Alasdair Macintosh Geddes

Alasdair Macintosh Geddes (14 May 1934 – 9 April 2024) was a Scottish medical doctor who was Professor of Infection at the University of Birmingham Medical School. In 1978, as the World Health Organization (WHO) was shortly to announce that the world's last case of smallpox had occurred a year earlier in Somalia, Geddes diagnosed Janet Parker with the disease in Birmingham, England. She was found to be the index case of the outbreak and became the world's last reported fatality due to the disease, five years after Geddes had gained experience on the frontline of the WHO's smallpox eradication programme in Bangladesh in 1973.

His early research included work on drug discovery and antibiotics, and the definitions and management of bacterial meningitis and pneumococcal disease. In 1975, he became Chairman of the first editorial board of the Journal of Antimicrobial Chemotherapy. 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, Geddes became an adviser on bioterrorism for the UK's Department of Health; his primary roles were 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, near Inverness, Scotland, on 14 May 1934, to Angus and Isabella Geddes. His early education was at the Fortrose Academy, the local school.

In 1957 Geddes graduated in medicine from the University of Edinburgh, where his interest in antibiotics later originated.

Medical career Geddes completed his early medical posts at the Royal Infirmary of Edinburgh and then in Perth, following which he spent two years completing National Service in the Royal Army Medical Corps, and rose to the rank of captain. He later recalled "I saw many cases of smallpox." 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. 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. 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". In 1977, he published on the efficacies of cephamycins, including their parenteral administration, dosages and penetrations through normal and inflamed blood–brain barrier. He made comparisons of clindamycin with lincomycin against Haemophilus influenzae in vitro, and later demonstrated that clindamycin was active against Coxiella burnetti, the cause of Q fever. Other research included studies on the antiviral aciclovir.

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 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. 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."

1990s In the 1990s, Geddes 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.

In 1991 Geddes 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.

Later career Following the September 11 attacks, Geddes became an adviser on bioterrorism for the UK's Department of Health, primarily working with the country’s national smallpox plan, and in biodefence training.

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.

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 was a Fellow of the Academy of Medical Sciences. In 2009, he received Honorary Membership of the International Society of Antimicrobial Chemotherapy. He received the European Society of Clinical Microbiology and Infectious Diseases award for excellence in clinical microbiology and infectious diseases in 2014.

His recollections of 1978 inspired Mark Pallen to write The Last Days of Smallpox: Tragedy in Birmingham, published in 2018.

Death Geddes died after a long illness on 9 April 2024, at the age of 89.

Selected publications

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