British Journal of Radiology (2004) 77, 499-503
© 2004 British Institute of Radiology
doi: 10.1259/bjr/15678109
The British Journal of Radiology and the Second World War: a radiologist's retrospective
I J Kenney, BSc, MBChB, FRCR
X-ray Department, Royal Alexandra Hospital for Sick Children, Brighton BN1 3JN, UK
 |
Introduction
|
|---|
The British Institute of Radiology (BIR) is the oldest radiological society in the world, having been in existence in various guises since 1896 and as the BIR since 1924. Such an august society clearly requires a journal of authority with which to communicate with members and to publicise its work, both scientific and political, to the wider scientific community. Although the new series of the British Journal of Radiology (BJR) was founded in 1928 to fulfil this role, like the Institute itself it had been around since 1896 under different names (Table 1
). Thus it was that in 1938, as the countdown to the second major conflict within a generation began, the BJR was already a mature publication. In what follows, I hope to provide a glimpse of the role that the Journal played in the life of the radiological community during that period and also to show the effect of the war on the Journal and thence on the workings of the Institute. I will not restrict myself solely to contents of the Journal. Where appropriate, I use BJR as a vehicle to talk "off camera" as it were about other pieces of historical information from the period that the reader might find of interest.
|
1938 – International tensions rise, but all's quiet at 32 Welbeck Street
|
|---|
The business that was the BJR was conducted by an Editorial Committee chaired by the Honorary Medical Editor Dr Peter Kerley. The Committee not only selected the papers to be published, but was involved closely in all aspects of the Journal's advertising and publication. Meetings were held monthly. In 1938 the Committee fulfilled its obligation to the Institute and its members by market testing the printing and design of the Journal. It was decided to retain Percy Lund Humphries as the printer for the next 3 years. The annual budget for the Journal was fixed at a princely £1,800 per annum. Several design options for the cover were reviewed and in November, the buff cover was unanimously chosen (Figure 1). Size was to be increased by 
inch each way, the number of pages expanded from 64 to 72, and double columns used.
1938 ended as it had begun, with the BJR doing its job of trying to keep members in touch with the latest thoughts of the authors and the BIR and providing notices of up-and-coming events. Membership of the BIR included the monthly Journal, and all for 3 guineas per annum.
|
1939 – War is declared
|
|---|
The Honorary Editors, Major Peter Kerley (Medical) and GE Bell (Physical and Technical), and the Editorial Committee are shown in Table 2.
Although it was becoming clearer that war was likely and indeed perhaps inevitable, life seems to have continued pretty much as normal for the Committee in early 1939. A taste of things to come arrived in spring with a letter from the National Library of Peiping asking whether the BIR could help in rebuilding its library. This had been lost in the war with Japan and was being reconstituted in Hong Kong. Peiping may be more familiar as Peking. After the end of World War II the city was entirely restored to Chinese sovereignty and is now Beijing, China's capital. Issues of BJR for 1938 and 1939 were sent.
Perhaps it was this request that prompted consideration at the editorial meeting of 11 May of the safety of the BIR's own library books and archive material in the event of an air attack. At this time there was a genuine and not unreasonable fear that bombers would cause major destruction with high explosive, incendiary and even gas munitions. This stemmed in part from the military doctrine called "Bomber Theory", which had held sway since World War I. This theory said that the self-defending bomber would always get through defences, and was somewhat strengthened by experiences in the German air campaign in Spain. Whilst subsequently proved incorrect, Londoners experiencing the blitz the following year might have been forgiven for thinking otherwise. Anyway, it was suggested that the archives and other chosen books could go down to the cellar for safe keeping. Dr Courtney Gage and the Honorary Editors were to choose which books should be accorded that honour. However, in June it was reported back to the Editorial Committee that after careful inspection by those delegated to do so, and subsequent to an ARP (Air Raid Protection) report at the Council meeting on 18 May, Council felt that while the basement would provide some protection from blast, the risks from fire and flood remained. They had therefore decided to store the Journal and valuable books in lead/zinc-lined tropical trunks and send them to the "country" for safe keeping. Other books could go into the wine cellar at 32 Welbeck Street, the Institute's home at the time. What became of the wine remains rather vague!
Events clearly then overtook the Editorial Committee and the June meeting was to be the last until March 1942. It simply was not possible to move around with the ease it had been previously, and probably not altogether desirable to congregate in London unless essential. All of the BIR's committee structure, including Council, was similarly affected. The business of the Society was placed in the hands of a small Committee of Management assisted by the Honorary Medical Editor until the war situation became clearer. This Committee undertook editorial duties for the BJR, which would continue in a somewhat reduced form. The Editorial Committee was disbanded.
But what of the publications in the Journal? The April 1939 issue carried a notice on behalf of the Royal Army Medical Corps (RAMC) announcing the formation of an Emergency Reserve of Officers and asking for radiologists to volunteer. It was suggested that many advantages would be gained by joining early, and of course a salary would be payable – £20 per annum. A number of articles appeared regarding safety, risk and storage of radium during war. Radium is highly radioactive (
, 
and high energy 
), has a half-life in the region of 1600 years and has radon gas as a daughter product, which degrades to radioactive dust. The possibility of destruction and dispersal of a radium source in a blast caused considerable concern.
The October issue carried notes of the annual meeting, which installed Major DB McGrigor as BIR President. He was to become one of the most important figures in military radiology. In fact, the first "military radiology" paper to appear was Major McGrigor's "Selected methods of foreign body localization adaptable to radiology in wartime" in the November issue. Perhaps surprisingly, the fact that war had been declared in September received no formal acknowledgment in the Journal's pages.
|
1940 – The Phoney War, Dunkirk, Battle of Britain and the Blitz
|
|---|
1940 was the year the war started for real for Britain, and a disastrous start May/June proved to be. France collapsed within a few weeks under the German onslaught and the British Expeditionary Force (BEF) was miraculously recovered (minus equipment and significant rearguard units) from the beaches of Dunkirk. The July issue of BJR carried its only notice of a radiology death on active service to appear during the war; Major Peter Robin Goodfellow. It was reported that he had been with 1st British General Hospital (BGH) at Dieppe and was killed when the hospital was bombed. In fact the story of this event is rather sadder still. Major Goodfellow, together with the rest of the specialists, had been ordered away from 1BGH as it retreated from Dieppe and were ordered to join 4BGH at La Baule on the French Atlantic coast. When the rest of 1BGH's staff eventually rejoined 4BGH, it was discovered that Major Goodfellow had fallen to his death from an upper window.
Articles on military aspects of radiology had yet to arrive, but the Journal's year is notable for one other event, the departure of the Honorary Medical Editor Major Peter Kerley (of Kerley's lines fame) for service overseas. He was replaced as Honorary Medical Editor in November by Dr H Courtney Gage. Kerley, despite his relative youth (born 1900, Dundalk), was already a high profile figure in radiology. Apart from his editorial duties, he had served on the BIR Council since 1934 and was Chairman of the Radiology Section of the Royal Society of Medicine in 1939/40. The upper age limit of the "draft" for doctors in 1940 was 41 years of age, and so despite his profile Kerley had to answer the call when it came.
After the disaster of Dunkirk, at least the failure of the Luftwaffe to win air superiority over southern Britain relieved the threat of invasion and lifted the nation's gloom somewhat as winter of 1940–41 approached.
|
1941 – Britain stands alone in Europe, and shortages bite
|
|---|
In 1941, articles on aspects of radiology and the military began to appear more frequently. For example, the March issue carried "The radiological investigation of dyspeptic soldiers" by R Saffley, Assistant Radiologist, Western General Hospital, Edinburgh. Dyspeptic soldiers were taken into the X-ray room in groups of five to have barium studies. 38% had duodenal ulceration. Saffley eloquently concluded that "in marching on its stomach, the army of today apparently produces considerable wear and tear."
In April it was reported in a tantalisingly succinct note that radiologists Majors Brocklebank, Cresswell, Maddocks and Punshon were mentioned in dispatches on account of gallant and distinguished conduct while serving with the BEF in France. Interestingly, as articles written by radiologists enlisted with the forces began to appear, the authors would give their name but not their unit or location. For example, an author might quote himself as "Eric Samuel, Major, RAMC", or even more cryptically, "Eric Samuel, Radiologist to a Military Hospital." Careless talk costs lives!
In September, an editorial proudly announced the promotion of the President, Lt.-Col. McGrigor, to full Colonel. It was opportune during these difficult years of the early war that the Institute had as its President a military man of such experience and standing. This happy circumstance was not lost on the Institute. McGrigor was re-elected twice, serving three terms as President (1939–42), something that has not happened since.
As Britain, its Commonwealth and a small but loyal group of allies fought the Axis powers in North Africa and the Middle East through 1941, the British public found themselves in the frontline as Germany attempted to starve Britain into surrender. Shortages caused by loss of trade and sinkings of merchant shipping on a dreadful scale were making an impact that would increase through 1942. The Ministry of Supply oversaw increasingly tight food, petrol and commodity rationing. For the BJR though, it was the paper shortage that would create most difficulty.
The end of 1941 saw America enter the war after Pearl Harbour and provided a powerful ally with industrial capacity that would ensure the Allies' ultimate triumph.
1942 – Paper shortages and the low point for Britain
On 29 January 1942, the BIR Council received a letter from the British Museum asking whether Volume 1–14 of the BJR, which had been destroyed by enemy action, could be replaced. On the night of 10 May 1941, the Museum had suffered catastrophic damage to several areas, amongst which was the south-west Quadrant, where a number of medical texts were located, including some squeezed in on temporary sliding racking. A canister of small incendiary bombs had apparently opened at unusually low level, raining a concentration of dozens of bomblets, which lodged in flammable roof cavities and crashed through the glass roof of the Quadrant. The closely packed books burned like a blast furnace while water from fire hoses put paid to many that escaped the flames. Around 250,000 volumes were lost, including BJR and its predecessors. The Institute was able to make good this loss from its reserve of back issues, all except the July 1938 journal that was later provided by private donation. The paper shortages mentioned above were taking effect. The Journal was reduced in size from 266 mm by 196 mm in December 1941 to 248 mm by 185 mm in January 1942 to ensure the supply of paper was sufficient to meet the Journal's needs up to and including the June 1943 issue. The March issue carried a notice to authors that, owing to shortage of paper, the facility for extra reprints was withdrawn immediately. Worse still was to come. The Ministry of Supply's Paper Control Committee had ordered the printers to cut to 30% the weight of paper used for the Journal in the March to June issues. Even this was a special dispensation. A reduction to 19.5% was generally being enforced. As an emergency measure for April, three papers were deleted, blank advertising inserts were utilized for editorials, print size was reduced and the total print run was reduced by 350. Going forward, it was decided that text pages should be cut from 32 to 26, advert pages from 18/20 to 14/16 and a markedly thinner cover of the same colours would be used. Print size would be reduced to 10 point for text and 8 point for abstracts. The usual print run had been 2500 copies. 870 went to BIR members and 1250 to Society of Radiography (SoR) members. The SoR cooperated with a reduction of 200 (members in arrears of subscriptions!). A prepaid postcard was sent to all members of the SoR and BIR asking whether they would be prepared to forgo BJR for 6 months, 1 year or the duration of the war. Staff in larger teaching hospitals were asked to share a library copy. These measures, together with reducing the reserve copies from 50 to 5, allowed an increase in the print run to 2400. An editorial note in the April 1942 issue explained the problem and apologised to members. It also asked that any unwanted issues be returned.
Britain might be starving and short of BJRs, but at least the threat of invasion had receded and the bombing had become largely a night-time event. This allowed a qualified return to "normality" for the Institute's committee structure. The Editorial Committee re-formed as the smaller Editorial and Library Committee, which began to meet again on 26 March 1942. Its members are listed in Table 3.
Papers on military aspects of radiological sciences were now commonplace, but in late 1942, two papers appeared that are worthy of special mention. In October, "The problems of post-war reconstruction in Radiology – a symposium" discussed, amongst other issues, the merits of the radiological specialist versus the generalist – a familiar debate still relevant today. Even in these difficult times it seems that thoughts in the profession were already turning to victory. In complete contrast but perhaps sharing the same irrepressible optimism, the November edition carried "Filling defects within the barium-filled duodenal cap. A case report" by Major C Winsor Horncastle, Radiologist, Kriegsgefangenen Lazarett, Stalag VIII B, Germany. The patient, a 30-year-old Indian seaman, had had symptoms since his capture 6 months previously. A barium meal showed two almost circular filling defects that varied in position. These were considered to be polyps. 5 days later the patient vomited a bean, coated with a thick layer of bile. This bean was of a type he had not apparently had the opportunity to eat since capture, but which had been a regular part of his diet on board ship. A repeat barium 2 h after the vomiting episode revealed only a single mobile filling defect. Happily the symptoms resolved after this event. Major Horncastle says in his reference section: "On Account of present circumstances, references are limited to. Schinz, Baenssch, Friedl. Lehrbuch der Röntgendiagnostik (4th Ed), and Köhler. Grenzen des Normalen und Anfänge des Pathologischen im Röntgenbilde (7th Ed)". Further, he expresses great regret that it proved impossible to include images with his case report. His desire to contribute puts many of us to shame. Winsor Horncastle took the Cambridge DMRE (Diploma in Medical Radiology and Electrology) in 1939 and undertook a period as a registrar at the Westminster before joining the RAMC. He survived his time in captivity, being awarded the MBE in December 1945 for "gallant and distinguished service" while a prisoner of war, before returning to practice in Peterborough. In theory at least, Horncastle should not have been a held prisoner. According to the Geneva Convention, to which both Germany and Britain were signatories, Medical Officers were to be regarded as non-combatants attached to an army. They were not to be treated as prisoners, were not to be held after capture, and during a period of capture were to be allowed to continue their work without distinction as to friend or foe, until their release. These niceties were widely ignored by all sides and a later assessment by the War Office suggested that over 400 RAMC officers were being held in captivity.
|
1943 – The tide of war turns
|
|---|
For the BJR, 1943 continued as 1942 had left off. Regular articles on aspects of military imaging appeared, together with the usual mix of civilian articles and notices. The year commenced with notice that the president, Col. McGrigor, had handed over after his epic term to physicist Prof. Mayneord. In handing over, he made special acknowledgment to the Editors Dr Courtney Gage and Mr Bell for piloting the Journal through a very difficult period.
In May 1943 the BJR announced that it was again embarrassed by a shortage of copies of the Journal. Members were requested to return any unwanted copies. Even in wartime the Journal's popularity was outstripping the restricted print run.
In August, Major NA Lawler RAMC was mentioned in dispatches for gallant and distinguished services in the Middle East. Although these citations never tell us what exploits our colleagues had undertaken to deserve such mention, we know that Lawler had attracted the attention of his superior, the Advisor in Radiology for the Middle East Force, by inventing a "reconditioner".
On the wider front, the pendulum of war was beginning to swing back, albeit slowly. The tide of Japanese advances in the Pacific had been halted and then turned. In Europe the battles against the U-boat in the Atlantic would be won by mid year and strangulation of these islands narrowly averted. Rommel's Afrika Korps was ejected from North Africa. British, Commonwealth and American troops had landed in Italy, and the Americans, including whole hospitals with their radiology departments and radiologists, were beginning to arrive in numbers in the UK in preparation for the invasion of mainland Europe.
In November, Major Eric Samuel took over as Honorary Medical Editor. Samuel was another big name in military radiology at the time, and was involved in the Army X-ray School at Millbank in London.
|
1944 – D-Day and the beginning of the liberation of occupied Europe
|
|---|
1944 is notable for a number of reasons; not least that 6 June would see the largest seaborne invasion ever, land on Normandy's beaches. The conscription of medical personnel in the build-up and support of this new campaign reached such numbers that civilian services were inevitably forced to suffer. Indeed, in January 1943, of 4444 specialists of all ages on the UK Medical Register, 842 were serving with HM Forces. Through the rest of 1943 and early 1944 the proportion serving increased further.
Throughout the year, names of colleagues who had distinguished themselves in service continued to appear. Mentioned in dispatches for distinguished service were Lt.-Col. JH Baird RAMC (February, Burma front), Major WH Milligan RAMC (April, Middle East) and Major CJ Hodson RAMC (October, 98BGH, North Africa).
In September it was noted that Captain JD Dow RAMC had been awarded the Military Cross (Figure 2) for distinguished and gallant service in the campaign in Italy. Interestingly, as his rank suggests (Captain as opposed to Major, the rank normally accorded to specialists serving with RAMC), Dow had been one of a new breed of "Graded Radiologists", a sub-consultant career grade in today's parlance. This grade was introduced in response to a critical shortage of specialist radiologists that had to be addressed in a very short time-scale. The war would not wait. Dow was converted from a general duty doctor into a radiologist by rapid intensive training at the Army X-ray School, before serving under supervision at 94BGH and then 96BGH in Algiers and then moving on into Italy with the invading forces. He obviously performed his duties beyond what could have been expected.
View larger version (86K):
[in this window]
[in a new window]
|
Figure 2. Military Cross. Silver cross, white riband with purple stripe. Awarded for distinguished and meritorious services by junior officers (Captain and below, extended to Major in 1931).
|
|
October carried an article of some interest, "X-ray diagnosis in gunshot wounds of the abdominal cavity and its significance in field surgery" by SA Reinberg. The author was Professor of Medical Science and Director of the Molotov Central Science Investigation Institute of Röntgenology and Radiology in Moscow. Not only is the article interesting for the picture it gives of the radiology of abdominal battle trauma, but there are other insights, e.g. "It is amazing the frequency with which a wounded patient arrives with the wrong diagnosis on his card." – no change there then! The Editor added a note to the effect that this article had been translated from Russian by the Soviet Embassy in London and that to avoid delay in publication, it was published without returning proofs to the author. One wonders how the article got from Moscow to London in the first place, and whether the note about proofs is a veiled reference to possible censorship. Reinberg's piece was a short excerpt from "Review of Military Radiology" published in Leningrad in 1940.
It is all too easy to equate military radiology with the RAMC. The BJR in 1944 saw articles published by radiologists from the medical corps of all three services – RAF and Royal Naval radiologists were inferior only in numbers.
The last issue of the year carried an appeal from the Conference of Allied Ministers of Education for copies of BJR to restock libraries in occupied countries. The territorial gains on all fronts by the allies were reducing the Axis powers' hold on continental Europe and were revealing that the ravages of war and wanton destruction of educational institutes and libraries had destroyed many collections. Unfortunately the continuing severe rationing of paper made it impossible to lay aside copies of the Journal to meet these needs. Members were asked to contact the Institute if they knew of copies becoming available from the libraries of deceased colleagues.
|
1945 – Victory at last
|
|---|
The pattern of military and civilian articles, by now familiar, continued. McGrigor, now Brigadier and OBE, featured heavily, starting in March a classic five-part series of articles with Lt.-Col. Eric Samuel on the radiology of war injuries. He also published a review of "The training of the military radiologist" in March.
The BJR continued to avoid political and historical comment in its pages. Just as the start of World War II had not been acknowledged in 1939, so its end in Europe in May 1945, and then in the East in September, evoked no comment. Similarly, the dropping of two atomic bombs in early August – events of massive significance to every radiation professional from then on – received no mention.
In November, GE Bell, having served as Honorary Physical and Technical Editor throughout the war, handed over to CW Wilson.
The last issue of the last year of this historical review recorded thanks and the names of 10 members of the Institute who had responded to the appeal of the previous December for collections of BJR to replace those destroyed in occupied countries. Finally, it was proudly announced that Lt.-Col. Eric Samuel had been awarded the Bronze Star by the President of the USA for his great contribution to American War Radiology.
|
Conclusion
|
|---|
I hope that this article has been able to provide the reader with some insight into the interrelationship between the BIR, BJR and radiologists during a conflict that, although costing 52 million lives, seems to have left British radiology none the worse for the trial. The BJR achieved uninterrupted publication at a time when members were unable to meet regularly and in many cases were working away from their civilian practices. I think it reasonable to conclude that the Institute and BJR contributed to the continued integrity of the profession.
It was a difficult period and a long time ago. That does not diminish the contribution of past colleagues as recorded in the pages of the wartime British Journal of Radiology.
|
Acknowledgments
|
|---|
Grateful thanks to Kate Sanders from the BIR Library, and Drs John Reid and David Hardwick and the current Editors for advice on the manuscript. It may also be appropriate here, on behalf of the "radiation professions", to record our thanks to all those involved in the Editorial Committee of the Journal over the many years of its existence, and without whose efforts it could not exist.
Received for publication February 9, 2004.
Revision received February 26, 2004.
Accepted for publication March 22, 2004.
Top
Introduction
1938 - International tensions...
