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Essentials of Abdomino-Pelvic
Sonography
Essentials of Abdomino-Pelvic
Sonography
A Handbook for Practitioners

Dr. Swati Goyal

CRC Press
Taylor & Francis Group
6000 Broken Sound Parkway NW, Suite 300
Boca Raton, FL 33487-2742

© 2018 by Taylor & Francis Group, LLC

CRC Press is an imprint of Taylor & Francis Group, an Informa business

No claim to original U.S. Government works

Printed on acid-free paper

International Standard Book Number-13: 978-1-1385-0182-9 (Hardback)

This book contains information obtained from authentic and highly regarded sources. Reasonable efforts have been made to publish
reliable data and information, but the author and publisher cannot assume responsibility for the validity of all materials or the
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Library of Congress Cataloging‑in‑Publication Data

Names: Goyal, Swati, author.

Title: Essentials of abdomino-pelvic sonography : a handbook for
practitioners / Dr. Swati Goyal.
Description: Boca Raton, FL : CRC Press/Taylor & Francis Group, [2018] |
Includes bibliographical references and index.
Identifiers: LCCN 2017034325| ISBN 9781138501829 (hardback : alk. paper) |
ISBN 9781351261203 (ebook : alk. paper)
Subjects: | MESH: Digestive System Diseases--diagnostic imaging |
Abdomen--diagnostic imaging | Pelvis--diagnostic imaging | Ultrasonography
| Ultrasonography, Prenatal
Classification: LCC RC78.7.U4 | NLM WI 141 | DDC 617.5/50754--dc23
LC record available at https://lccn.loc.gov/2017034325

Visit the Taylor & Francis Web site at

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Dedication

Dedicated to my adorable kids, Prisha and Rushank, who invigorated me in spite of all the time the task
of book writing took me away from them.
Contents

List of Abbreviations xxiii

Preface xxv
Acknowledgments xxvii
About the Author xxix

PART I USG PHYSICS 1

1 Ultrasound Physics 3
Introduction 3
Principle of sonography 3
Based on pulse-echo principle 3
Instrumentation 3
Ultrasonography transducer 4
Types of transducers 4
Selection of transducers 4
Specialized transducers 5
Real-time ultrasound 5
Construction of a transducer 5
Piezoelectric crystal 5
Piezoelectric effect 6
Curie temperature 6
Q factor (Quality factor or mechanical coefficient K) 6
Ultrasound gel 6
Resolution 6
Contrast resolution 6
Temporal resolution 6
Spatial resolution 6
Normal imaging 7
Orientation of probe 7
Time-gain compensation 7
Duty factor 7
Acoustic impedance 7
Acoustic interface 7
Interaction with tissues 8
Imaging pitfalls 8

vii
viii Contents

Reverberation artifacts 9
Comet tail (Ring down) artifacts 9
Refraction 9
Side lobe 9
Acoustic shadowing 9
Acoustic enhancement 9
Overpenetration 10
Partial volume effect 10
Multipath artifacts 10
Mirror artifacts 10
Anisotropy 10
Biological effects 10
Streaming 10
Chaperone 10
Suggested readings 10

PART II ABDOMINAL USG 13

2 Liver 15
Introduction 15
Anatomy 15
Segmental anatomy 15
Vascular anatomy 15
Other ligaments 16
Protocol 16
Indications 16
Normal findings 16
Echogenicity 16
Pathologies 17
Hepatitis 17
Acute hepatitis 17
Chronic hepatitis 17
Cirrhosis 17
Infective lesions 17
Liver abscess (Pyogenic) 17
Amoebic abscess 17
Subphrenic abscess 17
Echinococcal (Hydatid) cysts 18
Fatty liver 18
Focal hepatic lesions 19
Simple cysts 19
Peribiliary cysts 20
Biliary hamartomas (Von Meyenberg complexes) 20
Hemangioma 20
Focal nodular hyperplasia 20
Hepatic adenoma 20
Biliary cystadenomas 20
Hepatocellular carcinoma 20
Fibrolamellar hepatocellular carcinoma 20
Metastases 21
 Contents ix

Intrahepatic cholangiocarcinoma 22
Hematoma—H/O trauma 22
Miscellaneous 22
Pediatric section 22
Neonatal hepatitis 22
Causes of cirrhosis in children 22
Infantile hemangioendothelioma 22
Mesenchymal hamartomas 23
Hepatoblastoma 23
Undifferentiated embryonal sarcoma 23
Metastases 23
3 Gallbladder 25
Introduction 25
Anatomy 25
Variants of gallbladder 26
Pathologies 26
Gallstones (Cholelithiasis) 26
USG 26
Bile sludge/sand/microlithiasis 26
Acute cholecystitis 26
Acalculous cholecystitis 27
Miscellaneous 27
Porcelain gallbladder 28
Polyps 28
Adenomyomatosis 29
Gallbladder carcinoma 29
4 Biliary Tree 31
Introduction 31
Pathologies 31
Choledocholithiasis (CBD stones) 31
Mirizzi syndrome 32
Cholangitis 32
Acute cholangitis 32
Ascariasis 32
Cholangiocarcinoma 33
Hilar cholangiocarcinoma 33
Distal cholangiocarcinoma 33
Intrahepatic 33
Pediatric section 33
Biliary atresia 33
Choledochal cysts 33
Biliary rhabdomyosarcoma 34
5 Spleen 35
Introduction 35
Anatomy 35
Pathologies 35
Splenomegaly 35
Cystic lesions of spleen 35
Solid lesions of spleen 36
Miscellaneous 36
x Contents

6 Pancreas 37
Introduction 37
Anatomy 37
Normal variant 37
Technique 37
Pathologies 37
Acute pancreatitis 37
Focal 37
Diffuse 38
Mild 38
Complications 38
Chronic pancreatitis 38
USG 39
Adenocarcinoma 39
USG 39
D/D 39
Cystic neoplasms of pancreas 39
Microcystic/serous cystadenoma 39
USG 39
Macrocystic/mucinous cystadenomas/cystadenocarcinomas 39
Intraductal papillary mucinous tumor/neoplasm 39
Solid papillary epithelial neoplasms 40
Pediatric specific 40
Pancreatoblastoma 40
Cystic fibrosis 40
Nesidioblastosis 40
7 Genitourinary Tract, GUT 41
Introduction 41
Anatomy 41
Vascular anatomy 41
Ureters 42
Bladder 42
Normal variants 42
Pathologies 42
Hydronephrosis 42
Congenital anomalies 43
Renal duplication 43
Weigert–Meyer rule 43
Ectopic kidney 43
Crossed fused ectopia 44
Horseshoe kidney 44
Pelvi-ureteric junction obstruction 44
Infective lesions 44
Acute pyelonephritis 44
Pyonephrosis 45
Chronic pyelonephritis 45
Cystitis 45
Calculi 45
Renal calculi 45
 Contents xi

Renal cystic disease 46

Simple renal cysts 46
Complex renal cysts 46
Parapelvic cysts 47
Medullary sponge kidney 47
Medullary cystic disease 47
Autosomal recessive polycystic kidney disease 47
Autosomal dominant polycystic kidney disease 47
Multicystic dysplastic kidney 47
Multilocular cystic nephroma 47
Medical disease of genitourinary tract 48
Neoplastic lesion 48
Renal cell carcinoma 48
Robson’s staging 49
Transitional cell carcinoma 49
Renal transition cell carcinoma 49
Ureteric transitional cell carcinoma 49
Bladder transitional cell carcinoma 49
Squamous cell carcinoma 49
Adenocarcinoma 49
Lymphoma 49
Oncocytoma 49
Angiomyolipoma 49
Miscellaneous 49
Compensatory hypertrophy 49
Enlarged kidneys 50
Small kidneys 50
Generalized thickening of the bladder wall 50
Localized thickening of bladder wall 50
Echogenic lesions within the bladder lumen 50
Renal trauma 50
Ureterocele 50
Neurogenic bladder 50
Bladder diverticula 51
Ureteral jet 51
Pediatric section 51
Prune–Belly syndrome (Eagle–Barrett syndrome) 51
Megacystis–microcolon malrotation intestinal hypoperistalsis syndrome 52
Exstrophy of the bowel 52
Urachal anomalies 52
Wilm’s tumor (Nephroblastoma) 52
Neuroblastoma 52
Mesoblastic nephroma (Fetal renal hamartoma, and congenital Wilm’s tumor) 52
Rhabdomyosarcoma (Sarcoma botryoides) 52
8 Adrenals Glands 53
Introduction 53
Pathologies 53
Infectious diseases 53
Neoplastic lesion 53
Adenomas 53
Myelolipomas 53
xii Contents

Pheochromocytomas 53
Adrenal metastases 54
Sarcomas 54
Miscellaneous 54
Adrenal cysts 54
Adrenal hemorrhage 54
Wolman’s disease 54
9 Aorta and Inferior Vena Cava 55
Introduction 55
Branches of aorta 55
Indications of USG 55
Normal aortic measurements 56
Atheromatous disease 56
Ectasia 56
Aneurysm 56
Pseudoaneurysm 56
Inferior vena cava 56
Points to note 57
10 Pelvic USG (Uterus and Ovaries) 59
Introduction 59
Uterus 59
Cervix 60
Vagina 60
Ovaries 60
Endometrium 61
Abnormal uterine bleeding 62
Etiology 62
Endometrial pathology 62
Endometrial polyps 63
Endometrial hyperplasia 63
Endometrial carcinoma 64
Menorrhagia 64
Fibroids (Leiomyomas) 64
Signs and symptoms 64
USG 64
Types 64
Other D/Ds 65
Broad ligament fibroid 65
Diffuse leiomyomatosis 65
Adenomyosis 65
Transabdominal sonography 65
Transvaginal sonography 65
Arterio venous malformations (Vascular tangle) 66
Postpartum/post D&C 66
Miscellaneous 66
Pelvic inflammatory disease 66
Arcuate artery calcification 66
Pelvic congestion syndrome 66
Hematometrocolpos 67
Etiology 67
Vaginal cysts 67
 Contents xiii

Cystic masses of pelvis 67

Follicular cysts/functional cysts 67
Corpus luteal cysts 67
Theca lutein cysts 68
Hemorrhagic cysts 68
Polycystic ovarian disease (Stein–Leventhal syndrome) 68
Hydrosalpinx 69
Parovarian cysts 69
Cystadenomas 69
Serous cystadenomas 69
Mucinous cystadenomas 69
Tubo-ovarian abscess 69
Endometriosis 70
Dermoid/mature cystic teratomas 70
Peritoneal inclusion cysts 70
Ovarian torsion 70
Miscellaneous 70
Malignant lesions of pelvis 71
Carcinoma endometrium 71
Carcinoma cervix (Mostly squamous cell carcinoma) 71
Carcinoma vagina 71
Sarcoma of uterus 71
Ovarian tumors 71
Malignant ovarian tumors 72
Features s/o benign pathology 72
Features s/o malignancy 72
Mucinous cystadenocarcinoma 72
Endometroid carcinoma 72
Malignant germ cell tumors 73
Metastasis (Krukenberg’s tumor) 73
Meig’s syndrome 73
Sex cord stromal tumors 73
Classification 73
Benign tumors 73
Cystic 73
Solid 73
Malignant tumors 73
Cystic 73
Solid 73
11 Prostate 75
Introduction 75
Zonal anatomy 75
Measurements 75
Seminal vesicles 76
Transrectal ultrasonography 76
Benign ductal ectasia 76
Benign prostatic hyperplasia 76
Prostatitis 77
Cysts 77
Prostate cancer 77
xiv Contents

12 Peritoneum and Retroperitoneum 79

Introduction 79
List of retroperitoneal organs 79
List of intraperitoneal organs 79
Peritoneal cavity spaces 79
Retroperitoneal spaces 80
Ascites 80
Retroperitoneum pathologies 80
Lymphadenopathy 80
Retroperitoneal fibrosis (Ormond’s disease) 81
Tumors 81
Lymphoma and metastases 81
Fluid collections 81
Miscellaneous 81
Cystic masses of abdomen 81
Mesenteric cysts 81
Peritoneal inclusion cysts 81
Peritoneal tuberculosis 82
Peritoneal carcinomatosis 82
13 Chest 83
Lung consolidation 83
Hepatization of lung 83
Atelectasis 83
Pleural effusion 83
Transudative fluid 84
Exudative fluid 84
Pneumothorax 84
Diaphragm 85
14 Critical Care Ultrasound—Including FAST (Focused Assessment with Sonography in Trauma) 87
Rush protocol (Rapid ultrasound in shock) 87
Fate protocol (Focused assessment by transthoracic echocardiography) 87
Left ventricular failure 87
Right ventricular failure 87
Pericardial tamponade 87
Pulmonary embolism 87
Deep vein thrombosis (DVT) 87
Hypertrophic obstructive cardiomyopathy with systolic anterior motion of mitral valve 88
Blue protocol (Bed-side lung ultrasound in emergency) 88
Falls protocol (Fluid administration limited by lung sonography) 88
Focused assessment with sonography for trauma 88
Advantages 88
Limitations 89
Extended FAST (e-FAST) 89
15 Acute Abdomen and Abdominal Tuberculosis 91
Abdominal tuberculosis 91
USG findings 92
Peritoneal tuberculosis 92
Suggested readings 92
 Contents xv

PART III OBSTETRICS USG 93

16 Introduction 95
Preparation 95
Position 95
17 First Trimester 97
Introduction 97
Physiology 97
Indications 97
USG appearances of a normal I/U gestation 97
Gestational sac 97
Double decidual sac sign (Interdecidual) 98
Double bleb sign 98
Gestational sac 99
Mean sac diameter 99
Yolk sac 99
Placenta 100
Fetal heart rate 101
Umbilical cord 101
Embryonic demise (Early pregnancy failure) 101
USG features 101
Guidelines 102
Abortion 103
Absent I/U sac 103
I/U sac without an embryo/yolk sac 103
Thickened/irregularly echogenic endometrium 103
First trimester complication 104
Termination of pregnancy 104
First trimester screening for aneuploidy 104
Normal embryologic development simulating pathology 104
18 Second Trimester 105
Normal USG 105
Indications of USG 105
Fetal morphology assessment 105
Chromosomal abnormality (Genetic) screening 107
Trisomy 21 (Down syndrome) 107
Sonographic markers 107
Biochemical markers 107
Trisomy 18 (Edward’s syndrome) 107
Trisomy 13 (Patau’s syndrome) 107
Turners syndrome (45 XO) 107
19 Third Trimester 109
Fetal biometry 109
Amniotic fluid evaluation 109
20 Fetal Malformations 111
Head 111
Fetal spine 112
Fetal lungs 113
xvi Contents

Fetal heart 113

Anomalies detected with four-chamber view 114
Anomalies diagnosed in outflow tract 114
Fetal gastrointestinal tract 114
Genitourinary tract anomalies 115
Skeletal system 115
Long bones and extremities 115
Spine and chest 115
Head 116
Degree of mineralization 116
21 Placenta 117
Introduction 117
Abruption 118
Types 119
Hemorrhage 119
Placenta previa 119
Chorioangiomas 119
22 Amniotic Fluid 121
Introduction 121
Functions 121
Amniotic fluid index technique 121
Stumbling blocks in correct estimation of amniotic fluid volume 121
Oligohydramnios 122
Causes 122
USG 122
Polhydramnios 123
Causes 123
23 Umbilical Cord and Biophysical Profile 125
Introduction 125
Anatomy 125
Nuchal cord 125
Biophysical profile—BPP (Manning score) 126
24 Gestational Trophoblastic Neoplasia 127
Introduction 127
Presentation 127
Imaging 127
USG 127
Diagnosis 127
Choriocarcinoma 128
Placental site trophoblastic tumor 128
Invasive mole 128
Management 128
25 Ectopic Pregnancy 129
Risk factors 129
USG 129
Site 130
26 Multifetal Pregnancy 131
Twin–twin transfusion syndrome 132
Twin reversed arterial perfusion sequence (Acardiac—parabiotic twin) 132
 Contents xvii

27 Hydrops and Intrauterine Fetal Death 133

USG 133
Causes 133
Intrauterine fetal death on USG 133
28 Incompetent Cervix 135
Introduction 135
Imaging 135
USG findings 135
Stumbling blocks 136
Management 136
Miscellaneous 136
Uterine fibroids 136
Focal myometrial contraction (Braxton–Hicks contractions) 136
Scar thickness 137
Luteal phase defect 137
29 Infertility 139
Ovary 139
Causes 139
PCO morphology 139
Normal spontaneous cycle 140
Induced cycles 140
Uterus 140
Tubal factor (Oviduct/fallopian tube pathology) 140
30 Pre-Conception Pre-Natal Diagnostic Techniques Act 143
Suggested readings 143

PART IV COLOR DOPPLER 145

31 Basic Terminology 147

Introduction 147
Types 147
Aliasing 148
Vessel waveform 148
32 Obstetric Doppler 149
Intrauterine growth retardation 149
Etiology 149
Types 149
Indications 149
Stages in ultrasonography prediction for intrauterine growth retardation 149
33 Carotid Doppler 153
Protocol 153
Evaluate 153
Vessel waveform 154
Vertebral artery 154
34 Doppler in Portal Hypertension 157
Budd Chiari syndrome 159
xviii Contents

35 Renal Doppler 161

Causes of renal artery stenosis 161
Normal waveform 161
Abnormal measurements 162
Parvus tardus waveform 162
36 Peripheral Vessel Doppler 163
Arterial duplex examination 163
Arterial anatomy 163
Technique 163
Venous duplex examination 163
Venous anatomy 163
Deep vein thrombosis 164
Suggested readings 164

PART V HIGH-RESOLUTION USG 165

37 Head and Neck with Thyroid 167

Introduction 167
Anatomy 167
Salivary glands 167
Lymph node levels 167
Thyroid 168
Parathyroid 168
Technique 168
Pathology 168
Lymph nodes 168
Congenital cystic lesions 169
Branchial cleft cysts 169
Thyroglossal duct cysts 169
Lymphangioma 169
Ranula 169
Dermoids/epidermoids 169
Neoplastic lesions 169
Lipoma 169
Nerve sheath tumors 169
Salivary gland tumors 169
Infective lesions 169
High-resolution sonography of thyroid gland 169
Introduction 169
Ultrasound examination technique 169
Normal anatomy and sonographic appearance 170
Diseases of thyroid gland 170
Diffuse thyroid disease 170
Multinodular goiter 170
Grave’s disease 171
Hashimoto’s thyroiditis 171
Dequervain’s thyroiditis 171
Acute suppurative thyroiditis 171
Reidel’s thyroiditis 172
 Contents xix

Thyroid nodules 172

Benign thyroid nodules 172
Thyroid adenoma 172
Malignant thyroid nodules 173
Malignant thyroid masses 173
Papillary carcinoma 173
Follicular carcinoma 173
Medullary carcinoma 173
Anaplastic carcinoma 173
Thyroid lymphoma 173
Metastases 174
38 Breast 175
Introduction 175
Annotation 176
Benign pathologies 177
Galactocele 177
Fibrocystic disease 177
Duct ectasia 177
Fibroadenoma 177
Cysts 177
Lipoma 178
Intramammary lymph node 178
Hamartoma/fibroadenolipoma 178
Papillomas (Intraductal and intracystic) 178
Fat necrosis 178
Cystosarcoma phylloides 178
Abscess 178
Radial scar 178
Premature asymmetric ripening 178
Gynecomastia 178
Sebaceous cyst 178
Malignant pathologies 178
Intraductal carcinoma 178
Medullary carcinoma 179
Lobular carcinoma 179
Inflammatory carcinoma 179
Breast implants 179
Birads classification 179
39 Anterior Abdominal Wall 181
Anatomy 181
Hernias 181
Rectus sheath hematoma 181
Fluid collections 181
Split image (Ghost artifact) 182
40 Skin (Cellulitis) and Soft Tissue 183
41 GIT Sonography 185
Acute abdomen 185
Acute appendicitis 185
Small bowel obstruction 187
xx Contents

Gastrointestinal neoplasms 187

Inflammatory bowel disease 188
Crohn’s disease 188
Pediatric section 188
Hypertrophic pyloric stenosis 188
Intussusception 188
Mesenteric adenitis 189
42 Scrotum 191
Normal anatomy and sonographic appearance 191
USG technique 191
Benign conditions 192
Testicular malignancy 193
Germ cell tumors 193
Metastases 194
Acute scrotum 194
Causes of acute scrotal pain 194
Testicular torsion 194
USG findings 194
Color doppler 194
Testicular inflammation 194
Testicular trauma 194
Cryptorchidism 195
43 Miscellaneous 197
B scan (Ophthalmic sonography) 197
Anatomy 197
Indications 197
Transfontanellar sonography 198
Indications 198
Suggested readings 198

PART VI USG-GUIDED INTERVENTIONS 201

44 USG-Guided Interventions 203

Advantages 203
Disadvantages 203
Preprocedural evaluation 203
Postprocedural evaluation 203
Thoracocentesis 203
Paracentesis 203
Cyst aspiration 203
Percutaneous abscess drainage 204
USG-guided FNA/biopsy 204
Complications 204
USG-guided vascular access 204
Suprapubic catheterization 205
Lumbar puncture 205
Transjugular intrahepatic portosystemic shunts 205
 Contents xxi

PART VII RECENT ADVANCES IN SONOGRAPHY 207

45 Recent Advances in Sonography 209

3D USG 209
Accelerated focused US imaging 209
TUI—Tomographic ultrasound imaging, volume USG 210
VCI–C—Volume contrast imaging–coronal 210
Applications 210
SRI—Speckle reduction imaging 210
STIC—Spatial temporal imaging correlation 210
MR/USG-guided high intensity focused ultrasound (HIFU) ablation 210
Principle 210
Indications 211
Advantages 211
Virtual CT sonography 211
Contrast enhanced (Gas-filled microbubbles) 211
Transperineal ultrasound 211
Intravascular ultra sound 212
Elastography 212
Introduction 212
Principle 212
Applications 213
Tissue harmonic imaging 213
Introduction 213
Principle 214
Advantages 214
Applications 214
Contrast harmonics 214
Suggested readings 214

Sample Questions 215

MCQs 217

Answer Key 231

Case Reports 235

Glossary 249

Index 251
List of Abbreviations

USG ultrasonography RA right atrium

MHz megahertz RV right ventricle
KHz kilohertz LA left atrium
PE piezoelectric effect LV left ventricle
IVC inferior vena cava AFI amniotic fluid index
GB gallbladder AFV amniotic fluid volume
HCC hepatocellular carcinoma IUGR intrauterine growth retardation
CT computed tomography CVS cardiovascular system
MRI magnetic resonance imaging GIT gastro intestinal system
CBD common bile duct CNS central nervous system
IHBR intrahepatic biliary radicle CDUS color Doppler sonography
RUQ right upper quadrant PI pulsatility index
M:F male: female EDV end diastolic volume
PUJ pelvi-ureteric junction PSV peak systolic velocity
TCC transitional cell carcinoma RI resistive index
RCC renal cell carcinoma MCA middle cerebral artery
UTI urinary tract infection ECA external carotid artery
HRT hormone replacement therapy ICA internal carotid artery
PID pelvic inflammatory disease CCA common carotid artery
OCP oral contraceptive pills PV portal vein
AFP alpha-fetoprotein HV hepatic vein
TAS transabdominal sonography SMV superior mesenteric vein
TVS transvaginal sonography SV splenic vein
LUS lower uterine segment H/o history of
FSH follicle stimulating hormone A/w associated with
LH luteinizing hormone D/D differential diagnosis
GS gestational sac C.f. compare from
MSD mean sac diameter S/o suggestive of
YS yolk sac hCG human chorionic gonadotropin
GA gestational age Pap smear papanikolaou smear
CRL crown rump length U/L unilateral
FHR fetal heart rate B/L bilateral
IVF in vitro fertilization EDTA ethylene diamine tetra
BPD biparietal diameter acetic acid
HC head circumference ERCP endoscopic retrograde cholangio
AC abdominal circumference pancreatography
FL femur length MRCP magnetic resonance cholangio
EFW effective fetal weight pancreatography
xxiii
xxiv List of Abbreviations

CECT contrast enhanced computed ACE angiotensin converting

tomography enzyme
CRF chronic renal failure pGTN persistent gestational
UPJ uretero-pelvic junction trophoblastic neoplasia
D&C dilatation & curettage IUCD intra-uterine contraceptive
TOA tubo-ovarian abscess device
HPV Human Papilloma Virus US ultrasound
DES Diethylstilbestrol IVF–ET/GIFT in vitro fertilization-embryo
BPH benign prostatic hyperplasia transfer/gamete intra
IUP intrauterine pregnancy fallopian transfer
LVOT left ventricular outflow tract FT fallopian tube
RVOT right ventricular outflow tract MDA mullerian duct anomalies
DWV dandy walker variant FB foreign bodies
UVJ uretero-vesical junction NHL non hodgkin’s lymphoma
SVC superior Venacava VR volume rendering
Preface
Sonography has emerged as a substantial mile-
stone in the field of radiodiagnosis, imparting
conspicuous contribution to early diagnosis and
aiding the management of most of the ailments.
The easy availability, noninvasive nature, and cost-
effectiveness have led to its necessity as a funda-
mental tool usually at the first referral level. The
number of radiologists and sonologists are not
commensurate with that of patients to render pro-
ficient technique and interpretation.
Sonography has been recognized as a sine qua
non for diagnosis of most of the conditions; hence,
its knowledge is desired by the practicing doctors
from most of the fields such as medicine, surgery,
gynecology, pediatrics, ophthalmology, orthope-
dics, and so on, apart from radiologists. This book
is formulated as a concise teaching guide for gen-
eral practitioners, sonologists, and resident doc-
tors aspiring for diagnostic medical sonography.
Although this book has been drafted mainly for
trainee sonologists, the text will be useful to other
physicians interested in medical imaging as well.
This book comprises 7 parts and 45 chapters.
Part I explains ultrasound physics in an uncom-
plicated and illustrated manner with basic line
diagrams. Part II and III consist of abdomi-
nal and obstetric sonography, respectively, and
include both normal and abnormal findings with
differential diagnosis and relevant images, usu-
ally encountered during routine practice, cover-
ing each of the body area in different chapters.
Parts IV through VI incorporate brief overview
of color Doppler, high-resolution sonography,
and USG-guided interventions. Doppler findings
in obstetrics, carotid vessels, renal artery, portal
vein, and peripheral vessels have been described
precisely. High-resolution sonography, including
head and neck thyroid, breast, anterior abdominal
wall, skin, gastrointestinal system, scrotum, and
miscellaneous (ophthalmic and transfontanellar)
have been compendiously described. In Part VII,
“Recent Advances in Sonography”—3D USG, elas-
tography, tissue harmonic imaging, and transperi-
neal sonography to name a few have been framed,
envisaging its future prospects. Succinct account
of various routinely experienced pathologies along
with suitable images has been enlisted. This book
includes sample questions (for competency-based
tests [CBT] under pre-conception pre-natal diag-
nostic techniques [Pc PNDT] in India) and multi-
ple choice questions (MCQs) with an answer key at
the end and case reports for practical orientation,
on a pattern based on various certificate examina-
tions and CBT for technicians and general practi-
tioners undergoing training for being sonologists.
Being an operator-dependent technique, appro-
priate training and expertise are required along
with the knowledge of sonography. This book is an
adjunct to standard textbooks and is not intended
to substitute for them.
This book is primarily for residents and doc-
tors pursuing bachelor/masters in medical ultra-
sound to assist them during their sonography
training with a focus on point-wise description of
abdomino–pelvic and obstetric imaging and help
them in guiding and writing certificate examina-
tions such as American Registry for Diagnostic
Medical Sonography (ARDMS) in the United
States and Canada, Consortium for Accreditation
of Sonographic Evaluation (CASE) accredited
ultrasound courses in the United Kingdom, or
CBT in India.
xxv
Acknowledgments
Albeit I am the sole author, this accomplishment
was beyond the bounds of possibility without the
support from many individuals who contributed,
from images and suggestions to viewpoints, and
above all their blessings.
I would thank Dr. R. K. Gupta, MD (Medicine)—
an outstanding practitioner and academician,
along with a doting father—who taught me the
value of education and hard work and inspired me
to write this book on sonography for beginners in
a language that is easy to comprehend.
Wholehearted appreciation to my husband
Dr. Sanjay Goyal, MD (Pediatrics), IAS, and a
visionary, for his optimistic and positive outlook,
and always standing beside me throughout my
career and for being there at every step of the way
to help me in this remarkable feat.
Hearty indebtedness to my mother and my
in-laws for their constant emotional support and
motivation.
Earnest gratitude to Professor Bisen, Retired
VC (Jiwaji University, Gwalior, India)—a vision-
ary academician—for guiding me in the right
direction.
Overwhelming thankfulness to Dr. Rajesh
Malik, who has been my mentor and an excep-
tional teacher.
Gratefulness to Dr. Akshara Gupta, HOD
(Radiodiagnosis) and Dr. J. S. Sikarwar, superinten-
dent, Jay Arogya Hospital (JAH), Gwalior, India for
their professional guidance and encouragement.
Special thanks to Dr. Pankaj Yadav for his time
and efforts in guiding and reviewing this book for me.
I would extend a deep personal thanks to the
following people:
● To Dr. Ratnesh Jain for his time and efforts in
preparing line diagrams for this book.
● To Dr. Sapna Somani, Dr. Mohinder Mehta,
and Dr. Vipin Goyal who provided me
sonographic images despite their busy schedule
as private practitioners.
● To Dr. Shimanku Maheshwari Gupta, MD
(Gynecology), for her inputs in the respective
sections.
● To my seniors and colleagues: Dr. Lovely
Kaushal, Dr. Amit Jain, Dr. Batham, Dr. Megha
Mittal, Dr. Rajesh Baghel, Dr. Manohar,
Dr. Purnima, Dr. Shiv, Dr. Sanyukta Ingle, and
Dr. Yogesh for their generous guidance—given
whenever required.
● To Dr. Saumya Mishra, SR, Sion Hospital,
Mumbai for her contribution in preparing the
thyroid and scrotum chapters.
● To Dr. Vivek Soni, Dr. Bhavya Shree (JR-3),
Dr. Sandeep, and Dr. Manoranjan (JR-2) for
assisting in formulating case reports and
providing images from the department.
● To Trapti Nigam for technical assistance.
I would acknowledge and appreciate all the authors
and editors whose books, journals, and websites I
have gone through since my medical residency
days and without which this book would never
have come to fruition.
Immense thanks to Joana Koster, publisher,
Taylor & Francis Group, CRC Press; Shivangi
Pramanik, Assistant Commissioning editor
(Medical); and her editorial assistant Mouli
Sharma who green lighted this book; and Bala
Gowri and Graphics team, Lumina Datamatics.
xxvii
Another random document with
no related content on Scribd:
 random, or deliberately conceal their most sacred institutions, or have
never paid any attention to the subject? (l.c., p. 41).

To remove this reproach was the work of Professor Tylor.

Edward Burnett It is difficult to express in adequate terms what
Tylor. Professor E. B. Tylor has done for ethnology. He is
the founder of the science of comparative ethnology; and his two
great works, Early History of Mankind (1865) and Primitive Culture
(1871), while replete with vast erudition, are so suggestive and
graced by such a charming literary style and quiet humour that they
have become “classics,” and have profoundly influenced modern
thought. From their first appearance it was recognised that a master-
mind was guiding the destinies of the nascent science. Some idea of
the magnitude and diversity of his work may be gathered from the
bibliography of 262 items, published between 1861 and 1907,
collected by Miss Freire-Marreco, Anthropological Essays Presented
to Edward Burnett Tylor in Honour of his Seventy-first Birthday, Oct.
2, 1907. An appreciation of the labours of Professor Tylor is given by
Andrew Lang in this volume. The true significance of the aims of “Mr.
Tylor’s Science,” as Max Müller called it, may be best gathered from
Professor Tylor’s own words:—
For years past it has become evident that the great need of
anthropology is that its methods should be strengthened and
systematised. The world has not been unjust to the growing science, far
from it. Wherever anthropologists have been able to show definite
evidence and inference, for instance, in the development series of arts in
the Pitt-Rivers Museum at Oxford, not only specialists, but the educated
world generally, are ready to receive the results and assimilate them into
public opinion. Strict method has, however, as yet, only been introduced
over part of the anthropological field. There has yet to be overcome a
certain not unkindly hesitancy on the part of men engaged in the precise
operations of mathematics, physics, chemistry, biology, to admit that the
problems of anthropology are amenable to scientific treatment. It is my
aim to show that the development of institutions may be investigated on a
basis of tabulation and classification.

This is the opening of a masterly paper “On a Method of

Investigating the Development of Institutions; applied to Laws of
Marriage and Descent.”[100]
100. J. A. I., xviii., 245, 1889.
The tabular method is not applicable to much of the vast mass of
material with which Tylor dealt; but the accuracy and systematising
of method are found throughout, and were of invaluable service to a
science peculiarly attractive to the vague speculator and enthusiastic
dilettante.
Tylor (1871) insisted on the necessity of sifting and testing all the
evidence, relying to a great extent on “the test of recurrence,” or of
undesigned coincidence in testimony; he says: “the more odd the
statement, the less likely that several people in several places
should have made it wrongly. This being so, it seems reasonable to
judge that the statements are in the main truly given, and that their
close and regular coincidence is due to the cropping-up of similar
facts in various districts of culture. Now the most important facts of
ethnography are vouched for in this way” (2nd ed., 1873, p. 10).
Avebury. A further stimulus to the study of comparative
ethnology in this country was given by the
publication of Sir John Lubbock’s (Lord Avebury’s) Origin of
Civilisation (1870), and opened the eyes of a large public to the
interest of ethnology and its value in throwing light upon the earlier
stages of culture of civilised peoples.
Sociology. The question as to the influence of environment
on the development of social organisation is as old
as the world’s oldest thinkers, and finds expression in Aristotle and in
Plato, though Sociology, as a science, is a product of the last
century. The word “Sociology” was first used by Auguste Comte
(1798-1857), who showed its aim to be to discover the nature, the
natural causes, and the natural laws of society. With the
development of natural science came the insistence on a naturalistic
interpretation of social differences, demonstrated by Guyot (1807-
1884) and Draper (1811-1882), and over-emphasised by Buckle
(1821-1862).
Comte Buckle.
 Comte’s method was that of deductive construction and
prescription. Buckle’s plan was to evolve a social science inductively
through a study of history, with the help of economics and statistics.
His History of Civilisation answers the great question which he sets
himself: “Are the actions of men, and therefore of societies,
governed by fixed laws, or are they the result either of chance or of
supernatural interference?” He attempted to show how “Climate,
Food, Soil, and the General Aspect of Nature” were the dominant
influences in early societies, determining the food supply, the degree
of population, and the economic condition.
Unfortunately, in pursuit of this idea Buckle was apt to overlook the
influences of culture-contact, and of economic factors; thus
deserving, to some extent, the censure of Jevons: “Buckle referred
the character of a nation to the climate and the soil of its abode.”[101]
At the same time Buckle must be regarded as the first historical
sociologist of the modern scientific movement.
101. Letters and Journal of Stanley Jevons, 1866, p. 454.
Herbert Spencer. The evolutionist explanation of the natural world
as applied to sociology found its fullest exponent
in Herbert Spencer (1820-1903), who studied the anatomy of the
social frame. He derived the principles of sociology from the
principles of psychology and of biology, and regarded social
development as a super-organic evolution.
But all these earlier attempts to discover a social science were
speculative rather than practical. The solid foundations of inductive
sociology were laid by Bachofen, Morgan, J. F. McLennan, and
others.
Bachofen, Bachofen (1861) was the first to study the
Morgan, system of filiation through the mother, or mother-
McLennan, and right, which was widely distributed among ancient
others.
peoples, and still occurs in many regions in a
more or less developed condition. McLennan frankly states that “the
honour of that discovery, the importance of which, as affording a new
starting-point for all history, cannot be over-estimated, must, without
stint or qualification, be assigned to him” (1876, p. 421).
Independently, however, J. F. McLennan (1827-1881), in his
Primitive Marriage (1865), arrived at the conclusion “that the most
ancient system in which the idea of blood-relationship was embodied
was a system of kinship through females only.”[102] He points out
more than once that “Mr. Maine seems not to have been able to
conceive of any social order more primitive than the patriarchal.”[103]
This book was reprinted with additions in 1876, and his two other
books were published posthumously (1885, 1896). In these and
more fugitive writings McLennan was a keen controversialist, and
with unnecessary vigour and animus attacked Morgan, Sir Henry
Maine, and Dr. Howitt. McLennan’s attitude may be partly explained
by the fact that he was a lawyer and a theorist, but he possessed
great enthusiasm, with which he infused those who came into
contact with him, and his labours served to advance the study of
sociology.
102. P. 124 of 1876 ed.

103. P. 181, ibid.

“From the time of Plato downwards, theories of human society

have been current in which the family living under the headship of a
father is accepted as the ultimate social unit. These theories have
taken various shapes ... with Sir Henry Maine (Ancient Law, 1861)
the theory becomes a theory of the origin of society, or at least of the
earliest stage of society in which Comparative Jurisprudence is
called upon to take interest.”[104]
104. D. McLennan, The Patriarchal Theory, 1885, p. x.
Morgan was undoubtedly the greatest sociologist of the past
century, and in his monumental work (1871) laid a solid foundation
for the study of the family and kinship systems; he formulated a
scheme of the evolution of the family based on a study of the
classificatory system of relationships,[105] of which he was the
discoverer. According to this scheme, human society has advanced,
through gradual evolution, from a state of complete promiscuity to
one characterised by monogamy. Dr. Rivers[106] points out that “In
recent years the scheme has encountered much opposition.... The
opponents of Morgan have made no attempt to distinguish between
different parts of his scheme, but, having shown that certain of its
features are unsatisfactory, they have condemned the whole.” The
greater part of Morgan’s work is, however, of lasting value. Morgan
based his conclusions on an enormous number of kinship terms
collected by himself and others from every available source. Dr.
Rivers has introduced[107] a new method of collecting similar data by
means of recording exhaustive genealogies from a limited area. In
this way not only can kinship terms be collected with accuracy, but a
large number of other sociological data are obtained with a
readiness and precision not hitherto possible. Indeed, it is no
exaggeration to say that this method is producing a revolution in the
method of sociological field work.
105. W. H. R. Rivers, “On the Origin of the Classificatory System of
Relationships,” Anthropological Essays (Tylor Volume), 1907.

106. Jour. Anth. Inst., xxx., 1900, p. 74; Sociological Rev., 1910.

107. In the classificatory system most of the kin in the same generation are
grouped under one general term; e.g., all the males of the grandfather’s
generation are called by one term—another term includes father, father’s
brothers, father’s male cousins, mother’s sisters’ husbands, mother’s female
cousins’ husbands, and so on.

In a later book (1878) Morgan summarised his earlier conclusions

and proposed a classification of culture consisting of a lower, middle,
and an upper Status of Savagery, a lower, middle, and an upper
Status of Barbarism, and the Status of Civilisation based upon
certain inventions and industries.
About this time various students wrote on marriage and the family,
of whom the foremost were Giraud Teulon (1867, 1874, 1884), H.
Post (1875), Letourneau (1888), Von Hellwald (1889), and others,
the conclusions of the earlier writers being summed up by Professor
E. Westermarck in his masterly History of Human Marriage (1891);
but much has been written since that date on this subject of
perennial interest.
 Professor F. H. Giddings, in his Principles of Sociology, sums up in
the following words the trend of modern writers on ethnological
sociology:—
Professor Ludwig Gumplowicz [1883] has tried to demonstrate that the
true elementary social phenomena are the conflicts, amalgamations, and
assimilations of heterogeneous ethnical groups. M. Novicow [1893],
generalising further, argues that social evolution is essentially a
progressive modification of conflict by alliance, in the course of which
conflict itself is transformed from a physical into an intellectual struggle.
Professor De Greef [1886], looking at the question in a very different way,
finds the distinctive social fact in contract, and measures social progress
according to the displacement of coercive authority by conscious
argument. Mr. Gabriel Tarde [1890], in an original and fascinating study,
which has made an enduring impress on both psychological and
sociological thought, argues that the primordial social fact is imitation, a
phenomenon antecedent to all mutual aid, division of labour, and
contract. Professor Émile Durkheim [1895], dissenting from the
conclusions of M. Tarde, undertakes to prove that the characteristically
social process, and therefore the ultimate social phenomenon, is a
coercion of every individual mind by modes of action, thought, and feeling
that are external to itself (p. 14).

According to Giddings, the original and elementary subjective fact in

society is “the consciousness of kind.”
Social psychology offers a vast and fertile field which has been but
little worked, and there was needed an introduction to the subject
which should afford that general point of view which is the starting-
point of further studies. This Dr. W. McDougall has attempted in a
recently published little book.[108] His general conclusion is that the
life of societies is not merely the sum of the activities of individuals
moved by enlightened self-interest, or by intelligent desire for
pleasure and aversion from pain; but that the springs of all the
complex activities that make up the life of societies must be sought
in the instincts and in the other primary tendencies that are common
to all men and are deeply rooted in the remote ancestry of the race.
Professor E. A. Ross, of Wisconsin, simultaneously attacked the
same subject, on the problems of which he had previously written.
[109]
Magic and Magic and religion are very generally held to be
Religion. not only distinct from one another, but antithetical.
There is, however, a tendency among certain living students to
regard them as analogous phenomena, both being expressions of a
belief in a power or energy which may be designated by the
Melanesian term “mana,” or the American “orenda.” It has more than
once been pointed out that it is in some cases very hard—perhaps
impossible—to determine whether certain actions can be classed as
either magical or religious, as they appear to belong to both
categories. As in the case of religion from the ethnological
standpoint, magic has been investigated in the field, and immediate
references to it are to be found in ethnological literature—the
comparative study of magic has to some extent been undertaken by
Frazer, Jevons, and others; but one of the most important
contributions to the subject is by Hubert and Mauss,[110] who treat it
from a sociological aspect.
108. An Introduction to Social Psychology, 1908.

109. Congress of Arts and Sci., St. Louis, 1904, v. (1906), p. 869.

110. H. Hubert et M. Mauss, “Esquisse d’une théorie générale de la magie,”

L’Année sociologique, vii., 1904. M. Mauss, “L’Origine des pouvoirs
magiques dans les sociétés Australiennes,” École pratique des Haute Études
(Sec. Relig.), 1904.
Anthropology Parson Thwackum in Tom Jones says: “When I
and Religion. mention religion I mean the Christian religion; and
not only the Christian religion, but the Protestant religion; and not
only the Protestant religion, but the Church of England.”
Anthropology, by a reverse process, passes “in larger sympathy from
specific creeds to partake of the universal spirit which every creed
tries to embody.”[111] The interest of Anthropology in religion was
defined by Huxley.[112] “Anthropology has nothing to do with the truth
or falsehood of religion—it holds itself absolutely and entirely aloof
from such questions—but the natural history of religion, and the
origin and growth of the religions entertained by the different tribes of
the human race, are within its proper and legitimate province.”
111. Clodd, Animism, 1905, p. 11.

112. Address to Dept. of Anthrop., Brit. Ass. Dublin, 1878.

This is not the place to attempt a definition of religion—a task

which has led to so many failures. We must be content with the
statement that it most frequently presents itself under the aspects of
ritual, myth, and belief. Anthropology has hitherto practically confined
its attention to ritual and myth, and but too frequently exclusively to
the last.
As Andrew Lang (1887)[113] points out, in the sixth century B.C.
Xenophanes complained that the gods were credited with the worst
crimes, and other classical writers were shocked at the
contradictions between the conception and ritual worship of the
same god. In ancient Egypt the priests strove to shift the burden of
absurdity and sacrilege from their own deities. It taxed the ingenuity
of pious Brahmans to explain the myths which made Indra the slayer
of a Brahman. Euhemerus (316 B.C.), in his philosophical romance,
Sacra Historica, in rationalising the fables about the gods was
regarded as an atheist. Certain writers like Plutarch (60 A.D.) and
Porphyry (270 A.D.) made the ancient deities types of their own
favourite doctrines, whatever these might happen to be. The early
Christians had a good case against the heathen. Eusebius, in the
Præparatio Evangelica, anticipating Andrew Lang himself, “ridiculed,
with a good deal of humour, the old theories which resolved so many
mythical heroes into the sun” (p. 20). “The physical interpreters,” said
Eusebius, “do not even agree in their physical interpretations.” The
light of the anthropological method had dawned on Eusebius. Many
centuries later Spencer, Master of Corpus Christi College,
Cambridge (1630-93), had no other scheme in his mind in his erudite
work on Hebrew ritual,[114] which he considered was but an
expurgated adaptation of heathen customs. Fontenelle[115] explained
the irrational element in myth as inherited from savagery.
113. 1899 ed., pp. 6, 7.

114. De Legibus Hebræorum Ritualibus, 1732.

115. De l’Origine des Fables: Œuvres, Vol. III., 1758.

 The revival of learning made scholars acquainted with the religions
not only of Greece and Rome, but of the nations with whom the
Greeks and Romans had come in contact—Egyptians, Semites,
Persians, and Indians. Travellers gave accounts of the religions they
found in remote parts of the world, and missionaries reported on
beliefs and customs of many nations. These were the sources from
which were compiled the comprehensive works on religion, from
Alexander Ross, View of All the Religions in the World, etc., 1652, to
Dupuis, Origine de tous les cultes ou Religion Universelle, 1794. All
heathen religions were believed to be based on sun and star
worship.
New vistas were opened up by the writings of De Brosses (1760),
who investigated the beliefs of savage races and based all religion
on “Fetishism.”
To quote once more from Lang: “In the beginning of the
[nineteenth] century Germany turned her attention to mythology. In a
pious kind of spirit, Friedrich Creuzer [1771-1858] sought to find
symbols of some pure, early, and Oriental theosophy in the myths
and mysteries of Greece. The great Lobeck, in his Aglaophamus
(1829), brought back common-sense, and made it the guide of his
vast, his unequalled learning. In a gentler and more genial spirit, C.
Ottfried Müller [1797-1840] laid the foundation of a truly scientific and
historical mythology. Neither of these writers had, like Alfred Maury
[1857], much knowledge of the myths and faiths of the lower races,
but they often seem on the point of anticipating the ethnological
method.” (L.c., p. 23.)
Folklore. The mythological aspect of the subject was
illuminated by the researches of the brothers
Grimm (J. L. K., 1785-1863; W. K., 1786-1859), whose collections of
Märchen (1812-5) were found to contain Teutonic myths, and by their
resemblance to Norse, Greek, and Vedic mythology suggested that
in German folklore were remains of a common Indo-Germanic
tradition. This was the beginning of the intelligent study of Folklore.
Mannhardt (1865) and others investigated popular, and especially
peasant, customs and beliefs connected with agriculture and
vegetation; and showed that here, in what Christianity had reduced
to superstition, were to be found survivals of the religions that
Christianity had supplanted. Thenceforward the study of Folklore,
and of the “lower mythology” of beliefs, customs, and superstitions,
gradually developed into a science, which is now recognised as the
valuable ally of Anthropology. Meanwhile the anthropological
signification of religion was emerging from the mass of materials
collected from all over the globe. Anthropology established its
universality, and made many attempts to find a common factor, first
in astral worship, then in Euhemerism (Banier, 1738), Fetishism (De
Brosses, 1709-1777), Nature-worship (Max Müller, etc.), Ancestor-
worship (Herbert Spencer, Lippert [1866], etc.), and later in
Totemism. These hypotheses were based on the erroneous
assumption that savage religion represented the primitive mode of
thought, out of which civilised religions had evolved. Later it was
realised that “The Australian black or the Andaman Islander is
separated by as many generations from the beginning of religion as
his most advanced contemporaries; and in these tens or hundreds of
thousands of years there has been constant change, growth, and
decay—and decay is not a simple return to the primal state. We can
learn a great deal from the lowest existing religions, but they cannot
tell us what the beginning of religion was, any more than the history
of language can tell us what was the first human speech.”[116]
116. G. F. Moore, “The Hist. of Religions in the Nineteenth Cent.,” Congress Arts
and Sci., St. Louis, 1904, p. 440.
Comparative The study of comparative religion, though not
Religion. originated by Max Müller (1823-1900), owed much
to his energy. His lectures on Comparative Mythology (1856) were
followed by lectures on the Science of Religion (1870), and on the
religions of the world (1873). He inaugurated the annual series of the
Hibbert Lectures with a study of the origin and growth of Religion, as
illustrated by the religions of India; and as Gifford lecturer at
Glasgow (1888-1892), discussed Natural Religion, Physical Religion,
Anthropological Religion, and Theosophy or Psychological Religion.
His Contributions to the Science of Mythology appeared in 1897. His
method of investigation was almost entirely linguistic, based on
phonetic laws which later research has discredited; and his theory of
“mythology as the disease of language” is no longer tenable.
The charm of the writings of Max Müller, and the interest which
they awakened in Vedic studies, gave a new impulse to the study of
the history of religions. The hymns of the Rig-Veda are by no means
the product of a simple society, as he supposed; in his view hymns
and myths were dissociated from ritual religion, and gods were
identified with natural objects. The death-blow to this method of
studying religion in our country was given by the keen criticism of
Andrew Lang (1884, 1887). The too-narrow basis of Max Müller’s
theories was overthrown by arguments derived from comparative
ethnology; “the silly, senseless, and savage element” (as he termed
it) in classical mythology proved to be the stumbling-block over
which he fell.
A firmer foundation for the study was laid by Tylor and Lubbock.
Though Max Müller originated the name Science of Religion, it was
Tylor who first introduced into it a scientific method, and so laid the
foundations for future investigation.
Later workers in the field fall naturally into two groups. Some make
intensive studies of particular forms of religion, either historical, such
as Robertson Smith (1846-1894), or living, such as Codrington in
Melanesia, J. O. Dorsey[117] in America, Spencer and Gillen in
Australia, and many others.
117. “Omaha Sociology,” Ann. Rep. Bur. Am. Ethn. Rep. iii., 1884; “Siouan
Sociology,” xv., 1897.

Other workers attempt, by correlating the mass of material, to

discover the fundamental religious conceptions of man, and to trace
their subsequent development. Among these may be noted Grant
Allen, Crawley, Frazer, Hartland, Jevons, Andrew Lang, Marett, and
many others.
To those who are acquainted with the modern study of
comparative religion in this country it is unnecessary to point out the
influence of such workers as Mannhardt, Tylor, and Robertson Smith
on subsequent writers; nor is it needful to draw attention to the vast
erudition and eloquent writing of Professor J. G. Frazer, whose
monumental work on The Golden Bough has become a classic, or to
the memorable Legend of Perseus by E. S. Hartland.
The study of the myths of various peoples is receiving the
attention of numerous students, and in Germany certain
ethnologists, such as Ehrenreich, Foy,[118] and Frobenius,[119] find sun
and moon gods in the most unlikely places. There is, however,
considerable danger that this nature-mythology is being carried too
far.
118. Archiv für Religionswissenschaft, x., 1907, etc.

119. “Die Weltanschauung der Naturvölker,” Beitr. z. Volks-und Völkerkunde, vi.,

1898; Das Zeitalter des Sonnengottes, i., 1904; The Childhood of Man, 1909.

The origin of the moral idea has also been discussed from the
ethnological point of view, as Hobhouse (1906) and Westermarck
(1906) have exemplified in their great books.
Magic, religion, and morality have, as we have seen, especially of
late years, been regarded almost entirely from the anthropological
standpoint. But a new school of French students has arisen who
maintain that these are essentially social phenomena. The writings
of Durkheim, Hubert and Mauss[120] have initiated a new method of
study which promises to have far-reaching results.
120. The work of this school is mainly to be found in L’Année sociologique (1898).
 Chapter XI.

LINGUISTICS

Linguistics as a department of Anthropology may be regarded from

many points of view. To the evolutionist language forms one of the
tests dividing the Hominidæ from the other anthropoids; the
somatologist is interested in correlating the phonetic system with the
structure of the organs connected with the mechanism of speech;
and the ethnologist studies language for the evidence it affords of
ethnic affinity or social contact, or as a means of determining the
grade of culture to which a particular people has attained, or, again,
as a reflection of their character or psychology. The linguistic
classifications of Gallatin, Humboldt, and Müller are referred to later.
The Aryan The connection between linguistics and
Controversy. anthropology assumed its greatest importance in
the middle of the nineteenth century, when the discoveries and
theories of philologists were adopted wholesale to explain the
problems of European ethnology, and the Aryan controversy became
the locus of disturbance throughout the Continent. “No other
scientific question, with the exception, perhaps, of the doctrine of
evolution, was ever so bitterly discussed or so infernally confounded
at the hands of Chauvinistic or otherwise biassed writers.”[121]
121. Ripley, 1899, p. 453.

In 1786 Sir William Jones had pointed out the relationship

between Sanskrit, Greek, Latin, German, and Celtic, and suggested
a common parentage, which was confirmed by Bopp in 1835.
Unfortunately, a primitive unity of speech was held to imply a
primitive unity of race.
Among the ethnological papers read at the meeting of the British
Association in 1847 was one “On the Results of the recent Egyptian
Researches in reference to Asiatic and African Ethnology, and the
Classification of Languages,” in which Baron Bunsen sought to show
that the whole of mankind could be classified according to language.
In fact, it was taken for granted in 1847 that the study of comparative
philology would be in future the only safe foundation for the study of
anthropology.[122] The spread of this fallacy is usually attributed to
Max Müller, whose charm of style and high reputation as a Sanskrit
scholar did much to popularise the new science of philology. He
invented the term “Aryan,” which in itself contains two erroneous
assumptions—one linguistic, that the Indo-Iranian group of
languages is older than its relatives; and the other geographical, that
its “cradle” was in ancient Ariana, in Central Asia. Moreover, in his
lectures he not only spoke of an Aryan language, but of an “Aryan
race.” He is credited with having made “heroic reparation” for these
errors when he wrote later: “To me an ethnologist who speaks of an
Aryan race, Aryan blood, Aryan eyes and hair, is as great a sinner as
a linguist who speaks of a dolichocephalic dictionary or a
brachycephalic grammar. It is worse than a Babylonian confusion of
tongues—it is downright theft.” But, as he pointed out,[123] he himself
never shared the misconception that he was accused of launching
on the world. He admits that he was not entirely without blame, as he
allowed himself occasionally the freedom to speak of the Aryan or
the Semitic race, meaning the people who spoke Aryan or Semitic
languages; but as early as 1853 he had protested against the
intrusion of linguistics into ethnology, and
called, if not for a complete divorce, at least for a judicial separation
between the study of Philology and the study of Ethnology.... The
phonologist should collect his evidence, arrange his classes, divide and
combine as if no Blumenbach had ever looked at skulls, as if no Camper
had ever measured facial angles, as if no Owen had ever examined the
base of a cranium. His evidence is the evidence of language, and nothing
else; this he must follow, even though in the teeth of history, physical or
 political.... There ought to be no compromise between ethnological and
phonological science. It is only by stating the glaring contradictions
between the two that truth can be elicited.[124]

122. Rep. Brit. Assoc. (Cardiff), 1891, p. 787.

123. Rep. Brit. Assoc. (Cardiff), 1891, p. 787.

124. Rep. Brit. Assoc. (Cardiff), 1891, p. 787.

The protest was in vain. The belief in an “Aryan race” became an
accepted fact both in linguistics and in ethnology, and its influence
vitiates the work of many anthropologists even at the present day.
Naturally the question of the identity of the Aryan race was soon a
subject of keen debate. The French and German schools at once
assumed opposite sides, the Germans claiming that the Aryans were
tall, fair, and long-headed, the ancestors of the modern Teutons; and
the French, mainly on cultural evidence, claiming that the language,
together with civilisation, came into Europe with the Alpine race,
which forms such a large element in the modern French population.
There are two ways in which linguistics may be studied as an aid
to Anthropology—first, with regard to structural analysis, by which
linguistic affinities may be proved; secondly, by what has been called
“linguistic palæontology,” or the study of root words, by means of
which the original culture of a people may be ascertained. Philology
pushed both these methods too far. It claimed the right, by proof of
structural analysis, to link up the racial relationships of the European
and Asiatic peoples, and, by linguistic palæontology, to determine
the culture of the original “Aryans,” and to identify their original
home. It was over the question of the “Aryan cradle” that they were
forced to relinquish their too ambitious claims.
At the beginning of the nineteenth century it was generally
believed that our first ancestors were created in 4004 B.C. and
spoke Hebrew, and that the origin of the European languages dated
from the migration of Japhet from the plains of Shinar, cir. 2247. The
Asiatic origin of race and language was for long unchallenged. But in
1839 Omalius d’Halloy, followed by Latham in 1851, began to cast
doubts on the Asiatic “cradle,” noting that the Asiatic languages had
no real claim to be considered older than those of Europe, and that
in many ways the Lithuanian and Armenian were the most archaic in
the family. More important still was the work of Benfey,[125] who may
be regarded as the originator of linguistic palæontology, and who
used its evidence to shift the original dispersal from Asia to Europe.
Various philologists followed, employing different methods to prove
different theories; and the Aryan cradle was located in many parts of
Europe and Asia, ranging from the Pamir plateau to the Baltic plains.
Max Müller confessed in 1888 that “the evidence is so pliant that it is
possible to make out a more or less plausible case” for almost any
part of the world.
125. T. Benfey, in preface to Fick’s Vergleichendes Wörterbuch der
Indogermanischen Sprachen, 1868.
Language and From claiming too much the swing of the
Race. pendulum brought linguistics into disrepute with
ethnologists, and for a time the evidence of language was looked
upon with suspicion. Even philologists were accused of going too far
in this direction.
Professor Sayce[126] says: “Identity or relationship of language can
prove nothing more than social contact.... Language is an aid to the
historian, not to the ethnologist.” But, as Professor Keane points out,
there are many cases in which language infallibly proves the
existence of ethnic elements which would otherwise have been
unsuspected—as, for example, in the case of the Basques of
Europe. “Language used with judgment is thus seen to be a great
aid to the ethnologist in determining racial affinities, and in solving
many anthropological difficulties” (1896, p. 205).
Although Max Müller wrote nearly twenty years ago, “I believe the
time will come when no anthropologist will venture to write on
anything concerning the inner life of man without having himself
acquired a knowledge of the language in which that inner life finds its
truest expression,” we are obliged still to echo his lament: “How few
of the books in which we trust with regard to the characteristics or
peculiarities of savage races have been written by men ... who have
learnt their languages until they could speak them as well as the
natives themselves!”[127]
126. Science of Language, ii., p. 317.

127. Rep. Brit. Assoc. (Cardiff), 1891, p. 792.

 Chapter XII.

CULTURAL CLASSIFICATION AND THE INFLUENCE OF

ENVIRONMENT

We have seen that in its beginning the science of man was little
more than a branch of zoology, and that his structural characters
were the first to attract attention and to form the material of study;
hence all the earlier classifications were based on physical features.
Gallatin was one of the first to classify mankind rather by what they
do than by what they are.
Gallatin. Albert Gallatin (1761-1849) was born at
Geneva, emigrated to America before he was
twenty, and rose rapidly to the position of one of the foremost of
American statesmen, becoming United States Minister to France,
and later to England. He noted the unsatisfactoriness of groupings
by colour, stature, head-form, etc., in the case of the races of
America, and made a preliminary classification of the native tribes on
the basis of language. Major J. W. Powell (1834-1902) and Dr.
Brinton (1837-1899) elaborated the linguistic classification of the
American Indians.
Wilhelm von Classification by language had already been
Humboldt. utilised by Wilhelm von Humboldt (1767-1835) in
the introduction to his great work on the Kawi language of Java,
entitled Ueber die Verschiedenheit des menschlichen Sprachbaues
und ihren Einfluss auf die geistige Entwickelung des
Menschengeschlechts, which was published posthumously, 1836-40.