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298 MEDICAL JURISPRUDENCE
vaginam or externally through the abdominal wall. Ballottement can be
tried from the fourth to the seventh month, but the test fails if the amniotic
fluid is scanty. In practised hands it is a sign of great value.
12. X-Ray Examination, — This is useful in the diagnosis of pregnancy
after the sixteenth week when the centres of ossification have become well
developed. The X-ray examination is not harmful to mother or foetus, as
the exposure with the modern apparatus lasts only a few seconds. The
X-rays are of great assistance particularly in a case of twins where one
ovum is suspected to be bigger than the other and in cases of suspected
hydatidiform rnole, pregnancy with fibroids, and foetal malformations.
13. The Biological Test. — From the above mentioned signs it is evident
that before the sixteenth or eighteenth week there are no certain signs from
which a medical man can give a definite opinion about the existence or
otherwise of pregnancy. In such a case it is always a safe plan to wait till
the definite signs develop or to perform a biological test devised by
Aschheim and Zondek in 1928 for detecting pregnancy in its early stage.
This test is popularly known as the Aschheim-Zondek test, and is based on
the fact that in a pregnant woman an abnormal amount of the anterior-
pituitary-like hormone of the chorionic villi is excreted in the urine, and
that shortly after the puerperium this excessive excretion of the anterior-
pituitary-like hormone stops. The presence of this hormone can be
demonstrated by significant developmental changes in the sex organs of
sexually immature female white mice, when small amounts of a pregnant
woman's urine are injected subcutaneously. The ovaries are enlarged.
The corpora lutea are formed and hsemorrhagic spots occur into the follicles.
There are often swelling and hyperaemia of the uterus. The technique for
performing the test is as follows : —
Five sexually immature female white mice, three to four weeks old,
and weighing from six to eight grammes, are inoculated twice daily
for three days with the catheterized morning urine of the suspected case
of pregnancy in quantities of 0.2 cc, 0.25 cc., 0.3 cc., 0.3 cc., 0.4 cc., and 0.4 cc.,
respectively. One hundred hours after the commencement of the test the
mice are killed and the ovaries are inspected with a hand lens or with the
naked eye. A positive reaction is characterized by the presence of corpora
lutea and haemorrhages into the follicles of the enlarged ovaries.
If the urine is turbid, it should be filtered and its reaction made slightly
acid if it is not already so. One drop of trier esol to each 30 cc. of urine
should be added if the specimen is not to be used at once or if it has to be
sent by post.8
The Aschheim-Zondek test gives a positive reaction in 98 to 100 per cent
of the cases of pregnancy. It is positive as early as ten to fourteen days
after conception and two days after the first missed menstrual period. It
remains positive throughout pregnancy and for a period of about seven days
after the termination of pregnancy or after the death of the foetus. It also
gives a positive reaction in ectopic gestation, hydatidiform mole, chorion-
epifhelioma, and certain cases of malignant diseases.
• The Friedman modification of this test can be carried out by injecting
7* to 10 cc. of the suspected morning urine into the marginal ear vein of a
virgin female rabbit, 12 to 14 weeks old, and weighing not less than 4
pounds. Twenty-four to thirty hours later a positive reaction will be
indicated by the presence of corpora lutea and corpora Laemorrhagica in the
hypertrophied ovaries of the raHbit There wil abo be marked injection
of the tttertte and ovfefecf.
IwL $n. Jfei Res^ .July 1031, p. 230.