Book Review of Contraception: A Medical Review of the Situation

The Committee on Maternal Health of New York is to be congratulated upon the appearance of Dr. Dickinson's report, which is perhaps the first essay of its kind to be published in this country. Even among those members of the medical profession who have taken the time and trouble to inquire into the actual present status of the practice of Birth Control in this country, definite scientific and statistical knowledge has been woefully scant. "The gist of what is known is here given," states Dr. Dickinson at the outset, "together with an account of the attempts to secure clinical data." The investigator reiterates the appeal that has so often been voiced in these pages--for the need of investigation by the medical profession. He agrees (though perhaps unconsciously) with the aims of the American Birth Control League, and with Lord Dawson of Penn, that "the medical profession alone can determine many physical questions bearing on structure, function, and abnormal or diseased states." In addition to this mechanical side, the various mental and moral reactions that come chiefly to the knowledge of the doctor, as the father-confessor in matters of sex, should be taken from available records for consideration. He repeats the appeal of the American Birth Control League for the correlation and co-ordination of medical records and clinical data. Not the least illuminating phase of this study is to be found in his appended diagrams, which throw considerable and valuable light on this hidden phase of human life.

With these outstanding virtues, it is the more lamentable that Dr. Dickinson has been unable, or has not seen fit, to publish fuller information about the birth control clinics in Holland. There is evident in his report an inclination to discredit statements made concerning the "52 clinics" of Holland. As, since my visit to Holland in 1915, I have been guilty of making these statements again and again I feel called upon here to say something in defense of them. Although in person I visited only five of these clinics, I would refer those interested in this matter to the Annual Report of the Nieuw-Malthusian Band for the year 1920. Dr. Rutgers was then president of the Dutch League, and in his report stated that a new board of directors had been formed. Dr. Rutgers at that time relinquished the presidency and the new board of directors, "more democratic" in spirit, took charge of the work. A period of disintegration seems to have set in, temporarily, and subsequent reports of the work have been less encouraging. But it is not enough to judge the work in Holland, which has covered such a long period of years, by a temporary depression due undoubtedly to the resignation and subsequent death of Dr. Rutgers, whose indefatigable devotion and tireless efforts, obtained notable results. The report of the Dutch League reported not 52, but 54 clinics, 8 doctors and 56 nurses in charge, and admitted that the year 1920 had been a difficult one for the Bund.

"Our search discovers no investigation of 'Birth Control' made in a scientific and ethical spirit approaching the subject "without bias ," asserts Dr. Dickinson. I regret that I must agree with this statement. But I am even more sorry that his own report, despite its protestations of impartiality, should itself be tainted with bias, the more so as he has the advantage of scientific training and should approach the problem without parti-pris. On page 20 of his report he speaks of "the clinic run by Dr. Dorothy Bocker next to the office of Margaret Sanger's Birth Control League." Surely it cannot be devotion to scientific precision that has led Dr. Dickinson to this combination of misstatements. Such lack of precision is hardly in accordance with the spirit of scientific impartiality which is, in the opinion of the present authority, the great present need in investigation of clinical data. In the first place, the organization to which Dr. Dickinson refers, is not "Margaret Sanger's;" it is the American Birth Control League, legally incorporated under the laws of the state of New York. In the second place, the "clinic run by Dr. Dorothy Bocker" is a research bureau conducted under the personal direction of Margaret Sanger, with Dr. Bocker as a medical director. Merely in the interest of accuracy and impartial fairness we offer these corrections here. Without a recognition of the manifold difficulties under which such pioneer work must be carried on in these United States, our aims and limitations may be misinterpreted by future investigators.

The whole subject of contraception, as Dr. Dickinson so rightly concludes, is susceptible of handling as clean science, with dignity, decency and directness. This indeed has from its inception been the aim of the American Birth Control League. Because of its unswerving adherence to these principles, it has won a place of respect among impartial scientists both here and abroad. Despite the complexity and menacing aspects of the problem it has attacked, despite its limited resources, despite the intellectual inertia of the medical profession and the languid interest of the American clergy, the League is gradually enlisting the competent co-operation of cool headed, impartial and unbiased scientists, and because of its irrefutable claim for respect, it will continue to do so.