expert to visit the university and check that
Bedson was taking adequate precautions. All looks perfectly standard, said
(09:01):
the expert, Same as any other smallpox lab. By nineteen
seventy eight, twelve years later, Henry Bedson has moved up
in the world. He's still at the University of Birmingham,
but he's now the head of Department of Medical Microbiology.
He's forty eight years old, married with three young kids.
(09:24):
He looks like a stereotypical academic scientist, bald, softly spoken,
tweed jacket. With his new departmental duties, Bedson no longer
has time to be so hands on in his old
smallpox lab, but he has a PhD student doing research,
and that research is important. In those twelve years, much
(09:48):
has changed. Smallpox is no longer common on the Indian subcontinent,
or indeed anywhere. It's been wiped off the face of
the earth. Teams of workers led by the World Health
Organization have been visiting the furthest flung villages of the
world's poorest countries, persuading people to be vaccinated, tracing contacts
(10:11):
where they find a case. Henry Bedson himself has been
involved the who sent him to Afghanistan and Pakistan as
part of an expert committee, and all that hard work
has succeeded. It's been eight months now since the last
report of a case of smallpox anywhere in the world.
(10:33):
That case was in Somalia. It looks likely to go
down in history as the very last time any human
gets this terrible disease. Ever, but what if there was
a way smallpox might come back? What if there was
a similar virus lurking in some population of wild animals,
(10:57):
liable to cross over to humans at any time? Smallpox,
after all, like many human diseases, originally came from animals,
maybe camels, gerbils. It's not entirely clear, and two recent
discoveries were troubling Henry Bedson. Researchers in the Netherlands and
(11:19):
Russia had found a virus that looked very much like smallpox,
lurking in samples taken from wild monkeys and rodents. This
new mystery virus had become known as whitepox. But what
was whitepox? How exactly did it differ from the various
(11:40):
strains of Variola major? Might it pose a threat to humans?
These were the questions Henry Bedson had his PhD student
investigating that Bedson had a problem because the wighthow was
worried about another way smallpox might come back. What if
(12:00):
it leaked from a lab? Plenty of labs around the world,
like Bedson's, were working on smallpox viruses. The wh show
wanted to restrict all future research to just a handful
of labs that would meet more stringent new safety standards.
Bedson's lab was not on the list. Henry Bedson wrote
(12:23):
to the World Health Organization, Can I have a few
more months to finish up my white box research? My
lab's been scaling down. I promise I'll be done by
the end of the year. Bedson was arguably being economical
with the truth. The lab had scaled down compared to
a few years ago. It had just one PhD student now,
(12:44):
but in the hope of completing his white box work
before his lab had to close, Bedson had just scaled
up his stocks of smallpox, taking delivery of twenty two
new samples of different strains of the virus. The World
Health Organization wrote back, okay, then just until the end
(13:06):
of the year. Bedson was relieved, and then one evening
in August at home, his phone rang. It was a
doctor he knew, calling from the hospital. Henry said the voice,
I've got a patient here with a suspected case of smallpox.
(13:30):
Cautionary tales will be back after the break. By nineteen
seventy eight, young Tony has left his job as the
medical photographer at the University of Birmingham. There's a new
(13:50):
photographer now working on the floor above Henry Bedson's smallpox lab.
Her name is Janet Parker and she's forty years old.
On the second Friday in August, Janet begins to feel unwell.
A few days later, she starts to get a rash.
She sees a doctor chicken pox. She also has sostiitis,
(14:14):
and the doctor prescribes antibiotics for that. A couple of
days later, the rash is much worse. She sees a
second doctor, maybe an allergic reaction to the antibiotic. He
prescribes a different antibiotic. Days go by and Janet's condition
gets worse and worse. She sees a third doctor. This
(14:38):
doctor calls the infectious diseases unit at the hospital. I
don't think it's chicken pox, she says. But I'm stumped.
Can one of your infectious disease specialists visit her home
and take a look. We don't do home visits, say
the hospital. That's the policy. Well, let it's smallpox. No
(14:59):
chance of that, says Janet's doctor. She hasn't been out
of the country for five years. The hospital will send
an ambulance and it is admitted to the infectious diseases unit.
The specialist there takes a close look at Janet and
makes some notes. Parsicular rash, most pronounced on the face,
(15:22):
lesions half a centimeter, white fluid, more advanced lesions with
darkened centers, no lesions in the mouth, febrile question mark
drug reaction, then question mark, question mark, question mark variola.
(15:45):
The doctor consults her colleagues it can't be smallpox, but
they're sufficiently puzzled to want to rule it out. The
trouble is none of them have experienced with smallpox. They've
only seen it in textbooks. But they still have access
to a designated regional smallpox consultant, a doctor who's worked
(16:06):
in Bangladesh and knows the disease. They find his number.
It's seven point thirty in the evening, and the regional
smallpox consultant is about to open a bottle of wine
at home when his phone rings. He doesn't get many
calls like this, maybe once a year, but he doesn't
mind because he gets a fee for every call out.
(16:29):
So far, it's always been either a bad case of
chicken pox or an allergic reaction to a drug. He
puts his wine aside, drives to the hospital, finds Janet's
room and that looks like smallpox. But who is this
woman and how on earth has she got smallpox in Birmingham,
(16:52):
eight months after the world's last recorded case in Somalia.
The doctors fill him in on Janet's details. She works
as a medical photographer at the University of Birmingham. Hm.
The consultant, of course, knows all about the smallpox lab
at the university. It'd better call Henry Bedson, Henry, he says.
(17:18):
When Bedson answers the phone, I've got a patient here
with a suspected case of smallpox. It's a lady who
works as a photographer at the medical school at the
other end of the line. Henry Bedson is too stunned
to speak. The consultant takes a sample of the fluid
(17:42):
from Janet's postules and drives to the medical school to
meet Henry Bedson. Together the two men open up the
lab and put the slide under the microscope. Bedson looks
first without a word. He moves aside to let the
consultant see. There's no doubt it's smallpox. They'll need to
(18:07):
run more tests to confirm that its very ola major
and find out exactly which strain. Bedson sets the tests
in motion. The regional smallpox consultant picks up the phone
and makes the call that he's never had to make before,
(18:27):
open up the isolation hospital at Catherine de Barnes. As
the fictional Dr Duffenschmertz might put it, if I had
a nickel for every time a medical photographer at the
University of Birmingham got smallpox, I'd have two nichols, which
(18:48):
isn't a lot, but it's weird that it happened twice.
Back in nineteen sixty six, when Tony got smallpox, it
had seemed ludicrous to think that the virus might have
gone walk about from Henry Bedson's lab around the building.
But soon after, in nineteen seventy, a young man in
Germany developed fever and a rash a week and a
(19:11):
half after flying home from a backpacking trip to Karachi.
With that travel history, German doctors suspected smallpox right away.
They put the man in strict isolation. Still, somehow, seventeen
other people in the hospital developed smallpox, including patients two
(19:33):
floors distant who never left their room. How One explanation
was that smallpox might be more capable of airborne transmission
than had previously been thought. Investigators set off a smoke
device in the room where the man had been and
tracked how the smoke wafted into the corridors, up the stairwells,
(19:55):
and into other rooms. The results mapped pretty well onto
the pattern of infections at the University of Birmingham. Henry
Bedson and his colleagues stand in the courtyard ou side
the medical school. They're checking how close the photographer's office
is to the smallpox lab. Not very close. They're at
(20:18):
least forty feet apart. If the virus particles wafted through
the air to Janet, it's far from obvious what route
they might have taken. By now, various authorities are competing
to take the situation in hand. One insists that everyone
who has anything to do with the smallpox lab has
(20:39):
to go into quarantine, including Henry Bedson. That seems like overkill.
Bedsen's been thoroughly vaccinated, and if it'd got smallpox at
the same time as Janet Parker, he'd have known about
it long before now. Still, though Bedson's told stay at
home you can't be too careful. Another authority insists that
(21:03):
the smallpox lab be immediately fumigated to kill any virus
particles that might be Only afterwards that they realize this
means they've killed the samples from Janet Parker that Bedson
had been testing to identify which strain of smallpox she'd got.
That Bette get another sample while they still can. At
(21:25):
the hospital in Catherine de Barnes. Janet is still just
about clinging to life. They call the smallpox lab at
the University of Liverpool and ask one of the professors
to drive the one hundred miles to Birmingham to visit
Janet and take samples back for testing. We'll arrange a
police escort, of course, they say. As the professor leaves
(21:49):
the motorway near Birmingham, he's met by a policeman on
a motorcycle who leads him through the city and down
the quiet country lanes to the twenty acre site of
the hospital at Catherine de Barnes. The policeman thinks his
job is done and says farewell. The professor is confused, Wait,
(22:09):
you're leaving me here, but surely the whole point of
a police escort is to get me safely back to
my lab when I'll have highly contagious samples of smallpox
in my car. Now, the Policeman's confused. Nobody's told me
anything about that, sir. All the way back to Liverpool.
I've finished my shift at five o'clock. At five o'clock,
(22:31):
they're still gridlocked in central Birmingham. The policeman waves goodbye,
screw this, Thanks the professor. He decides to give the
rush hour traffic time to clear and detours into the
suburbs to call in at the home of his old friend,
Henry Bedson. Bedson is not coping well with quarantine. He
(22:56):
hates being holed up at home when he could be
doing something to help. The phone keeps ringing, and he
keeps thinking he'd better answer it in case it's important.
But it's always some journalist trying to get into admit
that he's to blame for all the chaos that's unfolding
in the city. The desperate search to trace and quarantine
and vaccinate anyone Janet Parker might have met. Bedson's friend
(23:21):
tries to lift his spirits, but the next morning Bedson
writes a note I'm sorry to have misplaced the trust
which so many of my friends and colleagues have placed
in me and my work. Bedson writes. I realize this
act is the least sensible thing I have done, but
(23:44):
it may allow my wife and children to get some peace.
Bedson calls to his wife, I'm just going to the
garden shed. Cautionary tales will be back in a moment.
(24:11):
Henry Bedson is still alive when his wife finds him
in the shed, though he's losing a lot of blood.
She runs back to the house. As she's about to
pick up the phone, it starts to ring local radio news.
Can I speak to Professor Bedson? Get off the line,
(24:32):
yells Bedson's wife. She slams the receiver down and picks
it up again. I don't know it's the wife, she says.
She wants us to get off the line. Henry Bedson
survives for five days on life support before doctors conclude
that he won't recover. Five days after that, Janet Parker's
(24:54):
life finally ebbs away. Funeral director Ron Fleet is sent
to collect her body. Janet is cremated, then they fumigate
the crematorium just to be safe. Janet Parker has infected
only one other person, her mum. Once her mum recovers,
(25:19):
humanity is once again free from smallpox. But if it's
going to stay that way, it might help to find
out how had Janet got it. The government appointed a
committee to investigate. They tried the same kind of test
as in the German hospital, setting off a smoke device
(25:42):
in the smallpox lab to understand where the airflow might go.
The smallpox lab was a small inner room connected to
a larger outer lab. If the door between those rooms
was open, the air from the smallpox lab could get
into the outer lab, and the door was open sometimes
(26:03):
because the smallpox samples were stored in that outer lab,
But if smallpox parts got loose in that outer lab,
it shouldn't pose a risk. Everyone who was allowed into
the outer lab had been vaccinated against smallpox. But a
little bit of the smoke drifted further, some beyond the
(26:24):
outer lab and into a corridor, and some into a
service duct, and from the service duct threw a badly
fitted access panel into a room on the floor above
not Janet Parker's office, another room used for storage, but
that also had a telephone with an outside line. Janet
(26:47):
Parker's office phone didn't have an outside line, so when
she needed to make orders for supplies of photographic materials,
should use the phone in that storage room, sitting close
to the badly fitted panel. The investigators determined that Janet
had placed an unusually large number of orders on the
(27:08):
line last Tuesday in July, two and a half, weeks
before she began to feel ill. That timeline doesn't quite
stack up. The usual incubation period for smallpox is one
to two weeks, not two and a half. And you
can query how relevant that German hospital really is. There
(27:30):
you had a young man with smallpox coughing up clouds
of virus particles. Here you had a lab with workers
trying carefully to minimize contamination. Still, the investigators conclude infection
through the service duct is the most probable route that
they could find. Armed with the investigator's report, a government
(27:54):
agency decides to sue the University of Birmingham for failing
to ensure health and safety at work. In his book
The Last Days of Smallpox, the author Mark Pallin describes
the case in detail. Witness after witness attests that Henry
(28:16):
Bedson was known for being meticulous about safety procedures. You
can't eliminate all risks from lab work. As one expert
witness says, perfection is impossible. But Henry Bedson's smallpox lab
was doing nothing ntypical by the standards of the time.
(28:37):
What about the pox in the ducts hypothesis? The university's
lawyer calls a professor to testify for the defense. I've
been doing some calculations, the professor says, based on how
much smoke made it from the smallpox lab into the
room with a telephone, and how many virus particles typically
(28:58):
get into the air from routine lab work, I reckon
you might expect virus particles to make it into the
telephone room at the rate of one particle every two
to twenty thousand years. The lawyer for the Health and
Safety agency calls an expert witness, too, but it seems
that he hasn't researched his experts views. When asked about
(29:22):
the investigator's theory that Janet had got the virus through
the service duct, the expert says he thinks it's highly implausible.
The lawyer's taken aback his own witness has just dismissed
the central plank of his case. But if we discount
the duct hypothesis, the lawyer asks, with what does that
(29:43):
leave us? The expert replies, it leaves you with a puzzle.
Say the words lab leak. Now, of course, and the
city that springs to mind isn't Birmingham, It's Wuhan. A
(30:04):
novel coronavirus pandemic just happens to start in a city
which has a lab that does research on novel coronaviruses.
Quite a coincidence. Was COVID a lab leak? That debate
rumbles on, But I wondered if the Birmingham story might
give us any general lessons about lab leaks. I think
(30:28):
there are two lesson. Number one, the puzzle might never
be solved. We might only ever have competing stories and
our own best guess as to which makes most sense.
The second lesson starts with another observation from that trial,
Perfection is impossible. No matter how careful you try to be,
(30:52):
there'll always be something you might overlook. Think about that
evening before Henry Bedson despairingly went to his garden. Shed
Bedsen's at home, forced to quarantine because you can't be
too care but parked outside on his drive is his
(31:13):
friend's car containing highly dangerous smallpox samples from Janet Parker.
The professor then drives his car one hundred miles up
the motorway with no police escort. What if it had
a crash? Or think about fumigating the crematorium after Janet
Parker's body was burned just to be safe. Yet nobody
(31:36):
had thought about the risk to funeral director Ron Fleet,
who had to lug Janet's corpse into his van without help,
praying the body bag wouldn't burst. There'll always be something
you might overlook. In twenty fourteen, in a lab in Bethesda, Maryland,
half a dozen glass pals of smallpox were discovered in
(31:59):
a cardboard box at the back of a cupboard, forgotten
since the nineteen fifties. If we're going to do research
on deadly viruses, we have to accept some risk that
something will go wrong in some way we hadn't considered.
So the second lesson I want to suggest is this,
(32:20):
we'd better be damn sure that that research is worth it.
Perhaps in the case of Birmingham, the puzzle has an answer.
In twenty eighteen, the author Mark Pallin tracked down the
lawyer who had represented the university in the court case.
(32:40):
The lawyer was now eighty five years old. The author asked,
do you know what really happened? Well, said the lawyer,
there was a rumor, a very strong rumor. I could
never get anyone to say it on the record, but
the rumor went like this, back in the nineteen seventies, Remember,
(33:05):
nobody had smartphones or digital cameras. To make holiday photos,
you needed roles of film, and they were pricey. A
photographer at an institution like a medical school could buy
those films in bulk at a discount. There was a
well established tradition in the medical school. The rumor went
(33:27):
that the photographer would get you cut price films. That
might explain why Janet was placing so many orders in
the last week of July, just before everyone went on
their summer holidays. And what if a few days later,
Janet had gone around the building delivering to her colleagues
(33:49):
the supplies she'd got for them. What if she had
popped into the outer lab just for a moment to
drop off a roll of film. What if this year
she had chosen just the wrong moment when there were
virus particles in the air or on a surface she
happened to touch. It's only a rumor, just one more
(34:13):
competing story. But if Janet had encountered the virus a
few days after the investigator's guessed, it would make the
incubation period line up. And if the tradition of photographers
delivering film to their colleagues went back to young Tony,
that would also neatly solve the two nickel question of
(34:37):
why an infection might have happened twice as one more
loose end to tie up. One final irony was the
research worth it. Henry Benson, remember had been anxious to
complete his work on whitepox, the mysterious virus from labs
(34:59):
in the Netherlands and Russia. If whitepox was similar to smallpox,
it might live in wild populations of monkeys and rodents
and then jump back to humans. After Bedson's death, other
researchers finished the job. They found that white pox was
(35:21):
a mirage. These viruses weren't just like smallpox, they were smallpox,
and the smallpox didn't come from the animals. The samples
from rodents and monkeys in the Dutch and Russian labs
had been contaminated with smallpox. In the labs themselves. The
(35:43):
monkeys and rodents had never had a pox like virus
at all. That kind of contamination shouldn't happen in a lab,
of course, but sometimes it does. Perfection is impossible. If
the work in Henry Bedson's lab had been perfect, Janet
Parker could never have got smallpox. But if the Dutch
(36:07):
and Russian labs had been perfect, Bedson wouldn't have been
doing that work in the first place. A key source
for this episode was Mark Pallon's book The Last Days
(36:29):
of Smallpox Tragedy in Birmingham. For a full list of
our sources, see the show notes at Timharford dot com.
Cautionary Tales as written by me Tim Harford with Andrew Wright,
(36:52):
Alice Fines, and Ryan Billy. It's produced by Georgia Mills
and Marilyn Rust. The sound design and original music are
the work of Pascal Wise. Additional sound design is by
Carlos san Juan at Brain Audio. Bend Dafhaffrey edited the scripts.
The show features the voice talents of Melanie Guttridge, Stella Harford,
(37:14):
Oliver Hembrough, Sarah Jupp, Massaam Monroe, Jamal Westman, and rufus Wright.
The show also wouldn't have been possible without the work
of Jacob Weisberg, Greta Cohene, Sarah Nix, Eric Sandler, Carrie Brody,
Christina Sullivan, Kira Posey, and Owen Miller. Cautionary Tales is
a production of Pushkin Industries. It's recorded at Wardoor Studios
(37:37):
in London by Tom Berry. If you like the show,
please remember to share, rate and review. It really makes
a difference to us and if you want to hear
the show, add free sign up to Pushkin Plus on
the show page, on Apple Podcasts or at pushkin dot fm,
slash plus
Pushkin a warning before we start. This cautionary tale discusses
death by suicide. If you're suffering emotional distress or if
you're having suicidal thoughts, support is available, for example, from
the nine eight to eight Suicide and Crisis Lifeline in
the US. Funeral director Ron Fleet is driving his van
(00:42):
to a hospital in Catherine de Barnes, a quiet village
in the countryside near Birmingham, England. Catherine de Barnes is tiny,
just a few dozen houses and a nineteenth century pub.
To get to the hospital, you drive half a mile
out of the village down a narrow lane flanked by
hedgerows and fields. The hospital is a big, old building
(01:05):
and twenty acres of grounds. The year is nineteen seven eight.
You might expect this to be a journey. Ron Fleet
knows well. Funeral directors do tend to become familiar with
their local hospitals. But no. The hospital in the village
of Catherine de Barnes hasn't seen a death for years.
(01:25):
It hasn't seen a patient for years. It's an isolation hospital,
kept empty but ready just in case someone gets some
appalling infectious disease that requires them to be confined safely
away from the public. Year after year after year, the
(01:45):
hospital's husband and wife caretakers have kept award with sixteen
beds on constant standby, ready for patients who mercifully never came.
But now they have had a patient and she's died.
(02:05):
Ron Fleet assumes that the body he's come to collect
will be in a morgue or a fridge. It isn't.
He's directed to a garage some distance away from the
main hospital building. In the garage, he finds a transparent
body bag. It's clear that this woman must have suffered terribly.
(02:30):
Her body and face are covered with saws, scars, and
fluid filled pustules, and the body's on the floor, not
a trolley. How's he going to get it into his van?
He goes back to the main building to ask someone
to help him. Nobody seems keen. Fleet opens the back
(02:52):
doors of his van and heaves the body inside. Some
kind of liquid sloshes around inside the transparent body bag.
I really hope this bag doesn't split, thinks ron Fleet.
I'm Tim Harford, and you're listening to cautionary tales. By
(03:40):
the nineteen sixties, smallpox had become rare enough in England
that when someone got it, it was often misdiagnosed. In
nineteen sixty six, for example, a young man called Tony
became ill with what seemed like flu. Tony called in
sick to his job as a medical photographer at the
University of Birmingham and spent a few days in bed
(04:03):
with aches and a fever. Then came the rash, when
he thought he'd better get a doctor to look at it.
Maybe a sweat rash, said the doctor. You'll have been
sweating with that fever, or it could be a reaction
to the medicine you've been taking. Anyway, nothing to worry about.
(04:24):
Tony starts to feel better, well enough to resume his
social life. He needs to freshen up a bit, so
he borrows his dad's raisor to shave. He's got to
be careful as he's still got that rash on his face,
and he accidentally slices through one of the pustules. He
(04:44):
goes to the pub with his dad and his girlfriend.
The barman winces sympathetically nasty attack of acne. A week
and a bit later, Tony's dad gets a spot on
his face where he's nicked himself with the razor Tony borrowed.
He then gets a fever and more spots. An old
(05:06):
man who'd been drinking in the pub gets hilled too,
who he infects his teenage grandson, who infects a hitchhiker
he meets at a roadside cafe while on a trip
to the beach. A couple of hours drive away. The
hitchhiker gets home to another part of the country and
infects his mum. Various people go to doctors who say,
(05:28):
probably flu or that looks like chicken pox. It's eight
weeks before someone sees a doctor who seen smallpox before
and says, hmm, let's test for that. There are two
types of smallpox. Veriola major was the one you really
(05:50):
didn't want. It killed about thirty percent of those it infected.
Veriola minor was much less serious, but still no joke.
Its fatality rate was one percent, comparable to COVID. Once
the tests confirmed that Variola minor is at large, the
medical authorities start to put the pieces together. They find
(06:14):
seventy three people who've been infected. Luckily, nobody's died. The
medics trace back the roots of infection, and they seemed
to converge on young Tony. But where had Tony got it? Well,
smallpox might have been rare in England at the time
that it was still common enough in the Indian subcontinent.
(06:38):
The last outbreak of small pox in Britain four years
earlier turned out to have started with people recently arrived
from Karachi. Birmingham had a high rate of immigration from
the subcontinent. Tony enjoyed a varied social life with friends
from all backgrounds. It was perfectly possible, as Tony's own
(06:58):
case showed, to go out on the town while not
realizing you're infectious with a mild case of Veriola minor.
Most likely Tony had picked it up from someone he
had met at a party. The building at the University
of Birmingham where Tony worked as a medical photographer, also
housed a laboratory that did research on smallpox. The lab
(07:23):
was run by a man called Henry Bedson, a well
respected smallpox expert. Bedson had been cultivating strains of Variola
minor just over a week before Tony's symptoms started. The
incubation period for smallpox is typically between a week and
a fortnight. Quite a coincidence. Was it just a coincidence?
(07:50):
Nobody seemed too worried. At the time, the university didn't
feel the need to hold an investigation. Tony's office wasn't
even on the same floor as the smallpox lab, and
everyone knew smallpox didn't spread that easily. It needed both
close personal contact and a dose bad luck. Think about
(08:11):
the outbreak Tony started. Yes, it passed it on to
a few people, but he met many more who didn't
get infected. In eight weeks, only seventy three people had
picked it up. The idea that virus particles might have
found their way out of Bedson's lab and wandered around
the building, missing everyone else, until they met Tony on
(08:34):
the floor above seemed fantastical. Still, the coincidence was striking.
It occurred to Bedson's boss, the head of the department,
that he should probably get an outside opinion. He asked
another smallpox expert to visit the university and check that
Bedson was taking adequate precautions. All looks perfectly standard, said
(09:01):
the expert, Same as any other smallpox lab. By nineteen
seventy eight, twelve years later, Henry Bedson has moved up
in the world. He's still at the University of Birmingham,
but he's now the head of Department of Medical Microbiology.
He's forty eight years old, married with three young kids.
(09:24):
He looks like a stereotypical academic scientist, bald, softly spoken,
tweed jacket. With his new departmental duties, Bedson no longer
has time to be so hands on in his old
smallpox lab, but he has a PhD student doing research,
and that research is important. In those twelve years, much
(09:48):
has changed. Smallpox is no longer common on the Indian subcontinent,
or indeed anywhere. It's been wiped off the face of
the earth. Teams of workers led by the World Health
Organization have been visiting the furthest flung villages of the
world's poorest countries, persuading people to be vaccinated, tracing contacts
(10:11):
where they find a case. Henry Bedson himself has been
involved the who sent him to Afghanistan and Pakistan as
part of an expert committee, and all that hard work
has succeeded. It's been eight months now since the last
report of a case of smallpox anywhere in the world.
(10:33):
That case was in Somalia. It looks likely to go
down in history as the very last time any human
gets this terrible disease. Ever, but what if there was
a way smallpox might come back? What if there was
a similar virus lurking in some population of wild animals,
(10:57):
liable to cross over to humans at any time? Smallpox,
after all, like many human diseases, originally came from animals,
maybe camels, gerbils. It's not entirely clear, and two recent
discoveries were troubling Henry Bedson. Researchers in the Netherlands and
(11:19):
Russia had found a virus that looked very much like smallpox,
lurking in samples taken from wild monkeys and rodents. This
new mystery virus had become known as whitepox. But what
was whitepox? How exactly did it differ from the various
(11:40):
strains of Variola major? Might it pose a threat to humans?
These were the questions Henry Bedson had his PhD student
investigating that Bedson had a problem because the wighthow was
worried about another way smallpox might come back. What if
(12:00):
it leaked from a lab? Plenty of labs around the world,
like Bedson's, were working on smallpox viruses. The wh show
wanted to restrict all future research to just a handful
of labs that would meet more stringent new safety standards.
Bedson's lab was not on the list. Henry Bedson wrote
(12:23):
to the World Health Organization, Can I have a few
more months to finish up my white box research? My
lab's been scaling down. I promise I'll be done by
the end of the year. Bedson was arguably being economical
with the truth. The lab had scaled down compared to
a few years ago. It had just one PhD student now,
(12:44):
but in the hope of completing his white box work
before his lab had to close, Bedson had just scaled
up his stocks of smallpox, taking delivery of twenty two
new samples of different strains of the virus. The World
Health Organization wrote back, okay, then just until the end
(13:06):
of the year. Bedson was relieved, and then one evening
in August at home, his phone rang. It was a
doctor he knew, calling from the hospital. Henry said the voice,
I've got a patient here with a suspected case of smallpox.
(13:30):
Cautionary tales will be back after the break. By nineteen
seventy eight, young Tony has left his job as the
medical photographer at the University of Birmingham. There's a new
(13:50):
photographer now working on the floor above Henry Bedson's smallpox lab.
Her name is Janet Parker and she's forty years old.
On the second Friday in August, Janet begins to feel unwell.
A few days later, she starts to get a rash.
She sees a doctor chicken pox. She also has sostiitis,
(14:14):
and the doctor prescribes antibiotics for that. A couple of
days later, the rash is much worse. She sees a
second doctor, maybe an allergic reaction to the antibiotic. He
prescribes a different antibiotic. Days go by and Janet's condition
gets worse and worse. She sees a third doctor. This
(14:38):
doctor calls the infectious diseases unit at the hospital. I
don't think it's chicken pox, she says. But I'm stumped.
Can one of your infectious disease specialists visit her home
and take a look. We don't do home visits, say
the hospital. That's the policy. Well, let it's smallpox. No
(14:59):
chance of that, says Janet's doctor. She hasn't been out
of the country for five years. The hospital will send
an ambulance and it is admitted to the infectious diseases unit.
The specialist there takes a close look at Janet and
makes some notes. Parsicular rash, most pronounced on the face,
(15:22):
lesions half a centimeter, white fluid, more advanced lesions with
darkened centers, no lesions in the mouth, febrile question mark
drug reaction, then question mark, question mark, question mark variola.
(15:45):
The doctor consults her colleagues it can't be smallpox, but
they're sufficiently puzzled to want to rule it out. The
trouble is none of them have experienced with smallpox. They've
only seen it in textbooks. But they still have access
to a designated regional smallpox consultant, a doctor who's worked
(16:06):
in Bangladesh and knows the disease. They find his number.
It's seven point thirty in the evening, and the regional
smallpox consultant is about to open a bottle of wine
at home when his phone rings. He doesn't get many
calls like this, maybe once a year, but he doesn't
mind because he gets a fee for every call out.
(16:29):
So far, it's always been either a bad case of
chicken pox or an allergic reaction to a drug. He
puts his wine aside, drives to the hospital, finds Janet's
room and that looks like smallpox. But who is this
woman and how on earth has she got smallpox in Birmingham,
(16:52):
eight months after the world's last recorded case in Somalia.
The doctors fill him in on Janet's details. She works
as a medical photographer at the University of Birmingham. Hm.
The consultant, of course, knows all about the smallpox lab
at the university. It'd better call Henry Bedson, Henry, he says.
(17:18):
When Bedson answers the phone, I've got a patient here
with a suspected case of smallpox. It's a lady who
works as a photographer at the medical school at the
other end of the line. Henry Bedson is too stunned
to speak. The consultant takes a sample of the fluid
(17:42):
from Janet's postules and drives to the medical school to
meet Henry Bedson. Together the two men open up the
lab and put the slide under the microscope. Bedson looks
first without a word. He moves aside to let the
consultant see. There's no doubt it's smallpox. They'll need to
(18:07):
run more tests to confirm that its very ola major
and find out exactly which strain. Bedson sets the tests
in motion. The regional smallpox consultant picks up the phone
and makes the call that he's never had to make before,
(18:27):
open up the isolation hospital at Catherine de Barnes. As
the fictional Dr Duffenschmertz might put it, if I had
a nickel for every time a medical photographer at the
University of Birmingham got smallpox, I'd have two nichols, which
(18:48):
isn't a lot, but it's weird that it happened twice.
Back in nineteen sixty six, when Tony got smallpox, it
had seemed ludicrous to think that the virus might have
gone walk about from Henry Bedson's lab around the building.
But soon after, in nineteen seventy, a young man in
Germany developed fever and a rash a week and a
(19:11):
half after flying home from a backpacking trip to Karachi.
With that travel history, German doctors suspected smallpox right away.
They put the man in strict isolation. Still, somehow, seventeen
other people in the hospital developed smallpox, including patients two
(19:33):
floors distant who never left their room. How One explanation
was that smallpox might be more capable of airborne transmission
than had previously been thought. Investigators set off a smoke
device in the room where the man had been and
tracked how the smoke wafted into the corridors, up the stairwells,
(19:55):
and into other rooms. The results mapped pretty well onto
the pattern of infections at the University of Birmingham. Henry
Bedson and his colleagues stand in the courtyard ou side
the medical school. They're checking how close the photographer's office
is to the smallpox lab. Not very close. They're at
(20:18):
least forty feet apart. If the virus particles wafted through
the air to Janet, it's far from obvious what route
they might have taken. By now, various authorities are competing
to take the situation in hand. One insists that everyone
who has anything to do with the smallpox lab has
(20:39):
to go into quarantine, including Henry Bedson. That seems like overkill.
Bedsen's been thoroughly vaccinated, and if it'd got smallpox at
the same time as Janet Parker, he'd have known about
it long before now. Still, though Bedson's told stay at
home you can't be too careful. Another authority insists that
(21:03):
the smallpox lab be immediately fumigated to kill any virus
particles that might be Only afterwards that they realize this
means they've killed the samples from Janet Parker that Bedson
had been testing to identify which strain of smallpox she'd got.
That Bette get another sample while they still can. At
(21:25):
the hospital in Catherine de Barnes. Janet is still just
about clinging to life. They call the smallpox lab at
the University of Liverpool and ask one of the professors
to drive the one hundred miles to Birmingham to visit
Janet and take samples back for testing. We'll arrange a
police escort, of course, they say. As the professor leaves
(21:49):
the motorway near Birmingham, he's met by a policeman on
a motorcycle who leads him through the city and down
the quiet country lanes to the twenty acre site of
the hospital at Catherine de Barnes. The policeman thinks his
job is done and says farewell. The professor is confused, Wait,
(22:09):
you're leaving me here, but surely the whole point of
a police escort is to get me safely back to
my lab when I'll have highly contagious samples of smallpox
in my car. Now, the Policeman's confused. Nobody's told me
anything about that, sir. All the way back to Liverpool.
I've finished my shift at five o'clock. At five o'clock,
(22:31):
they're still gridlocked in central Birmingham. The policeman waves goodbye,
screw this, Thanks the professor. He decides to give the
rush hour traffic time to clear and detours into the
suburbs to call in at the home of his old friend,
Henry Bedson. Bedson is not coping well with quarantine. He
(22:56):
hates being holed up at home when he could be
doing something to help. The phone keeps ringing, and he
keeps thinking he'd better answer it in case it's important.
But it's always some journalist trying to get into admit
that he's to blame for all the chaos that's unfolding
in the city. The desperate search to trace and quarantine
and vaccinate anyone Janet Parker might have met. Bedson's friend
(23:21):
tries to lift his spirits, but the next morning Bedson
writes a note I'm sorry to have misplaced the trust
which so many of my friends and colleagues have placed
in me and my work. Bedson writes. I realize this
act is the least sensible thing I have done, but
(23:44):
it may allow my wife and children to get some peace.
Bedson calls to his wife, I'm just going to the
garden shed. Cautionary tales will be back in a moment.
(24:11):
Henry Bedson is still alive when his wife finds him
in the shed, though he's losing a lot of blood.
She runs back to the house. As she's about to
pick up the phone, it starts to ring local radio news.
Can I speak to Professor Bedson? Get off the line,
(24:32):
yells Bedson's wife. She slams the receiver down and picks
it up again. I don't know it's the wife, she says.
She wants us to get off the line. Henry Bedson
survives for five days on life support before doctors conclude
that he won't recover. Five days after that, Janet Parker's
(24:54):
life finally ebbs away. Funeral director Ron Fleet is sent
to collect her body. Janet is cremated, then they fumigate
the crematorium just to be safe. Janet Parker has infected
only one other person, her mum. Once her mum recovers,
(25:19):
humanity is once again free from smallpox. But if it's
going to stay that way, it might help to find
out how had Janet got it. The government appointed a
committee to investigate. They tried the same kind of test
as in the German hospital, setting off a smoke device
(25:42):
in the smallpox lab to understand where the airflow might go.
The smallpox lab was a small inner room connected to
a larger outer lab. If the door between those rooms
was open, the air from the smallpox lab could get
into the outer lab, and the door was open sometimes
(26:03):
because the smallpox samples were stored in that outer lab,
But if smallpox parts got loose in that outer lab,
it shouldn't pose a risk. Everyone who was allowed into
the outer lab had been vaccinated against smallpox. But a
little bit of the smoke drifted further, some beyond the
(26:24):
outer lab and into a corridor, and some into a
service duct, and from the service duct threw a badly
fitted access panel into a room on the floor above
not Janet Parker's office, another room used for storage, but
that also had a telephone with an outside line. Janet
(26:47):
Parker's office phone didn't have an outside line, so when
she needed to make orders for supplies of photographic materials,
should use the phone in that storage room, sitting close
to the badly fitted panel. The investigators determined that Janet
had placed an unusually large number of orders on the
(27:08):
line last Tuesday in July, two and a half, weeks
before she began to feel ill. That timeline doesn't quite
stack up. The usual incubation period for smallpox is one
to two weeks, not two and a half. And you
can query how relevant that German hospital really is. There
(27:30):
you had a young man with smallpox coughing up clouds
of virus particles. Here you had a lab with workers
trying carefully to minimize contamination. Still, the investigators conclude infection
through the service duct is the most probable route that
they could find. Armed with the investigator's report, a government
(27:54):
agency decides to sue the University of Birmingham for failing
to ensure health and safety at work. In his book
The Last Days of Smallpox, the author Mark Pallin describes
the case in detail. Witness after witness attests that Henry
(28:16):
Bedson was known for being meticulous about safety procedures. You
can't eliminate all risks from lab work. As one expert
witness says, perfection is impossible. But Henry Bedson's smallpox lab
was doing nothing ntypical by the standards of the time.
(28:37):
What about the pox in the ducts hypothesis? The university's
lawyer calls a professor to testify for the defense. I've
been doing some calculations, the professor says, based on how
much smoke made it from the smallpox lab into the
room with a telephone, and how many virus particles typically
(28:58):
get into the air from routine lab work, I reckon
you might expect virus particles to make it into the
telephone room at the rate of one particle every two
to twenty thousand years. The lawyer for the Health and
Safety agency calls an expert witness, too, but it seems
that he hasn't researched his experts views. When asked about
(29:22):
the investigator's theory that Janet had got the virus through
the service duct, the expert says he thinks it's highly implausible.
The lawyer's taken aback his own witness has just dismissed
the central plank of his case. But if we discount
the duct hypothesis, the lawyer asks, with what does that
(29:43):
leave us? The expert replies, it leaves you with a puzzle.
Say the words lab leak. Now, of course, and the
city that springs to mind isn't Birmingham, It's Wuhan. A
(30:04):
novel coronavirus pandemic just happens to start in a city
which has a lab that does research on novel coronaviruses.
Quite a coincidence. Was COVID a lab leak? That debate
rumbles on, But I wondered if the Birmingham story might
give us any general lessons about lab leaks. I think
(30:28):
there are two lesson. Number one, the puzzle might never
be solved. We might only ever have competing stories and
our own best guess as to which makes most sense.
The second lesson starts with another observation from that trial,
Perfection is impossible. No matter how careful you try to be,
(30:52):
there'll always be something you might overlook. Think about that
evening before Henry Bedson despairingly went to his garden. Shed
Bedsen's at home, forced to quarantine because you can't be
too care but parked outside on his drive is his
(31:13):
friend's car containing highly dangerous smallpox samples from Janet Parker.
The professor then drives his car one hundred miles up
the motorway with no police escort. What if it had
a crash? Or think about fumigating the crematorium after Janet
Parker's body was burned just to be safe. Yet nobody
(31:36):
had thought about the risk to funeral director Ron Fleet,
who had to lug Janet's corpse into his van without help,
praying the body bag wouldn't burst. There'll always be something
you might overlook. In twenty fourteen, in a lab in Bethesda, Maryland,
half a dozen glass pals of smallpox were discovered in
(31:59):
a cardboard box at the back of a cupboard, forgotten
since the nineteen fifties. If we're going to do research
on deadly viruses, we have to accept some risk that
something will go wrong in some way we hadn't considered.
So the second lesson I want to suggest is this,
(32:20):
we'd better be damn sure that that research is worth it.
Perhaps in the case of Birmingham, the puzzle has an answer.
In twenty eighteen, the author Mark Pallin tracked down the
lawyer who had represented the university in the court case.
(32:40):
The lawyer was now eighty five years old. The author asked,
do you know what really happened? Well, said the lawyer,
there was a rumor, a very strong rumor. I could
never get anyone to say it on the record, but
the rumor went like this, back in the nineteen seventies, Remember,
(33:05):
nobody had smartphones or digital cameras. To make holiday photos,
you needed roles of film, and they were pricey. A
photographer at an institution like a medical school could buy
those films in bulk at a discount. There was a
well established tradition in the medical school. The rumor went
(33:27):
that the photographer would get you cut price films. That
might explain why Janet was placing so many orders in
the last week of July, just before everyone went on
their summer holidays. And what if a few days later,
Janet had gone around the building delivering to her colleagues
(33:49):
the supplies she'd got for them. What if she had
popped into the outer lab just for a moment to
drop off a roll of film. What if this year
she had chosen just the wrong moment when there were
virus particles in the air or on a surface she
happened to touch. It's only a rumor, just one more
(34:13):
competing story. But if Janet had encountered the virus a
few days after the investigator's guessed, it would make the
incubation period line up. And if the tradition of photographers
delivering film to their colleagues went back to young Tony,
that would also neatly solve the two nickel question of
(34:37):
why an infection might have happened twice as one more
loose end to tie up. One final irony was the
research worth it. Henry Benson, remember had been anxious to
complete his work on whitepox, the mysterious virus from labs
(34:59):
in the Netherlands and Russia. If whitepox was similar to smallpox,
it might live in wild populations of monkeys and rodents
and then jump back to humans. After Bedson's death, other
researchers finished the job. They found that white pox was
(35:21):
a mirage. These viruses weren't just like smallpox, they were smallpox,
and the smallpox didn't come from the animals. The samples
from rodents and monkeys in the Dutch and Russian labs
had been contaminated with smallpox. In the labs themselves. The
(35:43):
monkeys and rodents had never had a pox like virus
at all. That kind of contamination shouldn't happen in a lab,
of course, but sometimes it does. Perfection is impossible. If
the work in Henry Bedson's lab had been perfect, Janet
Parker could never have got smallpox. But if the Dutch
(36:07):
and Russian labs had been perfect, Bedson wouldn't have been
doing that work in the first place. A key source
for this episode was Mark Pallon's book The Last Days
(36:29):
of Smallpox Tragedy in Birmingham. For a full list of
our sources, see the show notes at Timharford dot com.
Cautionary Tales as written by me Tim Harford with Andrew Wright,
(36:52):
Alice Fines, and Ryan Billy. It's produced by Georgia Mills
and Marilyn Rust. The sound design and original music are
the work of Pascal Wise. Additional sound design is by
Carlos san Juan at Brain Audio. Bend Dafhaffrey edited the scripts.
The show features the voice talents of Melanie Guttridge, Stella Harford,
(37:14):
Oliver Hembrough, Sarah Jupp, Massaam Monroe, Jamal Westman, and rufus Wright.
The show also wouldn't have been possible without the work
of Jacob Weisberg, Greta Cohene, Sarah Nix, Eric Sandler, Carrie Brody,
Christina Sullivan, Kira Posey, and Owen Miller. Cautionary Tales is
a production of Pushkin Industries. It's recorded at Wardoor Studios
(37:37):
in London by Tom Berry. If you like the show,
please remember to share, rate and review. It really makes
a difference to us and if you want to hear
the show, add free sign up to Pushkin Plus on
the show page, on Apple Podcasts or at pushkin dot fm,
slash plus
Host
Tim Harford
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