The advent of radiation protection through WWI radiology martyrs

Dr Adrian Thomas

As we commemorate the centenary of the outbreak of World War One and as we approach Armistice Day on 11 November, Dr Adrian Thomas, BIR Honorary Librarian, reflects on the huge impact that the WWI radiology martyrs had on the radiation protection standards we take for granted today.

 

Many things were to change in 1914 at the start of hostilities and were never quite the same afterwards. The old confidences were shaken.

One item that symbolizes this period for me is an old wrist watch given to me by Yvonne Beech. It was presented to Corporal Edward Wallwork RAMC (Royal Army Medical Corps). Wallwork was from Lancashire and had worked in the cotton industry; he came to London during the Great War, joined the RAMC and trained as a radiographer.

 

The wristwatch presented to radiographer, Corporal Walwork, by three London radiologists

The wristwatch presented to radiographer, Corporal Walwork, by three London radiologists

At the outbreak of hostilities the War Office requisitioned a newly completed five-storey warehouse, H.M. Stationery Office in Stamford Street, for a 1650-bed Red Cross military hospital. The hospital was close to Waterloo Station and was connected by a tunnel. The building today is part of King’s College London.

The silver Swiss wristwatch was presented to Wallwork by doctors Ironside Bruce (1879–1921), Stanley Melville (1867–1934) and George Harrison Orton (1873–1947).

2bThe three doctors had all served in the forces as radiologists. Before the war men wore pocket watches and only ladies wore wristwatches. It was said that a man would sooner wear a dress than a wristwatch! However, pocket watches were not practical in the trenches. The wristwatch is a typical good quality Swiss wristwatch from the end of the First World War period and the numerals and hands were designed to be filled with radium to create a luminous dial.

The presentation of the watch was as a token of appreciation for Wallwork’s work in the X-ray department of the King George Hospital from 1915 to 1919.

Patients rehabilitating at King George Hospital

Patients rehabilitating at King George Hospital

All of the three doctors were deeply involved in the BIR or its predecessor organisations and sadly all three suffered from radiation-induced disease.  Their names are recorded on the X-ray martyr’s memorial in the grounds of St George’s Hospital in Hamburg.

Ironside Bruce was on the staff of Charing Cross Hospital and the Hospital for Sick Children in Great Ormond Street. He was very talented and published widely and his well known book “A System of Radiology; with an Atlas of the Normal” came out in 1907.

The British radiological world was shocked when Bruce died of radiation-induced aplastic anaemia in 1921 at the young age of 42. The outcry resulting from his death resulted in the formation of a radiation protection committee.

George Harrison Orton was a pioneer of radiotherapy and was in charge of the X-ray department at St Mary’s Hospital in London. After his death it was said in his obituary that he was “perhaps the last martyr pioneer of radiology”. Stanley Melville worked at St George’s Hospital in London and was BIR president in 1934. Both Orton and Melville served periods as co-secretary with Sidney Russ (physicist at the Middlesex Hospital) of the newly formed British X-ray and Radium Protection Committee set up by the BIR, and radiation standards were set.

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About Dr Adrian Thomas

Dr Adrian Thomas

Dr Thomas was a medical student at University College, London. He was taught medical history by Edwin Clarke, Bill Bynum and Jonathan Miller. In the mid-1980s he was a founding member of what is now the British Society for the History of Radiology. In 1995 he organised the radiology history exhibition for the Röntgen Centenary Congress and edited his first book on radiology history.

He has published extensively on radiology history and has actively promoted radiology history throughout his career. He is currently the Chairman of the International Society for the History of Radiology.

Dr Thomas believes it is important that radiology is represented in the wider medical history community and to that end lectures on radiology history in the Diploma of the History of Medicine of the Society Apothecaries (DHMSA). He is the immediate past-president of the British Society for the History of Medicine, and the UK national representative to the International Society for the History of Medicine.

BRITISH INSTITUTE OF RADIOLOGY www.bir.org.uk

BRITISH SOCIETY OF HISTORY OF RADIOLOGY http://www.bshr.org.uk

 

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Spreading the word about radiation protection

Jeanette Snowden

Jeanette Snowden

Lead Radiographer Jeanette Snowden, from Derriford Hospital, talks about the impact of delivering a BIR accredited radiation protection course at Kitale Hospital, Kenya.

There are many charitable organisations quietly delivering fantastic projects around the world with little fanfare. EGHO (Exploring Global Health Opportunities) and MEAK (Medical and Educational Aid to Kenya) work together to improve health in Kenya, focussing on trauma and orthopaedics, patient safety, hospital staff education and training, and community health. The aim is to teach and leave a legacy of education.

In April 2013 I was approached by EGHO, who wanted an imaging service delivered to theatres in Kitale District Hospital, West Kenya, which was new to the project. The hospital required an image intensifier (II) and an educational package, and the trip was planned for November 2013. My imaging department donated a II, which was collected and whisked into a container for its lengthy sea-bound journey within a week. The educational package required a bit of thought; I have been teaching radiation protection (RP) for a number of years to many professions, and I know it’s not the sexiest of subjects to teach– it does not have the attributes of, for example, ED trauma education, which can be dressed up with graphic photos and adrenaline. However, RP is essential training.

Listening to the experiences of radiographers who had provided imaging back up on previous orthopaedic EGHO trips to other Kenyan hospitals, I realised there was little interest from the local radiographers to continue the theatre imaging service Kitale signonce the project had returned to the UK. The image intensifier remained dormant, restricting the scope of surgical procedures and directly affecting patient care. However, I discovered that accredited courses with a certificate are held in very high regard within the Kenyan working community. Engaging the local radiographers and the theatre staff in the safe use of the II and RP was essential to the delivery of the project, and I believed a certified course, accredited by the BIR, would be the key to its success. With the support of the Clinical and Radiation Physics department within my Trust, and Andy Rogers, Vice President (External Affairs) at BIR and Head of Medical Physics at Nottingham University Hospitals Trust, I wrote a RP course, to include a practical session for the radiographers, an exam, safety signage and the all-important certificates. Rather brilliantly, the BIR accredited it.

MEAK team with Kitale staff, handing over the IIThe journey from the UK to Kitale took a slightly-longer-than-expected 36 hours, but the reception we received from the staff couldn’t have been more welcoming. The UK team arrived with over 30 cases of donated kit, and the staff set about finding storage in the fairly limited facilities. Nothing was too much trouble. The donated II had spent four months languishing on the docks in Mombasa awaiting Kenyan authorisation to travel to West Kenya, and to our relief was given the stamp of approval just after we arrived in Kitale. I spent a day travelling to collect it with a truck and a driver, and our return caused quite a stir – I had not known that this intensifier was only the second one in the whole of West Kenya – no one had seen one before, let alone know what it was capable of! Much to my amazement, given the journey it had just undertaken and how ‘temperamental’ they can be, the II worked the moment I switched it on. We were all set to go.

I delivered the RP practical training over a few days, given the space restrictions of theatre, but the Powerpoint presentation was attentively received by 23 candidates (3 radiographers, 15 doctors and all of the theatre staff), all crammed into a tiny staff room at 8.30am. I tested their prior and post-course knowledge, and am happy to report that all candidates significantly improved their RP knowledge. Practical training occurred during operative sessions, where all staff complied with the signage, maintenance of Controlled (Restricted) Area, and wearing of PPE. And-the theatre Charge nurse adopted the responsibility of supervising the area after the team returned to the UK. I trained a senior radiographer, Mr Okumu, in the specific use of the image intensifier.

Franklin's injury

Franklin’s femur before surgery

I cannot over emphasise the delight with which the imaging equipment was received by the local staff, nor the impact that it has already had on patient care. Franklin was one of our patients who had been on the orthopaedic ward in Kitale for over three months with a fractured femur, sustained during a motorbike road traffic collision. He had stones tied to his leg to act as traction. He told me he thought he was going to die in that bed.

Franklin's femur post-surgery

Franklin’s femur post-surgery

Using the II for guidance, the UK team were able to teach the local general surgeons how to implant a sign nail into Franklin’s badly-fractured femur. On our final ward round, we saw Franklin putting weight through his leg; a massive grin on his face, singing and high-fiving everyone in the team. He said we had saved his life.

 

II arriving in KitalleKitale District Hospital now has an imaging service in theatre, delivered by local professionals who have completely engaged in education accredited by the BIR.

Through this experience I have learnt a great deal, not least to truly appreciate, and not take for granted, the undeniable volume of work that has resulted in the high level of safety and the high quality healthcare system that we have in the UK. Jeanette is due to return to Kenya in April 2014.

To support radiography departments in Kenya visit her fundraising page http://uk.virginmoneygiving.com/JeanettteSnowden  

About Jeanette Snowden, Lead Radiographer for Theatre and Mobile Imaging at Derriford Hospital.

I look after over 35 theatres and 40 wards, including 4 critical care wards, and I am RPS for the whole area. I teach radiation protection at both Plymouth and Exeter Universities, to the student radiographers and to all amenable staff at Derriford! I love my job, and believe that every quality improvement should have a direct impact on the care that we give to our patients.