10.6092/issn.2038-3460/17297
application/pdf
2038-3460
17297
1
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Serena Naim
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Tecnoscienza – Italian Journal of Science & Technology Studies
Malcolm Nicolson and John E.E. Fleming, Imaging and Imagining the Fetus: The Development of Obstetric Ultrasound, John Hopkins University Press, 2013
Text.Serial.Journal
https://tecnoscienza.unibo.it/
7
Book Reviews
2016-07-08
2023-06-20
2016-07-08
2023-08-07
164-167
TS
Serena Naim
2016/07/08
10.6092/issn.2038-3460/17297
164
Queen Mary, University of London
2038-3460
1
en
167
Malcolm Nicolson and John E.E. Fleming, Imaging and Imagining the Fetus: The Development of Obstetric Ultrasound, John Hopkins University Press, 2013
https://tecnoscienza.unibo.it/article/download/17297/16164
7
164                                                           Tecnoscienza - 7 (1)

References
Haraway, D. (2004) The Haraway Reader, New York, Routledge.




                                     ***


    Malcolm Nicolson and John E.E. Fleming
Imaging and Imagining the Fetus: The Development of Obstetric
Ultrasound, Baltimore, John Hopkins University Press, 2013, pp. 336

Serena Naim Queen Mary, University of London

    Until fifty years ago, pregnancy could only be studied through its ef-
fects on the pregnant woman's body. Hidden from the medical gaze, the
fetus was a part of a process, more than a specific subject with its own
identity and rights. In the last fifty years, however, the fetus has acquired
a social status of its own. In their book Imaging and Imagining the Fetus,
Nicolson and Fleming investigate this changing perception of pregnancy
by analysing the development and diffusion of the ultrasound scanner, as
“both a major agent for and a potent symbol of the medicalization of
childbirth” (3), retracing in a very detailed manner the complex interac-
tions of social, medical, and technological conditions that led to the estab-
lishment of this new technology as a widely accepted medical instrument.
    The book benefits from a multidisciplinary approach, thanks to the
different backgrounds and perspectives of the two authors. Working side
by side, Malcolm Nicolson, Director of the Centre for the History of
Medicine at the University of Glasgow, and John E. E. Fleming, retired
engineer who was part of a team working on the ultrasound scanner's
prototypes, wrote a book that is both historically and technically accurate,
making it a compelling account of how technological innovation is a
winding and messy path, more than a straight line from one point to an-
other. By investigating the original documentation as well as by re-
enacting some of the experiments, Nicolson and Fleming manage to high-
light the complex and sometimes fortuitous sequences of connections and
coincidences that led to the diffusion and stabilization of the new tech-
nology.
    Between the 1950s and the 1970s, experiments on the medical appli-
cations of ultrasound were ongoing, more or less independently, in differ-
ent parts of the world. Nicolson and Fleming’s work focuses on the Brit-
ish context and, more specifically, on the role of Ian Donald, Regius Pro-
fessor of Midwifery at the University of Glasgow, and key figure in the
development of the ultrasound scanner in the UK. The book is a rich ac-
Book Reviews                                                             165
count of the complex network of actors involved in the development of
Donald's prototype of the ultrasound scanner, and includes references to
similar experiments in Sweden, Japan and the US. Their work, however,
risks focusing a little too heavily on the influence of Donald, as great care
is dedicated to retracing his personal and professional life more than that
of others involved in the development of the ultrasound.
    In terms of its structure, the book can be divided into three main sec-
tions. In the first section, Nicolson and Fleming retrace the history of ul-
trasound from its early application for military purposes. Chapter 2
brings the reader to the origins of ultrasound echolocation, back to the
first sonar (SOund Navigation And Ranging) that was employed by the
Royal Navy in 1922 to detect enemy submarines and anti-submarine
weapons. In peacetime, sonar became a common method to measure the
depth of the sea. During the 1930s, the ultrasound found an application
in industry to detect flaws in metal machinery parts. Investigators in dif-
ferent parts of the world also started researching possible clinical uses of
the echolocation technique, thanks, in part, to the cheap electronic parts
made available by the military surplus. At the same time, Ian Donald
started his education at St. Thomas's Hospital Medical School, an institu-
tion that valued a holistic approach to illness, encouraging students to be
moral guides as much as a doctors. Nicolson and Fleming analyse the in-
fluence that Donald's (Anglo-Catholic) religious and academic education
had on his profession, with chapter 3 being a detailed account of the
formative lessons, both moral and professional, that Donald received at
St. Thomas, and of his early interest the clinical use of ultrasound.
    In the second section, the authors painstakingly recount the several at-
tempts made by Donald and his team to use the industrial flaw detector
for medical investigation, from the A-scope to the first automatic scanner,
and finally the Diasonograph. Nicolson and Fleming reconstruct the se-
ries of fortunate events that allowed Donald to secure the academic and
financial interest to pursue his project, and the valuable partnership he
forged with Thomas Brown, an engineer at Kelvin and Hughes Ltd.
Brown fixed and improved Donald’s machine, but most importantly he
convinced Donald, initially sceptical, to find a way to display the infor-
mation collected with the ultrasound in a brightness-modulated form.
With Brown's method, the pulse-echo signal was no longer producing a
pattern of spikes, but rather a two-dimensional image. The images that
Brown's prototype was able to produce, however, were very crude and
hard to interpret. As the authors clearly explain, making sense of these
pictures was difficult also because what was displayed was something
completely novel; no one had ever looked at the abdomen that way be-
fore, and the pictorial reproductions of the organs in anatomy books were
not helpful. Moreover, the body itself proved to be a challenging subject
of study; apart from the individual differences between subjects, the con-
ditions affecting the ultrasound echoes were many and hard to predict.
With a precise account of the team's many attempts and failures in chap-
166                                                           Tecnoscienza - 7 (1)

ters 5 and 6, Nicolson and Fleming convincingly prove their point, ac-
cording to which “[t]he development of obstetric ultrasound [was] a par-
ticular sequence of complex interactions between physical entities (sound
waves, piezoelectric crystals, potentiometers, and the like), the biological
substrate of the human body, and human actors from a variety of back-
grounds and with diverse skills and interests.” (8)
     In chapter 7, they recall the last steps that led to the commercialisa-
tion of the final prototype of the Diasonograph. An important move for-
ward was possible thanks to Brown's development of an automatic scan-
ner, which allowed him to produce consistent and comparable scans. As
Nicolson and Fleming note, the automatisation of the scanning process
was instrumental to the diffusion of the scanner as a black-box. Brown's
last prototype, a semi-automatic machine with a manual probe operated
by the practitioner, could now be used by physicians with no understand-
ing of engineering, and it quickly made its way to the market as a medical
commodity.
     The third and last section engages with the consequences of the in-
corporation of the ultrasound scanner into medical practice. Allowing the
physician as well as the pregnant woman to see, for the first time in histo-
ry, a fetus long before it was born, the ultrasound scanner had great im-
pact on people's perception of both the fetus and the pregnancy. As Nic-
olson and Fleming argue, “the ultrasound scanner does not reveal the fe-
tus directly or unproblematically” (267). The last three chapters are, in-
deed, an attempt to investigate what happened after the new technology
became black-boxed. Aware that the stabilization of a technology is not
the end of the story, the authors recount the controversies following the
general acceptance of the ultrasound scanner as a valuable tool for clinical
investigation. Clearly, most of the controversies revolve around changing
perspectives on pregnancy. In order to make sense of the new social sta-
tus gained by the fetus, Nicolson and Fleming adopt Donna Haraway's
approach to human experience as technologically mediated (1991). The
fetus comes to be a cyborg, accepted as a patient on its own through the
mediation of a technology. This changing status of the fetus affected peo-
ple’s attitudes on abortion and, consequently, on a woman's right to ter-
minate her pregnancy. The possibility of actually seeing the fetus had a
huge impact on women's rights, casting a long shadow that is still evident
fifty years later, as the ultrasound images of the fetus are still used as po-
litical tools by the pro-life movement against those who decide to termi-
nate their pregnancy. On the other hand, as the authors recall, being able
to detect fetal pathologies at a very early stage might foster abortion in
case of malformations, a possibility that Donald considered morally re-
pugnant.
     Nicolson and Fleming's account of the ethical and social consequenc-
es of the diffusion of the ultrasound scanner is remarkable, yet they only
partially succeed in problematizing them, as a close examination of the ef-
fects of the invention on women's agency is somehow missing. The au-
Book Reviews                                                                167
thors recall a few different, and sometimes opposite, positions on the
medicalization of childbirth coming from feminist scholars; as explicitly
stated, however, Nicolson and Fleming decided “not to interrupt the flow
of the narrative with theoretical digressions or engagement with the work
of other scholars” (7), and only briefly mention the controversies and
conflicts following the changing attitude towards the fetus.
    In conclusion, Imaging and Imagining the Fetus constitutes a valuable
example of the messy path that leads to the emergence and stabilization
of a new technology. Following Pickering's framing of research as a pat-
tern of modeling, resistance, and emergence (1995), Nicolson and Fleming
convincingly describe the complex entanglement of personal skills and in-
terests, social and political context, technical and financial resources, as
well as fortuitous encounters, fundamental for a technological innovation
to be successful.

References
Haraway, D. (1991) Simians, Cyborgs, and Women: The Reinvention of Nature,
    London, Free Association Press.
Pickering, A. (1995) The Mangle of Practice: Time, Agency, and Science, Chicago,
    University of Chicago Press.




                                     ***


   Philippe Sormani
Respecifying Lab Ethnography: An Ethnomethodological Study of Experi-
mental Physics, Farnham, Ashgate, 2014, pp. 278

Paolo Volonté Politecnico di Milano

    This book presents a laboratory study based on the conviction that la-
boratory studies have failed up to now to achieve their goal. According to
the author, laboratory studies’ failure is “the failure to describe any partic-
ular discipline of the natural sciences in its constitutive practices” (16). The
very constructivist approach that has characterized lab studies from their
beginning contributed to such failure, because it drove to interpret labor-
atory practices in terms of concepts alien to them. There arose the ten-
dency to ignore any self-instruction in the enquired domain of research
practice, and the interpretively analytic relevancies distanced themselves
from the practically ordered ones. To avoid such trap, Sormani’s study
accomplishes a change in orientation lead by ethnomethodology. Its cen-
tral concern is to recover the local production of social order in a physics
