History of the Aberdeen Typhoid outbreak 1964
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Dr David Smith (History), Professor Hugh Pennington (Medical Microbiology) and Professor Elizabeth Russell (Public Health) have been awarded a grant of approx £90,000 by Wellcome Trust for a grant for a project on the history of the Aberdeen typhoid outbreak of 1964.
The project began in February 1999 and Lesley Diack (Department of History) is the project's research assistant.
Contacts:
Lesley Diack: h.l.diack@abdn.ac.uk
David
Smith: d.f.smith@abdn.ac.uk
Address: DEPARTMENT OF HISTORY,
UNIVERSITY OF ABERDEEN, CROMBIE ANNEXE,
MESTON WALK, KING'S COLLEGE OLD ABERDEEN, AB24 3FX
Telephone
01224 273885 (Diack)
01224 273676 (Smith)
Fax
01224 272203
During the course of the project some details concerning pregress and findings will be posted on this page.
A small exhibition about the project has been prepared for exhibition at Aberdeen Central Library during late April, early May 1999. This exhibition will be added to during the course of the project for display elsewhere, and will be available on loan to interested parties.
A copy of an article about the project, which appeared in Wellcome News no 19 (April 1999) is available on application to the above address.
The following brief summary gives some details of background to and aims of the project.
Summary
Medical, scientific, political and public interest in food poisoning increased during the 1980s and 1990s, as a result of the salmonella in eggs affair, listeria and BSE/CJD problems, and Scottish E.coli outbreaks. These incidents have emphasised the role that such episodes play in conditioning the attitudes of the population towards health risks, and in driving Government food and health policies. The latest development in this connection is the announcement of the formation of a Food Standards Agency. Food poisoning scares are also influential determinants of public perceptions of biomedical science and of the public health services. The media clearly plays a key role, not only in the transfer of information, but also in the formation of opinion.
The proposed project will contribute towards the development of a historical perspective that will provide useful insights into these recent events. The Aberdeen typhoid outbreak of 1964 represents the first serious challenge to the British system for ensuring food safety during the period since the Second World War. It was the first major food safety incident to occur after the establishment of the NHS, and received saturation media coverage from all sectors. For the first time, television played a significant role as an instrument for outbreak control, and as a medium for airing public reaction. The Aberdeen outbreak was large, with 487 hospital admissions, but mortality was minimal. However, the issues raised achieved great public prominence, and influenced the subsequent attitudes, policies and actions of public health professionals, politicians and administrators concerned with health and food. An official enquiry led to a number of recommendations with significant policy implications at Scottish, UK and international levels, some of which were never implemented.
The aim of the proposed study will be to analyse the Aberdeen typhoid outbreak, its context, and its local, national and international repercussions. The roles of the local authority Public Health department, NHS Public Health laboratory and the politicians, administrators, scientific and medical personnel of the Ministries of Health and Agriculture, Fisheries and Food and Scottish Home and Health Department will all be examined. The influence of the media and its local and national impact will be studied in detail, as will the longer-term consequences of the outbreak - the official investigations and their impact on policy, legislation and institutional developments. The research will involve the consultation of archival sources in Aberdeen, Edinburgh and London and the conduct of oral history interviews. Oral history interviews, with some of the surviving professionals who were involved, will make it possible to explore the influence of the outbreak upon the later administrative, scientific and medical strategies. Some of the victims and their relatives will also be interviewed and an attempt will be made to locate and gain access to diaries written by local people at the time of the outbreak.
It is anticipated that the proposed study will not only provide insights of contemporary interest and relevance, in view of the recent and current food poisoning episodes, but will also extend recent historical scholarship on the history of epidemics and on the role of science and medicine in food policy making.
Introduction
The diagnosis of two cases of typhoid fever in Aberdeen on 20th May 1964 signalled the beginning of one of the largest outbreaks of food-borne infections recorded in Britain in the decades after the Second World War (Special Correspondent 1964). Over four hundred individuals were infected and as a result of the publicity given to the outbreak, Aberdeen quickly acquired an image of a 'beleaguered city'. A royal visit at the end of the outbreak was organised to 'cleanse' the city of its plague-ridden status (Burrell 1964, MacQueen 1964), and the civic impact of the episode has not been exceeded by any other event in the last half-century, except, perhaps, by the Piper Alpha disaster in 1988.
The importance of the Aberdeen typhoid outbreak rests not only on its size and local impact, however. Public concern was sufficient to cause the Government to set up an official enquiry (Milne 1964). The incident involved not only the local health services but also the Ministries of Health and Agriculture, Fisheries and Food, and the Scottish Home and Health Department. As the scientific evidence clearly pointed to Argentinean corned beef as the source of the causative organism, the affair also involved a significant international dimension.
The outbreak tested, and resulted in some modification of, the formal local and central government machinery for the control and investigation of food poisoning. The affair also appears to have been a formative experience for some of the people involved. Sir Michael Franklin, for example, Permanent Secretary at the Ministry of Agriculture Fisheries and Food until 1987, remarked that one of his earliest political lessons came from the outbreak. This was the realisation that 'the time Ministers need to devote to a subject is not in proportion to its intrinsic importance nor to the extent to which they can really do anything about it but to the volume of public concern' (Franklin 1994). In Aberdeen the outbreak control team made vigorous use of the media and the affair provides the first example of intense and sustained television coverage of an acute public health crisis in Britain. The Medical Officer of Health, Ian MacQueen, claimed that this strategy made it possible to declare an 'all clear' only 28 days after the initial cases (MacQueen 1964). One civil servant, however, complained of MacQueen's 'ridiculous antics' and 'desire for personal aggrandisement' and drew attention to the 'serious social, economic and financial consequences at home and abroad which flowed from - [the] publicity' (Humphrey-Davies 1964).
Aims of the Project
A historical perspective on food poisoning scares and incidents : In the last decade there have been a series of food poisoning episodes, and scares or panics about the possible harmful consequences of eating certain foods. The frequency and public impact of such events have caused many governments across the world to make major changes to their food policies (Lang, Millstone and Raymer 1997). In connection with these events, a number of academic biomedical scientists have been drawn into policy-making, and some have become well-known to the public through appearances in the media. In Britain these scientists include one of the co-applicants (Pennington). Some sociological studies of these recent episodes have been conducted under the Economic and Social Research Council's 'Nation's Diet' initiative (Miller and Reilly 1995, Reilly and Miller 1997, Macintyre, Reilly, Miller and Eldridge 1998), but such research has been confined largely to the role of the media. Due to the lack of availability of internal civil service documents, it is not possible to explore governmental decision-making processes in detail for these very recent events. In consequence, as the government both use and are influenced by the media, even the understanding of the role of the media that can be achieved by this sociological research is limited. In the view of the applicants, a study of the Aberdeen typhoid outbreak can overcome these limitations and promises to be an important part of the process of developing a historical framework for understanding aspects of the recent and current food safety scares in Britain.
Inter-disciplinary collaboration : The principal applicant (Smith, Wellcome Lecturer in the History of Medicine) has substantial experience in researching the history of nutrition science, mainly during the first half of the twentieth century. The involvement of nutrition scientists in policy-making has frequently been an important dimension of this work (Smith, 1987, 1995, 1997, 1998). The first co-applicant (Pennington, Professor of Medical Microbiology) has been involved in various capacities in the recent food poisoning episodes. This includes chairmanship of an official enquiry into the Scottish E. coli outbreak (Pennington Group 1997). The second co-applicant (Russell, Professor of Social Medicine) was involved, as a house physician at the City Hospital, Aberdeen, and member of the local control team, in the Aberdeen typhoid outbreak itself. The proposed project therefore offers a unique opportunity for the creative combination of interests, experiences and skills of the applicants (and also those of the preferred research assistant, Lesley Diack, who has a background in local history) in an interdisciplinary historical project of contemporary relevance.
Specific aims : The project will document and analyse:
a) the national and local and administrative, political, medical, and scientific aspects of the Aberdeen typhoid outbreak.
b) the role of the media in the affair.
c) the experiences of the population affected, as patients and otherwise.
The national dimensions will include: i) the government machinery existing prior to 1964 to monitor food safety and respond to food poisoning incidents; ii) the immediate national administrative and political response to the Aberdeen outbreak; iii) the short-term aftermath, for example the appointment, proceedings, and report of the official enquiry, and iv) the longer-term consequences, such as legislative, administrative and other changes that resulted from the outbreak and the official report. The local dimensions will include the roles of: i) the Medical Officer of Health, Dr MacQueen, and his colleagues, including health visitors, at the Health and Welfare Department of Aberdeen Corporation; ii) the Health and Welfare Committee of the Corporation and local political responses; iii) the Aberdeen City Hospital Laboratory; iv) the University Bacteriological Laboratory, and v) general practitioners. The administrative, medical and political responses in areas surrounding Aberdeen will also be investigated.
The activities of the media will cover: i) newspapers, especially the Press and Journal; ii) BBC and Scottish / Grampian television, and iii) radio. The testimony of local people will be collected by oral history interviews and other means. This will cover not only victims and their families, but also some others who were particularly affected, such as members of the staff of the supermarket to which the outbreak was traced.
Work that has led up to the Project
A study of the Aberdeen typhoid outbreak is not only of interest in view of contemporary food poisoning and food scares, but will also continue and extend scholarship in the history of medicine in two areas: the history of epidemics, and the history of food and health.
The history of epidemics : Several scholars have included typhoid as one of a number of endemic diseases that stimulated public health and environmental reform during the nineteenth century (Luckin 1986, Hardy 1993). However, the applicants consider the current project to lie more within the long-standing tradition of writings on epidemics as crises which provide a vantage point for important social and cultural processes. Such work includes, for example, Giovanni Boccaccio's The Decameron (1351-53), a series of tales set in the Black Death of 1348, and Daniel Defoe's Journal of the Plague Year (1722) which purports to be an eyewitness account of the epidemic of bubonic plague in England in 1665. Turning to modern historical scholarship, cholera in the nineteenth century has aroused much interest, especially the epidemic of 1830-32. Asa Briggs, in 1961, called for new work that would allow comparisons between 1830-32 and the epidemics that occurred during later decades (Briggs 1961, 89). Nevertheless, as Richards Evans points out (Evans 1987, 472), subsequent research continued to concentrate overwhelmingly on the initial outbreak (e.g. Morris 1976). Evans' work on the Hamburg cholera outbreak of 1892 is a rare example of a study of an epidemic that occurred after the discovery of bacteria. For the twentieth century there is little comparable work, although research on the 1918-19 influenza pandemic (e.g. Tomkins 1992), and AIDS (e.g. Berridge 1993, 1996) illustrate the value of the study of epidemics during this period.
Historians have expressed differing opinions regarding the value of focusing research upon epidemics. According to Margaret Pelling, cholera epidemics in England during the nineteenth century were 'a distraction rather than an impetus to reform' (Pelling 1978, 5-6). Charles Rosenberg, in contrast, is more positive, suggesting 'an epidemic - provides a convenient and effective sampling device for studying in their structured relationship some of the most fundamental components of social change' (Rosenberg 1962, 452). Evans effectively demonstrates the role that epidemics may play in stimulating broader historical developments. He claims that the Hamburg cholera epidemic 'marked, even if it was not alone in bringing about, the victory of Prussianism over liberalism, the triumph of state intervention over laissez-faire' (Evans 1987, viii). While it is unlikely that the applicants will be able to demonstrate links between the Aberdeen typhoid outbreak and such large-scale changes in the 1960s, we are confident that emulating Evans' holistic study of an acute epidemic in a single city will provide new and important insights.
The history of food and health : While the study of epidemics during the twentieth century has been relatively neglected, the role of science and scientists in the making and application of policies concerning food during the same period has been an area of increasing interest. To date, this work has concentrated largely upon nutrition, and the earlier part of the century, covering, for example, the role of nutrition scientists during the world wars (Teich 1995, Smith 1997). New knowledge of nutrition and the food and pharmaceutical industries during the inter-war period has been considered, (Horrocks 1997) and some committees concerned with nutritional requirements during the 1930s have been investigated (Smith 1995). Charles Webster's paper on school meals and milk is one of very few dealing with the period since the Second World War (Webster 1997). However, a project funded by the Wellcome Trust at the London School of Hygiene and Tropical Medicine, on nutrition policy-making since the Second World War is about to begin under the supervision of Virginia Berridge. The principal applicant (Smith) is a member of the advisory committee established in connection with the LSHTM project, which is part of a broader programme on science and health policy, in which the role of the media is one dimension under consideration. The current proposal intends to develop this trend towards contemporary history, covering a different aspect of food policy (food safety), involving a different area of biomedical science (microbiology), and applying a different methodology. It is also proposed that Virginia Berridge will act as collaborator with and adviser to the Aberdeen team.
Previous work on the Aberdeen typhoid outbreak : As yet there has been no serious attempt to assess the long-term impact of the Aberdeen typhoid outbreak. The outbreak is only mentioned in passing, for example, in R. Williams' history of the Public Health Laboratory Service (Williams 1985). The official report on the outbreak was based upon evidence submitted in the immediate aftermath of the affair and was published before the end of 1964 (Milne 1964). In addition, immediately after the outbreak, an MD thesis was prepared by one the applicants (Russell 1965). This described the patient population, the clinical features of the disease, the results of follow-ups of patients after discharge, and a clinical trail of antibiotics as a treatment of chronic carriers of the typhoid microbe. The outbreak control team also published an account of their experiences in the Scottish Medical Journal (Walker 1965), and several technical papers appeared on special aspects of the outbreak (e.g. Galloway, Clark and Blackhall 1966, Brodie 1967).
Bibliography
- V. Berridge
and P. Strong
AIDS and contemporary history, Cambridge, Cambridge University Press, 1993. - V. Berridge
AIDS in the UK: the making of policy, 1981-1994, Oxford, Oxford University Press, 1996. - J. Brodie
'Antibodies and the Aberdeen typhoid outbreak of 1964. 1. The Widal Reaction', Journal of Hygiene (Cambridge), 1967, vol. 79, p. 161, and 'Coomb's, Complement fixation and fimbrial agglutination tests', ibid, p. 181. - A. Briggs
'Cholera and Society in the Nineteenth Century', Past and Present, 1961, vol. 19, pp. 76-96. - J. Burrell
'Typhoid in Aberdeen', Aberdeen Postgraduate Medical Bulletin, 1964, pp. 240-44. - R. J. Evans
Death in Hamburg. Society and Politics in the Cholera Years 1830-1910, Oxford, Clarendon, 1987. - M. Franklin
'Food Policy Formation in the UK/EC', in S. Henson and S. Gregory (eds), The Politics of Food, Reading, Department of Agricultural Economics and Management, University of Reading, 1994. - H. Galloway
N. S. Clark, M. Blackhall, 'Paediatric Aspects of the Aberdeen Typhoid Outbreak', Archives of Diseases in Childhood, 1966, vol. 41, pp. 63-8. - S. Horrocks
'Nutrition science and the food and pharmaceutical industries in inter-war Britain', in Smith (ed.), 1997, pp. 53-74. - P. Humphrey-Davies
'Memo on the Milne Report', 20 November 1964, Public Record Office, MAF 282/96. - H. Kamminga
and A. Cunningham
The Science and Culture of Nutrition 1840-1940', Amsterdam, Rodopi, 1995. - T. Lang, E.
Millstone, M. Raymer, M.
'Food Standards and the State: a Fresh Start', Discussion Paper 3, London, Thames Valley University, Centre for Food Policy, 1997. - B. Luckin
Pollution and Control, Bristol, Adam Hilger. - S. Macintyre,
J. Reilly, D. Miller and J. Eldridge
'Food choices, food scares, and health: the role of the media', in A. Murcott (ed.), 1998. - I. MacQueen
'Random Reflections on the Outbreak', Health and Welfare, 1964, No. 23, pp. 1-6. - D. Maurer and
J. Sobal (eds)
Eating Agendas, New York, Aldine de Gruyter, 1995. - D. Miller and
J. Reilly
'Making and issue of food safety: the media, pressure groups and the public sphere', in Maurer and Sobal (eds), pp. 305-36. - D. Milne (chairman)
The Aberdeen typhoid outbreak, 1964, Edinburgh, HMSO, 1964. - R. J. Morris
Cholera 1832: the social response to an epidemic, London, Croom Helm, 1976. - M. Pelling
Cholera, Fever and English Medicine 1825-1865, Oxford, 1978. - The Pennington
Group
Report on the circumstances leading to the 1996 outbreak of infection with E. coli O157 in Central Scotland, the implications for food safety, and the lessons to be learned, Edinburgh, HMSO, 1997. - J. Reilly and
D. Miller
'Scaremonger or scapegoat? The role of the media in the emergence of food as a social issue', in P. Caplan (ed.), Food, Identity and Health, London, Routledge, 1997, pp. 234-51. - C. Rosenberg
The Cholera Years: the United States in 1832, 1849, and 1866, Chicago, University of Chicago Press, 1962. - E. M. Russell
'Typhoid fever in Aberdeen a critical Analysis', unpublished MD thesis, Glasgow University, 1965. - D. F. Smith
'Nutrition in Britain in the Twentieth Century', unpublished PhD thesis, University of Edinburgh, 1987. - D. F. Smith
'The Social Construction of Dietary Standards: The British Medical Association - Ministry of Health Advisory Committee on Nutrition Report of 1934', in D. Maurer and J. Sobal (eds), 1995, pp. 279-304. - D. F. Smith
(ed.)
'Nutrition in Britain: Science, Scientists and Politics in the Twentieth Century, London, Routledge, 1997. - D. F. Smith
'Nutrition Science and the Two World Wars', in D. F. Smith (ed.), 1997, pp. 142-66. - D. F. Smith.
'The Carnegie Survey: background and intended impact', in A. Fenton (ed.), Order and Disorder, Edinburgh, Tuckwell Press, forthcoming, 1999. - D. F. Smith
'Nutrition Scientists, Scientific Knowledge, and Dietary Change', in A. Murcott (ed.), The Nation's Diet, London, Addison-Wesley Longman, forthcoming, 1998. - Special Correspondent
'Typhoid at Aberdeen', British Medical Journal, 1964, vol. 1, pp. 1500-1501. - M. Teich
'Science and food during the Great War: Britain and Germany', in Kamminga and Cunningham (eds), 1995, 213-34. - S. M. Tomkins
'The failure of expertise: public health policy in Britain during the 1918-19 influenza epidemic', Social History of Medicine, 1992, vol. 5, pp. 435-54. - W. Walker
'The Aberdeen Typhoid Outbreak of 1964', Scottish Medical Journal, 1965, vol. 10, pp. 466-79. - C. Webster
'Government policy on school meals and welfare foods, 1939-1970', in Smith (ed.), 1997, pp. 190-213. - R. E. O. Williams
Microbiology for the public health: The evolution of the Public Health Laboratory Service, 1939-1980, London, Public Health Laboratory Service, 1985.