Woman of Valor (39 page)

Clinic policy at the time also permitted the “quiet” referral of patients presenting no health indications whatsoever to private physicians known to fit diaphragms under these conditions. This was particularly important because many newly married women sought service, and Stone very much wanted to accommodate them. The policy seemed suspect to the Committee on Maternal Health, however, not only because of its questionable legality, but also in light of its potential abuse by doctors given an incentive to work at the clinic in order to expand their own private practices. Indeed, one such physician actually quit in 1929 on the grounds that she wasn't receiving enough private business to make her time there worthwhile. At Margaret's direction, Stone thereafter took personal charge of all referrals for “no health reasons” as well as for any other recommended gynecological procedures, so as to enforce a uniform policy and avoid the appearance that staff physicians might benefit personally from their affiliation. At one point Margaret intervened personally and fired a doctor who had turned away a woman who deserved to be served at the clinic and not outside it.
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In the end, however, the issue of the license, and not the desire of Dickinson and his committee to regulate either the fertility of middle-class women or the ethics of women doctors, became the stumbling block to affiliation. After seven months of effort and two hearings on the matter, he came away empty-handed from the New York State Board of Charities, the professional panel authorized to grant medical licenses. Though no evidence survives to verify his claim, Dickinson charged that the board had added an unofficial fourth condition to the standard burdens of “proof of need, proof of character of the incorporators, and sufficiency of funds,” required for a license. He accused it of demanding “a waiver of objection” to the license from the Catholic Church. He could get no further in Albany than Margaret had on her own.

Indeed, in what appears to have been a classic political shuffle, the three physicians who served as gubernatorial appointees to the panel simply announced that they found the granting of a license “inexpedient from the standpoint of public policy,” while they quietly made it known through a representative of the Rockefellers that they would not interfere if Dickinson went ahead without a license, just as Margaret had been doing. New York's governor, Alfred E. Smith, was, of course, a Catholic with prospects as a Presidential candidate in the Democratic party. He was unwilling to risk the erosion of his political base of support by giving even a hint of legitimacy to Margaret Sanger. Though Dickinson was willing to proceed under these circumstances, his colleagues at the Committee on Maternal Health adamantly refused. Subsequent efforts on his part to interest New York Hospital in administering the clinic as an outpatient facility, covered under the umbrella of its own license, also came to naught. Fearful of giving up her independence to the lumbering bureaucracy of an elite hospital that at best would have had a marginal interest in providing women with access to quality birth control, Margaret ultimately refused to endorse this plan, and it was never pursued.
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For Margaret the clinic had by this time become nothing less than a crusade. What had once been only a lofty, rhetorical promise was transformed into a reality as more and more women crowded into the facility, fully two thirds of them on the recommendation of someone who had already been there before. By decade's end, the bureau was serving almost 5,000 new patients a year. Revisits for regular checkups and renewal of supplies brought the number of annual client contacts to well over 20,000—more than the aggregate of all the rest of the voluntary birth control clinics in the country combined. The facility was open five days a week and held evening sessions to accommodate working women. Several hundred private physicians were also receiving instruction each year in the proper fitting of diaphragms.

From the single nurse and social worker who had originally assisted Hannah Stone, the staff expanded to include twelve women doctors working part-time under her, assisted by a rotating battery of nurses, social workers, administrative personnel, volunteers, and field workers who indefatigably pursued delinquent cases either by letter or in person. To support this growth Sanger charged patients for consultation and supplies on a sliding scale, each according to her ability to pay, and made up the clinic's small deficit by dunning individual benefactors and by sponsoring any socially acceptable fund-raising gimmick she could come up with, including, on one occasion, the selling of chances on a string of cultured pearls.
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“Founded upon nothing more substantial than faith in its humble and despised beginnings,” she wrote in an annual report for 1929, “it has grown steadily until it has become not only a clinic where individual women may receive expert medical advice for their most troubled and intimate problem, but a definite social force within the community.” Elsewhere she again sounded the visionary themes of her early writings—the clinic would “lead woman out of darkness and despair into the light of sane living.” It would place in her hand the “key of self-mastery and self-direction.”
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Owing as much to these bold claims, perhaps, as to her considerable successes, Margaret once again found herself a target of the New York City Police Department in 1929, whose impulsive intervention in the clinic's operation only served to help stimulate more business. On April 15, eight police officers entered the facility, drove out fifteen patients, arrested eight staff members, including the two physicians, and seized confidential medical records. The complainant was a married undercover policewoman named Anna McNamera, who several weeks earlier had been fitted with a diaphragm after her medical and social histories were taken, and she had received a thorough pelvic examination.

A young and still promising assistant district attorney by the name of Frank Hogan, soon to earn his reputation as one of the country's most respected municipal prosecutors, was put in charge of the case, but even he was no match for Margaret's longtime lawyer, Jonah Goldstein, who deftly turned the pretrial hearings into a referendum on the right of physicians to professional autonomy. The presidents of the New York Academy of Medicine and of the somewhat more professionally plebeian New York County Medical Society, along with Dickinson and a former commissioner of the New York City Department of Health, each testified that McNamera had exhibited reasonable medical indications for birth control under the provisions of the law. After two such hearings the charges were dropped, and the police commissioner issued a public apology. The administrator of the department's women's bureau, who had supervised the raid, was demoted from her position for exceeding the authority of the arrest warrant when she ordered the confiscation of confidential medical records, almost all of which were immediately returned.
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The outburst of publicity surrounding these events propelled a final round of discussions about affiliation with Dickinson and the Committee on Maternal Health. This time, however, all the doctors had to offer was a plan to supplant the existing nine-member advisory board of the clinic with local people of their own who would come around and make regular medical inspections. Dickinson was adamant about the need for trained obstetricians and gynecologists on the clinic's board and also proposed the continuation of efforts to have New York Hospital take it over altogether. An organizational plan was drafted that placed Margaret's Baltimore supporter Adolf Meyer, M.D., as president of an executive board, and left Sanger herself as vice-president. The prominent obstetrician J. Whitredge Williams and the gynecologist Frederick Holden, however, were also to join, along with Katherine Bement Davis of the Bureau of Social Hygiene. Hannah Stone would remain as medical chief of staff but would be made to answer to an inspection and consultation committee of outside physicians.

Complicated negotiations went on for months, and the extensive talks produced reservations on the part of the clinic's existing Advisory Committee about the danger of compromising institutional autonomy. Stuart Mudd, M.D., an immunologist from Philadelphia who had long been a board member, may have done the most to provoke Margaret's concern when he encouraged her to cooperate with the Committee on Maternal Health, yet, at the same time, wrote of the “wonderful personal good will and humanitarian spirit you have introduced in the clinic, which could not be replaced by merely expert and scientific skill.” She, in turn, complained to him that unless she swallowed “hook, line and sinker” every Dickinson proposal, she was accused of being “sassy”—“which makes me tired,” she added frankly. The Advisory Board finally reached what was communicated as a unanimous conclusion that sharing authority for clinic policy would never work, and Margaret, basking in all the positive publicity she had just received, politely turned Dickinson down altogether, subjecting herself to his angry accusations that she was “playing fast and loose” with the prestige of the New York Academy of Medicine.
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If Dickinson went away mad, however, he did not stay that way for long. Margaret quickly announced her intention to solicit medical consultation independent of him. She approached officers of the Academy of Medicine directly and encouraged them to undertake another survey of the clinic's medical operations with the aim of adding several of its members to the existing clinic structure as consultants and visiting physicians. The investigation went forward, and this time the doctors claimed to be impressed by Dr. Stone's competence and sincerity. Margaret went out of her way to be charming personally, and even the dour and often abrasive George Kosmak found little to criticize. During his inspection, however, he apparently complained to the clinic's social worker, Mary Macaulay, that “husbands don't figure here at all,” a comment which provoked some cynical comments about his condescending attitudes toward the autonomy of women in her private letter describing the visit. Kosmak also worried about the numbers of women who were receiving free services, a percentage that grew steadily as the onset of the Depression increased levels of unemployment and need, and provoked further anxiety among Academy members about the dangers of “socialized” medicine.

Nevertheless, the Academy published a favorable report on the clinic in its bulletin and actually issued its first official endorsement of the use of contraception for the prevention of disease—six years before the American Medical Association finally took a position in 1937. The Academy's director, Dr. Linsly R. Williams, then claimed, at least, that he made an effort to find recruits for a medical board but did not succeed, admitting to Margaret that a negative view of her work predominated among his members, who continued to believe that a birth control facility could never function in a scientific manner “as long as it is under private and independent control.”
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Acting on his own and not in any official capacity, however, Dickinson did join the Birth Control Clinical Research Bureau's advisory board and added himself to the growing ranks of Margaret's fawning admirers. The two of them bickered over any number of policy issues and almost came to blows again three years later when Dickinson and his associate, Marie Kopp, published a historic report on the bureau's first 10,000 cases, which left Margaret's name—and Hannah Stone's as well—off the title page. The relationship of the two women to the Birth Control Clinical Research Bureau was mentioned only in passing in the text. Dickinson insisted that Margaret's reputation as a propagandist would compromise the scientific credibility of the document and accused her of a desire for “self-glorification,” because she wanted the study to come out as a joint publication. Arguing that this had been the understanding when the research was first funded by the Bureau of Social Hygiene, she only relented after Ruth Topping of the Rockefeller staff said the arrangement had been left unclear. Dickinson's concession was to offer clinic board member Adolf Meyer, M.D., the opportunity to write a foreword to the study.

As further provocation, Margaret then went ahead and defiantly showed a prepublication draft to a reporter. Dickinson, in turn, called her “impetuous and indiscreet” but also tried to placate her with a patronizing request that she sit for a portrait to be hung in his offices at the academy. Within months, however, she was back in his good graces, and some years later, when she came under renewed fire from her adversaries in the American Birth Control League, he rose forcibly to her defense:

“Mrs. Sanger is the symbol, the international figure, possessed of ability to beget enthusiasm for this work beyond anyone else whatever. She has a way of delivering the goods…. She has ideas. She secures funds to set these ideas at work,” he wrote. In a private letter, he also praised her for having remained steadfast through their many differences and confided: “Leadership sometimes means loneliness. Ideals so far in advance of public opinion as to be bitterly opposed, may breed sternness. For you to keep your kindliness and tenderness is one of the traits your friends most prize.”

Until he died, Robert Dickinson kept a picture on his desk of Margaret Sanger, which was inscribed to him affectionately, and with self-evident humor, from “Saint Margaret.”
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H
ad Margaret capitulated to Robert Dickinson and relinquished complete authority for her clinic to the medical establishment, she undoubtedly would have achieved credibility in certain influential quarters. With the intervention of male physicians and hospital bureaucrats, however, she could not have maintained the clinic facility as the intimate sorority to which she remained fiercely committed—a community of women helping each other to achieve control over their personal lives. This alone, in her view, would empower them in a larger world governed by men. Her ambivalence toward male professionals, who exhibited an unmistakable gender and class bias in their dealings with her, and with clinic staff and patients as well, must be seen in the context of this consistent, if not always outspoken, motivation. Having ceded control of the American Birth Control League, she was also understandably more reluctant to give up the autonomy of her New York clinic in 1929 than she might previously have been, and she was a good deal more wary of the practicality of management by committee. She therefore consolidated her hold over the one institution that remained hers alone, rather than take a back seat, as Dickinson wanted, and as a team of management consultants she hired herself also advised that she do.
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Within a decade, in fact, the facility was renamed the Margaret Sanger Bureau in her honor. With these questions of governance resolved, she also turned her attention back to national and international organizing and began to spend less and less time in New York, keeping her hand in clinic policy and operations only by carefully selecting a staff and board of directors loyal to her vision and to her leadership, and always in touch with her by mail or by telephone. Yet surprisingly, she knew a great deal about what went on day to day, even when she was out of town. When a member of the clinic staff strayed from objectives she had carefully set, the behavior was immediately reported to her. On one occasion, a nurse's abrupt handling of a patient was called to her attention. “I am sure you know one of the dreams of my life has been to have our clinic different from every other so-called public clinic in the world,” she immediately wrote in rebuke. The way to accomplish that goal is to “create an atmosphere of welcome, of kindness, of understanding, where women may come and tell us their troubles and be received with understanding and not with suspicion or
derision
,” she added. The caring atmosphere of the clinic remained her paramount concern, and soon thereafter, when the nurse's behavior did not improve, Margaret summarily fired her.
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To preside over the facility in the manner she ordained, Margaret could not have chosen a physician of more steady but gentle temperament than Hannah Stone. Her face, serene and olive-skinned—her thick, dark hair wrapped in a neat and simple chignon at the nape of her neck—Stone was a madonna-like figure. She was legendary for her sensitivity to patients and her methodical attention to research. Calm, dignified, and intelligent, she was also a consummate professional—the perfect foil for her intensely driven boss, who nonetheless, by all accounts, revered her.

Stone is perhaps best captured in a transparently autobiographical scene from
The Group
, Mary McCarthy's comic and yet poignant novel about the rites of passage of American college women in the 1930s. Stone is seen through the eyes of Dottie Renfrew, an edgy Vassar College senior who has just lost her virginity to a man she hardly knows and, at his instruction, goes to get herself a diaphragm:

Stone's actual situation reflected the anomalous predicament of a generation of American women who came of age in the 1920s with serious professional aspirations but then confronted systematic opposition and institutionalized obstacles to their career advancement. She and hundreds of other similarly situated women doctors, denied hospital affiliation because of gender and class discrimination, found opportunity and challenge, as well as professional community, in birth control clinics throughout the country. Lena Levine, M.D., a gynecologist with additional training in psychiatry who also came to the Sanger clinic at this time, had been among only twenty-five women in her medical school class of 400 in New York and one of six who worked part-time at the clinic to get training in sexuality and birth control. Not a single male colleague ever showed.

Dr. Gerda Bruno had a similar experience. Fully a fourth of the medical school class at the University of Heidelberg in Germany, where she first trained in internal medicine, were women, but the young emigré physician found herself with no comparable network of gender support when she came to New York in 1934. She worked in hospital laboratories until she earned her American medical certification and then set up a private practice in a neighborhood of uprooted European Jews like herself. Married and soon pregnant with her first child, she started working part-time at the Sanger clinic despite the scorn of male associates, who joked about birth control and made no distinction between diaphragms and such traditional devices as condoms or nonmedical techniques like withdrawal. Her own mother could not understand her decision to affiliate with an institution whose reputation she thought scandalous. But Bruno believed in the diaphragm's clear scientific superiority over all other contraceptive options, simply because it gave women confident control over a responsibility she thought men would never take seriously enough.

To these younger women doctors, Margaret was an inspirational figure, if sometimes distant and imperious. “Fantastic, fantastic, charming, beautiful, petite and feminine…and she led such an interesting life,” Bruno recalled years later, after her own retirement. Yet Cheri Appel, M.D., a strong-willed professional who had political ties on the left, felt quite differently. Appel traveled to the Soviet Union with Margaret in 1934. On this trip and in the clinic, in her view, Margaret was frosty and often appeared jealous of the professional credentials of the women doctors. Appel claims that the congenial atmosphere of the Sanger facility was due to the doctors themselves, who worked under the direction of the much nicer Hannah Stone.
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Clinic work demanded a high level of personal commitment from staff physicians, administrators, social workers, and nurses alike. A collective sense of mission linked these younger professionals to the older generation of volunteer activists. Mary Macaulay, who had been director of fieldwork for the Child Study Association of America, a prominent voluntary social welfare institution, came to the clinic as assistant director in 1929. Within a year she established a personal rapport with Sanger and become her resident eyes and ears in New York. Her letters, filled with detailed observations about the staff, the Dickinson controversy, and other official business, invariably ended with effusive, worshipful praise of Margaret herself: “Anyway be sure I love you and acclaim your truth and goodness, the precious dearness of your own life with its great meaning and purpose…,” went one typical example, written after Macaulay had left her position to pursue a love affair in England, the details of which she also confided.

Macaulay's shoes were then filled by Florence Rose, a former social worker no less devoted to the cause and to Margaret personally, whose typical, monthly summary of activities for February of 1936 exemplifies her characteristic zeal. In addition to working with patients, Rose held thirty-two interviews outside the clinic under the combined rubrics of fund-raising and field organization. She saw individuals ranging from a Methodist missionary group leader to the heads of the Brooklyn Association of Rabbis, the Jewish Board of Guardians, and the Federation of Jewish Women's Organizations of Greater New York. Other members of the medical and social work staff were also lecturing in the community at the time, with sixty-four total appearances listed for one calendar year. This level of commitment was best described by another zealous staff member, Cecil Damon, who wrote to Sanger of the need to “clean out those in the organization who consider the work a job.”
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In its early years the clinic struggled with problems of organization and funding, and as might be expected in such fluid circumstances, it suffered a reasonable amount of staff turmoil and turnover. Like most social service and health institutions at the time, it paid low salaries that did not always keep pace with the high expectations made of employees. And although Hannah Stone may have acted as a force of moderation, Margaret herself remained a volatile and exacting personality who could easily drive a less zealous worker to despair with her endless demands that things happen better and faster.

Yet, archival material also reflects that Margaret went out of her way to praise and reward those who performed to her satisfaction. Marcella Sideri, for example, a young Italian nurse earning $135 per month, was arrested in the clinic raid of 1929. When she left to return to Italy with an unemployed husband two years later, Margaret sent her a personal check for $50 with a note about how much she would be missed. Lini Fuhr, a nurse who did follow-up work with delinquent patients, once wrote to Margaret: “Sometimes I feel I should not be paid for doing something which is not work to me, but living.” Fuhr was a widow whose financial responsibility for a young daughter necessitated that she be more realistic about salary. She had been working for wages since the age of thirteen, when she started as a bobbin girl in the mills of Paterson, New Jersey. In 1937, she left her job and her daughter to volunteer in the Spanish Civil War but soon thereafter returned to work as a visiting nurse, while she also went to college for a degree in social work.
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Autonomy provided the Sanger Bureau with a great deal more administrative and ideological flexibility than it could possibly have had under corporate medical control. Despite dire warnings about the hazards of trying to sustain a “one woman movement,” the facility continued to thrive even as the economic and social turbulence of the 1930s lowered expectations for its growth. It was, in fact, one of the only social welfare agencies in New York City that never incurred a deficit during the Depression. The budget, instead, steadily expanded, while other competitive organizations in the birth control field struggled to raise funds and barely survived, as was the fate of Dickinson's committee (renamed the National Committee on Maternal Health) and also of the American Birth Control League in the years Margaret did not head it.
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Once again, Noah Slee provided the financial foundation on which this success rested. In 1930, he purchased an elegant five-story town house at 17 West 16th Street in Manhattan for $80,000. The Birth Control Clinical Research Bureau moved its examination rooms to the parlors of this fine example of Greek Revival architecture, where it remained for forty-three years, rendering medical and counseling services to women in what had once been the handsome home of a prosperous nineteenth-century family. The distinguished building provided a warm and welcoming environment, not unlike a settlement house. Glowingly describing the charms of the new facility and its furnishings, Margaret boasted to Havelock Ellis, “We are grand as can be. Your picture hangs on our walls as always and graces and blesses our work.” The facility was inaugurated, to considerable fanfare in the local papers, at a gala luncheon where the popular British scientist Julian Huxley was cheered for his proposition that only through the dissemination of birth control could man truly hope to control his destiny.
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When the Depression deepened in the winter of 1932, Noah suffered substantial financial reverses, but the clinic does not seem to have been affected. The records are sparse, because as treasurer of what was, after all, a private facility, Noah chose not to publish complete financial statements. Accounts that do remain, however, show no itemization of any payment of rent by the organization, which may mean that, despite the hard times, he personally carried the $33,000 mortgage on the building. This left only staff salaries, utilities, and the cost of supplies as major recurring expenses. During the worst years of the Depression, the operation continued to function on a substantially self-supporting basis, with occasional shortfalls of 10 percent of the budget at most—$5,000, for example, on $50,000 of reported expenses for 1931. At that point, several local social welfare agencies began to contribute a portion of the cost of supplies for women on relief, despite a disparaging view of welfare handouts typical even of reformers in this period, who felt that these materials would probably be used more carefully if clients themselves had to pay at least a small amount for them. The cost of supplies dropped, in any event, as a function of increased availability and the overall deflation. Staff salaries were also cut. Physicians' fees were apportioned on a sliding scale, and no one was turned away because of lack of funds.
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Margaret also stepped up her efforts to accommodate the new circumstances by replacing the volunteer women who had previously assisted her as fund-raisers with a weightier board of directors, which included the wives of some of New York's best known and wealthiest industrialists and financiers like J. P. Morgan, William K. Vanderbilt, Thomas Lamont, and Otto Kahn. Such prominent surnames—even if it was only the wives who participated—in turn made board service appealing to some prominent younger men in the legal and business community. The board seems to have exercised little, if any, influence on policy, but it did formally assume financial responsibility for all operating deficits.