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 Behind The Lens:
An Interview with Lennart Nilsson
NOVA: Tell me about the first time you used an endoscope [an instrument
used to visualize the interior of a body cavity or a hollow organ].
LN: In the spring of '65, Life Magazine published a story about human
reproduction—a cover and sixteen pages. I worked for twelve years on this
story. One of the pictures was the face of an embryo inside the uterus taken
with an endoscope with an electronic flash. And I remember that the editors
wanted to have a witness to say that this was really the case, because it was a
very sharp picture of the just the face, the head of the fetus inside the womb.
But this was not my very first endoscopic picture. The very first, we took it
in 1957—but in that case I didn't get the face. I just got the legs, hands,
feet, sex organs and so on. But I was trying to get just the face. And
I remember we did have very special lighting with a strobe at the front of the
endoscope—it was an American endoscope. And when I saw the fetus, I
remember it was a fetus about 15 weeks old—sucking the thumb—and when I
tried to press the button of the camera, the flash strobe didn't work. There
was something wrong with it! It took many years before I got the next chance.
NOVA: It sounds like endoscopes have come a long way...
LN: Oh, yes. There has been a revolution by a German optical company called
Storz. They have made an endoscope with a diameter of 0.6 millimeters and one
that is 0.8 millimeters. So now we can check the human embryo in a very smooth
and very nice way.
 NOVA: Do you go through the cervix?
LN: No, not the cervix. We make a kind of laparoscopy through the uterine
wall. You know when the doctors are checking the genes with amniocentesis? We
have done a few cases here in Sweden and in Europe during amniocentesis. And
there we had the opportunity to take wonderful pictures of the fetuses.
NOVA: Does the endoscope follow the head of the needle?
LN: Yes, more or less right, but we sometimes have them very very close
together. This is a wide angle endoscope—about 100 degrees—a new way
which gives an extremely sharp image. This is what I call a revolution
in endoscopy.
NOVA: What has been the technological breakthrough that has made these tiny
devices possible?
LN: There is a new way with very very tiny fiber optics, which give an
enormous high resolution. There are many many thousand fibers, very very close
together with a very small diameter.
NOVA: What about the lens?
LN: The lens is extremely tiny. I think the diameter of the lens is 0.5
millimeters and it gives enormous high quality. And we are using the Betacam
(video) recorder to get the very very best image. About two months ago, at the
Women's Clinic in Göteborg, we did a very fantastic sequence with the 0.8
endoscope and there was panning and tilting. It was fantastic to see the heart
beating and the fetus was moving and it was extremely sharp and the
depth of field was unbelievable!
NOVA: You've been very involved in the development of the equipment you use,
haven't you?
 LN: Always, always. I have a direct connection with the inventors both in
Germany and in Japan. So we are working together, I am often going over to
Tokyo for discussions. And even to Germany to the Storz optic company—we
have been working together more than 25 years. If I have an idea, let's say,
to make a new kind of endoscope with an extremely small diameter, I go to them
and I discuss it with their engineers, with the inventors, the optical experts.
And then later they send me some drawings, then I go back again and then they
start to do the work. You know it's very very hard to do lenses that are a
third of a millimeter. But I have just ordered an extremely small tiny
endoscope. The diameter will be about a fifth of a millimeter and even
smaller, because I'm going to do new kinds of pictures—especially with
embryos.
NOVA: What do you do for light inside the womb?
LN: We put in a light with the fibers all the time. And sometimes we put in
another light from the side too, when we have space. But the piece I just
worked on in Göteborg was unbelievable. The fetus was moving, not really
sucking its thumb, but it was moving and you could see everything—heartbeats
and umbilical cord and so on.  It was extremely beautiful, really beautiful!
And I did some panning ... I was extremely satisfied with the 0.8. So this is
a new way.
NOVA: The mother must have loved seeing her unborn child in such detail.
LN: Oh yes! She was absolutely proud, happy, happy. It was like a
portrait!
NOVA: Of course, many of your photographs are taken outside the body. Where
do you get these fetuses?
LN: For the animals, they came from the University in Uppsala and all
different kinds of clinics here. The chickens came from the University of
Uppsala and the human embryos came from women's clinics in Stockholm and in
Göteborg and so on. And from Germany, we have gotten some material from a
pig.
NOVA: Tell me a little about working with a scanning electron microscope—how do you prepare a specimen?
 LN: You know, of course, the specimens are not alive. We have to fix them in
a fixing liquid formaldehyde and then we have to do a rinsing and
then we have to coat them in a thin layer of gold. We sometimes freeze the
specimen with liquid nitrogen, which is extremely cold, you know. This is
another technique we use now—but the specimens are not alive. But there is
a new kind of low voltage scanning electron microscope that allows us to take
ciliated cells alive. This is a new way.
NOVA: I understand that one of the rooms in your lab is kept at body
temperature. Is this the room you use for photographing these live cells?
LN: Yes. This is the thermo-room. There I can follow a living cell for a
whole week. In this room I have a microscope and special chambers with
liquids. We have a monitor outside the room where we can check the image,
because we take one frame every minute (or sometimes two or three frames per
minute) and, my assistant and I, we can check the focusing—and we can focus
on our side too, because we never enter the thermo-room during our work,
because of the vibration. So we do everything remotely. This is something
very important for looking at white blood cells, bacteria and so on.
NOVA: It sounds challenging...
LN: Yes. This is something that is extremely, extremely difficult. And my
real enemy is not to hold the specimen sterile, but it's the lighting. The
light is our real enemy. So we have to work with very very poor lighting.
But we can increase the light with computers. That's the new way—with
computers, computers, computers. That's the way we can have the cell survive
and get some new information in high resolution. We started about five years
ago and, today, I think we have reached the target. We can even look at
viruses. I have seen viruses with a light microscope. They are very very
tiny, but I have seen them.
 NOVA: Your photographs always seem to reveal the most miraculous things. I'm
curious if you've ever been disappointed by something you've revealed.
LN: Oh yes, very very very often. It's often that something bad happens
during the filming—egg cells are dying inside the woman, the fertilized egg
cell is not going to get fertilized inside the body. And for example, the
implantation—only 40% of all fertilized cells are going to get implanted
inside the body. Of course it's much harder in vitro, outside the body, to do
the same. So, of course, many times we are disappointed.
NOVA: How did you feel when you saw the HIV virus? Was it an emotional
experience?
 LN: Oh, yes. Absolutely. I remember it was maybe ten years ago. I got a
specimen in Stockholm and then I went over to Paris to prepare look at it with
Dr. Luc Montagnier at the Pasteur Institute in Paris. He was the very first to
discover the AIDS virus. So we have had a very good collaboration. When I saw
the first image, I was really shaken. I saw something extremely sharp, because
I had a new high resolution scanning electron microscope from Japan—the
resolution was unbelievable—5 or 6 ångstroms. So when I saw it, and
just the sharpness of it, I thought, "this is something very remarkable." And
when I pressed the button to take the pictures, I felt something very unusual,
because this was a great killer in the world—and is still a great killer in
the world.
NOVA: Is it true that you wanted to attend medical school just for the
knowledge?
LN: Yes, you know, I decided, I think it was '58, to go to the Karolinska
Institute—in the medical school here. And I had decided it, me and my
family. And then professor Axel Ingelman-Sundberg, who was the first author of
the first edition of A Child Is Born, said, "Lennart, don't lose five years."
Why? I was really angry. I have many times thought I did the wrong thing, but
the reason was not to be a medical doctor—it was just to have the
information. But then, maybe I was wrong, I don't know. Of course, today at
the Karolinska Institute, I am working with some top experts—even some Nobel
prize winners. They have the latest news and I have the technique.
NOVA: Can you tell me what you're working on now?
LN: I am trying to get some images of viruses, because there is a scientist in
Göteborg here in Sweden—and there are some relatives of the AIDS virus.
So this is what we are working with now. And then I have decided to make a new
addition of the book, A Child Is Born. And then we are going to start a
new television film about the miracle of love—the chemistry of love.
Everything before the kiss. (laughs) The chemistry of love is something which
is extremely extremely unbelievable. This is something we have planned for
more than two years, so I hope that we are going to start in the beginning of
next year. [Ed. note: Watch for the Miracle of Love on NOVA.]
NOVA: Are you still looking at the moon and the planets?
 LN: Yes, sometimes in the country. I have an idea to try to photograph the
stars and the sky in a new way with a telescope—to make them more familiar.
I have an idea—I have already taken some still pictures of it. So, maybe
we can do something in the future, but you know, I have to do one thing and
concentrate on it. But this is a dream I have.
NOVA: What do you find most exciting about your work?
LN: It's to surprise people about something that is extremely well known. I
mean human reproduction, the human body, nature and so on. To surprise them
with a new technique. Like a journalist! Like you! I am not a writer, but I
am a writer with my cameras. But I don't like to talk big about anything. I
have some friends, colleagues here at the Karolinska Institute and even in the
United States and many other countries too, because we are working together as
scientists. I have the instruments, ideas, technology, computer techniques.
We try to create or see something, which has not been known before—just to
discover something together. This is always my dream.
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