Imaging and Imagining the Fetus

How engineers and clinicians developed the ultrasound diagnostic scanner and how its use in obstetrics became controversial.

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."