Tuesday, 22 April 2014

Politics versus Public Health

(no prize for guessing which wins)
Typhoid in Aberdeen, 50 years ago...

"Scotland's leading resort" in the 1950s:Aberdeen was promoted as a holiday destination.
Part of Aberdeen and harbour, early 1970s
Between May and October 1963 three small outbreaks of typhoid occurred in England - in Harlow, South Shields and Bedford; in May/June 1964 an “explosive” outbreak of typhoid in Aberdeen (Scotland) landed more than 500 people in hospital. Researchers have found that the failure to implement preventive measures, in particular the withdrawal from circulation of corned beef from a canning plant in Argentina (Establishment 25) in time to pre-empt the last episode, involved factors other than public health considerations. The Ministries of Health (MoH) and of Agriculture, Fisheries and Food (MAFF) were “very concerned to avoid publicity” (so no surprise there): MAFF especially in view of negotiations currently going on with the Argentine government, the MoH in the default mode of the civil service culture of secrecy. When the suspect corned beef was eventually withdrawn, it was left to the company concerned to get this done, without either informing local medical officers of health in Britain or publicising the source of the problem - untreated cooling water - in South America.

Establishment 25 was found satisfactory by MAFF's chief technical adviser on meat inspection but untreated water had been in use by two others, Argentine 1A and Uruguay 5. Consignments of corned beef from the former already in Britain were not withdrawn, leading to the Aberdeen typhoid. This outbreak, making hundreds of people sick, could not be covered up. Press interest and public outrage were intensified, interestingly but as it turned out mistakenly, by an allegation from the city’s medical officer of health to the effect that the culpable corned beef may have originated in stores stockpiled for the eventuality of nuclear war, as part of the government's extensive and elaborate (futile, wasteful, risible) Civil Defence preparations. A committee of inquiry (Milne) was formed, of course, as well as a special committee of ministers. Macmillan’s Tory government was on its last knockings, with a general election imminent: “The political stakes were high and decisive action was called for if public confidence was to be regained.”
During June recommendations by expert advisers were approved for the withdrawal of successive batches of canned meat. “Compared to decision-making in 1963, these decisions were made rapidly, stimulated by domestic political considerations, the intense public, press and parliamentary interest, and the sense of crisis that prevailed.” The customary convolutions of decision-making processes, however, compounded by turf-war-type disputes, meant that the Milne committee recommendation with regard to approving meat exports to Britain was delayed, and “it was also implemented half-heartedly, largely just to make it possible for the government to claim it had implemented the recommendation. The key factors involved here, then, were inter-departmental and inter-professional rivalries and wider pre-existing policy agendas, as well as political considerations.”
Getting the dodgy meat back out there
There were commercial considerations at work too, needless to say. A working party considered means of reprocessing to make the meat safe, and the Milne committee recommended that once a safe method was finalised, the suspect corned beef could be reprocessed and distributed. After trials, the Ministry of Health was satisfied that the reprocessed product (Establishment 1819 stock) posed no health risk. But there were objections both from sections of the food trade fearing consumer reaction, and from some consumers' representatives, with renewed press coverage. Harold Wilson, heading the Labour government elected with a tiny majority in October 1964, came out in favour of the permanent withholding of both the reprocessed and the suspect corned beef.
MAFF agreed to withhold their suspect nuclear stockpile stock permanently if the large producers and importers undertook to do likewise; the big firms subsequently re-exported their suspect stock to South America. But holders of the 1819 (as in Establishment, not year) stock had refused to be bound by same undertaking, and one lot began to distribute their reprocessed stock. “There were no legal powers to prevent this because no health risk was involved.”
“A further round of publicity, a chorus of protest from trade organisations, and further interventions from the Prime Minister followed. After meetings with the Minister of Agriculture the 1819 stock holders then agreed not to market their stock in Britain, in the expectation that MAFF would help them to find export markets. In the end, however, MAFF did little to help and the 1819 stock was eventually disposed of abroad on the initiative of the stockholders - and most of it was eaten without reprocessing. A few years later, most of the suspect stockpile stock was shipped to Gibraltar for reprocessing, on condition that it would not be returned to Britain.”
Thus an increased health risk (in the case of the 1819 stock) “was ultimately exported (and probably without the risk-receivers knowing of it) to inhabitants of foreign countries.”
There’s always vegetarianism...
There were further repercussions for international relations in connection with the food hygiene and the safety of meat imports.
At one stage notice was to be given to Argentina that, unless they cleaned up their meat industry, exports to Britain would be banned, but the British ambassador in Buenos Aires had other ideas, to do with increasing British exports to Argentina, and negotiating for Argentine support in the UN over Middle East issues. He was over-ruled, and a deadline, 1 June 1968, was set for improvements. “In retaliation, Argentina threatened not to proceed with the purchase of British military equipment and other orders, and, as a result, the public-health issues were again sidelined.”
“MAFF officials recommended to their minister that unless [meat plants which had not made improvements] were removed from the approved list British consumers would be exposed to risks of 'typhoid, paratyphoid, botulism and staphylococcal toxin'. However, in view of fears of further trade retaliation, no action was taken.”
By early 1969 improvements were found to have been effected, “largely independent[ly] of any British or Argentine government activity specifically concerned with the public-health dimensions of meat hygiene.” These were down to impending policy changes allowing into Britain only boned Argentine meat, which could not be produced reliably and profitably in run-down, unhygienic plants. “It was therefore commercial interests rather than public-health considerations which finally forced the owners to make the necessary investments in their premises and equipment.”
Main source for the above, including quotations: 
Lessons for food-safety policy from the Aberdeen typhoid outbreak, 1964, by David Smith http://www.historyandpolicy.org/papers/policy-paper-32.html
Some relevant files in the National Archives (TNA)

  • T 227/1655 Government inquiry into typhoid epidemic in Aberdeen. Treasury: Social Services Division (SS and 2SS series) 1964  
  • MAF 282/96 Milne Committee Report concerning the investigation into primary infection in outbreak of typhoid: Aberdeen. Ministry of Food and Ministry of Agriculture, Fisheries and Food: Meat and Livestock Division and successors: Meat Hygiene (FH Series). 1964
  • MAF 282/88 Typhoid outbreak in Aberdeen. 1964 - 1967   
  • PREM 11/5073 Outbreak of typhoid in Aberdeen: ministerial discussions; compensation   Prime Minister's Office: Correspondence and Papers, 1951-1964. SCOTLAND.
  • MH 148/354 Typhoid and paratyphoid: memorandum by Ministry of Health to Committee of Enquiry into Outbreak of Typhoid Fever in Aberdeen 1964 (Milne Committee). 1964  

A View from the North
In May or June 1964 at a school (Dingwall Academy, Ross-shire) about 20 miles north-west of Inverness, so not very close to Aberdeen, one lunch-time there was a meeting of the Young
Farmers' Club run by the Geography teacher (people joined who would otherwise have avoided it like the proverbial plague, because there wasn't a lot else going on and it was a way of getting into the building between canteen dinner and afternoon classes).
The chosen subject of his talk was the topical one of the Aberdeen typhoid outbreak, and the tone was calculated to induce maximum alarm and moral panic. Symptoms – with hindsight, apparently confused by the speaker with those of cholera – were described in lurid detail, and the risk of infection presented as being extremely high. Rather than any practical advice on hygiene and preventive measures generally, he seemed to favour quarantine + ostracism of as a first response, the implication being that we were probably all doomed otherwise. He waxed particularly alarmist over the announcement that a band from Aberdeen was to be playing for a dance at the 'Strath' (The Pavilion Ballroom, Strathpeffer, a magnet for the youth of the district on Friday and Saturday nights) that weekend, ranting that it shouldn't be allowed and should be boycotted.
One or two of his captive audience may have recalled an earlier rant inflicted on a younger class some years before, on the subject, coincidentally, of corned-beef production in the Argentine, which may have put them off the stuff if not turned them vegetarian, temporarily at least.
In Aberdeen itself, by autumn that year, the epidemic did not seem to be very much on people's minds or a cause of anxiety at the university, although of course it was known about, and it was said it had led to the public toilets in the city being made free of charge. (instead of the then customary penny-in-the-slot access to cubicles,  + 3d for wash & brush-up). Later still, not many signs were observable to indicate that the episode was in the forefront of people’s minds, and still fewer to suggest a collective trauma about it, apart from the occasional pointing out of the shop that was implicated in its origin, allegedly, through a consignment of dodgy corned beef..

The official repercussions rumbled on, however, and there was a small postscript in (around) May of 1965 when newsagents displayed a poster with the headline "
Corned Beef: Wilson [Harold, the then PM] steps in", causing some hilarity among passing students and youth.
- Personal communication

By-the-way Comment: Interesting to speculate whether the revelations about the government’s ‘nuclear stockpile’ of  food, and therefore readiness to contemplate mass deaths in a  nuclear war, may have fed in, as it were, to the mid-1960s phenomenon that was Aberdeen Youth CND. 

Banner in Trafalgar Square, Easter 1965

1 comment:

  1. For some more positive aspects of the history of medicine and public health in Aberdeen, see Secret Aberdeen, by Lorna Corall Dey (Amberley, 2016), pp.68-95 (chapters 7 and 8).