January 23, 2017History of Medicine
The Egyptian Ebers Papyrus from 1550 BCE and the Kahun Papyrus from 1850 BCE have within them some of the earliest documented descriptions of birth control: the use of honey, acacia leaves and lint to be placed in the vagina to block sperm.
The Egyptian Ebers Papyrus from 1550 BCE and the Kahun Papyrus from 1850 BCE have within them some of the earliest documented descriptions of birth control: the use of honey, acacia leaves and lint to be placed in the vagina to block sperm. It is believed that in Ancient Greece silphium was used as birth control which, due to its effectiveness and thus desirability, was harvested into extinction. In medieval Europe, any effort to halt pregnancy was deemed immoral by the Catholic Church, although it is believed that women of the time still used a number of birth control measures, such as coitus interruptus and inserting lily root and rue into the vagina. Women in the Middle Ages were also encouraged to tie weasel testicles around their thighs during sex to prevent pregnancy. The oldest condoms discovered to date were recovered in the ruins of Dudley Castle in England, and are dated back to 1640. They were made of animal gut, and were most likely used to prevent the spread of sexually transmitted diseases during the English Civil War. Casanova, living in 18th century Italy, described the use of a lambskin covering to prevent pregnancy; however, condoms only became widely available in the 20th century.
The birth control movement developed during the 19th and early 20th centuries. The Malthusian League, based on the ideas of Thomas Malthus, was established in 1877 in the United Kingdom to educate the public about the importance of family planning and to advocate for getting rid of penalties for promoting birth control. It was founded during the Knowlton trial of Annie Besant and Charles Bradlaugh, who were prosecuted for publishing on various methods of birth control. In the United States, Margaret Sanger and Otto Bobsein popularized the phrase birth control in 1914. Sanger was mainly active in the United States but had gained an international reputation by the 1930s. At the time, under the Comstock Law, distribution of birth control information was illegal. She jumped bail in 1914 after her arrest for distributing birth control information and left the United States for the United Kingdom to return in 1915. Sanger established a short-lived birth-control clinic based in the Brownville section of Brooklyn, New York in 1916, which was shut down after eleven days and resulted in her arrest. The publicity surrounding the arrest, trial, and appeal sparked birth control activism across the United States.
The first permanent birth-control clinic was established in Britain in 1921 by Marie Stopes working with the Malthusian League. The clinic, run by midwives and supported by visiting doctors, offered women’s birth-control advice and taught them the use of a cervical cap. Her clinic made contraception acceptable during the 1920s by presenting it in scientific terms. In 1921, Sanger founded the American Birth Control League, which later became the Planned Parenthood Federation of America. In 1924 the Society for the Provision of Birth Control Clinics was founded to campaign for municipal clinics; this led to the opening of a second clinic in Greengate, Salford in 1926. Throughout the 1920s, Stopes and other feminist pioneers, including Dora Russell and Stella Browne, played a major role in breaking down taboos. In April 1930 the Birth Control Conference assembled 700 delegates and was successful in bringing birth control and abortion into the political sphere. Three months later, the Ministry of Health, in the United Kingdom, allowed local authorities to give birth-control advice in welfare centers. In 1936 the U.S. court ruled in U.S. v. One Package that medically prescribing contraception to save a person’s life or well-being was not illegal under the Comstock Law. Following this decision, the American Medical Association Committee on Contraception revoked its 1936 statement condemning birth control. A national survey in 1937 showed 71% of the adult population supported the use of contraception. By 1938 347 birth control clinics were running in the United States despite their advertisement still being illegal. First Lady Eleanor Roosevelt publicly supported birth control and family planning. In 1966, President Lyndon B. Johnson started endorsing public funding for family planning services, and the Federal Government began subsidizing birth control services for low-income families. The Affordable Care Act, passed into law on March 23, 2010 under President Barack Obama, requires all plans in the Health Insurance Marketplace to cover contraceptive methods. These include barrier methods, hormonal methods, implanted devices, emergency contraceptives, and sterilization procedures.
In 1909, Richard Richter developed the first intrauterine device made from silkworm gut, which was further developed and marketed in Germany by Ernst Grafenberg in the late 1920s. In 1951, a chemist, named Carl Djerassi from Mexico City made the hormones in progesterone pill using Mexican yams. Djerassi had chemically created the pill but was not equipped to distribute them to patients. Meanwhile, Gregory Pincus and John Rock, with help from the Planned Parenthood Federation of America, developed the first birth control pills in the 1950s, such as mestranol/noretynodrel, which became publicly available in the 1960s in the US under the name Enovid. Medical abortion became an alternative to surgical abortion with the availability of prostaglandin analogs in the 1970s and mifepristone in the 1980s.
2017 marks the 57th anniversary of the birth control pill, which many considered to have empowered women and sparked the sexual revolution. However, for centuries, women have had some control over reproduction, although perhaps, not as effective as what’s available today.
Records exist of women in ancient Rome and Greece relying on dances and amulets to prevent pregnancy, and we can assume that those practices probably didn’t work.
Citric acid is said to have spermicidal properties, and women used to soak sponges in lemon juice before inserting them vaginally. Mentioned in the Talmud, this was a preferred method of birth control in ancient Jewish communities. The sponge itself would act as a pessary, a physical barrier between the sperm and the cervix. The great womanizer Casanova was said to have inserted the rind of half a lemon into his lovers as a primitive cervical cap or diaphragm, the residual lemon juice serving to annihilate the sperm. Lemon- and lime-juice douches following coitus were also recommended as a form of birth control, but this method was likely less effective, since sperm can enter the cervix – and hence out of reach of any douching – within minutes of ejaculation. Incidentally, some alternative medicine practitioners today suggest that megadoses of vitamin C (6 to 10 g a day) could induce an abortion in women under 4 weeks of pregnancy, but there’s no evidence that citrus fruits were used in this way in ancient times.
Queen Anne’s Lace is also known as wild carrot, and its seeds have long been used as a contraceptive. Hippocrates described this use over two millennia ago. The seeds block progesterone synthesis, disrupting implantation and are most effective as emergency contraception within eight hours of exposure to sperm, a sort of morning after form of birth control. Taking Queen Anne’s Lace led to no or mild side effects (like a bit of constipation), and women who stopped taking it could conceive and rear a healthy child. The only danger, it seemed, was confusing the plant with similar-looking but potentially deadly poison hemlock and water hemlock.
Pennyroyal is a plant in the mint genus and has a fragrance similar to that of spearmint. The ancient Greeks and Romans used it as a cooking herb and a flavoring ingredient in wine. They also drank pennyroyal tea to induce menstruation and abortion. 1st-century physician Dioscorides records this use of pennyroyal in his massive five-volume encyclopedia on herbal medicine. Too much of the tea could be highly toxic, however, leading to multiple organ failure.
Blue cohosh, traditionally used for birth control by Native Americans. It contains at least two abortifacient substances: one mimics oxytocin, a hormone produced during childbirth that stimulates the uterus to contract, and a substance unique to blue cohosh, caulosaponin, also results in uterine contractions. Midwives today may use blue cohosh in the last month of pregnancy to tone the uterus in preparation for labor. The completely unrelated but similarly named black cohosh also has estrogenic and abortifacient properties and was often combined with blue cohosh to terminate a pregnancy.
Dong quai, also known as Chinese angelica, has long been known for its powerful effects on a woman’s cycle. Women drank a tonic brewed with dong quai roots to help regulate irregular menstruation, alleviate menstrual cramps and help the body regenerate after menstruation. Taken during early pregnancy, however, dong quai had the effect of causing uterine contractions and inducing abortion. European and American species of angelica have similar properties but were not as widely used.
The Tacuinum Sanitatis, a medieval handbook on wellness, lists the following 5 properties of rue:
The refined oil of rue is an emmenagogue and was cited by the Roman historian Pliny the Elder and the gynecologist Soranus as a potent abortifacient (inducing abortion). Rue, a blue-green herb with feathery leaves, is also grown as an ornamental plant and is favored by gardeners for its hardiness. It is rather bitter but can be used in small amounts as a flavoring ingredient in cooking. Soranus, a gynecologist from 2nd-century Greece, described its use as a potent abortifacient, and women in Latin America have traditionally eaten rue in salads as a contraceptive and drunk rue tea as emergency contraception or to induce abortion. Ingested regularly, rue decreases blood flow to the endometrium, essentially making the lining of the uterus non-nutritive to a fertilized egg.
The earliest evidence of cotton use has been found at sites where cotton threads were preserved in copper beads; these finds have been dated to Neolithic (between 6000 and 5000 BCE). Cotton cultivation in the region is dated to the Indus Valley Civilization.In the ancient medical manuscript the Ebers Papyrus (1550 BCE), women were advised to grind dates, acacia tree bark, and honey together into a paste, apply this mixture to seed wool, and insert the seed wool vaginally for use as a pessary. Granted, it was what was in the cotton rather than the cotton itself that promoted its effectiveness as birth control – acacia ferments into lactic acid, a well-known spermicide – but the seed wool did serve as a physical barrier between ejaculate and cervix. Interestingly, though, women during the times of American slavery would chew on the bark of cotton root to prevent pregnancy. Cotton root bark contains substances that interfere with the corpus luteum, which is the hole left in the ovary when ovulation occurs. The corpus luteum secretes progesterone to prepare the uterus for implantation of a fertilized egg. By impeding the corpus luteum’s actions, cotton root bark halts progesterone production, without which a pregnancy can’t continue.
In South Asia and Southeast Asia, unripe papaya was used to prevent or terminate pregnancy. Once papaya is ripe, though, it loses the phytochemicals that interfere with progesterone and thus its contraceptive and abortifacient properties. The seeds of the papaya could actually serve as an effective male contraceptive. Papaya seeds, taken daily, could cut a man’s sperm count to zero and was safe for long-term use. Best of all, the sterility was reversible: if the man stopped taking the seeds, his sperm count would return to normal.
Silphium was a member of the fennel family that grew on the shores of Cyrenaica (in present-day Libya). It was so important to the Cyrenean economy that it graced that ancient city’s coins. Silphium had a host of uses in cooking and in medicine, and Pliny the Elder recorded the herb’s use as a contraceptive. It was reportedly effective for contraception when taken once a month as a tincture. It could also be used as emergency birth control, either orally or vaginally, as an abortifacient. By the second century CE, the plant had gone extinct, likely because of over harvesting.
Civilizations the world over, from the ancient Assyrians and Egyptians to the Greeks, were fascinated by mercury and were convinced that it had medicinal value and special curative properties, using it to treat everything from skin rashes to syphilis. In ancient China, women were advised to drink hot mercury to prevent pregnancy. It was effective at convincing a woman’s body that she wasn’t fit to carry a child, leading to miscarriage, so, it did work as a contraceptive. However, mercury is enormously toxic, causing kidney and lung failure, as well as brain damage and death.