Woman of Valor (37 page)

Such candid writing about sexuality, even if linked to wedded life, was not calculated to endear the book to moralists, and a lawyer for Margaret's publisher warned that it would probably be censored. His letter referenced the brief that had been submitted by prosecutors in Marie Stopes's censorship case. “Is there nothing else in the marriage state but degenerate thoughts of sexual passion and sexual indulgence?” the prosecuting attorney had asked the courts in seeking to ban Stopes's book. “If the marriage state has no higher aspiration than only the single gratification of sexual desire, then civilization has gone back to Pagan times, and the destiny of the human race and the expectations of the glorious future of our country have descended to the degenerate period of voluptuous Rome.”

Jonah Goldstein, Margaret's longtime counsel, gave different advice. He submitted a long list of suggested deletions and changes, and then told her to go ahead and publish. No legal actions were, in fact, ever brought, and the view prevailed, as a reviewer for
The New York Times
put it, that “the terrible Margaret Sanger whom thousands of the pious have been taught to regard as the female Antichrist…is engaged in no more iniquitous enterprise than the effort to help people be happy.” Indeed, Margaret's overriding desire not to be censored, and not to shock, may actually have made her seem a bit old-fashioned to those already inclined to support her by buying the book. This time, the liberal reading public in this country was ready for an even less inhibited sexual discourse than she was willing to risk.
²⁷

Much to her dismay,
Happiness in Marriage
never sold well and was quickly upstaged by the cookbook variety of sex manuals that have since become standard publishing fare. What is more, this sexually explicit literature then earned legal protection in 1930, ironically enough, when her old rival Mary Ware Dennett challenged the censorship of one of her own sex education pamphlets and won on appeal. In
United States v. Dennett
, the Second Circuit Court of Appeals in New York ruled that, in seeking to regulate obscenity, the Comstock laws should not interfere with serious, scientific sex instruction “unless the terms in which the information is conveyed are clearly indecent.” The decision reconstrued
Swearingen v. United States
, a landmark case of 1895, where the Supreme Court had defined obscenity in printed matter as anything “calculated to corrupt and debauch the mind and morals of those into whose hands it might fall.” The new rule of reasonable construction, as it was called, by insisting that the definition of obscenity inhere in the text itself whatever its intended motive, paved the way two years later for a lifting of the longtime ban in this country on Marie Stopes's
Married Love
, and for the publication of even more explicit manuals of scientific sex instruction. It would serve as precedent in the famous obscenity ruling on the importation of James Joyce's
Ulysses
in 1934, and also as the criterion for subsequent reinterpretations of the Comstock law with respect to contraceptive information and supplies.
²⁸

In the interim, in fact, an English translation was made available in this country of the work of the Dutch physician T. H. Van de Velde, whose graphic representation of the physiology and technique of lovemaking defied all prior standards of modesty. Van de Velde's
Ideal Marriage
was no less carried away in its enthusiasm for a higher level of sexual aspiration in marriage than Margaret's work. He was even more pietistic and far less cautious than she in promising a transcendent moment of sexual congress, which would transform marriage, as he put it, into a lifelong “honeymoon of rapture.” He did, however, present a virtual encyclopedia of coital calisthenics and other erotic practices that had previously been labeled perverse but were legitimized as acceptable sexual practice with the help of his graphic and instructive discussion. The book became an immediate best-seller, eclipsing everything that had been written before it.
²⁹

Not one to take a flop lightly, Margaret read her rejection by the marketplace as a sure sign of her inadequacies as a writer. In 1927, she confided to Hugh that she would thereafter leave books to professional writers and never publish again. It was in this context that she and Noah came up with the idea that de Selincourt himself write her biography. She finished yet one more book called
Motherhood in Bondage
, a compilation of the most heartrending letters she had received over the years, which came out in 1928. But the tragic confusion about sexuality and reproduction communicated in her mail did not turn out to be popular reading material either, and so few copies sold that Noah graciously bought up all the remainders and gave them away.

None of Margaret's books, in fact, ever again attracted the big audience of her early work, but as with the debacle of the American Birth Control League, this setback did not deter her. Instead, she achieved renewed fame and public stature in the 1930s by committing herself to the very tactics of conventional political organization and lobbying she had previously slighted. Democratization of birth control during the Depression, however, presumed the legitimacy she also helped secure for it among the country's emerging medical and scientific elites. And this she accomplished by first making her birth control clinic in New York a priority.
³⁰

M
argaret had long hoped that the 1918 ruling of the New York State Court of Appeals in her Brownsville clinic conviction would embolden physicians in hospitals and public health stations to give out contraceptive advice to women with medical indications for its use. The following year, however, along with her friend and personal physician, Dr. Mary Halton, she had taken two sick women—one with tuberculosis, the other with syphilis—to virtually every hospital in Manhattan, and all had refused contraceptive service. She'd then sent out a questionnaire to fifty metropolitan area hospitals. Only a handful admitted to any policy at all on contraception, and of these, most said they did not give out information. Judicial clarification of New York's Comstock law regarding the rights of doctors to prescribe contraception for reasons of health had done little to help women who could not afford private health care. They continued to be denied access to medically sound advice.
¹

Physicians in private practice also betrayed a startling reticence and lack of information on the subject. Organized medicine remained notoriously sex shy, and a characteristic timidity was clear even among those doctors who made the effort to attend the American Birth Control League's inaugural conference in 1921. A session limited only to medical professionals began with a review of known commercial and folk methods for controlling conception, including the condom and suppositories made of occlusive jellies, such as vaseline and cocoa butter. The chairwoman, Lydia DeVilbiss, M.D., who had been trying to promote discussions of the subject at the New York Academy of Medicine since 1915, claimed that she had seen these suppositories work successfully when mixed with chemicals toxic to sperm, like quinine or zinc oxide, but this was as much as she could say for them.

The highly respected Baltimore psychiatrist, Adolf Meyer, whose early willingness to associate with Margaret was especially significant, then initiated a debate of the merits of the commonly employed practice of coitus interruptus, both in terms of its reliability and its potential side effects on hygiene and psychology. The self-consciousness of at least some of the participants was readily apparent. One speaker revealed, with some hesitation, what he claimed to have learned from his patients—that withdrawal worked best when combined with manual masturbation of the husband by his wife until orgasm was achieved. There was more candor, but still considerable confusion of fact, about whether or not the use of pessaries or diaphragms might impede female orgasm. Dr. Meyer nevertheless underscored the significance of the very fact that a group of doctors was openly discussing sexuality by urging them to take greater responsibility for sex counseling, “to individualize their outlook” and experiment with whatever contraceptive techniques seemed to work best for the maximum sexual gratification of their patients. He told them to be alert to the enormous changes taking place in sexual attitudes and behavior and deplored the continued refusal of the American Medical Association, the New York Academy, and other like-minded professional associations to endorse and give legitimacy to birth control.
²

This professional discussion amply demonstrated that sexual prudery hindered medical acceptance of responsibility for contraception, but it also indicated scorn for unscientific, imperfect technology. Heavily invested in their campaign for professional stature during the 1920s, American physicians and the associations that represented them wanted little part of birth control practices long identified with the unorthodox approaches, and indeed in some instances the very medical and pharmaceutical quackery they were trying to conquer and overcome. Long after the passage of the first Food and Drug Act in 1906, progressive health reformers continued to bemoan the absence of strong regulations over the patent medicine industry. Medical literature frequently warned against commercial nostrums, along with cervical caps, pessaries, and other intervaginal apparatus sold in drugstores or by mail, which, if left in place for a long period of time or used in an unsanitary fashion, were thought to cause infections inducing sterility or perhaps even cervical cancer. At the same time, chemical douches, advertised for their alleged hygienic as well as contraceptive utility, remained suspect, because they tended to cause vaginal sensitivity or burns.

The best-selling douching agent in America at this time was the household cleaning product, Lysol, which was widely advertised as an antiseptic, disinfectant, and germicide, “invaluable for personal hygiene.” The ads ran in the women's magazines along with notices for various “fountain syringes” or douche bags. Unlike bichloride, another popular douche, Lysol was not toxic in small doses, but women who mistakenly used it intensely put themselves at risk, especially if they were already pregnant, when the flooding of the vagina with chemical liquids under pressure could force air into the uterus, weakening blood vessels and causing spontaneous abortions and other vascular problems. When the Depression intensified many women's fears of getting pregnant, the Lysol ads became even more explicit, claiming the chemical's “penetrating power, reaching into every fold and crevice…soothing and healing enough…with no caustic alkali…to inflame tender feminine tissue…. It contributes to a woman's sense of fastidiousness, as well as to her freedom from fear.”
³

Many doctors also feared, or perhaps themselves shared, the public's still common confusion between contraception and abortion. Health professionals, especially in cities like New York, were increasingly concerned about their inability to reduce the country's appallingly high rates of maternal mortality, and they blamed the problem in part on the numbers of women dying from complications of illegal or self-induced abortion. In respectable circles, illegal abortion was universally condemned as primitive, dangerous, and disreputable, and this was clearly the reason why Margaret reversed the endorsement of the procedure she had made in her
Woman Rebel
days.

Even therapeutic and professionally supervised abortions, however, presented more difficult professional and ethical considerations than simple contraception. Complicating the matter even further, the line between the two was blurred by the sudden appearance on the medical market of a so-called wishbone or stem pessary, which was fitted through the cervix into the uterine canal and, much like the intrauterine devices marketed today, contravened pregnancy by preventing fertilization of the ovum. Medical literature of the period universally condemned these devices on the grounds that they acted as an abortifacient and were unsafe. And in an article in the
American journal of Obstetrics and Gynecology
in 1924, Margaret was criticized for promoting the controversial procedure, which her friend and personal physician, Dr. Mary Halton, strongly endorsed. At the historic 1921 gathering of doctors, Halton had presented preliminary findings of a two-year test with more than 700 patients using an intrauterine coil made of silver or gold, which was then being more widely employed in Germany. She reported few harmful side effects in her sample. Chastened by the criticism, however, Margaret then took care to warn against coils in the chapter on contraception she included the following year in
Happiness in Marriage
. (Halton later began testing an IUD made of a ring of silk suture, but publication of her findings was still rejected by the
American journal of Obstetrics and Gynecology
in 1947 as “too hot” an issue. It was not until the 1960s that the medical profession changed its mind about the procedure.)
*

Explanations of recently developed sterilization procedures, still known to only a few practicing physicians, were also presented to the doctors attending this first conference in 1921, along with research findings demonstrating that neither surgical removal of a section of the female fallopian tube, nor male vasectomy, interfered with normal sexual functioning. Finally, Margaret, who was the only non-professional participating, reviewed the results of a five-year trial of the rubber-spring diaphragm by Dutch physicians, who reported a negligible failure rate when the method was employed in combination with individual examination and instruction. Indeed, until the marketing of oral anovulant birth control pills forty years later, the state of contraceptive technology did not advance measurably beyond the collective knowledge gathered together for the first time at this very first discussion she sponsored.
⁴

If reasonably sound knowledge was available, however, it enjoyed virtually no scientific credibility, and Margaret's suspect reputation with most doctors hardly helped the matter. In 1920, Robert Latou Dickinson, M.D., who had earlier decried the association of contraception with political radicals like Sanger, was elected president of the American Gynecological Society and began to stir up organized professional interest in birth control. In his inaugural address, he lamented the absence of authenticating clinical data on contraception and openly attacked his colleagues for shirking their responsibilities as specialists in gynecology and obstetrics by failing to study it. During his long experience in the private practice of obstetrics and gynecology in Brooklyn, Dickinson had come to the same conclusion Margaret reached in the course of her nursing among the poor. He believed that problems of sexual ignorance and maladjustment were widespread in American marriage, and he wanted an enlightened, scientific response to them, not what he characterized as the cant of propagandists. Determined to enlist the support of the right kind of people, he closed his private practice in Brooklyn and set up offices in the New York Academy of Medicine to conduct research. He asked the members of the gynecological society:

However controversial this undertaking, Dickinson was himself a gentlemanly product of New York's social and professional establishment. He was, at least for the time being, willing to move ahead with caution and restraint. Margaret, of course, was not. Nor was she prepared to step aside for an individual, who by dint of gender, professional training, and social standing, quite clearly saw himself as her superior. In 1920, she had syndicated the chapter on birth control clinics that provided the peroration of
Woman and the New Race
in
American Medicine
, a popular health journal read by many doctors. And within a year she announced she would again open a clinic to treat patients presenting medical indications for contraception. This time she pledged to work within the framework of the law and also promised to collect case histories on which a scientific, clinical study of birth control could be based.

Margaret had arranged for the clinic to be administered by the same Lydia DeVilbiss who chaired the medical forum on contraception at the 1921 conference. But Dr. DeVilbiss, protective of her own professional credentials, refused to move forward as planned when New York State authorities arbitrarily denied the two women an operating license. In view of the venture's questionable legal status, the directors of the American Birth Control League also decided not to risk the new organization's tenuous stature, or their own personal liability, by linking themselves legally to it. The clinic finally opened in 1923 under a separate organizational umbrella—its medical delivery and research objectives carefully distinguished from the league's agenda of education and legislation. With contributions of $3,600 from Clinton Chance, a wealthy British manufacturer and Neo-Malthusian whom Margaret had met in London, and $2,500 from her longtime benefactor Dorothy Straight, she rented space across the hall from the league's office on lower Fifth Avenue and opened the Birth Control Clinical Research Bureau, so named in order to follow the spirit, if not the letter, of the law, which required any facility calling itself a “clinic” to have the state dispensary license she could not get. The operation was run essentially as the private practice of Dr. Dorothy Bocker, a graduate of Brooklyn's Long Island Medical College, who had been working in Georgia, running a division of the state's public health program. In order to land herself a guaranteed $6,000 salary back in New York, she dared to circumvent the law. Margaret warned Bocker that her medical license could be jeopardized as a result of her association with this undertaking, and in a letter explaining the terms of her job offer, she underscored that she did not anticipate “a peaceful, harmonious, uneventful year.”
⁶

In fact the only controversy that plagued the clinic in its first two years of operation was the quality of Dr. Bocker's research. With references from charitable and religious institutions, from some private doctors and nurses, and simply by word of mouth, the facility attracted a steady clientele of young women. They came predominantly from modest circumstances, two thirds having already attempted some form of contraception on their own, though without satisfactory results. Birth control had received extraordinary amounts of publicity and raised the level of demand among women in New York, but as so many of them lamented, their heightened expectations had not been easily met. Most claimed to have tried varieties of commercially available sponges, tampons, pastes, effervescent tablets, chemical douches, condoms, and pessaries. Many had resorted to abortion and, when examined, revealed a high incidence of pelvic disorder. One even claimed that she had gone in desperation for better advice to the keeper of a local brothel.