Aroused

Aroused
Author: Randy Hutter Epstein

Background

This book is an enthralling account of the breakthroughs in the field of endocrinology in  which the author narrated a history abounding with ‘discovery, wrong turns, persistence, and hope‘. The content is also replete with profiles of early pioneers such as Claude Bernard, ‘the father of endocrinology’, and Arnold Berthold, the discoverer of ‘how hormones worked’. The book chronicles how an ‘inchoate field‘ transformed into an essential specialty through watershed experiments such as those of William Bayliss and Ernest Starling which discovered the first hormone secretin, and of Georgeanna Seegar which proved that the pregnancy hormone human chorionic gonadotrophin was not produced by the pituitary gland but by the placenta. The book’s exploration covered the hormonal underpinnings of such physiological processes as love and menopause, and the pathological mechanisms behind disorders such as Addison’s disease. The author also complemented the comprehensive academic narrative with illustrative and intriguing anecdotes, such as of John F. Kennedy, and of the fat bride Blanche Grey – stories which eloquently portrayed the human angle of the specialty (pages xii-xvii, 1-22, 89-90, 182 and 216).

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Synopsis

Predictably, the physiological and pathological dimensions of hormones form the foundation of the book. This feature, reflected in every chapter, is well-illustrated in the author’s exploration of growth hormone, a molecule that was discovered by Herbert Evans and Cho Hao Li when they demonstrated its growth-enhancing effect on rats fed pituitary extracts. The author also recounted the chequered history of the therapeutic use of growth hormone which was initially extracted from the brains of cadavers, and which inadvertently transmitted Creutzfeldt Jacob disease to many recipients. The author’s discussion of growth hormone also symbolised the interaction of different hormones in controlling the same metabolic process; in this case growth hormone and sex hormones act in concert to coordinate growth. The book’s discourse on growth also explored growth deficiency, particularly highlighting the differences between such disorders as achondroplasia and hypopituitary dwarfism (pages 127-135 and 162-167).

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If any individual stood out on account of depth of coverage in the book, then it was the neurosurgeon Harvey Cushing. Portraying him as a man who ‘had to be the best at whatever he did’, the author illustrated his perfectionist qualities with reference to the extensive collection of brain specimens he catalogued, and the ‘meticulous medical records‘ he kept; indeed she hinted that his scrupulous nature may have been the trigger for the ‘bouts of depression’ he experienced throughout his life. The book also detailed his medical pedigree, the author noting that he came from a wealthy medical family, and was mentored by two of the greatest figures in medical history – physician William Osler and surgeon William Halstead. The author portrayed him as a ‘skilled, daring, and confident‘ neurosurgeon who, by tackling challenging surgical problems emerged as ‘the father of neurosurgery‘. She however pointed out that it was through his ‘trailblazing hormone studies‘, by which he explored the hitherto ‘inaccessible pituitary gland‘, that he established himself as a leading expert in the ‘burgeoning field of endocrinology’. As a reflection of his endocrine legacy, the book highlighted the syndromes of pituitary or adrenal overactivity which bear his name (pages 34-43).

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Although most of the discoveries the book reviewed made great impacts on medicine, it is perhaps the introduction of radioimmunoassay (RIA) that most defined the modern face of endocrinology. Depicting this technology as ‘a way to measure the immeasurable‘, the author described how RIA revolutionised the specialty by its ability to accurately detect the typically trace amounts of hormones that circulate in the blood. To illustrate the momentous impact of this technology, conceived by the inimitable Rosalyn Yalow, the author remarked that ‘almost everyone in the world has had an affliction whose treatment has been informed by her work‘. The author underscored Yalow’s staggering accomplishment when she remarked that ‘the history of endocrinology cannot be fully understood without knowing about RIA’ and ‘RIA cannot be fully appreciated without knowing about Rosalyn Yalow’. In an awe-inspiring narrative, the author described how RIA, which detects the glowing of hormone-antibody bonds when they are irradiated, is now deployed in such diverse situations as screening for neonatal hypothyroidism, monitoring of drug levels, and detecting viruses such as HIV (pages 149-159).

Some of the themes in the book had underlying ethical and moral dilemmas as reflected in the complex subject of gender determination – a topic that has striking contemporary resonance. In tackling this issue, the author explored such disorders as congenital adrenal hyperplasia (CAH) in which ‘a block in the cortisol pathway‘ results in the excessive production of androgens and the masculinisation of genetic females. She also reviewed 5-alpha-reductase deficiency where genetic males are unable to produce the appropriate sex hormones and therefore appear as females. She illustrated the social complications that these disorders generate with several heartbreaking stories. One of these anecdotes was of Brian Sullivan who was born a boy with an underdeveloped penis, a uterus, and ovaries, but was raised, with devastating consequences, as Bonnie – a girl – after his surgeon amputated what was evidently an enlarged clitoris (pages 102-119).

Uterus. Servier Medical Art. https://www.flickr.com/photos/serviermedicalart/9714261259

Whilst the book was dominated by laudable feats of innovation and creativity, the author also portrayed the discreditable side of the field in some depth. An example which stood out was the theory put forward, by the physiologist Eugene Steinach, that vasectomy could ‘rejuvenate elderly men’ and ‘boost sex drive, intellect, energy, and just about anything else that withered with age’. It was poignant that Steinach was otherwise a remarkable scientist who discovered that testosterone was produced by the Leydig cells of the sperm duct. Another infamous landmark in the history of  endocrinology was the classification of people by hormone personality types, a categorisation conceived by the endocrinologist Louis Berman; he had argued that he could tell from people’s faces if they were ovary, adrenal, or pituitary types. Similarly absurd was the self-experimentation by the neurologist Charles Edouard Brown-Sequard who injected testicle secretions to show that this would boost libido. And perhaps to reflect how society tries to manipulate science to its end is the excuse given by the leal team of young and wealthy Nathan Leopold that it was his hardened pineal gland that endowed him with ‘too much libido’ and drove him to bludgeon another teenager to death (pages 70-74, xiii and 54-55, 61 and 75).

Top 23 hormones. DES daughter on Flickr. https://www.flickr.com/photos/diethylstilbestrol/30936321072

Opinion

Ambitious in scope, this book encompasses the detailed history of the pioneering workers and innovative discoveries that powered the growth of one of the most important medical specialities. With such a wide array of endocrine organs and disorders, the author’s systematic approach helped to make the subject both enlightening and entertaining. Part story-telling and part academic text, the contextual style served to emphasise the important role the hormones have in the human body. With an excellent balance of physiology and pathology, the author indeed achieved the remarkable feat of projecting the breadth and depth of endocrinology. Apart from a rather dull cover, there isn’t much to criticise about this book.

Overall assessment

The author, a physician by training, has condensed the history and impact of endocrinology, highlighting the breakthroughs that we today take for granted. She has placed the important but often overlooked diverse field of endocrinology in context, highlighting its inspiring pioneers as well as its occasional faltering steps. It is a lesson not just on how science progresses, but also on the pitfalls that threaten its advances. The subject is important to health care and I recommend the book to all doctors.

Book details

Publisher, Place, Year: Norton, New York,  2018
Number of chapters: 15
Number of pages: 313
ISBN: 978-0-393-23960-7
Star rating: 4
Price: £6.64

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