Using a Type F Monobar at St Mary's Hospital Medical School, London

Written by Emrys Sparks,
Director of Medical Photography and TV at St Mary's Medical School for nearly 30 years.


 Few professional photographers other than those involved in the medical / technical fields have ever come across the Ilford Monobar camera, and at first sight it's rather a strange beast. However after using one for a while you realise what a useful and versatile piece of kit it is, especially if you are used to humping around a 5x4 stand camera; but that shows my age!

I first came across the Monobar in 1966 when I joined a team of Medical photographers at St Mary's Medical School in London, under the directorship of Dr Peter Cardew, one of the leading lights in Medical photography.*

I had just returned from a year's contract making a film in Alexandria (that's another story), and was offered a six months temporary position, to cover maternity leave, at St. Mary's. This "temporary "job was to last me nearly 30 years.

I understand that Dr. Peter Cardew, along with his colleagues Dr Charles Engel and Dr. Peter Hansell at Westminster Medical School, were involved with Ilford and Kennedy Instruments during the design and development of the Monobar.**

When I retired from St Mary's in 1994 I was given a complete Monobar Type F camera, in a leather fitted case, with two lenses, and three 35mm film cassettes as a souvenir (see pictures below, courtesy of Doug McKee, now the new owner). Scroll below pictures to continue reading Emry's story.

Below; The Monobar Type F, with Film Magazines, Packed into the Fitted Case

Medical Photography (an overview)

The Monobar was used for many different applications, particularly in macro work in the studio where a 5x4 view camera would have been cumbersome, and with the additional economical versatility of 35mm film. It was occasionally used at other sites, because St Mary's, in Paddington, also covered other hospitals in the group.

The main use for the Monobar was for taking sets of serial pictures rapidly of patients in B/W, and colour reversal, all from exactly the same viewpoint.

A professor of Endocrinology was following the development of many Metabolic patients over weeks, months and even years, and it was important that photographs taken today could be repeated in a year's time to the exact view, scale, and lighting, and obtain matching prints for direct comparison.

Most people would say that this is relatively simple, but with several medical photographers working a rota system, it was rare that the same photographer was available to take the repeat views over a long period. Therefore, absolute standardisation every time was paramount for accurate somatotyping.

For anyone unfamiliar with the demands of medical photography, the key to success is that pictures can be exactly repeated, no matter what the time scale between follow ups. It is therefore necessary that pictures are taken to a set scale whether a full length shot of the whole body or a 1:1 close up of a finger nail, and also that every photographer can obtain identical results. This may sound like "robotic" photography, but it is important that the physician is able to chart the progress of any lesion over a long period, from a series of matching photographs.

Every patient photographed has a record card, which on one side records all relevant medical and diagnostic details, including the doctor requesting the pictures, the reverse is completed by the photographer (including his / her name) with details of camera, lens and aperture, lighting and, most importantly, the scale used.

We standardised on Nikon outfits, and had four aluminium camera cases, all containing identical outfits, and a good stock of film. In each case there were three Nikon bodies, a small flash gun (fully charged), a motor drive, a standard 55mm Macro lens, a 105 mm Macro and a 28mm wide angle. One camera body was loaded with FP4 film and the other two with Kodachrome 25 reversal film. Each camera body was numbered.

Each case also had a card with the list of scales numbered I to 9, showing the area each lens covered, and the correct aperture if using hand held flash. Each roll of film had a unique number, giving details of every frame taken, the patients name, hospital number and date. This was all entered into a day book (later computerised and copies backed up at a central IT unit), so that any enquiry about every patients' pictures could be instantly traced, including the photographer involved.

It is important to realise that if we received 10 rolls of processed film in the post, we could identify each individual frame, which was then matched to each patient. A copy of every colour picture was kept in our slide library (see below), and all B/W negatives filed and stored.

In a busy department, if an urgent call was received from the Accident & Emergency (A&E) department, or the operating theatre, the photographer could collect a camera case without delay, knowing that inside there would be a complete kit. It was almost a sackable offence to leave a camera not loaded, or the flash not charged.

There was a rota system for each photographer, such that one was available for everyday booked patients in the studio or ward, and another always on standby in case of an emergency call out.

NB: The 105mm macro lens is particularly useful in the operating theatre to avoid being too close to sterile areas. It is imperative that all trained medical photographers be conversant with the correct clothing and procedures for working in theatres or sterile areas. One becomes part of a team and must be aware of everyone working around you, the main requisite being that there is no time to think about apertures and shutter speeds, these have to be second nature and automatic in such situations. There is no second chance, it has to be right first time, every time, and the photographer must not delay the operation or procedure unduly.

Slide Library

A copy of every colour 35mm transparency was filed, so that comparison was possible for follow up pictures. This cross referenced filing system, started by Dr. Peter Cardew in the 1950's, was one of the most comprehensive in the country. When I retired (1994) t amounted to 45,000 colour slides, which were much in demand by publishers, TV companies and as teaching aids. The library was available to all medical staff, and extra colour copies were made if requested. It is now computerised and part of the Photo Science Slide Library.

Identical lighting is also paramount, so that swellings or rashes are shown clearly without undue shadow or highlights which could distort the condition, particularly in pictures of skin lesions. Colour must be natural and accurately reproduced over long periods, and to this end we purchased colour stock in large batches (750 rolls of Kodachrome 25) all with the same emulsion number, which was refrigerated on delivery. A control strip of colour patches and grey scales of every new batch was taken and filed, giving an exact comparison of processing conformity over the years.

Fortunately Kodachrome processing by Kodak was kept within tight parameters, and there was a special professional service which, although involving additional cost, enabled us to have a 24/48 hour turnaround. Just before I retired, computer controlled processing of Professional Ektackrome was installed, which was also offered as a service to many labs in the School who used colour film (Pathology, etc).

All colour printing was done by an outside professional laboratory in London, who specialised in printing for medical photographers, bearing in mind the confidentiality and content of some of the pictures. In house colour printing was installed in the 1980's.

Monochrome (B/W) processing (of Ilford FP4) was also tightly controlled, by the use of temperature stabilised deep tanks, with rigid records of the amount of films processed and pH adjusted and replenishment if required. The deep tanks were used daily for 5x4 negative processing. Normally, all B/W films from the Monobar camera were processed every Friday morning to a set time in Ilford ID.11, with a grey scale control strip included, so that densitometer readings could be made and recorded.

We normally processed a batch of 20 to 30 rolls of film on spirals, per week, (though occasionally films had to be processed quickly if the doctor requested urgent prints).

After processing, the films were printed to set scales on Durst auto-focus enlargers, onto Kodak grade 2 glossy paper. Originally prints were hand processed, but auto processors were installed in the 1980's, which gave standardised quality dry prints in less than 10 minutes, a great asset when producing 250 or more prints per day.

Setting up and Use of the Monobar Camera

In the studio we used Cambo stands for all our cameras from 5x4 to 35mm. These have massive central columns, with a right angled arm and platform, which can be quickly moved from floor level to about 2.5 metres high and locked in any position on the column. At the end of the side arm is a screw fitted platform for the cameras, which could be revolved around a central axis, with spirit levels allowing the cameras to be set horizontally, or vertically, very accurately.

The Monobar camera was mounted horizontally on the platform, with the viewing screen in the vertical position. On the central column there was a pre-set marker and the side arm was positioned on this marker. Thus the lens was always at a constant distance from the floor. On the floor there was a painted mark, and the Cambo stand, which moves easily on castors, was positioned over the mark and by pressing a foot pedal on the column, the whole of the stand was locked firmly to the floor.

The studio had a roll of white background paper from the ceiling, down the rear wall and across the floor for about 3metres, and a 2.5metre wooden scale marked in centimetres was positioned on the background paper just beneath a short length of chain hanging from the ceiling lighting grid. Thus the camera and scale were always at the correct distance and height for each patient. Shadow-less lighting was provided by 5,000Joules of electronic flash, with lamps fixed either side of the background, and overhead from the ceiling grid, all permanently wired to a central control consul in the studio. A large diffused electronic flash lamp was positioned directly above the camera lens, to give shadow less lighting.

With the 2" lens fitted, the patient (undressed) was asked to stand beside the scale, at which time, front, lateral and rear full length pictures were taken in B/W and colour, taking advanatge of the ease of changing of film cassettes. The 4" lens was then fitted, the camera was raised to a higher position, as marked on the Cambo column, and head and shoulder, front lateral and rear pictures again taken, without the patient moving.

Reading this may make the whole sequence seem very long and complex, but in fact it only took about 10 to 15 minutes for each patient. If several patients were to be photographed one after the other, the close ups could be taken first and then the full lengths, and vice-versa, and often groups of patients were booked in at one time from the clinic to allow this procedure to flow smoothly. We would usually photograph 10 to15 patients per week.

Using this method, all photographers followed the same procedure, and once set up the results were always consistent.

This was our primary use of the Type F Monobar, as 'camera movements' were not required. In fact, it was imperative for somatotyping that the patients were photographed without any of the distortion which could result from the lens and film plane not being parallel.

As we had two Cambo stands in our studio, we usually left the Monobar set up and ready for use, should any metabolic patients arrive from the clinic. It was also used for some Macro work, see example of close up of Penicilium Notatum alongside.

References & Acknowledgments

*    Dr Peter Cardew
** "The Cameras of Ilford, 1899-2005" By Andy Holliman.

I am indebted to Douglas McKee for his knowledge of the history and construction of the various models of Monobar Cameras.
I have also recently been in contact with Matt Gunn, Research Technician at Aberystwyth University Physics Department, who has modified a Type U Monobar for Digital photography. More details can be found on the Pentax Users Forum.


This page last updated: 29th April 2010