Woman of Valor (38 page)

Bocker, however, was not an experienced researcher, and she ran into trouble when she employed thirteen different contraceptive, regimens and failed to produce a statistically valid test with any one of them. Lacking sufficient funds to hire an assistant, she also neglected to follow up on those 20 percent of the women who did not return to the clinic for further instruction after their first visit. Assuming they were using the methods successfully, when, in fact, the opposite was more likely to have been true, she undermined her claim that she had achieved a failure rate of less than 10 percent.

When a report of her research was privately printed in New York by Noah Slee, it immediately came under the fire of Dickinson, writing in the
American journal of Obstetrics and Gynecology
. Dickinson had, in fact, already sent undercover nurses to investigate the Sanger clinic and had learned to his surprise that Bocker, a graduate of his own alma mater in Brooklyn, had a good deal more professional standing than he had assumed. Whatever her qualifications, he was nonetheless obliged to challenge research he found far from unassailable. In his critique, however, he did take the trouble to distinguish “the present character” of Margaret Sanger's initiative from her prior undertaking in Brownsville. Less charitable was the judgment of the National Catholic Welfare Conference in Washington, which circulated a flier calling the Bocker report unscientific, unethical, and insensitive to the potential of contraception's harm to the “nervous system or morals” of its users.
⁷

 

Dickinson had earlier prevailed on several of Margaret's own donors in the world of New York society, including Gertrude Pinchot, to fund an organization of eminent physicians to sponsor research. He named it the Committee on Maternal Health, and took office space for the group at the New York Academy of Medicine, though there was no formal affiliation between the two. A savvy operator in the politics of his profession, he also secured the qualified participation in this effort of George Kosmak, the prominent editor of
The American Journal of Obstetrics and Gynecology
who had once told his colleagues to counsel continence over contraception. Though a practicing Catholic and a vocal opponent of birth control, Kosmak joined up on the grounds that a responsible alternative was necessary to the work of the propagandistic and unprofessional Margaret Sanger.

To secure reliable data for his proposed study, Dickinson then enlisted the cooperation of the outpatient departments of seven leading Manhattan hospitals. He purchased the necessary supplies and also issued standard forms on which clinical case histories could be collected as data. He ran into a problem, however, when he was able to secure only condoms and spermicidal jellies for trial. He tried to import rubber diaphragms from Europe, but his shipment was intercepted by United States customs officials acting under the provisions of the Comstock laws. He was unable to find others until Margaret herself capitulated to him in 1925 and agreed to sell her contraband product at an extravagant 50 cents apiece.

Sensitive to a prevailing disdain and fear of social medicine among his colleagues, Dickinson agreed not to advertise the availability of his clinic services. He also established rigid procedures for the written referral of patients by reputable doctors in private practice, but then gave them no real incentive to get involved. His regulations were, in fact, so complicated that after eight months, only nine patients had made themselves available for research, and three of them were already pregnant. Even when the requirement of physician referral was later dropped—when hospitals were offered a small financial incentive to produce patients, and limited publicity was allowed—Dickinson could not seem to get his project off the ground. Five years' effort produced only 335 incomplete case histories, forcing him to admit the necessity of exactly the kind of propaganda he had criticized and to rely on the only available source of data he could find—Margaret Sanger's Birth Control Clinical Research Bureau.
⁸

As it happened, Dickinson and Sanger in 1924 found themselves in competition for funding from the Bureau of Social Hygiene, the research institution established by John D. Rockefeller, Jr., which had for years been zealous in its investigations of commercialized vice and prostitution. The bureau was then run by Katherine Bement Davis, a patrician graduate of Vassar with a Ph.D. in sociology from the University of Chicago. Earlier she had distinguished herself as a progressive prison administrator in New York State and City, where she came under Margaret's venomous attack in 1917 as the individual responsible for the inferior conditions of the women's prisons in which she and her sister were incarcerated. Shortly thereafter, however, Davis had left city government for the safer harbor of foundation work, and under her tutelage the staid Bureau of Social Hygiene broadened its reach to embrace the larger study of normal human sexuality and social hygiene, not just problems of deviance.

Davis provided an avenue of reconciliation between the birth control propagandists she had reluctantly come to admire and her establishment friends in the medical profession. In 1924, she recommended that Rockefeller personally donate $10,000 toward Margaret's research, with the proviso that her data then be submitted to Dickinson's Committee on Maternal Health for professional analysis and review. At this juncture, Margaret also won the endorsement of the New York lawyer Raymond F. Fosdick, one of Rockefeller's most trusted counselors and a member of the Advisory Committee he established to supervise his personal charitable contributions. At Fosdick's urging, Rockefeller, using the Bureau of Social Hygiene as a conduit, anonymously donated $5,000 to Margaret. This private support was renewed each year thereafter at approximately the same levels, and in 1925 and 1926, the Bureau of Social Hygiene also made two additional anonymous contributions of $10,000 to facilitate the cooperation between Sanger and Dickinson that Davis desired. The following year, however, Margaret's bold request for increased funding of an expansion budget of $50,000 was turned down, with the Social Hygiene Bureau staff officially saying only that the cause remained too controversial for such substantial underwriting. In this period Rockefeller's policy limited his contributions to a fraction of any one institution's budget, and he was already funding her at a level comparable to all but the most exceptional of his beneficiaries. The millionaire industrialist whose assassination for crimes against working people she had once publicly advocated, thus became, after her own husband, her largest single source of support. He acted at the behest of Davis, another progressive do-gooder Margaret had once lambasted. Yet the only indication that either one of them may have held her accountable for her prior behavior was the demand that their contributions never be made public.
⁹

With the Rockefeller money still at stake, Margaret sent her new medical emissary, Dr. James Cooper, to talk to Dickinson and inquire what she might do to win his approval. From Cooper, the word came back that to win his support she would have to jettison Dorothy Bocker. Though she had already signed off on Bocker's findings, she complied immediately, her discomfort apparent from the awkward manner in which she handled the firing, first saying she would help set Bocker up in a practice of her own, then agreeing to keep her on part-time, and only then severing the relationship completely. Bewildered but defiant, Bocker left in a huff taking all of the precious clinical files with her. Margaret then blamed the hapless woman for a “betrayal of trust” in leaving with the records, though as presiding physician of the clinic, they were technically hers to keep.
¹⁰

The parting proved fortunate because in Bocker's place Margaret hired Dr. Hannah Meyer Stone, a thirty-two-year-old pediatrician affiliated with the Lying-in division of the distinguished New York Hospital and Medical College, from which she had graduated in 1920, after first earning a degree from the Brooklyn College of Pharmacy. Margaret also formed an advisory board for the bureau composed completely of men willing to support Stone's work. All of them were reasonably eminent professionals in either medicine or the social sciences, but because Dickinson had not as yet agreed to work with the clinic, most of them were not from New York City, and none were physicians with gynecological or obstetrical specialties. Finally, acceding to another Dickinson request, the clinic was physically separated from birth control propaganda activities and moved to freestanding space on West 15th Street.

Yet despite these accommodations and Stone's unassailable academic credentials, Dickinson's board at the Committee on Maternal Health still refused to cooperate. Since few prominent internships or residencies were then open to women doctors, and hardly any women taught on medical school faculties, Stone was without the kind of professional distinction that alone might have impressed them. She also happened to be Jewish and the daughter of immigrants, but even had she possessed more “acceptable” academic or social credentials, she probably would have remained suspect. “Men, in general, do not like to work under women, even when they do not have half as much sense; and doctors are particularly jealous cattle,” E. M. East, the Harvard sociologist and Sanger clinic board member, reminded Margaret several years later as tortured negotiations with Dickinson continued. He doubted whether male doctors would ever volunteer for birth control service so long as Dr. Stone was in charge. Though she only worked for Sanger part-time, in fact, Stone was forced to give up her Lying-in privileges as a result of her birth control affiliation. Until 1932, she was also repeatedly denied membership in the New York Academy of Medicine, a situation that one admirer later described as a “kind of polite torture,” which she accepted without “a trace of martyrdom.”
¹¹

The equanimous Stone, nonetheless, went ahead and prescribed contraception to more than 1,600 women during her first year on the job. She kept extensive medical and sexual histories, along with socioeconomic data of interest to the Research Bureau's social scientists. Meticulous in her record keeping and determined not to repeat her predecessor's mistakes, she also dispensed a social worker to follow up on delinquent cases, a frustrating and enormously costly task in a city the size and complexity of New York, where residential and employment turnover made women difficult to locate—not to speak of the fact that some who came to the clinic undoubtedly gave false identities.
*

So intense was the interest in this work that Margaret had to book a larger hall, and schedule a double session, when more than 1,000 physicians registered to hear Stone's preliminary report on her clinical experience at the well-publicized Sixth International Neo-Malthusian and Birth Control Conference in New York in 1925. This was so despite the fact that the Committee on Maternal Health officially vetoed the meetings, still refusing to have anything to do with the birth control propagandists. Dickinson, however, broke ranks and attended, ex officio, and, impressed by Stone's presentation, appealed two years later to the preeminent
Journal of the American Medical Association
to publish her research findings. When he was politely rejected there, he helped Stone find a place in a respectable professional publication called
Medical Journal and Record
, and, thereafter, worked with both Sanger and Stone in varying degrees of compatibility.
¹²

At the behest of the Bureau of Social Hygiene, Dickinson had come up with a plan to create a Maternity Research Council composed of specialists in obstetrics and gynecology who would essentially take charge of the Sanger operation. The facility was still a shoestring operation when Margaret agreed to this proposal in exchange for the promise of professional endorsement and Dickinson's pledge to secure her a dispensary license from the New York State Board of Charities. The plan allowed her to back out if the license did not materialize, but, if all went well, she would cede her authority as head of the clinic to the physicians. Adolf Meyer, M.D., who had also become a member of the clinic's original advisory board, encouraged her cooperation with Dickinson at this time, as did the majority of his colleagues. One of them, though, C. C. Little, who was then president of the University of Michigan and a prominent eugenicist, objected on the grounds that it made no sense to reward the same medical men who had “made a mess” of the problem of contraception in the first place.
¹³

As it turned out, Dickinson's colleagues also lacked enthusiasm for the proposal and only under duress agreed to appoint a three-member committee of the New York Academy of Medicine to investigate the clinic officially as a preliminary to formal affiliation. The vocal obstructionist, George Kosmak, was made a member of this group, and after a personal inspection of the facility, his vitriolic unofficial suggestion was that it ought to be closed down as “a violation of the law” and “a public menace.” As an official matter, however, the investigating committee limited its objections to the fact that Hannah Stone was taking too liberal an attitude toward what constituted a medical indication for birth control under the law. She had added child spacing and other psychological factors to the long list of obvious physiological conditions that might make pregnancy hazardous. Any woman with a baby under the age of nine months, for example, was automatically given birth control. The doctors instead called for a more narrow interpretation of the law and also demanded that the
Birth Control Review
be removed from the reception area where it was prominently displayed, along with posters that explained the differences between contraception and abortion, so as to make clear that the clinic practiced medicine and not propaganda. A draft statement of principles also clarified that the committee wanted to help “legitimate” applicants for contraception “while not losing sight of encouragement to couples whose progeny promise to be of value to the community to bear as many children as they may.”