PAST, PRESENT AND FUTURE OF
INTER-UNIVERSITY SCHOOL OF MEDICAL ULTRASOUND
prepared at 2009
Prof. Ian Donald (1910-1987)
Ian Donald, by the invention of diagnostic ultrasound, has changed the face of obstetrics and gynecology in the middle of the twentieth century more than any others did. Hardly any area in medicine has experienced such dramatic technical advances during the past four decades as diagnostic ultrasound. The development of high-resolution two-dimensional probes and improvements in color Doppler ultrasound have been critical milestones in the recent history of sonographic diagnosis. Especially in prenatal diagnosis and gynecology, ultrasound has become an indispensable, noninvasive diagnostic tool.
With the recent advent and evolution of three-dimensional (3D) ultrasound technology during the past 10 years, we now stand at a new threshold in non-invasive diagnosis. Donald was born in Cornwall on 27 December 1910. He went to school in England but when he was 14 years of age his family moved to South Africa because of his father’s ill health. His early education was in Edinburgh, and then in South Africa where he graduated in Arts in Cape Town. His father and grandfather had been doctors.
After wartime service in the Medical Branch of the Royal Air Force he returned to obstetrics and gynecology, and after becoming a Reader at the Institute of Obstetrics and Gynecology at Chelsea, he started on his work on respiration of the newborn at Hammersmith.
It was in 1954 when he was appointed Regius Professor of Midwifery at the University of Glasgow, that he went north of the border. His three main objectives were to build a new maternity hospital, to write a books on obstetrics based on his own experience and to perform some really original work. He was successful in all three. He was a brilliant teacher and his textbook Practical Obstetric Problems went to five editions. He was later Professor of Obstetrics and Gynecology in Glasgow at the Queen Mother’s Hospital, where the maternity unit was built entirely to his design. The diagnostic ultrasound origins go back into maritime history. Donald’s often stated preference for the term ・・sonar・・ (which stands for ・・sound navigation and ranging・・) when referring to ultrasonic echography is based on his acknowledgement of this historical fact. It was in about 1916/1917 that the French and British Admiralties formed a joint committee to counter the growing threat, and for whom the French physicist, Paul Langevin, a one-time colleague of Marie Curie, conceived the principle of locating submarine in the ocean by using beams of sound waves of such high frequency as to be non-divergent and thus under directional control. Since the speed of sound, and therefore ultrasound in its passage through water, is known, both the direction and distance of an object in the ocean could be determined. The miniaturisation of the technique came as a breakthrough in the USA during the last war by Firestone with his “reflectoscope” for detecting flaws in metal structures, since the passage of a beam of ultrasound directly through a homogeneous metal was found to be interrupted in varying degree by cracks or flaws. This vital discovery was classified as a military secret and therefore not published until after the war but has since become standard metallurgical practice in engineering and affords a much simpler alternative to cumbersome high voltage X-ray examination.
On arrival in Glasgow in 1954 Donald soon set about trying to learn something about the energy properties of ultrasound and managed to borrow from an engineering firma powerful ultrasonic generator situated in a bath of carbon tetrachloride in which it created massive turbulence. He then suspended samples of unclotted bloom in it for varying periods and then, by cell counting, determined the degree of haemolysis. One of Donald’s initial clinical frustrations on coming to Glasgow was the problem of the woman with grossly-distended abdomen in which the traditional methods of clinical diagnosis were simply inadequate. Those were the days of massive tumours, both ovarian and uterine, of ascites whether cardiac, neoplastic or hepatic in origin and of obesity such as one seldom sees in the working classes of today. Donald always remembered that hot sunny afternoon of 21 July 1955 when they took to the factory some selections of the last few days operating, in the boots of two cars, large ovarian cysts and uterine fibroids, calcified and plain. The firm very thoughtfully provided a truly massive piece of prime steak as a control material. All he wanted to know was whether a metal flaw detector could show him on A-scan, which was then all they had, the difference between a cyst and a myoma. To his surprise and delight the differences were exactly as his reading had led him to expect, the cysts showing clear margins without intervening echoes because of its fluid content and the fibroid progressively attenuating the returning echoes.
His incursion into the study of pregnancy did not begin until 1957. In pregnancy the only echoes of which they could be reasonably sure at that time were those provided by the fetal head. It was this which led him to undertake a series of water tank expe riments in which he learned to identify the biparietal diameter and, with later development, its accurate measurement. True tissue differentiation was only to come many years later, especially with the development of grey scaling. Nevertheless, at this time in 1958 they could differentiate with reasonable certainty between quite a variety of gynecological tumors and ascites both benign and malignant (the latter having a characteristically bizarre appearance) and, of course, gross obesity. They could also demonstrate fetal echoes in utero, particularly the fetal head provided the uterus was enlarged above the level of the smyphysis pubis.
Donald’s team first went to press in The Lancet in 1958 and he regarded this as one of the most important papers he had ever written, noteworthy also because there had, so far, been no subsequent need to repeal anything he had then written. The automatic B scanner was completed in 1960 and Donald and his team were able to identify and measure biparietal diameter accurately.
The biparietal cephalometry had a remarkable development. The glimpses which they obtained with a hand-held probe left insufficient time to measure the distance between the relevant blips from the parietal eminences on the cathode ray tube face.Accordingly, his colleague Tom Brown borrowed from his employers a two-channel gated flaw alarm unit which triggered a solenoid-operated polaroid camera from whose photographs measurements could be accurately made. This was an ingenious device with which it was hoped to simplify biparietal cephalometry in the course of random searching in the region of the anterior fetal parietal bone. A physicist, Tom Duggan, joined the team. He introduced electronic cursors consisting of bright-up dots which could be placed by knob manipulation on the leading edges of the blips and provide a digital read-out of the distance between them. This proved even more accurate and saved money on photographic materials.
Bertil Sunden from Sweden was Donald’s first distinguished foreign pupil to whom he taught all he then knew. He returned to Lund with his own apparatus and contributed greatly to the subject, mainly in the identification of twins by counting fetal heads and in recognizing the characteristic features of hydramnios.
Donald’s experience grew in a number of directions, most notably of all perhaps in the rapid and easy diagnosis of hydatidiform mole. From 1962 onwards Donald’s team has established contact with Joe Holmes and his colleagues in Denver with whom a successful co-operation and association has been maintained ever since. Both groups made research to identify the placenta as an extension of the principles underlying the diagnosis of hydatidiform mole. A really important breakthrough occurred in 1963 when a nervous patient presented herself for examination with extremely full bladder. This at once made possible visualization of the pelvic viscera, even though not enlarged, since it had the effect of displacing gas containing and therefore impenetrate bowel out of the field and also provided a built-in viewing tank without interfering with the ultrasonic picture. With full bladder even the contents of a normal size uterus could have been then studied. Early pregnancies, normal, abnormal, aborting and continuing could have been then studied serially in great detail from the fifth week onwards and they soon collected a mass of material. Donald published the various appearances throughout prenatal development in an article in the Journal of Pediatrics in 1969. This was written under quite difficult circumstances since he was being treated in hospital at the time for acute cardiac failure, just prior to his first mitral valve replacement with a homograft.
By the early 1970s Donald’s team began to recognize the phenomenon of ovum blighting and published their findings on the subject in 1972. Donald clearly stated that “its frequency in early pregnancy failure, if searched for, is not surprising in terms of biology. That it should recur so often in the same patient is a tragedy often associated with abnormal karyotypes. All such cases should be investigated by tissue culture and full genetic assessment and not just dismissed as idiopathic early abortions.”
Hugh Robinson came on the scene to replace Stuart Campbell who had done so much (and is still doing) to import sonar to a city like London. Robinson’s most significant contributions were the determination of the fetal crown/rump length and its accurate relation to early gestational age and the positive identification of early fetal heart movement by time motion display. These provided concrete evidence of continuing fetal life long before ultrasonic Doppler studies become worthwhile.
In 1974 a scan converter and accessories were linked up with Donald’s standard Diasonograph B-scanner. This immediately made grey scaling possible. The quality of the pictures as regards organ outline remained as good as ever but also, by different shades of grey, gave a far better indication of tissue characterization. This facility has opened up a whole new avenue of approach, especially in the study of tissue parenchyma. Finally, just before his retirement in 1976, there came on the scene a whole crop of real-time scanning machines.
Recent technological breakthroughs in diagnostis ultrasound have surpassed all expectations. With these advances, clinicians now have the tools needed to contend with many significant diagnostic challenges. The rapid improvement in ultrasound image quality that has occurred, particularly over the past 10 years, has enabled us all to a degree that was thought inconceivable at Donald’s time. What is undeniable however are the dramatic changes by the advent of color Doppler, power Doppler and more recently 3D imaging. The simultaneous development of ultrasound contrast has also widened the diagnostic armamentarium at our disposal.
Donald’s opposition to the Abortion Act of 1967 was somewhat controversial. Possibly because of it some of the honours he might have received were withheld from him. He died on 19 June 1987 in his retirement home in Essex to which he and his wife Alix had gone in order to be able to indulge his hobbies of water colour painting and small boat sailing.
The Ian Donald International School of Ultrasound bears testament to globalization in its most successful and worthwhile form. The school was founded in Dubrovnik in 1981. Since then, the growth has been meteoric and now consists of 36 branches throughout the world. The reason for this success has been the tireless and selfless efforts of the world’s leading authorities in ultrasound who are willing to dedicate their valuable time without reimbursement to teach sonologists and sonographers throughout the world. The teachers put national, religious, political, and other parochial considerations aside as they strive to improve the care of all women and fetal patients. Our politicians in all of the 36 countries represented in the school have much learn from the purity of spirit that exists throughout the international family of Ian Donald schools. We believe that Ian Donald is smiling down from heaven at the School that bears his name.
It is not overstating the fact to say that Donald’s innovation has changed the thinking of our age. The magnitude of this step alone is incalculable. Indeed, diagnostic ultrasound, more than any other modern technique, has made manifest that the fetus is an individual virtually from conception.
Foundation of the Ian Donald School
In 1981, during the 4th European Congress on Ultrasound in Medicine and Biology held in Dubrovnik, a multidisciplinary group of enthusiasts met at the Inter-University Center for Postgraduate Studies (IUC) and established an advanced course which was named after Ian Donald and planned to have annual meetings within this unique institution.
The first Ian Donald course was held in 1982, co-organized by ASIM KURJAK and GEORGE KOSSOF, and was attended by 152 parti cipants from 42 countries. IAN DONALD and his wife Alix attended the first 12 courses held at the School. Since its foundation, the School has organized 32 advanced courses in Dubrovnik and throughout the world and has beenattended by 2520 students from 63 countries. It is now an integral part of the University of Zagreb. In 2002 the School celebrated its 20th year of existence by organizing a special course at the end of May attended by all School Directors and many of the previous lecturers. After GEORGE KOSSOFF’s retirement, FRANK CHERVENAK was named co-director.
One of our many guests, Professor TOMMY THOMPSON, former president of The World Federation for Ultrasound in Medicine and Biology, wrote:
≪Recently, I had the opportunity of taking part in a rather unique and outstanding ultrasound conference held in Dubrovnik, organized by the Ultrasonic Institute, Medical School University of Zagreb. The Ian Donald course was outstanding in that it presented the most up-to-date, state-of-the-art information on ul trasound that is available today. The faculty was exceptional in that world leaders were brought together from more than a dozen different countries. The subjects covered included prenatal diagnosis and therapy of congenital fetal abnormalities, ultrasonic-guided puncture techniques, ultrasound in the management of female infertility, fetal, uterine, and ovarian blood flow determinations and application, and a round-table on controversies in obstetric ultrasonography. There was a free flow of information and an unusual amount of participation by the audience, most of whom were authorities on many of these subjects in their own rights. This was an intense 5-day meeting dedicated to the higher levels of ultrasound knowledge and thinking in the world and it took place in a unique and beautiful setting on the Adriatic coast. It was by all standards a superb conference geared to the leading edge of present-day ultrasound knowledge. The Ultrasonic Institute from Zagreb should be congratulated for having deve loped a most timely, informative and well-presented international ultrasound school.≫
The School has evolved to have 18 international Chapters or Branches. This permits the spread of knowledge throughout the world. Each Ian Donald Chapter has developed according to the character of the respective country and culture. This structure permits international cross-fertilization of ideas while remaining sensitive to the uniqueness of each participating country throughout the world.
This first Chapter was organized in Trieste, Italy by GIAMPAOLO MANDRUZZATO who coordinated three successful courses (1991, 1992 and 1993). Professor VINCENZO D’ADDARIO, Head of the Department of Obstetrics and Gynecology, University of Bari is the new director of the Italian branch. Professor D’ADDARIO taught at the first Ian Donald School in Dubrovnik and has coordinated basic ultrasound courses in Bari. This program is complemented by advances of ultrasound in Obstetrics and Gynecology
under the Ian Do nald School. The first Ian Donald advanced course was held in Bari in June 2003. In 1992, the first Ian Donald course was established in Granada, Spain with Professor GON ZALEZ-GOMEZ as the course director. The program of the School was soon recognized as an integral part of the postgraduate curriculum at the Medical School, University of Granada. Three successful courses have been organized in Granada. In 2002, the decision was made to continue the Spanish Ian Donald courses in Barcelona under the leadership of Professor JOSE MARIA CARRERA. The Ian Donald School in Barcelona was held on November 25, 2002.
In 1995, we were invited by Professor CIHAT SEN to organize the first Ian Donald course in Istanbul, Turkey. Since then, the Turkish branch has been extremely active. Four courses have been held in Turkey under the organization of Professor SEN as the Course Director. There have been two courses in Istanbul and two courses in Antalya. Last year in Antalya there were more than 600 participants.
Ian Donald courses started in Japan where Professor KAZUO MAEDA organized the first course in Fukuoka in July, 1998. The second school was held from 17-18 June 2000 in Tokyo with Professors HISAYA TAKEUCHI and ASIM KURJAK as Directors, while the third one took place in Echigo-Yazawa in April 2001. All three meetings were very well attended not only by physicians but also by enthusiastic nurses and midwives. The fourth Ian Donald School was held in October 2002 in Nagoya. The coordinator was Professor ICHIRO KAWABATA. The next one will be in November 2003, organized by Professor KUNIHIRO OKAMURA.
In 2000, Professor SARRAF from Al-Amal Hospital, Amman, Jordan established a Center for postgraduate teaching in ultrasound, joining the Ian Donald School. The new center in Amman, now in its third round of training, stands as a great opportunity for physicians to learn their skills in the field of ultrasound. The Amman Center for the Middle East initiated its first training course in 2001. Despite the fact that the idea of such a center was novel in the region, the interest and the participation of physicians who readily enrolled on the course were overwhelming. The positive response of the participants demonstrated the success and the welcoming of such courses. It is important to note that the Amman Center is publishing a quarterly journal called Sonanews, edited by MAHER G. SARRAF, containing much useful scientific and organizatio nal information, which is distributed all over the Middle East region.
There is a long-standing tradition of organizing annual advanced national courses in Athens by Professor ARIS ANTSAKLIS. A few years ago, our Greek colleagues joined the Ian Donald School, becoming the Greek branch with ARIS ANTSAKLIS as the course director. The first course sponsored by the Ian Donald School was held from 22-23 February 2003 in Athens and was attended by 300 participants.
We welcomed the 7th branch of our School – the Indian Ian Donald course, organized in Agra. Professor N. MALHOTRA is a very well-known ultrasonic expert in India and was organizer of several advanced courses under the title ≪Agra Update-Obstetrics and Gynecology Ultrasound Course≫. In 2003, he continued his courses under the direction of the Ian Donald School, where he expected 600-700 participants.
The follow branch of the Ian Donald School was planned for Hungary. This branch is directed by Professor ZOLTAN PAPP. The course was scheduled for November 2003. Finally, between 2003 and 2009 the Uruguay (Director: ANA BIANCHI), Argentina (Director: LILIANA VOTO), Serbia (Director: ALEKSANDAR LJUBIC), Russian Branch (Director: ANTON MIKHAILOV), Bosnia and Herzegovina (Director: ZLATAN FATUˇSIC´), Slovenia (Director: VELJKO VLAISAVLJEVIC), Romania (Director: FLORIN STAMATIAN), Iran (Director: ABBAS AFLATOONIAN), UAE (Director: AWATIF AL BAHAR), Colombia (Director: NELSON AGUILAR), Qatar (Director: B. AHMED), Oman (Director: S. A. SULTAN), Bangladesh (Director: M. A. BASHED), Czech Republic (Director: PAVEL CALDA), China (Director: TONY DUAN), Egypt (Director: A. EBRASHY), Albania (Director: O. GLOZHENI), Hong Kong (Director: T. KIN LAU), Portugal (Director: A. MATIAS), Sudan (Director: A. L. ASHMAIG), Georgia (Director: A. PAPITASHVILI), Indonesia (Director: A. SALIM), Ukraine (Director: Y. P. VDOVICHENKO), Poland (Director: M. WIELGOS), USA (Director: IVICA ZALUD), Ecuador (Director: R. CASSIS), Nepal (Director: H. SHRESTHA), Germany (Director: E. MERZ) and France (Director: Y. VILLE) branches were established.
Prof. Ian Donald Lecture Speech of the Prof. IAN DONALD at the openning School in Dubrovnik in 1982. That memorable occasion at the first Ian Donald Inter-University School was vividly illustrated in the following lecture given by Prof. Ian Donald.
” There is a saying in the English language that some men sow and others reap. reap. It has been my own priceless privilege that I have been allowed to reap what I have helped to sow. This is exemplified today in the foundation of this School of Medical Ultrasound which bears my name. Now, at the end of my days, I could ask for no better epitaph. All this is thanks to the University of Zagreb and to Professor Asım Kurjak whose vision of the future has brought about what I would never myself have thought possible. My wife Alix has always been included in these happy Yugoslav meetings and she is with me here today to join me in our best wishes for your success. Asım is good friend to us all and, like Yugoslavs in general, he gives generous hospitality whose warmth far exceeds what we deserve, but he has also succeeded in bringing together delegates from 17 different countries in fruitful unison. In this respect, this school may stand as a memorial to the preeminence of Yugoslavia in the field of ultrasonic diagnosis.
Any alleged success which I may have had can be attributed to the fact that I was the first to apply ultrasonic techniques to gynecology and obstetrics. I must also acknowledge the engineering expertise which I was able to enlist in the city of Glasgow.
Being a professor in Scotland is a highly privileged position, unlike in the USA where professors tend to be regarded as a lower form of life. My professional colleagues took a characteristically patient and lenient view of what they doubtless regarded as my eccentricities in those early days. I doubt if I would have got very far in London, for example, and it was my good fortune to happen to be in the right place at the right time. In fact, my original intention away back in 1954 was to seek a more reliable method of differential diagnosis in cases of very gross abdominal distension in females, a common problem in clinical practice in which humiliating mistakes are frequently made by employing the standard diagnostic techniques.
Common causes often pose diagnostic problems because of their very size, for example, gross obesity, massive ovarian cysts, benign as well as malignant, other very large tumors of all varieties —renal, splenic, hepatic, aneurysm, retroperitoneal, genitourinary and involving the abdominal wall— and also all types of ascites, benign as well as malignant. Naturally, pregnancy, as quite the commonest cause of female abdominal distension, came under ultrasonic scrutiny as well, but not initially by us before 1956-57. This was mainly due to the geographic separation at that time of my gynecological unit from my obstetric hospital.
I do not deny that we had our full share of discouraging problems and our early apparatus was laughably crude. As I commented in our first article in The Lancet, what surprised and delighted us was that we got any results at all. You must remember that we had no yardsticks by which to control the rate or method of scanning, or even the best frequencies to use, and it was only the ready feedback of information such as one gets in gynecology, which made it possible to standardize our scanning techniques. Even so, we had very serious technical difficulties 20 or more years ago, such as the unreliability of our sine/cosine potentiometers, poor transducers, no controllable persistence cathode ray tubes, let alone storage tubes and computer storage systems, which today you all take for granted. We worked literally in the dark in more senses than one.
Looking back over what has been a long story of trial and even more of error, I cannot help feel a sense of surprise at all the lucky strikes which have been made over the years and their associated spin-offs. Who, for example, would have thought that our crude early work would have made possible the correct diagnosis of hydatidiform mole within a matter of minutes or that we would ultimately, subsequent to this, have refined the technique to demonstrate the placenta, both its site and its nature. Here I must acknowledge our co-operation with our friends in Denver, Colorado with whom we have maintained a happy liaison over the years. Our experiments in 1961 in measuring the biparietal diameter proved to be the start of all the present sophisticated forms of fetal biometry.
Newcomers to the field of ultrasound must be bewildered as to which sort of apparatus to select. There are many manufacturers, but I have noticed a steadily increasing convergence as to quality of performance as well as price, so that you get roughly what you pay for. Cheap apparatus, cheap results. Expensive apparatus may yield results beyond your clinical needs, so you should think well before choosing. Much will depend upon the sort of work you want to do, and the available anatomical access. For example, if you want to look deeply into the pelvis at very early pregnancy or for early tumor or even for ripening ovarian follicles, the keyhole approach provided by sector scanners through the full bladder will, in my opinion, give the best results. The same remarks in favor of the sectorized view apply to subcostal studies in the upper abdomen and through the intercostals spaces and particularly in echocardiology, anywhere, in fact, where access is small and the window area requires a sectorized view. The view can be improved considerably if a compound sector scan can be employed which provides an appreciation of the organ under study in its relationship to the rest of the body, particularly the urinary bladder. Unfortunately, the use of sector scanners calls for more skill than the linear array systems which, though providing a blinkered ・・mouth organ・・ type of view, are very much easier to handle, especially in the hands of the relative novice who is able, proprioceptively, to appreciate just how well he is lining up his linear array. Their most impressive use is in the middle trimester of pregnancy when the fetus is likely to be no longer than the array system and the abdominal wall will be soft enough to accommodate it throughout its entire length. The advent of real-time scanners, both linear and sector, has revolutionized ultrasonic diagnosis, chiefly because it not only allows the continuous movement patterns of what is being studied to be graphically displayed and recorded but, even more important, it speeds up the whole process of ultrasonic search. Added to this, various methods of frame-grabbing or framefreezing can be employed which provide static records for later scrutiny. This facility enormously increases the throughput of patients, since it speeds up the whole examination. The various storage, recording, and photographic systems are mainly responsible for the differences in price between one apparatus and another.
A real-time scanner can be combined with a static compound sector scanner. There is a choice of sector scanners between the wholly electronic phasedarray systems, which are expensive, though very compact, and particularly useful in cardiology, and the combined mechanical and electronic systems employing either spinning rotors with several transducers or rockers, either transducer crystals or mirrors. The linear-array systems are all electronic and without moving parts, as in the case of phasedarray scanners. As they say in English slang, ・・You pays your money and takes your choice・・. It distresses me that there are sometimes arguments about who should be in control of ultrasound scanning —just like dogs squabbling over a bone. Naturally, I now expect you all to be so much better at the ultrasonic art than me, so that I can safely withdraw into my old age. But I do recognize that there are many disciplines involved. On the whole, in medical sonar, there has been a happy club-like liaison between clinicians, radiologists, radiographers, physicists, engineers, embryologists, geneticists and technical staff of all types. Each has something to contribute and I feel strongly that no one group should exclude another, whatever money-obsessed administrators may feel. For goodness sake, let us keep it that way. Speaking for myself, I can say that the specialty has brought us many friends from all over the world, and sonar has built an intellectual bridge between East and West, as well as a bridge between medicine and engineering. The existing liaison between Yugoslavia and Egypt provides a very good example of international co-operation, largely thanks to Asım Kurjak and Maher Mahran.
It is interesting that the scope of interest has now extended to the veterinary world, and next month I have to lecture to an audience mainly interested in racehorse breeding —a very lucrative subject, I should imagine. The ability to diagnose a number of fetal developmental defects in the first half of pregnancy was, I suppose, inevitable. This facet, to me at least, is one of the sadder aspects of this work since, so far, so little can be done in the curative sense and the offer of termination of pregnancy is the most that one can suggest. From all this, there has grown a natural tendency to institute a sort of witch hunt, especially in the case of older pregnant women who are at statistically greater risk. The unhappy dilemma, often unnecessarily inflicted on our patients, has to be reckoned with in advocating massive screening program. As I have already hinted, it is perhaps time I withdrew. One of my constant nightmares of years ago was that someone, one day, would conclusively show that sonar did some unexpected and unforeseen harm to the developing fetus, in spite of my own efforts and that of others to verify the safety of the technique. The subject has greatly exercised my mind since the very beginning and, in the book I wrote with Salvator Levi in 1973, I dealt at length with all that was then known about possible bioeffects. I have seen nothing fresh of much significance Donald School Textbook of Ultrasound in Obstetrics & Gynecology since then. Meanwhile, hundreds of thousands of babies must by now have been screened by sonar all over the world and still there is no sign of trouble. Surprisingly enough, legal liability seems to have turned in the opposite direction, and a doctor is more likely now to be prosecuted for failing to make use of ultrasonic diagnosis in pregnancy in cases where a baby’s misfortune or handicap is alleged to be due to negligence in this respect. The well recognized uses, however, so far outweigh theoretical hazards for which there is as yet no convincing proof that the subject has become truly entrenched in the clinician’s diagnostic repertoire. For me personally, the ultimate climax to the ultrasonic art with which I have been associated is the filming of very early fetal life. To be able to study in real time a baby’s reactions to all manner of stimuli opens up an enormous field of dynamic research which is, as yet, barely touched upon. I leave this exciting field to you. When a pupil can teach his teacher, as I now recognize, then it is not only time to stop but also to rejoice at the newly found success of his one-time disciple. For myself, I do not think that I deserve more acknowledgement than a man who happens to win a football pool. Nevertheless, I trust that I may be forgiven for feeling proud of so many of you, proud to have been invited here with my wife to this opening, proud of who and what you are and proud of what
I know you will achieve.
Thank you !