Paper - The Aschheim-Zondek hormone test for pregnancy
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The Aschheim-Zondek Hormone Test for Pregnancy
By Harry E. Kaplan, M.D.
- Read before the Obstetrics and Gynecology Section of the California Medical Association at the Fifty-Eighth
Annual Session, May 6-9, 1929. (December, 1929)
My purpose in presenting this article is to report brieﬂy my experiences with the Aschheim-Zondek test for pregnancy which I had the opportunity of observing last winter in the laboratories of the Jewish Hospital of Brooklyn, New York.
Need of a Dependable Test
There has long been a want for a desirable and dependable laboratory test for pregnancy. Erdheim and Stumme} pointed out that during pregnancy marked changes in the histologic structure of the anterior lobe of the pituitary gland take place. Smith and Engle 2 and Evans and Long 3. demonstrated that the injection of anterior lobe of the pituitary gland into mice and rats caused marked enlargement of the ovaries. Aschheim and Zondek,‘ conﬁrmed these observations and discovered that during pregnancy there was a striking overproduction of the hormone of anterior lobe of the pituitary gland, leading to its excretion in the urine. They also found that the subcutaneous injection of urine of pregnant women into immature female mice was followed by striking alterations in the ovaries, manifested by swelling, congestion, hemorrhage, and the premature maturation of the ovarian follicles. These changes were easily visible to the naked eye. Louria and Rosenzweig 5 carried out this test in one hundred and thirty-two cases. Eighty-seven specimens came from women in all stages of pregnancy and showed a positive reaction in 98 per cent. For controls they used the urine of nonpregnant women, among which were the urines from patients with ﬁbroid uterus, ovarian cysts, functional amenorrheas, as well as normal women in the premenstrual and postmenstrual epochs and in the menopause. Specimens of urine from males were also injected for controls. These showed a negative reaction in 91 per cent.
The Aschheim-Zondek Test
The Aschheim-Zondek test is performed on female white albino mice, ranging in age from four to six weeks, their weight averaging about fifteen grams. Three-tenths of a cubic centimeter of urine is injected subcutaneously three times a day for three days. The injections should be at least three hours apart, although they can be separated by more time. It is best to use a rustless needle for the injections. The mice are autopsied on the third day following the last injection or the sixth day after the ﬁrst injection.
The morning specimen of urine is preferable, although the casual can be used. It is very important not to let the urine stand around and it should be used the same day. It is also very important to keep the urine on ice. A clean bottle should be used for collecting the urine.
The autopsies reveal marked changes in the immature ovaries, such as swelling, congestion, hemorrhage and maturation of the follicles. There is also an associated enlargement and engorgement of the uterus and tubes, but in accordance with the views of Aschheim and Zondek this was interpreted as being secondary to increased ovarian activity. The ovaries in immature mice are small pale bodies. On autopsy, following the injection of the urine of pregnant women, the ovaries of the mice become enlarged to three times the normal size and have a pinkish red appearance. The hemorrhagic areas are visible to the naked eye and stand out prominently on the surface of the ovary. The premature ripening follicles are easily seen as small yellow spots.
The earliest case of pregnancy examined was in a woman whose menstrual period was seven days overdue. There were several other women in the ﬁrst three weeks of gestation, all of whom showed a positive test. The importance in this type of case is obvious in that a diagnosis of pregnancy is possible before physical examination is positive, thereby differentiating the pregnant uterus from the slightly enlarged nonpregnant uterus.
1. Erdheim, J., and Stumme, E.: Beitr. z. path. Anat. u. z. allg. Path., 46:l32, 1909.
2. Smith, P. E., d E 1, E. T.: A . ,40:l59, November 1337. nge m. J Anat.’
3. M., and Long, J. A.: Proc. Nat. Acad.
4. Aschheim S. and Zondek B. The diagnosis of pregnancy from the urine by demonstration of the hormone of the pituitary body. (1928) Klin. Wschr., 7: 1401.
5. Lour°a, H. W., (1 R ' , M.: , A, , 91:25, Dedember 22,aln928. Osenzwelg J M. A’
DISCUSSION by John C. Irwin, M. D., Lo: Angeles;
Ludwig A. Emge, M. D., San Francisco; Gertrude Moore, M. D., Oakland.
JOHN C. IRWIN, M. D. (1709 West Eighth Street, Los Ange1es).
I have had no personal experience with the Aschheim-Zondek test of pregnancy, but in July of 1928 had the opportunity of meeting doctors Aschheim and Zondek and watching their work at the Charité Frauenklinik in Berlin, wh-ere the test was perfected. At this clinic I saw Professor Wagner operate upon a case under a diagnosis of left broad ligament ﬁbroid and prove the preoperative diagnosis. This diagnosis had been made because of a negative test for pregnancy in the face of a typical textbook history_ of extra-uterine pregnancy. This case shows the reliance placed in the test at that clinic. Similar results were being found at the clinics in Vienna, where all who had undertaken the test were enthusiastic about it.
In Berlin I was given the following figures by Doctor Aschheim:
The test was positive for pregnancy four times in two hundred and ﬁfty—eight nonpregnant cases. In thirty—two cases of ﬁve to six weeks’ pregnancy thirty were positive, and two were negative; in thirty-six cases of seven to eight weeks’ pregnancy thirty-six were positive, and none were negative; in one hundred and three cases of three to ten months’ preg nancy one hundred and one were positive, and two were negative; in twenty-six cases of unknown duration of pregnancy twenty-six were positive, and none were negative; or four negative reactions in one hundred and ninety-seven cases of pregnancy which equals two per cent errors.
This percentage of ‘error is so small as compared with the Abderhalden and other serum reactions for pregnancy that it seems we can at last discard the older methods. The reliability of the test and the ease with which it can be done makes it possible for every hospital or commercial laboratory to furnish us a quite accurate diagnosis of early pregnancy in the puzzling case. The technique described by Doctor Kaplan is the _same as that used by Aschheim and is much more easily executed than the Abderhalden or any other serum test with which I am familiar. The only diﬂicult part of it is having female white mice at three to four weeks of age just at the time when the test is to be made, since immature mice must be used. The observations can be made with or without the aid of a microscope, which is time-saving as a laboratory procedure.
I am glad Doctor Kaplan has brought this test to our attention, and I hope that at least one laboratory in each California city will undertake this test for the profession, as it would no doubt help us in many cases where there is a question of early pregnancy.
LUDWIG A. EMGE, M. D. (2000 Van Ness Avenue, San Francisco).—As far as I can learn from the literature the Aschheim-Zondek test for pregnancy offers the highest percentage of correct diagnoses of any tests so far introduced for the same purpose.
The real value of this test centers in the aid it offers in the diagnosis of pregnancies obscured by tumors and in the diagnosis of extra-uterine gestation. Since the test has proven itself dependable in these groups, its value will be inestimable. The test in itself is simple, and were it not for the constant necessity of having immature mice on hand, could be handled by any good laboratory. The mouse problem complicates matters considerably and conﬁnes the test to institutions whose large breeding pens furnish a constant supply of very young mice. In our laboratory at the Stanford women's clinic, Doctor Fluhmann is working at present on a serum modiﬁcation of this test. His observations are very promising.
Doctor Kaplan’s concise report is very gratifying and creditable for bringing this test to the attention of the profession at large.
GERTRUDE MOORE, M. D. (2404 Broadway, Oakland). Doctor Kaplan’s paper is indeed timely in bringing to the attention of the medical profession a test of such‘ practical value. Our experience with it for the past year has led us to conclude that it is simple in performance, easy of interpretation, and reasonably reliable. Its accuracy in the hands of most workers compares favorably with that of other laboratory procedures. The statement has been made that the test is impractical because the average pathologist cannot have the necessary immature female mice always at hand, but this difﬁculty has been met in our laboratory by purchasing these animals from commercial producers at the time that the test is ordered. We have found this plan very satisfactory and urge its trial by those ‘who have looked upon this as an insurmountable obstacle, feeling sure that they will conclude, as we have, that it is the only test ever proposed for the diagnosis of pregnancy which is worthy of serious consideration.
Cite this page: Hill, M.A. (2020, January 21) Embryology Paper - The Aschheim-Zondek hormone test for pregnancy. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Paper_-_The_Aschheim-Zondek_hormone_test_for_pregnancy
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