Use of the tests introduced by laboratory scientists was not restricted to the laboratory. Sex endocrinologists involved in the study of sex hormones transferred the tests from the laboratory to the clinic, thus enhancing their material authority to a larger domain than just the laboratory. In the 1930s, tests developed to measure the sex of substances were used increasingly as diagnostic tools in the clinic. The next sections evaluate the impact of the introduction of laboratory-based tests on medical practice.
Measuring disorders in the female body
The introduction of laboratory tests by sex endocrinologists had major consequences for medical practice, particularly in the gynecological clinic. As we saw in Chapter 2, gynecologists had entered the emerging field of sex endocrinology mainly because of its promises of a better understanding and therefore greater control over the complex of disorders in women frequently associated with the ovaries. The American gynecologist Robert Frank described this interest of gynecologists in 1929 as follows:
The study of the female sex hormone…has now reached the critical
stage in which we may hope at any time to obtain a pure substance.
Such an achievement will not only be another triumph for the physiologist, endocrinologist, and chemist, from the theoretical standpoint, but will carry with it many invaluable, practical results in the treatment of diseases of women.
(Frank 1929:1)
The tests developed in the laboratory provided the gynecologists with a tool to measure female sex hormones in their female patients. Gynecologists expected that the excretion of hormones in urine indicated an abnormally high quantity of hormones in the female body which was considered as the cause of female disorders (E. Laqueur 1937). Robert Frank played a major role in transferring the laboratory tests to the women’s clinic. In 1925 Frank was one of the first to investigate the presence of female sex hormone in the blood of female animals. This research facilitated Frank’s move from the laboratory to the clinic, as he said. “Based upon these findings it was natural for me to study and investigate the human female” (Frank 1929:177). One part of The Female Sex Hormone (1929) was devoted to “the biology, pharmacology and chemistry of the female sex hormone,” and the other part solely to “the clinical investigations based on the female sex hormone blood test” (Figure 3.2).
The female sex hormone blood test consisted of injecting blood extract of female patients into test mice. Subsequently, the vaginal smear test was applied to determine the quantity of female sex hormone in the blood. The results of these tests were compared with the hormone blood level of “the normal woman,” a standard that Frank derived from the average of blood tests in more than 500 women. The female sex hormone blood test was performed upon patients in whom abnormalities of the function of the ovaries were suspected (Frank 1929:211). Frank applied this test for two general purposes. Based on his study of 500 patients Frank introduced a classification system of four types of women:
On the basis of these studies, the patients examined have been divided into various groups which include women suffering from hypofunction of the ovaries, hyperfunction of the ovaries, major endocrine disturbances…. Most patients can be classified under 4 types, the normal feminine, the infantile, the eunuchoid, and the virile. In addition, more marked endocrine disturbances enable us to differentiate pituitary, thyroid, adrenal and gonadic types.
(Frank 1929:295)
In addition to classification Frank used the female sex hormone blood test for the diagnosis of menstrual disorders (ascribed to hypofunction or hyperfunction of the ovaries), the diagnosis of pregnancy, and the differential diagnosis between pregnancy, amenorrhea (absence of menstrual bleedings)