Making Medical History: The Sociologist Who Helped Legalize Birth Control

When sociology and economics professor Norman E. Himes published The Medical History of Contraception in 1936, he had made a daring, yet tactical move. At the time, contraception was not, legally speaking, considered a medical matter at all. Under the Comstock Act, which had been in effect since 1873, all literature and devices used for contraceptive purposes were considered “obscenities”—illegal to possess or distribute. A doctor sending a woman home with a diaphragm or informational birth control pamphlet was not dispensing a prescription; he was committing a crime.

Himes, a strong proponent of legal, accessible contraception, was one man in an army fighting to strip birth control of its “obscene” label. He counted himself among a legion of white, middle-class feminists called the “birth control movement,” whose agenda was to secure the right to prevent unwanted pregnancy. Under the leadership of Margaret Sanger (a figure now known as much for her controversial ties to the American eugenics movement as for paving the way to accessible birth control), the movement adopted a singular stratagem to achieve its goal: to legalize birth control by medicalizing it. In other words, Sanger and her organizers sought to transform illegal contraceptive devices—specifically, the diaphragm and spermicidal jelly—into medical devices in the eyes of the law.

In order to medicalize what was largely understood as a social vice, the birth control movement attacked from multiple angles. Women organizers across the nation opened underground family planning clinics, and Sanger laid the groundwork for a pharmaceutical contraceptive supply chain. Meanwhile, Himes went to work behind the scenes cultivating an encyclopedic expertise of modern birth control, eventually resulting in the publication of Medical History. But Himes’ academic pursuits had an agenda: by writing the history of contraception as a “medical” one, he repositioned physicians as the natural and rightful authority on contraception, thereby legitimizing a previously salacious practice. A closer look at the oft-forgotten work of Himes reveals how a man with no medical training ironically became the foremost expert on medical birth control and helped achieve a medical model of birth control by writing it into existence.

Outside of the research he produced, not much is known about Norman Himes the man, or the motivations for his avid support of the birth control movement. What we do know is that, at the time of its publication in 1936, his Medical History of Contraception was the only text of its kind. Not only was there no other comprehensive history of contraceptive practices and technologies around the world, there was scarcely any published literature on contemporary birth control methods in the United States. The Comstock Act had rendered the topic too taboo to warrant serious academic attention, and the medical community was at odds about whether it was scientific—or morally defensible—enough to enter its purview. What Himes’ book sought to do was to not only fill the void of reputable research on the history of contraception, but to help achieve the birth control movement’s goal of “legalization via medicalization.” By writing his history of contraception as a “medical history,” Himes strategically positioned physicians as the primary stakeholders and technical experts of contraceptive knowledge and technologies.

As a covert operative for the birth control movement, one of Himes’ greatest strengths was his keen awareness of how information on contraception might be received by a medical audience that was almost uniformly older, white, and male. When developing written materials for physicians, Himes routinely de-emphasized the role of feminist activists—”propagandists,” as he called them—in the push toward legal, medical birth control.^[1] “Whatever you or I may think of the work of Mrs. Sanger,” he explained to Sanger’s secretary after omitting her impassioned book, Women and the New Race, from a bibliography, “it is no doubt true that many medical men resent instruction from a nurse.”^[2] While he personally respected Sanger’s contributions to the movement, he also understood that his social position as a white man with a doctorate made him uniquely attuned to the average physician’s biases, and uniquely suited for the role of liaison.

However, writing from a non-medical background, Himes still needed to tread carefully so as to respect the social prestige and technical expertise of his readers. A few years in advance of his book’s publication, he prudently wrote directly to the New England Journal of Medicine to ingratiate himself with his medical audience. “I come to you with some timidity as a layman,” he humbly announced. “Let me assure you at once that my investigation of the history of contraception has proceeded from no desire to usurp a medical function.” He repeated this disclaimer once again in the introduction of his book.^[3]

But this disclaimer was more for show than for substance. In reality, Himes was more knowledgeable on the medical aspects of contraception than the vast majority of American physicians. Until the American Medical Association deemed birth control a suitable topic for medical education in 1937, medical schools did not teach about contraceptive practice, and the big professional journals refused to publish clinical studies about it. Since the Comstock Act restricted a physician’s ability to distribute contraceptive information and devices, none but the few doctors secretly affiliated with the birth control movement were familiar with the science on the subject. Himes, on the other hand, had not only collected, evaluated, and anthologized all reputable research on contraceptive methods and their actual use in his Medical History; he had firsthand experience delivering diaphragms, spermicidal jellies, and literature to American women through the already-thriving underground market.

Himes’ primary role in the birth control movement was as a consultant to its various organizational arms, including Margaret Sanger’s American Birth Control League (ABCL, the precursor to Planned Parenthood), the National Committee on Maternal Health, and the Holland-Rantos Company. The latter outfit was the only U.S.-based pharmaceutical manufacturer of high-quality, albeit illegal, diaphragms and spermicidal jelly. Although in name Holland-Rantos was owned by Herbert Simonds, an engineer, it was in practice run by Sanger herself to provide contraceptives to her ABCL clinics.

Himes’ correspondence with Holland-Rantos throughout the 1920s and 1930s reveals that he was far more than just a casual academic consultant. Rather than simply supplying the facts and figures for informational diaphragm pamphlets from his cache of research, Himes frequently ghost-wrote the pamphlets himself, including the detailed medical indications and instruction. In cases where physicians authored Holland-Rantos’ medical literature, the company still turned to Himes as the final authority on the finer details. For example, in a 1929 letter to Himes, a Holland-Rantos secretary expressed that the company “had some doubts in regard to the explanation of the technique in relation to the use of the diaphragm. Percy Clark [the company’s resident physician] insists that the constrictor cunni muscle must be identified for a proper fitting. Will you please let us have your view on this point.”^[4] It was therefore Himes—not another physician—who was developing the knowledge base and clinical protocol for the medical establishment to learn and follow.

In December of 1936, less than a year after the Medical History of Contraception was published, Margaret Sanger, on behalf of the entire birth control movement, won the landmark Supreme Court case, United States vs. One Package. The case effectively overturned the Comstock Act, ruling that contraceptive materials were considered legal medical devices that could be dispensed by licensed physicians. Although Himes did not work alone in securing this victory, his role in researching, compiling, and communicating reputable research on birth control to the medical establishment should not go uncredited. While Sanger took the stand, Himes was fighting a case of his own, making a written appeal to physicians about the future they could have as the sole gatekeepers of contraceptive knowledge and devices. The same physicians who testified and lobbied for medical control over contraception likely did so at least in part because they thumbed the pages of Himes’ book, having been persuaded that, “since the problem [of conception control] is essentially medical, instruction ought to be in the hands of the medical profession.”^[5]

To be sure, the success of the birth control movement was in every sense a collaborative effort, one driven primarily by women whose names have been buried in history far deeper than even Himes’. For every Norman Himes, there were hundreds more women working in the shadows who put their time, resources, and livelihoods on the line to fight for access to safe and effective birth control. Nevertheless, Himes’ story powerfully illuminates how writing history can shape the future.

Lea Eisenstein

Lea Eisenstein is a recent graduate of the University of Pennsylvania, where she received her BA studying the history of medicine, the history of technology, and gender and health. Her honors thesis, "From Icon to Bygone: The Rise and Fall of the Diaphragm in Twentieth-Century America," explores the social history of the contraceptive diaphragm.

• Lea Eisenstein

  https://nursingclio.org/author/lea-eisenstein/

  The Women’s Health Movement and the Dream of the Diaphragm