What the eye doesn’t see: ultrasound, monitoring, and

the ‘unborn’

HI 269

Week 7

Seeing is believing: A quick history of medical imaging

1895 Prof Wilhelm Roentgen discovers ‘X-rays’; they quickly become a popular phenomenon and fad; only later are they adopted for medical purposes (eg onlyIn 1920 are 100% of fracture cases examined by x-ray in large US hospitals).

Seeing is believing: A quick history of medical imaging

“It is worse than useless to suppose that any new method of forming mental pictures, no matter how startling or radical, can equal the accuracy or approach in value those which the science of medical diagnosis has taught us to form with well-nigh infallible precision. It would be supererogation on the part of anyone to think that the mental pictures which he might form by use of the Roentgen rays could replace or even add much to the pictures which modern physical diagnosis is capable of presenting. The property which gives this new method of diagnosis its greatest value ... is its power to form real images, to make tangible shadows where before only mental pictures were possible. These tangible shadows eliminate the personal equation of the observer from the resulting diagnosis, and thus remove a source of error common to all methods that depend on the senses of the individual for the accuracy of their results.”

CC Leonard, 1897

Seeing is believing? Interpreting the x-ray

“The fondest swain would scarcely prizea picture of his lady’s framework;

to gaze on this with yearning eyes would probably be voted tame work!”

“Whether stout or thin, the x-ray makes the whole world kin.” 1897

“Sight is a much more satisfactory agent of information than hearing or touch.” Philip Mills Jones, 1897

"I will admit that I can see broken bones; that I can see metallic foreign bodies in the extremities, but when it comes to X- rays of the chest and to

some extent of the abdomen, I am much less clear. Frank Williams has just shown you some plates and tells you that the heart is here and the lung is here. Now I can't see a thing in these plates, and to be truthful, I don't think he can." Dr. F.C. Shattuck, after a presentation by Francis Williams, 1899

Seeing the foetus before ultrasound

Hunter, Anatomy of the gravid uterus, 1764

Leonardo daVinci, Sketch-Books, c. 1510

The Foetus in Pop Culture:

Giving the Foetus a ‘Public

Presence’

‘The astonishing medical machine resting on this pregnant woman's abdomen in a Philadelphia hospital is “looking” at her unborn child in precisely the same way a Navy surface ship homes in on enemy submarines. Using the sonar principle, it is bombarding her with a beam of ultra-high-frequency sound waves that are inaudible to the human ear. Back come the echoes, bouncing off the baby's head, to show up as a visual image on a viewing screen.’ (p. 45)

Text from Life’s ‘A Sonar “Look” at an Unborn Baby’, 1965 [quoted in Rosalind Pollack Pechesky, "Foetal Images: the Power of Visual

Culture in the Politics of Reproduction,", Feminist Studies, Vol. 13, No. 2 (Summer, 1987), pp. 263-292 at p.276.]

Foetus in Pop Culture

Art for Arthur C. Clarke,2010 Space Odyssey, novel (1982) and film (1984)

Technologies and ideologies:‘The Silent Scream’

Role of Cinematic technology• Allows widespread electronic

distribution via TV, web..• Edits image to increase drama (eg.

speeding up images to create sense of fetal movement)

• Allows simultaneous ‘interpretation’ of images (which are not immediately transparent without medical expertise)

"Now let's turn to the actual film itself. We are now looking at a sector scan of a real time ultrasound imaging of a 12 week, unborn child. The child is oriented in this direction. You are looking now at the head of the child... here... the body of the child... here.. and this image is the child's hand approaching its mouth. Looking a little more closely at the child, we can discern, the eye or the orbit of the eye, here, the nose of the child, here... and the mouth of the child... here.. and we can even look at the ventricle of the brain, here… Now, we see the heart beating, here in the child's chest …And we can see the child moving rather serenely, in the uterus. One can see it shifting position from time to time. It is still orientated in this manner and the mouth is receiving the thumb of the child. The child again is moving quietly in its sanctuary.“

Narrative of ‘Silent Scream’ 1985

1984 report by joint National Institutes of Health/ Food and Drug Administration panel on

the use of ultrasound in pregnancy:

Results of study:• “no clear benefit from routine use” • “no improvement in pregnancy outcome”• no conclusive evidence either of its safety or harm.

Recommendation: • not for “routine use” or “to view ... or obtain a

picture of the fetus” or “for educational or commercial demonstrations without medical benefit to the patient”

• Approved for use to “estimate gestational age”

Images and the right to choose?

• This is the ONLY image of a foetus I have been able to find used in a pro-choice political context (and it is hardly intended as a tool of persuasion) Why?

• Could pro-choice activists use medical imagery to advance their message?

Do technologies (necessarily) create a tension between

maternal and foetal interests?• Womb as ‘hostile environment’ or womb as

foetal ‘sanctuary’: do either of these images benefit women?

• Can we envision a way of imaging the foetus that would not exclude the woman carrying it?

• What do women gain from ultrasonography?• Do men gain more (and if so, do their gains

come at cost to women?)

Reading Self-Assessment:Did you notice these key terms and concepts?

• From Pollack Petcheskyautonomous fetus/fetal autonomyadversarial pregnancyvisual ‘bonding’‘Silent Scream’/Dr.Nathansonhomunculousfetus fetishfetus as ‘patient’‘prevalence of the gaze’‘panoptics of the womb’

• From Sandelowski‘two-patient model’ of obstetrics‘family-centred maternity care’‘vicarious knower’/’parental

knower’/’professional knower’EpistemologyWomen as gatekeepers (and

spectacles)/men as spectators‘democratization of fetal experience’

• From Taylor‘unskilled reproductive workers’reproduction/pregnancy as consumptionfetus as commodity/person (‘commoditized’

vs ‘singularized’)‘doctors as managers’/’mothers as

consumers’ pathological vs normal pregnant subjects ethnography

• From Oaks‘public fetus’/’fragile fetus’/fetus-as-subject’fetal protection messages‘pregnancy policing’‘fetal abuse’maternal/fetal conflict (but not paternal/fetal

conflict)‘Smokey Sue/ Itty Bitty Smoker

Seminar Topics

• When does a woman become a mother, responsible socially and legally for the wellbeing of her child?

• Do men become fathers at the same time and in the same way?

• Who qualifies as a ‘person’ in our culture, and what effect have technologies of visualization had on our perceptions of ‘personhood’?