Social affairs

Ultrasound, a Scots invention that emigrated

From the Herald 28 Dec 1995

Scots pioneered the technology and techniques for one of the most amazing pieces of medical equipment in hospitals today.

Yet, as Jackie Kemp discovers, lack of insight and investment meant that their innovation was ignored here and taken over by other countries.

IT'S the first picture in junior's photograph album - a grainy black and white shot of something that looks a lot like a space monster and a little like a human baby. Almost all pregnant women undergo the ultrasound test that produces a picture like this at least once. Recently there has been concern that the method may be overused. The World Health Organisation cautions against routinely exposing pregnant women to it and warns it may be more sensible to use it only when necessary.

Despite these doubts, there is no denying that it has helped to revolutionise the diagnosis of abnormalities in pregnancy. Early scans can show up twins or triplets and can sometimes spot foetuses which are not growing properly. Ultrasound pictures allow amniocentesis tests for Down's syndrome and spina bifida to be carried out more safely.

Most antenatal clinics are bristling with ultrasound machines. In the Queen Mother's Hospital in Glasgow alone there are around a dozen of them. A close observer would discover that the majority are marked with the word Toshiba, for the Japanese electronics firm are one of the world's leading manufacturers of ultrasound machines. However, medical ultrasound as we know it started in Glasgow.

Belatedly the Wellcome Trust is funding a research project into the history of this remarkable discovery and Glasgow University is collating material for a book and an archive. And yet Glaswegian Tom Brown - the man whose name is listed on the early worldwide patents as the sole inventor of the first commercial ultrasound machine - sits sadly in his Wimbledon flat flicking through a scrap book of memories.

His eyes fill with tears as he recalls how the hope and promise of the early days led to disappointment and financial ruin. Back in the 50s, Brown was a young engineer at Kelvin Hughes in Hillington working on industrial ultrasound, a modification of the sonar technique used in the Second World War which on a smaller scale could detect flaws in metal objects. At that time there were only two places in the world where people were working on the potential of medical ultrasound.

One was Denver, Colorado, and the other was Glasgow University. In Denver, a man named Douglas Howry had modified a B 52 gun turret and was using low-energy sonar to get pictures of patients' innards. The one drawback of his method was that they had to be suspended naked in a tank of water while the terrifying machine revolved around them. Although it produced high-quality pictures, its obvious disadvantages for the treatment of the sick meant it never caught on.

But at the same time, Glasgow University's Professor of Midwifery, Ian Donald, had become interested in the subject. He had gotten hold of an industrial flaw detector and was doing his best to adapt it to allow him to distinguish between fluid-filled cysts and cancerous tumours.

Howry was immersing his patients in water in the US because ultrasound waves don't travel so well through air. Donald had different solutions - he tried immersing the sound probe in a plastic bucket precariously balanced on the patient's stomach - that didn't work and tended to end up soaking both patient and doctor, so he tried another trick. A fellow professor volunteered to buy condoms for Donald in a chemist's shop in West Nile Street so that the eminent professor, a figure of some standing in the Glasgow Episcopalian community, would be saved from scandal.

He tried filling the condoms with water but that did not work much better. While these experiments were being carried out, an engineer from Kelvin Hughes fitting a shadowless lamp in Donald's theatre returned to Hillington with the tale of how the professor was using an industrial flaw detector. Tom Brown was immediately inspired by the idea.

That evening he contacted the professor. Donald was friendly and invited Brown up to the hospital. Brown quickly saw that the machine being used had been modified in a way that was causing more problems than it solved.

He took a new model to the Western Infirmary. This was a contact scanner and it was possible to use it simply by smearing the patient's stomach with olive oil and touching the probe to it. This was Brown's radical solution to the contact problem, a technique broadly similar to the one used today.

Work on the project continued and Brown came up with an oscilloscope camera to photograph the ultrasounds. Soon, Donald was able to tell sceptics the story of how he had saved the life of a patient believed to be dying of cancer. An X-ray and other signs had prompted the cancer diagnosis, but an ultrasound test showed she was actually suffering from an ovarian cyst which was cured by surgery.

It was one of the directors of Kelvin Hughes, William Slater, who spotted the commercial potential of the project Brown was involved in. He offered #500 towards the work and Brown was allowed to devote one working day a week to it. Brown was soon designing a prototype machine.

He was concerned the thing should not look too initimidating for the patients and enlisted the help of a Glasgow design student - now the principal of Glasgow Art College - Dugald Cameron to help him. Cameron is still proud of the order from Kelvin Hughes for the design drawing he sold, for the world's first commercial medical ultrasound machine, dated June 27 1961. It awarded him the magnificent sum of #21.

This ``elegant piece of equipment'' was the only one Brown actually supervised in construction. Soon he was withdrawn on to another project and a modified form of the machine - bulkier and more awkward - went into limited production. But there was not the money or the belief in the machine for Kelvin Hughes to carry on pumping cash into something that was as yet unprofitable. The medical establishment was sceptical and hospitals in the west of Scotland were not buying ultrasound machines.

Donald had published a paper in the Lancet, tentatively spelling out the progress so far: ``The fact that recordable echoes can be obtained at all has both surprised and encouraged us but our findings are still of more academic interest than practical importance and we do not feel that our clinical judgment should be influenced by our ultrasound findings.''

In response to the article, one eminent gynaecologist summed up the uses of ultrasound as being for gynaecologists who were ``deaf, dumb and blind and had lost the use of their hands''. There were many in the medical profession who failed to see the potential of the new technique.

By the early 60s, just as the global race for development of the new technology was hotting up, Kelvin Hughes had been bought by Smiths Industries (England) Ltd who closed down the Hillington factory. The ultrasound department was bought by Nuclear Enterprises Ltd in Edinburgh. They sold off the stock and carried on making similar machines but made few technological changes.

Brown says that the intense research and development work needed to stay ahead just didn't happen. He went to work for Sonicaid in Livingston where in the early 70s he researched into 3D scanners. It was virtual reality before you had virtual reality, he says.

Now work has restarted on similar projects. But his work in the 70s was deemed too expensive and was discontinued. Brown couldn't get another job in medical technology and ended up driving a crane in the oil industry. ``I still believe that we nearly got there, we nearly did it. But the money ran out,'' he says. ``I had to take the professional consequences of being associated with failure. No-one wanted to employ me after the collapse of the 3D project. I was unemployed and unemployable.''

This was the end of ultrasound pioneer Tom Brown's work in the field. Neither he nor Professor Donald received much recognition for their contributions. The story is a cautionary tale for Dugald Cameron: ``Here is a product that was invented in Glasgow and here we are having to import it from Japan. It was a wonderful product. We should have an electronics industry that is based on it. The brains were here, the skill and talent and imagination were here but we couldn't carry it though in terms of investment and business opportunity.''

At the Queen Mother's Hospital few of the expectant mothers who file out clutching those strange little pictures, know that the technique that seems so miraculous was invented so close to home.

In a little room hidden away at the back stairs, a collection of the early equipment gathers dust. In this unvisited room, hidden away from all but the most determined, a portrait of modern pioneer Professor Ian Donald smiles above the first human ultrasound machine, cobbled together from a hospital bed table and a flaw detector. ``It's not the original bed table though. I had to give that back to the ward,'' says Tom Brown ruefully. ``I just managed to borrow it for a while.'