It was billed as a mass assault on a public health crisis that was gripping an impoverished post-war Glasgow.
In 1957, the Scottish city had the highest death rate from tuberculosis (TB) in Europe, and in an extraordinary effort, health officials embarked on an ambitious “X-ray now” mass-screening campaign that saw more than 700 000 people in five weeks.
An army of 12 000 volunteers mobilised nearly three quarters of Glasgow’s population to get checked, with health officials throwing in the incentive of free prize draws for those who got X-rayed.
This included draws to win TVs, holidays and cars, but also included more unconventional prizes such as cigarettes, chickens and chocolates.
BBC Scotland reports that the resounding success of the 1957 programme meant 2 369 people with TB were caught and treated – but a new study led by the University of Glasgow has established wider benefits.
The researchers found that because the screening programme stopped TB circulating so widely in the city, in the next five years, an estimated 4 599 cases were averted, saving countless lives.
Peter MacPherson, professor of global public health at the University of Glasgow, said he hoped the lessons from 1957 could help efforts to eradicate TB today, as the disease still kills more than 1.2m people a year worldwide.
“This mass screening had a huge impact, doubled the rate of people being detected with TB, and really accelerated the reduction in cases.
“There really is nothing comparable in the world in terms of the programme’s scale.
“We can learn a lot from what has been done historically – it was real civil enterprise, people’s motivations were to help their neighbours, as at that time, probably everyone knew someone who was affected by TB.”
The rapid screening programme in Glasgow involved a total of 37 mobile X-ray units and radiographers seconded from cities across the UK.
A publicity blitz about the campaign saw loudspeaker vans and an illuminated tram car tour the city, aeroplane banner advertising and two specially-commissioned campaign songs broadcast at football matches.
Everyone who underwent a chest X-ray received a badge, and randomly selected people who were spotted wearing badges received small gifts such as chocolates, chickens, and cigarettes.
There were also prize draws for participants which saw refrigerators, TVs, washing machines, holidays, furniture and a car up for grabs.
MacPherson said some of the prizes, like the cigarettes, are “things we would not recommend nowadays”, but, he added, researchers working on the study were struck by the scale of the volunteer effort to make the programme a success.
“The total of 12 000 volunteers was remarkable – the community of Glasgow really came together for this, going door-to-door and encouraging people to come forward.”
He said TB is quintessentially a disease of poverty.
“Post-war Glasgow had some of the highest rates in Europe of TB and that was really driven by overcrowding and substandard housing, really poor nutrition after WW2, and air pollution.
“Nowadays the centres of the TB infections are Africa, Asia and South America, and we still have guidelines for mass screening for TB …but we don’t have a good handle on what works. This historical evidence from Glasgow can help these places, I think.”
Rising cases in Scotland
Data from Public Health Scotland last month revealed that the number of TB cases in Scotland increased by more than 40% in 2023 to the highest number since 2017.
The statistics showed 283 cases of the disease were recorded last year compared with 201 in 2022.
Public Health Scotland said the incidence of the disease in people born overseas was 19.2 times higher than for people born in Britain, and there remains a strong link between TB cases and areas of deprivation.
The study was published in PLOS Medicine.
Study details
Impact of active case finding for tuberculosis with mass chest X-ray screening in Glasgow, Scotland, 1950–1963: An epidemiological analysis of historical data
Peter MacPherson, Helen R. Stagg, Alvaro Schwalb et al.
Published in PLOS Medicine on 5 November 2024
Abstract
Background
Community active case finding (ACF) for tuberculosis was widely implemented in Europe and North America between 1940 and 1970, when incidence was comparable to many present-day high-burden countries. Using an interrupted time series analysis, we analysed the effect of the 1957 Glasgow mass chest X-ray campaign to inform contemporary approaches to screening.
Methods and findings
Case notifications for 1950 to 1963 were extracted from public health records and linked to demographic data. We fitted Bayesian multilevel regression models to estimate annual relative case notification rates (CNRs) during and after a mass screening intervention implemented over 5 weeks in 1957 compared to the counterfactual scenario where the intervention had not occurred. We additionally estimated case detection ratios and incidence. From 11 March 1957 to 12 April 1957, 714,915 people (622,349 of 819,301 [76.0%] resident adults ≥15 years) were screened with miniature chest X-ray; 2,369 (0.4%) were diagnosed with tuberculosis. Pre-intervention (1950 to 1956), pulmonary CNRs were declining at 2.3% per year from a CNR of 222/100,000 in 1950. With the intervention in 1957, there was a doubling in the pulmonary CNR (RR: 1.95, 95% uncertainty interval [UI] [1.81, 2.11]) and 35% decline in the year after (RR: 0.65, 95% UI [0.59, 0.71]). Post-intervention (1958 to 1963) annual rates of decline (5.4% per year) were greater (RR: 0.77, 95% UI [0.69, 0.85]), and there were an estimated 4,599 (95% UI [3,641, 5,683]) pulmonary case notifications averted due to the intervention. Effects were consistent across all city wards and notifications declined in young children (0 to 5 years) with the intervention. Limitations include the lack of data in historical reports on microbiological testing for tuberculosis, and uncertainty in contributory effects of other contemporaneous interventions including slum clearances, introduction of BCG vaccination programmes, and the ending of postwar food rationing.
Conclusions
A single, rapid round of mass screening with chest X-ray (probably the largest ever conducted) likely resulted in a major and sustained reduction in tuberculosis case notifications. Synthesis of evidence from other historical tuberculosis screening programmes is needed to confirm findings from Glasgow and to provide insights into ongoing efforts to successfully implement ACF interventions in today’s high tuberculosis burden countries and with new screening tools and technologies.
See more from MedicalBrief archives:
TB back as world’s deadliest infectious disease
WHO lists top endemic pathogens urgently needing new vaccines
Good diet, social benefits, can halve TB infection – Indian study