Reproductive Health · 1958
Diagnostic medical ultrasound for obstetrics and abdominal masses (Donald)
When Ian Donald took up his chair as Regius Professor of Midwifery at the University of Glasgow in the mid-1950s, the available tools for diagnosing abdominal masses were limited to clinical examination, plain radiography, and, where available, pneumoperitoneum contrast studies. None could distinguish a solid tumor from a fluid-filled cyst without invasive intervention, and none could safely image a pregnant uterus with any anatomical detail. Donald, a wartime Royal Air Force officer who had worked with radar and sonar technology, suspected that pulsed ultrasound might cross from industrial flaw detection into medicine.
His practical collaborator was Tom Brown, an engineer at the firm Kelvin and Hughes who modified an industrial metal-flaw detector for biological use. Working at the Glasgow Western Infirmary, Donald, Brown, and obstetrician John MacVicar spent several years scanning patients with known diagnoses to correlate the acoustic patterns with pathology. Their June 1958 paper in the Lancet described the examination of abdominal masses in dozens of patients, demonstrating that cystic structures produced strong posterior echoes while solid tumors did not, allowing reliable differentiation. They imaged ovarian cysts as small as a few centimeters and correctly identified a large fibroid by its acoustic signature.
The obstetric application emerged in parallel. Donald's group showed that fetal structures, including the fetal head, could be visualized in the second trimester using the same pulsed technique. This mattered enormously: X-ray pelvimetry exposed the fetus to ionizing radiation and was falling out of favor, yet obstetricians had no safe real-time alternative. Ultrasound carried no known radiation risk, could be repeated as often as clinically needed, and returned results immediately.
Technical limitations of the early A-mode display, which rendered echoes as spikes on an oscilloscope trace rather than anatomical images, constrained the method for several years. B-mode gray-scale imaging, developed through the 1960s by Stuart Campbell and others building on Donald's foundation, converted those traces into two-dimensional anatomical cross-sections that clinicians could interpret without specialized training. By the early 1970s obstetric ultrasound was routine in British and American teaching hospitals.
Standard antenatal ultrasound now covers gestational dating, placental localization, amniotic fluid assessment, and fetal anomaly screening at 18 to 20 weeks. The 1958 Lancet paper, produced with a machine borrowed from an industrial warehouse, supplied the clinical proof of concept for all of it.
Key People
- Ian Donald — Obstetrician who pioneered clinical ultrasound applications in Glasgow.
- Tom Brown — Engineer who built the adapted ultrasound scanner Donald used.
- John MacVicar — Co-author who contributed clinical cases and analysis to the 1958 Lancet paper.
- Stuart Campbell — Developed B-mode gray-scale imaging that made fetal anatomy interpretable.
Lancet, 1958
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