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Imaging and Imagining the Fetus

The Development of Obstetric Ultrasound

Malcolm Nicolson and John E. E. Fleming

Publication Year: 2013

To its proponents, the ultrasound scanner is a safe, reliable, and indispensable aid to diagnosis. Its detractors, on the other hand, argue that its development and use are driven by the technological enthusiasms of doctors and engineers (and the commercial interests of manufacturers) and not by concern to improve the clinical care of women. In some U.S. states, an ultrasound scan is now required by legislation before a woman can obtain an abortion, adding a new dimension to an already controversial practice. Imaging and Imagining the Fetus engages both the development of a modern medical technology and the concerted critique of that technology. Malcolm Nicolson and John Fleming relate the technical and social history of ultrasound imaging—from early experiments in Glasgow in 1956 through wide deployment in the British hospital system by 1975 to its ubiquitous use in maternity clinics throughout the developed world by the end of the twentieth century. Obstetrician Ian Donald and engineer Tom Brown created ultrasound technology in Glasgow, where their prototypes were based on the industrial flaw detector, an instrument readily available to them in the shipbuilding city. As a physician, Donald supported the use of ultrasound for clinical purposes, and as a devout High Anglican he imbued the images with moral significance. He opposed abortion—decisions about which were increasingly guided by the ultrasound technology he pioneered—and he occasionally used ultrasound images to convince pregnant women not to abort the fetuses they could now see. Imaging and Imagining the Fetus explores why earlier innovators failed where Donald and Brown succeeded. It also shows how ultrasound developed into a "black box" technology whose users can fully appreciate the images they produce but do not, and have no need to, understand the technology, any more than do users of computers. These "images of the fetus may be produced by machines," the authors write, "but they live vividly in the human imagination."

Published by: The Johns Hopkins University Press

Cover

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p. 1-1

Title Page, Copyright, Dedication

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pp. 2-7

Contents

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pp. vii-viii

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Acknowledgments

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pp. ix-xii

We have been engaged in this work for what seems like an inordinate amount of time and have acquired many substantial debts over the years. We are particularly happy to acknowledge the support of Professor Iain T. Cameron. Following his appointment to Glasgow University as Regius Professor, he initiated collaboration ...

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Chapter 1. Introduction: Historiographies of Obstetrics

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pp. 1-11

Visualizing the internal structures of the living body is a characteristic and defining feature of modern medicine.1 Several new imaging technologies were invented in the second half of the twentieth century, with ultrasound, computerized tomography, and magnetic resonance imaging being the most famous examples.2 ...

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Chapter 2. Diagnostic Ultrasound before Thomas Brown

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pp. 12-45

Ultrasonic echolocation has its origins in the military and industrial contexts. We describe in this chapter the more important of the early attempts to adapt the technology for medical purposes.1 We investigate the problems and difficulties— biological, physical, electronic, social, and organizational— that confronted the pioneers of diagnostic ultrasound, ...

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Chapter 3. Ian Donald before Ultrasound I: St. Thomas’s Hospital and the Royal Air Force

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pp. 46-71

Ian Donald, Regius Professor of Midwifery at the University of Glasgow, was the leading clinician involved in the introduction of obstetric ultrasound. In this chapter, we explore his early life and career with a view to understanding how and why he developed his distinctive practice of obstetrics and his interests in medical technology. ...

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Chapter 4. Ian Donald before Ultrasound II: Hammersmith and Glasgow

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pp. 72-87

In the years before he began his work on diagnostic ultrasound, Ian Donald developed a characteristic approach to clinical work, and to the professional and social role of the obstetrician, that would be formative in his relationship to the new technology. In this chapter, we explore his maturing as a clinician and a researcher, ...

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Chapter 5. A-Scope Investigations in Glasgow

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pp. 88-118

By 1955, Ian Donald was established in his post as Regius Professor of Midwifery and had already begun working on a new research project. In this chapter, we investigate his earliest attempts to apply ultrasound technology to clinical problems. In the course of our investigations, we employed an unorthodox historical method: ...

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Chapter 6. The First Contact Scanner

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pp. 119-143

In the early months of 1957, Ian Donald, Tom Brown, and John MacVicar were hard at work in Glasgow’s Western Infirmary, applying their Kelvin and Hughes Mk IV flaw detector to the abdomen of any patient who looked suitable and trying to understand the echoes they received. ...

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Chapter 7. The Automatic Scanner and the Diasonograph

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pp. 144-172

The first ultrasound images of the fetus were published in June 1958.1 The Lancet article by Ian Donald, John MacVicar and Tom Brown occasioned a great deal of interest and comment, in Britain and abroad. However, the scanner that Brown had built for Donald was not much more than an experimental mock-up. ...

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Chapter 8. Behind the Iron Curtain: Ultrasound and the Fetus

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pp. 173-202

Ian Donald’s earliest clinical investigations with the ultrasonic scanner were in the field of gynecology, but there is no doubt that his imaging research achieved its greatest impact through its application to the gravid uterus. During the early 1960s, in a series of publications, Donald and his colleagues revealed the developing fetus and its disorders ...

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Chapter 9. Diffusion, Controversy, and Commodification

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pp. 203-233

By the late 1960s, the diagnostic potential of ultrasound scanning was becoming widely accepted. The Queen Mother’s Hospital, in Glasgow, was the nationally and internationally acknowledged center for research into obstetric ultrasound. A steady stream of visitors— clinicians, radiologists, and engineers— traveled to Glasgow ...

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Chapter 10. Ian Donald after Ultrasound: Contraception and Abortion

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pp. 234-249

In his last decade as Regius Professor at the University of Glasgow, Ian Donald continued his work with ultrasound and developed some other technological interests. In 1968, he adopted the “Snake” as a tool to hold surgical instruments in place during intricate procedures, pioneering its application in the new technique of laparoscopic sterilization.1 ...

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Chapter 11. Maternity and Technology

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pp. 250-268

At Ian Donald’s memorial service, James Willocks suggested that those seeking a memorial to him should look around them in any maternity hospital. But one particular hospital manifested Donald’s legacy very directly indeed. The Queen Mother’s Hospital was, to a substantial degree, Donald’s creation. ...

Notes

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pp. 269-308

Index

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pp. 309-317


E-ISBN-13: 9781421408248
E-ISBN-10: 1421408244
Print-ISBN-13: 9781421407937
Print-ISBN-10: 1421407930

Page Count: 336
Illustrations: 15 halftones, 2 line drawings
Publication Year: 2013