Born in the aftermath of the Second World War, some of the most imaginative and far reaching innovations brought forward by the new NHS actually had their roots in conflict. Nowhere is this more apparent than in the development of ultrasound.
Now a standard feature on hospital wards, ultrasound was developed over fifty years ago by a team of researchers in Glasgow, led by Professor Ian Donald and Dr John McVicar. But the inspiration for the paper they submitted in 1958 to the medical journal The Lancet came from Donald's own experiences in the Royal Air Force. And with the RAF over ninty years old it's about time the story of Ian Donald, the Royal Air Force, the National Health Service and the invention of ultrasound was told.
Ian Donald served with distinction as a medical officer with the RAF during the Second World War. He was mentioned in dispatches and awarded a medal for rescuing airmen from a burning aircraft. When the war ended, Donald moved to specialise in obstetrics and gynaecology. It was about as far removed from military medicine as could be imagined. But in his new career Donald drew heavily on his wartime experiences. When he took up the Chair of Midwifery at Glasgow University in 1954 he said he did so "with the residue of a Leverhulme Research grant, a rudimentary knowledge of radar from my days in the RAF and a childish interest in machines, electronic and otherwise". This was combined with an awareness of echo-sounding, something he had learned about during anti-submarine sorties.
If cutting edge technology could be used in such a powerful and destructive way, might it also be harnessed for good? If you could 'see' a U-boat far under the ocean, could the same techniques be used to monitor changes in the human body? It all seemed a bit far fetched, but Ian Donald surrounded himself with other like minded individuals, such as fellow obstetrician Dr John McVicar and engineer Tom Brown, from the Glasgow firm, Kelvin Hughes. Together their work would revolutionise medical diagnostics.
Reaction to The Lancet report over fifty years ago was stunning. The paper entitled 'Investigation of abdominal masses by pulsed ultrasound' described the results obtained by Donald, McVicar and Brown from scanning over one hundred patients with an early prototype scanner which had been developed from industrial metal flaw detector technology. Courtesy of a loan from the British Medical Ultrasound Society, this machine is now on show at the Hunterian Museum in the University of Glasgow as part of the 'Healing Passion' exhibition on medical history in the West of Scotland. The prototype was assembled using all sorts of pieces of equipment, including bits of Meccano and a hospital bed table. Tom Brown, who built the scanner, said that "It was a case of scrounging for parts wherever I could".
The potential to reveal information on the growing foetus in the womb was soon realised and the use of ultrasound spread quickly, making pregnancy and labour safer and allowing for the much more effective detection and treatment of foetal abnormality. Within a few years ultrasound scanning became a routine part of ante-natal care. And as the science of ultrasound developed, so did its applications. Ultrasound scanning is now used in a myriad of other areas, and recent advances in technology have enabled three dimensional images to be produced.
Ian Donald even had personal experience of the importance of ultrasound. He required major heart surgery on three occasions and following on from the final procedure he was persuaded by a friend to commit to writing his memories of the ordeal. In a moving, yet wryly humorous essay, Donald described how he self-diagnosed his own condition, but that it required an ultrasound picture to convince his doubting, cardiac colleagues!
In honour of his achievement, the Ian Donald School of Medical Ultrasound was opened in Croatia in 1981. A further recognition of his pioneering work in ultrasound, is the annual Ian Donald Gold Medal, which is awarded to the person whose work is considered to have the most profound influence in the development of Obstetrical and Gynaecological ultrasonography.
Ultrasound is probably the most obvious example of peacetime medical technology evolving from science that had been developed with war in mind. But it is far from the only one. The crippling and disfiguring effects of artillery bombardments during the First World War created a huge need for functioning and realistic prosthetic limbs, and gave birth to modern plastic surgery. The leading light in this was Sir Harold Gillies, a New Zealand surgeon with family roots in Scotland.
Gillies developed a particular interest in facial repair work. He pressed for, and in 1917 secured, a specialist hospital at Sidcup in England. There Gillies and his colleagues developed many techniques of modern plastic surgery, performing more than 11,000 operations on the shattered faces of returning soldiers. He continued his work after the war and in 1930 invited his cousin Archibald McIndoe to join him in private practice. Together they would become the most pre-eminent practitioners in the country, if not the world. But within a decade and with war clouds again gathering over Europe, the skills these men possessed would be called upon by the military once more.
McIndoe, another New Zealand Scot, was attached to the Royal Air Force during the Second World War. Like his cousin, he was a brilliant surgeon who came up with new and successful techniques for treating badly burned aircrew. This included the development of the walking-stalk skin graft and the discovery that immersion in saline promoted healing as well as improving survival rates for victims with extensive burns.
But McIndoe also recognised the psychological damage caused by facial disfigurement. He stressed the need for proper rehabilitation and of social reintegration back into normal life. One small but important step was his decision to get rid of 'convalescent uniforms' and to allow patients to use their service uniforms instead. McIndoe was conscious that his job as a doctor involved repairing the minds every bit as it did the bodies of the burnt and scarred young men who arrived at his hospital.
In 1956 Archibald McIndoe took his talents overseas and, in the foothills of Mount Kilimanjaro, he founded AMREF the African Medical and Research Foundation. Initially conceived to provide medical assistance to the remote regions of East Africa, AMREF continues to this day, working across the entire continent and offering help to those who need it.
The pioneering work of McIndoe and Gillies made Britain a world leader in plastic surgery. And that reputation continues to this day, especially in Scotland. Surgeons like David Koppel and his team in Glasgow work tirelessly in facial reconstruction and in the treatment of rare conditions such as Goldenhar Syndrome. The techniques used are rooted in the ground-breaking work of Gillies and McIndoe.
One, perhaps unexpected, spin off from the advances made in plastic surgery during the Second World War came in 1946 when Gillies performed the world's first sex reassignment procedure from female to male. Five years later he took this to the next level, with a male to female transformation using techniques which would become the standard for more than forty years.
Scotland has also led the way in the treatment of reproductive problems such as endometriosis. This painful condition which impacts on female fertility affects around two million women in Britain, yet is little understood and can be difficult to diagnose.
That is why the announcement of a Centre for Reproductive Endocrinology and Medicine in 2008 was so significant. This collaborative venture between the University of Aberdeen and the Medical Research Council Human Reproductive Sciences Unit in Edinburgh strives to lead to a better understanding and offer ways ahead for control and treatment of the condition. In part this involves looking at the potential impact on our reproductive health from the cocktail of chemicals we are all exposed to on a daily basis.