Alasdair Macintosh Geddes

In 1973, the Department of Health assigned Geddes as a visiting fellow with the World Health Organization (WHO) smallpox eradication effort in Bangladesh, where he spent seven weeks under the leadership of Nick Ward, travelling through villages and gaining frontline experience in smallpox vaccination.[5][6] He later recalled "I saw many cases of smallpox."[5]

In October 1973, as a consequence of the oil crisis, he was called to return to England.[6] In the same year, he was designated Birmingham’s smallpox consultant.[7] 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.[8]

In 1975, Geddes became Chairman of the first editorial board of the Journal of Antimicrobial Chemotherapy.[4] 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.[9][10] 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?"[11] Throughout his career, Geddes authored almost 200 scientific publications covering a wide range of infectious disease topics.[5]

His early research included work on drug discovery and studies on the use of cephaloridine.[5][12] Pertaining to trials of what became known as Augmentin, a combination of amoxicillin and clavulanic acid, 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”.[13] In 1977, he published on the efficacies of cephamycins, including their parenteral administration, dosages and penetrations through normal and inflamed blood-brain barrier.[14] He made comparisons of clindamycin with lincomycin against H. influenzae in vitro, and later demonstrated that clindamycin was active against Coxiella burnetti, the cause of Q fever.[15] Other research has included studies on the antiviral aciclovir.[16]

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.[17][18][19] She had been admitted to Ward 32 at East Birmingham Hospital after being diagnosed with at first chicken pox 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 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, compatible with smallpox. Until this time, all the call-outs he received for suspected smallpox cases were false-alarms such as erythema multiforme and Stevens–Johnson syndrome.[7][17][19] 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.[20] 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."[5]

He was appointed professor of infectious diseases at Birmingham University in 1982.[1] 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.[21]

In the 1990s, he was involved in tuberculosis (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.[5][22]

In 1991 he became professor of infection at the University of Birmingham Medical School, where in 1994 he became its Deputy Dean then Associate Dean from 1999 to 2002.[1] He has served as civilian consultant in infectious diseases and tropical medicine to the Royal Navy, Deputy Chairman of the Tropical Diseases Research Board of the UK Medical Research Council, and the Committee on Safety of Medicines and of the Joint Committee on Vaccination and Immunisation.[5]

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  Child with Smallpox, Bangladesh, 1973, the year Geddes was assigned to the WHO smallpox eradication effort in Bangladesh[23]
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  The rear of the Medical School showing the location of the smallpox laboratory (bottom) and the rooms where Parker worked (above)
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  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).
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  Ward 32, where Geddes diagnosed smallpox in 1978
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  Electron micrograph of smallpox virus, similar to what Geddes would have seen in Parker's sample.[17][24]
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  University of Birmingham Medical School, where Geddes became professor