A Brief History of the Sonogram

Scotland has given the world myriad designs that have irrevocably shaped modern life, including the telephone, the adhesive postage stamp, the bicycle, penicillin and insulin (Alexander Fleming’s double whammy), and the television. In this very long list of inventions, one that is little known even by Scots themselves is obstetric ultrasound, developed in the 1950s in Glasgow and now one of the most common medical tools used during pregnancy across the globe.

Ian Donald was the Regius Professor of Obstetrics and Gynaecology at the University of Glasgow in the 1950s, when he partnered with John MacVicar, an obstetrician at the city’s Western Infirmary, and the industrial engineer Tom Brown to build various obstetric ultrasound scanner prototypes over nearly a decade of collaboration. In 1963, they produced the Diasonograph, the world’s first commercial ultrasound scanner.

Utilizing sound waves with frequencies higher than the upper audible limit of the human ear, and measured in hertz (Hz), ultrasound technology had long been employed in Glasgow’s industrial factories and shipyards. A crucial moment in the design’s development occurred in the spring of 1955, when the husband of one of Donald’s patients who worked for a boiler fabrication outfit allowed the doctor to divert the company’s industrial ultrasound technology from its usual deployment—checking for flaws in welds—to test whether it could differentiate between tissue samples (including an ovarian cyst and a juicy steak). It could.
 

Similarly applied to a pregnant human abdomen, the technology produced a dark oval with crackling shadows. The image offered a window into the uterus, with white lines indicating a placenta in formation and, at a nine-week scan, a fetal heartbeat pulsing away at about 140 beats a minute.

Donald, MacVicar, and Brown’s article “Investigation of Abdominal Masses by Pulsed Ultrasound” was published by the esteemed medical journal The Lancet in 1958 following their years of research. The transformation of the ultrasound echo into visual information allowed accurate dating of a pregnancy through correlation of fetal size with charts of normative growth trajectories, enabling more precise medical management of the patient and more accurate timing of biochemical tests, such as one made possible by another contemporaneously emerging technology, amniocentesis. Sonogram technology was taken up widely as machines dropped in price beginning in the 1970s. However, displacing embodied maternal knowledge in favor of scientific rationalization delivered by external machinery was resisted by some who saw it as part of a larger project of medicalization of pregnancy and birth that usurped a pregnant person’s own intuition.

In 1961, a 23-year-old industrial design graduate of the Glasgow School of Art, Dugald Cameron (who became its director in the 1990s), streamlined the apparatus in what was his first paid design commission after finishing his course of study. Cameron had been recruited to figure out the problem of patient and physician comfort after the University Hospital in Lund, Sweden, placed an order based on an early version of the scanner developed by Donald and his colleagues. Cameron recalled needing to do some serious revision, given the menacing aspect of the prototype:

I thought it looked like a gun turret and that it was thoroughly inappropriate for pregnant ladies …. [W]hat 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. That was the first drawing which I had been commissioned to do, and for which I received an order for £21.

Oral histories of the midwives and expectant mothers who experienced the first obstetric ultrasounds performed by Donald and his colleagues in Glasgow hospitals between 1963 and 1968 relay the wonder and delight of staff and patients alike. Pat Anusas, a young midwife who worked at the Queen Mother’s Hospital between 1963 and 1965, recalls watching one of the early scans: “I still to this day can’t believe what I saw … didn’t know if it was going to work or not—but it did work. And both the mother and I were so excited—she couldn’t believe she could see her baby.” 

Right-to-life campaigners, in the United States in particular, have deployed ultrasound imagery as campaign propaganda and, recently, as an additional hurdle to be surmounted in some states before an abortion can be performed. Lesser known is that Ian Donald held his own faith-based opposition to abortion. Deborah Nicholson, author of a comprehensive thesis on the medical history of obstetric ultrasound, notes that he “often performed ultrasound scans on women seeking terminations of pregnancy with the express intention of dissuading them from pursuing this action. In particular, the scan images would be shown to these women, while the implications of what was displayed on the image [were] carefully pointed out by the eminent professor using emotive language.”

While the black-and-white ultrasound image is immediately recognizable to many people, few meet the specialists—experts in anatomy, physics, and pattern recognition—who make these internal portraits. Tom Fitzgerald, formerly a general practitioner, began using ultrasound in 1982 at the Victoria Hospital in Glasgow before applying to train in radiology, a growing specialty at the time. As he notes, an ultrasound is more than a routine screening: “You’re trying to get as much information about and for the patient as you can … even though most pregnancies don’t need any intervention there’s a small percentage that do. The earlier you find out that they do need some help, the better.”

Fitzgerald recalls the changes over the course of his career as relating not only to upgrades in technology but to improvements of the patient-radiographer relationship. Patients initially came in without their partners. Now three-dimensional scanning— which emerged from the work of Kazunori Baba at the University of Tokyo in the mid-1980s—offers the ability to visualize the unborn in increasingly lifelike ways, and whole families might turn up for the scan, viewing it as an event. In the early days the scan did not show movement, with the in-utero picture instead built up from many different still images, and the substrate between the transducer wand and the baby bump was olive oil, a messy medium since replaced by a clear, water-based gel. Yet, as Fitzgerald outlines, breaking bad news when something atypical is detected or a heartbeat can’t be found never gets easier. Ultrasound, he stresses, has always been and still is about empathy as much as technology.

Michelle Millar Fisher, a curator and architecture and design historian, is Ronald C. and Anita L. Wornick Curator of Contemporary Decorative Arts at the Museum of Fine Arts, Boston. She lectures frequently on design, people, and the politics of things.

Amber Winick is a writer, design historian, and recipient of two Fulbright Awards. She has lived, researched, and written about family and child-related designs, policies, and practices around the world.

Excerpted from Designing Motherhood: Things that Make and Break Our Births by Michelle Millar Fisher and Amber Winick. Reprinted with Permission from The MIT PRESS. © 2021.