Ultrasound is now a routine procedure in the monitoring of pregnancies but most Australian mothers would be unaware that the technology was developed by a small team of Australian research scientists and medical specialists who won international and national acclaim for their work.
Bill Garrett was a 31-year-old obstetrician at Sydney's Royal Hospital for Women (RHW) in 1959 when he was asked to join a small interdisciplinary team to investigate whether high frequency sound waves could be applied for imaging of the pregnant uterus. This team was put together by Norman Murray, the head of Commonwealth Acoustics Laboratory, and the ultrasonic research section was headed by research scientist George Kossoff, with Garrett as medical adviser and technical officers Reg Allen and Laurie Lean.
In 1962 the team was the first in the world to identify a number of foetal anatomical structures. Garrett and Kossoff were joined by research scientist David Robinson, then technicians Ian Shepherd and George Radovanovich. Kossoff says that the team knew the importance of ultrasound was growing as the group started out in a "miserable basement" but as the service grew they were moved to the first floor, "prime real estate". By 1965 ultrasonic testing was part of clinical practice at RHW.
William John Garrett was born on November 25, 1927, the son of Jack Garrett and his wife, Elsie (nee Black). He was dux of Parramatta High School and in 1951 graduated second in his year in medicine and surgery from University of Sydney. He worked as a ship's doctor to pay his passage to Britain and took a D Phil in Medicine from Oxford in 1955. He also received a Doctor of Medicine from University of Sydney in 1962.
Even as a fresh graduate Garrett was making his mark, his study of ergotamine was published as a single author paper in the British medical journal The Lancet. His work disproved claims of Swiss pharmaceutical company Sandoz relating to their ergotamine product, particularly regarding its mode of action and the claim that it was safe for use during labour. The article was published despite a Sandoz representative lunching with Garrett to encourage him not to publish.
In 1957, Garrett married Yorkshire-born Nancy Cardno. Their values were similar, shaped by the Depression, which made them both generous and frugal, and determined to help those who were not as fortunate. They worked together in an obstetrics/gynaecology practice, with Nancy focusing on gynaecology after the arrival of their children. The only time Garrett admitted to being nervous was when Nancy passed the Royal College of Obstetricians and Gynaecologists exam ahead of him (the exam sometimes had a pass rate as low as 15 per cent), despite having spent the day before the exam sitting in a park reading a novel.
By the early 1970s the ultrasound technology was becoming more advanced. Kossoff and Robinson's first two designs used the water delay principle to produce high grade resolution and Garrett led the world in identifying foetal anatomy and abnormalities. In particular he was able to measure foetal brain and trunk growth and could determine if growth of the foetus was retarded. He also envisaged that foetal surgery would soon be possible using ultrasound. The team eventually grew to 25, as the technology spread for use in breast, heart, abdominal and paediatric examinations.
By 1969 Kossoff, Garrett and colleagues moved from the black and white, signal/no signal of the echoscope to the spectacular improvement provided by grey scale technology, which used the grey scale of a photographic film to make an image of the echoes. This worked by compressing the large echoes and using all the available dynamic range to display smaller echoes so that for the first time soft-tissue detail was available. Now the organ structure – placenta, liver, kidneys, pancreas, and brain – of the foetus could be seen. Moreover, the size and distribution of these internal echoes were specific to the type of tissue being imaged, so normal and pathological tissue could be differentiated.
Garrett was able, in a 1970 world first, to diagnose a polycystic kidney in a 31 week neonate[1] and in the same year to measure foetal heart size in vivo. Garrett and Kossoff in 1975 published a comprehensive atlas of the normal infant brain, again a world first.
Garrett served as president of the Australian Society of Ultrasound in Medicine (founded in 1970) from 1972 to 1974 and helped to establish the Ultrasonics Institute in 1975. The RHW opened a Department of Diagnostic Ultrasound in 1976, with Garrett as founding medical director. At the same time the technology made a further advance with the invention of the Octoson, which employed eight transducers in an arc, scanning in synchrony. This could give a wide angle view of the entire anatomy, especially suited to the pregnant uterus and abdomen, breasts and neonatal[2] brain. He also chaired the fourth meeting of the World Federation of Ultrasound in Medicine and Biology, held in Sydney 1985.
What made the Australian team so successful? The inter-disciplinary nature of the team was significant and that research was guided by the visions of the research scientists with medical specialists deciding how the technology could be applied. In contrast, the early work of overseas researchers had their teams guided by medical specialists with the research scientists trying to design what was wanted. Importantly, the Australian team worked without jealousy, capable of offering and accepting constructive criticism and encouraging each other to publish their work.
To ensure the ultrasound technology was used by appropriately qualified personnel, in 1976, Garrett was instrumental in setting up the Diploma of Diagnostic Ultrasound for doctors and the Diploma of Medical Ultrasound for sonographers. He also served on the board of examiners for the first decade of the medical diploma. The work of the Ultrasonics Institute team was commemorated with a 2004 Australia Post stamp in its Australian innovation series, and Garrett and ten other members of the team were awarded Australian honours. Garrett received an AM in 1985.
After the melancholy and adjustment following Nancy's premature death in 1994, Garrett set himself to the task of learning to live in a new context, diving into the study of Latin, genealogy and cooking, as well as resuming choral singing, joining the Paddington Society, opera and much more.
Confident and fearless, but without pride, Garrett was both an independent and intellectual thinker. His objectivity and coherence as an expert witness in one legal case was such that his testimony was appropriated in the closing remarks of both defence and prosecution.
Garrett was one of the longest serving (1958-1995) medical consultants at RHW, continuing as Consultant Emeritus after 1995.
Garrett always considered himself lucky, especially in the education and opportunities he was given in life. Without drawing attention to it, he supported the high schooling of many disadvantaged children and was a strong benefactor of many charities, especially the Benevolent Society (founder of RHW) and Matthew Talbot hostel.
Bill Garrett is survived by his children Jemima, Tom and Cathy and grandchildren Kate, Hugh, Tim, Ben, Phoebe and Jacob.
Helen Fraser, 'Garrett, William (Bill) (1927–2015)', Obituaries Australia, National Centre of Biography, Australian National University, https://oa.anu.edu.au/obituary/garrett-william-bill-23446/text32514, accessed 1 September 2024.
5 November,
2015
(aged 87)
Paddington, Sydney,
New South Wales,
Australia