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Wellcome Witnesses
to Twentieth Century Medicine
Witness Seminar Transcript edited
by E M Tansey and D A Christie
AWitness Seminar held at the
Wellcome Institute for the History of Medicine,
London, on 10 March 1998
Volume 5 – January 2000
LOOKING AT THE UNBORN:
H I S TO R I CA L A S P E C T S O F O B S T E T R I C U LT R A S O U N D
CONTENTS
Introduction
E M Tansey i
Transcript 1
List of plates
Figure 1. Ian Donald. 6
Figure 2. Henry Hughes ‘Mark IIB’ Supersonic Flaw Detector.7
Figure 3. A Kelvin & Hughes Mark IV flaw detector.8
Figure 4. An A-scan from about 1956, showing the presence
of a large simple ovarian cyst. 8
Figure 5. Image from the first contact B-scanner,
a large simple ovarian cyst. 9
Figure 6. Tom Brown, standing in front of the newly built
contact scanner, c. 1957. 9
Figure 7. The first contact scanner in clinical use
in the Western Infirmary. 12
Figure 8. The first automatic scanner, designed byTom Brown. 12
Figure 9. Dugald Cameron’s sketch ideas on an
original proposal for the Lund machine.24
Figure 10. The re-designed Lund machine as it was actually
built and delivered. Drawing by Dugald Cameron. 24
Figure 11. The Lund machine. 25
Figure 12. A newly assembled Diasonograph shown at Smiths
(Kelvin & Hughes Ltd) Hillington works, Glasgow. 25
Figure 13. The Diasonograph showing the electronics
console and mechanical assembly. 26
Figure 14. Control panel of the Diasonograph. 26
Figure 15. The apparatus in use for fetal cephalometry by ultrasound. 52
Photographs and captions for Figures 1– 6 and 8 provided by Mr John Fleming,coordinator of the
British Medical Ultrasound Society (BMUS) historical collection.© BMUS historical collection,1999.
Photograph and caption for Figure 7 provided by Mr Tom Brown.© Mr Tom Brown, 1999.
Permission granted to reproduce photographs 9–14,Professor Dugald Cameron,1999.
© Professor Dugald Cameron,1999. Permission granted to reproduce photograph for Figure 15,
Dr James Willocks.© Dr James Willocks,1999.
Glossary 71
Index 73
i
1Nuclear magnetic resonance and imaging we re the subjects of a previous Witness Se m i n a r , published as Tansey E M,
Christie D A. (eds) (1998) Making the Human Body Transparent: The impact of nuclear magnetic resonance
and magnetic resonance imaging. InWellcome Witnesses to Twentieth Century Medicine, vol 2. London:
The Wellcome Trust, 1–74.
INTRODUCTION
During the twentieth century the human body has become increasingly transparent.
Since the announcement of X-rays in 1896, ever more sophisticated techniques have been
d e veloped to allow non-inva s i ve examinations of the human body, including NMR, PE T
and CAT scanning.1It is now possible, with the benefit of ultrasound imaging, to see a
body within a body, that is a developing fetus within its mother’s womb. The ability to
image the fetus and its associated stru c t u res has re vo l u t i o n i zed the clinical management
of pre g n a n c y. The obstetric ultrasound scanner had its major origins in a programme of
research undertaken in Glasgow in the 1950s and 1960s, under the leadership of the
obstetrician, Professor Ian Donald. Donald’s work was characterized by a remarkable
series of collaborations between engineers and clinicians, many of whom have come
together to take part in this Witness Seminar to consider the early history of ultrasound
imaging, its technical development and clinical applications.
Roughly divided into two halves, the first session of the meeting discussed the early
technical and engineering developments of the scanner. An important figure was
William Slater of the Kelvin engineering firm (it went through several name changes and
mergers during the period examined here) who believed in the medical and commerc i a l
possibilities of the new ultrasound technology, and who provided financial support for
re s e a rch and development work, often in opposition to his Board colleagues. It was
the encouragement of Slater that allowed the young engineer Tom Brown the time
and a modest budget to collaborate with Ian Donald in the development of a
two-dimensional, direct contact scanner, first built in 1956. Brown also met Du g a l d
C a m e ron, then a young art student interested in industrial design, whose early sketches
of an improved ergonomic machine, made on the largest piece of tracing paper he could
a f f o rd, we re the source of his first paid commission. We are grateful to Pro f e s s o r
C a m e ron for his permission to re p roduce some of those early drawings here .
Convincing sceptical doctors that this new approach was useful was a story that emerged
during the second part of the meeting. Many of the clinicians at the meeting recall the pre -
eminence at the time of ‘clinical judgement’ and resistance of doctors who had spent ye a r s
in ‘training their hands to see’, to a machine that they considered redundant. It was the
practical demonstrations of the capabilities of the early scanners, the publications that aro s e
f rom their use, and the increasing streamlining of the machines and their control consoles,
that made them what one witness refers to as ‘doctor-proof’ as possible, that gradually
convinced the majority of obstetricians to invest time and training in this new technology.
These are just a few of the memories and issues that are discussed here by our witnesses,
to whom we are grateful for the time they gave us not only in planning and holding this
meeting, but also during the lengthy editorial process, which is described below.
ii
2Much of the following text is also published in the ‘Introduction’ to vol. 6 of Wellcome Witnesses to Twentieth
Century Medicine. London: The Wellcome Trust, 2000.
WITNESS SEMINARS: MEETINGS AND PUBLICATIONS2
In 1990 the Wellcome Trust created the History of Twentieth Century Medicine
Group to bring together clinicians, scientists, historians and others interested in
contemporary medical history. Amongst a number of other initiatives, the format of
Witness Seminars – used by the Institute of Contemporary British History to address
issues of recent political history – was adopted, to promote interaction between these
different groups, to emphasize the potentials of working jointly, and to encourage the
creation and deposit of archival sources for present and future use.
The Witness Seminar is a particularly specialized form of oral history where several
people associated with a particular set of circumstances or events are invited to meet
together to discuss, debate, and agree or disagree about their memories. To date, the
History of Twentieth Century Medicine Group has held over 20 such meetings, most
of which have been published, as listed in the Table below.
Subjects for such meetings are usually proposed by, or through, members of the St e e r i n g
Committee of the Gro u p, and once an appropriate topic has been agreed, suitable
p a rticipants are identified and invited. These inevitably lead to further contacts, and more
suggestions of people to invite. As the organization of the meeting pro g resses, a flexible
outline plan for the meeting is devised, usually with assistance from the meeting’s
chairman, and some participants are invited to ‘set the ball ro l l i n g’ on particular themes,
by speaking for a short period of time to initiate and stimulate further discussion.
Each meeting is fully recorded, the tapes are transcribed and the unedited transcript
is immediately sent to eve ry participant. Each is asked to check their ow n
contributions and to provide brief biographical details. The editors turn the transcript
into readable text, and part i c i p a n t s’ minor corrections and comments are
incorporated into that text, while biographical and bibliographical details are added
as footnotes, as are more substantial comments and additional material provided by
participants. The final scripts are then sent to every contributor, accompanied by
copyright assignment forms. As with all our meetings, we hope that even if the precise
details of some of the technical sections are not clear to the non-specialist, the sense
and significance of the events are understandable. Our aim is for the volumes that
emerge from these meetings to inform those with a general interest in the history of
modern medicine and medical science, to provide for historians new insights, fresh
material for study, and prompt fresh themes for research, and to emphasize to the
participants that events of the recent past, of their own working lives, are of proper
and necessary concern to historians.
iii
ACKNOWLEDGEMENTS
‘Obstetric Ultrasound’ was suggested as a suitable topic for a Witness Seminar by Dr
Malcolm Nicolson of the Wellcome Unit for the History of Medicine, University of
Glasgow, and his colleague Mr John Fleming. They are currently engaged on a major
historical study of medical ultrasound, and provided the names of many of the
individuals to be invited, as well as assisting us in planning the meeting and deciding
the topics to be discussed. They both contributed throughout the meeting and we are
grateful to them for their input. We are equally grateful to Dr Angus Hall who also
helped in planning the meeting itself, and for his excellent chairing of the occasion.
Given the very visual nature of the subject, many of the participants brought slides
that they showed during the meeting. It has not been possible to reproduce all of this
material, but we do thank all those participants who have allowed us to reproduce
some of their illustrations, and also Mr Tom Brown for providing a detailed key to
Figure 7. Tom Brown and John Fleming have also assisted us at every stage of the
editorial process, and been patient and generous in answering our questions.
As with all our meetings, we depend a great deal on our colleagues at the Wellcome
Trust to ensure their smooth running: the Audiovisual Department, the Medical
Photographic Library, and the Publishing Department, especially Julie Wood who has
supervised the design and production of this volume. Mrs Jaqui Carter is our
transcriber, and Mrs Wendy Kutner and Mrs Lois Reynolds assist us in running the
meetings. Finally we thank the Wellcome Trust for supporting this programme.
Tilli Tansey
Wellcome Institute for the History of Medicine
iv
1993 Monoclonal antibodies3
Organizers: Dr E M Tansey and Dr Peter Catterall
1994 The early history of renal transplantation
Organizer: Dr Stephen Lock
Pneumoconiosis of coal workers4
Organizer: Dr E M Tansey
1995 Self and non-self: a history of autoimmunity3
Organizers: Sir Christopher Booth and Dr E M Tansey
Ashes to ashes: the history of smoking and health5
Organizers: Dr Stephen Lock and Dr E M Tansey
Oral contraceptives
Organizers: Dr Lara Marks and Dr E M Tansey
Endogenous opiates3
Organizer: Dr E M Tansey
1996 Committee on Safety of Drugs3
Organizers: Dr Stephen Lock and Dr E M Tansey
Making the body more transparent: the impact of nuclear magnetic
resonance and magnetic resonance imaging6
Organizer: Sir Christopher Booth
1997 Research in General Practice6
Organizers: Dr Ian Tait and Dr E M Tansey
Drugs in psychiatric practice6
Organizers: Dr E M Tansey and Dr David Healy
3Published in Tansey E M, Catterall P P, Christie D A, Willhoft S V, Reynolds L A. (eds) (1997) Wellcome Witnesses
to Twentieth Century Medicine, vol. 1. London: The Wellcome Trust, 135pp.
4P D’Arcy Hart, edited and annotated by E M Tansey. (1998) Chronic pulmonary disease in South Wales
coalmines: An eye-witness account of the MRC surveys (1937–1942). Social History of Medicine 11: 459–468.
5Lock S P, Reynolds L A, Tansey E M. (eds) (1998) Ashes to Ashes: The history of smoking and health. London:
The Wellcome Trust, 228pp.
6Published in Tansey E M, Christie D A, Reynolds L A. (eds) (1998) Wellcome Witnesses to Twentieth Century
Medicine, vol. 2. London: The Wellcome Trust, 282 pp.
HISTORY OF TWENTIETH CENTURY MEDICINE WITNESS SEMINARS, 1993–1999
v
The MRC Common Cold Unit6
Organizers: Dr David Tyrrell and Dr E M Tansey
The first heart transplant in the UK7
Organizer: Professor Tom Treasure
1998 Haemophilia:recent history of clinical management8
Organizers: Dr E M Tansey and Professor Christine Lee
Obstetric ultrasound: historical perspectives9
Organizers: Dr Malcolm Nicolson, Mr John Fleming and Dr E M Tansey
Post penicillin antibiotics10
Organizers: Dr Robert Bud and Dr E M Tansey
Clinical research in Britain, 1950–1980
Organizers: Dr David Gordon and Dr E M Tansey
1999 Intestinal absorption
Organizers: Sir Christopher Booth and Dr E M Tansey
The MRC Epidemiology Unit (South Wales)
Organizers: Dr Andy Ness and Dr E M Tansey
Neonatal intensive care
Organizers: Professor Osmund Reynolds, Dr David Gordon
and Dr E M Tansey
British contribution to medicine in Africa after the Second World War
Organizers: Dr Mary Dobson, Dr Maureen Malowany,
Dr Gordon Cook and Dr E M Tansey
7Tansey E M, Reynolds L A. (eds) (1999) Early heart transplant surgery in the UK. Wellcome Witnesses toTwentieth
Century Medicine, vol. 3. London: The Wellcome Trust, 72pp.
8Tansey E M, Christie D A. (eds) (1999) Haemophilia: Recent history of clinical management. Wellcome Witnesses
to Twentieth Century Medicine, vol. 4. London: The Wellcome Trust, 90pp.
9Tansey E M, Christie D A. (eds) (2000) Looking at the unborn: Historical aspects of obstetric ultrasound.
Wellcome Witnesses to Twentieth Century Medicine, this volume, 80pp.
10Tansey E M, Reynolds, L A. (eds) (2000) Post penicillin antibiotics: From acceptance to resistance? Wellcome
Witnesses to Twentieth Century Medicine, vol. 6. London: The Wellcome Trust, 72pp.
LOOKING AT THE UNBORN:
H I S TO R I CA L A S P E C T S O F O B S T E T R I C U LT R A S O U N D
The transcript of a Witness Seminar held at the
Wellcome Institute for the History of Medicine,
London, on 10 March 1998
Edited by D A Christie and E M Tansey
PARTICIPANTS
Mr Usama Abdulla Professor Norman McDicken
Dr Wallace Barr Dr Margaret McNay
Mr Thomas Brown Dr Malcolm Nicolson
Professor Dugald Cameron Professor Jean Robinson
Professor Stuart Campbell Dr Norman Slark
Mrs Alix Donald Dr Ian Spencer
Mr Demetrios Economides Dr Tilli Tansey
Mr John Fleming Professor Peter Wells
Mr Hans Gassert Professor Charles Whitfield
Dr Angus Hall (Chair) Dr TonyWhittingham
Professor John MacVicar Dr James Willocks
Others present at the meeting included:
Sir Christopher Booth, Dr Robert Chivers, Dr Rosalinda Snijders,Dr Saffron Whitehead
Apologies:
Professor M G Elder, Mr Gordon Higson,Dr Patricia Morley
Looking at the Unborn
3
Dr Tilli Tansey:1The subject of today’s meeting, medical ultrasound, has arisen from
a project that Dr Malcolm Nicolson is spearheading in the Wellcome Unit at the
University of Glasgow, aided and abetted by Mr John Fleming. Malcolm, John and
I have organized this meeting, Malcolm and John having done most of the hard work.
A lot of that hard work is finding a suitable chairman and we are delighted that Angus
Hall has agreed to do this. Angus started his engineering career at Kelvin & Hughes2
in Glasgow and spent many years working in the Department of Midwifery at The
Queen Mother’s Hospital in Glasgow. He told me at lunchtime, he then decided that
he would like to take life more easily. I don’t know whether he was successful in that,
but he moved to become Head of the Department of Medical Physics at St James’s
University Hospital in Leeds. He is a former Secretary and President of the British
Medical Ultrasound Society3so we are very grateful that we have his expertise and
historical knowledge to call on today in his role as Chairman of this meeting.
Dr Angus Hall:4Thank you very much. I would like to welcome you all to this
meeting, in particular, Mrs Donald.5The reason we are here today is to debate the
1Dr Tilli Tansey is Convenor of the History of Twentieth Century Medicine Group and Historian of Modern
Medical Science at the Wellcome Institute for the History of Medicine.
2The rapidity of the development of medical ultrasound in Glasgow was due in substantial part to the active
support of the Glasgow branch of Kelvin & Hughes Ltd, and its resident director, Mr WT Slater (see biographical
note 38). Over the decade that it was involved, the trading name of the Glasgow operation (which was by then
owned by S Smith & Sons England Ltd) changed with minor variations – first to Smiths Industrial Division, and
then for a year or so before its closure in 1966 to The Kelvin Electronic Company.The Glasgow branch of the
company had strong associations with one of the giants of nineteenth century science, William Thomson, later
Lord Kelvin (1824–1907), who formulated the first and second laws of thermodynamics, and gave his name to the
Absolute Scale of Temperature. While Professor of Natural Philosophy at Glasgow University (1846–1899), Kelvin
took an interest in a business originally formed by his instrument maker, James White, renaming it Kelvin & James
White Ltd. This then became Kelvin Bottomley & Baird Ltd in 1913 and became world famous for the
manufacture of ships’ compasses and other marine navigational equipment. After amalgamation with Henry
Hughes and Sons of Barkingside in the late 1940s, the company’s name changed again to Kelvin & Hughes Ltd.
It was this traditional but highly innovative business which supported the ultrasound work during the critical
formative years. Information provided by Mr Tom Brown, 24 May 1999.
3The British Medical Ultrasound Society (BMUS) was formed in 1977 out of the British Medical Ultrasound
Group, which was an informal discussion group set up around 1969 as a joint initiative by those working in the
field either as users or developers, the (then) Hospital Physicists Association, and The British Institute of
Radiology. That Group, in turn, had its origins in a series of annual meetings organized by the journal Ultrasonics.
These meetings covered various ultrasound topics, including the emergent medical interest, and a number of
semi-private medically oriented meetings arranged by Dr Douglas Gordon (see also note 30 below). Information
provided by Mr Tom Brown and Mr John Fleming, 24 May 1999.
4Dr Angus J Hall CEng FIEE FIPEM (b. 1939) initially trained as a Merchant Navy Radio Officer but after a
short time at sea joined Kelvin & Hughes Ltd (see note 2 above) in 1957 as a trainee instrument maker and later
worked as an electronics engineer on medical ultrasonic diagnostic equipment. He left the company in 1966
shortly before it closed, and, after a short spell with IBM, joined Professor Donald at the Department of
Midwifery, University of Glasgow to carry out research and development in ultrasound. He was Secretary, for a
number of years, and subsequently President (1981/82) of the British Medical Ultrasound Society (see note 3)
which he, with others, was instrumental in setting up in the 1970s. Since 1982 he has been Head of Medical
Physics at St James’s University Hospital, Leeds, until his early retirement in February 1999.
5Mrs Alix Donald (b. 1918) married Ian Donald in London in 1937.
Looking at the Unborn
4
a c h i e vements, the failings, and the consequences and the impact of the work
u n d e rtaken over the years. Today we are going to seek to answer two questions. W h a t
was it like at the time? And why did things happen the way they did? T h e re are, I think,
two strands to today’s meeting and I have tried to compartmentalize it.
For the first half of the meeting, we will talk about the science and technology,
s t a rting with the events that led up to the introduction of contact B-scanning and the
g overnmental and other implications that went with that; then after a break for tea, we will
talk about clinical matters. So could I now call on Malcolm Nicolson to give a ve ry quick
re f r esher for some of us whose memories may be fading slightly. Malcolm is the senior
re s e a r ch fellow at the Wellcome Unit in Gl a s g ow and, as has already been said, has been
w o rking with John Fleming and others on the historical development of ultrasound.6
Dr Malcolm Nicolson:7I thought it would be appropriate to commence pro c e e d i n g s
with a portrait of Ian Do n a l d ,8Regius Professor of Mi d w i f e ry at Gl a s g ow from 1954 to
1976 (Fi g u re 1). I think it’s fair to say that, without Do n a l d’s leadership and energy,
medical ultrasound would not have developed as early or as quickly as it did. It’s also ve ry
likely that without Do n a l d’s influence, medical ultrasound would not have taken on the
vital clinically directed orientation that so strongly characterized the pioneering work in
Gl a s g o w. It was not immodest of Donald to say, as he did in 1969, that he had launched
a new diagnostic science9with the emphasis ve ry much on the word ‘d i a g n o s t i c’. So we
a re indeed honoured, as Angus has said, to have Mrs Alix Donald with us here today.
As most of you will know, the first ultrasound machine used by Donald was an
industrial flaw detector (Figure 2), as employed in the non-destructive testing of
metals.10 A similar machine was in use in this industrial setting at Babcock and
Wilcox11 at Renfrew (Figure 3), where Donald did his very earliest investigations on
biological materials. Here’s the sort of image that these early machines produced. This
is what is called an A-scan. We can see the large non-reflective space between two
6See, for example, Fleming J E E, Spencer I H, Nicolson M A. (1997) Forty years of ultrasound. In Cockburn F.
(ed.), Advances in Perinatal Medicine, Proceedings of the XVth European Congress of Perinatal Medicine, Glasgow,
September 1996. New York, London: The Parthenon Publishing Group, 92–99.
7Dr Malcolm Nicolson (b. 1952) is Senior Lecturer at the Wellcome Unit for the History of Medicine, University
of Glasgow. He is working with John Fleming (see biographical note 20 below) and Ian Spencer (see biographical
note 209 below) on a study, funded by the Wellcome Trust, on the development of ultrasound in Glasgow.
8Professor Ian Donald CBE FRCOG FRCP (1910–1987) trained in obstetrics and gynaecology in London. He
was appointed Reader at StThomas’ Hospital, London, and then at the Hammersmith Hospital, London, where
his main research interest was respiratory problems of the newborn. In 1954 he was appointed to the Regius Chair
of Midwifery at the University of Glasgow. His initial work on ultrasound was at the Royal Maternity Hospital
and the Western Infirmary in Glasgow; he moved to the new Queen Mother’s Hospital at Yorkhill in 1964. He
received many honours, including the Blair gold medal, the Eardley Holland gold medal, the Victor Bonney prize
and the Maternity prize of the European Association of Perinatal Medicine.
9Donald I. (1969) On launching a new diagnostic science. American Jo u rnal of Obstetrics and Gy n e c o l o gy1 0 3: 609–628.
10 op. cit. note 33 below.
11 Babcock and Wilcox Ltd of Renfrew manufactured boilers and other large welded pressure vessels for industrial
and nuclear purposes, and used ultrasonic instruments extensively for weld-testing. Information provided by
Mr Tom Brown and Mr John Fleming, 24 May 1999.
Looking at the Unborn
5
echoes which marks the presence of a large simple ovarian cyst (Figure 4). This image
dates from about 1956. Donald began his investigations with A-scan ultrasound in
1955.12 Ian Donald and his colleagues achieved some very impressive diagnostic coups
with this equipment but it is significant, or at least it seems so to me as a historian,
that Donald did not publish any account of his clinical investigations with the A-scan.
For his first paper on ultrasound we had to wait until 1958 and until after the two-
dimensional B-scanner had been invented. Perhaps this is a question that the meeting
might consider later in the afternoon: why no A-scan publications?
The first two-dimensional, dire c t - c o n t a c t1 3 B-scan machine was built by Tom Brow n1 4
in 1956. He re is the sort of quality of image that the machine was capable of pro d u c i n g
by the end of 1957 (Fi g u re 5). Again, it is an image of a large simple ovarian cyst. To d a y
I am speaking from my perspective as a historian, and I think the transition from
A-scan to B-scan was by far the most significant single step in the development of the
n ew technology. B-scan incorporated the ultrasonic image into the re c e i ved framew o rk
of normal and pathological stru c t u re in a way that A-scan never could. I am not saying,
of course, that this incorporation into the re c e i ved image of anatomical stru c t u re was
an unproblematic process, but B-scan made possible the production of images that
we re in principle at least recognizable as parts of human bodies.
We are accordingly very fortunate in having Mr Tom Brown, the architect of contact
B-scanning, here with us today. I will embarrass him, of course, by showing a picture
12 Mr John Fleming prepared a draft chronology of medical ultrasound which was distributed at this meeting.
For a history on the development of ultrasound see, for example, Blume S S. (1992) Insight and Industry: On the
dynamics of technological change in medicine. Cambridge, MA: MIT Press, ch. 3, The constitution of diagnostic
ultrasound, 74–118. McNay M B, Fleming J E E. (1999) Forty years of obstetric ultrasound 1957–1997: from
A-scope to three dimensions.Ul t rasound in Medicine and Bi o l o gy 2 5: 3–56. See also O’Dowd M J, Philipp E E. (19 9 4 )
The History of Obstetrics and Gynaecology. London: The Parthenon Publishing Group.
13 Mr Tom Brown wrote: ‘The prototype “bed table” two-dimensional scanner went into use late in 1956 [referred
to as a “bed table” because a hospital bed table was used to support the scanning mechanism]. It was the first
ultrasound scanner which produced a “compound” cross-sectional scan, combining translational and angular
movements with the ultrasonic probe in direct contact with the patient’s skin. All previous attempts had been based
on much simpler scanning patterns or involved some sort of water-bath “stand-off” between the probe and the
surface of the patient.’ Letter to Dr Daphne Christie, 20 July 1998.
14 Thomas Graham (Tom) Brown CEng MIEE (b. 1933) joined Kelvin & Hughes Ltd (see note 2 above) in Gl a s g o w in
1951 as a trainee engineer. After some work on industrial ultrasonic equipment he began collaborating with Professor Ia n
Donald (see biographical note 8 above) in 1956 and continued this until leaving the company in early 1965, by which
time he was in charge of all the industrial and medical ultrasound re s e a rch and development work. After two years work i n g
on cardiological equipment he returned to medical ultrasound in 1967 when Nuclear Enterprises Ltd acquired the
c o m p a n y’s medical ultrasound business, and was joined shortly after by Brian Fraser (see biographical note 18 below).
In 1970 Brown was a Re s e a rch Fe l l ow at Edinburgh Un i ve r s i t y, where he investigated three-dimensional ultrasound
imaging techniques. These would allow him to circ u m vent his basic patents on two-dimensional scanning (op. cit. note
89 below )which, apart from the restricted licence enjoyed by Nuclear Enterprises, effectively precluded any further UK
p a rticipation in two-dimensional ultrasound developments. In 1973 he set up a small operation near Edinburgh on
behalf of Sonicaid Ltd, to develop and manufacture a radically new form of ultrasound contact scanner that could
produce three-dimensional stereoscopic virtual images of the body tissues. This was called the Multiplanar Scanner
and was brought to market by 1976. It sold modestly to UK and overseas hospitals, but the project did not succeed
commercially and was closed in 1979. Being unable to find further employment in the medical instrumentation
industry, Brown moved into the offshore oil and gas business, where he remained until 1998. Tom Brown and Ian
Donald were elected as the first Honorary Life Members of the British Medical Ultrasound Society in 1982.
Looking at the Unborn
6
Figure 1. Ian Donald, Regius Professor of Midwifery at Glasgow University, from 1954 to 1976.
Looking at the Unborn
7
Figure 2. Henry Hughes ‘Mark IIB’ Supersonic Flaw Detector designed for the non-destructive testing of metals. Ian Donald’s first
experiments in the Western Infirmary, Glasgow, were with an instrument of this type.
Looking at the Unborn
8
Figure 3. A Kelvin & Hughes Mark IV flaw detector being used by the late Mr J Davis in the Babcock and Wilcox factory at Renfrew,
where Ian Donald did his very earliest investigations on biological materials.
Figure 4. An A-scan from about 1956. Note the large non-reflective space between two echoes which marks the presence of a large simple
ovarian cyst.
Looking at the Unborn
9
Figure 5. Image from the first contact B-scanner, dating from the end of 1957. The image is of a large simple ovarian cyst.
Figure 6. Tom Brown, standing in front of the newly built contact scanner, c. 1957.
Looking at the Unborn
10
of a rather younger Tom Brown, standing in front of the newly built contact scanner
( Fi g u re 6). He re’s the same machine in clinical use in the Western In f i r m a ry (Fi g u re 7):
you can see the screen behind the scanning box that sits above the patient. Mr Brow n
went on to build the first automatic scanner1 5 and here are Ian Donald and Jo h n
Ma c Vicar employing it clinically (Fi g u re 8). This process of technical deve l o p m e n t
resulted in the Diasonograph, the first ultrasound scanner to be commerc i a l l y
p roduced and marketed. The sort of image that a Diasonograph was capable of
p roducing from around 1964 was that of a polyhydramnios. The fact that this re l a t i ve l y
r a re1 6 complication of pregnancy was successfully imaged at that date, which is after all
fairly early on in the history of the technology’s development, raises for me an
i n t e resting historical issue. It has been argued, notably by Ann Oa k l e y,1 7 that obstetric
ultrasound, at least in the ve ry beginning, was a ‘t oy for the boy s’, that is to say its early
d e velopment was driven by technical rather than by clinical priorities. It would, I think,
be foolhardy to deny that such considerations we re not present in the early stages of the
t e c h n o l o g y’s history. Donald had always been fascinated since his boyhood by
mechanical devices and therein certainly lay part of the attraction that the ultrasound
scanner had for him. And he was certainly exemplarily well served by his engineering
colleagues and co-workers, notably of course by Tom Brown, also by Brian Fr a s e r1 8 and
15 The automatic scanner was built to standardize the compound scanning process and to remove, as far as possible,
operator bias from the results. It was a complex machine and probably the only one of its kind ever produced.
Nevertheless, it worked successfully for about five years, during which time it allowed Donald and his colleagues
to amass a large amount of clinical experience – from which any suggestion of operator bias had been substantially
removed – and so helped establish the technique (see note 47 below). It was eventually replaced by the first of the
hand-operated Diasonograph machines, but is preserved in the British Medical Ultrasound Society historical
collection. Information provided by Mr Tom Brown, 24 May 1999.
16 Mr Tom Brown wrote: ‘I don’t think polyhydramnios – or usually just “hyd r a m n i o s” – is all that rare. It just means
e xcess amniotic fluid in the womb, usually because the baby can’t swallow for some reason. What w a s r a re, and what
could be dramatically demonstrated, was hydatidiform mole. This was said to be “ve ry rare” but it’s such a nasty
condition and so difficult to diagnose otherwise, that we made a big impression by being able to e xc l u d e h yd a t i d i f o r m
mole in a surprisingly large number of re f e r red cases.’ Letter to Dr Daphne Christie, 20 July 1998. Dr Malcolm Ni c o l s o n
w rote: ‘Mr Brown is right – the words “re l a t i vely rare” we re not well chosen. What I was attempting to allude to was that
h ydramnios was a condition that was particularly well suited to identification using the early ultrasound equipment and
that the ability to make a reliable diagnosis seems to have led to a more frequent recognition. But hydatidiform mole
p rovides a better exemplification of the clinical usefulness of the technology at that stage in its deve l o p m e n t .’ Letter
to Dr Daphne Christie, 1 April 1999. See, for example, Robinson D E, Ga r rett W J, Kossoff G. (1968) The diagnosis
of hydatidiform mole by ultrasound. Au s t ralian and New Zealand Jo u rnal of Obstetrics and Gy n a e c o l o gy8: 74–78.
17 Professor Ann Oakley has been Director of Social Science Research Unit, Institute of Education, University of
London, London, since 1990. Her many publications include Oakley A. (1984) The Captured Womb. A History of
the Medical Care of Pregnant Women. Oxford: Basil Blackwell Publisher Ltd. idem (1986) The history of
ultrasonography in obstetrics. Birth 13: 8–13.
18 Brian Fraser was a senior development engineer within Kelvin & Hughes Ltd (see note 2 above) and joined Tom
Brown in about 1959 to assist with the development of the hand-operated scanning machine which had been
ordered by Dr Bertil Sundén at Lund. Following the departure of Tom Brown in 1965, Fraser became head of the
ultrasound engineering group at Kelvin & Hughes until its closure in 1966. He later joined Tom Brown at Nuclear
Enterprises Ltd, Edinburgh. When the latter left to go to Edinburgh University, Brian Fraser led a team which
brought about the development of the NE4102 and NE4200 series of Diasonograph instruments. These proved
to be extremely successful products and became the de facto standard ultrasound scanners in the UK and elsewhere
during the 1970s. Following the closure of Nuclear Enterprises, Fraser devoted his energies largely to veterinary
applications of ultrasonic imaging. Information provided by Mr Tom Brown and Mr John Fleming, 24 May 1999.
Looking at the Unborn
11
later by John Fleming.1 9 Certainly the technical story of ultrasound is a fascinating one
by itself, but to my mind (contrary to Ann Oakley) what is really impressive about the
early history of ultrasound is how closely the technical development process was
linked to a clinical agenda and indeed how soon a clinical payoff came, and how very
considerable that clinical payoff was.
Despite the fact that we are showing you these pictures, I would argue that Donald was
not primarily interested in making pictures; he was interested primarily in making
diagnoses. A simple example established the point and that is the case of placenta praevia.
Reliable visualization of the placenta was achieved from about 1960 onwards. Not long
after that innovation, and consequent upon it, came a wholesale transformation of the
clinical management of suspected placenta praevia which was undoubtedly of enormous
clinical and also, of course, social benefit to many expectant mothers who we re there by
s a ved months of hospitalization. I hope that I am not trespassing upon the pre ro g a t i ve of
the Chair by expressing the hope that perhaps later in the course of the afternoon we might
d e vote some attention to gathering ideas from the members of our distinguished audience,
as to which of the early clinical applications we r e most significant and most profound in
their impact upon patients’ care. Having posed one question about the history of the
technology and one about its clinical aspects, I shall hand the meeting back to our Chair.
Hall:Thank you very much, Malcolm. I am sure that those pictures brought back a
few memories to some of us. I would now like to start the proceedings. We have a slide
projector here which people are very welcome to use – but the intention, I am told,
of this meeting today is to get a written record. So please use slides if you must, but
dare I say it, no lectures. Could I now ask John Fleming from Glasgow to say a few
words about Tom Brown please.
Mr John Fleming:2 0 When I was thinking what I might say today, a memory came back
of something that Tom Brown had written and I thought that might be quite an
interesting way to introduce him and to say a little about my involvement in
ultrasound too.
Tom had been thinking about ultrasound, the scanning problem, and had been sent
to Bill Halliday, the Chief Scientist of Smiths,2 1 his employers, for an opinion on the
building of such a machine. Thinking that the somewhat deaf Halliday had not quite
understood, he started to explain again, and Halliday stopped him and said, ‘Brown,
I now appreciate the full enormity of what you are proposing’. I thought perhaps that’s
quite a way to sum up what in fact has happened, and that was in 1956.
19 See biographical note 20 below.
20 John Fleming (b. 1934) worked in electronics at EMI and Ferranti for 11 years, and in 1962 moved to Smiths
Industries Ltd, Glasgow, as a development engineer on medical ultrasound projects, principally the Diasonograph.
Following Smiths’ closure in 1967, he, together with Angus Hall (see biographical note 4 above), joined Professor
Ian Donald at The Queen Mother’s Hospital where he worked until his retirement in December 1997. He is
Coordinator of the British Medical Ultrasound Society (BMUS) historical collection and Honorary Assistant
Keeper of ultrasonic equipment to the Hunterian Museum, University of Glasgow, and an Honorary Life Member
of BMUS (1994).
21 See note 2 above.
Looking at the Unborn
12
Figure 7. The first contact scanner in clinical use in the Western Infirmary, Glasgow.
Figure 8. The first automatic scanner, designed by Tom Brown, being operated by Ian Donald and John MacVicar in the Western
Infirmary, Glasgow, c. 1960.
Looking at the Unborn
13
Mr Tom Brown wrote:‘This figure shows the prototype
“bed-table” scanner made for Professor Ian Donald in
1956,with which the results reported in the Lancet were
obtained (see notes 13, 25, 48 and 126).This apparatus
forms the centre piece of the British Medical Ultrasound
Society historical collection.
Mechanical System
The borr o wed hospital bed table [1] with its ori g i n a l
wooden top removed (and carefully stored for future
r e s t o ra t i o n ) .The two rails [2],cut from propri e t a ry cabinet-
c o n s t ruction extruded aluminium alloy section,are fi xed to
c r o s s - m e m b e rs clamped onto the bed table fra m e.
The scanner box [3], sometimes known as the “bread
tin”because of its appearance, formed from a U-shaped
heavy aluminium base,with a light steel cover. Two
“kinematically-correct” vee-rollers [4] running on one
rail,with a plain cylindrical roller (hidden) running on the
far ra i l , p r oviding fi ve constra i n t s , and perm i t t i n g
longitudinal movement only along the ra i l s . T h e
longitudinal movement was measured by an ex-
Government 4” diameter wire-wound potentiometer
fitted with a large “Meccano”*sprocket wheel. The
sprocket wheel was driven by a length of Meccano chain
running the length of the rails.The chain can just be seen
[5] where it passes over another sprocket at the left
hand end of the rails and disappears down a tube [6],
within which it is attached to a counterweight.
The vertical “blade” [7] supports the probe spindle.
This blade could move in a vertical direction only,
being constrained by two vee-rollers on one edge and
one spring-loaded vee-roller on the opposite edge. The
vertical movement was measured by a second ex-
Government 4”wire-wound potentiometer, operated by
an internal system of glass-fibre cords and pulleys.
The weight of the blade and probe assembly was
counterbalanced by the Meccano chain passing down
over two small sprockets and round an idler sprocket on
the probe spindle.In this way the tension in the chain
created by the counterweight in the tube [6] balanced
the weight of the blade and probe assembly.
The double-transducer “probe” [8] was mounted on a
spindle at the bottom of the blade between parallel
plates,in such a way that it was free to rotate only in the
plane of the horizontal and vertical motions. Rotation
of the probe spindle was transferred via a system of glass
fibre cords and pulleys to operate a sine/cosine
potentiometer within the scanner box.
John MacVicar’s hand and arm [9] can be seen reaching
up from his crouching position to operate the probe on
Tom Brown’s abdomen [10], illustrating that ergonomic
excellence had not taken a very high priority in this
“feasibility study”design.
Electronic System
The electronic system was based on a converted Kelvin
& Hughes Mark IV Flaw Detector [11].This provided the
basic double-transducer transmitter/receiver functions,
and an A-scope display screen [12].
The special circuitry for the contact compound scanning
computational and display system was housed in the
main cabinet [13]. Also in this cabinet was a second
cathode ray tube (crt) to display the B-scan image. The
necessary high-voltage power supplies were taken via a
special connector [14] which can be seen low down on
the side of the Mark IV unit.
The B-scan image was recorded by a Cossor 35mm
oscilloscope camera [15] mounted in front of the second
crt.The camera back contained two cassettes capable of
handling thirty-foot rolls of film.One of the chores which
fell on Brown or MacVicar after each scanning session
was to open the camera back and remove the take-up
cassette, and then in a “portable darkroom”glove system
(not shown) remove the exposed film and seal it into the
developing tank [16] for processing, all without letting
any light in to destroy the day’s work.
A further compound scanning display unit, fitted with a
long-persistence crt [17], was initially placed on top of
the Mark IV. The intention was to allow the operator to
view the structures being scanned.Unfortunately, this led
to the operators dwelling too long on structures which
interested them,and so negating the compound scanning
process and overexposing the “interesting” parts of the
photographic image. Accordingly, the secondary display
unit “disappeared” and the operators were then forced
to scan “blind”,with only the A-scope display to reassure
them they were actually in contact and receiving echoes.
The entire electronic system was mounted on a hospital
“ a p p a ratus trolley” [ 1 8 ] . Just visible on the bottom shelf
of the trolley is a large box [19]. This is a mains
voltage stabilize r, to ensure that the sensitivity of
the scanning equipment was not affected by fluctuations
in the electricity supply, not altogether unknown in
G l a s g ow in the 1950s.’ E-mail to Dr Daphne Chri s t i e,
25 November 19 9 9 .
*Meccano – a mechanical model construction set
popular in the 1930s through to the 1950s.
Photograph and caption provided by Mr Tom Brown.
© Mr Tom Brown,1999.
Key to Figure 7
Looking at the Unborn
14
22 Similar problems are discussed in the NMR story, see Christie D A, Tansey E M. (eds) (1998) Making the
Human Body Transparent: The impact of nuclear magnetic resonance and magnetic resonance imaging. In
Wellcome Witnesses to Twentieth Century Medicine, vol. 2. London: The Wellcome Trust, 1–74.
23 Hugh Robinson (b. 1943) worked in The Queen Mo t h e r’s Hospital, Gl a s g ow as a Re s e a rch Registrar from 1971 to
1976, then as Lecture r , Un i versity of Gl a s g ow, from 1976 to 1978. In 1976 the Head of De p a rtment, Professor Ia n
Donald, was succeeded by Professor Charles Whitfield. In 1978 Robinson moved to the De p a rtment of Ob s t e t r i c s
& Gy n a e c o l o g y , Un i versity of Melbourne, Australia. Since 1981 he has been Senior Specialist in Ultrasound at the
Royal Wo m e n’s Hospital, Melbourne. He is author or co-author of over 80 publications on ultrasound in obstetrics
and gynaecology, which include his early work on fetal heart movement and pregnancy failure in the first trimester
( o p. cit. note 172 below). Tow a rds the end of his time in Gl a s g ow he was invo l v ed in the study of follicular
d e velopment (op. cit. notes 175 and 176 below). Information provided by Mr John Fleming, 24 May 19 9 9 .
24 Mr John Fleming wrote: ‘This data was obtained using a Diasonograph (a static scanner) but did not need re v i s i n g
for use with real-time scanners.’ E-mail to Dr Daphne Christie, 26 October 1999. The measurement of ‘c row n - t o -
rump length’ remains the method of choice for estimation of gestational age in the first trimester. See Robinson H P.
(1973) Sonar measurement of fetal crow n – rump length as means of assessing maturity in first trimester of pre g n a n c y.
British Medical Jo u rn a l i v: 28–31. Robinson H P, Fleming J E E. (1975) A critical evaluation of sonar crow n – ru m p
length measurements. British Jo u rnal of Obstetrics and Gy n a e c o l o gy8 2: 702–710. See also British Medical Ul t r a s o u n d
So c i e t y. (1990) Clinical Applications of Ul t rasonic Fetal Me a s u re m e n t s. London: British Institute of Radiology.
25 Mr Tom Brown wrote: ‘T h e re is a good yarn about how the prototype came to be pre s e rved, involving one of the most
c o l o u rful figures in the business, the late Dr Norman Smyth. Dr Smyth had both engineering and medical qualifications,
and worked at Un i v ersity College Hospital as a clinician, and at the No r thampton Polytechnic in the evenings deve l o p i n g
the So k o l ov ultrasonic image conve rter tube – a kind of specialized television camera aimed at conve rting ultrasound
images directly into TV ones. Although he successfully supplied these tubes to the nuclear industry for examining fuel
cells, there we re many difficulties encountered when attempting to use them for medical purposes. In the early 1960s
after the automatic scanner had been used routinely by Professor Donald, Dr Smyth borrowed the original “bed table”
p rototype scanner together with circuit diagrams of the electronics, to carry out direct comparisons between the two
a p p roaches to imaging. The prototype scanner was lost sight of until the late 1960s, when Dr Smyth contacted me to
say that he was having to leave his laboratories at Un i versity College Hospital and did I want the prototype back? T h e
f o l l owing Sunday he turned up in his car at my home with the scanner in the boot. It then lay in my junk room for
s e veral further years, until an exhibition, arranged to mark Ian Do n a l d’s re t i rement, when it was passed into the safe
keeping of John Fleming, and it now forms the centrepiece of the BMUS historical collection. An example of
Dr Sm y t h’s So k o l ov tube is held by the Science Museum in London.’ Note on draft version of transcript, 24 May 1999.
I joined Smiths as a development engineer in 1962, so things had moved on quite a long
way from then. I just wanted to escape from an increasing invo l vement in military
e l e c t ronics. My main task was to redesign the circuits of the prototype machines, so that
they could be put into production, something that Malcolm has already re f e r red to. I
w o rked with Ian Donald and John Ma c Vicar and it was really quite a strange experience
for me; I had never even met a professor before, let alone Ian Donald. After five years at
Smiths they closed, and that’s perhaps an aspect that may come up in this afternoon’s
meeting; the sort of commercial problems that companies face are really quite an
i n t e resting aspect and influential aspect of the whole history.2 2 I was fortunate enough to
be able to move into the unit that Professor Donald set up in The Queen Mo t h e r’s
Hospital and induced Angus Hall to return from an invo l vement with computers –
re l a t i vely boring things compared with ultrasound. He came back from IBM and we set
up a small unit and carried on work improving the Diasonograph and making it a much
m o re stable machine (although it still had lots of problems), and getting invo l ved in fetal
m e a s u rements to a great degree. I had a particular working relationship with Hu g h
Ro b i n s o n .2 3 We established the measurement of crown-to-rump length which I am
very happy to see in use in virtually the same way.24 Then in 1980 Tom Brown gave
me the contact scanner that he had built for Ian Donald, to take care of.25
Looking at the Unborn
15
I unsuccessfully tried to offload this onto the Hunterian Museum in Glasgow,
thinking, ‘I am not a historian or a museum collector or anything.’ But then a bit later
on, the President of BMUS [the British Medical Ultrasound Society], Pat Morley,26
who unfortunately is not able to be with us today, asked me to build up a historical
collection for the Society, and I thought, ‘That will be an interesting thing to do.’ So
I visited museums and I started work on this project of collecting things and built up
quite a large collection of material. But long term is something that you have to think
about in a museum and I am particularly grateful to Tony Whittingham for his
support in persuading the Hunterian Museum, in the long term, to look after this
collection, which has now become very substantial. When I visited Washington last
year with Margaret McNay we saw the collection there27 and I think we can say that
the BMUS collection is larger and somewhat better organized than even the American
collection! We have quite a substantial body of material; that’s partly what induced
Malcolm Nicolson to get involved with it four years ago and then to persuade the
Wellcome Trust to provide a grant and employ Ian Spencer28 and the whole thing has
taken off and here we are today. So in a way perhaps I can paraphrase Bill Halliday
and say, ‘Brown, I now appreciate the enormity of the proposal that I should look after
that scanner.’Tom, it’s very good to see you here today and everybody else of course.
I am very pleased that this meeting is taking place.
Hall: Well, Tom, without any further ado, could I ask you to tell it how it was, starting
with the first bed-table contact scanner and how that came about.
Mr Tom Brown:2 9 I haven’t prepared anything very formal at all, but thinking about
this meeting it occurred to me that in that brief period from 1956, through 1957 to
1958, a great deal was accomplished in a relatively short space of time.
Since that time, it has fallen to me to manage other people’s research and development
work, and were I faced with putting a timescale on what was actually done in Glasgow
at that time, it would have been extended a good deal more.
There were several of influences at work. One of them was that we were living in the
aftermath of World War II. There was an enormous collection of technology that had
26 Mr John Fleming wrote: ‘Patricia Morley (b. 1929) began her work in ultrasound in 1968 as an Assistant in
Radiology at the Western Infirmary, Glasgow. In 1980 she was awarded the FRCR and in 1982 was appointed
“Consultant Radiologist with a major interest in Ultrasound” in the same department, retiring in 1994.
Throughout her working life she was involved mainly with abdominal ultrasound but she had an interest in all
specialities and was a major influence in the development of clinical diagnostic ultrasound. Pat’s publications
include many papers and chapters in textbooks and, in addition, she lectured extensively. A major work was the
publication of Clinical Diagnostic Ultrasound, co-edited with Ellis Barnett (op. cit. note 187 below), her long-time
colleague at the Western Infirmary (see also Fleming J E E, Spencer I H, Nicolson M. (1999) Medical ultrasound:
germination and growth. In Baxter G M, Allan P L P, Morley P. (eds) Clinical Diagnostic Ultrasound, 2nd edition.
Oxford: Blackwell Science). From 1978, she was a member of BMUS Council and, after four years, was elected
Vice-President, serving as President from 1982 to 1984. During this time she suggested the establishment of a
BMUS historical collection.’ E-mail to Dr Daphne Christie, 31 May 1999.
27 This refers to the collection held by the American Institute of Ultrasound in Medicine near Washington, DC, USA.
28 Dr Ian Spencer contributes later in the meeting, see biographical note 209 below.
29 See biographical note 14 above.
Looking at the Unborn
16
been developed and beautifully documented, particularly in the MIT [Massachusetts
Institute of Technology] handbooks, so that if one had a technical problem – and a
lot of the problems were electronic, not mechanical – there was a ready resource
available for sifting through.
The other thing was that I didn’t come into the medical ultrasound business ‘cold’.
Although I was still a young man, aged only 23, I had already spent a couple
years directly invo l ved under the late Alex Rankin,3 0 in the development of
new ultrasound techniques for non-destructive testing. There was a great deal
of technical commonality between that and what we had to do with the
scanning machine.
I now (mis-)quote the phrase, ‘Shame is the spur’. When I had finished with the
industrial ultrasound project I got the proverbial pat on the head and was told, ‘Right
lad, you’ve got to go to University, and we’ll pay.’ I spent an abortive year at what is
now Strathclyde University attempting to learn applied physics, but I spent too much
time playing snooker and generally enjoying the student lifestyle. However, I had
really bitten off far more than my intellectual equipment could chew, so that, at the
end of that year, I had to go back to Kelvin & Hughes,3 1 feeling very sore, and ask
for my old job back.
I was not popular; I was in disgrace and knew it. I was stuck in a corner and given a
miserable little project to look after. So that, when the opportunity arose, and I heard,
by chance, of Donald’s use of an A-scope machine on people – and by the way
Malcolm it wasn’t that A-scope that he used,3 2 it was another one – I could hardly
contain myself.
I went home, looked up Professor Donald in the phone book and phoned him up, on
Western 5050, that night. Had he been the least bit stuffy, none of this might have
happened, but in fact he was delightful, and it wasn’t long before I was invited to go
30 Alexander [Alex] Bryce Calder Rankin (1924–1963) trained as a metallurgist and was a pioneer in the
application of ultrasound to non-destructive testing of metals. He was Head of Applications Engineering for this
activity within Kelvin & Hughes (see note 2 above). Prior to 1956, Alex Rankin had been actively involved in
supporting some of the pioneering work by Leksell and others in Sweden, and also workers elsewhere, including
Dr Douglas Gordon (see note 3), in the use of ultrasound for detecting mid-line shifts in the brain. It was Alex
Rankin who kick-started the relationship between Tom Brown and Ian Donald in 1956 by arranging the (semi-
official) loan of a new Mark IV Flaw Detector for Donald’s use. Alex died a tragic and untimely death in 1963.
Information provided by Mr Tom Brown and Mr John Fleming, 24 May 1999. Mr Tom Brown wrote:
‘Dr Douglas Gordon (1909–1997) contributed to the development of several electromedical technologies,
including electroencephalography, electroconvulsive therapy and medical photography, before becoming one of the
earliest in the UK to be interested in medical ultrasound. Probably his best-known and most successful innovation
was his “comparator”. This was used for obtaining substantially simultaneous A-scope traces from a pair of
transducers placed on opposite sides of the head to detect asymmetry in the mid-line structures of the brain. Later
in life he devoted much energy to the development of a mechanical pantograph-type two-dimensional scanning
machine, but this venture was probably over-ambitious for the limited resources he had available, and was never
fully completed. He was a colourful figure who travelled and lectured widely; he organized some of the earliest peer
group meetings on medical ultrasound.’ E-mail to Dr Daphne Christie, 9 November 1999.
31 See note 2 above.
32 See page 4.
Looking at the Unborn
17
and see what he was doing, and see the old black-crackle painted, Mark IIB
‘Supersonic Flaw Detector’ which he had managed to scrounge from the Royal
Marsden Hospital in London.3 3
It became clear, even with that rather comical demonstration, with the ‘water stand-
off’3 4 and all the rest of it, that it looked as if there was data coming back from within
the body. I managed to scrounge a rather better machine through the good offices of
Alex Rankin,3 5 who contributed a lot indirectly to this subject.
Although this was a huge improvement, it seemed to me that the nature of the
A-scope presentation was fundamentally incompatible with the nature of the problem,
and particularly with the perceptual faculties of the user. In the years to come I was
always wrestling with the problems of matching the apparatus to the perceptual
faculties of the human user, all the way through into stereoscopy and three-
dimensional imaging.3 6
So, with the background knowledge of Kelvin & Hughes’ radar technology, it seemed
to me that there was a reasonable chance of making a machine which would match
the perceptual faculties and the echo information somewhat better.The fact that it
turned out to be a two-dimensional ‘slice’ scanner was really due to the limitations of
the technology of the day, because even then it was recognized that the problem was
essentially a three-dimensional one.
But it was a case of one step at a time. I was quite impotent on my own, so I had to
seek resources from the company and it was that which led to that wonderful
interview with Halliday3 7 – a quite delightful man.
The extent of the original undertaking on the part of Kelvin & Hughes was in a memo
33 Professor Mayneord at the Royal Cancer Hospital, now the Royal Marsden, in London had been using a Henry
Hughes Mark IIB Supersonic Flaw Detector to examine the brain through the intact skull, though without much
success. White D N. (1988) Neurosonology pioneers. Ultrasound in Medicine and Biology14: 541–561. This
apparatus was later loaned to Donald and was the machine in use when Tom Brown first met him in 1956.
34 During the modification of the machine (Mark IIb) before Donald received it, the transmitter pulse generator
had been connected directly to the input of the sensitive receiver amplifier, in an attempt to make the same
transducer act as both transmitter and receiver.This was instead, as was normal at that time, of having separate
transducers for transmitting and receiving purposes. The effect of this was to overload the sensitive amplifier and
cause it to go into ‘paralysis’ for a time, thus incapable of detecting echoes from within the first few inches of the
patient’s tissues. Donald’s pragmatic solution to this problem was to place the end of an open-ended glass cylinder
about 250 mm long by 75 mm in diameter onto the patient’s skin, using Vaseline as a seal, fill the cylinder up with
water from a jug, and then dip the transducer (or ‘probe’) into the water. By the time the ultrasonic pulse had
reached the patient’s skin, the amplifier had had time to recover from its paralysis, and echo signals from within
the patient could be seen at the extreme right hand end of the A-scope trace. The practical problem which followed
was somehow to get the water back into the jug without soaking the patient or the professor.This is what is meant
in this instance by a ‘water stand-off’. The description is used differently elsewhere in the text: to mean any means
of interposing water between the probe and the patient, for example, as Douglass Howry did, by placing the
patient in a water tank (op. cit. note 39 below) or as Kossoff did (op. cit. note 78 below). Information provided
by Mr Tom Brown, 24 May 1999.
35 See biographical note 30 above.
36 See note 14 above.
37 The interview described by John Fleming on page 11.
Looking at the Unborn
18
from Bill Slater3 8 who was the Deputy Managing Director and resident in Glasgow,
which stated that Mr Brown had permission to spend half a day a week working with
Professor Donald and had a budget of £500 with which to do the work.
It was on that understanding that the first contact scanner actually came into being.
It was a very elastic sum of money and it owed a great deal to the scrounging
capabilities of the young Brown and the tolerance of other people, because everyone
really was on the side of the angels. There was a general desire to help.
One of the things that is often asked is this. Were we aware at that time, or was I aware
at that time, of the work done by Douglass Howry?3 9 The answer is, curiously, ‘no’.
Perhaps we should have been. Certainly I know that the Managing Director of Kelvin
& Hughes4 0 did have copies of Howry’s paper, including his early neck pictures, which
he did make available to us later.
Howe ve r , I think that had we been aware of what How ry was doing, and had set out our
stall to improve on How ry’s work, we would have been stuck with immersion scanning.
Contact scanning came about for two reasons. One was that we didn’t know any
better; I didn’t know what Howry had been up to.4 1 Secondly, the practicalities of
examining the patients in Donald’s wards were such that there was absolutely no
question of putting these people in tubs of water.
We did attempt, briefly, to have a ‘water stand-off’ in the form of a water-filled
condom between the probe and the patient. However, I knew enough about the
problems of water immersion testing for industrial purposes to know how difficult
38 William T Slater (Bill) (1903–1977) joined Kelvin Bottomley & Baird in 1923 (see note 2 above), and went on
to hold many senior positions through the various amalgamations and reorganizations which followed. He oversaw
many technological and commercial developments in the company’s marine, industrial, aviation and medical
businesses. He saw the medical and commercial potential of the medical ultrasound technology, and provided it
with such active encouragement and financial support as he could manage, sometimes almost in defiance of the
rest of the Board. Without Slater’s enthusiasm and backing, and despite the contributions of all the others
involved, it is very unlikely that the project would have succeeded, though sadly he retired before being able to see
any commercial returns. Nonetheless, he played a most vital and far-seeing, if little known, role in the ultrasound
story. Information provided by Mr Tom Brown, 24 May 1999.
39 Douglass H How ry (1920–1969) became interested in the study of ultrasound for anatomical imaging during his
internship in radiology at the De n ver Un i versity Hospital in 1948. He published many papers on ultrasound,
including How ry D H, Bliss W R. (1952) Ultrasonic visualization of soft-tissue stru c t u res of the body. Jo u rnal of
L a b o ra t o ry and Clinical Me d i c i n e 4 0: 579–592. How ry D H. (1957) Techniques used in ultrasonic visualization of
soft tissues. In Kelly E. (ed.) Ul t rasound in Bi o l o gy and Me d i c i n e, Symposium, June 20–22, 1955, Il l i n o i s .
Washington: American Institute of Biological Science, 49–65. Tom Brown and Douglass How ry became firm friends
b e f o re the latter’s untimely death. Information provided by Mr Tom Brown and Mr John Fleming, 24 May 19 9 9 .
40 Mr GB GPo t t e r, Managing Di rector of Kelvin & Hughes during the critical period, was somewhat unsympathetic
to the medical ultrasound project, which put Mr Slater in a difficult position from time to time. Information
provided by Mr Tom Brown, 24 May 1999.
41 It must also be re m e m b e red that this was not a traditional scholarly academic project, where one might expect a
t h o rough literature search before embarking on further work. The initiative to develop the imaging system came fro m
within Kelvin & Hughes, and this was to all intents an initial, inexpensive feasibility study for a new product, in which
time was of the essence. (Tom Brown was shortly due to go off to do his National Se rvice for two years, though that
n e ver actually happened.) In the normal course of events this feasibility study would be followed by a patent search, in
which any prior art would emerge, as in reality it did. Information provided by Mr Tom Brown, 24 May 19 9 9 .
Looking at the Unborn
19
that would be, and it was very quickly abandoned, and we went directly to the direct
contact scanning system.
Hall: Can I just ask you something there, Tom? You had got to the stage where you’d
got this B-scanner working. If we look at the images now, and I am being provocative,
I could say that it was the eye of faith, that there was the ‘famous’ incident recorded
of the patient, linked with Professor MacVicar. She had a large cyst which was actually
non-malignant, but she had been left to quietly die.
Brown: [Looking at MacVicar for confirmation] No, it wasn’t. I think that was done
with an A-scope.
Hall: But I was under the impression that that’s what brought the clinical interest
forward diagnostically.
Professor John MacVicar:42 Yes, it certainly was. The Professor of Medicine had made
a diagnosis of malignant ascites in an elderly lady which seemed to be confirmed by
radiography. Then from another unit a young upstart came with a machine to her
bedside (it was with the A-scope we did it) and said, ‘This isn’t a malignancy, this is
an ovarian cyst!’43 I remember Professor Donald kicking me under the bed-screen and
saying, ‘Not at all, it is a malignancy, the Professor of Medicine says so.’ So I kept quiet
after that.
Hall: Would you say that that was a watershed?
MacVicar: It certainly was the first thing that made staff in the hospital recognize that
this was a possible tool for the future.
Hall: I think Ian Donald himself said on a number of occasions that he thought that
that was the watershed. In his own inimitable manner, he said, ‘From that point on
there could be no turning back’ and he viewed it as being a stroke of luck, after some
less fortunate events. Of course, the end of the story was that the patient was taken
upstairs [to the gynaecological department] and had this great big cyst removed and
lived, so far as we know, happily ever after.
MacVicar: What annoyed me was that Ian Donald got a cake from that woman every
Christmas afterwards, and I never got any!
Hall: I think saving lives carries its own disappointments.
Brown: But we were told that the cake was totally inedible!
Hall: Could I ask either Dr Willocks or Professor MacVicar, in those early days, how
42 Professor John MacVicar FRCSGlas FRCOG (b. 1927) was appointed Registrar in the Department of Obstetrics
and Gynaecology at the Western Infirmary and Royal Maternity Hospital in Glasgow in 1956 and was later
Lecturer and Senior Lecturer in the Department of Obstetrics and Gynaecology, University of Glasgow. In 1974
he became Foundation Professor of Obstetrics and Gynaecology at the University of Leicester and retired from that
post in 1992, now Emeritus.
43 Mr Tom Brown wrote: ‘If the Professor of Medicine said you had a malignancy, that was that, and it was not
normally open to question. Our intervention was quite dramatic, and it was the fact that we had the temerity to
question the Professor of Medicine’s diagnosis on the basis of this upstart technique which gave the incident its
high profile.’ Letter to Dr Daphne Christie, 20 July 1998.
Looking at the Unborn
20
much value in fact did the simple B-scanner (the over-the-bed scanner) have in clinical
practice as opposed to maybe being a vehicle for generating papers, if I could be
slightly naughty in suggesting that?
Brown: Can I answer that? As a layman one of the things which impressed me about the
medical people with whom I was dealing, was the courage with which they had to make
life or death decisions on a patient’s behalf, on the basis of guesswork. The impact of
ultrasound on obstetrics, to me, was to re m ove a great deal of the guesswork which had
h i t h e rto applied. I came to the conclusion that in medicine there is no disgrace in not
k n owing that something is going on, if there is no diagnostic tool available with which to
deduce it. In obstetrics in those days there was a lot of talk about ‘clinical judgement’ and
‘my hands’ and all this sort of thing, but at the end of the day you didn’t know what was
going on inside the uterus until it manifested itself externally, and sometimes tragically.
I don’t think that case [of mistaken diagnosis of ovarian cyst] was a ‘watershed’. I don’t
think it was a road-to-Damascus experience on Donald’s part, although it’s nice to
simplify and dramatize things that way. I think there was, instead, a gradual process,
which went on over a period of years, of demonstrating common clinical conditions
which could be diagnosed, or of which a prospective diagnosis could be made
ultrasonically and then tested against the clinical outcome.
One of the factors which is rarely talked about was the library of case notes which we
built up. This occupied many drawers of our filing cabinet with every case, complete
with notes and photographs and settings of the machine at the time.4 4 One of the
things that I think that Donald and John MacVicar and others did was to be religious
about reviewing the outcome of these early investigations.
Hall: Could I take you on a bit, Tom. Sorry to put all the questions to you, but you
were the key link in the early days, certainly scientifically and technically. What
brought about the automatic scanner? With hindsight I could suggest it was a red
herring in the development, certainly of contact B-scanning.
Brown:Well, there was great variability in the results. That variability could be due to the
apparatus, or it could be due to the process of scanning, or could be due to differe n c e s
b e t ween the patients themselves. The automatic scanner was, to some extent, an attempt
to standard i ze the apparatus side of the equation.4 5 The electronic side of it was alre a d y
reasonably well standard i zed with the transmitter attenuators and the powe r - s u p p l y
stabilization and the calibration system and so on – but the scanning process was not.
With the prototype B-scanner, the process of scanning was ergonomically horrific.
The number of times I have seen John [MacVicar] here, crouching at the bedside,
reaching up under this infernal machine, trying to carry out a regular compound scan
over the patient, while getting olive oil running up his arms, and bumping his head
on the underside of the frame. Generally it was an ergonomic catastrophe.4 6
44 See note 47 below.
45 See note 15 above.
46 Mr Tom Brown wrote: ‘But it w a sall done – after all – on a £500 budget!’ Letter to Dr Daphne Christie, 20 July 1998.
Looking at the Unborn
21
The other side of it was that we we re working in quite a Victorian environment. I was
itching to get my hands on the equipment and determine what it could do, but there was
absolutely no way in which a young male layman was going to lay a hand on a female
abdomen in the obstetrics and gynaecology wards of the Western In f i r m a ry in the 1950s.
So, I took control of the scanning process, through the automatic scanner. Whether
that was a valid reason for building one or not, I don’t know, but the payoff at the end
of the day was that for the period from about 1960 through until 1965, when it was
replaced by the first of the Diasonographs, the automatic scanner scanned I don’t
know how many thousand patients – but quite a few thousand patients47 – and did so
in a reproducible, standardized way.
The results of all those scans were logged in the database (a punch-card database, but
it was a database nonetheless). That period in the early 1960s was a period of
consolidation which, I think, really put the technique on the map.
Hall: You have forgotten, Tom, about one machine, the Sundén machine,48 and that
was a ve ry interesting development. I would like to ask Professor Dugald Cameron to tell
us about his invo l v ement, which, of course, was with the aesthetics of the machine, and he
also bears subsequent responsibility for the Diasonograph series of equipment. So, Du g a l d ,
would you like to give us the, dare I say, art i s t’s viewpoint of the development at this time?
P ro fessor Dugald Camero n:4 9 I feel as if I am an impostor in this distinguished
gathering, because I was a final-year art student at the Gl a s g ow School of Art and like
a number of my colleagues, we all fell in love with Tom Brow n’s sister-in-law, Elsa, who
was a first-year art student at the Gl a s g ow School of Art. She had told me that her
b rother-in-law was developing this new machine at Kelvin & Hughes and that, in fact,
he didn’t think much of industrial designers. That gave me the spark, because I was a
ve ry cheeky so-and-so then, probably as now, and I was determined that I would meet
this chap and we would talk about it. We met in your flat, Tom, in Mount Florida and
I ’ve got some slides here that show this (Fi g u res 9–14).5 0 I have actually kept the re c o rd s
47 Mr John Fleming wrote: ‘Over 3000.’ Letter to Dr Daphne Christie, 28 July 1998. Mr John Fleming later
added: ‘The number is uncertain but, during the five or six years that I assisted Ian Donald and John MacVicar at
the one or two scanning sessions per week, each with at least five patients, we must have scanned more than 2000.
And there were many drawers full of record cards carrying sets of Polaroid prints before I joined the group. A few
hundred still exist in the BMUS historical collection.’ Note on draft version of transcript, 24 May 1999.
48 In 1958, Dr Bertil Sundén, a young Resident in the Obstetrics and Gynaecology Department of the University
Hospital in Lund, Sweden, convinced the authorities there to purchase an instrument like Donald’s prototype
bed-table scanner. The placing of a commercial order for such a machine (at £2500) was a breakthrough and an
enormous morale boost for those involved at Kelvin & Hughes. It led to the conceptualization of a ‘production’
hand-operated machine. This instrument is referred to in this meeting as either the ‘Lund’ or ‘Sundén’ machine.
This was the very first direct-contact scanning machine to be sold commercially anywhere in the world. For his
published thesis see Sundén B. (1964) On the diagnostic value of ultrasound in obstetrics and gynecology.
Acta Obstetrica et Gynecologica Scandinavica 43: 1–191.
49 Professor Dugald Cameron OBE FCSD FRSA (b. 1939) was an Industrial Design student at Glasgow School
of Art when he first came into contact with Tom Brown in about 1960, and went on to become Head of Industrial
Design at the Glasgow School of Art in 1970, and Director in 1991.
50 Only some of the slides are illustrated here. Copies of the slides will be deposited with the records of this meeting
in the Contemporary Medical Archives Centre of the Wellcome Library.
Looking at the Unborn
22
of it all, including my first order for drawing, probably the first art i s t’s drawing of an
ultrasonic machine. T h a t ’s how I got invo l ved in it and got fascinated by it.
I knew nothing whatever about the whole business, but had a desire to make the thing
ergonomically better so that the approach to the patient was better and that the doctors
would find it easier to use. Indeed, To m’s view was to make it ‘d o c t o r - p ro o f’ and we
tried to do this. These, in fact, we re the first sketches done on your [to Tom] dining
room floor in Mount Florida of how we thought this Sundén machine should be
( Fi g u res 9 and 10). This is the automatic contact scanner that we we re talking about.
And that was the proposal that Tom had – to make the Lund machine (Fi g u re 11).5 1 I
remember saying that I thought it looked like a gun turret and that it was thoro u g h l y
i n a p p ropriate for pregnant ladies. This was the design drawing: Tom and I we re arguing
over how to make it so that it could be used by a seated or a standing doctor, but we
determined, in fact, that you couldn’t. It was useless for both, and there f o re on that
ergonomic basis this was not the right configuration for the machine. That was my
attempt to give a three-dimensional view of what that machine was going to look like.
On the left are the two sketches where what we thought we ought to do was to separate
out the patient, the doctor, and the machine and try and put these three things in a
better ergonomic relationship with one another, so that the doctor would actually be
on a level with the patient and seated. That was the first drawing which I had been
commissioned to do, and for which I re c e i ved an order for £21. I had completed my
studies and won a travel scholarship to Scandinavia, so this £21 helped that along quite
a bit. But you will notice that there’s one thing in the history of engineering drawings,
t h e re are ve ry few that have been drawn to a scale of one-sixth. This one was because it
was the biggest bit of tracing paper that I had and I couldn’t afford any others. T h a t
s h owed the basic relationship of a desk for the doctor in which he could keep the
various bits and pieces, including the olive oil when needed. The machine could be
rotated in different ways so that it was ve ry handy and the doctor could speak to the
patient ve ry easily. We had a lot of discussions about how to make it, but in fact it was
made from a pro p r i e t a ry system called Widney Do r l e c ,5 2 which was then adapted a bit
and I had a lot of arguments about that. In fact, in re t rospect, it was the right way to
do it, because you didn’t want to waste time on a lot of other things in concentrating
on seeing if the thing would work. And we we re ve ry proud of that. I remember on one
occasion though, going in and we had to saw a bit off the column because it wouldn’t
go through the door. I was ve ry privileged to be invo l ved with this group of engineers
at the time, as I then became a postgraduate art student and I learnt an enormous
amount from it. Tom and his colleagues we re enormously patient with me, but I
c e rtainly learnt a ve ry great deal. That was the first layout – not drawn by me – of the
Diasonograph. This was to be the production version of the Sundén machine, and yo u
see we we re intending to make a bed for the patient as an integral part of that machine.
The mechanics and the electronics of the thing we re all separate. Indeed it was a
51 Also referred to as the Sundén machine in this meeting. See note 48 above.
52 Mr John Fleming wrote: ‘Widney Dorlec Ltd, England, manufactured a set of components for the constru c t i o n
of cases suitable for electronic and electromechanical equipment.’ E-mail to Dr Daphne Christie, 26 October 1999.
Looking at the Unborn
23
modular construction which you can see in a moment or two. That was the first
Diasonograph built at Kelvin & Hughes at Hillington. Standing beside it, to add scale
to the photograph, is Arthur Jo h n s o n 5 3 ( Fi g u re 12).
Hall: Dugald, can I stop you there and ask you a key question? You developed one
machine – the Sundén machine – which, for the record, takes its name from Dr Bertil
Sundén,5 4 who ordered it. It was supplied to the University of Lund near Malmö [in
Sweden]. You developed this Sundén machine at much expense and time. Why was it
not pursued as the production machine?
Brown: It became clear that the automatic scanner was a one-off. The results obtained
with the automatic scanner, although they we re more consistent, we re not different in kind
f rom those which you could obtain with a manual machine, a hand-operated machine.55
Hall: Could that have been, Tom, because, in fact, the electronics hadn’t improved?
Basically the old bed scanner and the automatic machine used the same electronics?
Brown: Yes, they did. But I think what it demonstrated was that with a bit of
assistance, a manual scanning process could achieve adequate clinical results without
the complication and expense of the automatic machine, which was undoubtedly a
very complicated bit of kit. The Sundén machine, in its own way, was also a prototype,
because it was an attempt to make a hand-operated machine which would be
functional but would not be oppressive to the patient.
If you cast your mind back to the image of the Sundén machine, it was on a heavy base,
counter-balancing, and supporting a ‘t ree tru n k’, which couldn’t possibly fall over onto
the patient. Vi s u a l l y, the scanning frame was supported off that tree trunk like a branch,
and the shape of the stru c t u re was such that we felt that a patient – and a ve ry vulnerable
patient with a pregnant abdomen – would not feel threatened by it. The display console
that hung on the other side, over the base, added to that feeling of security.
However, the mechanical complexity involved in the ‘elbow-shoulder and wrist-joint’
mechanism in the Sundén machine was difficult to make. So when we came to think
about a production machine, following the Sundén machine, the measuring frame
which is a white box with a probe sticking out at the bottom was the same, however
the mechanism for supporting it was simplified, and became a couple of bars that ran
backwards and forwards inside a strong cabinet. So this was an attempt to make a
cheaper Sundén machine. As it happened,5 6 it turned out to be far more slab-sided and
53 Arthur Johnson was one of the draughtsmen at Kelvin & Hughes.
54 See note 48 above.
55 Note that the Sundén machine was operated by hand. Mr John Fleming and Dr Angus Hall wrote: ‘This
machine is sometimes incorrectly referred to as “the Diasonograph”.’ Note on proofs, 23 December 1999.
56 Mr Tom Brown wrote: ‘The mechanical engineer involved, Mr David McNair, was working very competently
in relative isolation at a time when everyone else was heavily involved in sorting out a commercially and technically
difficult situation on industrial ultrasound. The emphasis was on ensuring that the mechanical design of the new
Diasonograph was physically safe for the patient, and straightforward to manufacture, and this resulted in a design
which was both of these things, though perhaps less pleasing aesthetically than the Sundén machine.’ Note on draft
version of transcript, 24 May 1999.
Looking at the Unborn
24
Figure 9. Dugald Cameron’s sketch ideas on an original proposal for the Lund machine.
Figure 10. General arrangement: the re-designed Lund machine as it was actually built and delivered. Drawing by Dugald Cameron.
Figures 9– 14.Early industrial design.
Looking at the Unborn
25
Figure 11. The Lund machine.
Figure 12. A newly assembled Diasonograph shown at Smiths (Kelvin & Hughes Ltd) Hillington works, Glasgow. Pictured next to the
machine, to give an indication of its dimensions, is Arthur Johnson, one of the draughtsmen involved in the project.
Looking at the Unborn
26
Fi g u re 14. Control panel of the Diasonograph – industrial design by Dugald Ca m e ron. The most frequently used controls are in the extre m e
right-hand section: from the top – frequency selector, power switch and transmitter attenuator. The large dial in the centre section was used
to set the mode of operation: B-scan, A-scan and inve rted A-scan (for echo-encephalography), or M-mode. The other controls in this area are
related to these modes of operation. At the left is a camera fitted with a Po l a ro i dT M film back and an information projector to allow re c o rd i n g
of patient data together with frequency and sensitivity settings, directly onto the film. A set of controls for occasional adjustment by an
engineer are behind the hinged panel below the main control panel. This could be opened by the handle at the bottom of the picture .
Figure 13. The Diasonograph was modular in design and construction. Shown here, on the left of the photograph, is the electronics console
which formed the lower half of the machine. The mechanical assembly on the right is the automatic scanner.This was originally
used with the electronics assembly designed for the ‘bed-table scanner’; at a later date this was replaced by a Diasonograph electronics
console as seen here. This photograph was taken in the factory at Hillington, Glasgow, c. 1966.
Looking at the Unborn
27
heavy looking than I wanted, or than Dugald wanted. Howe ve r , by that time we had all
s o rts of other problems within Kelvin & Hughes and at least a machine was produced.
Hall: And this is, in fact, what we are looking at, a Diasonograph (Figure 12). One of
the things that always struck me – and I had only ever seen this once before in a
Charlie Chaplin movie – a convict with arrows on his suit: low-and-behold, on the
back of the Diasonograph on the maker’s plate, was a government arrow. That was
there, Dr Slark, for a very good reason, which I would like you to tell us about, from
the point of view of governmental support of the ultrasound industry at that time.
Dr Norman Slark:5 7 As I didn’t come on the scene of ultrasound until about the back
end of 1970, I feel very much a new boy in this environment. My recollection is that
when I joined the Scientific and Technical Branch of the Supply Division of the
Department of Health, which was at the beginning of December 1970, there was
already at that time a perception of a need to evaluate some of this new equipment.
There was, in fact, an evaluation programme just getting going which, as far as I can
remember, involved a Diasonograph and also a Picker B-scanner, that looked like an
oscilloscope with an arm on it.
Hall:The Picker B-scanner was, in fact, built around a Tektronix Storage Scope.
Slark: I can remember those two systems and we had a programme running with the
Atomic Weapons Research Establishment (AWRE). The history was that there had
been a cutback on AWRE nuclear weapons work. AWRE was told by the Government
that it had to get a certain amount of its income from activity funded from external
sources outside the nuclear weapons industry. So AWRE was looking for work. The
Department of Health actually placed the technical evaluation of this equipment with
AWRE, which was not, I may say, very successful. We intended to do a comparative
reporting series. In fact, the delays on the production of reports were such that we
decided that we were not going to get satisfactory comparative reports and it was far
better to do things serially. That was a lesson we learned the hard way. Subsequent to
that, the evaluation of ultrasound equipment was eventually taken over by the Scottish
Common Services Agency, where Eric Leask58 was involved at that time. Coming back
to your starting point about broad arrows: there was a broad arrow on it. Perhaps this
had some connection with the defence industry or was an original throwback to the
early days of ultrasound, but Tom will know why it’s got a broad arrow on it.
Brown: I think it may have meant ‘This way up’.
Cameron:You may want to know that the configuration was split into the mechanics,
57 Dr Norman Slark (b. 1934) worked at the English Electric Valve Company on military and civil imaging systems
for 11 years. In 1970 he joined the Scientific and Technical Branch of the Department of Health and was
responsible for physics-based medical equipment research and development, later taking responsibility for
radiology equipment services and evaluation. He retired from the Department of Health in 1994 but continued
his imaging interests on a part-time basis at the Imperial College of Science, Technology and Medicine.
58 Eric Leask was a senior civil servant in the Scottish Common Services Agency, and actively supportive
throughout the period medical ultrasound was being developed in Glasgow and later in Edinburgh. Information
provided by Mr Tom Brown, 24 May 1999.
Looking at the Unborn
28
which are the white bits, and the electronics, which were the grey bits. It was envisaged
that the electronics, in fact, would be used on their own, so quite apart from sort i n g
out the design of the machine ergonomically, in terms of patient and doctor, it was also
s o rted out in terms of mechanics and electronics. I would maintain to this day that the
original design of this machine would stand up now in terms of its basic configuration,
which was carried through and extended, in terms of the design of the Diasonograph.
Just to finish off the design story, this (Figure 13) was the automatic scanner fitted
with a new electronics unit, which was the base of the Diasonograph, which in fact
was sold on its own.5 9 So it did stand up on its own.
The details of it: this was the control panel (Figure 14). It actually took quite a lot of
thinking about, because part of Tom’s requirement to make it ‘doctor-proof’ was to
make it very easy to use. However, there were naturally a lot of knobs and switches
associated with it, which determined three levels of control. For a really experienced
experimenter like Donald, you had a whole series of controls in the panel that you
brought forward below the control panel, so that was the tertiary bit. The secondary
controls were the middle panel on the right of the camera and the primary controls
were on the far right and you had a little blind to draw across, so in fact it could be
operated by about three knobs.
We were due to get a Design Award, one of the very first ones, for the Diasonograph.
Unfortunately, when the evaluation team came up to see it the actual machine was
covered in notes and whatnot and I think Professor Donald was showing the full range
of its activities and it frightened the life out of them. In fact, had it been a nurse or
someone using it, we perhaps would have got the Design Award. There was a lot of
early ergonomic thinking that went into the design, particularly for the design of the
Sundén machine, which preceded the Diasonograph.
Finally, there was the Diasonoscope (a small portable device), which is basically a
tarted up MarkVII flaw detector. We put it on its side in a decent box. I had an awful
job with Kelvin & Hughes over the ‘hammered-finish’ paint. It was the flaw detector
which basically produced the Diasonoscope. During the 1980s I renewed my interest
with Tom and his three-dimensional scanning developments.
It was a great excitement for me, and Kelvin & Hughes had a rather special spirit
about them which I saw from the outside, and even experienced in a way, which
was wonderful. Peter Turner (who died a few years ago), the chief engineer at that time
went to work for Honeywell6 0 after it all folded up very sadly. He didn’t like it very
much and renewed his flying instructor’s licence and then taught me to fly! So I have
a lot to thank Tom for, and to thank Elsa Stevens6 1 as she was then, for introducing
me to the whole thing. It’s a curious business to find that the first concept
59 Mr John Fleming wrote: ‘One was sold to Dr (now Professor) Wells and one to a Government department.’
Letter to Dr Daphne Christie, 28 July 1998.
60 Honeywell Controls Ltd, Newhouse, near Glasgow.
61 Tom Brown’s sister-in-law.
Looking at the Unborn
29
drawings were actually done in the basement of Charles Rennie Mackintosh’s
Glasgow School of Art.
Hall:Thank you. Could I turn to Dr Willocks and Professor MacVicar and ask if they
could comment on how the images improved, if at all, from the automatic scanner
towards the early Diasonograph?
MacVicar: I believe that Tom always thought I could cheat, because by using the
manual controls he insisted I could make the picture look like the diagnosis I wanted.
Now that was not really true but it was the stimulus for Tom to find something to
remove operator bias, which was why he was so keen to develop the automatic scanner
– to stop me cheating! But there were drawbacks to the automatic scanner.
H a l l: Usama, you we r e invo l ved in the early days and if my memory serves me right, one
of the areas that you looked at was in fact placenta praevia and its diagnosis by ultrasound.
Mr Usama Abdulla:6 2 Yes, indeed. I think Professor Donald was very keen to publicize
our results and show the relevance of diagnosing placenta praevia. The placenta could
not be seen initially but could be recognized by its fetal surface. For some time we
knew that the space was that of the placenta, but placenta praevia was the difficult one
to diagnose. Obviously a number of mistakes were made in the early days, but I think
eventually the full bladder has helped6 3 as we could see the lower edge of the placenta
and the segment much more easily than before, and that was a big help. Obviously the
use of olive oil on the patient’s abdomen made it even easier to visualize.
Hall: Professor Stuart Campbell, would you like to add your bit?
Professor Stuart Campbell:6 4 I think it was a great disappointment to Donald that he
wasn’t the first to publish on placenta praevia, because clearly Usama and Ian Donald
62 Mr Usama Abdulla FRCOG (b. 1937) worked with Professor Donald from 1965 to 1969 and together they
published many papers on the early uses of diagnostic ultrasound, including placentography (op. cit. note 65 below ) .
His research into the safety of ultrasound continued when he moved to Queen Charlotte and Chelsea Hospitals
in London. With his appointments as Lecturer and then Senior Lecturer at Oxford and Liverpool Universities,
respectively, he helped to establish the first ultrasound department in each of these cities. He has been Consultant
Obstetrician and Gynaecologist at Fazakerley Hospital, Liverpool since September 1986.
63 A full bladder has the effect of displacing the bowel and therefore allows a clear view of the pelvic organs,
including the uterus. Diagnoses of small pelvic tumours and of early normal and abnormal pregnancy were then
possible under these conditions. See, for example, MacVicar J, Donald I. (1963) Sonar in the diagnosis of early
pregnancy and its complications. Journal of Obstetrics and Gynaecology of the British Commonwealth70: 387–395.
Donald I. (1966) The interpretation of abdominal ultrasonograms. In Grossman C, Joyner C, Holmes J M,
Purnell E W. (eds) Diagnostic Ultrasound. New York: Plenum Press, 316–332.
64 Professor Stuart Campbell DSc FRCPEd FRCOG FACOG (b. 1936) graduated from the Faculty of Medicine,
University of Glasgow in 1961 and in 1965 worked as a research registrar under Professor Ian Donald at the Queen
Mother’s Hospital, Glasgow. In 1968 he took up a lectureship in obstetrics and gynaecology at the Queen
Charlotte’s Maternity Hospital in London, working under Professor Sir John Dewhurst, and became Senior
Lecturer in 1973 and Professor of Clinical Obstetrics and Gynaecology in 1976. He was Professor of Obstetrics
and Gynaecology at King’s College Hospital, London from 1976 to 1996 and has been Professor and Chair at the
Department of Obstetrics and Gynaecology and the Fetal Medicine Unit at St George’s Hospital Medical School,
London since 1996. He was President of the International Society of Ultrasound in Obstetrics and Gynecology
from 1990 to 1998 and is an Honorary Fellow of the American Institute of Ultrasound in Medicine and Honorary
Life Member of the British Medical Ultrasound Society.
Looking at the Unborn
30
were the first actually to show the placenta and I think Ian was very disappointed.65
I think in fact his paper was held by the American Journal of Obstetrics and Gynecology
for many, many months and I think he felt that it may have been a little bit deliberate.
Ken Gottesfeld brought out the first paper.66 But if you look at Ken Gottesfeld’s paper
there are no real images of the placenta, there is a space where you assume the placenta
to be, and the displacement of the head forward, as Usama said. The first paper where
there was real visualization of the placenta was by Ian Donald and Usama.67 Ernest
Kohorn and I slipped in a smaller paper,68 in the same issue on the same subject,
because I had moved down to London by that time, but clearly he and Usama were
the pioneers of placentography.
Dr James W i l l o c k s:6 9 I would like to say something about the question of manual
scanning. As obstetricians we use our hands and Tom [Brown] has made re f e rence to that
a l re a d y. Abdominal palpation is an important part of almost eve ry examination at the
antenatal clinic.7 0 The eye of faith can certainly be misleading sometimes, and you mustn’t
a l l ow it to influence you too much, but the long training that we had in abdominal
palpation did certainly help when it came to using manual scanning techniques. This, I
b e l i e ve, gave us an advantage over radiographers and others and partly explains why
diagnosis by ultrasound has flourished in the hands of obstetricians and gynaecologists.
H a l l: I would like just now to digress slightly. T h e re is a technical explanation in hindsight,
which is a re m a rkably pre d i c t i ve factor as we all know. In fact, the early machines suffere d
f rom lack of sensitivity and I would like to ask John Fleming and Professor Peter Wells to
g i ve some comments on that, because certainly the early Diasonograph series of
equipment suffered from inherent instability and other such problems that meant that
one couldn’t use all the gain that was available there to image the internal body stru c t u re s .
65 Donald I, Abdulla U. (1968) Placentography by sonar.Journal of Obstetrics and Gynaecology of the British
Commonwealth 75: 993–1006.
66 Taylor E S, Holmes J H, Thompson H E, Gottesfeld K R. (1966) Ultrasonic placentography – a new method
for placental localization. American Journal of Obstetrics and Gynecolog y 96: 538–547.
67 op. cit. note 65 above.
68 Campbell S, Kohorn E I. (1968) Placental localization by ultrasonic compound scanning. Journal of Obstetrics
and Gynaecology of the British Commonwealth 75: 1007–1013. See also Kohorn E I, Secker-Walker R H, Morrison
J, Campbell S. (1969) Placental localization: A comparison between ultrasonic compound B-scanning and
radioisotope scanning. American Journal of Obstetrics and Gynecology103: 868–877. Morrison J, Kohorn E I,
Ashford C, Tredgod C, Walker R H, Blackwell R J. (1969) Ultrasonic scanning in obstetrics. 2. The diagnosis of
placenta praevia. Australian and New Zealand Journal of Obstetrics and Gynaecology 9: 206–208.
69 Dr James Willocks FRCOG FRCP (b. 1928) has been Honorary Clinical Lecturer in the University of Glasgow
since 1964. He joined Professor Donald in 1958 when first training as an obstetrician and gynaecologist. He began
scanning at the Western Infirmary and later moved to the Royal Maternity Hospital where he used the A-scope.
His main interest in ultrasound was in establishing fetal cephalometry for clinical purposes. He was Consultant
Obstetrician and Gynaecologist at The Queen Mother’s Hospital and Western Infirmary from 1966 to 1990. He
is the author of various articles on the life and work of Ian Donald, including Willocks J. (1993) Ian Donald and
the birth of obstetric ultrasound. In Neilson J P, Chambers S E. (eds) Obstetric Ultrasound 1. Oxford: Oxford
University Press, 1–18. idem (1996) Medical ultrasound. A Glasgow development which swept the world.
Avenue (University of Glasgow Magazine) 19: 5–7.
70 Dr James Willocks wrote: ‘We were trained to form an “image”, as it were, of the fetus by using our hands in
gentle abdominal palpation.’ Letter to Dr Tilli Tansey, 2 September 1998.
Looking at the Unborn
31
Professor Peter Wells:7 1 That’s certainly true and I’d like to explain that we used in
Bristol the base of the Diasonograph. We were perhaps one of the first groups who
actually acquired one of those and at the same time built our own scanning arms, very
much like the Physionic scanner, although perhaps a little bit more cumbersome. Our
scanner was described in 19647 2 at about the same time that the Physionic scanner
came onto the market. Of course we had lots and lots of trouble with the stability of
the Diasonograph electronics and it was only because of our firm friendship with Tom
Brown, Angus Hall and John Fleming, that we were able to keep this going.
I remember making pilgrimages to Glasgow and people from Glasgow came down to
help us as well. The thermionic valve and other devices continuously drifted and
stories were told of the ‘third level of control’. There were other controls hidden inside
the machine, which we became more and more familiar with. So we did learn a lot
about how to use the Diasonograph as the basis for our scanner.
Can I also put in a word about the American scene? I wanted to try and put that into
perspective. I think what we have heard about so far today has been British –
particularly Scottish – and that’s quite right, but I think it’s worth remembering D H
Howry’s work in Denver in 1947 and that he made his first two-dimensional pictures
in 1951 or 1952.73 Also in the United States, Wild and Reid described their two-
dimensional scanner in 1952.74 At about the same time, developing from Dussik’s
work in Austria (I think it was with transmission ultrasound),75 Heuter and Bolt wrote
a report for the US Government on the future of ultrasound diagnosis – Heuter and
Bolt were tremendous opinion formers in the acoustics world – which concluded that
pulse-echo ultrasound wouldn’t work, and that the future lay in transmission
ultrasound.76 A year or so later a man called Güttner, I think it was, a neurosurgeon,
published a paper demonstrating that even with empty skulls you could get pictures
71 Professor Peter Wells FIPEM FInstP FIEE FREng (b. 1936) began work on medical ultrasound in 1960 and,
from 1963, was concerned with developments in diagnostic methods. Working with his clinical colleagues Dr
(later Professor) Ken Evans and Dr Frank Ross, he constructed an articulated arm scanner that was used with the
Diasonograph electronics (see note 59 above) to provide a routine obstetric service in Bristol. He is presently Head
of the Department of Medical Physics and Bioengineering of the United Bristol Healthcare NHS Trust, Honorary
Director of the Centre for Physics and Engineering Research in Medicine in the University of Bristol, and an
Honorary Professor in the University. He is also Editor-in-Chief of Ultrasound in Medicine and Biologyand was
conferred the Ian Donald Medal for Technical Merit by the International Society of Ultrasound in Obstetrics and
Gynecology in 1998.
72 Wells P N T. (1964) Developments in medical ultrasonics. World Medical Electronics 4: 272–277.
73 op. cit. note 39 above.
74 Wild J J, Reid J M. (1952) Application of echo-ranging techniques to the determination of structure of
biological tissues. Science 115: 226–230.
75 Karl Dussik (b. 1908) began his study in ultrasonography during the late 1930s and was one of the first
physicians to use ultrasound for diagnostic purposes, in particular applying ultrasound to brain structures. See
Dussik K T. (1942) On the possibility of using ultrasound waves as a diagnostic aid. Neurology and Psychiatry 174:
153–168. See also Shampo M A, Kyle R A. (1995) Karl Theodore Dussik – pioneer in ultrasound. Mayo Clinic
Proceedings 70: 1136.
76 Heuter T F, Bolt R H. (1951) An ultrasonic method for outlining the cerebral ventricles. Journal of theAcoustical
Society of America 23: 160–167.
Looking at the Unborn
32
which looked like pictures of the brain,77 and that put transmission ultrasound into
disrepute. I ask whether it set our American colleagues back because of those
influential people going along a blind alley, and that gave the British the opportunity
to race ahead thanks to Professor Donald’s inspirational leadership?
Hall: John, is there anything you would like to add to that?
F l e m i n g: Yes. You have raised the question of sensitivity, Angus. I was talking to To m
[ Brown] last night about this and we we re recalling that initially there seemed to be the
o b j e c t i ve of outlining organs in the body, not looking at their texture at all, just the outline.
But this is a very messy, complex sort of issue, because I remember Tom saying that it
seemed to be that it was Kossoff7 8 in Australia who had shown that greyscale was of
value, but Tom was trying to get the full greyscale range of echo amplitudes recorded
in the images, right from the beginning.
When I came and did some work on it, I had the impression that all we would ever
do was to record the outline of structures and that seemed to be reluctantly accepted.
The American machines went along that line quite a lot. When they eventually came
into production they were based on this idea – most blatantly, with bi-stable tubes
with just simple, black-and-white outlines and no internal structure of the organs. But
then as the sensitivity improved, it became possible to record a much wider range of
echo amplitudes; as Tom pointed out to me last night, you wouldn’t have real time
unless you could record a very wide range of echo amplitudes.
H a l l: That touches on some work that we did at The Queen Mo t h e r ’s Hospital, which
o bviously coincided with the failure of Kelvin & Hughes (formerly Smiths In d u s t r i e s ).7 9
Kelvin & Hughes only ever built, if my memory serves me right, 12 Di a s o n o g r a p h s .
T h e re was, just for the re c o rd, a political crisis in Scotland because yet another Gl a s g ow
company was failing. I forget if there was an election or something, but the Scottish
office, I suspect, persuaded the Pringles, who owned Nuclear En t e r p r i s e s,8 0 to bail them
out by taking over the business.8 1 They bought the ultrasound business, and please
77 Güttner W, Fiedler G, Pätzold J. (1952) Über Ultraschallabbildungen am Menschlichen Schädel.Ac u s t i c a2:14 8 –15 6 .
78 See, for example, Kossoff G, Garrett W J, Radovanovich G. (1973) Grey scale echography in obstetrics and
gynaecology. Australasian Radiology 18: 62–111.
79 See note 2 above.
80 Nuclear Enterprises (GB) Ltd, Edinburgh.
81 Mr Tom Brown wrote: ‘This is a considerable over-simplification. In reality the Supply Division of the De p a rt m e n t
of Health at Russell Sq u a r e, London (Mr Sam Davies, Un d e r - Se c re t a ry), played the leading role in finding a new home
for what was considered to be a British – not just Scottish – development. Although I was working for Ho n e y well by
then and technically out of that business, I visited Sam Davies and during a memorable interv i ew, in which he agre e d
to listen but say nothing, gave him a good deal of background information about the situation. He in turn sent me to
see various senior people in quite a number of UK companies who might be interested. Tow a rds the end there was in
fact quite a bit of competition, but latterly Nuclear Enterprises “came from behind” as it we re and took the business
v i rtually out of the mouth of Barr and St roud of Gl a s g ow, who we re confidently expecting to get it. Un f o rt u n a t e l y ,
Nuclear Enterprises did not buy the patent rights, and we re content with a “p a i d - u p” roy a l t y - f ree licence. They paid
£ 2 5 000 for the business, and for that acquired something like £65 000 of stock and work - i n - p ro g ress, and re c o u p e d
their investment many times ove r. The main patent rights then went to America, which is why I had to make the
Sonicaid machine a 3-D one, to get round my own previous patents!’ Note on draft version of transcript, 24 May 1999.
Looking at the Unborn
33
c o r rect me if I am wrong, Hans [Ga s s e rt], they bought it thinking that they would make
a quick buck by selling off the stock for what they could get and then recoup their
i n vestment and get the political masters out of a hole. That certainly wasn’t the case,
because we went on to see the Nuclear Enterprises series of Di a s o n o g r a p h s .8 2 Ma y b e
Hans Ga s s e rt could fill us in on the viewpoint of Nuclear En t e r p r i s e s’ side of the story.
Mr Hans Gassert:8 3 Eve rything that was said already sparks off memories and I don’t
k n ow if I have been incredibly lucky all my life, because I came to Scotland and
stumbled into Nuclear Enterprises because of Me rcedes cars. I came upon Tom and
Brian Fr a s e r8 4 by accident, at a coffee machine, and being the sort of guy I am, I think I
said something like, ‘W h a t’s that old rubbish in the corner?’ and they started explaining.
Hall: Just for the record Tom Brown and Brian Fraser, who had both worked for
Kelvin & Hughes, had with the equipment joined Nuclear Enterprises in Edinburgh.
G a s s e rt: All I was going to say is that as far as I was concerned at this time I was selling
nuclear equipment in Scotland. All of a sudden Tom Brown and Brian Fraser appeare d ,
together with what I thought was a load of old junk – equipment full of va l ves, which by
that time we re really old hat. Being technically useless, especially at that time, know i n g
nothing about ultrasound, I made negative comments about this redundant equipment,
and I wasn’t surprised that I had to be educated about things like this. So they persuaded
me – and I think I have got Tom probably to blame for getting infected by the ultrasound
thing – after quite some persuasion, to take a piece of equipment, a simple A-scan unit,
to a hospital and to show it to a doctor, because I couldn’t see any point in trying to sell
this stuff. I remember introducing it to people at the Western General Hospital in
Edinburgh along the lines of, ‘I am sorry to waste your time, and this is old junk and these
people won’t leave me alone, they forced me to show this to somebody,’ and they said,
‘ Oh, I read something about this and let’s have a look.’ And they got a volunteer and
looked at the vo l u n t e e r’s head and they got quite excited about it. Then they said, ‘By the
w a y, what does this control on the front panel mean?’8 5 And this control said, ‘Pig alive’
and ‘Pig dead.’ I hadn’t noticed that they had given me a ‘pig grader’ version (sold to pork
p roducers!) of the old Diasonoscope. Anyway, I certainly remember that.
There were stories like this almost every time I tried hard to put people off buying
this equipment, and virtually every time they bought it. I was a very slow learner;
82 Mr John Fleming wrote: ‘These were designated NE4101 (which was virtually identical to the Smiths
“Diasonograph”), NE4102, NE4200, etc.’ Letter to Dr Daphne Christie, 28 July 1998.
83 Mr Hans Gassert (b. 1944) was in Marketing and Sales at Nuclear Enterprises Ltd from 1962 to 1975 and
founded Diagnostic Sonar Ltd at the beginning of 1976.
84 See notes 14 and 18 above.
85 Mr Tom Brown wrote: ‘This is a good anecdotal after-dinner story, but, in fact, it relates to a very basic and
inexpensive instrument produced by Kelvin & Hughes to measure back-fat thickness on pigs. Because sales for this
purpose were somewhat disappointing, an enterprising Kelvin & Hughes sales manager, Charlie Oliver, suggested
that we might sell it to beauty salons or health farms to convince the clients that they were actually receiving some
benefit for their money. The story is, that because of the instrument’s origins, one of the controls was (somewhat
inappropriately for this application), marked “Live – Killed – Cured” since the velocity of sound in pig fat depends
on the status of the pig.’ Letter to Dr Daphne Christie, 20 July 1998.
Looking at the Unborn
34
it took me months and months and months before I thought this was rather strange
and, then I think it was Tom who was to blame or Brian, they finished me off by
taking me to Glasgow where I met Ian Donald. That was a bit like somebody who’s
slightly religious meeting Ma rtin Luther King, and after that I was totally
convinced about ultrasound. Then I met so many wonderful people and had
many, many confrontations telling people about ultrasound in hospitals. Usually the
response was, ‘What is it?’ Smart as I am, I used to explain that it was sound that
you couldn’t hear, and they used then to go on and say, ‘Why do I want to buy sound
that I can’t hear?’ Then the arguments went on to what I heard earlier, ‘I have had
five years of training using my hands to see’8 6 and I used to somehow have to explain,
‘Well, it’s not good enough and you need this machine to see.’ It got quite
tricky sometimes.
But back to Nuclear Enterprises, and yes, they thought they were making a killing
buying the ultrasound business. They didn’t know what to do with it to begin with,
and I think nobody paid any attention to making any equipment until, I think with
a little help from me, we ran out of the first few machines and we had to put together
the next few. It was starting to get busy again and it took quite a while before we put
together the first B-Scanner. I think they only sold one or so NE4101
Diasonographs8 7 – that was really before my time – but then Brian [Fraser] and his
colleagues (notably Mr Alan Cole) got busy designing the NE4102, and that was a
different game altogether.
Hall:There was an interesting development there if I could comment, because, correct
me if I am wrong, Tom, the old Diasonograph was built to be operated by two people,
the classic doctor and assistant team. I believe it was planned that, in fact, the doctor
would stand on the far side of the machine scanning the patient and somebody else
would be operating the controls. Was that the case, Tom?
Brown:The object was to enable the machine to be used by one person. The original
design which Dugald [Cameron] produced had an examination couch which was
operated from the control panel side of the console. That design was not put into
production. What was put into production was a machine that had to be used by two
people, to my disgust and regret, but I was out of the scene by that time. The original
design envisaged a situation where two people might well want to use it – one
scanning and the other operating the controls – but it had to be possible in my view,
and in our view, to operate the machine singlehandedly.
While I have the microphone, can I outline what actually happened commercially
during that period, because it explains a lot of what happened subsequently.
Kelvin & Hughes were in the industrial ultrasound flaw detection business, and had
been involved in a long-running law suit with the Sperry Products Division of
Automation Industries in the States over fairly fundamental patents on industrial
86 This refers to the obstetrician’s training in abdominal palpation, described by Dr Willocks on page 30.
87 See note 82 above.
Looking at the Unborn
35
ultrasound. They were known as the ‘Firestone patents’.8 8 Kelvin & Hughes had built
up quite a respectable set (or ‘portfolio’) of patents themselves on ultrasound, to which
I contributed some, including a very fundamental one on contact B-scanning.8 9
It is astonishing that the ultrasound project survived at all, since after starting in 1956
and being left to run more or less unencumbered until 1959 or 1960, it was suddenly
the case that the focus of all ultrasound work in Glasgow had to shift to industrial
ultrasound, because of commercial difficulties the company got into over industrial
automatic ultrasonic testing equipment.9 0 So medical ultrasound had to take a very
severe back seat from 1960 onwards. It was during that period that the development
of the Diasonograph from the Sundén machine proceeded, but proceeded very much
in the background – and very slowly.
It was for that reason that the Diasonograph never went into production until about
I think 1965 or 1966, by which time I had left the company, and had been away at
Honeywell for a couple of years.
In about 1966 the lawsuit between Kelvin & Hughes and Sp e r ry9 1 was finally decided
in the US Su p r eme Court in favour of Sp e r ry, and as part of the settlement there a f t e r,
88 Mr Tom Brown wrote: ‘These we re mainly to do with high-speed testing of railway track, using the Sp e r ry wheel
p robe. This was a special ultrasonic probe arrangement with transducers fixed inside two hollow, water-filled ru b b e r
t y res which ran, one on each rail, and could detect cracks in them even when travelling at substantial speed. T h e
c rucial thing was that there was s o m e t h i n g – i.e. in this case the water and the tyre wall – between the transducer and
the thing being tested. This was patented, and the crux of the patent battle was that any arrangement, with a n y t h i n g
b e t ween the transducer and the testpiece, was said to come within the patent claims. The arguments went on for
years, but the case was finally lost by Smiths in the US Su p reme Court. It was this decision which was effective l y
the deathknell for all UK invo l vement in ultrasonic testing, including indire c t l y, medical ultrasound. Ne ve r, eve r,
u n d e restimate the importance of patents!’ Note on draft version of transcript, 24 May 19 9 9 .
89 The operating principle of the contact compound scanner was the subject of patents in which Tom Brown is
named as inventor (British Patent 863,874 Improvements in and Relating to the Examination by Ultrasonics of Bodies
having a Non-Planar Surface (1958)) and corresponding foreign patents, including US Patent 3,086,390, the main
claims of which are generally accepted as covering all subsequent 2-D contact scanning systems. There was also a
little-known patent in which Tom Brown and Roy Haslett are co-inventors: British Patent 941,573 (1959), which
anticipated the development of dynamically focused annular array transducers. These and other ultrasonic patents
were subsequently acquired by Automation Industries Inc, in America, in about 1967, following the Smiths/Sperry
patent lawsuit, and the closure of the Kelvin & Hughes ultrasound business. Information provided by Mr Tom
Brown and Mr John Fleming, 24 May 1999.
90 Mr Tom Brown wrote: ‘The work I had done with Alex Rankin [see biographical note 30 above] around
1953/54 had resulted in a patented system for semi-automatic testing of metal parts, with various novel facilities
such as stabilization of the test sensitivity, and recording of defect signals from selected regions of the test piece.
This was particularly directed at testing of welded structures such as pressure vessels. Unfortunately, the
performance of the prototype system made in Glasgow was never equalled by the “production” version, but in the
interim the company had accepted a number of orders based on the performance of the prototype. This was to
result in a number of disputes between the company and its customers, and in 1961 the entire industrial ultrasonic
activity was transferred from the Essex factory to Glasgow to be sorted out. It was this task that occupied the
attention of the team which had been originally built up to service the medical ultrasound project, although it was
then augmented to support the industrial work. This redirection of resources resulted in the slowing down of
development of the Diasonograph medical scanning machine. With hindsight, and from the point of view of
overall medical acceptance, it was possibly not an altogether bad thing, because it provided a breathing space in
which Donald, and later Sundén, could consolidate the medical usefulness of the techniques.’ Note on draft
version of transcript, 24 May 1999.
91 Sperry Products Division of Automation Industries Inc., see note 88 above.
Looking at the Unborn
36
Kelvin & Hughes had to give an undertaking to come out of the ultrasound business
c o m p l e t e l y. This was part of the reason that the Gl a s g ow factory was closed down, and
it was the reason that they had to divest themselves of the ultrasound business altogether.
It was for that reason that Nuclear Enterprises came into the picture. They were not
the only suitors – there were a number of companies interested at that time9 2 – but
Nuclear Enterprises finally got it, and they got with it a paid-up licence to make these
2-D ultrasound machines. They didn’t have any other licence rights, but they had the
right to continue to manufacture 2-D machines to the basic patent. It was for that
reason it appeared at the time to be impossible to persuade any other UK company to
invest in the medical ultrasound market, making two-dimensional contact scanners.9 3
That was the reason, when I went to Sonicaid, that we made a three-dimensional
scanner, because it was the only way I could find of getting round my own basic patent
on the two-dimensional scanning principles.
Cameron: That’s the actual drawing of the Diasonograph [this slide is not illustrated
here], which shows the bed that we put in, and which actually moved, and which was
an integral part of the machine. That was how it was intended to be.
I hadn’t realized, Tom, what had happened, because as a proud Glaswegian very much
working in the city, I’ve watched the decline of industries along Clydeside – not only
the shipbuilding but things like Kelvin & Hughes, a very proud name. It’s a very sad
business to see how many things were in fact developed, even invented, in Glasgow
and the West of Scotland, which we now import. When we look at the
unemployment, and so on, there’s a social dimension and an economic dimension to
the whole business, quite apart from the other fundamental parts of this, and it’s a very
sad story that we have. The ultrasound story is something that we should have been
able to do. I hadn’t realized in fact that Sperry had put the spanner in the works.
Hall: We now have the situation where we have got contact B-scanning: a new
generation of equipment – the NE4102 series of equipment – was (dare I suggest it)
more ergonomically designed so that the operators could scan, and also the controls
faced them. This was probably, with hindsight, a forward step but a reverse step at the
same time. That was, unfortunately, because the only means of recording images easily
was to use what engineers called ‘bi-stable storage tubes’. They, of course, reinforced
the outline approach to imaging, where you didn’t see the entire contents of the
abdomen. If we now look at modern images, they are full of greyscale
92 A survey commissioned by the National Science Foundation in the 1970s suggested there were five firms selling
on the US market by 1969 (including one Japanese firm, Toshiba) and twelve by 1973. (By the end of the 1970s
there were around 37 firms offering equipment worldwide.) See Colton R M. (ed.) (1982) Analysis of the Five
National Science Foundation Experiments to Stimulate Increased Technological Innovation in the Private Sector.
Section V (medical instrumentation). Washington DC: National Science Foundation.
93 Mr Tom Brown wrote: ‘Automation Industries, having acquired the basic medical scanning patents, went on to
try to enforce them and claim royalties from all the manufacturers then in the field, but this was resisted, and, it
is said, that it was the threat of an anti-trust action which dissuaded them, and cleared the way for future
competitive development of ultrasound scanners. Nevertheless, the demand for a substantial initial fee plus
punitive royalty demands thereafter existed for some years and inhibited commercial development of other 2-D
scanners.’ Note on draft version of transcript, 24 May 1999.
Looking at the Unborn
37
information; they give all the visual clues to diagnosis. If we could jump ahead a
bit, possibly to think about the introduction of scan conversion, I wonder, John
Fleming, if you might give us some input to what was a very significant development
in modern imaging.
Fleming: Yes, it suddenly allowed you to store images with significant greyscale. The
first scan converters were introduced for television systems conversion,94 but they were
applied to ultrasound, which was a different format of scan conversion and you got a
bright, clear image. The first ones were analogue and pretty unstable. You needed to
be a bit of artist to keep them adjusted correctly, but it was a very significant step.
Hall:The problems that the early scanners had focused on the fact that they used
Polaroid™film, which has poor characteristics anyway in terms of greyscale.95 What
you were asking the operator to do was to scan a variable-size abdomen, requiring
certain sensitivity of controls, at speeds such that you managed to expose the picture
properly on this Polaroid™ film; very difficult to do. Scan conversion removed that;
it has what we would call a ‘peak memory’, which simply remembered the peak value
of echo stored in any one location. You could scan over an area and it would simply
record the maximum value. It simplified the scanning process. We could photograph
the result after we’d looked at the image. Still not easy to do, but it became much
more practical. At the same time we moved into the advent of real-time scanning96 and
there were two developments there. There was the linear-array real-time scanner
with no moving parts, followed possibly by the rotating-wheel type of mechanical
94 They were first developed to convert from the original 405-line TV standard developed by EMI to the 625-line
system. Information provided by Mr Tom Brown and Mr John Fleming, 24 May 1999.
95 Tom Brown wrote: ‘This touches on a very significant historical twist in the ultrasound story, which is central
to an understanding of why things happened the way they did. It is misleading to suggest that the greyscale
limitations “focused” or were otherwise due to the use of Polaroid™film. The characteristics of Polaroid™film
were known, and could be accommodated in the design of the electronic system. Alternatively, as was done for a
time, the “bottom bend” in the photographic characteristics could be compensated by slightly pre-exposing the
film before use in the “light box”, which was otherwise used to photograph the record card giving details of the
scan. However, the most significant issue is that first Douglass Howry, and then independently myself, and later
Kossoff who took the process even further, recognized the potential advantages of “compound scanning” and
integration of the echo information on a photographic emulsion. This allowed the build-up of genuine echo
information obtained during multiple “passes” of the scanning sound beam over the target structure, while
spurious artifacts, due to reverberation or side lobes, faded into a background haze. It also had the subtle advantage
of exchanging some redundancy in the scanning process for an enhancement of the otherwise poor lateral
resolution of the transducer, by “looking” at the same target from several different directions. As Kossoff in
particular demonstrated, this also led to quantitatively meaningful greyscale rendition. This process has much in
common with signal averaging techniques used in other fields to extract genuine signals from a noisy background.
However, these advantages only arise with a systematically executed compound scan, and in practice few manual
operators carried out such a scan properly, and so the full advantages of photographic integration were seldom
achieved. The significance of the use of a peak-reading scan converter was that it made it easier for a user to obtain
a relatively indifferent if passable image, even with poor scanning technique, but it completely negated the
advantages of compound scanning and signal integration (see Brown T G. (1967) Visualization of soft tissues in
two and three dimensions – limitations and development. Ultrasonics 5: 118–124). There is a curious side-light on
all this, in that CT scanning can be regarded as an extreme example of “viewing” the radiodensity of tissue cells
from a multiplicity of positions, and using computational methods rather than photographic integration to make
a diagnostically useful cross-sectional image.’ Note on draft version of transcript, 24 May 1999.
96 For a review see Winsberg G. (1979) Real-time scanners: a review. Medical Ultrasound 3: 99–106.
Looking at the Unborn
38
scanner.97 Certainly that type of scanner was an adjunct to the Diasonograph series of
equipment manufactured by Nuclear Enterprises. I would like to hear how that
d e velopment came about.
Dr To ny W h i t t i n g h a m:9 8 I came into ultrasound in 1970. At that time it was a world of
contact scanners and water-bath scanners. Phased arrays had been invented by Jan So m e r
in Ho l l a n d :9 9 this was a way of electronically steering a beam from a fixed point against
the skull. He was interested in imaging the brain. His system had side lobe problems and
the beams we re rather wide, so few people we r e getting really excited by this work.
T h e re had also been some work done by Buschmann, developing an eye
scanner based on 10 discrete transducers arranged around the arc of a circle,1 0 0 but
generally everything was either contact scanner - or water bath-based. Suddenly into
this situation, in 1971, came a publication by Bom in Holland. He arranged 20
disk transducers in a block of plastic in a linear format so that each one looked
straight ahead. By switching between these elements (transducers) in sequence,
hecould produce a 20-line image of the moving heart, with frame rates of 190
frames per second.1 0 1
97 Largely developed by Professor Mc Di c k e n’s (see biographical note 109 below) group in the De p a rtment of
Medical Physics at Edinburgh Un i ve r s i t y, and incorporated into the Nuclear Enterprises Diasonograph pro d u c t s .
Information provided by Mr Tom Brown and Mr John Fleming, 24 May 1999. Dr Angus Hall wrote: ‘T h e re are
various ways of producing a real-time image by mechanical means, either by rocking a single transducer backward s
and forw a rds or by using a rotating wheel. In either case the imaging format is a sector. In collaboration with the
De p a rtment of Medical Physics, Un i versity of Edinburgh, Nuclear Enterprises produced a real-time scanning
assembly based on a rotating wheel driven by a stepper motor. Within the wheel we re four discrete transducers
mounted radially at 90-degree intervals. The active face of each transducer was flush with the wheel rim. The wheel
was coupled to the patient via an acoustic window. The transducer assembly could either be used with a stand-alone
e l e c t ronics unit or be plugged into the later series of Diasonograph instruments, in which case the operator had the
option of either contact B-scanning or real-time sector imaging.’ Letter to Dr Daphne Christie, 11 August 1999.
98 Dr Tony Whittingham FIPEM FInstP (b. 1944) has been Head of the Ultrasonics Section at the Northern
Regional Medical Physics Department at Newcastle General Hospital since 1972. He has been teaching ultrasound
scanning since the 1970s in Aberdeen, and later Newcastle-upon-Tyne, and pioneered the development of
linear-array scanners in the UK. He was President of the British Medical Ultrasound Society from 1988 to 1990.
99 Somer J C. (1968) Electronic sector scanning for ultrasonic diagnosis. Ultrasonics 6: 153–159. Somer J C,
Lengdeek J. (1971) Ultrasonic processing for medical diagnostics. Proceedings of the British Acoustical Society,
Spring Meeting, April 1971. Mr Tom Brown wrote: ‘Though Somer pioneered their use for medical purposes,
phased-array beam-steering systems had been known for a very long time before that, having been developed and
used extensively in submarine warfare, but the technology was all classified. Bill Halliday, Kelvin & Hughes’ Chief
Scientist to whom I was sent in 1956, was in the difficult position of knowing a good deal about this, but was
inhibited from telling me because of the Official Secrets Act. Several parties, including Professor D G D Tucker’s
group at Birmingham University, had been attempting to have the work declassified by developing alternative
means of doing the same things. It was Tucker’s published work, coupled with that of Voglis, which prompted
Haslett and me to file our application for patents in 1959 (see note 89) covering an annular array dynamically
focused transducer system, intended for medical purposes (Tucker D G, Gazey B K. (1966) Applied Underwater
Acoustics. Oxford: Pergamon Press Ltd).’ Note on draft version of transcript, 24 May 1999.
100 Buschmann W. (1964) Ein neues Gerät der Ultraschalldiagnostik. Proceedings of Symposium Internationale
de Diagnostica Ul t rasonica in Op h t h a l m o l o g i a. Berlin, 3–5 June, 1964. Augenklinik der Charité:
Humboldt–Universität zu Berlin, 31–35. idem (1965) New equipment and transducers for ophthalmic diagnosis.
Ultrasonics 3: 18–21.
101 Bom N, Lancee C T, Honkoop J, Hugenholtz P G. (1971) Ultrasonic viewer for cross-sectional analysis of
moving cardiac structures. Biomedical Engineering 6: 500–503, 508.
Looking at the Unborn
39
I think it was in 1971 that I was at a meeting of the British Medical Ultrasound
Society in Glasgow. Bom was unable to attend to present his work, but he sent a film.
I remember to this day the excitement when the film was shown of his 20-line image.
The audience stood up and applauded the celluloid, because Bom wasn’t there to
receive the accolade himself.That, to me, showed that a hand-held, lightweight probe
that could be moved around the patient was now possible. None of this cumbersome
equipment, water-bath or otherwise, was there to hover over the patient, and it was
the way forward. The problem was that 20 lines is nowhere near enough for an
acceptable diagnostic image. As you know, if you look at a television screen there are
500 visible lines, and the line structure becomes evident once you get below about 200
lines. So the challenge that I saw was how to make the number of lines greater. I tried
various ideas, but the one that worked was to make an array of very narrow
rectangular elements and to use a group of these to form a square aperture. This group
of elements defining a composite transducer would scan the line in front of itself.
Then you drop one element off from one end, put another element on at the other
end, in front of the group, and advance the active group along the array in this way.
When I was doing this I was totally unaware that it would work. I hoped it would
work, but I was worried that there would be cross-coupling from the end elements
of the group into what should have been passive elements, so that you might not
be able to get a well-defined active aperture. But it did work, and that proved to be
the way forward, because you could make finer and finer elements and get more
and more lines into the array.1 0 2
Tom Brown has said he was unaware of the work of Howry1 0 3 when he was developing
the contact scanner and the water-bath scanners. I subsequently found out that King
in America was working on the same idea as me.1 0 4 He had a group of three elements
in the array, whereas I had four. Today the number of elements goes up to 128 or
more. I think this has been a feature in the development of medical ultrasound. People
have been very enthusiastic. They have had an idea but they have been perhaps less
than perfectly diligent in doing the literature searches. We have found that time and
again people have got excited, thinking that they have invented something, and they
have, in fact, been one of a number of simultaneous inventors.
Hall: I wonder if I could ask Professor Campbell to comment on the introduction of
real-time scanning in conjunction with NE4102? Because, to be provocative, it seems
it was almost a rear-guard action – the static B-scanner, with the facility to do
real-time scanning as an add-on. Did it really have a part to play, Stuart?
Campbell: If I can just go back a little, one of the seminal moments in my scanning
career was when I first saw Kossoff’s pictures from Australia where he used the
102 See Whittingham T A. (1979) Theoretical and Experimental Studies of Real-Time Ultrasonic Imaging in Medicine.
PhD Thesis. Newcastle upon Tyne: University of Newcastle upon Tyne.
103 op. cit. note 39 above.
104 King D L. (1973) Real-time cross-sectional ultrasonic imaging of the heart using a linear array multi-element
transducer. Journal of Clinical Ultrasound 1: 196–200.
Looking at the Unborn
40
Oc t o s o n .1 0 5 I know he used a water-delay scanner, but he was the first, to me as a
clinician, to introduce the concept of greyscale. Subsequently the scan conve rters came
along ve ry quickly and greyscale was introduced to the Diasonograph, to our B-scanner.
When I was at Queen Charlotte’s Hospital (I had moved to London), I was asked to
train some people in Singapore in ultrasound. I went with great alacrity – I had never
been so far away before – and it was a Siemens Vidoson machine, with flickering real-
time images. A rotating mirror produced the real-time image, but it was cumbersome
and very difficult to use and no way was the resolution as good as the Diasonograph.
So I really didn’t think much of real-time at that time. Then I paid a visit to Montreal
to give a lecture. Fred Winsberg, who invited me, said, ‘Do you want to see the
ADR1 0 6 real-time scanner?’ It was Marty Willcocks [founder of ADR] who was the one
who really developed electronic real-time scanning in a commercial way. I went down
and I was just so bowled over with this concept of placing a linear-array transducer on
the patient, seeing the fetus and its movements, and with the ease of scanning that I
picked up the phone and phoned the Chief Executive of my hospital straight away
and said, ‘You must buy this machine, it would cost £13000.’ So I ordered it straight
away and took it back to London and to me it was one of the most staggering
innovations in ultrasound I had experienced in my life. It, of course, made scanning
immediately much easier. In fact I led a very nice life at the time with the
Diasonograph because you needed years of practice to be able to use it, and once you
reached that level, very few people could overtake you, for the Diasonograph was the
best machine in the world.
Even before the scan converter, the Diasonograph had some levels of dynamic range1 0 7
– I don’t know if Tom [Brown] can talk about that – which was much greater than
the Picker machine in America. So I could virtually go to America anytime and
know nobody had got anywhere near the quality of the images or the techniques
that we were using.
All of a sudden, with real-time, anybody could be trained to do ultrasound ve ry quickly.
It unive r s a l i zed ultrasound. It meant that ultrasound took off in virtually eve ry district
hospital ve ry, ve ry quickly. If we had stayed in the static era, it would still have been in
the hands of an elite few who had trained and practised the craft of ultrasound. Now
ultrasound became a universal technique, so real-time was the great bre a k t h ro u g h .
Hall: It’s interesting to hear your comment about Kossoff’s water-bath scanner,1 0 8
because using that type of water-bath scanner obviously gave you much more control
105 op. cit. note 78 above.
106 The Advanced Diagnostic Research Corporation (ADR) was founded in February 1972 in Tempe, Arizona, to
research ultrasound technology for obstetrical and abdominal applications. ADR developed the first commercial
linear-array real-time scanner; these were marketed in 1974. An improved machine, Model 2130, was announced
in 1976. ADR was acquired by Advanced Technology Laboratories Inc in 1982, now one of the large ultrasound
companies. Information provided by Mr Tom Brown and Mr John Fleming, 24 May 1999.
107 op. cit. note 111 below.
108 op. cit. notes 78 and 95 above.
Looking at the Unborn
41
over the scanning time and speed and therefore it was easier to fit the returning echoes
into the exposure characteristics of the film, again a problem of contact B-scanning.
P ro fessor Norman McDicke n:1 0 9 Just to complete the picture. You mentioned the
spinning wheel real-time scanner. I think one of the things that we learned from the
Australian work was the value of good transducers and the importance of ve ry we a k
signals. Although we called it greyscale scanning, we had good transducers and we kept
ve ry weak signals in the picture. As better and better transducers we re put onto the
Diasonograph and we thought that, since the linear-array images and so on we re still
fairly crude, we could do better if we could get the transducers off the Di a s o n o g r a p h s ,
put them on a wheel and spin them in an oil bath, with a small hand-held device.
So we developed that. We did that in Edinburgh, actually, and sold it to EMI (by that time,
Nuclear Enterprises had become EMI).11 0 So that’s how that real-time scanner ended up on
the Diasonograph and there was also a stand-alone unit. I think EMI sold about a thousand
of them, so they came in with good-quality images. That sort of technology functioned
well; we can still buy them, but it’s something like 15 years into the lifetime of that type of
real-time scanner. T h e r e was a ve ry immediate debt in the subject to the Australian work
when things started looking like anatomy. It was a very significant step forward.
B row n: The whole question of greyscale is shrouded in quite a bit of misunderstanding,
I think. One of the things that one learned from radar technology is that the signals which
come back from a target area are of two types. T h e re is specular reflection, which is when
the energy is reflected as though from a mirro r , and the size of the signals which come
back can be extremely high. Then there is scatter, which is from the substru c t u r e of the
medium through which the energy is being transmitted. The fact of the matter is that in
the early days of contact B-scanning the sensitivity, particularly of the quartz transducers
which we re available, was such that one could really only obtain specular glint echoes.
A lot of the early effort was devoted to increasing the dynamic range111 of signals that
could be captured and presented on the display. Although I had been unaware of
1 0 9 Professor Norman Mc Dicken FIPSM (b. 1940) took up medical ultrasonics in 1967 when he moved to the
De p a rtment of Clinical Physics and Bioengineering in Gl a s g ow after completing his PhD in nuclear physics at the
Un i versity of Gl a s g ow. He ran probably the first teaching course in the world on medical ultrasound, set up by
Dr John Lenihan, Di rector of the Physics De p a rtment. In 1974 he moved to the Un i versity of Edinburgh to continue
w o rk on ultrasound and became Professor of Medical Physics and Medical Engineering and Di rector in 1988.
1 1 0 Electrical and Musical In s t ruments (EMI) ( Mi d d l e s e x ) traditionally made re c o rds and home entert a i n m e n t
equipment, having pioneered electrical (in place of mechanical) re c o rding in the 1920s and television in the 1930s.
Later they we r e heavily invo l ved in Radar and other defence projects. EMI, who had developed a phased-array system,
model 4500, took over the ultrasound division of Nuclear Enterprises in 1977, recognizing the prospects that
ultrasound was seen as having and hoping to consolidate their position in the medical field. EMI’s role in computed
tomography (CT) and nuclear magnetic resonance (NMR) is described in Christie D A, Tansey E M. (eds) (1998) op.
cit. note 22 above. Mr John Fleming wrote: ‘Would it be correct to say that EMI is better known for its invo l ve m e n t
in CT than NMR? Perhaps it is just me as I worked with [Professor Sir Go d f rey] Hounsfield before he got onto CT;
hence I was very aware of that work although I had left EMI.’ Note on draft version of transcript, 24 May 1999.
111 Mr Tom Brown wrote: ‘As time went on we could also see that there were smaller echoes present, but there was
a practical problem in the electronics, complicated by the limited range of tones available in the film, of somehow
“compressing” the very large and very small signals into the same image – this is what is called the “dynamic
range”.’ Letter to Dr Daphne Christie, 20 July 1998.
Looking at the Unborn
42
Howry’s work at the time we started in 1956,11 2 I subsequently got to know Doug
Howry very well indeed and we became quite close friends. I found a parallelism
between his approach and my own, in terms of ‘hunting for (weak) echoes’ using a
compound scanning process.11 3
One of the subtle advantages of the compound scanning process is that it enables you,
with a fairly wide acoustic beam, to exchange a certain amount of redundancy in the
scanning process for an enhancement in the azimuthal (lateral) resolution. The initial
raison d’être of compound scanning was to find echoes from structures which did not
lie parallel to the skin surface, but it had this additional bonus of enhancing the
resolution by redundancy in the scanning process. That resolution enhancement is the
same basic technique which was used in neurology for signal averaging of
electroencephalogram signals coming back from the brain, hidden beneath a noise
level. Curiously, it is the fundamental principle that underpins the CAT scanner.11 4
The CAT scanner just does it on a grand scale.
So it was a sound principle, but because we were focused on this business of specular
and non-specular echoes with a very large dynamic range, and all the difficulties this
led to, I tended somewhat to discount the early real-time scanning attempts –
particularly the 20-element array.
It was a bit like the occasion when Lord Kelvin was reputed to have said that heavier-
than-air flying machines we r e a physical impossibility.1 1 5 It was a mistake, and a mistake
on a grand scale, and it didn’t take me terribly long to re a l i ze it. The thing that
real-time has that contact B-scanners don’t have is the vital ability to display motion.
If you display a moving picture to someone, then that someone will see – or will
believe they see – far more detail in the image than they will do if you freeze that
image and present them with a still picture. The reasons behind it are to do with the
ways the brain processes information. These are very subtle and I wouldn’t even
attempt to explain them, but you have only got to go to a cinema and see a moving
picture and then stop it as a still frame to realize the immediate degradation in the
quality of the image. It is that which to me is the real magic of real-time scanning.
Hall: I wonder if we could just go back and talk about the scientific and technical
aspects of an area that Professor Stuart Campbell was very much instrumental in
following on from the work of Dr Willocks and, I think, yourself, Professor MacVicar
– namely fetal measurement, first of all biparietal diameter measurement, and then, of
course, later on, area and circumference measurement. Dr Willocks, as I recall, you
started off on fetal growth and fetal maturity simply using A-scan equipment. Would
you like to tell us something very briefly about that?
112 See note 39 above.
113 See notes 15 and 95 above.
114 Mr John Fleming wrote: ‘Originally the technique was referred to as computed axial tomography (CAT); later
axial was dropped (CT).’ E-mail to Dr Daphne Christie, 26 October 1999.
115 Lord Kelvin was Professor of Natural Philosophy at Glasgow University, see note 2 above.
Looking at the Unborn
43
W i l l o c k s: T h e re was a flaw detector available in the Royal Maternity Hospital in
Gl a s g ow. Now I must explain that Professor Donald had responsibility for two separate
d e p a rtments, obstetrics and g y n a e c o l o g y. Gynaecology was at the Western In f i r m a ry,
which he made his base and where all the ultrasound equipment was established. But the
p roject of studying fetal biparietal cephalometry was conducted naturally enough where
the pregnant women we re, at the Royal Maternity Hospital at Ro t t e n row on the other
side of the city centre .1 1 6 T h e re was now h e re to keep the equipment; it just stood in the
corner under a sheet. T h e re was no cupboard even in which to store it and we had to wheel
it around the wards on a little tro l l e y. T h e re we re a number of things that assisted us in
getting reasonable results. One was that perfected by my colleague, Tom Du g g a n :11 7 t h e
technique of the electronic cursor, which produced the bright spot on the sharp echo that
you obtained from either side of the biparietal diameter if you we re examining corre c t l y.
We we re then able to conduct a series of pathological studies at the same time to give
some information about the speed of ultrasound in the various components of the fetal
skull, scalp, bone, etc. So we we re able to produce a reliable figure for conve rting time
into distance and seeing what the biparietal diameter was. A-scan hung on, in this are a ,
because it was the only equipment we had on site to do this, and it gave reasonable re s u l t s .
You have referred to our use of serial measurements of the fetal head during pregnancy
to indicate growth. This was the first study using ultrasound to measure fetal growth
anywhere in the world. It proved to be of considerable importance.11 8
When The Queen Mother’s Hospital opened in 1964 everything became unified and
I think we should hand over to Professor Campbell at this point, because it was he
who developed the technique further, using the B-scan presentation, and planned an
outline of the fetal skull which provides more sophisticated results.
Campbell: I came to The Queen Mother’s Hospital in 1964 and in 1965 was made a
Hall Tutorial Fellow which is a position, I was told, where everybody subsequently
succeeded, so there was a great onus on me to succeed. I was attached to the man with
the machine – that is, James Willocks – because he used to go round the wards with
116 Willocks J, Calder A A. (1985) The Glasgow Royal Maternity Hospital 1834–1984. 150 years of service in a
changing obstetric world. Scottish Medical Journal 30: 247–254.
117 Tom Duggan (b. 1933) began working with Ian Donald in the De p a rtment of Mi d w i f e ry, in Ma rch 1959, on
neonatal re s p i r a t o ry problems. He transferred to the De p a rtment of Anaesthetics in Ma rch 1962, but continued
to work with Donald, and that year developed the prototype ‘fetal cephalometer’ in collaboration with Dr Ja m e s
Willocks [see biographical note 69 above]. This, also known as an ‘ultrasonic caliper’, added bright dots to the
A-scan trace. These dots could be set onto the echoes defining the biparietal diameter and their separation, in
m i l l i m e t res, could be read from a dial. Tom Duggan was employed by Kelvin & Hughes from Fe b ru a ry to
November 1963 to assist with transducer development, and then went on to work for the Un i versity of
St r a t h c l yde from 1963 on tissue mechanics, and later at Me a r n s k i rk Hospital on powe red prostheses. In 1973,
f o l l owing the depart u re of Norman Mc Dicken [see biographical note 109 above], he joined Dr Lenihan’s
d e p a rtment to take over running the courses on medical ultrasound. Information provided by Mr Tom Brow n
and Mr John Fleming, 24 May 19 9 9 .
118 See Willocks J. (1963) Foetal Cephalometry by Ultrasound. MD Thesis. Glasgow: University of Glasgow.
Willocks J, Donald I, Duggan T C, Day N. (1964) Foetal cephalometry by ultrasound. Journal of Obstetrics and
Gynaecology of the British Commonwealth 71: 11–20. Willocks J, Donald I, Campbell S, Dunsmore I R. (1967)
Intrauterine growth assessed by ultrasonic foetal cephalometry. ibid. 74: 639–647.
Looking at the Unborn
44
the Diasonoscope, this metal flaw detector which displayed little blips from the sides of
the fetal skull. James said that it gave reasonable results, but I also went round with a pair
of calipers and measured the baby’s head afterw a rds to see how they correlated, and they
d i d n’t always correlate ve ry we l l . 1 1 9 That was understandable, because the right section of
the head often wasn’t always obtained. I then learned with Ian Donald how to scan with
the Diasonograph. I started to scan the fetal head and I was able to work out the planes,
to be able to cut the fetal head so that you could always see the midline echo, which
we called the falx. I think it was the medial aspect of each cerebral hemisphere, so that
if a true transverse section of the head was obtained, the midline echo was always in
the middle of the skull. Then I switched to the A-scan for measurement, because in
those days you could get a more precise measurement with the A-scan. Now we don’t
bother: we just put calipers on the B-mode image, but the technique is basically the
same. You have to align the probe, but it’s so much easier with real-time now to obtain
the correct plane. In those days it took time to adjust the scanning gantry so that the
midline echo was in the middle and aligned right down the middle of the brain. So I
built up what I regarded were accurate charts of the growth of fetal skull throughout
pregnancy.There was no such thing as research fellowships in those days. You did your
research when you were a Registrar. So I had my clinic on Sunday mornings. I said to
Ian Donald that cephalometry was the new religion. So all these Glasgow ladies who
were very tolerant of me came up on Sunday mornings and I measured their babies’
heads and drew graphs of the normal growth of the skull throughout gestation and
then started to check gestational age by early measurements, and then when I went to
London I got onto abdominal circumference and other measurements.
H a l l: John, could you, just for the re c o rd, talk about the development of the incorporation
of cephalometry into B-scanners, because that was not an overnight pro c e s s .
Fleming: Yes. I’ll go back a step. At Smiths1 2 0 we built a Diasonoscope which was an
A-scan instrument designed for echo-encephalometry.That had an add-on unit which
matched it visually, which was a fetal cephalometer, unbelievably large in volume.
That was sold for a while as a fetal cephalometry system, but then that quickly
disappeared with Stuart’s work and the cephalometer was added to the Diasonograph.
Hall: I have got to stop you. There was another stage before that. If my memory serves
me right, Stuart actually scanned the patient, found the right location, and actually
switched over to the cephalometer, which was quite separate.
Fleming: I never knew how that switch actually got there. I think Stuart must have put
it there himself. He’s an electronic engineer and he doesn’t let on. Yes, there was a
coaxial switch, rather a strange device, stuck on the bezel of the Diasonograph so he
119 Dr James Willocks wrote: ‘The measurement made by ultrasound was checked after birth by measuring the
baby’s biparietal diameter with a caliper fitted with a Vernier scale. It was interesting that babies born in the normal
way usually had a measurement less than that obtained antenatally by ultrasound. This was due to the moulding
process during birth. Babies born by elective Caesarean section had measurements which correlated much more
accurately with the antenatal measurements by ultrasound.’ Letter to Dr Tilli Tansey, 2 September 1998.
120 See note 2 above.
Looking at the Unborn
45
could scan, get an image, and then switch over and do his measurement on a Mark
VII flaw detector and I, do have a picture of that. Yes, you are quite right.
Campbell: One of the frustrating things was the caliper dials – they wouldn’t go below
5cm. Therefore all my charts started at 20 weeks initially and it was only when
eventually John [Fleming] managed to get them to go right down that I extended
them right down to about 14 weeks.
Hall: And then after that, John – if I can prompt you – the cephalometer was installed
alongside the static B-scanner.
Fleming: Yes, but it was just an add-on unit. It was only when you came to the
NE4102 that the caliper became part of the scanning machine.
Hall: And that really led to modern measurement techniques as we now know them?
Fleming: And then you [Hall] and I, if I can just jump ahead slightly, developed an
area perimeter measuring unit, which again was an add-on to a Diasonograph.
Campbell: Just one trivial thing. One of the things that I did differently was that,
while most people sat to scan, I stood to scan, because it meant that I could switch
over to the A-scan machine much more easily, and also I could get through more
patients much more quickly. So the huge gantry of the Diasonograph I managed to
push around while I was standing, and I found that that speeded up the process.
I remember Ernest Kohorn121 coming from London and saying, ‘Oh, that has opened
a new vista; standing to scan has made a big difference.’
Hall: It was always said in the early days that an alcoholic tremor could be an asset,
because these early operators actually indulged in a form of manual real-time
scanning. Certainly looking at an early pregnancy, they would scan in a darkened
room looking at the long persistent display on the Diasonograph, and you could see
very clearly what Tom [Brown] was alluding to. You could see the moving fetus, yet
when photographed on Polaroid™film there appeared to be very little there. It was a
very early demonstration of the persistence of vision and also what the eye can
integrate and interpret. Malcolm, you wanted to say something.
Nicolson: If you indulge me just a bit, it goes back to my first comments and
what Tom said about them. Tom kindly suggested that the slide of the Mark IV
ultrasonic flaw detector wasn’t the appropriate one. He’s quite right, of course, that the
first one that Donald used clinically was the Mark II and, I suppose, being defensive
as we historians are, I should explain to you why I picked the slide of the Mark IV to
show, rather than the slide of the Mark II. The reason I picked the Mark IV was
that our researches in Babcock and Wilcox,122 in reconstructing the experiments that
Donald did at Babcock and Wilcox, have led us to the opinion that the very
first machine that Donald had in his hands was actually a Mark IV, albeit only
121 Ernest Kohorn was then at University College Hospital. He published work with Campbell on placental
localization. op. cit note 68 above.
122 See note 11 above.
Looking at the Unborn
46
for two days at Babcock and Wilcox. But the first clinical work done was with
the Mark II.
Hall: I must thank our clinical colleagues for their forbearance in an arena which was
somewhat technical at some stages, but brought back memories to quite a few of us.
I would now like to deal with the clinical aspects of the development of obstetric
ultrasound and could I suggest we just follow the same format, starting with the early
days and working forwards and to that end I would like to invite James Willocks to
open this session by giving us a very quick overview of the early days and then you
will be followed by Professor MacVicar who will expand on that.
Willocks: Professor MacVicar and I have always had a certain crisis of identity.We are
like Tweedle-dum and Tweedle-dee, we always seem to be one mistaken for the other.
So it came as no surprise to find that we were both invited to do the same thing at this
meeting. We have been through it all before. I was congratulated on my appointment
to the Chair of Obstetrics and Gynaecology in Leicester1 2 3 and John MacVicar was
congratulated by an eminent Professor of Medicine on the birth of my third daughter!
So we are quite familiar with this sort of scene.
The first thing to be said about the early days of ultrasound from the clinical point of
view is that this was research in the clinical front line. It was work done on and with
women who were facing major gynaecological surgery or childbirth, both of them
significant crises in life, and it is against this background that you must think about
what went on in these early days.
In modern times we would never have got away with it. The Ethical Committee
would have refused it flat, but such was the prestige of a Scottish professorial medical
unit in the 1950s that there was never a word, and I don’t remember any woman
refusing examination. The end result was a development from Glasgow which swept
the world. Our ancient University, founded in 1451, has seen many developments in
science, in medicine, and in engineering, but it is safe to say that in the 20th century
one of the most significant of these has been the medical use of ultrasound. It, of
course, would never have happened had it not been for Ian Donald.
I would like for the purposes of this meeting to turn the clock back to the time when
a young, irre ve rent, re d - h a i red professor from London came into the conserva t i ve
a t m o s p h e re of Gl a s g ow to turn eve rything upside down. As has been said, Pro f e s s o r
Do n a l d’s wartime experience interested him in the possible medical use of So n a r,1 2 4
which was not a particularly user-friendly technique until contact scanning was
d e veloped with Tom Brown at the helm on the technical side. Scanning was done
p re - o p e r a t i vely in a side room adjacent to the gynaecological wards in the We s t e r n
In f i r m a ry and it was followed up in many cases by operative treatment which re ve a l e d
whether the ultrasound diagnosis was correct or wrong, and rejoicing or mourning
f o l l owed accord i n g l y. The operative sessions could be quite fraught and I must say in
123 This was MacVicar’s appointment, not Willocks’.
124 Sonar: Sound Navigation and Ranging.
Looking at the Unborn
47
all this Ian Donald was greatly sustained by the calm, good humour and supre m e
o p e r a t i ve skill of Dr Wallace Ba r r,12 5 who is here today. Some people, reading about
Do n a l d’s work with ultrasound, might go away with the idea that he was some kind of
a backroom boffin, but in fact he was a clinical chief of the old school, a full-blooded
f i g u re, larger than life to many people. John Fleming said that, when he joined us, he
d i d n’t know anything about professors and he certainly didn’t know anything about a
super professor like Ian Donald, who had all the characteristics in full measure.
The early results of the A-scan pictures weren’t particularly good in 1956, but things
improved with time. An interesting B-scan presentation was of John MacVicar’s
abdomen. I don’t know whether the measurements are still the same or whether they
are more or less as they were in those days, but this just shows that the investigators
were quite willing to submit themselves to this technique. When I started it was
gleefully said that my head contained no solid material!
All the early work came together with the most important paper ever published on
medical ultrasound. It had rather an unpromising title, ‘Investigation of abdominal
masses by pulsed ultrasound’,12 6 and the tone of the paper, if you read it, was rather
diffident. It introduced this technique and hinted gently at the end that it might be
of great use in the future, but now Donald, MacVicar and Brown had really got things
going. We have heard a bit from Brown, and we are now going to hear from MacVicar.
M a c V i c a r: I consider that the success of the original work depended on three separate
things: the people, the place and the time. And I would like to start with the time,
because James has already re f e r red to that. 1956 was a lot different from 1996 and I
really don’t think a Western In f i r m a ry Ethical Committee would ever have allowed us to
use an industrial flaw detector on patients.12 7 Nor do I think that the patients would
h a ve submitted to examination if they had had to sign a form which said, ‘I here b y agre e
to this examination by an experimental machine and I don’t know all the consequences
t h e re o f.’ Although we had a lot of discussion with the patients beforehand, it cert a i n l y
would not have been accepted nowadays. We we re lucky in 1956.
With regard to the people, it was fortunate that the three of us came together during
1956 in Glasgow, each of whom contributed in their own particular way to the
development of ultrasound for diagnostic purposes. Ian Donald was a visionary, a man
of ideas, with intensive drive. As head of the University Department, he had access to
many different patients, and these patients worshipped the ground he walked on and
therefore would allow any examination he wanted to be carried out. Tom Brown had
the technical expertise which made him capable of acknowledging what was possible
and was able to produce the machines which complemented the ideas the clinicians
suggested. The generous support of Tom by Kelvin & Hughes should never be
125 Dr Wallace Barr contributes later in the meeting.
126 Donald I, MacVicar J, Brown T G. (1958) Investigation of abdominal masses by pulsed ultrasound. Lancet i:
1188–1195.
127 See also Professor Jean Robinson’s comments on page 67.
Looking at the Unborn
48
forgotten. I was merely a young, aspiring Registrar who wanted to get some research
work under my belt so that I might succeed in a specialist career. So these were the
people at the start.
The place was a gynaecological ward, and gynaecological wards are full of patients
with big masses and it was big masses initially which ultrasound was able to diagnose.
Some people have referred today to the work that the Americans had done previously
but having viewed that later, when I was doing my thesis,128 I discovered that a lot of
their work was done on very small breast lesions where they were trying to make a
diagnosis which was very difficult histologically, far less ultrasonically.129 So we were
lucky that this flaw detector could now detect flaws in the human body – because they
were big.
Acoustic coupling proved a problem initially and various materials were used to try to
improve picture quality. Several Japanese groups and some in America had acquired a
barrel-shaped water-bath where the probe went around the outside. Acoustic coupling
between body and probe was effective and efficient because of the layer of water. But
any of you who know Glasgow women will appreciate that it is not easy to get them
into water for hygienic purposes, far less to get them into water for investigations. The
idea that they would take to water for an ultrasound examination was a non-starter.
Then came the use of condoms and finger cots, because we thought that condoms and
finger cots full of water would be efficient and more acceptable. If any of you have
ever experienced a condom burst by a probe on a patient’s abdomen which soaks the
patient, soaks the bed and soaks you, you will realize that we had to find another
method for acoustic coupling!
This was when olive oil became the substance of choice since it was well tolerated by
patients, especially if it was suitably warmed. The bottle used to be balanced on the
radiator in the room all afternoon while the scanning was in progress and the patient
had to have a good wash afterwards. Although olive oil proved a very good acoustic
coupling medium, it was messy. After a session, Tom and I had our hands, shirts, ties,
h a n d k e rchiefs and trousers completely impregnated with olive oil and smelt
accordingly. So also did the patient’s records.
We started using different frequencies.1 3 0 We would start with 2.5 MHz and go to 1.5
and then to 1 MHz.1 3 1 In these very large abdominal masses, if you used a 1.5-MHz
128 MacVicar J. (1959) Ultrasound as a Diagnostic Aid in Obstetrics and Gynaecology. MD Thesis. Glasgow:
University of Glasgow.
129 Wild J J, Reid J M. (1952) Further pilot echographic studies on histologic structures of tumors of the living
intact human breast. American Journal of Pathology 28: 839–861.
130 The frequencies of the ultrasound probes used at that time were 1, 1.5 and 2.5 million cycles per second – MHz
in present terminology. (Lower frequencies penetrate better but give poorer resolution.)
131 Mr John Fleming wrote: ‘I have no memory nor evidence of the 1 megacycle per second [1 MHz] probe.’ Letter
to Dr Daphne Christie, 28 July 1998. Mr Tom Brown wrote: ‘A 1MHz frequency was provided, originally used
industrially for testing coarse-grained materials like cast iron, but in practice it was rarely used medically.’ Note on
draft version of transcript, 24 May 1999.
Looking at the Unborn
49
probe, you could make a fibroid look like an ovarian cyst. Eventually it became
obvious that the 2.5 MHz-probe was preferable.
To record the images obtained, we used a 35-mm camera fitted to the screen of the
Mark IV flaw detector. Obstetrical training teaches you to identify objects in darkened
cavities by touch and this was why I was chosen to use the so-called mobile darkroom
which looked like a woman’s muff. Into this I would put the 35-mm film, so that at
the end of the afternoon when it was developed we had a pictorial record of all we had
done. As I was manipulating the film within the ‘darkroom’, it occasionally slipped
out and rolled along the floor – thus the records of the whole of the afternoon’s work
were lost. The advent of the Polaroid™camera was a great boon and blessing.
Although the team was overjoyed at detecting at least a difference in acoustic
properties between ovarian cysts and fibroids, a further study of these tumours
immediately after surgical removal, as James has mentioned, was undertaken using a
plastic water-bath with a rubber diaphragm at one end on which to place the probe.
It soon became apparent that the A-scan was not good enough, because as you rotated
the tumour within the water-bath you got completely different pictures. Also it
became obvious that tumours outside the body had different acoustic properties to
tumours in situ. Blood coursing through them in the patient was almost certainly the
reason for the different properties.
Somebody mentioned how nothing was published on the A-scan work.1 3 2 This was
due to the fact that it was only used for a matter of a year to 18 months before being
superseded by the B-scan. The main clinical value of A-scan was to assist in
prioritizing patients. Gynaecological waiting lists extended for a year to 18 months. If
a woman had a fibroid which was not giving her any trouble you could wait and
operate at her convenience. If she had an ovarian cyst, it necessitated operation as soon
as possible in case of malignancy.
Similarly, when we started using B-scan we compared the appearance of malignant
with non-malignant ascites which proved of help as far as the diagnosis of the
underlying cause was concerned and the urgency of treatment. The initial work was
not met with great enthusiasm by anyone, especially some of my colleagues. I
remember one saying that the new technique was only of value to a gynaecologist who
was blind and had lost the use of both hands – but he has denied that since!
It soon became apparent that we had to go on from A- to B-scanning. Tom Brown, as
I said earlier, was very concerned that with manual scanning we could cheat and make
the pictures look anything we liked to agree with our clinical diagnosis. Tom wanted
to get rid of operator bias.1 3 3
The development of the automatic scanner was one solution, although I did not
particularly approve of it. I felt that patients accepted the doctor using the probe
across their abdomen and not just standing at the side and operating it automatically.
132 See Dr Malcolm Nicolson’s contribution on page 5 above.
133 See note 15 above.
Looking at the Unborn
50
I remember a disastrous day when we had a very stout patient. We put the automatic
scanner on her and it suddenly started to dig in because the soft flabby fat stopped
progress across the abdomen and the probe oscillated on one spot burrowing deeper
into the six or eight inches of fat. We had to stop rather hurriedly.
The new display (B-scan) coupled with immediate Po l a ro i d™p i c t u res reduced the
time necessary for scanning and a diagnosis was reached far more quickly. When we
s t a rted on pregnancies, one of the drawbacks to pro g ress was the length of time before
the scanning of early pregnancies with the patient having a full bladder was considere d .
H a l l: Can I stop you there, John, and ask you a question about that? To what extent was
it fortuitous that The Queen Mo t h e r ’s Hospital opened and the patients moved to that
side of the city and gave you access readily to obstetric patients? Because in the We s t e r n
In f i r m a ry there we r e gynaecological patients. You could say that you we re going to open
them up anyway, so the result of the ultrasound examination did not matter.
MacVicar: No. In the Western Infirmary we had often patients with early pregnancy
complications, either incomplete, threatened or missed abortions. With these we
wanted to establish a diagnosis early but scanning before 12 weeks was difficult.1 3 4
Having used my own full bladder as an ovarian cyst1 3 5 it was strange that it passed us
all by that looking through the bladder was a very reasonable way to examine the
pelvic organs in early pregnancy.
Brown: May I interrupt you, John. One of the early applications of ultrasound, if you
recall, was measuring residual urine after Manchester repairs1 3 6 and you became expert
in assessing the amount of urine in the bladder using the A-scope. You had a curious
formula for doing it, I seem to remember, but I think it was that experience that led
to the recognition that a full bladder was a window into the pelvic organs.1 3 7
MacVicar: It might have been because it was a very sensitive area to me. The amount
of urine in the bladder after repairs, especially my repairs, was easy to assess since my
patients had more urine in the bladder than anybody else’s. But why did we not think
of using the full bladder to see early pregnancies long before we did?
The hours of work and the tiredness of those taking part are difficult to appreciate
after all this time. Patients were meticulously examined and when we ran out of
patients we just used ourselves and I mentioned my tummy earlier and I’ve got Tom’s
134 Professor John Ma c Vicar wrote: ‘Be f o re 12 weeks of pregnancy the uterus lies within the pelvis as does the empty
b l a d d e r. When the woman lies on her back loops of small bowel, containing air, lie just underneath the abdominal
wall which reflect the ultrasound waves so that they cannot penetrate down into the pelvis. After 12 weeks of
p regnancy the uterus rises up into the abdomen and pushes the bowel upw a rds away from the anterior abdominal
wall. Si m i l a r l y, as the bladder fills it also rises up into the abdomen and thus a “w i n d ow”, which can look down into
the pelvis, is formed through which the ultrasound can penetrate.’ Letter to Dr Daphne Christie, 30 Ma rch 19 9 9 .
135 op. cit. note 63 above.
136 Using ultrasound, the amount of residual urine could be roughly estimated without resorting to catheterization.
Mr Tom Brown wrote: ‘A Manchester repair was an operation used to correct a gynaecological prolapse (prolapsed
uterus).’ Note on draft version of transcript, 24 May 1999.
137 op. cit. note 63 above.
Looking at the Unborn
51
neck and his leg in my own collection. Nevertheless, had it not been for the
enthusiasm of Ian Donald, the many hours of work might well have achieved nothing
worthwhile. But irrespective of how tired or depressed Tom and I were, Ian Donald
always maintained that there was a big future for this diagnostic science and said, ‘You
are going to do the following tomorrow.’That was what kept us coming back the next
day. I think each of us contributed a little and there was the tremendous driving force
behind us. You must bear in mind that this was done over and above a normal day’s
work. Tom and I particularly used to work until eight and nine at night and then go
home exhausted, sometimes without even a film of the day’s work!
Hall: As an addition to that, I can remember as a much younger man than I am now
attending the British Congress of Obstetrics and Gynaecology in Glasgow in 1967.
Ian Donald was speaking – that was the only reason I was there – and I remember
getting quite distressed when a comment that has been echoed here already was made
in front of me, when this chap turned to somebody and said, ‘This really is nonsense’
and I saw my career vanishing down the tubes. I am glad to say that was not the case.
But then, Professor MacVicar, you along with Donald and others moved to The
Queen Mother’s Hospital where there was more space available. Usama [Abdulla],
I can’t remember, but were you involved before Stuart Campbell or at about the same
time? Would you like to take up the tale of the early days of that development?
Abdulla: I arrived in Glasgow in July 1965. I remember there was the British Congress
which I attended just before I became involved. The year before that Professor Donald
was visiting Iraq, and said, ‘Would you like to come and learn something about a new
technique which I have developed called ultrasound?’ I leapt at the idea and within a
year I was in Glasgow using the Diasonograph. In those days, as mentioned before,
we used lots of the olive oil and I don’t know how we still have our wrists intact, as
the repetitive movement especially over the pregnant abdomens was so continuous. At
one time I could recognize whether the scan was done by Professor Donald, by Stuart
Campbell, or by other colleagues, just from the shape of the movement over the
abdomen; that in turn was printed on the Polaroid™ prints and slides.
Professor Donald was a very persuasive person. He enthused everybody and always
wanted to see further progress. That is how I am sure we were so keen to discover and
see more and more with ultrasound.
Hall: At that stage of the development, how do you think the asset of having
ultrasound really affected clinical diagnosis and practice?
Abdulla: I think it did. Initially there were some doubts and some of these have been
mentioned. For example, we thought that the placenta was low-lying, or that there
could be twin pregnancy, when this was not the case. Obviously the images were not
as good as one sees now and therefore the accuracy wasn’t as good and so there was
some doubt about the value of ultrasound. But under that sort of pressure we all
continued and carried on until the results became better and better and with better
results the implications for clinical diagnosis were greater.
Looking at the Unborn
52
Figure 15. The apparatus in use for fetal cephalometry (head measurements) by ultrasound.
Willocks: Professor Donald’s tireless ability to publicize this technique, his great
persistence and courage in facing all criticism and his always hopeful attitude, were
very essential things. Had ultrasound not been driven by such a strong personality I
doubt whether it would have got off the ground even with all the good clinical results
that were obtained. It might have languished as some other developments in medicine
have in the past.
I have been asked to speak about the early days of fetal measurement.1 3 8 I started on
these investigations round about 1960. The principle of the ultrasound cephalometry
done by A-scan is where you see clear echoes obtained only when the beam passes
through the biparietal diameter.That is the principle it works on and we built the
technique up, as I said, with some experimental work, including pathological work.
There was the apparatus in use in the maternity hospital and pretty primitive it looks
now (Figure 15). A barium titanate1 3 9 probe was used at that time, and that was the
basis on which we were able to go forward and devise not only an idea of the size of
the infant based on the size of the head, but also of the growth of the child by serial
measurement over many weeks of the later part of pregnancy. A side-shoot of this was
an attempt to develop echo-encephalography in the newborn, and those of you who
have had or have newborn babies will know that they are rather mobile objects and
are not very easy to examine. The only way to do it was to put the probe on the one
side of the head and then on the other.
What we we re trying to discover was any shift in the midline of the brain and the
p resence of possible intracranial haemorrhage. Many pre m a t u re babies died fro m
i n t r a ventricular haemorrhage. We we re, for example, trying to pick up blood clots inside
Looking at the Unborn
53
the brain. It didn’t pro g ress perhaps as well as it should, but as Professor Campbell has
told you the work on fetal cephalometry went on and is still used after many years.
Professor Donald, in the early 1960s, was facing a personal crisis with heart disease. He
had the first of his several operations for mitral stenosis while this work was all going
on. T h e re was a memorable meeting at the Royal Society of Medicine on the 12th of
Ja n u a ry 1962. Ian Donald was still technically an inpatient in the Western In f i r m a ry in
Gl a s g ow re c overing from his va l vo t o m y , which in these days was a pretty hazardous and
major operation. We had pre p a red a film on the various applications of ultrasound
which we thought was pretty good, and we we re n’t worried about the meeting. Jo h n
Ma c Vicar and I we re more worried about the state of health of our chief who emerged
on a dark, foggy night to go to London looking blue and breathless. Howe ve r, we
got to the meeting and the Professor began his presentation, ‘A new diagnostic
echo-sounding technique in obstetrics and gynaecology.’1 4 0 The film that we had bro k e
in several pieces and had to be hastily re p a i red. The Professor collapsed with acute
dyspnoea and eve ry sign of a medical crisis in the early stages of the meeting but rapidly
re c ove red. John Ma c Vicar and I continued with our presentation and we all bre a t h e d
a great sigh of relief at the end of the day. That was in 1962 and it was the first time
that many people in our specialty had heard of diagnosis by ultrasound.14 1
Hall: I wonder if we could now move on and hear from that great exponent of fetal
cephalometry and the development of other relevant methods of measurement,
Professor Stuart Campbell.
Campbell: I arrived in Glasgow in 1964/5 as a senior house officer, so I really came at
the same time as Usama [Abdulla]. I thought he came a little before me, but we started
about the same time. As a Hall Fellow I immediately became involved in ultrasound,
following the white coat tails of James Willocks, the man with the machine, and then
basically introducing myself to Ian [Donald] who was really quite an intimidating
senior doctor to a young Registrar because he was totally brilliant – he always asked
quick, unexpected questions and expected you to know the answer. He did have a
quick temper. I learned the technique of just being quiet while he calmed down a little
bit, and then he was fine, the essence in the ultrasound department. If a patient’s bladder
was ove rfull, Ian would be pretty angry, not with the patient, but with whoever it was
that allowed the bladder to be ove rfull. So you just learned to be quiet and he soon
calmed down, because he was an extraordinarily generous man I have to say – quite the
most ethical and generous senior doctor I have ever really met. I worked with Ian and
1 3 8 The measurement of crow n - t o - rump length and fetal cephalometry. Dr James Wi l l o c k s’ recollections about the early
days of fetal measurement at that time are written in a letter to Dr D Christie on 2 September 1998, and will be deposited
with the re c o rds of this meeting in the Contemporary Medical Arc h i ves Centre of the Wellcome Library. See also page 43.
139 Barium titanate is a synthetic ceramic which has greatly superior properties as a transducer to the natural quartz
ones used earlier.
1 4 0 Donald I, Ma c Vicar J, Willocks J. (1962) Sonar: a new diagnostic echo-sounding technique. Il l u s t r a t i ve example
of ultrasonic echograms. The use of ultrasonic cephalometry. Proceedings of the Royal Society of Me d i c i n e 5 5: 637–640.
141 MacVicar J, Donald I. (1963) op. cit. note 63 above.
Looking at the Unborn
54
d e veloped this A- plus B-scan technique of measuring the head and developed grow t h
c h a rts. My obsession while I was still at The Queen Mo t h e r’s Hospital was to pre d i c t
gestational age accurately, and to predict the date, the time, of delive ry.
I started to measure the fetal head in women with uncertain dates and then to pre d i c t
when they would deliver and compare it with the vague dates that they usually gave. I
published that work after I came to London,1 4 2 but it was all based on the Gl a s g ow data.
Few people believed it in those days, and it’s only over the years that people have
accepted it as the way of dating the pre g n a n c y, and the earlier you do it the better. I was
limited initially by the five - c e n t i m e t re problem with the calipers,1 4 3 but that was solve d .
Usama worked on placentography – that was his thing – and eventually they published
the seminal paper on placentography which was slightly after the Americans did.1 4 4
Howe ve r, because the Americans we re using the Picker machine their placentography
paper wasn’t ve ry convincing whereas Ian Do n a l d’s and Us a m a’s was totally convincing.
After I left for London, Hugh Robinson came to Gl a s g ow and he developed the crow n -
t o - rump length measurement. The machine [NE4102] was modified in such a way
that you got much higher resolution, with expanded images. Hugh was able to enlarge
the image so that you saw the early embryo and the crow n - t o - rump length much better.
He actually developed charts of the growth of the embryo in the first trimester which
I still use today.1 4 5 His work with John Fleming was classical, seminal work. I moved to
London and I introduced routine screening of the whole population in Qu e e n
C h a r l o t t e’s. When I got to Queen Charlotte’s they didn’t have a Diasonograph and I
used to take my ladies over to Un i versity College Hospital where Ernest Kohorn was.1 4 6
I used to drive them over in my little red MGB with the patient in a red blanket and I
used to park in the car park about 500 yards away from the hospital. We used to walk
t h rough the streets of London to the hospital and I would diagnose placenta praevia or
w h a t e ver it was and then take them back to Queen Charlotte’s Ho s p i t a l .
Eventually the Department of Health gave us a machine for trial and I was able
to get going with some work and I introduced screening for all women for dating.
In my 1969 paper147 I recommended that all women should be dated, not just
women with suspect dates, and so I put it into practice there. Then I began to see
anomalies such as anencephaly.148 Alphafetoprotein was being measured at this
142 Campbell S. (1968) An improved method of fetal cephalometry by ultrasound. Journal of Obstetrics and
Gynaecology of the British Commonwealth 75: 568–576. idem (1969) The prediction of fetal maturity by ultrasonic
measurement of the biparietal diameter. ibid. 76: 603–609.
143 This refers to the caliper dials not going below 5 cm.
144 op. cit. note 65 above.
145 op. cit. note 24 above.
146 See note 121 above.
147 Campbell S. (1969) op. cit. note 142 above.
148 Professor Stuart Campbell showed several slides of fetal anomalies which are not illustrated here. See, for
example, Campbell S, Johnstone F D, Holt E M, May P. (1972) Anencephaly: early diagnosis and active
management. Lancet ii: 1226–1227. Chervenak F, Isaacson G, Campbell S. (eds) (1992) Textbook of Ultrasound in
Obstetrics and Gynecology. New York: Little Brown.
Looking at the Unborn
55
time.149 Some women came with high alphafetoprotein, but some anomalies we picked
up just because of this routine scanning that we were doing at around 20 weeks. I am
not sure whether this came from high alphafetoprotein or whether from a routine
scan: I would have to look up the paper.
Real-time scanning produced an even better image of an anencephalic fetus. This
would be in the mid-1970s when this would be diagnosed. So real-time made a huge
improvement. Even in those early days, certainly in the second trimester, you could
see that large U-shaped abnormality in the fetus, and I realised that you could
diagnose spina bifida. So I started to look very hard. I started to look at the skull. I
could see the ventricles of the brain. I concentrated on spina bifida, hydrocephalus
and other anomalies at that time.
There were other groups beginning to do this work also, Hansmann150 in Germany
and John Hobbins151 in America, but the diagnosis of anencephaly, spina bifida
and hydrocephalus or ventriculomegaly were the first early diagnoses made of
fetal abnormalities.
Having said so, they weren’t the first diagnoses to be made, because Sundén, I think,
probably has to be given the credit of recording the first anencephalic, but he
diagnosed it in the third trimester and he did that way back in the early 1960s.1 5 2
I think James Willocks or John MacVicar will probably confirm that. The diagnoses
I made were before 20 weeks and so, of course, this actually influenced the decision-
making process as to whether to offer termination or not. To me the great seminal
changes were the introduction of greyscale in the early 1970s, then in the mid-1970s
the linear-array real-time scanning, which totally transformed the way we practised; in
the 1980s it was then transvaginal ultrasound.
Although most of the credit will go to people like Ti m o r - Tr i t s c h1 5 3 and a lot of Is r a e l i
g roups, transvaginal sonography actually began with Kratochwil1 5 4 in Vienna in the late
1960s, early 1970s, but he was not using real-time scanning and there f o r e it was ve ry
difficult and it never took off. Really transvaginal sonography took off from in v i t ro
f e rtilization (IVF). I set up the first IVF unit that was completely outpatient, based on a
149 See, for example, Brock D J, Sutcliffe R G. (1972) Alpha-fetoprotein in the antenatal diagnosis of anencephaly
and spina bifida. Lancet ii: 197–199. Seller M J. (1972) Alpha-fetoprotein in anencephaly. ibid. 716–717.
150 Hansmann M, Windemuth W, Bellmann O, Niesen M, Lang N. (1975) Prenatal diagnosis of fetal
abnormalities in the second half of pregnancy. Archiv fur Gynakologie 219: 406–408. Hansmann M, Häckelöer B
J, Staudach A. (1986) Ultrasound Diagnosis in Obstetrics and Gynaecolog y. Berlin: Springer Verlag.
1 5 1 Hobbins J C, Winsberg F. (1978) Ul t ra s o n o g raphy in Obstetrics and Gy n e c o l o gy. Ba l t i m o re: Williams and Wilkins.
152 op. cit. note 48 above.
153 Timor-Tritsch I E, Rottem S. (1987) Transvaginal ultrasonographic study of the fallopian tube. Obstetrics and
Gynecology 70: 424–428. idem (1991) Transvaginal Sonography. Amsterdam: Elsevier.
154 Alfred Kratochwil practised as an obstetrician and gynaecologist at the Second University Frauenklinik, Vienna,
Austria, using A-mode ultrasound on his patients. He first published on diagnostic ultrasound in gynaecology and
obstetrics in 1966. See, for example, Kratochwil A. (1966) Possibilities of ultrasound diagnosis in labor gynecology.
Wiener Klinische Wochenschrift 78: 190–191. idem The diagnostic use of ultrasonics in obstetrics and gynecology.
Zentralblatt fur Gynakologie 88: 1032–1042.
Looking at the Unborn
56
technique that was first described by Susan Lenz155 from Copenhagen, where she
actually put a needle through the maternal bladder into the ovary, into the follicle, and
aspirated an egg. When I was at King’s I said to John Parsons,156 whom I had just
appointed, ‘That’s the way you are going to get eggs, no more general anaesthetic, no
more laparoscopy, we are just going to stick a needle through the woman’s bladder and
collect the eggs.’ We did that, and had an outpatient IVF system before anybody else.
Then people started to look for other methods. John Parsons started to pass the needle
through the urethra – still doing abdominal scanning – and then the transvaginal
method (I think it was a chap called Dellenbach back in France who developed a
transvaginal method),157where he slid the needle along the transvaginal probe into the
ovary, and that was the opening up of a huge improvement in imaging.
Hall: Could you put an approximate date on when the type of transvaginal scanning
you have just described started in IVF? I don’t mean Kratochwil’s work, which was
known about. Also, for reasons that maybe some of the clinicians could advance, can
you say why transvaginal scanning never really took off in the early days?
Campbell: It would be about 1982 or thereabouts.
We l l s: What about von Mi c s k y ?1 5 8 I thought von Micsky in New Yo rk preceded that work .
Campbell:What work was this? [The transvaginal work.] He developed a transvaginal
probe didn’t he? I would have to check up the references.
Hall: Are you talking pre-Kratochwil?
Campbell:The first person to design a transvaginal probe was J J Wild.1 5 9 There is a
prototype there and I think he actually used it.
155 Lenz S, Lauritsen J G, Kjellow M. (1981) Collection of human oocytes for in vitro fertilization by ultrasonically
guided follicular puncture. Lancet i: 1163–1164.
156 Mr John Parsons FRCOG has been Ho n o r a ry Consultant and Senior Lecturer in Gynaecology at King’s College
Hospital, London, since 1984 and was one of the first pioneers in the technique of outpatient in vitro f e rt i l i z a t i o n .
See, for example, Parsons J, Riddle A, Booker M, Sharma V, Goswamy R, Wilson L, Akkermans J, Whitehead M,
Campbell S. (1985) Oocyte re t r i e val for i n - v i t rof e rtilisation by ultrasonically guided needle aspiration via the ure t h r a .
L a n c e t i: 1076–1077. Riddle A F, Sharma V, Mason B A, Fo rd N T, Pampiglione J S, Parsons J, Campbell S. (1987)
Two years’ experience of ultrasound-directed oocyte retrieval. Fertility and Sterility 48: 454–458.
157 Dellenbach P, Nisand I, Mo reau L, Durand J L, Ro u a rd M, Forrier A, Gerlinger P. (1988) The transvaginal method
for oocyte re t r i e v al. An update on our experience (19 8 4 –19 8 7 ) .Annals of the New Yo rk Academy of Sciences 5 4 1: 111–12 4 .
158 Lajos I von Micsky (1918–1976) joined the obstetric and gynaecology staff of St Luke Hospital in New York
in 1963, and became Chief of the Ultrasonic Division of the Radiology Department in 1969. Professor Peter Wells
wrote: ‘On page 9 of Medical Diagnostic Ultrasound: a Retrospective on its 40th Anniversary, [Goldberg B B,
Kimmelman B A. (1988) Kodak Health Sciences, Eastman Kodak Company] there is a photograph with the
caption “Dr Wild’s rigid transvaginal probe, c.1960”. Professor Campbell was correct, and I was wrong. The work
of von Micsky is mentioned in the same publication, on pages 28 and 29; he developed a probe that was actually
inserted transvaginally into the uterus.’ Letter to Dr Daphne Christie, 29 March 1999. See also von Micsky L I.
(1965) Ultrasonics in obstetrics and gynecology. Obstetrics and Gynecology 25: 420–421.
159 John Julian Wild (b. 1914) built the first handheld ‘contact’ scanner for clinical use in the basement of his home
in Minnesota. Wild subsequently developed other types of ultrasonic imaging equipment including transrectal and
transvaginal scanners and a scanning device for mass screening of patients for breast cancer. See Goldberg B B,
Kimmelman B A. (1988) op. cit. note 158 above. See also Shampo M A, Kyle R A. (1997) John Julian Wild –
pioneer in ultrasonography. Mayo Clinic Proceedings 72: 234.
Looking at the Unborn
57
Wells: That was the transrectal probe. I don’t think he ventured into the vagina.
Dr Margaret McNay:1 6 0 Could I just add that I think the Japanese too developed a
transvaginal approach, if you refer back to the early papers in the 1950s. There was
very little interchange of ideas between the Japanese and the West, but I think, Tom,
am I not right, that many of their developments were along very similar lines to your
own in the early days and they certainly described a transvaginal approach?1 6 1
Brown:There was a famous Japanese stool with an opening on which the patient was
sat and which was a transrectal probe at that time. When this subject came up for
discussion with Ian Donald he just sniffed at it, and said, ‘Typical psychopathology
of the Japanese’ and the idea was dismissed. It was a long time coming and it should
have come earlier.
W h i t t i n g h a m: Could I make a comment on the caliper side of things? It’s just an
i n t e resting point about the choice of caliper ve l o c i t y. I think it was the NE4102 that
had the foresight to have a little panel with controls behind it, allowing you to set
the caliper ve l o c i t y, and in fact the system ve l o c i t y, to anything you wanted.
T h e re was a period of a few years where this, and whatever the other manufacture r s
we re doing, led to some confusion. A given patient could have a BPD [biparietal
diameter] measurement in one hospital, where they’d decided to adopt, say, 1600
m e t res per second, as recommended by Professor Campbell in his paper,1 6 2 and then
up the road where the machine might be calibrated, at 1540 metres per
second. The baby would apparently shrink in the course of the two measure m e n t s ,
just because it was a different assumed speed of sound. I wrote a letter to the
British Jo u rnal of Ra d i o l o gyin 1971,1 6 3 n a i vely as a physicist, saying why don’t we just
stick to what the machine can measure – which is time – and quote the BPDs in
m i c roseconds. It’s been done by the astronomers. They talk about light years. It didn’t
seem to be ve ry well re c e i ved. I can’t think why! But nowadays, and I am not sure
h ow it happened, eve rybody seems to have settled on 1540 metres per second. It isn’t
questioned anymore .
160 Dr Margaret McNay FRCOG (b. 1945) developed the clinical application of ultrasound from 1978 to 1996 in
The Queen Mother’s Hospital, Glasgow, where she was Consultant and Head of the Department of Obstetric
Ultrasound. Her main interest was in the prenatal diagnosis of congenital abnormalities and fetal therapy.
161 In 1958 M Ishihara and H Murooka presented a paper at the 19th meeting of the Japanese Society of Obstetrics
and Gynaecology, describing the practice of the vaginal probe and A-mode presentation and demonstrating a
relatively large series of a given anomaly. See also Wagai T, Yoshimoto S. (1959) Application of ultrasonic
diagnostic methods in obstetrics and gynaecology.Journal of the Japanese Obstetric and Gynaecological Society 11:
169. Tanaka K, Wagai T, Kikuchi Y, Uchida R, Uematsu S. (1966) Ultrasonic diagnosis in Japan. In Grossman C,
Joyner C, Holmes J H, Purnell E W. (eds) Diagnostic Ultrasound. New York: Plenum Press, 27–45.
162 Mr John Fleming wrote: ‘The value of 1600 metres per second was originally suggested by Dr James Willocks
in his MD thesis (op. cit. note 118 above). His measurements on neonates and post mortem specimens gave an
average of 1600 metres per second which was generally used in Glasgow including, of course, being used by Stuart
Campbell.’ E-mail to Dr Daphne Christie, 26 October 1999. See Campbell S, Newman G B. (1971) Growth of
the fetal biparietal diameter during normal pregnancy.Journal of Obstetrics and Gynaecology of the British
Commonwealth 78: 513–519.
163 Whittingham T. (1971) The ultrasonic biparietal diameter, expressed in time units. British Journal of Radiology
44: 481–482.
Looking at the Unborn
58
Hall: If I could just make a comment as Chairman’s privilege? What the early workers
were trying to do was to make the ultrasound measurement agree with what they
mechanically measured. If you actually think about it, if you are measuring growth, it
doesn’t matter if you use 1540 metres per second, provided you use that figure
consistently and establish that diameter measurement to the maturity of the fetus. I
think that’s how the confusion came about.
Dr Wallace Barr:16 4 My only contribution to the proceedings is the fact that I was there
at the moment of conception of ultrasound. When Ian Donald came to Gl a s g ow I was
his fellow consultant in the Western In f i r m a ry and it was our custom to have a session
each day to discuss the proceedings over a glass of sherry. When he came to Gl a s g ow
he had invented or contrived some additions to a re s p i r a t o r.1 6 5 This didn’t really satisfy
his inve n t i ve capacity and he was looking around for something else. One day he came
in and said, ‘I think I have found it’ and he proceeded to produce an article about
submarine detection.1 6 6 He said, ‘I think this ASDIC1 6 7 technique could be applied to
m e d i c i n e’ and the next thing was that he had to find some means by which a detector
of this kind could be available. He learned that Babcock and Wi l c ox, a firm of
boilermakers in the district,1 6 8 had an ultrasonic flaw detector so he immediately
contacted the Di rector of Re s e a rch in Babcock and arranged a meeting. I went to that
meeting and the next thing was to arrange to visit the factory to see the flaw detector
in use. We did this and, of course, there was nothing which would be suitable for the
detection of tumours. But Ian talked this over with them and they decided that he
could come down again, this time bringing a selection of tumours; my motor car boot
was filled with large ovarian cysts and fibroids and so on, which we took down to the
f a c t o ry. They had produced some kind of primitive transducer and a water-bath,
because it was re a l i zed that air produced acoustic impedance. Anyway, this was taken
and we took primitive pictures with an engrossed audience of the workers in the factory
who thought it looked rather like an abattoir. We came back and he was still fru s t r a t e d
by the fact that there was something in this idea, and how could he develop it.
That same evening1 6 9 a telephone call came from one Tom Brown, purely by chance,
and that was the start of this providential partnership between Tom Brown and Ian
Donald. I would like to emphasize the fact that if it hadn’t been for Tom Brown’s
ability to provide the technical know-how, ultrasound might never have got off the
164 Dr Wallace Barr FRCSGlas FRCOG (b. 1919) has been Honorary Clinical Lecturer at the University of
Glasgow since 1960. He was Consultant Obstetrician at The Queen Mother’s Hospital in Glasgow from 1960 to
1985 and Consultant Gynaecologist at the Western Infirmary in Glasgow from 1955 to 1985.
165 See Willocks J. (1993) op. cit. note 69 above.
166 Langevin M P. (1928) Les ondes ultrasonores. Revue Générale de l’Electricité 23: 626–634. Biquard P. (1972)
Paul Langevin. Ultrasonics 10: 213–214.
167 ASDIC, the Allied Submarine Detection Investigation Committee.
168 See note 11 above.
169 Mr Tom Brown wrote: ‘I do hope Dr Barr will forgive me, but there was in reality quite a gap between these
two events. I’ve long believed in the intervention of Lady Serendipity in our affairs, but that would have been
asking rather too much of her.’ Note on draft version of transcript, 24 May 1999.
Looking at the Unborn
59
g round. Then, of course, he had the enthusiastic help of the junior staff, James Wi l l o c k s
and John Ma c Vi c a r , who immediately added to the speed of the whole thing.
I would like just to emphasize this coming together of the two factors; if it hadn’t been
for Tom Brown and Ian Donald, there might never have been ultrasound as we know it.
Hall: I would like to take the opportunity to pick up on one little aspect of Hugh
Robinson’s work.1 7 0 The detection of early fetal life these days is routinely done by
Doppler ultrasound,1 7 1 but there was a period before that when Hugh Robinson was
using measurements, calipers, and crown-to-rump length measurements, but he also
used that as a technique for the detection of early fetal life.1 7 2 John [Fleming], can you
maybe talk on that for a minute or two?
Fleming: He used actually an A-scan technique. It was on the Diasonograph NE4102.
He would search until he saw a fluttering movement on the A-scan and then switch
to M-mode and record heart rate and produce graphs of heart rate against gestation.
It was a very positive indication of fetal life.
Hall: I think the advantages often were that you no longer had the patient waiting for
several days or more for a diagnosis of missed abortion. You could tell if there was still
viable fetal life there and, I suspect, though I may be wrong, that it still can be done
earlier than you might detect early fetal life by Doppler ultrasound. Can anybody
comment on that?
Campbell: I think Doppler is the earliest now. You can see the fetal heart beating at
six weeks.1 7 3
Hall:Which is about the same time that Hugh Robinson was detecting early fetal life,
at six or seven weeks.
Campbell: I wanted to mention one other advance that was made in Glasgow after I
left. A chap called Joachim Hackelöer came as a research fellow from Germany.
Kratochwil had, with his transvaginal scanner, actually observed the follicle,1 7 4 but
nobody had paid much attention. Joachim Hackelöer tracked the development of the
follicle in the follicular phase of the menstrual cycle and the development of the
corpus luteum.1 7 5 It really set a whole new application of ultrasound in motion, that
is, the monitoring of ovulation, especially in the infertile woman. As I mentioned
170 See notes 23 and 24 above.
171 See, for example, De Vore G R, Brar H S, Platt L D. (1987) Doppler ultrasound in the fetus: a review of current
applications. Journal of Clinical Ultrasound 15: 687–703. Maulik D. (1989) Basic principles of Doppler ultrasound
as applied in obstetrics. Clinical Obstetrics and Gynecolog y 32: 628–644.
172 Robinson H P. (1972) Detection of fetal heart movement in the first trimester using pulsed ultrasound. British
Medical Journal iv: 466–468. idem (1975) The diagnosis of early pregnancy failure by sonar.British Journal of
Obstetrics and Gynaecology 82: 849–857.
173 op. cit. note 171 above.
174 op. cit. note 154 above.
175 Häckelöer B J. (1978) Ultrasonic demonstration of follicular development. Lancet i: 941. Häckelöer B J,
Robinson H P. (1979) Ultrasonic demonstration of follicle and corpus luteum development in normal menstrual
cycle and its relation to hormone profiles. Archives of Gynecology 228: 556–558.
Looking at the Unborn
60
before, it was not a big step to then place a needle in the follicle to collect eggs for IVF
treatment. But the tracking of the ovarian follicle began in Glasgow with Hackelöer,
and Hugh Robinson was on the paper.1 7 6
Hall:What I would like to do is to go forward to the more modern diagnostic
techniques, looking at Professor Whitfield and Margaret McNay, and then finish off
on the question of safety.
Gassert: Just two or three quick comments. I have experience of almost everything
that has been mentioned, but often on the other side of the fence. For example, you
mentioned vaginal scanning. I believe the single most significant thing that helped
vaginal scanning to catch on was the experience of doctors in America. In America
they are faced with very many large, really fat, patients in early pregnancy. It’s very
difficult to scan them abdominally and, in fact, the enthusiasm of these doctors that
I met and talked to was instant when they realized that you didn’t need to fill the
bladder, you didn’t have to rely on the patient’s information being accurate, you could
scan everybody and I think that it was the commercial drive that made the
transvaginal scan common or standard.
A very quick thing on the subject of oil, which gets everywhere. I learnt the hard way
a long time ago (which is why we started producing ultrasound gel in Scotland) to save
my own shirts from having to get washed because of the oil. When I took the first
samples of Diagnostic Sonar gel to Ian Donald he was not at all impressed; in fact he
said, ‘This stuff is rubbish, it needs to be fluid.’ I went away somewhat upset and then
one evening, because he constantly mentioned this word oil, oil, oil, it must be oil,
arachis oil, olive oil, any kind of oil is fine, I thought blast, ‘I wonder that if the word
‘oil’ is in someway something that can be used, does it describe a particular product
or something?’ So I looked it up in the dictionary and I discovered that it only really
refers to viscosity, so I named the first gel that I succeeded in selling Ian Donald ‘echo
oil’. As soon as I brought the bottle and the label said ‘oil’ on it, he said, ‘This is great.’
But it was a thin gel, so that was another story.
To comment on Stuart’s [Campbell] experiences. Much of the work he has done I
have ‘sold’ abroad everywhere without Stuart realizing it. It’s because I sold Stuart’s
work that people like Hackelöer came. I can remember Stuart upsetting me once in
the early days when he didn’t know me very well, when I brought two ‘gurus’ from
Germany, Hansmann and Hackelöer, and I phoned him up from London saying these
chaps had just arrived. I said something like, ‘I believe they know you’ and Stuart said,
‘Of course they know me.’ So they learnt about the early experiences in Glasgow and
they had their Siemens machines in those early days. They couldn’t do the early
pregnancy examinations and accurate dating because the Siemens machine didn’t have
any calipers. People were using mechanical calipers to make very crude measurements;
they were really Doubting Thomases who didn’t believe until they came and people
like Stuart showed. Then they went away and they bought these Diasonograph
176 See Häckelöer B J, Fleming R, Robinson H P, Adam A H, Coutts J R. (1979) Correlation of ultrasonic and
endocrinologic assessment of human follicular development. American Jo u r nal of Obstetrics and Gy n e c o l o gy1 3 5: 122–128.
Looking at the Unborn
61
machines. But they never scrapped their real-time scanners and that’s what convinced
me that real-time scanning was going to take off. It’s a great shame that the company
I worked for, Nuclear Enterprises, didn’t build a real-time machine.
The first commercial real-time scanner was the Siemens machine, but the first
commercial linear-array real-time scanner was not ADR,1 7 7 but Organon Teknika.1 7 8
The second one was probably ADR, and the third one was definitely from a little
company called Diagnostic Sonar.1 7 9
Whittingham: Just to make a comment on that last remark. There was in fact a British
machine that pre-dated the Organon Teknika. That was a device sold by GEC
Medical1 8 0 by the name of RITA (real-time imaging transducer array) which was a
little device which you could add to your static B-scanner and turn it into a real-time
machine.1 8 1 That was sold commercially in the UK.
Hall: I wonder if we could now jump forward and talk about the clinical aspects of
ultrasound in the context of the modern equipment. I wonder if some of you
clinicians can comment on what real-time scanning has brought to the clinical scene.
P ro fessor Charles W h i t f i e l d:1 8 2 I was asked to answer a question, ‘What it was like at
the time’ and I am afraid I took that to mean at the ve ry early clinical development of
obstetric ultrasound. My experiences of scanning we r e simply with an old Vidoson that
we used to navigate amniocentesis. This was in Belfast, where we did about 30 or 40
amniocenteses a week. This use has not been touched on. To us it was a huge adva n t a g e
to be able to avoid the placenta, particularly in somebody who has re l a t i v ely little
amniotic fluid, and sometimes these are the mothers from whom we most often wanted
a sample of amniotic fluid. Ultrasound helped you there. Of course the more modern
indication is with intravascular fetal transfusion and all sorts of fetal surgical
i n t e rventions. What I call the navigational side of ultrasound is of great assistance.
177 See note 106 above.
178 Organon Teknika. Data on this company’s products are in the BMUS historical collection.
179 Dr Angus Hall wrote: ‘Diagnostic Sonar Ltd, Livingston, West Lothian, Scotland. An early manufacturer of
real-time scanners. The company is still trading.’ Letter to Dr Daphne Christie, 30 October 1999.
180 GEC Medical Equipment Ltd, Nuclear, Therapy and Ultrasound Division. Mr John Fleming wrote: ‘I have, in
the BMUS collection, a pamphlet showing the RITA instrument. The leaflet is not dated but is filed with a price
quotation dated 20 December 1977. The price is given as £2500 plus a charge of £225 for interfacing to the
customer’s standard A- and B-scan equipment.’ E-mail to Dr Daphne Christie, 17 November 1999.
181 Mr Hans Gassert wrote: ‘I am absolutely convinced Whittingham’s comment about RITA predating Organon’s
scanner is incorrect. Whittingham himself earlier refers to the inventor of the linear array (Professor Nicolaas Bom)
of the Cardiothoracic Centre in Rotterdam and Organon co-operated with Bom. I saw Organon scanners on the
Continent long before RITA was ever heard of.’ Fax to Dr Daphne Christie, 18 October 1999.
182 Professor Charles Whitfield FRCPGlas FRCOG (b. 1927) was Senior Lecturer, Consultant Obstetrician and
Gynaecologist at the Belfast Teaching Hospital from 1964 to 1974, Professor of Obstetrics and Gynaecology at
University Hospital of South Manchester from 1974 to 1976 and Regius Professor of Midwifery at The Queen
Mother’s Hospital and Western Infirmary, Glasgow, from 1976 to 1992, succeeding Professor Ian Donald. He was
Chairman of the Joint Ultrasound Group (to establish training requirements) of the Royal Colleges of
Obstetricians and Gynaecologists and of Radiologists from 1986 to 1987 and of the Working Party on Obstetric
Ultrasound in Scotland in 1988.
Looking at the Unborn
62
Regarding the specific question, ‘What was it like at this time?’ and then, ‘Why did
things happen the way they did?’, I think that these have been dealt with or will be
dealt with. From the viewpoint of obstetricians in general – what were our real
concerns once it seemed clear that ultrasound was going to have a future? An honorary
attachment with Professor Donald in Glasgow in 1964 had convinced me that
obstetric ultrasound did have a future, but later in that year in America I was told it
was just a dream of a mad, red-headed Scotsman, so I should forget it! I was told
confidentially, nothing, no good will come of it, but of course that was wrong.
What were our main problems in the 1950s, 1960s, and into the 1970s? On the
maternal side, maternal deaths, of course, but death is just the tip of the iceberg, below
which is a lot of morbidity that is often due to the same causes, but not quite so severe.
There were three big causes of mortality and morbidity in those days, two of which
ultrasound can’t help, namely abortion, and in those days mainly illegal abortion,1 8 3
and hypertensive diseases. But haemorrhage was still one of the major killers and that
was where we’ve already talked about placentography,1 8 4 in which ultrasound was a
huge advance. Up to then X-rays could be used, and similarly in the early days of
ultrasound, you diagnosed or you thought you diagnosed where a placenta was, either
because there seemed to be nothing else there, or by displacement of the fetal head.
So ultrasound made a huge advance there. With the less dramatic bleeds after
miscarriage or after delivery, the information that there were no longer bits of placenta
in the uterus was a huge advantage, not only clinically, but also in the context of the
savings of hospital beds, because the alternative was to keep the patient in. For
example, in placenta praevia you might keep the poor lady in hospital for months.
But the fetus was, of course, the subject that was really exercising most of us, and of
our two patients, it is the one that, generally speaking, is at most danger. And this was
at a time when astronauts were beginning to go up in the sky and round the world
and it seemed odd to a lot of us, who thought that we were experts on the fetus, that
there had been no mortality among the astronauts but there was still much among our
fetuses. Of course, one of the reasons was that the astronauts were highly selected,
whereas the fetus is not selected; they would be well-trained and were all very fit,
nothing like our fetuses. But the most important thing was that they were able to stick
transducers on the astronauts so nobody ever had to ask them what they were doing,
or how they were feeling, and they didn’t even need to take pictures of them. In the
meantime, here was the fetus and all we could do was listen to its heartbeat and try to
feel its outline (palpation still comes in useful today). It was now that fetal
phonocardiography and electrocardiography and ultrasound became the parents of
real fetal medicine.
So what were the main things that we wanted to know about the fetus? We wanted to
know if there was a fetus present in early pregnancy. Ultrasound’s the answer; if so,
how many? Multiple pregnancies have much bigger risks of lots of things, as the
183 The Abortion Act was passed in 1967.
184 op. cit. notes 62, 65–66 and 68.
Looking at the Unborn
63
obstetricians know.1 8 5 Is it alive (or are they alive)? That was important. How old is the
fetus? That is ve ry important. It may be hard for non-obstetricians to understand this
simple point, because people have been dating pregnancies, quite often incorre c t l y, fro m
the menstrual cycle for I don’t know how many centuries. But it is terribly import a n t
because we we r e getting more and more interested in the fetus that was at risk, doing all
s o rts of tests, mostly biochemical, but largely forgetting that the normal values for a lot
of these tests change as pregnancy proceeds. So unless you really know how old the fetus
is, in terms of gestational age, no wonder some of these tests gave the wrong results. It
is terribly important for the fetus that’s at risk from simply snuffing out in utero, as yo u
really need to know when it is safe to deliver or unsafe to go on waiting. This has
changed ve ry much recently with better paediatric care, giving you much more leew a y.
I used to think about the high-risk pregnancy in terms of two lines crossing on a scre e n ,
with the risks in utero i n c reasing as the pregnancy proceeds, but also with the counter-
risk of delivering too early and of neonatal death from re s p i r a t o ry immaturity
d e c reasing. What you wanted was to pick out where those two lines crossed, show i n g
when to deliver the patient. T h e re we re many tests, but it’s only if you know the
p roblem, the scale of the problems, and the gestational age, that you can interpret these.
We also want to know if the fetus is properly formed in most of these things and how
much amniotic fluid there is – and only ultrasound gives us real help.
Hall: Dr McNay is a successor of, dare I say, the older gentlemen who are sitting here
who used to work at The Queen Mother’s Hospital. I think you, Margaret, may well
be able to give us an insight into the period beyond the beginning when the
equipment became up-to-date, and what implications it’s had from your viewpoint.
McNay: I think it would be true to say, and I think the others would agree with me,
that ultrasound has contributed more to changes in obstetric practice in the second
half of this century than any other form of investigation. Much has already been said
about ultrasound answering so many of the clinical questions and dilemmas, and
Stuart [Campbell] has alluded to its role in prenatal diagnosis and in invasive
procedures. Most of us are well aware of how it is now used so successfully. But I think
the point that I would like to make is that I didn’t come into ultrasound until 1978,
by which time it was really established. I was a junior in Glasgow in the early 1970s
and even at that time – and I think this is probably relevant for people to remember,
despite all that has been said positively about the role of ultrasound – it still wasn’t
accepted by many of Ian Donald’s clinical colleagues. Glasgow was in some ways a
divided city and there was the new Queen Mother’s Hospital and Rottenrow.1 8 6 I was
185 Professor Charles Whitfield wrote: ‘The best highly ultrasound-relevant example is intrauterine growth
restriction of one or both fetuses. Other examples, in which ultrasound is most helpful (and these days could fairly
be called essential), include: hypertensive disorders, including pre-eclampsia, antepartum haemorrhage, both
placenta praevia and placental abruption.’ Letter to Dr Daphne Christie, 12 April 1999.
186 Dr Malcolm Nicolson wrote: ‘...McNay is talking about there later being two maternity hospitals in Glasgow
with two Professors of Obstetrics, with very different views on a number of matters – Professor Sir M C
MacNaughton in the Glasgow Royal Maternity Hospital and Professor Ian Donald in The Queen Mother’s
Hospital.’ Note on draft version of transcript, 16 November 1999. See also note 116 above.
Looking at the Unborn
64
brought up in Rottenrow. Ultrasound in those days was simply not believed and it’s
sad, looking back on it now, but I think it is important that people recognize that
those who had the courage of their convictions to maintain their research and
development in ultrasound really have to be congratulated. Without the vision of Ian
Donald and his successors we wouldn’t be in the position we are today, and even in
those times when one might have thought that it would have been more generally
accepted throughout the UK, it wasn’t.
Hall: We’ve talked extensively about ultrasound in its obstetric context, but I would
like to record at this meeting the contribution made in the Western Infirmary by Pat
Morley and Ellis Barnett1 8 7 who, using the Diasonograph series of equipment and the
earlier equipment, carried out many examinations in other organs of the body that are
now routinely examined, the kidneys and the liver. There were some remarkably good
greyscale images in the early days of liver disease, and they pushed it forward in that
area. It’s unfortunate that for personal reasons neither of them can be here today, but
I think it’s well worth recording the contribution they made.
Campbell: Can I add two more things? They are both bees in my bonnet, so I may as
well get them out. We haven’t mentioned Doppler ultrasound (colour Doppler). To
me colour Doppler has already made huge advances into obstetrics, and also in
gynaecology. It began in the early 1980s and the quality of the colour Doppler
equipment is so staggeringly good now, that in the uterus you can see virtually every
spiral artery with the new Acuson Sequoia machine.1 8 8 And with colour and pulsed
Doppler we can now predict women who are at risk of pre-eclampsia and, as a result,
we can prevent a lot of it happening. We can detect hypoxia in the fetus with Doppler
and can trace the progression to acidaemia. We can predict when a fetal heart is going
into failure by measuring venous flow to the heart. It is such a source of knowledge
that we mustn’t ignore this tremendous development. Although Tom was a pioneer of
3-D, the 3-D machines now give fairly fast reconstruction and are giving quite
staggeringly beautiful images of things like the fetal face and extremities. I haven’t the
slightest doubt that when this process is speeded up with faster computing and
electronic scanning that 3-D will make a big impact in the future. What I am really
trying to say is that it hasn’t stopped. Ultrasound is a technique which has continued
to develop. All these clever engineers continue to develop new equipment and it is we
clinicians who get the benefit and apply it in clinical situations. If there weren’t new
developments, of course, the development of new clinical applications would stop,
and we would say we have done everything. But the engineers keep coming up with
new things and it’s still a very exciting field. There is now a journal Ultrasound in
187 Drs Patricia Morley and Ellis Barnett were at the Radiodiagnostic Department of the Western Infirmary in
Glasgow. Using a prototype version of the Nuclear Enterprises Diasonograph they studied over 250 patients with
pelvic masses. See Morley P, Barnett E. (1970) The use of ultrasound in the diagnosis of pelvic masses. British
Journal of Radiology 43: 602–616. See also note 26 above.
188 Acuson was founded in 1979 and in 1983 introduced ‘system 128’ using ‘Computed Sonography’. Further
development and enhancement has led to the current model, ‘Sequoia’, with a wide range of Doppler facilities.
Information provided by Mr John Fleming, 24 May 1999.
Looking at the Unborn
65
Obstetrics and Gynecology,1 8 9 which is devoted to the whole science and now has a high
impact rating: it’s one of the top journals now in obstetrics and gynaecology.1 9 0
Mr Demetrios Economides:1 9 1 I wanted to ask a question of all the people who were
involved at the time. What were their thoughts regarding the safety of ultrasound in
scanning pregnant women, especially in early pregnancy?
Hall: It’s a subject that has waxed and waned over the years. Would anybody like to
speak on that topic to close the meeting, the last bit of the session?
W h i t t i n g h a m: T h e re has been an incredible increase in power levels and intensity leve l s
f rom the machines of those early days to those that are around today.1 9 2 A manufacture r
f rom America said to me just in conversation a few weeks ago, ‘Some of our machines
a re hot.’ That was the American way of putting it. Our own measurement experiences
indicate that whereas average intensities of a fraction of a milliwatt per square
c e n t i m e t re we r e fairly common in the early 1970s, they are now measured in watts per
s q u a re centimetre. This is partly because the absolute powers have increased in the
s e a rch for smaller and smaller signals and at higher and higher frequencies, and part l y
because the beams are getting narrower and narrower and that’s putting up the
intensities. So I think that in the early days they we re quite right to say that ultrasound
was safe; whether that’s so certain today is only true if you exe rcise pru d e n c e .
Abdulla: I think all of us who worked with early ultrasound were very concerned that
ultrasound may cause problems or damage, especially to the fetus. Ian Donald raised
this subject on many occasions1 9 3 and he was always wondering whenever there was a
case of fetal abnormality whether it had anything to do with the ultrasound. One of
the projects he undertook was that he linked with workers in Lund, Sweden and
Professor Hellman of New York. They surveyed a vast number of maternity patients
and looked at the incidence of abnormalities in babies born to patients who had
ultrasound examinations, and found favourable results.1 9 4 There were problems when
in 1970 an article by MacIntosh and Davey from South Africa showed that there were
189 Ultrasound in Obstetrics and Gynecology, the official journal of the International Society of Ultrasound in
Obstetrics and Gynecology, was launched in 1990 byThe Parthenon Publishing Group. Professor Stuart Campbell
is Editor-in-Chief.
190 All significant journals within a specialty are ranked by impact factors, which show the average citation rate per
published item, which is measured by dividing the number of times the journal has been cited by the number of
items it has published. See Garfield E. (1979) Citation analysis of scientific journals. InCitation Indexing, its
Theory and Application in Science, Technology and Humanities. Toronto: John Wiley & Sons, 148–239.
191 Mr Demetrios Economides FRCOG (b. 1956) has been Consultant Obstetrician and Gynaecologist, Senior
Lecturer at the Royal Free Hospital School of Medicine, London, since 1992. His research interests include
ultrasound in early diagnosis of fetal abnormalities.
192 Whittingham T A. (2000) Acoustic outputs of diagnostic machines. In Ter Haar G, Duck F A. (eds) Safety of
Medical Diagnostic Ultrasound. London: British Institute of Radiology, 16-31.
193 See, for example, Donald I. (1974) The safety of using sonar.Developmental Medicine and Child Neurology 16:
90–92. idem Placental localization by sonar – a safe procedure. British Journal of Radiology 47: 72.
194 Hellman L M, Duffus G M, Donald I, Sundén B. (1970) Safety of diagnostic ultrasound in obstetrics.
Lancet i: 1133–1134.
Looking at the Unborn
66
chromosomal breakages or damage when they exposed human blood cultures to
continuous ultrasound.1 9 5 This worried a lot of people, so much so that when the news
hit the local papers the number of ladies attending the ultrasound department
virtually dropped to zero that week.
Hall: I can add a comment on the MacIntosh and Davey scenario which was very
worrying at the time, because they were claiming chromosome abnormalities at the
levels produced by a Doptone instrument1 9 6 which, of course, is used for the routine
detection of fetal life. Not so many people know of the subsequent refutal of that
paper by one, if not both, of the authors.1 9 7 Unfortunately, I can’t recall the details off
the top of my head, but it does exist. The work was subsequently refuted.
Abdulla:The work we did at Queen Charlotte’s Hospital, when I moved from
Glasgow and joined Stuart [Campbell], involved looking at ladies who were exposed
to ultrasound just before they were delivered, so that the baby’s blood was exposed to
recent ultrasound while being monitored in labour. Also, we looked at blood cultures
from patients and fetuses exposed to ultrasound just before termination of pregnancy.
I remember having to take the blood sample from the Chelsea Hospital to the Ge n e t i c s
L a b o r a t o ryat University College Hospital. These fetuses were exposed for quite a long
time to ultrasound but we found no increase in the chromosomal damage or
breakages.1 9 8 I think that with the negative results from these papers one could manage
to refute the implications of that worrying article from South Africa.1 9 9
MacVicar: I suppose it appears simplistic now, but we knew that there could be
damage from ultrasound because of its use in therapeutics. We went to the
Department of Anatomy in the University of Glasgow and were told that a very
sensitive tissue was the demyelinated nerve fibres in the brains of new-born kittens.
So we took the machine (A-scan) and we irradiated the brains of kittens, having
removed the top of the skull, for over an hour.2 0 0 The kittens were then killed and the
195 MacIntosh I J C, Davey D A. (1970) Chromosome aberrations induced by an ultrasonic fetal pulse detector.
British Medical Journal iv: 92–93.
196 This instrument was manufactured by Smith Kline Instrument Co., USA.
197 MacIntosh I J C, Davey D A. (1972) Relationship between intensity of ultrasound and induction of
chromosome aberrations. British Journal of Radiology 45: 320–322. See also MacIntosh I J C, Brown R C, Coakley
W T. (1975) Ultrasound and ‘in vitro’ chromosome aberrations. ibid. 48: 230–232.
198 Boyd E, Abdulla U, Donald I, Fleming J E, Hall A J, Ferguson-Smith M A. (1971) Chromosome breakage and
ultrasound. British Medical Journal ii: 501–502. Abdulla U, Dewhurst C J, Campbell S, Talbert D, Lucas M,
Mullarkey M. (1971) Effect of diagnostic ultrasound on maternal and fetal chromosomes. Lancet ii: 829–831.
Abdulla U, Talbert D, Lucas M, Mullarkey M. (1972) Effect of ultrasound on chromosomes of lymphocyte
cultures. British Medical Journal iii: 797–799.
199 op. cit. note 195 above.
200 This work was carried out on anaesthetized animals in accordance with Home Office regulations under the
Cruelty to Animals Act (1876). Professor John MacVicar wrote: ‘The work was carried out within the Department
of Anatomy, University of Glasgow. The animals were supplied to them and we merely put the transducer on the
animals after they had been anaesthetized and the top of the skull removed by the Reader in Anatomy, Professor
Bacshish, who held the appropriate licence to carry out such animal experiments. ...The experiments were legally
covered and correctly carried out.’ Letter to Dr Daphne Christie, 11 November 1999.
Looking at the Unborn
67
histology looked at by the anatomists. They found, to our relief, no detectable
abnormality or tissue damage.2 0 1 Later we went on to irradiate pregnant rats, and over
three generations the anatomists didn’t find any abnormalities in the offspring, but
then we were not looking for genetic defects.
Brown: It’s extremely difficult to prove a negative and it appears to me that crying
wolf about the safety of medical ultrasound has almost become an industry. That
paper from South Africa was extremely destructive and I believe that it was later found
that the results were due to faulty experimental technique.
Hall: Yes, they were in fact found to be due to a faulty experimental technique.
B row n :Sterilizing agents in the vessels or something of the sort [H a l l :T h a t’s correct]. It
was a horrific incident and, of course, the press picked it up and made a meal of it.
Howe ve r , that does not mean that one should not exe rcise re s p o n s i b i l i t y, and one of the
things about which I feel some pride in the early medical ultrasound work in Gl a s g ow
was that we set out with a policy of reducing the energy transmitted into the patient to
the absolute minimum, consistent with an adequate clinical result. Now, unfort u n a t e l y,
that policy was not followed in America. I don’t think it is being followed there even now.
If you wish to control the sensitivity of an ultrasound machine, you can do it in two
ways. You can modify the gain of the amplifiers which are receiving the signals or yo u
can modify the amount of energy transmitted into the patient. Our philosophy was to
h a ve the amplifiers running full out, limited only by noise, and to control the sensitivity
by reducing the amount of energy transmitted. I’d still commend that as a way to go.2 0 2
Professor Jean Robinson:2 0 3 First, I would like to comment on the remark that
‘modern-day ethics committees would not allow what had gone on in Glasgow.’2 0 4 I
came here hot-foot from a multi-centre research ethics committee which was
discussing trials of completely new equipment which had not been used on live
patients. It wasn’t ultrasound stuff, but, of course, ethics committees do require you
to say exactly what you are doing, exactly which questions you are trying to answer
and, of course, to get consent. That is the thing that has changed. This question of
safety does worry me. I do remember reading on a number of occasions that Ian
Donald raised this.2 0 5 Antenatal ultrasound is one of the technologies which has
201 The results of this work are reported in Ian Donald’s 1958 Lancet article, op. cit. note 126 abo ve.
202 Dr Angus Hall wrote: ‘The effectiveness of altering the power transmitted into the patient to control system
sensitivity during scanning was investigated. It was found to reduce considerably the energy transmitted into the
patient whilst still obtaining clinically acceptable images. See Hall A J. (1975) An Investigation into Certain Aspects
of the Safety of Diagnostic Ultrasound. MSc Thesis. Glasgow: University of Glasgow.’ Letter to Dr Daphne Christie,
30 October 1999.
203 Professor Jean Robinson was Chair of the Patients Association from 1973 to 1975 and has been Honorary
Research Officer, Association for Improvements in the Maternity Services since 1989 and visiting Professor, School
of Health Sciences, University of Ulster since 1997.
204 See Dr James Willocks’ contributions on page 46.
205 op. cit. notes 126, 193 and 194 above. See also Donald I. (1974) New problems in sonar diagnosis in obstetrics
and gynecology.American Journal of Obstetrics and Gynecology118: 299–309. idem (1979) Practical Obstetric
Problems, 5th edn. London: Lloyd–Luke (Medical Books).
Looking at the Unborn
68
functioned within a background pattern of quite well-informed consumer criticism
for a very long time and despite the very clever and brilliant work which people have
done, why is it that consumers have been continually critical? First, the fact that it was
translated into routine use without proof of necessity or benefit, and secondly that we
wanted long-term follow-up of people on whom it was used, and controls to see what
there should be. The long-term epidemiological studies are not entirely reassuring.
The studies on monkeys are certainly not reassuring; what we learned as consumers
f rom the ultrasound history was that we we re going to demand that long-term follow - u p
should be built in on all technology and treatments on pregnant women,2 0 6 and that one
should look at the social costs and psychological costs and benefits as well as whether
the technology itself worked. But we want a richer, wider, deeper, and longer term
evaluation of what very clever, very well-meaning, very brilliant people are doing.
H a l l: I think we have got to be careful to distinguish between what harm or damage is
done by inexperience or clinical misdiagnosis and what Tony Whittingham was re f e r r i n g
to as the increase in the power modern ultrasound machines used in certain imaging
modalities, certainly with power Do p p l e r, continuous high-power Doppler use.
Wells: I just wanted to make the point that the purpose of today, I think, is to review
the history and what actually happened. We are not here to make points about what
should happen in the future, we are here to review what’s happened in the past and to
hear people who actually remember events as they took place, telling us about it. And
I think, although the safety issue is a very important problem and it’s something which
prudent people will be concerned about in current practice, from my point of view
today I hope we won’t spend a lot of time being anxious about the safety and the way
in which it is being handled. I want to hear how it was handled, I don’t really want to
discuss in the light of what we know today whether what was done then was what we
would have done today had we been in those circumstances.
C a m p b e l l: I promise these are my last words. I think the first thing is that the 1958
p a p e r ,2 0 7 that classic paper which James Willocks alluded to, contained quite a big
section on safety, so it was quite clear even in 1958 that Ian Donald was ve ry concerned
about safety issues and in fact it’s an amazing paper. You know, the modern tendency
is to string out your data into about five or six papers, but Ian Donald had basic
techniques described in great detail, clinical examples, discussion and safety. It was a
magnum opusin eve ry sense of the word. Professor Ro b i n s o n’s comment that there was
g reat consumer opposition to ultrasound, of course, is absolutely nonsense. T h e re is no
technique – n o technique – which is so ove rwhelming demanded by women.
Hall: Sorry, Stuart, I have said already we are not here to discuss this – it’s the history
we are talking about.
C a m p b e l l: I think it’s re l e vant to the history that this has always been a technique that
206 For an account of experimental animal work, see Hu J H, Ulrich W D. (1976) Effects of low-intensity
ultrasound on the central nervous system of primates. Aviation Space and Environmental Medicine 47: 640–643.
207 op. cit. note 126 above.
Looking at the Unborn
69
has been welcomed by women. We won’t get into discussions on safety, because
t h e re is quite an extensive amount of follow-up now of babies in randomized studies,
which is re a s s u r i n g .2 0 8 We won’t get into that debate, but just to make one point ve ry
c l e a r, this has always been a technique which has been ve ry easy for the
practitioners to use. It’s always been a joy, because the ultrasound image should be a
s h a red experience, and that’s the exciting thing that those of us who work in ultrasound
h a ve always experienced no resistance to at all. Maybe we have oversold it, but whateve r
it is, women want it, because they can see their babies and bond with their babies.
Hall: I am sure that you and Professor Robinson will have a fascinating discussion after
the end of the meeting.
Dr Ian Spencer:209 One of the nice things about doing the job as the research assistant
on this particular project – the history of obstetric ultrasound – is of course you get
to read a lot of the early papers. One of the first MDs on diagnostic ultrasound was
that written by Professor MacVicar.210 One of the most interesting parts of Professor
MacVicar’s thesis is that there is an extensive review of the safety question in the
period up to the beginning of that team’s work on the question of obstetric ultrasound
and, indeed, gynaecological ultrasound. Perhaps it’s a story which is not part of our
brief, but the interesting thing that Professor MacVicar reviewed in his MD thesis was
that, of course, therapeutic ultrasound, with much higher power outputs, had actually
been used in Britain since the 1930s. Quite apart from that, there was a number of
other studies on attempts at diagnostic ultrasound. The interesting thing was that all
of these Glasgow experiments used power outputs which were far lower than anything
that had been reviewed previously. And, although in hindsight one can look at
Professor Donald’s experiments on cats’ brains211 or whatever else and say, ‘Well, that’s
not a lot for a new technology, is it?’, at the time, in relation to other techniques which
were being introduced, it was actually seen as an extremely conservative approach. So
there is also the whole history of therapeutic ultrasound.
The other thing that’s interesting is that engineers working with ultrasound in
industry had been using it for a number of years and curiously enough no-one
thought to inquire, ‘Is this injuring engineers at all?’ And one of the other factors
which I suspect was reassuring to Professor Donald and the rest of his coworkers, was
the fact that engineers had been using the thing for years with obviously no ill-effects.
208 See, for example, Salvesen K A, Bakketeig L S, Eik-Nes S H, Undeheim J O, Okland O. (1992) Routine
ultrasonograpy in utero and school performance at age 8–9 years. Lancet 339: 85–89. Salvesen K A, Vatten L J,
Eik-Nes S H, Hugdahl K, Bakketeig L S. (1993) Routine ultrasonography in uteroand subsequent handedness and
neurological development. British Medical Journal 307: 159–164. For a review on the safety of obstetric
ultrasound, see Economides D L, Braithwaite J M. (1996) Safety of ultrasound in obstetrics. Contemporary Reviews
in Obstetrics and Gynaecology 8: 11–14.
209 Dr Ian Spencer (b. 1961) was research assistant to Professor Iain Cameron and Dr Malcolm Nicolson at the
Wellcome Unit for the History of Medicine, University of Glasgow, from 1995 to 1998. During that period he
studied the development of medical ultrasound in Glasgow, 1954–1976.
210 op. cit. note 128 above.
211 See page 66.
Looking at the Unborn
70
Hall: Can I just make one comment on that? The ill-effects on the engineers actually
would be that their thumbs dropped off, or in my case that my mental acuity would
disappear, because I used to check the mid-line shift instruments on my head. Need I
say any more on that possibility? I would like now to bring the meeting to a close, but
I think it’s fitting as I do so that, we’ve spoken scientifically and technically and
clinically about our experiences, but I wonder if Mrs Donald might like to say
something from a personal viewpoint?
Mrs Alix Donald:2 1 2 T h e re’s not much I can say after this wonderful afternoon where
t h e re has been so much of great interest. I looked up some things early this morning as I
needed to be reminded when things happened ultrasonically. I didn’t find the paper that
I really wanted, which was an account of the first 25 years of ultrasound.2 1 3 It was perhaps
just as well, as these steps forw a rd have been discussed this afternoon by so many far better
qualified to talk about them than I am. But two incidents came vividly to mind.
In Dallas, Texas, Ian was shown the first real-time scanning machine brought fro m
Phoenix, Arizona, by some talented young men. Ian was, of course, wildly excited. T h e y
wanted to carry him off to Phoenix to show him more, but sadly Ian couldn’t change his
next commitments. Howe ve r, it wasn’t too long before he had one of his ow n .
I was also reminded of the date of Ian’s meeting with the Pope in 1979. Ian was invited
to speak in Milan. He showed a real-time film of an eight-to-nine-week fetus,
perfectly formed, with all four limbs moving energetically, which infuriated a lot of
Italian women in the audience who hoped for an abortion law in Italy.The film
seemed to make it unthinkable. Ian was hurried out by the back door in case of
trouble. The Pope was, of course, delighted and received Ian very kindly in Rome
speaking excellent English. Ian was surprised to notice that a Cardinal in attendance
on the Pope carried a small tray on which lay some of his reprints!
I could talk endlessly of such memories. Thank you for making it such a wonderful
opportunity for me to see, and hear, so many old friends from Glasgow, and from all
over the place.
212 See note 5 above.
213 Donald I. (1980) Medical Sonar: the first 25 years. In Kurjak A. (ed.) Recent Advances in Ultrasound Diagnosis
2. Amsterdam: Excerpta Medica, 4–20.
Looking at the Unborn – Glossary
71
Acidaemia
An abnormally low pH of whole blood.
Alphafetoprotein
The fetal equivalent of albumin. During
pregnancy the detection of raised maternal serum
alphafetoprotein might indicate the presence of a
fetal abnormality, such as neural tube defects.
Amniocentesis
A procedure in which a needle is placed
transabdominally into the amniotic cavity
in order to remove fluid for analysis, inject
solutions that will induce abortion, or infuse
dyes for radiographic studies. Often used in
the diagnosis of chromosomal abnormalities
and genetic disorders.
Anencephaly
The absence of a major portion of
the cerebral hemispheres in the fetus.
Ascites
The intraperitoneal accumulation of watery
fluid in the nature of a transudate (like sweat).
The abdomen may be greatly distended by
the accumulation of many litres of fluid.
A-mode
A-mode display is one in which the presence of
echoes is indicated by vertical ‘blips’ on a bright
horizontal baseline. The higher the blip, the
stronger the echo signal. The greater the distance
of the blip from the left of the screen, the greater
the distance of the reflecting structure from the
ultrasonic transducer (see Figure 4).
B-mode
B-mode (or B-scan) is a generic term that is now
used in medical ultrasound to describe all display
systems which present a two-dimensional ‘s l i c e ’
p i c t u re of reflecting tissue interfaces in the flat plane
being scanned. This applies to both static and re a l -
time scanners. Usually the echoes are shown as bright
spots or lines on a dark background, although a
‘n e g a t i v e’ image is technically possible and has
sometimes been used. With the advent of thre e -
dimensional ultrasound imaging, the use of ‘B-mode’
should probably be restricted to two-dimensional
ultrasound imaging systems which scan and display
only a single plane at any one time (see Fi g u re 5).
Biparietal diameter (BPD)
The diameter across two parietal bones of fetal skull
[see Willocks J, Donald I, Duggan T C, Day N.
(1964) op. cit. note 118 above].
Bi-stable image
High-amplitude signals are represented as white
dots and weaker echoes are represented as black,
without any shades in between.
Caliper
The ultrasonic caliper is used to measure the
separation between the echoes representing the
separation of two surfaces. It is commonly used to
measure BPD. It takes its name from a mechanical
instrument with a pair of adjustable legs that can
be set against opposing surfaces or at two specific
points on a surface for the precise measurement
of the distance between them. It is often used to
measure the inside or outside diameter of an object.
Crown-to-rump length
The distance between the crown of the fetal head
and the tip of the fetal rump in the normal
curled-up fetal position.
Echo-encephalometry
A technique used for detecting mid-line shifts of
the adult brain, due to injury or disease, through
the intact skull.
Greyscale mode
Amplitudes of varying intensity are assigned
shades from black to white, thereby greatly
improving image quality.
Hydatidiform mole
A pre-cancerous condition in which the placental
villi become oedematous, thus forming small
watery cysts which are well described as having
the appearance of a ‘bunch of grapes’. See also
note 16 above.
Hydrocephalus
Any condition in which there
is an abnormally large volume of cerebrospinal
fluid within the skull.
Hypoxia
An inadequate oxygen concentration in
body tissues.
GLOSSARY
Looking at the Unborn – Glossary
72
Laparoscopy
The endoscopic examination of the peritoneal
cavity and surface of accessible abdominal organs
(for example, the uterus)by means of a laparoscope.
Commonly used for the diagnosis of endometriosis.
M-mode or motion ultrasound
See Time motion (TM)-mode.
Phased arrays
A technique for changing the effective direction
of an ultrasonic beam, either during transmission
or reception or both, by introducing controlled
time delays between signals entering or leaving
different parts of a subdivided transducer.
Placenta praevia
A placenta situated more or less centrally in the
lower segment of the uterus, so blocking the os,
or birth canal, and likely to result in severe
haemorrhage during the birth process.
Polyhydramnios (or simply hydramnios)
The presence of an abnormally large amount of
amniotic fluid for a particular stage of pregnancy,
commonly associated with fetal abnormality,
maternal illness or interference in normal fetal
physiology by toxic or other substances.
Pre-eclampsia
An obstetric condition occurring in the second
half of pregnancy, characterized by hypertension,
proteinuria and usually oedema.
Real-time imaging
Allows the acquisition and display of images to
occur so rapidly that their formation and display
appear to be simultaneous. The first commercially
available real-time ultrasound machine was the
Siemens Vidoson (invented by Richard Soldner).
Scan conversion
A process carried out in an electronic device, usually
with some form of intermediate storage mechanism,
by means of which an image created in one format –
for example, as a series of ‘ve c t o r s ’ (lines) in arbitrary
d i rections – can be conve rted to another format,
such as a ‘raster’ image as used in television. In the
p rocess of conversion other aspects of the image may
also be altered, such as the degree or characteristics
of the ‘g re y s c a l e’ that is presented to the observe r.
Spina bifida
Lower developmental defects characterized by the
absence of the vertebral arch, usually in a number of
contiguous vertebrae (i.e. a common defect affecting
several otherwise joined up vertebrae).
Three-dimensional (3-D)ultrasound
Ultrasound scanning and imaging was extended
into three dimensions at quite an early stage in the
development of medical ultrasound, though it has
only recently become commonplace. The object is
to present a three-dimensional image of the tissue
structures. This can be either a ‘perspective view’
of a tissue surface, such as a baby’s face, or a
‘volume’ image showing the relationship of
multiple tissue structures in three-dimensional
space. In the latter case, stereoscopy is sometimes
used to give the user a greater appreciation of the
spatial relationships involved.
Time motion (TM)-mode
TM-mode is employed to examine the movement
of tissue structures with time. The most common
application is echocardiography, where it is used
to display the motion of the heart valves and wall.
However, it was also used, early in the development
of obstetric ultrasound, to detect early fetal heart
movements to confirm fetal life. TM-mode is
rather like A-mode, but in TM-mode the baseline
is brightness-modulated by echo signals, and
the entire baseline is moved, relatively slowly,
perpendicular to its length, so that movement
of the echoes is traced out.
Trimester
A period of three months. First trimester, the first
three months; second trimester, the middle three
months; third trimester, the last three months, of
a human pregnancy.
Ultrasound
Sound waves, or mechanical vibrations, beyond
the range of human hearing. In the medical
context, these are in the region of one to
20 million vibrations per second.
Ventriculomegaly
Abnormally large ventricles of the brain.
Looking at the Unborn – Index
73
A-mode, 55, 57, 71
A-scan ultrasound, 16–17, 26
clinical use, 49, 55, 59
early images, 4–5, 8, 47
fetal measurements, 42–43, 44–45, 52, 54
image display, 13
lack of publications, 5, 49
mid-line brain structures, 16
pig fat grading, 33
safety testing, 66–67
abdominal circumference, fetal, 44
abdominal masses, 47, 48
abdominal palpation, 30, 34, 62
abdominal ultrasound, 15, 29, 47, 49–50
abortion, 62, 70
illegal, 62
incomplete, 50
missed, 50, 59
threatened, 50
acidaemia, 64, 71
Acuson Sequoia, 64
Advanced Diagnostic Research
Corporation (ADR), 40, 61
Advanced Technology Laboratories Ltd, 40
alphafetoprotein, levels of, 54–55, 71
American Institute of Ultrasound in
Medicine, Washington, DC, 15, 29
American Journal of Obstetrics and Gynecology, 30
amniocentesis, 61, 71
amniotic fluid estimation, 63
anencephaly, 55, 71
animal experiments
kittens, newborn, 66–67, 69
monkeys, 68
annular array dynamically focused transducers, 35, 38
antenatal screening, routine, 54–55
antenatal ultrasound, 67–68
area perimeter measurement, 42, 45
ascites, 19, 49, 71
ASDIC (Allied Submarine Detection
Investigation Committee), 58
Atomic Weapons Re s e a rch Establishment (AWRE), 27
Australia, 14, 32, 39–40, 41
Austria, 31, 55
automatic contact scanner, 10, 20–21, 29
as basis for Diasonograph, 26, 28
disadvantages, 23, 49–50
photograph, 12
Automation Industries Inc.
acquisition of patents, 35, 36
Sperry Products Division, 34–36
B-mode, 26, 71
clinical value, 49–50
contact scanners, see contact B-scanners
fetal measurements, 43–45, 54
Babcock & Wilcox Ltd, Renfrew, 4, 8, 45, 58
barium titanate transducer, 52, 53
Barr and Stroud, Glasgow, 32
bed-table scanner, 5, 13, 15, 21, 26
Belfast, 61
Bi-stable image, 71
Bi-stable storage tubes, 32, 36
biparietal diameter (BPD), 42–45, 52, 71,
see also fetal cephalometry
units of measurement, 57–58
Birmingham University, 38
bladder
full, 29, 50
overfull, 53
blood cultures, effect of ultrasound, 66
BMUS, see British Medical Ultrasound Society
BPD, see biparietal diameter
brain
imaging, 17, 38
mid-line shifts, 16, 52–54
newborn kittens, see animal experiments
transmission ultrasound, 31–32
breast scanning, 48, 56
Bristol, 31
British Congress of Obstetrics and Gynaecology,
Glasgow (1967), 51
British Institute of Radiology, 3
British Journal of Radiology, 57
British Medical Ultrasound Group, 3
British Medical Ultrasound Society
(BMUS), 3, 11, 15, 38, 39
historical collection, 10, 11, 13, 14, 15, 21, 61
Caesarean section, 44
calipers, ultrasonic, 43, 44, 60, 71,
see also biparietal diameter
5-cm problem, 45, 54
velocity, 57
camera, 35mm, 13, 49
CAT, see computed tomography
cephalometry, fetal, see fetal cephalometry
Chelsea Hospital, London, 29
INDEX:SUBJECT
Looking at the Unborn – Index
74
chromosomal damage, 66
colour Doppler, 64
compound scanning, 5, 37, 42
computed tomography (CT, CAT scanning), 37, 41, 42
condoms, water-filled, 18, 48
consent, 47, 67
consumers, attitudes of, 68–69
contact B-scanners, 36, 38, 39
automatic, see automatic contact scanner
clinical use, 46–47
design of early, 21–23, 24
Diasonograph, see Diasonograph
fetal measurements, 43–44
first, 5–10, 12, 13
clinical value, 19–20
development, 15–19
electronic system, 13
ergonomic problems, 12, 13, 20
fate, 14–15
images, 9
mechanical system, 13
lack of sensitivity, 30, 32, 41
patents, 35, 36
Picker, 27, 40, 54
Sundén, see Sundén (Lund) machine
vs real-time scanners, 42
vs water-bath scanners, 40–41
Copenhagen, 56
corpus luteum, 59
coupling, acoustic, 48
coupling gel, 60
crown-to-rump length, 14, 53, 54, 71,
see also fetus, measurements
CT, see computed tomography
cursor, electronic, see calipers, ultrasonic
darkroom, portable, 13, 49
database, early scans, 20, 21
delivery, timing of, 63
Denver, Colorado, 18
Department of Health, Supply Division, 27, 32, 54
design, industrial, 21–29
Design Award, 28
Diagnostic Sonar Ltd, 33, 61
diagnostic ultrasound, 4, 60, 69,
see also fetal abnormalities
antenatal, 54–55
clinical value, 49, 50, 51–52
early use, 10, 11, 19–20, 29–30, 46–47
Royal Society of Medicine meeting (1962), 53
Diasonograph, 60–61, 64
early (Kelvin & Hughes), 21, 22–29, 32–34, 51
Bristol modification, 31
control panel, 26, 28
delays in production, 27, 35
design, 22–29
development, 10, 14, 27, 28
electronics, 22, 26, 28, 32
instability, 30–31
lack of sensitivity, 30, 32
mechanics, 22, 23, 26, 27–28
photographs, 23, 25
fetal measurements, 44–45
greyscale, 40
with integral bed, 36
Nuclear Enterprises series, 10, 33, 34, 38,
see also NE4102
Real-time imaging, 39, 40, 41, 45
routine antenatal screening, 54
Diasonoscope, 28, 33
fetal cephalometry, 44–45
‘doctor-proof’ ultrasound machines, 22, 28
Doppler ultrasound, 59, 64, 68
Doptone instrument, 66
dynamic range, 40, 41–42
echo amplitude, range of, 32
echo-encephalography, 26, 52,
see also newborn babies
echo-encephalometry, 44, 71
Edinburgh University, 5, 10, 38, 41
electrocardiography, fetal, 62
electroencephalography, 16
EMI (Electrical and Musical Instruments), 11, 41
ergonomics
first contact B-scanner, 12, 13, 20
later contact B-scanner, 22, 28
ethical aspects, 46, 47, 67–68
eye scanner, 38
fetal abnormalities, see also anencephaly,
hydrocephalus, spina bifida, ventriculomegaly
antenatal ultrasound and, 65–66
prenatal diagnosis, 54–55, 57, 63
fetal cephalometer, 43, 44–45
fetal cephalometry, 30, 42–45, 52–54,
see also biparietal diameter
antenatal vs postnatal, 44
units of measurement, 57–58
fetal head
imaging, 44
measurement, see fetal cephalometry
fetal therapy, 57, 61
Looking at the Unborn – Index
75
fetus, 62–64
Doppler ultrasound, 64
growth assessment, 42, 43, 45, 52, 54
heart, 14, 59, 64
heart rate, 59
intravascular transfusion, 61
measurements, 14, 42–45, 52–54
movements, 40, 45
safety of ultrasound, 65–67
fibroids, 49, 58
finger cots, water-filled, 48
‘Firestone patents’ (Sperry lawsuit), 34–36
flaw detectors, industrial, 4, 7, 8, 47–48, 58
fetal head measurements, 43, 44–45
Mark IIB, 7, 17, 45–46
Mark IV, 8, 13, 16, 28, 45–46, 49
Mark VII, 45
patent problems, 34–36
follicular development, 14, 59–60
frequencies, ultrasound, 48–49
GEC Medical Equipment Ltd, 61
Germany, 55, 59, 60
gestational age, estimation, 14, 44, 54, 63
Glasgow, 46, 47, 54, 63–64,
see also specific institutions
Glasgow Royal Maternity Hospital,
Rottenrow, 4, 19, 30, 43, 63–64
Glasgow School of Art, 21, 29
Glasgow University, 3, 4, 14, 19, 29, 30, 41, 46
government support, 27
greyscale, 36–37, 55
development, 32, 40, 41
mode, 71
growth, fetal, see fetus, growth assessment
gynaecology, 43, 46–47, 48–50, 64
haemorrhage
antepartum, 63
intracranial, 52–53
obstetric, 62
Hammersmith Hospital, London, 4
hand-operated scanners, 10, 23, 30, 56
hands, use by obstetricians, see abdominal palpation
heart
fetal, 14, 59, 64
real-time imaging, 38–39
heart rate, fetal, 59
Henry Hughes Mark IIB Supersonic
Flaw Detector, 7, 17, 45–46
Henry Hughes and Sons, Barkingside, 3
history of development of ultrasound, 4, 5, 69
Honeywell, 28, 32, 35
Hospital Physicists Association, 3
Hunterian Museum, University of Glasgow, 11, 15
hydatidiform mole, 10, 71
hydramnios, 10, 72
hydrocephalus, 55, 71
hypertensive disorders (of pregnancy), 62, 63
hypoxia, 64, 71
IBM, 3, 14
impedance, acoustic, 58
in vitro fertilization (IVF), 55–56, 60
industrial ultrasound, 18, 23, 69–70,
see also flaw detectors, industrial
Sperry lawsuit, 34–36
infertility, female, 59–60
intensity, ultrasound, 65
International Society of Ultrasound in
Obstetrics and Gynecology, 29, 31, 65
intracranial haemorrhage, 52–53
intrauterine growth restriction, 63
Italy, 70
Japan, 36, 48, 57
Kelvin & Hughes Ltd (formerly Smiths
Industries Ltd), 3, 10, 11, 43
commercial problems, 14, 27, 32–33, 34–36
Diasonoscope, see Diasonoscope
Diasonograph machines, see Diasonograph, early
importance of contribution, 17–18, 28, 47–48
name changes, 3
pig fat grading machine, 33
Kelvin & James White Ltd, 3
Kelvin Bottomly & Baird Ltd, 3, 18
The Kelvin Electronic Company, 3
kidneys, examination of, 64
King’s College Hospital, London, 29
kittens, newborn, see animal experiments
labour, monitoring during, 66
Lancet, 47, 67
laparoscopy, 56, 72
linear-array real-time scanning, 37, 40, 41, 55
early development, 38–39
first commercial machines, 61
liver, examination of, 64
Lund, Sweden, 21, 65, see also Sundén
(Lund) machine
M-mode, 26, 72, see also time motion-mode
fetal heart rate, 59
malignancy, 19, 49
Manchester repair, 50
manual scanners, see hand-operated scanners
Massachusetts Institute of Technology (MIT), 16
Looking at the Unborn – Index
76
maternal deaths, 62
Mearnskirk Hospital, 43
Meccano, 13
medical ultrasound, 4, 39, see also history
of development of ultrasound
chronology, 5
teaching courses, 41, 43
technical development, 10, 11–46
metals, see also flaw detectors, industrial
non-destructive testing, 4, 7, 16
semi-automatic system for testing, 35
mitral valvotomy, 53
monkeys, see animal experiments
Montreal, 40
Multiplanar Scanner, 5
multiple pregnancy, 51, 62–63
NE4101, 33, 34
NE4102, 10, 33, 34, 36
clinical use, 54, 59
real-time imaging, 39
NE4200, 10, 33
New York, 56, 65
newborn babies
echo-encephalography, 52–53
head size, 44
newborn kittens, see animal experiments
Newcastle-upon-Tyne, 38
Nuclear Enterprises (GB) Ltd, Edinburgh, 5, 10, 61
Diasonograph machines, 10, 33, 34, 38,
see also NE4102
EMI takeover, 41
entry into ultrasound business, 32–34, 36
nuclear magnetic resonance (NMR), 14, 41
nuclear weapons industry, 27
obese patients, 50, 60
obstetric ultrasound
early, 10, 29–30, 43, 46–48, 50–54
later development, 54–58, 61–64
safety, 65–70
obstetricians, use of hands, see abdominal palpation
Octoson, 40
Official Secrets Act, 38
oil coupling, 60
olive oil, 20, 22, 29, 48, 51, 60
oocyte retrieval, ultrasound-directed, 56, 60
operators
bias, 10, 29, 49
ergonomic problems, 12, 13, 20, 22
numbers, 34
standing position, 45
Organon Teknika, 61
organs, internal structure, 32
ovarian cyst, 49, 58
early images, 5, 8, 9
mistaken diagnosis, 19, 20
ovarian follicles, development, 59–60
ovulation, monitoring, 59–60
patents
annular array dynamically focused
transducers, 35, 38
Sperry lawsuit (‘Firestone’), 34–36
two-dimensional ultrasound, 5, 32, 35, 36
patients, 47, 54, 68–69
peak memory, 37
pelvic tumours, 29
phased-array beam-steering systems, 38
phased arrays, 38, 41, 72
phonocardiography, fetal, 62
photographs
image integration using, 37
image recording, 13, 49
Polaroid,™see Polaroid™photographs
Physionic scanner, 31
Picker B-scanner, 27, 40, 54
pig fat grading, 33
placenta
abruption, 63
localization (placentography),29–30, 51, 54, 61, 62
praevia, 11, 29–30, 54, 63, 72
placentography, see placenta localization
Polaroid™ photographs, 26, 49, 50, 51
collection of early, 21
disadvantages, 37, 45
polyhydramnios, 10, 72
potentiometer, wire-wound, 13
power output, 65, 67, 68, 69
pre-eclampsia, 63, 64, 72
pregnancy
dating, see gestational age estimation
early, 29, 50, 62–63
complications, 14, 50
detection, 59, 62
high-risk, 63
multiple, 51, 62–63
routine screening, 54–55
safety of ultrasound, 65–70
termination, 55
premature babies, 52–53
prenatal diagnosis, 54–55, 57, 63
Pringles, 32
probes, see transducers
prolapse, uterus, 50
pulse-echo ultrasound, 31
pulsed Doppler, 64
Looking at the Unborn – Index
77
quartz transducers, 41, 53
Queen Charlotte’s Maternity Hospital, London, 29,
40, 54, 66
radar technology, 17, 41
rats, pregnant, 67
real-time imaging, 32, 37–40, 70, 72
20-line image system, 38–39, 42
early manual form, 45
fetus, 44, 55
first commercial machine, 61
importance, 40, 61–64
rotating-wheel type scanner, 37–38, 41
recording, image, 13, 26, 49
records, early case, 20, 21
resolution, azimuthal (lateral), 42
RITA (real-time imaging transducer array), 61
rotating-wheel mechanical scanner, 37–38, 41
Royal Free Hospital School of Medicine, London, 65
Royal Marsden Hospital, London, 17
Royal Society of Medicine meeting (1962), 53
S Smith & Sons England Ltd, 3
s a f e t y , ultrasound, 65–70, see also animal experiments
St George’s Hospital Medical School, 29
St James’s University Hospital, Leeds, 3
St Thomas’ Hospital, London, 4
scan conversion, 37, 40, 72
scatter, 41
Scientific and Technical Branch,
Department of Health, 27
Scottish Common Services Agency, 27
screening, routine antenatal, 54, 55
sensitivity
control, 67
early scanners, 30, 32, 41
Siemens machines, 40, 60, 61
signal averaging, 37, 42
Singapore, 40
Smith Kline Instrument Co., 66
Smiths Industries Ltd, see Kelvin & Hughes Ltd
Sokolov ultrasonic image converter tube, 14
Sonar, 14, 29, 30, 46, 53, 59, 65, 70
Sonicaid Ltd., 5, 32, 36
South Africa, article, 65–66, 67
specular reflection, 41, 42
Sperry Products Division of Automation
Industries Inc., 34–36
Sperry wheel probe, 35
spina bifida, 55, 72
Strathclyde University, 18, 43
submarine technology, 38, 58
Sundén (Lund) machine, 10, 21, 25, 35
design, 22–23, 24, 28
Supersonic Flaw Detector, Henry Hughes Mark
IIB, 7, 17, 45–46
Sweden, 16, 21, 65
technical development, medical ultrasound, 10, 11–46
Tektronix Storage Scope, 27
television systems conversion, 37
The Queen Mother’s Hospital,
Glasgow, 43–44, 50, 51, 63
appointees, 3, 11, 14, 29, 30, 57, 58
therapeutic ultrasound, 66, 69
thermionic valve, 31
three-dimensional ultrasound, 17, 28, 72
fetal imaging, 64
Sonicaid machine, 5, 32, 36
Time-motion (TM)-mode, 59, 72, see also M-mode
Toshiba, 36
transducers (probes)
barium titanate, 52, 53
early A-scanner, 17
first contact B-scanner, 13
hand-held, lightweight, 39
linear-array, 40
quartz, 41, 53
Sperry wheel, 35
spinning wheel type, 37–38, 41
transmission ultrasound, 31–32
transrectal ultrasound, 56, 57
transvaginal ultrasound, 55–57, 60
trimester, 14, 54, 55, 59, 72
trolley, apparatus, 13
tumours, excised, 49, 58
two-dimensional ultrasound
development in America, 31–32
first contact B-scanner, s e e contact B-scanners, first
mechanical pantograph-type, 16
patents, 5, 32, 35, 36
Ultrasonics, 3
ultrasound, definition, 72, see also diagnostic
ultrasound, history of development, obstetric
ultrasound, pregnancy
Ultrasound in Medicine and Biology, 31
Ultrasound in Obstetrics and Gynecology, 64–65
United States
development of ultrasound, 18, 31–32, 48, 54
obstetric ultrasound, 55
power levels used, 65, 67
real-time scanning, 39, 40, 70
transvaginal ultrasound, 56–57
University College Hospital, London, 14, 54, 66
urine, residual, 50
Looking at the Unborn – Index
78
Vaseline, 17
velocity, ultrasound, 57
ventricles, cerebral, 55
ventriculomegaly, 55, 72
veterinary uses, 10
Vidoson machine, 40, 61
voltage stabilizer, mains, 13
water
condoms filled with, 18, 48
immersion ultrasound, 17, 18–19, 58
‘stand-off’, 5, 17, 18–19
water-bath scanners, 38, 39, 40–41, 48
water-delay scanner, 40
Wellcome Trust, 15
Wellcome Unit for the History of Medicine,
University of Glasgow, 3, 4, 69
Western General Hospital, Edinburgh, 33
Western Infirmary, Glasgow, 43, 64
appointees, 4, 15, 19, 30, 58
early use of ultrasound, 7, 10, 12, 21, 46–47, 50
Widney Dorlec Ltd, England, 22
Looking at the Unborn – Index
79
Abdulla, Usama, 29–30, 51, 53, 54, 65–66
Barnett, Ellis, 15, 64
Barr, Wallace, 47, 58–59
Bolt, R H, 31
Bom, Nicolaas, 38–39, 61
Brown, Thomas Graham (Tom), 3, 4, 5, 9–11,
12, 13, 14–19, 20–21, 22, 23, 27, 28, 30, 31,
32, 33, 34–36, 37, 38, 39, 40, 41–42, 43, 45,
46, 47–48, 49, 50–51, 57, 58–59, 67
Buschmann, W, 38
C a m e ron, Dugald, 21–23, 24, 26, 27–29, 34, 36, 51
Campbell, Stuart, 29–30, 39–40, 42, 43–44, 45,
53–56, 57, 59–60, 63, 64–65, 66, 68–69
Cole, Alan, 34
Davey, D A, 65–66
Davies, Sam, 32
Davis, J, 8
Dellenbach, P, 56
Dewhurst, Sir John, 29
Donald, Alix, 3, 4, 70
Donald, Ian, 3, 4–5, 6, 7, 10–11, 12, 13, 14,
16–19, 20, 21, 28, 29–30, 34, 43, 44, 46–47, 51,
52, 53–54, 58–59, 60, 61, 62, 65, 67, 69, 70
Duggan, Tom, 43
Dussik, Karl, 31
Economides, Demetrios, 65
Evans, Ken, 31
Fleming, John, 3, 4, 5, 10, 11, 14–15, 16, 17, 21,
22, 23, 28, 30, 31, 32, 33, 35, 37, 38, 40, 41, 42,
43, 44–45, 47, 48, 54, 57, 59, 61, 64
Fraser, Brian, 5, 10–11, 33, 34
Gassert, Hans, 33–34, 60–61
Gordon, Douglas, 3, 16
Gottesfeld, Ken, 30
Güttner, W, 31
Hackelöer, Joachim, 59–60
Hall, Angus J, 3–4, 11, 14, 15, 19–20, 21, 23, 27,
29, 30, 31, 32–33, 34, 36–38, 39, 40–41, 42, 44,
45, 46, 50, 51, 53, 56, 58, 59, 60, 61, 63, 64, 65,
66, 67, 68, 69, 70
Halliday, Bill, 11, 15, 17, 38
Hellman, L M, 65
Hansmann, M, 55, 60
Haslett, Roy, 35, 38
Heuter,T F, 31
Hobbins, John, 55
Hounsfield, Sir Godfrey, 41
Howry, Douglass, 17, 18, 31, 37, 39, 42
Johnson, Arthur, 23, 25
Kelvin, Lord, 3, 42
King, D L, 39
Kohorn, Ernest, 30, 45, 54
Kossoff, G, 17, 32, 37, 39–40
Kratochwil, Alfred, 55, 56, 59
Langevin, M P, 58
Leask, Eric, 27
Lenihan, John, 41, 43
Lenz, Susan, 56
MacIntosh, I J C, 65–66
MacNaughton, Sir Malcolm, 63
MacVicar, John, 10, 12, 13, 14, 19–20, 21,
29, 42, 46, 47–51, 53, 55, 59, 66–67, 69
Mayneord, Professor, 17
McDicken, Norman, 38, 41, 43
McNair, David, 23
McNay, Margaret, 15, 57, 60, 63–64
Morley, Patricia (Pat), 15, 64
Nicolson, Malcolm, 3, 4–5, 10–11,
15, 16, 45–46, 49, 63, 69
Oakley, Ann, 10, 11
Parsons, John, 56
Pope (Jean Paul II), 70
Potter, G B G, 18
Rankin, Alexander (Alex), 16, 17, 35
Reid, J M, 31
Robinson, Hugh, 14, 54, 59, 60
Robinson, Jean, 47, 67–68, 69
Ross, Frank, 31
Slark, Norman, 27
Slater, William (Bill), 3, 18
Smyth, Norman, 14
Somer, Jan, 38
Spencer, Ian, 15, 69
Stevens, Elsa, 28
Sundén, Bertil, 10, 21, 23, 55
INDEX:NAME
Looking at the Unborn – Index
80
Tansey, E M (Tilli), 3
Thomson, William (later Lord Kelvin), 3, 42
Timor-Tritsch, I E, 55
Tucker, D G D, 38
Turner, Peter, 28
von Micsky, Lajos, 56
Wells, Peter, 28, 30, 31–32, 56, 57, 68
White, James, 3
Whitfield, Charles, 14, 60, 61–63
Whittingham, Tony, 15, 38–39, 57, 61, 65, 68
Wild, John Julian, 31, 56
Willcocks, Marty, 40
Willocks, James, 19, 29, 30, 34, 42, 43–44, 46–47,
49, 52–53, 55, 57, 59, 67, 68
Winsberg, Fred, 40
