Abstract
By Malcolm Nicolson and John E E Fleming
Baltimore: The John Hopkins University Press, 2013
ISBN-13: 978-1421407937, Price £26
This book describes the history of diagnostic ultrasound in gynaecology and obstetrics in Glasgow under the leadership of Ian Donald, Professor of Midwifery in Glasgow, over two decades from the mid-1950s.
An early chapter gives an interesting review of previous and contemporary attempts at medical ultrasonic imaging by researchers in several different countries using both A-scan and cross-sectional imaging techniques. Two developments were particularly relevant and known to Donald but seemingly not to his future coworker Tom Brown. These were an automatic compound scanner that involved the subject sitting in a water bath, published by Howry in 1954, and both linear and compound contact scanners published by Wild and Reid in 1952. (Further details of these and other early research work can be found on the web site of Dr Joseph Woo – http://www.ob-ultrasound.net/history1.html.)
The account of the Glasgow work begins with the efforts, between 1954 and 1956, of Donald, and midwifery registrar John MacVicar, to use an ultrasonic flaw detector to investigate gynaecological anatomy and pathology. Their limited success was greatly boosted in late 1956 when Brown, a young engineer from Kelvin and Hughes, the Glasgow-based manufacturers of flaw detectors, became involved. He replaced their outdated machine with a more modern one and made further instrumentation improvements. Brown went on to design and construct a contact scanning two-dimensional imaging system with a hand-guided probe that the user could rock to provide compound scanning. Ultimately, Brown’s scanner was refined and marketed from 1963 as the Diasonograph by Smiths Industries (as Kelvin and Hughes had become) and later as the NE4101 by Nuclear Enterprises. Further design improvements culminated in the more widely sold NE4102, launched in 1972.
Later chapters describe how users of this equipment in Glasgow and elsewhere discovered how ultrasonic imaging could benefit the management of obstetric patients, for example, through more reliable diagnosis of missed abortion and hydatidiform mole, improved placental localization, and monitoring of BPD, CRL and foetal heartbeat.
The final chapter relates to the word ‘Imagining’ in the title. It considers the social implications of making the foetus visible as a living individual, particularly with regard to its effect on discussions and decisions regarding abortion.
It is disappointing that the authors choose to label the works of some other researchers, such as Wild and Reid, Howry, Hueter and Dussik as ‘failed’. They do this on the grounds that, unlike the Glasgow work, their work did not lead to ‘sustained technical development or significant clinical application’. In fact, the works of all pioneers are, like the Glasgow work, bricks in the wall of progress. Negative results, blind alleys and short-lived developments all provide valuable lessons that contribute to the total progress. The Glasgow work was particularly fortunate in benefitting from a combination of favourable factors: Donald’s clinical interest in gynaecological masses and the pregnant uterus –particularly ‘photogenic’ sites for ultrasonic imaging due to the contrast of solid and liquid-filled structures; Donald’s strong personality, providing drive, the ability to attract funding and other help and a marked preference for immediately trying out ideas on real patients rather than experimenting with laboratory models; Brown’s familiarity with, and access to, up-to-date components of flaw detection equipment and the strong support of a commercial manufacturer of such equipment.
Nevertheless, this book provides a fascinating and detailed account of the development of a landmark scanning machine, the people involved and their contribution to ultrasonic imaging.