In the decades following World War II, tuberculosis remained one of Australia’s leading causes of death. Often dubbed the ‘silent killer’, tuberculosis could remain undetected for months or even years, spreading quietly through the population. In response, public health authorities launched an Australia-wide initiative that ran from 1948 until 1976. In this post, we take a closer look at the origins of the South Australian programme, how it operated and its impact on the South Australian public.
What is Tuberculosis
Tuberculosis (TB) is a contagious bacterial disease caused by Mycobacterium tuberculosis. It primarily affects the lungs, but can also spread to other parts of the body, including the kidneys, spine and brain. An infected person spreads TB through the air by coughing, sneezing, or even talking.
The symptoms of TB can be subtle in the early stages, but often include a persistent cough, chest pain, fatigue, night sweats, weight loss and fever. Over time, the disease can cause serious tissue damage, especially to the lungs. If left untreated, TB can be fatal.
The National Fight Against TB
In 1925, a Federal Royal Commission on Health recommended action to stop TB’s spread. It advised the newly established Commonwealth Department of Health develop a national plan. However, it wasn’t until 1945 that the Australian Parliament passed the Tuberculosis Act 1945, marking the beginning of a comprehensive national health campaign to eradicate TB.
In 1948, the government updated the Act, enabling the Commonwealth to take the lead in a nationwide effort. The programme was known as the Australian Tuberculosis Campaign (ATC). The ATC, which ran from 1948 to 1976, was the country’s first large-scale public health campaign. It provided free diagnostic chest x-rays, medical care, and a Tuberculosis Allowance for patients undergoing treatment.
When x-rays detected abnormalities, medical staff referred patients for further testing and, if necessary, treatment in hospital. The introduction of antibiotics such as streptomycin in 1945 and isoniazid in 1952 significantly reduced TB cases. The ATC distributed these antibiotics free of charge.
South Australia’s Pioneering Approach
South Australia was a global leader in TB control, becoming one of the first places in the world to make the notification of pulmonary tuberculosis compulsory in 1899. This progressive measure ensured that cases were reported to health authorities. Once notified, local boards of health dispatched nurses or health officers to educate households on disinfection, hygiene, and proper behaviour for individuals with TB.
Pulmonary tuberculosis must be notified by the medical practitioner attending the case to the Local Board of the District in which the patient resides in.
The Health Act 1898, Adelaide Observer, Saturday, 11 February 1899, page 15.
Voluntary and Compulsory Testing
Voluntary TB testing for the South Australian public began in the late 1940s and continued into the early 1950s. The first compulsory mass testing occurred in 1952 in Clare. Everyone aged 14 to 65 was required to undergo testing, while it remained voluntary for those outside this age range. Of the 2,152 individuals x-rayed in Clare, 30 were referred for further medical examination and treatment. Additionally, new migrants to South Australia were subject to compulsory TB screening upon arrival.
Under the Act, the government legally required people aged 14 to 65 to attend compulsory chest x-rays. Failure to do so could result in the person being fined or prosecuted. Health authorities took the legislation seriously and followed up with those who did not attend. In some cases, police escorted non-compliant individuals to x-ray centres to ensure the screening.
Mobile X-Ray Units
To carry out compulsory x-rays, the government commissioned a purpose-built mobile unit (bus). This unit allowed health staff to x-ray people all over South Australia. Initially, the South Australian Department of Health operated the service. Later, the Royal Adelaide Hospital Chest Clinic took over the programme.
Compulsory testing ceased in 1976, but voluntary screening continued, particularly at the Royal Adelaide Hospital. Until 1987, health workers used the mobile unit to monitor and treat high-risk groups. These groups included migrants, the homeless, and people in geographically isolated areas. But due to its age and condition, the mobile unit was retired for use in 1987.
In 1991, the Royal Adelaide Hospital Department of Thoracic Medicine again commissioned the building of a mobile x-ray machine to conduct tuberculosis screening of remote areas. The bus played a vital role in identifying TB cases in high-risk populations or those who had been in recent contact with an active infectious case. Royal Adelaide Hospital staff performed tuberculin skin testing and chest x-rays onboard. They developed the x-rays during the patient’s visit. Operating costs for the unit were covered by the Royal Adelaide Hospital. Combined with advances in medical treatment, the programme contributed to a significant decline in tuberculosis in South Australia.
Written by Margot Way, CALHN Health Museum