Category Archives: pregnancy diagnosis

Unpregnancy and arctic exploration

What has historical pregnancy testing got to do with arctic exploration and the expedition to rescue John Franklin, lost during his attempt to find a Northwest Passage? The idea of finding a Northwest passage, between the Pacific and the Atlantic oceans, was a long-held fixation; as early as the sixteenth century explorers had dreamed of it. Attempting to make that idea a mapped reality was perilous; those who attempted it were working at the extreme limits of endurance and at the edge of the known charted world. In contrast to the exotic problem that that search held out, the problem of pregnancy diagnosis was much more familiar, every day and domestic.  Yet it was equally elusive.

Elisha Kent Kane. Wood engraving by [S. T.], 1856. Image from Wellcome Collection

These two exploratory fields are brought together in the extraordinary biography of Elisha Kent Kane, an adventurer, naval officer and doctor who was enlisted to go on Grinnell’s expeditions to find John Franklin in 1850 and 1853, the second of which he led. He graduated from the medical faculty of the University of Pennsylvania in 1842. The dissertation that he submitted as part of his training concerned experiments he conducted on the urine of pregnant and lactating women. His account of these experiments is full of odd case studies of women in the Philadelphia hospital, which give us an extraordinary glimpse of unpregnancy in the past.

In my Conceiving Histories project I am interested in the difficulty of diagnosing pregnancy and the time of not knowing – the am-I-aren’t-I time (that’s what I refer to as ‘unpregnancy’). I think that looking at the past before modern diagnostic technologies were available can give us ways of thinking about the times when our testing technologies aren’t useful, in the so-called two week wait before a pregnancy test, say, or in the weeks waiting for a viability scan. How did people try to know the body before our dipsticks and scans? At the very least I think that their endeavours testify to the fact that unpregnancy is a thing, that a state of indeterminacy is reasonably common, and that our abiding sense of a clear binary between not being pregnant and being pregnant is not exactly or not always how the (un)reproductive body is experienced.

One persistent idea, available throughout ancient, medieval and more modern medical writing, was that it might be possible to diagnose pregnancy by looking at and analysing urine in different ways. Of course urine testing has turned out to work like that, as it was always imagined it would. Technologies have to be imagined before they can be realised and so it has proved in this case.

Kane was impressed by work that had been done by a French scientist Jacques Louis Nauche in 1831. Nauche had identified a substance in the urine of pregnant women which he named Kiesteine. This is a word made from the Greek word for conception, κύησις [kyesis], made to look technical by adding  -ine, an inflection which was being used to name elements and other substances in a new chemical vocabulary (think of words like chlorine and bromine and so on). Kiesteine was a precipitate which appeared in pregnant urine which had been allowed to stand. It formed a pellicle, a skin or scum, on the surface of the urine. That sounds pretty disgusting but the way Kane describes it makes it sound rather beautiful:

…a continuous scum of an opaline white or creamy appearance, with a slight tinge of yellow, which gradually becomes deeper and more decided. The uniformity of this colour, however, is generally broken by granulated spots of a clearer white, giving it a dotted or roughened aspect. The crystals of the forming stage now appear like shining points, and I have sometimes found numerous small brownish specks, sprinkled over the surface, not unlike the gratings of nutmeg.

Kane did experiments on the urine not only of pregnant women but also lactating women in the hospital and also checked his findings by doing studies of other test groups: people with pathological conditions of different kinds. He found that kiesteine could be found in the urine of pregnant women and that in lactating women it could sometimes be found, especially during weaning or when breast feeding stopped for another reason. Kane recognised his work to be operating in a long tradition extending back into the medieval and classical past. He appreciated that something very like Kiesteine had been described by medical writers like for example Avicenna, writing in the early eleventh century, and carried into Western medical literature. Kane noted that writing on urine often described pregnant urine as containing clouds, like carded wool, soft and webby. Carding wool is not something many of us do now, but it would have been a very familiar description to people before the industrial revolution.

Kane’s tables of data, ‘Experiments on Kiesteine’.

The case studies are perhaps the strangest part of Kane’s thesis and give us an oblique view of women caught in the in-between of unpregnancy. Kane reproduces some of his data in tables (above) and some as narrative histories. Those narratives are all about how he used kiesteine correctly to diagnose pregnancy in hard cases. We are sometimes given the names and ages of these women, and sometimes not; we are often told in which ward they were being treated.  In some cases we know that these women are black or white, because they are patients in segregated wards. Some of them have had many children and are already mothers. The list includes women who are deliberately pretending to be or not to be pregnant, and others who are mistaken about their own conditions; in some cases Kane is just sorting those that are from those that aren’t, with little comment about what the women themselves thought, believed or tried to pretend. His testing technique is clearly particularly useful for achieving negative results which are often more elusive. After all, the birth of a baby is the surest sign of pregnancy.

I find these case studies hard to read. The details of these women’s lives rip vividly across time, but of course we have no way of finding out about how they felt either about being pregnant or not or winding up as a test subject in Kane’s experiments. The first on Kane’s list, Helen Anderson, may be a sex worker; she is being treated on the hospital’s venereal ward for gonorrhea and Kane describes her sexual habits pejoratively as ‘promiscuous’. Kane successfully diagnoses her pregnancy and she gives birth to a baby prematurely. Isabella Smith is 25 and comes into Kane’s data set from the white obstetrical wards. She seems to have a well-advanced pregnancy but it hasn’t been possible to do an internal examination because she has ‘epileptic paroxyms’ which result in ‘her temporary removal to the women’s lunatic asylum’, where Kane acquires a urine sample. Kane records her test as a negative which satisfy him ‘that she was an imposter’. Then, ‘during a well simulated paroxysm of epilepsy, her dress gave way, and disclosed an abundant mass of hair padding ingeniously arranged over the abdomen’. There is no hint as to her motive, why she might need to pretend. Another test subject, Maria Hero, is just 15 and borrows urine samples from her neighbour who isn’t pregnant, to hide her condition from the doctors.

Little disguises the note of triumph that Kane sounds at being able to see through women’s deceptions or, in cases where there is no attempt to deceive but a genuine confusion, to read through misleading symptoms. Clearly he understands his success to be measured in the admiration of his male colleagues who are sending him samples and marvelling that he can invariably make a correct diagnosis. Of seven samples they ‘presented under fictitious names, and at a distance of two miles from the place where they were voided’, Kane could perform the trick of correctly picking out the four cases of pregnancy. He shows no empathy for the women he researches, or any concern about the emergencies which may have brought them into his case notes.

Of the nine narratives that Kane details, three are pregnant and clearly resistant to being so, like Maria Hero. The others are not. One is the ‘imposter’ with the hair padding I mentioned above, but there are an astonishing four cases (of just nine) who clearly believe themselves to be pregnant, in whom ‘the evidences of pregnancy were well marked’, but who aren’t. The longest of Kane’s case note entries concerns 37-year-old Mary Welsh. Not only do her periods stop – they are  irregular anyway– her abdomen is swollen, milk has come into her breasts, and she feels foetal movements. She is multiply examined internally and externally; doctors including Kane have listened with a foetal stethoscope for a uterine ‘souffle’ or foetal ‘pulsation’. These different physical examinations prove inconclusive. Kane’s observations of her urine convince him that she is not pregnant despite all this ambiguity; ‘much against her own wishes and those of her fellow patients’ he discharges her to the female working wards. She is undelivered of this phantom pregnancy at the time Kane writes, perhaps as much as year after she began to suffer.

Elisha Kent Kane. Engraving by D. G. Thompson, 1858, after J. B. Wandesforde. Image from Wellcome Collection.

Many years later, when Kane kits himself out for his arctic adventure, he clearly still sees himself as an experimental scientist, and his task as not only about finding Franklin. As well as making himself a wolf-skin robe, which he says ‘wandered down’ to him from the ‘snowdrifts of Utah’, and getting some good warm knitwear, he buys himself ‘instruments for thermal and magnetic registration’. His journey notes are full of his findings and thoughts on all sorts of natural forms and phenomena, as well as the indigenous people that his party meets on its way. On his trip, he turns his considerable powers of observation and description from the specimen bottle to these exotic novelties. Kane notes, though, that there is much that surpasses his ability with words, so that he confesses himself

…amused with the embarrassments which my journal exhibits in the effort to describe [the icebergs]. Certain it is that no objects ever impressed me more. There is something about them so slumberous and so pure, so massive yet so evanescent, so majestic in their cheerless beauty without, after all, any of the salient points which give character to description, that they almost seemed to me the material for a dream, rather than things to be definitely painted in words.

Kane’s expedition never did find Franklin, just the remains of his winter camp. Experiments into kiesteine went nowhere. Here, then, are two dead ends in the map of history. Both eluded the efforts of Kane and others to define and settle them. Whatever clarity kiesteine gives Kane, it is firmly dismissed as nonsense by the scientists in the early twentieth century, who developed accurate animal tests.  Neither his work, nor that of others who were also experimenting with kiesteine, fed into modern diagnostic practice. Experiments into kiesteine were overtaken by other means and ways of discovering pregnancy.

Kane’s account of the unpregnant women in Philadelphia Hospital show us of course that men had a curiosity and investment in clarifying and settling pregnancy diagnoses, but there are also hints here about how it also must have mattered to women, many of whom were suffering with symptoms but never delivering. For scientists like Kane, unpregnancy was an exciting exploration into uncharted and unknown places, full of puzzles and wonders, but for the women on whom he experiments, unpregnancy was a very cold and hostile wilderness in which some were hopelessly lost and from which there was little or no hope of rescue.


Elisha Kent Kane, ‘Experiments on Kiesteine’, American Journal of the Medical Sciences 4 (1842): 13-38.

Elisha Kent Kane, The United States Grinnell Expedition in Search of Sir John Franklin: A Personal Narrative (Philadelphia: Childs & Peterson, 1856).

Featured Image:

Ship model, thought to be of HMS Erebus, one of the ships that John Franklin led in his 1845 expedition. © National Maritime Museum Collections

The Experimental Conception Hospital

Imagine a dark Gothic building, with walls a hundred foot high. Inside are one hundred female experimental test subjects, ranging in age from fourteen to forty five. The staff over-seeing this curious institution are recruited from monasteries and relied on to keep accurate scientific data. No men are allowed into this hospital, part from male midwives of scrupulous integrity. Their visits are part of  a clinical research trial, to discover the exact length of human gestation, and from when and what to date pregnancy.

This is the bizarre science-fictional building imagined by Robert Lyall, who was a nineteenth-century physician, botanist and traveller, in response to the confusing medical evidence presented in the Gardner peerage dispute heard in the House of Lords 1825-6.

This story testifies to how difficult it sometimes was for historical physicians, let alone lay people, to diagnose pregnancy reliably and early. The medical evidence gives us all sorts of information about how pregnancy was dated at the beginning of the nineteenth century, showing that there was little agreement between practitioners about the best way to do it. Just like today, people in the early nineteenth century understood themselves to be living through a hypermodern age, when all sorts of strides were being made in technology and science: for example, in steam power, electricity, and air flight. And yet, for all this progress, it still wasn’t possible to get a fix on the reproductive body, which was so familiar and close to hand. It felt anachronistic, Robert Lyall tells us in his eccentric commentary on the Gardner case.

We might reflect on a similar feeling of anachronism that people, and particularly women today encounter in the two week wait, in the time after embryo transfer or ovulation and before a pregnancy test is reliable. Just as women search their bodies for pregnancy signs and symptoms, Robert Lyall speculates on whether conception would feel like ‘the sting of a wasp, or like the bite of some other insects’. But, in the time before it’s possible to test, women today are in the same position as those in the past who didn’t have the test at all.

Read more about the Experimental Conception Hospital in a free open access article at The Social History of Medicine here.

Watch a short video made by Anna Burel, which sets Robert Lyall’s words to images, and evokes the hospital’s inmates.

Featured image:

Anna Burel, 99, 76, 12, 93, 7, 22/100 (2016).

Frogs and annunciations

As soon as the doctor told her she was pregnant, she felt frail and nauseous, although she had not done so before.

‘But are you sure?’ she asked, foolishly, she felt, picking up her skirt and stockings. The doctor was washing his hands.

‘Oh yes,’ he said. ‘No doubt. Better book you into a maternity hospital.’

She laid a hand wonderingly on her stomach.[1]

This is how the writer Angela Carter imagined a pregnancy diagnosis at eight weeks in her unpublished short story ‘The Baby’ from about 1961. The skirt and stockings on the floor, the doctor washing his hands: Carter imagines an internal examination. ‘The Baby’ is intended to be naturalistic – a woman discovers she is pregnant and worries, particularly about her relationship with her partner. The story is mostly not magical realism of the kind that made Carter famous. However, an eight week pregnancy couldn’t, indeed still can’t be, determined by internal examination and so the story in this excerpt is inadvertently magical, more like a fairytale than anything true to life. Carter imagines the doctor here as all-knowing, even as having special powers.

One of the things that the conceiving Histories project is trying to do is to look at the history of not-knowing, a history of the time when people are wondering ‘am I? aren’t I?’. Part of what we want to look at is the search for a diagnosis in that in-between time and the desires and fantasies generated in ignorance. In ‘The Baby’ the protagonist feels foolish because she doesn’t know and the doctor does. But there is an even more profound unknowing which may be the source of the sense of foolishness described here.

Before it was possible to piss on a stick to determine pregnancy, urine was injected sub-dermally into animals. For much of the twentieth century it was frogs, mostly South African clawed xenopus laevis toads – aquatic, carnivorous and tropical. Frogs because they emitted eggs externally and did so in reaction to the injection of pregnant urine, and so didn’t have to be dissected to get the result. As Edward Elkan, a doctor  who kept a hundred frogs in a tank on the balcony of his flat overlooking Regents Park for testing his private patients in the 1930s, wrote: the xenopus test has the advantage over other tests which require ‘hecatombs of young mice’.[2] The test was as accurate as our pregnancy tests are today.

The logistics of this test, as it developed in the ‘40s and ‘50s are extraordinary. Women’s urine was sent with a fee by post from doctors’ surgeries and pharmacies to diagnostic centres where it was injected into frogs which had been sent by ship from South Africa. The Family Planning Association archive, at the Wellcome Library, is full of documents about the international transport in these frogs.[3] The FPA got their frogs from Peers Snake Farm and Zoo in Cape Town, through an animal transport agent, Thomas Cook and Sons.

London, Wellcome Library, SA/FPA/A3/11/13: Box 23
London, Wellcome Library, SA/FPA/A3/11/13: Box 23

They bought them in batches of 500; mainly these were female frogs but sometimes also male ones. They started getting them in 1949 and stopped in 1963 when immunoassay tests were available. The frog supply was dependent on the weather and the health of the population; sometimes they died in transit. One of the main questions which dogs the archive, to give a sense of the logistical challenge presented by this test, is whether it is cheaper to ship back the containers that the frogs came in or buy new ones each time.

Pregnancy really wasn’t diagnosed through internal examination, then, in the way that Carter imagines in ‘The Baby’. This lack of knowledge isn’t peculiar to Angela Carter. Most people didn’t know how pregnancy was diagnosed at the beginning of the 1960s; lots of medical practitioners themselves had no idea. Lots of people don’t know today that this was the way that pregnancy testing was done for most of the twentieth century.[4] Women got their results from doctors, rather from the test centre itself. Because tests were usually done in extremis, the result was no doubt the important thing, rather than finding out how the trick was done.

The Family Planning Archive is full of all sorts of documents about this test but what isn’t in the archive is much about women themselves, the people being tested. So, on the one hand, we have Angela Carter’s story and a lack of knowledge about how a result was achieved, that is how pregnancy was diagnosed and, on the other hand, the archive articulates an equivalent ignorance or at least a lack of curiosity about the people whose urine was being tested in the frog labs. The labs tested urine, not people.

In response to this, Anna Burel, who is making artwork as part of the Conceiving Histories project, has set about the task of creating a fictional archive which re-introduces the idea of the tested woman missing from the archive.

Frog Work, © Anna Burel 2017
Frog Work, © Anna Burel 2017

She is using the forms of the documents in the Family Planning Archive to do this, picking out the visual elements of telegrams which went backwards and forwards between the Association’s diagnostic centre in Chelsea, Thomas Cook and the snake farm in Cape Town.

Frog Work, © Anna Burel 2017
Frog Work, © Anna Burel 2017

She has also made a number of plaster frogs, each has its own type written label, marked with the name of a fictional person. Each of those tags corresponds to the label on a urine sample bottle.

Frog Work, © 2017
Frog Work, © Anna Burel, 2017

Making fictitious matches between frog and urine, by inserting names, Anna’s work is trying to close the gap between the diagnostic centre, and what went on there, and the lives of people who sent in their samples and waited for results. She is presenting, through the gesture of her figures, an impression of their responses to their results.

Anna and I have been thinking a lot about the annunciation, in relation to the whole project, as a pregnancy test before such things existed; no doubt there’ll be another blog post about it. What a wish-fulfilment fantasy: someone will come from another world and tell me the answer. We have been thinking about the annunciation, too, in relation to the lack of knowledge of the urine/xenopus test. In the traditional idea of the annunciation – when the angel Gabriel tells Mary that she’s going to have a baby in the Gospel – Mary’s pregnancy isn’t just announced it is also brought into being at exactly the same time. Often this is depicted in medieval art by a ray of sunlight, coming through a window, beaming onto or into Mary, sometimes carrying a little image of Christ or the holy spirit in the form of a dove.

Gentile da Fabriano, Annunciazione (1423-5) Pinacoteca Vatican
Gentile da Fabriano, Annunciazione (1423-5) Pinacoteca Vatican

Returning to Angela Carter’s imagined scene, she describes something rather similar. The doctor knows by putting his hands inside her, penetrating her in a mundane version of the divine conception. He magically reports and also symbolically impregnates, putting the foetus into the womb by hand.

Frog Work, © Anna Burel, 2017
Frog Work, © Anna Burel, 2017

Given the lack of knowledge about diagnostic practice, women might as well have been told their results by angels, the diagnostic centre was as remote as the other, spiritual world from which angels are thought to come.






[1] ‘The Baby’ (c. 1961), London, British Library MS Additional 88899/1/42

[2] Edward Elkan, Sketches from my Life, (1983), p. 56. London, Wellcome Library MS 9151.

[3] London, Wellcome Library, SA/FPA/A3/11/13: Box 23.

[4] One person who does know is Cambridge researcher Jesse Olszynko-Gryn. He is currently preparing a book on the history of pregnancy testing. You can read some of his work and find out more about the xenopus test here.

The Experimental Conception Hospital

In the past medical practitioners were in the same boat as their patients when it came to diagnosing early pregnancy. If you’ve ever wondered ‘am I pregnant?’ you’ll know that it’s not always that straightforward to ascertain. Some people, of course, know it straight away: their symptoms are really strong and when they do a pregnancy test it’s confirmed. Others experience things differently. They might not be sure at all but getting a positive pregnancy test sorts it out for them. Those that get a negative result may have to wait a little longer to find out but, eventually, a negative is a negative and they can be sure. The ambiguity of early pregnancy is capped for us, in a way that it wasn’t in the past, by reliable tests and sonography.

Just like their patients, modern medical practitioners also have a wait before they can rely on the tests and scans. In that wait they may well feel for their patients, recognizing that the wait isn’t very easy especially if they’re waiting like this every month for years indefinitely. They don’t, though, endure the wait in quite the same way; they have lots of patients and no doubt their own preoccupations. The cap provided by modern testing technologies means that they are removed from a considerable predicament which medical practitioners faced in the past. Of course, practitioners’ concerns are different from those of their patients. Whilst some of them worried about pregnancy diagnosis because they wanted to help their patients, others worried for themselves – for their medical reputations – and others worried for society at large. After all, if you can’t diagnose pregnancy it is hard to establish paternity and so ensure correct title and property transfer, those things which underpinned social, economic and political life. In societies which put a lot of store in blood lineage, a woman’s curiosity about her condition and her future were much less important than male anxieties about whether their children were their children.

Sadly we don’t have as much historical evidence as we would like about the feelings of ordinary people who were trying to conceive and not having much luck. But what we do have is quite extensive evidence of the difficulty that practitioners report about trying to diagnose pregnancy. Looking at that evidence exposes as age-old some of the perplexities within the experience of trying to conceive and, because of this, thinking about those difficulties in the past may help us to think through our own today. Sometimes it’s easy to think that in our modern times we are peculiarly impatient, peculiarly unused to desires not being realized, peculiarly anxious to know about our futures; it’s easy to imagine that people in the past accepted unknowns more readily than us. However, that’s not what the archive shows. People in the past were just as eager as we are to know things and they thought hard about how they could to come to know them.

The Experimental Conception Hospital is a fictional laboratory invented in relation to a legitimacy case in 1825-6. It is an extraordinary idea about how conception might be pinpointed in a time before the relationships between menstruation, ovulation and the processes of conception were fully known. Our project has been working on this fantasy institution in different ways, writing an account of it for publication but also making art work which takes a different look at the Hospital. We have put together a little 5 minute film (below). The images are part of a long piece of artwork which Anna Burel is making to present the Hospital’s 100 female experimental subjects. They are in different stages of undress and take up different postures. They are waiting, queueing perhaps. They are faceless, wearing masks. They are just numbers. The sound gives the full text of the Hospital’s description, detailing how it will be arranged. It is a dream institution which will resolve the questions of law raised by the difficulties of pregnancy diagnosis. It is imagined from a male perspective and gives no thought at all to the people incarcerated and experimented on. It is a dark Gothic science-fiction, an erotic fantasy about walling up women.