Alasdair Macintosh Geddes (born May 1934) is Emeritus Professor of Infection at the
University of Birmingham Medical School
The University of Birmingham Medical School is one of Britain's largest and oldest medical schools with over 400 medical, 70 pharmacy, 140 biomedical science and 130 nursing students graduating each year. It is based at the University of Birmi ...
. In 1978, as the
World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
(WHO) was shortly to announce that the world's last case of
smallpox
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
had occurred a year earlier in Somalia, Geddes diagnosed a British woman with the disease in
Birmingham
Birmingham ( ) is a City status in the United Kingdom, city and metropolitan borough in the metropolitan county of West Midlands (county), West Midlands in England. It is the second-largest city in the United Kingdom with a population of 1. ...
, England. She was found to be the
index case
The index case or patient zero is the first documented patient in a disease epidemic within a population, or the first documented patient included in an epidemiological study.
It can also refer to the first case of a condition or syndrome (not n ...
of
the outbreak and became the world's last reported fatality due to the disease, five years after he had gained experience on the frontline of the WHO's
smallpox eradication
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) cer ...
programme in Bangladesh in 1973.
His early research included work on
drug discovery and
antibiotics, and the definitions and management of
bacterial meningitis
Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or ...
and
pneumococcal disease. In 1975, he became Chairman of the first editorial board of the ''
Journal of Antimicrobial Chemotherapy
The ''Journal of Antimicrobial Chemotherapy'' is a peer-reviewed medical journal which covers antimicrobial chemotherapy, including laboratory aspects and clinical use of antimicrobial agents. It is published by Oxford University Press on behalf o ...
''. In the same year he was co-editor of the best seller book titled ''Control of Hospital Infection'', later known as ''
Ayliffe's Control of Healthcare-Associated Infection: A Practical Handbook''.
Following the
September 11 attacks
The September 11 attacks, commonly known as 9/11, were four coordinated suicide terrorist attacks carried out by al-Qaeda against the United States on Tuesday, September 11, 2001. That morning, nineteen terrorists hijacked four commer ...
, Geddes became an adviser on
bioterrorism
Bioterrorism is terrorism involving the intentional release or dissemination of biological agents. These agents are bacteria, viruses, insects, fungi, and/or toxins, and may be in a naturally occurring or a human-modified form, in much the same ...
for the
UK's Department of Health, his chief role being in the national smallpox plan and in
biodefence training.
In 2015, he retired from his position as Editor-in-Chief of the ''
International Journal of Antimicrobial Agents'', having served the journal for the previous 10 years.
His recollections of smallpox in Birmingham inspired
Mark Pallen to write ''
The Last Days of Smallpox: Tragedy in Birmingham'', published in 2018.
Early life and education
Alasdair Geddes was born in
Fortrose
Fortrose (; gd, A' Chananaich, sco, Chainry) is a town and former royal burgh in Highland, Scotland, United Kingdom. It is on the Moray Firth, about north-east of Inverness. The burgh is a popular location for trying to spot bottlenose dolp ...
, near
Inverness, Scotland, in May 1934, to Angus and Isabella Geddes. His early education was at the Fortrose Academy, the local school.
![Edinburgh Medical School building, Teviot Place](https://upload.wikimedia.org/wikipedia/commons/d/dd/Edinburgh_Medical_School_building%2C_Teviot_Place.jpg)
In 1957 he graduated in medicine from the
University of Edinburgh
The University of Edinburgh ( sco, University o Edinburgh, gd, Oilthigh Dhùn Èideann; abbreviated as ''Edin.'' in post-nominals) is a public research university based in Edinburgh, Scotland. Granted a royal charter by King James VI in 15 ...
, where his interest in
antibiotics
An antibiotic is a type of antimicrobial substance active against bacteria. It is the most important type of antibacterial agent for fighting bacterial infections, and antibiotic medications are widely used in the treatment and prevention o ...
later originated.
Medical career
He completed his
early medical posts at the
Royal Infirmary in Edinburgh and then in
Perth
Perth is the capital and largest city of the Australian state of Western Australia. It is the fourth most populous city in Australia and Oceania, with a population of 2.1 million (80% of the state) living in Greater Perth in 2020. Perth i ...
, following which he spent two years completing
National Service
National service is the system of voluntary government service, usually military service. Conscription is mandatory national service. The term ''national service'' comes from the United Kingdom's National Service (Armed Forces) Act 1939.
The ...
in the
Royal Army Medical Corps, and rose to the rank of captain.
[ Subsequently, he gained experience in infectious diseases and general medicine first at Edinburgh and then as a medical registrar at ]Aberdeen
Aberdeen (; sco, Aiberdeen ; gd, Obar Dheathain ; la, Aberdonia) is a city in North East Scotland, and is the third most populous city in the country. Aberdeen is one of Scotland's 32 local government council areas (as Aberdeen City), and ...
and began research on antibiotics, with publications in the '' British Medical Journal'' and ''The Lancet
''The Lancet'' is a weekly peer-reviewed general medical journal and one of the oldest of its kind. It is also the world's highest-impact academic journal. It was founded in England in 1823.
The journal publishes original research articles, ...
''. After a visit to the United States, he returned to Britain and took up a post as one of two consultants in infectious diseases at the East Birmingham (now Heartlands) Hospital in May 1967, at the same time as the local smallpox hospital, Witton Isolation Hospital
Witton Isolation Hospital was a facility for the treatment and quarantine of smallpox victims and their contacts in Birmingham, England, from 1894 to 1966.
History Operation
Built in 1894, Witton Isolation Hospital was initially in a semi-rural ...
, was deemed unnecessary and therefore demolished by fire. Geddes, at the time, settled in Solihull
Solihull (, or ) is a market town and the administrative centre of the wider Metropolitan Borough of Solihull in West Midlands County, England. The town had a population of 126,577 at the 2021 Census. Solihull is situated on the River Blyth ...
.[
He later recounted that when "I told my friends in Edinburgh that I was going to work in infectious diseases, they thought I was a bit stupid. They said you’re mad, infectious diseases are disappearing, we have antibiotics and vaccines, why don't you do something more interesting!"][
]
Bangladesh (1973)
In 1973, the Department of Health
A health department or health ministry is a part of government which focuses on issues related to the general health of the citizenry. Subnational entities, such as states, counties and cities, often also operate a health department of their ow ...
assigned Geddes as a visiting fellow with the World Health Organization
The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level of ...
(WHO) smallpox eradication
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) cer ...
effort in Bangladesh, where he spent seven weeks under the leadership of Nick Ward, travelling through villages and gaining frontline experience in smallpox vaccination
The smallpox vaccine is the first vaccine to be developed against a contagious disease. In 1796, British physician Edward Jenner demonstrated that an infection with the relatively mild cowpox virus conferred immunity against the deadly smallpox ...
. He later recalled "I saw many cases of smallpox
Smallpox was an infectious disease caused by variola virus (often called smallpox virus) which belongs to the genus Orthopoxvirus. The last naturally occurring case was diagnosed in October 1977, and the World Health Organization (WHO) c ...
."[
In October 1973, as a consequence of the oil crisis, he was called to return to England.] In the same year, he was designated Birmingham's smallpox consultant. The following year, in an article in the '' British Medical Journal'', he described signs and symptoms of smallpox and wrote that
the possibility of smallpox should be considered in every patient with unexplained fever who has recently visited the five countries of the world where this disease is still endemic-namely, India, Pakistan, Bangladesh, Nepal and Ethiopia. The likelihood of smallpox re-appearing in countries other than these five should always be remembered.
Writing
In 1975, Geddes became Chairman of the first editorial board of the ''Journal of Antimicrobial Chemotherapy
The ''Journal of Antimicrobial Chemotherapy'' is a peer-reviewed medical journal which covers antimicrobial chemotherapy, including laboratory aspects and clinical use of antimicrobial agents. It is published by Oxford University Press on behalf o ...
''.[ In the same year, he co-edited the best-seller ''Control of Hospital Infection'', later known as '' Ayliffe's Control of Healthcare-Associated Infection: A Practical Handbook''.] In 1976 L. P. Garrod stated in his review of the book that it made much "of how to cope with a suspected case of smallpox. As the WHO claims that this disease is on the verge of extinction, even in Bangladesh, may future editions safely omit this?" Throughout his career, Geddes authored almost 200 scientific publications covering a wide range of infectious disease topics.[
]
Antibiotics
His early research included work on drug discovery and studies on the use of cephaloridine. Pertaining to trials of what became known as Augmentin
Amoxicillin/clavulanic acid, also known as co-amoxiclav or amox-clav, sold under the brand name Augmentin, among others, is an antibiotic medication used for the treatment of a number of bacterial infections. It is a combination consisting of ...
, a combination of amoxicillin
Amoxicillin is an antibiotic medication used to treat a number of bacterial infections. These include middle ear infection, strep throat, pneumonia, skin infections, and urinary tract infections among others. It is taken by mouth, or less c ...
and clavulanic acid
Clavulanic acid is a β-lactam drug that functions as a mechanism-based β-lactamase inhibitor. While not effective by itself as an antibiotic, when combined with penicillin-group antibiotics, it can overcome antibiotic resistance in bacteria t ...
, he later recalled that “getting the right dose of amoxicillin proved important for efficacy and getting the right dose of clavulanic acid was key to tolerability”. In 1977, he published on the efficacies of cephamycin
Cephamycins are a group of β-lactam antibiotics. They are very similar to cephalosporins, and the cephamycins are sometimes classified as cephalosporins.
Like cephalosporins, cephamycins are based upon the cephem nucleus. Unlike most cephalospo ...
s, including their parenteral administration
A route of administration in pharmacology and toxicology is the way by which a drug, fluid, poison, or other substance is taken into the body.
Routes of administration are generally classified by the location at which the substance is applied. ...
, dosages and penetrations through normal and inflamed blood–brain barrier. He made comparisons of clindamycin with lincomycin
Lincomycin is a lincosamide antibiotic that comes from the actinomycete '' Streptomyces lincolnensis''. A related compound, clindamycin, is derived from lincomycin by using thionyl chloride to replace the 7-hydroxy group with a chlorine atom wit ...
against ''H. influenzae
''Haemophilus influenzae'' (formerly called Pfeiffer's bacillus or ''Bacillus influenzae'') is a Gram-negative, non-motile, coccobacillary, facultatively anaerobic, capnophilic pathogenic bacterium of the family Pasteurellaceae. The bacteria ...
'' in vitro, and later demonstrated that clindamycin was active against ''Coxiella burnetti
''Coxiella burnetii'' is an obligate intracellular bacterial pathogen, and is the causative agent of Q fever. The genus ''Coxiella'' is morphologically similar to ''Rickettsia'', but with a variety of genetic and physiological differences. ''C. ...
'', the cause of Q fever
Q fever or query fever is a disease caused by infection with ''Coxiella burnetii'', a bacterium that affects humans and other animals. This organism is uncommon, but may be found in cattle, sheep, goats, and other domestic mammals, including ...
. Other research has included studies on the antiviral aciclovir
Aciclovir (ACV), also known as acyclovir, is an antiviral medication. It is primarily used for the treatment of herpes simplex virus infections, chickenpox, and shingles. Other uses include prevention of cytomegalovirus infections following tra ...
.
Birmingham (1978)
In August 1978, five years after returning from Bangladesh, Geddes diagnosed smallpox in Janet Parker, a medical photographer working in the East Wing of the medical school in Birmingham. She had been admitted to Ward 32 at East Birmingham Hospital after being diagnosed with at first chickenpox and then a drug reaction. Several physicians saw her before Geddes was called to the hospital for an opinion. Aware that Parker also worked in a room above the regional smallpox laboratory, he in turn called upon virologist Henry Bedson
Henry Samuel Bedson, MD, MRCP (29 September 1929 – 6 September 1978), was a British virologist and head of the Department of Medical Microbiology at Birmingham Medical School, where his research focused on smallpox and monkeypox. He was ...
and both confirmed their suspicions that same day when they examined fluid from Parker's blisters and saw brick-shaped particles under the electron microscope
An electron microscope is a microscope that uses a beam of accelerated electrons as a source of illumination. As the wavelength of an electron can be up to 100,000 times shorter than that of visible light photons, electron microscopes have a hi ...
, compatible with smallpox. Until this time, all the call-outs he received for suspected smallpox cases were false-alarms such as erythema multiforme
Erythema multiforme (EM) is a skin condition that appears with red patches evolving into target lesions, typically on both hands.
It is a type of erythema possibly mediated by deposition of immune complexes (mostly IgM-bound complexes) in th ...
and Stevens–Johnson syndrome
Stevens–Johnson syndrome (SJS) is a type of severe skin reaction. Together with toxic epidermal necrolysis (TEN) and Stevens–Johnson/toxic epidermal necrolysis (SJS/TEN), it forms a spectrum of disease, with SJS being less severe. Erythema ...
.[ With the WHO about to announce the eradication of smallpox, it was widely thought that the last ever case of smallpox had occurred the previous year, in 1977 in Somalia. Parker later died on 11 September 1978 and became the last reported fatality due to the disease.] Later, in an interview in 2004, when asked if Parker's case had any link with the 1966 smallpox outbreak in Birmingham, he replied "it is probably significant that the initial case in the variola minor outbreak in the West Midlands in 1966 was, like Janet Parker, a photographer in the Birmingham Medical School, where research was being carried out on smallpox viruses."[
]
1980s
He was appointed professor of infectious diseases at Birmingham University
, mottoeng = Through efforts to heights
, established = 1825 – Birmingham School of Medicine and Surgery1836 – Birmingham Royal School of Medicine and Surgery1843 – Queen's College1875 – Mason Science College1898 – Mason Univers ...
in 1982. In chapter seven of the ''Report of a committee of inquiry into the future development of the Public Health Function'', chaired by the then Chief Medical Officer Sir Donald Acheson and presented to parliament in the wake of the 1984 outbreak of Salmonella in Wakefield and the 1985 outbreak of legionellosis at Stafford, Geddes was noted to head a subcommittee to deal with control of communicable disease and infection.
1990s
In the 1990s, he was involved in tuberculosis
Tuberculosis (TB) is an infectious disease usually caused by '' Mycobacterium tuberculosis'' (MTB) bacteria. Tuberculosis generally affects the lungs, but it can also affect other parts of the body. Most infections show no symptoms, i ...
(TB) research, leading the University of Birmingham team in the Glaxo Action tuberculosis programme that studied the molecular biology of '' Mycobacterium tuberculosis'' and new ways of delivering medicines into the TB infected cells. By studying how the human immune system responded to TB, Geddes hoped that the results would lead to a new vaccine, more effective than the BCG.
In 1991 he became professor of infection at the University of Birmingham Medical School
The University of Birmingham Medical School is one of Britain's largest and oldest medical schools with over 400 medical, 70 pharmacy, 140 biomedical science and 130 nursing students graduating each year. It is based at the University of Birmi ...
, where in 1994 he became its Deputy Dean then Associate Dean from 1999 to 2002. He has served as civilian consultant in infectious diseases and tropical medicine to the Royal Navy
The Royal Navy (RN) is the United Kingdom's naval warfare force. Although warships were used by English and Scottish kings from the early medieval period, the first major maritime engagements were fought in the Hundred Years' War against ...
, Deputy Chairman of the Tropical Diseases Research Board of the UK Medical Research Council, and the Committee on Safety of Medicines
The Committee on Safety of Medicines (CSM) was an independent advisory committee that advised the UK Licensing Authority on the quality, efficacy, and safety of medicines.
Following the thalidomide tragedy of 1957 to 1961, in 1963 the government ...
and of the Joint Committee on Vaccination and Immunisation.[
File:Child with Smallpox Bangladesh.jpg, Child with Smallpox, Bangladesh, 1973, the year Geddes was assigned to the WHO smallpox eradication effort in Bangladesh
File:University of Birmingham Medical School Building Smallpox Laboratory.jpg, The rear of the Medical School showing the location of the smallpox laboratory (bottom) and the rooms where Parker worked (above)
File:Infectious Diseases Ward EBH 1978.jpg, The ward block at East Birmingham Hospital, Birmingham UK in 1978. It has since been demolished. It shows Wards 31 (ground level) and 32 (upper level).
File:Parker Ward.jpg, Ward 32, where Geddes diagnosed smallpox in 1978
File:Smallpox virus.jpg, Electron micrograph of smallpox virus, similar to what Geddes would have seen in Parker's sample.]
File:BirminghamQueenElizabethHospitalMedicalSchool.jpg, University of Birmingham Medical School, where Geddes became professor
Later career
Following the September 11 attacks
The September 11 attacks, commonly known as 9/11, were four coordinated suicide terrorist attacks carried out by al-Qaeda against the United States on Tuesday, September 11, 2001. That morning, nineteen terrorists hijacked four commer ...
, Geddes became an adviser on bioterrorism for the UK's Department of Health, his chief role being in the national smallpox plan and in biodefence training.
In 2002, Geddes told the Global Health Security Initiative that the
diagnosis of a smallpox case must not be underestimated. Differential diagnosis against influenza, chickenpox, Eczema herpeticum
Eczema herpeticum is a rare but severe disseminated infection that generally occurs at sites of skin damage produced by, for example, atopic dermatitis, burns, long-term usage of topical steroids or eczema. It is also known as Kaposi varicellifor ...
, Eczema vaccinatum
Eczema vaccinatum is a rare severe adverse reaction to smallpox vaccination.
It is characterized by serious local or disseminated, umbilicated, vesicular, crusting skin rashes in the face, neck, chest, abdomen, upper limbs and hands, caused by wi ...
and drug eruptions
In medicine, a drug eruption is an adverse drug reaction of the skin. Most drug-induced cutaneous reactions are mild and disappear when the offending drug is withdrawn. These are called "simple" drug eruptions. However, more serious drug eruptions ...
/erythema multiforme
Erythema multiforme (EM) is a skin condition that appears with red patches evolving into target lesions, typically on both hands.
It is a type of erythema possibly mediated by deposition of immune complexes (mostly IgM-bound complexes) in th ...
is necessary. The last smallpox case in Birmingham, UK, caused by a lab infection in 1978, was initially misdiagnosed by 3 physicians, leading to a significant delay in treatment and containment measures. This fact underlines the importance of an appropriate education and training of physicians to diagnose disease caused by bioterroristic agents as part of the preparedness plans.[Geddes, Alasdair (September 2002]
“Smallpox – Pathology and Clinical Features”
G7+ - Global Health Security Initiative (GHSI); Workshop, Best Practices in Vaccine Production for Smallpox and other Potential Pathogens. Paul-Ehrlich-Institut, Langen (Germany), P. 16
With smallpox in the media again after 2001, and noting that Parker had previously received two smallpox vaccinations, he became interested in how long immunity lasts in those who have previously been immunised. It led him to study and publish in 2005 an article on the Edinburgh smallpox outbreak of 1942, where six of the 36 cases of smallpox had received previous vaccination.[ The following year he published "The history of smallpox".
In 2015, after 10 years in the post, he retired from his position as Editor-in-Chief of the '' International Journal of Antimicrobial Agents''.]
Awards and honours
Geddes is a Fellow of the Academy of Medical Sciences
The Academy of Medical Sciences is an organisation established in the UK in 1998. It is one of the four UK National Academies, the others being the British Academy, the Royal Academy of Engineering and the Royal Society.
Its mission is to adv ...
.[ From 1996 to 1998 he was president of the ]International Society for Infectious Diseases
The International Society for Infectious Diseases (ISID), established in 1986, is a nonprofit organization that monitors infectious diseases on a global scale. It also offers grants and fellowships, publishes a journal, and runs online learning pl ...
.[ The following year, the ]British Society for Antimicrobial Chemotherapy
The British Society for Antimicrobial Chemotherapy (BSAC) is a UK-based multi-professional organisation with worldwide membership for clinicians and scientists with a specialist interest in antibiotic management and therapy. It is headquartered ...
awarded him the Garrod Medal, following which he delivered its accompanying lecture.[Geddes, A. (2000) "Infection in the twenty-first century: predictions and postulates". The 1999 Garrod Lecture. ''Journal of Antimicrobial Chemotherapy''. School of Medicine, University of Birmingham. Vol. 46, pp. 873–877] In 2009, he received Honorary Membership of the International Society of Antimicrobial Chemotherapy
International is an adjective (also used as a noun) meaning "between nations".
International may also refer to:
Music Albums
* ''International'' (Kevin Michael album), 2011
* ''International'' (New Order album), 2002
* ''International'' (The T ...
. He received the European Society of Clinical Microbiology and Infectious Diseases award for excellence in clinical microbiology and infectious diseases in 2014.[ Subsequently, in 2015 he received the Hamao Umezawa Memorial Award (HUMA) Award.][
His recollections of 1978 inspired Mark Pallen to write '' The Last Days of Smallpox: Tragedy in Birmingham'', published in 2018.]
Selected publications
*
* (Joint author)
* (Joint author)
*
* (Joint author)
References
Further reading
*
*
External links
A. Geddes, publications, University of Birmingham
ATV Today: 30.08.1978: Smallpox Alert in Birmingham
{{DEFAULTSORT:Geddes, Alasdair Macintosh
1934 births
Living people
20th-century British medical doctors
Academics of the University of Birmingham
Fellows of the Academy of Medical Sciences (United Kingdom)
People from the Black Isle
Smallpox eradication
University of Edinburgh Medical School alumni