Ultrasound in Lund —three world premieres

In the historical section of the monograph Ultrasound in Medical Diagnosis, published in 1976, one can read that a substantial part of the early development of the ultrasound-echo method took place in the little university town of Lund in Sweden. It is not without pride that the Lundensians Inge Edler and Hellmuth Hertz comment upon this in a later review article. They also describe what happened in Lund in the 1950s which they thought contributed in a decisive way to diagnostics in cardiology, neurosurgery, and obstetrics and gynaecology. Apart from the cardiologist Edler and the physicist Hertz the pioneers were the neurosurgeon Lars Leksell and the obstetrician Bertil Sundén. Hertz and his pupils were to a high degree responsible for the technical development and the application in all three specialities. During the late 1940s and the early 1950s surgery of the heart was started in Lund. The first common lesion to be corrected in adults was mitral stenosis. The valve was opened by forced dilatation. Results were often good but there was a diagnostic problem. In some patients the symptoms were not due simply to a small valve opening. There was also a leakage of blood ‘backwards’, mitral insufficiency. This condition of course could not be improved by such a primitive operation. Instead, the procedure might make the condition worse. There was thus a great need for improved diagnostics before operation. This was when the young internist Inge Edler entered the scene. Born in 1911 he had started his career in internal medicine in Malmö but in 1950 he moved to Lund where he became responsible for the preoperative heart evaluations. He immediately focused his interest on the possibilities of making a quantitative diagnosis of mitral stenosis and to determine the existence of mitral insufficiency. Edler’s nurse was married to a physicist, Jan Cederlund. Hence it was natural for Edler to ask Cederlund if the radar technique developed during world war II could be used for examination of the heart. Cederlund forwarded the question to his friend Hellmuth Hertz, also a physicist.