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Nicholson, Deborah (2003) Secrets of success:the development of obstetric ultrasound in Scotland, 1963-1990. PhD thesis http://theses.gla.ac.uk/3400/ Copyright and moral rights for this thesis are retained by the author A copy can be downloaded for personal non-commercial research or study, without prior permission or charge This thesis cannot be reproduced or quoted extensively from without first obtaining permission in writing from the Author The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the Author When referring to this work, full bibliographic details including the author, title, awarding institution and date of the thesis must be given Glasgow Theses Service http://theses.gla.ac.uk/ [email protected] Secrets of success: the development of obstetric ultrasound in Scotland, 1963-1990 Deborah Nicholson Thesis submitted to the University of Glasgow in patiial fulfilment of the requirements for the degree of Doctor of Philosophy. (January 2003) Abstract This thesis examines the diffusion of obstetric ultrasound technology in Scotland, from the early 1960s through to the end of the 1980s. Although the origins of obstetric ultrasound can be traced to 1955, and the pioneering work undertaken by Professor Ian Donald and his colleagues in Glasgow on the gynaecological applications of ultrasound, it was not until the early 1960s that the pathologies associated with pregnancy were directly investigated. Over the next thirty years, the technology underwent a number of significant transformations - in technical design, application and use, and organisation. The main focus of this thesis is on the uptake and implementation of obstetric ultrasound in new locations across Scotland, and on the dynamics of change associated with its use in clinical practice. U sing a case-study approach which centres on four individual Scottish hospitals, this thesis traces the complexity and heterogeneity evident in the diffusion of this technology. The definition of 'technology' employed in this thesis is three-dimensional - comprising of technical, cognitive and interactive/performative dimensions. Here it is argued that all three of these dimensions compose a technology, and that all three are open to adaptation and change, thus essentially changing the nature of the technology itself. This is highlighted through a comparative account, focussing on site-specific differences in the development, organisation and use of the technology. The evidence presented here has been drawn from a variety of historical sources. The recollections of a number of actors involved in the introduction, use and development of obstetric ultrasound in Scotland, as well as of women who experienced ultrasound during their pregnancies, have been collected using semi-structured interviews. To this oral history has been added information from a variety of archival sources held at the British Medical Ultrasound Society's Historical Collection (housed at The Queen Mother's Hospital, Glasgow). These include specialist professional journals, correspondence relating to ultrasound, manufacturers' literature, draft versions of key published papers, transcripts of interviews with prominent actors in the field and material donated by ultrasound workers across Scotland. Furthermore, the Collection also boasts a wide array of visual information (including pictures of various types of ultrasound equipment and images generated from them) and artifacts (ultrasound machines dating from the 1950s through to the 1980s). These, less conventional, historical sources are also employed in this thesis. In this comparative study of the diffusion of ultrasound, three related arguments are presented. Firstly, it is argued that innovation and diffusion are not mutually exclusive terms or periodising concepts, but are interwoven processes and forms of activity. The diffusion of obstetric ultrasound did not signal the 'end' of innovation, but merely the point at which new actors in new locations undertook it. Innovation is a crucial component in adapting a technology to new circumstances, users or contexts and thus it is argued that innovation and diffusion are inter-related, mutually dependent forms of interested human action. Secondly, obstetric ultrasound is characterised in this thesis as an emergent phenomenon, shaped by both technical and social factors. When the development of this technology is examined in a variety of historical and spatial contexts, it is evident that the form it takes is determined by the interplay of social factors (professional relationships and interests, actors interpretations of technology, etc.) and more technical or material factors (the way a machine responds to new demands or itself requires certain types of human or social response). Thus a complete account of the diffusion of obstetric ultrasound necessitates an approach that considers both social and material influences on technological change. Finally, this thesis explores the significance of site-specific local arrangements for the shaping of obstetric ultrasound. Interactions with technology take place within specific historical and locational settings. The specific character of each setting can affect the nature of inter-professional relationships, the organisation and administration of the technology, the characteristics of the patient population, and so on. Thus, the diffusion of obstetric ultrasound and the form that it takes in each new location are partly shaped by the way in which the technology interacts with new environments. 11 Acknowledgements I am deeply indebted to my supervisors Dr Malcolm Nicolson and Professor Ray Stokes. Without their guidance, patient support and encouragement this thesis may never have been completed. Furthermore, their experience and knowledge of their respective fields helped to shape my ideas into some form of coherence. For this, I will be indebted to them long after this thesis begins to gather dust in Glasgow University Library. With one supervisor steeped in sociology of science and medical history, and the other in history of technology, the emergent product is a true hybrid. The progression of this thesis has also been greatly aided by the material accumulated by Malcolm Nicolson and John Fleming (along with Ian Spencer) on the history of diagnostic ultrasound. Their project has been an invaluable source of information for me and provided me with material which I would otherwise have been unable to access within the confines of PhD research. I am extremely grateful to Malcolm for making this material available to me. I also owe a great deal to Mr. John Fleming, former colleague of Professor Ian Donald and curator of the British Medical Ultrasound Society's Historical Collection at The Queen Mother's Hospital in Glasgow. Not only did John provide a wealth of archival material and know instinctively where I might find the information I needed, but he has also been an invaluable font of knowledge in his own right. As well as providing me with lists of potential interviewees from his contacts in the field past and present, John patiently (and repeatedly) explained to me the physics and engineering aspects of ultrasound. Pointing out the key components of the machines in the collection, drawing diagrams and continuously simplifying the complex expert knowledge of physics into the required 'ultrasound for idiots' guide, John enabled a technologically illiterate historian to come to terms with the complicated world of diagnostic ultrasound. Any remaining inaccuracies are therefore mine alone. Dr Margaret McNay, former consultant obstetrician at the Queen Mother's Hospital, was also an invaluable source of information, providing contacts and explaining the nature and significance of obstetric pathologies. I am also extremely indebted to all those involved with the development and use of ultrasound in Scotland who gave up their time to speak to me, and to the women who were prepared to share their ultrasound experiences. Without their co-operation, this thesis would not have been possible. III I would also like to thank my former and current colleagues in the Centre for the History of Medicine who helped sustain a research community which was both supportive and divergent in ideas. I would particularly like to mention Ian Spencer, James Bradley, Andrew Hull, Gayle Davis, Rosemary Elliot, Anne Cameron, Krista Maglen, Jenny Cronin and Lindsay Reid. Particular gratitude goes to Matt Egan and Catriona Macdonald, for their intellectual and personal support and encouragement. I am also grateful to Marguerite Dupree and Anne Crowther for their guidance, and to Ann Mulholland and Rae McBain for their support and good humour. To my colleagues at the University of Paisley (especially Kathryn Burnett, Ian Watt, Renee Bleau, Charlie Johnston, Hugh Maguinness, Ian Weddle, Kate Thomson and Kathleen Ward) I also owe a debt of gratitude. In particular, however, I wish to thank Gwyneth Nair. She was my 'Miss Jean Brodie', providing me with support and encouragement during my undergraduate years, fostering my interest in history and introducing me to the history of medicine. Without her influence this thesis would never have been conceived, and without her support since my return to Paisley as a staff member, it may never have been completed. Nevertheless, research communities are rarely geographically located and I received a great deal of encouragement from the following: Steve Sturdy and Mike Barfoot at the University

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