An intensive drive against tuberculosis’ 1939-1943

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‘MAKE A DATE FOR MASS X-RAY’

The post-war mass miniature X-ray campaign

For over 30 years from the 1950s, a fleet of mobile X-ray units travelled New Zealand’s highways, back roads and suburban streets, the highly visible flagships of the country’s anti-tuberculosis efforts. The post-war mass X-ray campaign was the most intensive and prolonged public health promotion New Zealand had experienced to that time, and its all-out nature illustrates the threat tuberculosis presented to society as a whole. Fear of TB was being countered worldwide by enormous confidence in new technological and medical advances and mass miniature X-ray was regarded as one of the lynchpins in the campaigns of New Zealand and other developed countries to eradicate tuberculosis. In conjunction with effective drug treatment, targeted BCG vaccination and rising living standards, the nationwide New Zealand mass X-ray scheme launched in 1952 saw tuberculosis move from being a threat to all New Zealanders to one that affected a much smaller group of people, with the Maori and Pacific Island communities dominating those for whom the disease remained a problem. Although serious questions were being asked about the cost-effectiveness of mass X-ray by the late 1960s, the capital organisational and symbolic investments in the programme meant it continued to target the whole population for another decade before being wound back to focus on at-risk groups.

The possibilities of mass X-ray

There was a sense of excitement during the 1940s in New Zealand and other developed countries about the prospects for dealing with tuberculosis.² As discussed in Chapters One and Two, the demands of war and new mass radiographic technology led to the decision to screen enlisting servicemen and women by X-ray. The results were unequivocal, and health authorities quickly recognised the benefits the technology could bring if extended for use among the civilian population.
In New Zealand, a school medical officer Dr Marie Buchler proposed the first civilian radiographic survey of Wellington secondary school children and factory and clerical workers in September 1941. The Medical Research Council (MRC) had been set up by New Zealand’s Board of Health in 1937 under the direction of the Director-General of Health. Committees to direct research were established in the areas of nutrition, goitre, hydatid disease, dental caries and tuberculosis, and funding for Buchler’s survey was obtained from the MRC’s Tuberculosis Research Committee.³ Buchler originally proposed the project as a counterpart to a study of pulmonary tuberculosis in 15 to 30 year old Adelaide conducted by South Australian chest physician (and later Federal Director of Tuberculosis) Dr Harry Wunderly.⁴ When it became apparent that Buchler’s project could be expanded to take in a broader age group and include men as well as women, the opportunity was taken. The survey offered a base against which to monitor an individual worker’s health but also provided valuable preliminary statistics about New Zealand’s true rate of tuberculosis infection.⁵
Buchler’s survey, which X-rayed 2204 office and factory workers and school children, confirmed other studies and the commonly-held view that men and women in the 25-29 age group were most at risk of tuberculosis. It also highlighted changing incidence profiles according to age. Both male and female factory workers had higher incidence than clerical workers in the 20-24 and 25-29 age groups. However, in the over-30-years category, female clerical workers had a substantially higher incidence and male clerical workers had a marginally higher incidence than factory workers. This shift in incidence between age groups led Buchler to emphasise the importance ‘of re-X-raying the negative-reactors again after a period of two years of stress and strain of wartime conditions’.⁶

The Taranaki Mobile X-ray Unit

Prior to the Division of Tuberculosis’s establishment in 1943, the rural, dairy-farming district of Taranaki was shown to have a high level of TB among its entire population, and particularly Maori. In recognition of the district’s high rates, the local Health Department office, Taranaki hospital boards and New Plymouth Hospital, under Dr Claude Taylor, had made special efforts to identify TB cases and to follow up contacts. In the short term, this vigilance increased the already alarming figures further. ⁷
In 1941, as part of the response to high TB rates, members of the Hawera Hospital Board visited the Taranaki Maori Trust Board to promote the possibility of urgent and co-operative action on the matter of Maori TB. The deputation suggested the district obtain a mobile X-ray unit that would allow the examination of Maori at their own homes. The elders of the Taranaki Maori Trust Board, eager to improve their people’s health and needing little convincing of the gravity of the situation, promised a grant of ₤2,200 for what would be the first mobile power X-ray unit in the country. ⁸ The Taranaki, Hawera, Stratford and Patea Hospital Boards were the other partners in this venture. A delighted Director-General Michael Watt praised its co-operative character and promised that, when requests for additional buildings were made as a result of the additional cases that would be found, the boards would receive ‘a sympathetic hearing’. The Taranaki moves were commended as ‘worthy of emulation in other districts’ in the Department’s 1943 Annual Report and received coverage in the press. The Taranaki Herald summed up the prevailing mood of determination in August 1942 when it hailed the Taranaki project as ‘striking at the roots’ of the ‘tuberculosis menace’.⁹
The Taranaki Mobile X-ray Unit was a co-operative undertaking and everyone involved was enthusiastic about the project, but it was almost five years before the first X-ray was taken. Delays occurred while the Native Affairs Department approved the Trust Board’s accounts. The order for the X-ray machine was placed at the end of 1942 through the United States Lend Lease Mission to New Zealand. The slow reality of such a project in wartime was illustrated by a Health Department memo in June 1944 advising the equipment was still in New York and the paperwork had to be approved by 23 separate committees in the United States before it could be shipped to New Zealand.¹⁰ The Westinghouse X-ray generator and tube finally arrived in September 1945 but had been damaged in transit. The Ministry of Supply had ‘fortunately taken the precaution of ordering two units’. Both units were damaged but, in the spirit of making do, the ‘undamaged portions’ were pooled to make one working instrument. Still to be obtained were a camera, the chassis and body for the truck and a car for the technician in a country under rationing and where the Army had first priority for vehicles and equipment. Between 1941 and 1945, costs had escalated to £4,710. This was funded by the Taranaki Maori Trust Board’s £2,200 grant and a Department of Health grant of £2,230. The four Taranaki hospital boards made up the balance of £280 and assumed responsibility for the operating costs over and above the Social Security subsidy of two shillings per micro X-ray.¹¹
The primary objective of the project was to reduce Maori TB. It was agreed that ‘Maori would have first call’ on the Unit’s services, although the Taranaki Maori Trust Board donation was made ‘without “tags” of any description’ and the Unit was to be used for all the people of Taranaki, irrespective of race.¹² Determined to get widespread Maori support for the project, the Taranaki Mobile X-ray Unit Executive Committee ensured that Maori protocol and sensitivities were recognised. It was agreed the X-ray technician should be Maori or, if not, ‘he must know the Maori mind’.¹³ The recruitment process took most of 1943, with behind-the-scenes representations in support of one candidate, who eventually refused the job on the basis of insufficient pay. Eventually, Hapi Love was appointed in December 1943 and undertook training at Wellington Hospital and locally.¹⁴
Mass X-ray was new technology but, in reality, it was also rudimentary and hardly high-precision work. The photographs taken on 35 millimetre film were very small and hard to read. They merely alerted physicians that the patient might have an abnormality and should be referred for a tuberculin test and large X-ray, which would then be read by a specialist. As a result, the qualities looked for in the X-ray technician were of a practical nature. It was apparently not necessary for him to know much about radiography as such, but ‘he MUST be completely at home with the apparatus itself, able to change tubes etc. He MUST know the local power supply.’ He also had to ‘be able to carry out ordinary running repairs to [the vehicle’s] electrical system, tyres, etc’. The Unit’s Technical Committee hoped for ‘someone who is prepared to “rough it” on occasion, though naturally this sort of assignment could not be insisted upon’.¹⁵

READ Domain Specific Languages Supporting Model Based Design

Chapter One ‘an intensive drive against tuberculosis’ 1939-1943
Chapter Two ‘the whole complex task’ 1943-1953
Chapter Three ‘Make a date for Mass X-ray’: the postwar mass miniature X-ray campaign
Chapter Four BCG Vaccination: just one of a slate of measures
Chapter Five The patient experience: a revolution?
Chapter Six The ‘problem’ of the TB immigrant
Chapter Seven Untouchables no more?
Conclusion
Appendices