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Uterus at 14 weeks pregnancy. A scan was taken one inch above the pubic bone. The shape in the left part of the large cystic cavity was recognized as an early fetus. The two echoes in the top part of the picture correspond with the abdominal and uterine walls.
From Ian Donald, ‘Investigation of abdominal masses by pulsed ultrasound’, The lancet 271, 1958, 1188–95, fig. 17, p. 1193.
Elsevier Ltd.
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Ultrasound diagnosis of early pregnancy. The first reported diagnosis of early pregnancy, in 1958, shows how the technique was reframed from a tumour-diagnostic tool into an instrument for the diagnosis and surveillance of pregnancy. A patient who had suffered from vaginal bleeding for three months was found to have a hard enlargement of the uterus corresponding in size with 14 weeks pregnancy. Having already had uterine fibroids, she was admitted for more surgery. But when Donald applied the ultrasound probe to confirm the tumour, he found a cystic cavity that he diagnosed as an early pregnancy. A hormonal test confirmed that the patient was pregnant.
Making obstetric ultrasound
In the 1950s, ultrasound promised a safe window into the womb.
Ultrasound, a technology that converts reflected sound waves into electrical impulses, was first developed to locate submarines in World War I. By the 1940s, ultrasound was used in engineering to detect flaws in metal structure and, by the 1950s, in clinical medicine for diagnostics as well as, at high energy, for therapy. Around 1950, the Denver radiologist Douglas Howry immersed patients in water to improve the quality of cross-sectional ultrasound scans; in Minnesota, the surgeon John Wild attempted to construct a device for quickly distinguishing normal from cancerous tissue.
In 1955, in the shipbuilding and industrial centre of Glasgow, the up-and-coming gynæcologist-obstetrician Ian Donald borrowed the ultrasound equipment from a local firm to differentiate abdominal masses indistinguishable by palpation. Sceptics reckoned the pictures unintelligible; others suggested that obstetricians’ experience of blind palpation trained them to assemble the pieces of a puzzle into a mental image. On the whole, by the late 1960s the diagnostic potential of obstetric ultrasound had become widely acknowledged.
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Technologies of ultrasound scanning. The first ultrasound images were A scans (for ‘Amplitude’), that is, single-line spikes and dips. These were soon replaced by the more ‘morphological’ B scans (for ‘Brightness’). This diagram demonstrates the difference. The upper picture represents the beam passing through the layers of the pregnant female abdomen: the skin (1), the uterus (2), and the two sides of the fetal head (3 and 4). In A-scan mode, the probe picks up the surfaces 1, 2, 3 and 4 as vertical blips. By contrast, the B-scan shows them as light dots (here shown as dashes), the positions of which correspond to the locations of each echoing interface in the body.
From Ian Donald, Practical obstetric problems, 5th edition, London: Lloyd-Luke, 1979, fig. 29/2, p. 1013. 21.5 x 14 cm.
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Technologies of ultrasound scanning, 1979
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| Ian Donald and John MacVicar examining a patient. Though a technology enthusiast, as an obstetrician Ian Donald was a holist who valued a clinician’s breadth of knowledge and experience. He specialized in obstetrics because it allowed him to treat the ‘whole patient’ rather than a diseased organ or system. Although socially sensitive and a supporter of the National Health System, he was a cultural conservative and leading campaigner against the 1967 Abortion Act.
Photograph taken in Glasgow’s Western Infirmary in 1960.
British Medical Ultrasound Society.
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Ian Donald and John MacVicar examining a patient, 1960
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