Smallpox in Wales: The Forgotten Killer

Dan? It's Dr Sharma. I'm here to help you.

Everything's all right.

-Let's take you home.

-Oh, no!

-What is it?

-No closer.

I'm sorry.

No, stay back.

It's smallpox.

This spring, drama series The Indian Doctor

returns to BBC Wales.

Series Two sees Dr Prem Sharma and the community

of the fictional South Wales town of Trefelin

facing a new and life-threatening challenge -

smallpox.

-What happened? Where is Kamini?

-Kamini is fine.

'It's a story inspired by real-life events -

'a smallpox outbreak in South Wales

'that was to claim more lives than any in Britain since the 19th Century.'

You don't understand, I have a suspected case of smallpox,

so you please get him out of bed!

And, cut! Check that, please.

When the disease arrived in January 1962,

it was to trigger the biggest health scare in Wales since the Second World War.

It led to the vaccination of nearly one million people,

claimed the lives of 19 victims and forced the quarantine of thousands.

It was a terrible disease to catch,

you could be scarred for life, you could be blinded.

An awful disease.

Because my father, he had smallpox on his diaphragm,

so for the last five or six days of his life, he hiccupped continually.

Now, on the 50th anniversary of the outbreak,

for the first time we can tell the full story of how

this deadly virus brought most of South Wales to a standstill.

It's a horrible disease to die from. It's very bad.

It is also a disease which should not have happened

-in South Wales at that time.

-It was real panic situations.

In fact, thinking back, I felt like a leper.

-Take one.

-Action!

The Indian Doctor is based on the real-life experiences

of the doctors who came to work for the NHS from India

in the 1950s and '60s.

You've got to help, please don't let him die, Doctor!

It's probably just a reaction to the vaccine.

Many of them had already experienced smallpox first-hand at home,

but never expected to meet it again in Wales.

In those days, smallpox was still present in India.

We didn't have many large epidemics,

but there would always be one or two cases here and there.

Occasionally, there would be a small epidemic in one particular village.

So even before I entered medical school, I knew smallpox was there,

there was always a lot of publicity to get people vaccinated,

make sure your child was vaccinated, that sort of thing.

Though there had been no significant outbreak in Britain

since the beginning of the century,

smallpox was still a disease without a cure.

Government information films from the time were keen

to remind people of its potential threat to public health.

Well, let's have it.

It's smallpox, I'm afraid.

Smallpox? But that's impossible!

Now, I'd like to show you what smallpox really looks like.

But I should warn you, it's not a very pleasant sight.

These are all typical cases.

'Smallpox was still common, not in Britain, but it was common in the world during this period.'

And in fact, all the way through the 20th century, Britain had outbreaks

of imported smallpox, it came quite regularly to these shores.

The events I'm going to talk about

happened pretty much in the first half of 1962.

Consultant virologist Diana Westmoreland

has spent years studying smallpox

and the threat it has historically presented.

Variola major had a mortality rate of between 40% and 60%.

And it killed, significantly, everybody.

It didn't just kill the poor, the disadvantaged -

it killed the rich and the famous and the leaders of Europe.

Smallpox is a very severe virus illness.

It's transmitted from person to person

and it infects every cell, every tissue of the body.

There are two ways, really, that smallpox can go from one person

to another, which is direct contact with the patient,

especially in the early stages of the disease, when they are infected.

Secondly, the virus is still alive in the scabs of the rash.

Clothing, any article that belonged

to the patient which had traces of the scabs

could easily pass on to somebody else.

So, in autumn 1961,

when reports first came through of a new epidemic in India

and Pakistan, the British authorities looked on with trepidation.

It is, in fact, in the villages of Asia and Africa

and the Middle East that smallpox is still a constant threat,

lying in wait beneath the surface of poverty.

Here, deaths from smallpox may cause tragedy and suffering,

never surprise.

As the virus threatened to engulf the whole subcontinent, it was clear

that the authorities were struggling to contain it.

The governments of Pakistan and India have, for many years, been fighting smallpox by the best means

available, mass vaccination. But this will take a long time.

Meanwhile, in Britain,

the Government attempted to limit numbers of arrivals

by introducing the Commonwealth Immigration Bill,

stirring up a familiar row.

What the Commonwealth Immigrants Bill was designed to do was

to eliminate the right that all British

and colonial subjects had to reside in the United Kingdom.

The Bill's effect was immediate - a huge influx of immigrants

from India and Pakistan, hoping to enter Britain before it became law.

1960, net immigration

from Pakistan to the United Kingdom, in other words,

people who came and stayed, was around 2,500.

By 1961, as the Bill is coming into action, in November,

it was measured in the 20 thousands.

The only way that somebody from Pakistan could get to the UK

was to fly from Karachi.

Well, they could come by boat, but the only airport was in Karachi.

Because of the outbreak, there were requirements that people

flying into the UK had to have a valid vaccination certificate.

-REPORTER:

-'Today, every country has its airports. The entry and the exit for men and women of all nations.

'And that was one of the key features

'that made this smallpox outbreak different from the ones

'that had preceded it. Not only were there very large

'numbers of immigrants coming,'

they were coming by air, there was no chance of seeing smallpox develop through the journey.

'And in a world that is becoming smaller and smaller,

'the virus of this killer disease can travel easier and faster.'

One of the rather inappropriate things that the ministry said was

that the airports were not prepared for "steerage class migrants".

With minor outbreaks in London,

Birmingham and Bradford in the autumn of '61,

the British Government went a step further,

ordering that all arrivals from Karachi carry proof of vaccination.

Among these arrivals, in January 1962,

was the young Pakistani man, Shuka Mia.

After landing at Heathrow,

Shuka Mia journeyed first to Birmingham

and then by train to Cardiff, where he had contacts

in the city's Pakistani community.

Wales is a really interesting case in this period.

Partly because Cardiff had the first mosque in Britain, back in 1919.

The Pakistani community, they probably all knew each other.

And they were providing a service that some people really wanted,

in that they had restaurants.

But when Shuka Mia eventually arrived

at the city's Calcutta Restaurant,

it was clear he was not in any condition to work.

Poor Shuka Mia is quite ill at this point and he goes to bed, a bedroom upstairs in the restaurant

and essentially stays there - he's too ill to get out of bed.

About the day after his arrival in Cardiff, he's seen by

a general practitioner, who doesn't see a rash, but clearly thinks

that Shuka Mia is significantly unwell and ought to be in hospital.

The GP suspects something is wrong and has him

transferred to the Infectious Disease Hospital in Cardiff,

where he is then diagnosed by one of the specialist panel in Wales

to handle cases of potential smallpox.

In one of the reports, it says that when Shuka Mia was in hospital,

there was no sign of him having any primary vaccination scar.

Smallpox vaccination leaves a scar.

It seems to me most probable that Shuka Mia received something

that had no vaccine in it at all and therefore, he wasn't immunised.

The Cardiff authorities quickly took steps to vaccinate anyone

who could possibly have come into contact with the disease.

I was a staff nurse in Cardiff Royal Infirmary

and because of the proximity to the docks,

we were all vaccinated earlier rather than later.

Alongside their immunisation programme, the city's health authorities acted quickly

to isolate and combat the threat.

The people on the train, we would say only about 50% of them

have so far contacted either the medical officers

or the general practitioners.

We would like to see more of them come along.

They would vaccinate all Shuka Mia's contacts,

keep an eye on them for 14 days and if they had no more cases,

they would assume that the outbreak had been stopped.

And that's essentially what happened.

By the end of January,

most of the city's Pakistani community and healthcare workers

had been vaccinated.

And Shuka Mia, still the only confirmed smallpox victim,

was in isolation in Penrhys Hospital above the Rhondda Valley.

It was a 16-bed, corrugated iron building

with the usual sort of caretaker's house

and toilet facilities...

laundry etc, disinfecting rooms.

Virtually, a building on top of a mountain.

Literally, it was surrounded by corrugated iron.

But I think by 1930, the council got a bit wary

and thought they should have it more secure,

so they built a seven-foot concrete wall around it,

which still remains today.

The authorities could breathe a sigh of relief.

Through their prompt action, the smallpox outbreak had been

successfully confined to the immigrant community. Or had it?

In truth, things had already started to go badly wrong.

On 5th February, a young pregnant woman had gone to her mother's house

in order that the last stage of her pregnancy would be

in her mother's care, I suppose,

and she had become unwell on probably the 6th or 7th February,

and on 8th February had had a tragic stillbirth in her mother's house.

Her mother and some of her friends

were assisting at this tragic stillbirth and after the stillbirth,

this young woman started to bleed uncontrollably.

An ambulance was called and she was rushed

-to East Glamorgan General Hospital.

-But despite everyone's best efforts,

before she could be operated on, the woman died.

Her obstetrician, Mr Hodgkinson, was immediately informed.

They rang my father, he went to the post-mortem the next morning

and he actually diagnosed this woman by looking at her pupils and

he said to the pathologist, "I think this is haemorrhagic smallpox."

And the pathologist said, "No, I don't think it is."

My father said, "I bow to your superior knowledge,

-"I've only ever seen it in textbooks."

-After the post-mortem,

the woman's body was released to her grieving family.

Her sister took her body and the body of her stillborn child

into her own home, into the sister's home,

where the poor deceased people were in an open coffin

in the front room, so that the family could come

and pay their respects.

But after several days of mourning,

many of those who'd come into contact with the pregnant woman

began also to exhibit worrying symptoms.

The brother of the original lady, he became ill

and he started to develop a rash.

On about 20th February, the young lady,

the original young lady who died of haemorrhage,

the pregnant woman, her obstetrician became unwell.

My father was very ill, he had a temperature of 105,

and could I possibly come home?

But I went to kiss him, and he said, "No, please don't kiss me.

"I've got smallpox."

He said, "Now, you look at these," and showed me the, you know,

they're umbilicated, they're like chickenpox,

but they've got a little line across them.

He said, "You look at this and if you ever see this,

"you'll know that it's smallpox."

And so, he wouldn't let me go very close to him.

All the new victims, including Mr Hodgkinson,

were sent to join Shuka Mia in Penrhys Hospital.

By this time, when you have got four or five people very unwell

with rashes, people are then aware that despite the apparent success

related to Shuka Mia, something has gone badly wrong in South Wales,

because they now have four cases of smallpox in Penrhys Hospital.

Penrhys now became the focus for wild speculation

about how the disease had spread.

The rumour mill starts and it simply doesn't stop.

In the press, amongst the officials, there is a great effort

to control them, but you can't stop people from talking.

And so, there are rumours about the husband of this lady

perhaps having a bit on the side,

with a woman who was known to mingle with the Pakistani community.

Conversely, there are rumours about the lady herself.

At the same time, there are rumours about the medical profession,

there are concerns that an ambulance went missing

and got lost up in the Valleys and that in opening the door to talk to a policeman,

they may have spread the smallpox. The policeman denies this story

and the medical authorities say it never happened,

and yet, that rumour continues to circulate.

How many contacts have been traced?

-Oh, hundreds all together.

-And you vaccinated...?

Hundreds, as well, have been vaccinated, yes.

Have you discovered yet where this outbreak came from?

We haven't, in fact.

We're working on it of course, but we can't give a definite answer yet.

As fear spread, public events were cancelled,

movements were restricted and relations between the Rhondda

and Cardiff stretched to breaking point.

The people outside of the Rhondda Valley could see this as being

a problem of the community in the Rhondda

and the last thing they wanted was people from the Rhondda

to be mixing in these other outside communities.

So, if you like to put it in a brutal sense, the people in Cardiff

blame the Valleys and the Valleys blame Cardiff for sending the problem in the first place.

The more people know about the disease,

-the less likely they are to panic.

-What should I tell them?

Well, the virus spreads where people congregate.

Especially in confined spaces. People have to stay at least six feet apart from each other.

The drama highlights how, as panic spread, the new doctors from India

found themselves drawing on their experience to calm the situation.

Local GPs would ring us and say "Look, you know, what should I do

"if I see somebody who might have smallpox, or how do I look out for it? What should I do?"

People with smallpox, in the early part of the disease, breathe out

quite a lot of smallpox virus and that's very highly infectious.

And if you think the risk is very high, there are statutory provisions for insisting on quarantine,

that is to say, locked up in their own homes.

Quarantining people in their own homes was considered the best way of isolating potential carriers.

Mr Hodgkinson's family was among the first to be confined.

My sister, my mother and myself were virtually in the house alone.

I think our GP came to see us.

But nobody else was able to come in.

And, you know, we didn't sort of see anybody.

We could shop so long as it was dropped at the end of the drive,

but we weren't allowed to pay for anything - they couldn't take our money.

So nothing was allowed to come past the garden gates.

It was all dropped outside on the road.

While some neighbours played their part,

others weren't quite so generous.

It became very clear that neighbours within the community were not

very nice to the families who were affected.

They reacted with fear and... They wanted them boarded up.

They were talking about boarding the quarantined people.

People who were in quarantine, if they as much as stuck their nose, outside the house,

board them up, "They need to be forced to stay away from us."

As panic gripped the Valleys, worse news was to come from

East Glamorgan Hospital where the virus had spread to Ward Three,

the children's ward.

A young boy who'd been admitted into East Glamorgan

for a major operation for kidney cancer,

he'd had his major operation on 9th February.

He became unwell on 17th February and he had the flu-like symptoms

and the fever. He developed a rash.

And he was in a paediatric ward in East Glamorgan General Hospital

recovering from his operation.

There was absolutely no reason at that time to think he'd any contact with anybody with smallpox.

Ward Three was isolated. All the patients there, the children,

had to remain in isolation. The parents couldn't visit the wards.

The staff agreed to stay on the ward. They weren't allowed out.

They were fed on the ward, they slept on the ward

and they lived on the ward virtually for the whole time of the outbreak.

The one thing that sticks out in my mind,

they had a bell outside the ward.

If they required anything they'd ring the bell

and a note would be placed, what they required, you know,

if there were samples to be taken to pathology, or material to go elsewhere.

I've sent for you because you all volunteered to take on isolation work in an emergency.

Well? I'm sorry...

Volunteering for isolation within the hospital was one thing.

But staff living in the community at large were also feeling isolated.

-I'm afraid it's very short notice, but I want you all ready to leave in an hour.

-Yes, matron.

You would get on the bus into Pontypridd,

any locals if they're on the bus would be at the back.

You sat down the front. Nobody bothered with you.

I'd catch the train - I was living at the time in my parents' home.

And I... People who normally sat by me on the train wouldn't bother.

They wouldn't walk from the station with me.

What really sticks out in my mind from the whole episode, actually.

I lived in one of the Valleys and caught the bus outside the hospital.

Erm...

We used to finish at 10 to 10. The bus would be there at 10 o'clock.

At 11:15, 11:20, we were still waiting because the buses wouldn't stop.

The public at large, it was real panic situations.

In fact, thinking back, I felt like a leper.

By the time of Mr Hodgkinson's death on 6th March,

smallpox had brought life in the Valleys to a standstill.

The crematorium in Pontypridd was next door to what was the grammar school.

So the grammar school was sent home from school early

so that no pupils were around about.

Body came through Pontypridd so Pontypridd was shut off

so that the ambulance - of course he was in a sort of plywood coffin -

so the ambulance brought him through Pontypridd.

So he was cremated in Glyntaff.

But the vicar couldn't come anywhere near us as a family

because of the quarantine.

My father was taken into the crematorium.

Sort of in through the back. Carol and I could see cameramen

and so we tried to sort of shield my mother from those as well.

Is there feeling in Ferndale that this may not be the end of it?

Yes, I'm afraid that's the feeling now.

In my opinion and... People are really getting perturbed about it.

Well, my wife is within hospital with this Dr Hodge...

Dr Hodgkinson, who died?

Hodgkinson and now they are coming to the house now three or four

times a day to examine her because she's home.

But up till now they're saying she's free from the smallpox.

As public anxiety reached new heights,

the Indian doctors knew there was only one foolproof solution.

The infection kept on spreading.

At first they would vaccinate the close contacts of people

who they thought were in danger of developing the disease.

But when that didn't control the infection

and it started to spread, then the next thing of course would be

mass vaccination of the whole community.

Now the authorities finally reverted to Plan B,

and thousands of people across South Wales formed queues

outside GPs' surgeries and public halls.

But mass vaccination had its own consequences.

Once people where being vaccinated in their droves for smallpox

many of them get what's called vaccinia virus

and so they get a rash, they don't have smallpox, but they are having

a rash in relation to the vaccine and that makes it even more difficult

to discriminate between vaccinia cases and mild cases of smallpox itself.

Despite the complications and cost of such a large-scale operation,

mass vaccination seemed to be working. By end of March 1962,

the authorities once more believed they had finally contained the outbreak.

Everything that moves in the South Wales Valleys has been vaccinated.

The level of immunity at that point will have been enormous.

The people who were ill with smallpox where largely getting better.

And there were less and less new cases as each week went past.

But the virus had one last, chilling trick to play.

Despite the isolation of known cases,

despite the mass vaccination, despite the quarantine,

there was something in this Welsh outbreak that just wouldn't go away.

It pops up again. And this is the strange thing about the Welsh outbreak

is that somehow the smallpox keeps slipping through the net that's working elsewhere.

Only four days after the Rhondda had been given the all clear,

reports came in of a new outbreak among the elderly patients

at Glanrhyd psychiatric hospital in Bridgend, more than 15 miles away.

These people had not been vaccinated during the huge vaccination campaign because they were so frail.

I keep alluding to the side-effects the vaccine.

It was felt that these people were in a locked ward,

they very rarely had visitors, most of them had been there for years,

if not tens of years.

And they never went anywhere, they never saw anybody, very frail,

it was just felt that the risk of them coming to harm

from vaccination far exceeded the risk of getting smallpox.

One of the smallpox panel was called to Ward F3

where they found eight people on the ward with smallpox rashes.

It was a very, very tense, serious time for a few weeks, actually.

Of course, as unfortunately the people who had smallpox were dying,

obviously, that increased the mood of... It was a very, very...

close-knit community at the psychiatric hospital at that time,

and everybody felt it.

This time, the authorities took no chances.

Glanrhyd was effectively quarantined

and its elderly patients transferred to an isolation hospital nearby,

but not before the virus had claimed another eight victims.

And once again, how it had spread remained a mystery.

Although the Rhondda was only 14-15 miles away from Bridgend,

there weren't any sort of direct train links or bus links,

had very little to do with the Rhondda.

If you're in a position of trying to do the detective work,

how has this infection arisen in this person,

and how is it being passed from that person,

clearly one way is that the two people have met

and that's a very reliable way of causing infection.

When you're talking about something where it's not so simple,

you have to think about other ways the disease might be transmitted.

There are a few possibilities.

Obviously people who were in from the Rhondda had visitors.

I would assume that the people on the ward,

where the smallpox broke out, would have been from the Rhondda, would have had visitors.

I think it is likely that there was some breach of discipline

certainly to cause the Glanrhyd outbreak.

It's quite possible that there was some breach of discipline

that led to the pregnant lady being infected, or a missed case.

Um... The health authorities never got to the bottom of that

so to that extent, they were found wanting.

By the summer of 1962, five months after Shuka Mia's Cardiff arrival,

the smallpox death toll had reached 19.

The trail of errors, misjudgements and expense

combined to form a damning indictment

of the South Wales' health authorities' inability to contain the virus.

In looking at the case in Wales and why there were such rumours about the medical profession

in this particular case, you need to look at the numbers.

The Welsh outbreak was much, much longer than the outbreak elsewhere.

And also, of the 62 indigenous cases of smallpox,

46 of them were in Wales. 19 of the deaths happened in Wales.

So it's not unreasonable that the Welsh people wanted to examine

what the health service was doing and was failing to do in the region.

And of these 46 cases, no less than 27 of them

were hospital-acquired infections, which is a very chilling statistic whichever way you look at it.

With the outbreak finally over,

life in the Valleys slowly returned to normal.

The World Health Organisation certified the eradication of smallpox worldwide in 1980,

and where Penrhys Hospital once stood is now a wasteland.

For those least affected, the 1962 smallpox outbreak is just a dim memory.

It's as if people would rather forget the disease ever came to Wales.

Diana Westmoreland has a theory as to why this may be.

There were a lot of able who behaved very heroically

in volunteering to be in hospitals, care of patients, driving ambulances

with cases to hospital, to drive the bodies to the morgue.

A lot of very heroic people, but they're all little people.

They're all people who are pulling together out of a sense

of community and a sense of obligation and an ability to help.

But that doesn't make for a big headlines.

It doesn't make for a dramatic tale of daring, do and triumph.

There are no particular heroes except ordinary people.

Subtitles by Red Bee Media Ltd