Margaret Sanger, "The Physician and Birth Control," Mar 1923.

Source: " The Medical Times, Mar. 1923, pp. 73-74, 77."

This article was co-authored by Thomas Webster Edgar. For a reprint of this article see, Margaret Sanger Microfilm, Collected Documents Series, C16:0189.


The Physician and Birth Control

Thomas Webster Edgar, M.D., and Margaret Sanger

320 West 82nd Street.

Foreword.

Due to my great interest in birth control, legitimately sponsored and properly advocated, I have collaborated with Margaret Sanger in presenting this article. My interest in the subject is purely humanitarian.--Thomas W. Edgar.

Although it is only in the last few years that the doctrine of Birth Control has assumed the proportions of a definitely crystallized world movement, its history is ancient. This history began with the first crude efforts to control and direct the human reproduction. This custom of infanticide, a custom practiced in certain portions of the globe even today, was the first crude and barbarous expression of a dim realization that instinct must in some way be made to subserve intelligent adaptation. The next step toward conscious control of population was the practice of abortion. It is unnecessary here to go into the history of this cruel and barbarous practice. Physicians even today are brought sufficiently into contact with the dangers and the frightful cost of this emergency measure, which still remains, among large sections of the world's population, the only method of control over the great overwhelming power of the procreative instincts. Birth Control, as it is understood by all intelligent students today, means the substitution of scientific contraception of a sanitary and harmless nature for the costly, cruel and often fatal customs of infanticide and abortion.

The World War has concentrated interest in and thrown new light on the complex problems of population, of racial conflicts, as well as upon the qualitative analysis of human intelligence. A large and distinguished body of social and economic thinkers are coming to realize that the complex economic and political problems which confront human society today are organically bound up with the question of Birth Control. But in thus emphasizing the larger aspects of this program, we should never forget that actual progress is impossible without the cooperation and the guidance of, the scientist and the physician.

The program for Birth Control parallels recent developments in the sphere of medicine. In the war against disease and epidemic, prevention and sanitation are now recognized as the only adequate weapons. Undoubtedly for many years to come the majority of physicians and surgeons must direct their energies to individual cases of disease. But because this is their task, a task requiring a vast fund of fortitude and patience, it would be an error to suppose that the role of the physician in society should be limited to the care and cure of the diseased and ailing. His is a vastly more important role. His sphere is by no means limited to the mere amelioration of human suffering; it embraces the whole of life, health as well as disease. Individual and racial health, as every day we are coming more intensely to realize, has its own laws and structure--laws as complex, as deeply rooted, and as worthy of investigation as those of disease. In our more superficially humanitarian efforts we have perhaps not realized until very recently, that the prevention of disease is dependent upon broadly based programs of social hygiene and racial prophylaxis. When laymen, as well as physicians, awaken to the fact that disease is not a matter of chance occurrence, but is closely related to every manifestation of life, the pivotal importance of the physician to every human being, in health as in illness, will be recognized. The day is not far distant let us hope, when the doctor, armed with the intimate knowledge of every phase of the human constitution, and standing with the calm authority of far-seeing vision, may be acclaimed, rather than the priest, the politician or the warrior, as the only true leader competent to show suffering humanity the path out of its vale of tears. For today only to the physician is afforded a view of man as a biological organism. If the physician be possessed of the "divine curiosity" of Science, he comes to the realization that the greatest menace to the health of humanity is found not in those dire epidemic of infectious or contagious diseases that may cut down whole communities, calamitous as these seem. The direct menaces is to be found in the heritable maladies and defects which are handed down to generation after generation, and manifest themselves in myriad forms. Thus syphilis allies itself with feeble-mindedness. And mental defect, wearing the mask of delinquency, pauperism, prostitution and crime, renders almost impossible the Herculean task of attaining racial health. Our poorhouses, our prisons, our asylums for the feeble-minded, all have a common biological root. Crime is not merely a matter of law. It has a physiological history. A faulty heredity, a defective germ plasm, a biological or physiological imperfection of the nervous and endocrine system--these lie at the root of most of our social and racial problems.

It has been the realization of these truths that has enlisted most of the physicians and scientists of other countries who have challenged conservative opinion by bravely championing the cause of Birth Control. This movement is by means of propaganda of extremists who are seeking to tell physicians and doctors their duty. On the contrary, from the earliest days of the Neo-Malthusian agitation it has been inspired and directed by physicians who had the clear vision that enabled them to look beyond the special individual case to the underlying significance. In England those valiant pioneer Doctors George and Charles R. Drysdale fought for years against the momentum of Victorian opinion. In Holland, where the First Birth Control Clinic in the world was opened in Amsterdam in 1881, it has been mainly due to the efforts of two physicians, Dr. Aletta Jacobs and Dr. J. Rutgers that we have that splendid example of what the practice of Birth Control and the establishment of clinics under the direction of trained specialists may accomplish for a nation.

We present hereith authentic tables indicating the results in Holland, where fifty-two clinics are in operation among a population of some 6,000,000 people:

Amsterdam (Malthusian [Birth Control] League started 1881; Dr. Aletta Jacobs gave advice to poor women, 1885.)

Birth Rate per 1,000 of populations 1881-1889 1906-10 1912 37.1 24.1 23.3 Death Rate per 1,000 of population 25.1 13.1 11.2 Infantile Mortality: Deaths in first year per 1,000 living births 203 90 64

The Hague (now headquarters of the Neo-Malthusian [Birth Control] League)

Birth Rate per 1,000 of populations 1881-1889 1906-10 1912 38.7 27.5 23.6 Rate per 1,000 of population 23.3 13.2 10.9 Infantile Mortality: Deaths in first year per 1,000 living births 214 99 66

Rotterdam

Birth Rate per 1,000 of population 1881-1889 1906-10 1912 37.4 32.0 29.0 Death Rate per 1,000 of population 24.2 13.4 11.3 Infantile Mortality: Deaths in first year per 1,000 living births 209 105 79

Fertility and Illegitimacy Rates

Legitimate fertility: Legitimate birth per 1,000 married women aged 15 to 45 1880-2 1890-2 1900-02 306.4 296.5 252.7 Illegitimate fertility: Illegitimate birth per 1,000 unmarried women aged 15 to 45 16.1 16.3 11.3

The Hague

Legitimate fertility 1880-2 1890-2 1900-02 346.5 303.9 255.0 Illegitimate fertility 13.4> 13.6 7.7

Rotterdam

Legitimate fertility 1880-2 1890-2 1900-02 331.4 312.0 299.0 Illegitimate fertility 17.4 16.5 13.1

At the present moment, England offers a brilliant illustration of the interest of physicians in the problem of Birth Control. The sensational address on "Married Love" of Lord Dawson, the King's physician, at the Lambeth Conference of the Bishop of the Church of England, in which he defended the practice of Birth Control, is one outstanding instance. At the Fifth International Congress on Birth Control held in London last summer, the Contraceptive Section, held for doctors and medical students only, under the presidency of Dr. Norman Haire, illustrated the growing adherence of British physicians to the movement. It was attended by no less than 164 medical men and women, including Lord Dawson and Sir Arbuthnot Lane, who, with the exception of only three dissenters, passed this resolution:

"That this meeting of the medical members of the Fifth International Neo-Malthusian and Birth Control Conference wishes to point out that Birth Control by hygienic contraceptive devices is absolutely distinct from abortion in its physiological, legal and moral aspects. It further records its opinion that there is no evidence that the best contraceptive methods are injurious to health or conducive to sterility."

Similarly, the Medical Section, held under the presidency of Dr. C. Killick Millard, unanimously passed the following resolution:

"That this meeting of the Fifth International Neo-Malthusian and Birth Control Conference, consisting chiefly of members of the British medial profession, considers that it is of the greatest importance that the provisions of hygienic Birth Control instruction should become part of the recognized duty of the medical profession, and that such instruction should especially be given at all hospitals and public health centers to which the poorest classes and those suffering from hereditary disease or defectiveness apply for help."

Previous to the Conference, Dr. Millard had sent a questionnaire to the leading members of the British medical profession. From their replies, Dr. Millard reported, it could no longer be claimed that the medical profession in Great Britain condemned contraceptive methods; but he made a strong plea that the profession should concentrate its attention upon this important subject, because, if it continued to be silent, it committed to laymen the solution of problems which are legitimately within the sphere of its activity. Two of the leading medical journals of Great Britain, the Lancet and the British Medical Journal, devoted much space to the conference, especially the contraceptive and medical aspects. The British Medical Journal notes: ". . .It was interesting to observe the way in which people who were sharply divided on other subjects found a common meeting place in Birth Control. The matter was pressed to the same conclusion from the point of view of the Socialist and the individualist, the nationalist and the internationalist. . . ." The Lancet reported the speeches of Lord Dawson, Sir Arbuthnot Lane, and other men eminent in the medical profession.

But it has not been in the Western world alone that physicians have pioneered the way for hygienic Birth Control. In Japan, Dr. Kezutami Ukita, a decade or so ago, courageously advocated Birth Control, in the face of the most powerful militarists of the island empire. Dr. Tokijiro Kaji, returning from Germany and Holland where he had undertaken a technical study of contraception, devised appropriate methods for the Japanese. He established a free clinic in Tokyo and finally opened the People's Hospital, for the benefit of women of the poorer classes. Only last year the Japanese Birth Control Association was organized, with Dr. Kaji as one of the four founders.

It would be unfair not to record here the strong support given to the Birth Control Movement in the United States by individual physicians. The scientific and medical magazines often contain papers of the greatest importance upon this question, and papers are read in the various societies that bear pertinently upon Birth Control. Unfortunately the physician too often confines his remarks to his colleagues, and the significant truths of his experiences are seldom conveyed to the general public. Thus, Dr. N. S. Yawger read a compelling paper before the Philadelphia Neurological Society (Footnote: January 27, 1922, N. Y. Med. Jour., Vol. CXVI, No. 6, p. 334), dealing with an epileptic and her sixteen children, a study "of a family that was rendered distressingly poor through the circumstances of a blind father, and of an epileptic mother who scouted race suicide by living up to sixteen pregnancies, who clung to all these maternal burdens save one--the tenth conception miscarried--but who still ran true to a total of sixteen, by reason of her first effort having brought forth twins. Despite the fact that there was no evidence of syphilis that the diseases and defects of the unfortunate children do not appear especially to have developed upon a leutic basis--only three of the children appeared to have escaped the hereditary blight. Dr. Yawger concludes that " a small volume could be written upon the disorders which will develop among the early descendants of this ill-fated family." Such studies are of the greatest value not merely to the medical profession, but to all who have the health of the nation and of the race at heart--and where else, we may ask, is true patriotism to be found? In the matter of breeding out disease and breeding in health, prophylaxis, as a distinguished authority asserts, is ninety per cent. of the cure. Until the medical profession, not merely at home but in all countries in the world, and the laity under the leadership of medical science, realize these fundamental and unchanging truths, we cannot hope to make any progress toward the eradication of those monstrous biological diseases, the full terror of whose blight we can only realize when we study them through a succession of generations, when we study them genetically instead of in the individual patient.

The profession of medicine stands upon the threshold of a new era in the social organism. The physician today is in possession of truths of the most vital importance to the community; and it is his duty, as a member of one of the noblest, if not the noblest of all professions, to co-operate to the full extent of his ability with Science in enlightening the public concerning those necessary biological laws which we must observe or perish.

In the past, medicine has too often been looked down upon as a plodding prosaic and uninteresting profession, secondary in importance to that of the Church, the law, or politics. " How can the voice of the physician be heard," exclaimed George Drysdale, "if he can urge only the feeble motives of expediency, while the moralist and the clergyman have at their command the armory of duty and religion, with the array of eternal rewards and punishments, to enforce reverence for their precepts?"

It is because the Birth Control Movement is the only organized current of thought in the world today that emphasizes the basic and fundamental place of the physician in the community that we urge upon all members of the profession the immediate study of this problem in all its aspects. Mere agreement with or assent to the doctrine is not enough. The immediate need of the country is technical study and experimentation, and the presentation of the results to all parents and parents-to-be. The destiny of the United States cannot be founded.


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