What Killed Jane Austen?: And Other Medical Mysteries (16 page)

Many of us have heard tell of the so-called ‘Spanish flu’ epidemic of 1918, and some will remember the ‘Asian flu’ pandemic of 1957 and the ‘Hong Kong flu’ of 1968. But not many will recall the ‘swine flu’ epidemic of 1976—this is perhaps hardly surprising, because it never happened.

In January 1976 at the American Army depot in Fort Dix, New Jersey, several soldiers became ill with a respiratory infection. Despite his fever, one foolhardy 19-year-old recruit went on an eight-kilometre march in the snow, then collapsed and died. Throat washings from him and four others identified two strains of influenza virus: A Victoria and another which the lab could not classify. If this proved to be a new breed of virus there could be no community immunity—the setting for an epidemic.

On 12 February the elusive culprit was identified as swine flu, so named because it was passed around pigs, but never before, it seemed, passed from human to human. However, it was for another reason that a few eyebrows were raised in the Centre for Disease Control (CDC) in Atlanta: the germ genetically resembled the virus which had caused the infamous 1918 Spanish flu epidemic during which 20 million people worldwide had died. It had never recurred, hence by 1976 nobody under the age of about 55 had any circulating antibodies. There was some high-level anxiety.

Two days later a medical conference of top brass was held where it was resolved to establish whether the infected four had had contact with pigs and if others were coming down with the fever. Was it the first rumblings of a pandemic?

Such imponderables are, of course, the breath of life to laboratory people, and they were exhilarated by the prospect of the heroic decisions that were to come. They were not to be disappointed.

At Fort Dix 77 soldiers were found to have swine flu antibodies, but were symptomless; 11 more were ill and positive. However, hundreds of others were in hospital with A Victoria flu alone. On the strength of these 11 it was concluded on 10 March that there was a ‘2 to 20 per cent’ chance of a swine fever epidemic. There was division on the seriousness of the scenario, but the fact that there had been one death, plus the spectre of 1918 and the low immunity within the population helped shape conclusions. Less troubled pathologists felt the 1918 deaths were largely due to a now-treatable bacterial infection occurring on top of the virus. But either way, the epidemiologists sensed their day was at hand and a vaccine should be prepared.

That being agreed, the next question was, should there be a prompt inoculation of everybody, or should it be stockpiled to await developments? More acrimony. It was pointed out that with 200 million plus doses, even a small percentage reacting unfavourably amounted to a sizeable number of people. But Dr David Sencer, the CDC’s director and a persuasive and respected scientist cum bureaucrat, was eager to proceed. He felt the vaccine was as ‘safe as water’ and the issue was one of ‘lives versus dollars’. The price of the 213 million doses was put at $135 million.

Vigorous prodding by Sencer forced a dithering David Mathews, Secretary of State for Health, not only to grow in enthusiasm but also to find it politically attractive to say ‘yes’. The watchdog of the country’s fiscal arrangements was more stubborn, until it was pointed out that he was dealing with death and, above all, it was a presidential election year, with all that that implied. If a clincher was needed, that was it.

Gerald Ford was the incumbent in the White House, and was already seen as indecisive and bumbling: ‘He couldn’t walk and chew gum at the same time.’ He tripped up aircraft steps and bounced golf balls off spectators’ heads, but the swine fever program offered him a heaven-sent opportunity to transform his image. If a pandemic did come it would not only have been morally delinquent but politically suicidal not to have offered protection.

So, on 24 March 1976, flanked by Jonas Salk and Albert Sabin, of polio vaccine fame, President Ford launched the program to inoculate ‘every one of my fellow Americans’ against Swine fever. It was an unprecedented decision by an American president and at the time seemed a major triumph for preventative medicine. In the end it became a victim of Murphy’s Law ‘whatever can go wrong, will’.

Many public health workers thought the plan premature; no other country had such a scheme. Some said that 15 per cent would get side effects—about 30 million people. Money for other pressing health measures had to be diverted. Eggs for the culture became scarce. Swine fever was mild and not very contagious—none of the soldiers relatives seemed to have caught it. The dose for children was uncertain. And so on.

By June there had been no new cases and the Press was asking questions. As early as April the manufacturers had said they could not produce 200 million doses by the autumn, the ideal time for inoculation. In the event only 21 million doses were ready when mass inoculations started on 1 October. Legal liability was feared, especially as insurance companies refused cover. But Ford saw much merit in the program and doggedly pressed on.

On 11 October three elderly people died of heart attacks while receiving shots in the same clinic. Public response became cautious, so the President took his injection on national TV.

In mid November the first case of the neurological Guillain-Barre syndrome (GBS) occurred. Others followed, but the significance was questionable. However, by 9 December there had been 26 cases of GBS, including three deaths. It was getting troublesome. The rate was about four times greater in the vaccinated than unvaccinated, so the occurrence was hardly due to chance.

This was the last straw for the detractors. So, after much soul searching, on 16 December Dr Sencer recommended the suspension of the program. The whole fiasco came to an end that afternoon, ‘in the interests of public safety’.

Since Fort Dix there had been three cases in the whole country, and those were on pig farms. As a pandemic it was a complete non event. Ultimately, neither epidemiologists nor politicians received any kudos, indeed Sencer was sacked.

Yet it was not just lack of cases which killed off the vaccination plan, but a mixture of the feared association of GBS (532 cases in the end), the problems of liability insurance allied with ill-understood informed consent and inadequate supplies.

During the 77 days of the loudly touted and politically expedient program, 44 million people were vaccinated. The other presidential candidate, Jimmy Carter, did not have a shot and went on to win the election; there must be a message in there somewhere.

(JL)

From time to time medical schools ask for bodies for dissection. Nothing precipitous you understand; they do not want them until after the actual death of the owner. This requirement has not always been the case; in times past, some students got their material by other means.

In the time of Hippocrates, about 2,400 years ago, human dissection was expressly forbidden, in either the dead or the living. This restriction delayed advances in medical expertise for hundreds of years, until, in fact, AD 1540. That year, the Belgian anatomist Andreas Vesalius, then in his twenties, defied this ancient restricting convention and became the first to do the heretical deed whilst having in mind to further learning rather than to satisfy an idle curiosity.

In the very same year, Henry VIII allowed that surgeons were somehow more worthy than their then professional associates, barbers, and awarded them two executed criminals a year for dissection. A little niggardly for such sanguinary times, perhaps.

Subsequently the gallows were a rich source of raw material, and 200 years later they gave William Hunter the chance to set up his School of Anatomy in Great Windmill Street, London. Today, if you can drag yourself away from the strip shows down this side street off Shaftesbury Avenue, you will see a plaque commemorating the event (high on a wall of the Lyric Theatre on the corner of the two roads).

In Edinburgh the students, eager as ever, could sometimes be a little previous in getting the criminals off the gibbet. One poor unfortunate came round during an unseemly post-drop scramble. She lived on for years as Half-Hangit Maggie.

Having now arrived in Edinburgh, let’s look at medicine’s most famous accumulators of bodies. For it was there that the redoubtable William Burke and William Hare conducted their grisly and dubious business activities to provide bodies for the medical school.

In 1826 there succeeded to the Chair of Anatomy in Edinburgh an inspirational teacher, born orator and military surgeon veteran of Waterloo, Robert Knox. Such was his charisma that within a couple of years his class numbered over 500, comprising not just medical students but lawyers, artists and gentlemen with time on their hands. As all wanted a piece of the action, bodies came to be in short supply.

Knox loved his job, especially the adoration it generated, but he had a logistic problem: he needed the meat. So he enlisted the aid of several sportive students as well as a number of devious men-about-town to supply bodies, no questions asked.

On the night of 29 November 1827 two new suppliers brought Dr Knox an old man in a sack; he paid out £7 10
s
for the body. It should be stressed that the man was dead all right, and from natural causes. He had been, in fact, an army pensioner who had snuffed it at the lodging house of one of the vendors, William Hare. Hare owed his landlord £4 back rent, and fellow lodger William Burke had the sublime idea that cash may be turned over from this grave situation by selling to Knox.

It took only a moment to crack open the coffin, pop the corpse back in bed, fill the empty box with the appropriate weight in tanners bark, and then let the pitifully few mourners in to wring their hands and squeeze out the odd tear. Doubtless none keened with greater vigour or managed more snivels than Messrs Burke and Hare themselves.

Although to these two layabouts it may have seemed a mortal sin to let something rot underground when it could be sold for £7 10
s
on top of the ground, dead bodies were not in steady and guaranteed supply. They had a merchandise-flow problem, so they decided to create their own product.

The first to present was a miller who lived in the house. He was ill anyway, so no qualms were felt over his suffocation. £10 was the negotiated fee.

Next a passing beggarwoman was invited in, filled with whisky, strangled, nailed in a tea chest and delivered to the good doctor, who was delighted with the freshness of the goods.

The fee was the same for each, but, as with all businesses, there were expenses—alcohol and a box, for instance. So the carve-up of profits was less.

Two more unfortunates met similar fates. A prostitute, Mary Patterson, was met by Burke in a tavern, taken home to breakfast, filled with whisky, despatched before lunch and delivered in the afternoon. Her unforeseen appearance gave one of the students a nasty turn as he had known her professionally shortly before—in her profession, not his. This was young Fergusson, later to become Sir William Fergusson, Sergeant-Surgeon to Queen Victoria herself, no less. Doubtless he kept this bit of intelligence from her.

Burke became so bold he even relieved two policemen of a drunken woman on the pretext that he knew where she lived and would conduct her home. The lads were honing their arcane skill into an art form.

They had a rewarding day at the end of June 1828. An old lady and her grandson were dispatched, but on the way to Knox’s establishment by horse-drawn cart, the animal collapsed between the shafts of its cart, so Burke and Hare collected from both the medical school and the knacker’s yard.

In all, their stock in trade garnered between 15 and 32 unsuspecting and usually impoverished down-and-outs. The exact figure is unknown.

It came to an end after nine months, when two other lodgers at the infamous boarding house grassed on them. The police found the last of the macabre line in Dr Knox’s cellar. Burke and Hare were arrested and charged with murder.

Their trial started at 10 a.m. on the morning of Christmas Eve 1828 and continued non-stop until 9.30 on Christmas morning, when Burke was found guilty. Hare, of course, would have suffered a similar fare had he not turned king’s evidence and slipped through the system.

The judge had no hesitation in passing a sentence of death by hanging, his only agony was to decide whether Burke’s body should hang in chains or his skeleton be preserved as a ghoulish warning to other like-minded villains. In the event, and fittingly, it was taken for dissection.

The execution itself was carried out publicly before a morbidly curious audience who were prepared to pay anything between five and 20 shillings for a window seat. Some 25,000 people attended what was obviously a gala event.

As the rope tightened, a shout went up for Knox to follow. He was a little hurt at the imprecations flung at him, considering it not to be within his academic duty to question the origins of still-warm specimens.

Knox himself appointed a committee of Scottish noblemen and gentry to examine his alleged connection. The committee’s subsequent whitewash job buttered no parsnips as far as the canny citizens of Auld Reeky were concerned, and in 1840 he was forced to leave Edinburgh, together with fame and fortune. He went to London, studied the anatomy of whales and died in obscurity in 1862.

There were some sequels to the sordid episode. The government was compelled to regulate such matters as medical dissection by the passage of the Anatomy Act in 1832. Burke gained dubious posthumous glory by having his name pass into the language—‘to burke’, meaning to kill secretly by suffocation or strangulation, or to hush up.

Many years later a postscript to the story emerged. In 1986 Professor Matthew Kaufman was appointed to the Chair of Anatomy at Edinburgh and during his early explorations of the rambling department he came across a hitherto forgotten collection of about 300 plaster death masks They had been bought by the anatomy unit from the Edinburgh Phrenological Society (who else) over a hundred years previously and promptly forgotten.