Friday, 4 November 2016

Mass Miniature Radiography

On return from maternity leave, Project Cataloguing Archivist, Clair Millar, gives us an insight into joining the RVHvsTB project.

In what has seemed like a very quick year, I am very pleased to be back working on LHSA’s Wellcome Trust funded projects. I am now working on our RVHvTB case note project, with fellow Cataloguing Archivists Becky and Aline. I will be working to complete cataloguing of the third part of the collection, LHB41/CC3 Regional Hospital Board National X-Ray Campaign case files’. This series relates to the Edinburgh X-ray Campaign of 1958, a collaboration between the Department of Health for Scotland, the Regional Hospital Board, the Edinburgh Corporation (now Council) and the residents of Edinburgh.

As early as 1944 there was a build up to this campaign, which recognised that alongside the introduction of new drugs in the efforts to combat TB, there was also a need for detection of the disease through concerted screening of the population at risk. Thus, Mass Miniature Radiography (MMR) was born which in essence was mobile units, in vans, that carried X-ray screening equipment and set up in community areas to encourage as many people as possible to be screened for TB and other abnormalities. This was effectively a ‘mobile hospital’ that would come to you and had particularly successful results in Edinburgh. The evidence of these efforts can be seen within the series that I am cataloguing which consists mainly of referral notes with patients’ results of the screening process. Below is a fairly typical (redacted) example of one of the referral letters.


 Before taking a more detailed look at Edinburgh’s 1958 X-ray campaign lets return focus back to the history of MMR. As Becky and Aline have already mentioned in previous blog posts, throughout the twentieth century major transformations were taking place in the fight against TB, including antibiotic drugs and the BCG vaccination. However, a final push was needed to bring the disease under control and an emphasis was made on the importance of finding undiagnosed cases that were potentially new sources of infection[1]. In theory this would not only lead to referrals for follow-up treatment but also raise awareness of the infectious nature of the disease that threatened the population. The first MMR units had been operating across Scotland since 1944 but on a very small scale. It was not until 1956 that the Scottish Secretary of State announced a more ambitious MMR campaign which aimed to make a more valuable response at tackling the disease via a fleet of MMR units and enhancing publicity of the campaign. [2].

National investment into MMR units was a way of creating a rapid survey which reflected the extent of the spread of TB. By literally using miniature X-ray equipment, in the form of a 70 mm wide film and by using low doses of radiation, it meant that the process of screening could become portable. A mobile van transported the MMR units and they could go straight into the heart of public hotspots, such as workplaces, schools and community areas. X-ray screening could produce relatively quick results to catch active TB and it was also used to detect any other abnormalities mainly in relation to chest and cardiovascular diseases. In either case, referrals were then made for the patient to go to the appropriate medical specialists, in the form of a Chest Clinic or their GP for further investigation and treatment.  

Men and women queuing up outside an x-ray screening van. P/PL41/TB/005

The two year MMR campaign was eventually launched in Edinburgh in 1958 and proved to be very successful due to good organisation and effective publicity. It was recognised that alongside increasing the number of mobile units on the ground, public co-operation and support was key to making progress. This concept laid the foundations for what was to be labelled a ‘Community Campaign’, where the public played an important role not only by attending screenings but there were also many volunteers recruited to co-ordinate screenings and help persuade people to attend[3]. This raised awareness led to a success rate of 84.4% of Edinburgh’s population being screened and contributed to the permanent decline in the rate of TB.


Edinburgh Castle with illuminated x-ray promotional sign. P/PL41/TB/042

Interestingly, I came across a piece of correspondence amongst the MMR case notes that mentioned entry into a prize draw for those X-rayed throughout the campaign. Upon further research into the Edinburgh MMR campaign, it appears that many incentives were used to encourage the public to attend a screening, including awarding them with both a badge and a raffle ticket that entered them into a special prize draw. There were some serious prizes that were donated to the cause up for grabs. Coming in at number one was a £3000 house, followed by a car, £2 per week pension for life, a bedroom suite, and a lounge suit, as well as numerous other smaller prizes. In just three weeks a total of 55,000 people in Edinburgh were also enticed to attend a screening, when a ‘Big Top’ circus tent was erected in Princes Street Gardens to provide entertainment for those awaiting X-ray.[4] These methods of persuasion were further enhanced by the general publicity promoted by the Campaign. Banners, posters, press releases, cinema and radio advertising, as well as an illuminated sign projected across Edinburgh Castle contributed to a well-executed public health campaign in Edinburgh and highlighted the importance of public participation in the fight against TB.

The 'Big Top' circus tent in Princes Street Gardens. P/PL41/TB/004

[1] F Ryan, Tuberculosis: The Greatest Story Never Told. Bromsgrove: Swift Publishers, 1992, pg 381.
[2] I Levitt, “TB, Glasgow and the Mass Radiography Campaign on the Nineteen Fifties: A Democratic Health Service in Action,” A paper prepared for Scottish Health History: International Contexts, Contemporary Perspectives Colloquium, 2003, pg 1-6.
[3] H E Seiler, A G Welstead, and J Williamson, “Report om Edinburgh X-ray Campaign, 1958,” Tubercle, vol. 39, 1958, pg 340.
[4] Ibid, pg 343.

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