Dig for gland of hope and glory

It is easy to write interestingly about sex, harder to be scholarly about this fascinating subject, and hardest of all to be both scholarly and interesting. Chandak Sengoopta has achieved this last feat.

The Most Secret Quintessence of Life is a major contribution to the history of sexuality and its medical investigation during the formative period of what is now the thoroughly respectable medical speciality of endocrinology.

Endocrinology's origins were slightly dubious, not because it was less scientific than other specialities, but for the therapeutic claims that some of its early advocates made.

The subtitle lists Sengoopta's major players. The glands are principally the ovaries and testes, although later in his analysis other glands, such as the adrenals and pituitary, make their appearance. His hormones, initially the unidentified substances secreted by the female and male gonads, also increase in number and action. Underlying his narrative is gender, and the material basis of maleness and femaleness. In examining the medical and scientific work that contributed to modern notions of sexuality, Sengoopta has set new standards in the fashionable historical discipline, the history of the body.

The Victorians took the male for granted but were fascinated by what they sometimes called "the woman question". Antiseptic, and then aseptic, surgery opened the abdomen to the surgical knife, and many enterprising surgeons and gynaecologists wondered if removing a woman's ovaries might cure her of her female problems.

A lot of early proto-endocrinology concentrated on the female gonad: experimental animals had their ovaries removed and sometimes transplanted, and the effects were observed. Women had the same things done to them, and this aspect of medical history has attracted much irate attention.

Sengoopta deals with this dark chapter, but his dispassionate analysis never loses its objectivity. Throughout the volume, he is as concerned with the scientific basis of clinical action as he is with the actions themselves. The effect is much more powerful than the tone of shrill condemnation characteristic of a good deal that has been written about sexual surgery.

The beginnings of endocrinology proper were no less murky, even if the male rather than the female was its principal object. Most early sex-gland work had been clinical. Late in the 19th century, Charles Edouard Brown-Sequard, a man with impeccable scientific credentials, entered the fray. This holder of the Parisian chair once graced by Claude Bernard, the most distinguished physiologist of the century, announced that testicular extracts had the power not only of increasing potency but also of rejuvenating the lucky recipient. Brown-Sequard was already an old man when he reported the results of his researches and self-experimentation. His death shortly afterwards should have put paid to the notion of artificially frolicking octogenarians, but he created a sensation and provided one of the recurrent themes of Sengoopta's monograph. For males, youth is associated with virility; for females, with beauty.

Brown-Séquard's vision was resurrected in the 1920s by Serge Voronoff, a Russian emigre surgeon with a fashionable practice in Paris. He used extracts or transplants of monkey testicles, which he argued could restore vitality in tired and prematurely old men. The research basis of his claims was slight, mostly carried out in his private laboratory, funded through his deceased American wife's fortune. Far more high-minded was Eugen Steinach (1861-1944), an experimental endocrinologist at the University of Vienna. Steinach did important work on the effects of castration and gonad transplantations on the development and behaviour of laboratory animals. His ideas provide the backdrop for much of Sengoopta's book.

Steinach always saw himself as a serious scientist; indeed, a good deal of his research was published in respected journals. When he sought to apply his animal models to clinical settings, however, the results were more controversial. Reflecting a contemporary theory that homosexuality was caused by hormonal imbalances, he attempted to treat it by injecting male sex hormones. The results were unimpressive. His second therapeutic innovation had a longer life. The "Steinach operation" consisted of ligating the vas deferens . It was a simple operation that produced atrophy of the man's germinal cells and an increase in the production of the male sex hormone. Within weeks patients reported an increase in energy, libido and muscle strength. Many famous and thousands of ordinary men had the operation done. W. B. Yeats believed that it gave him an Indian summer, during which some of his best poetry was produced. Sigmund Freud hoped that having his own vas deferens ligated might arrest the cancer of his jaw. There is no good evidence that it did, but Freud remained convinced that it helped his general vitality.

Comparable efforts to restore feminine vitality were less readily available. Irradiation of the ovaries was popular for a brief time, and the novelist Gertrude Atherton was convinced that she had been so vitalised: her fictionalised account of the treatment, Black Oxen (1923), was a bestseller and contributed to the public's fascination with the wonders of modern medicine. Although eternal youth escaped even Atherton, she did live into her nineties, so maybe Steinach's disciple Harry Benjamin knew what he was doing when he treated her.

These sensational claims on behalf of endocrinology kept it in the newspapers and magazines during the interwar period, and they provide spice for Sengoopta's analysis. He has a wonderful eye for the telling quotation and anecdote, but his compelling narrative is based on a comprehensive mastery of the relevant medical and scientific literature. Too often, historians of sex and the body resort to caricature. Sengoopta takes his actors seriously and treats them as complex human beings, acting from motives that were neither black nor white but the all-too-human shades of grey.

This fine monograph is cultural history of medicine at its best.

W. F. Bynum is emeritus professor of history of medicine, University College London.