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From Crocodile Dung Pessaries to the Pill

A History of Birth Control

Birth control—or contraception, which means the “deliberate use of artificial methods or other techniques to prevent pregnancy as a consequence of sexual intercourse” (Knowles)—may seem like a relatively modern topic, and it is surely controversial. However, humans have been using a dizzying array of birth control methods since ancient times, and some of these might seem bizarre or have proved to be very dangerous.

From the crocodile dung pessary of the ancient Egyptians to the birth control pill that revolutionized female contraception in the 1960s to the hormone patches, gels, and implants we have today, this article will explore some of the more interesting methods and devices humans have used for purposes of contraception from ancient times to modern day.

Coitus Interruptus: Pre-17th Century B.C.

Possibly the earliest form of birth control was called coitus interruptus, where the male withdraws his penis before ejaculation occurs. It is perhaps the single most common contraceptive method in history (Gordon). There is documented evidence that ancient cultures from the Jewish to the Egyptian to the Chinese practiced this method of birth control. It is even mentioned in the Bible in the Book of Genesis, when Onan incurred the wrath of Yahweh by releasing his seed onto the ground rather than into the womb (Riddle 1992).

The Egyptians: 1850 to 1500 B.C.

Jar of Honey One of the ancient Egyptian prescriptions for birth control includes a tampon-like pessary smeared with honey mixed with soda or salt peter

Other methods and devices used strictly for birth control have also been around since ancient times, beginning with the ancient Egyptian civilization. The Kahun Papyrus dates from 1850 B.C. and is the oldest known medical text in the world today. It includes three fragments of prescriptions designed to prevent pregnancy. All of them deal with pessaries, or vaginal suppositories. One of the prescriptions calls for crocodile dung to be mashed up and mixed with a fermented dough, and another calls for honey mixed with soda or saltpeter. The third prescription calls for unreadable ingredients which were also mixed with a fermented dough (Bullough).

Other medical papyruses, including the Ramesseum Papyrus from the 17th century B.C, also advise the use of crocodile dung. Dung from various animals was used because it was sticky and might have formed a semi-successful barrier to hinder sperm penetration. It could also be that the use of crocodile dung had a religious meaning as well, as the crocodile was the animal associated with the Egyptian God Set—who, in turn, is associated with hemorrhaging, miscarriage, and abortion (ibid).

The Ebers Papyrus, from around 1550 B.C., describes a birth control prescription using a mixture of acacia berries and colocynth (also known as bitter apple or desert gourd) mixed with honey to form a sort of tampon that was then inserted into to a woman’s vulva. This method was known to prevent pregnancy for up to three years. Acacia forms lactic anhydride when it is compounded, which is often a component in modern contraceptive jellies (James and Thorpe).

The Greeks: 4th to 2nd Century B.C.

Olive Oil Ancient Greek philosopher Aristotle noted that one of the ingredients common in birth control in his day was olive oil, and 20th century studies have shown it is an effective spermicide

The ancient Greeks also had their own methods of birth control. The Greek gynecologist Sorianus of Ephesus in the 2nd century, who also practiced in Rome, suggested that women drink water that blacksmiths had used to cool iron. The philosopher Aristotle noted that women in his day tended to coat their cervixes with a mixture of cedar or frankincense and olive oil with an ointment of white lead before intercourse. The olive oil applications of his day did likely prevent pregnancy as studies done in the 20th century by Marie Stopes, a modern pioneer of contraception, showed that olive oil does significantly decrease the motility of sperm (ibid).

The Greeks also relied on prostheta or pessos, which were very similar to the Egyptian pessaries. They were made from linen, sponge, or wool and rolled into a finger-like shape and coated with various drugs that could induce an abortion. They were wound up with a thin thread that could be easily pulled out. Others were in the shape of a small egg, nipple, or a tiny pencil or acorn. Greek physician Hippocrates recommended the use of a sort of pumpkin pessary which he described as they “the inside of a pumpkin well crushed in cedar resin, wrapped into a cloth leaving its end bare, then inserted as deep as possible, after it is stained with blood, it is pulled out.” (Bujalkova).

The Romans: 1st Century A.D.

WIld Carrot Roman physicians such as Galen listed about 12 plants that acted as effective contraceptives, including Queen Anne’s Lace, juniper, and pennyroyal

Some Roman scholars such as Pliny recommended that women wear an amulet made of the insides of hairy spiders wrapped in deerskin or mouse dung applied in the form of a liniment. Other physicians, such as Dioscorides (c. 40‒80) and Galen (129‒199), listed about a dozen plants that acted as effective oral contraceptives. These included asafetida, juniper, pennyroyal, “squirting cucumber,” and Queen Anne’s lace (wild carrot) (James and Thorpe).

These early forms of herbal birth control were effective; however, they did prove to have dangerous side effects, which is why physicians like Soranus returned to the traditions of Aristotle and ancient Egypt in his text Gynaecology, where he favored the use of “vaginal plugs of wool or smearing the orifice of the uterus all over with old olive oil, honey, cedar resin, or the juice of the balsam tree, alone or together with white lead; or with an anointment containing myrtle oil and white lead” (ibid).

Eastern Roman Empire: 6th Century

With the fall of the Roman Empire and the rise of Christianity and the Roman Catholic Church, the history of birth control becomes harder to follow in Europe because of, especially, its prohibition by the church. In the Eastern Roman Empire, 6th-century Byzantine court physician Aëtio of Amida adapted from Soranus the use of astringent, fatty, or cooling ointments to close the womb and prevent sperm from entering. He also is on record as counseling men to wash their genitals with vinegar or brine before intercourse—and vinegar, with its high level of acidity, has proven to be a very effective spermicide. However, he was also highly influenced by church teachings and particularly recommended the “rhythm method,” having intercourse during a safe period at the beginning or end of menstruation (ibid).

The Islamic World – 10th Century A.D.

Avicenna Canon Muslim physician Avicenna included 20 different birth control methods in his Canon of Medicine

The Islamic world was also not affected by the Christian condemnation of birth control practices or methods, and Arabic medical writers drew on Indian, Greek, and Roman knowledge of the subject. In the 1st century, Avicenna included in his Canon of Medicine 20 different contraceptive methods along with his commentary on their effectiveness. He advised coating the penis with white lead or pitch and putting the pulp of a pomegranate mixed with alum into the vagina. He also recommended vaginal suppositories made of willow leaves or colocynth pulp, mandrake, iron dross, sulfur, scammony, and cabbage seed. He also believed that inserting pepper into the coitus prevented conception. (Bullough).

Avicenna’s text was the main source of medical information relied on by the Western world until well into the 19th century, and Norbert Himes, the pioneer historian of contraception noted as late as 1936 that Avicenna was as well advanced as many modern physicians in understanding that traditional contraceptives could actually be effective (ibid).

Spain: 13th Century

On September 13, 1276, a man named Peter of Spain was elected pope and assumed his new name, John XXI. Born in Lisbon, Portugal, he studied at the University of Paris and went on to teach medicine at the University of Siena in Italy. Before he became pope, he wrote a medical treatise called Thesaurus pauperum (Treasury of the Poor) in the 1270s while serving as physician to Pope Gregory X. This text may be the greatest single source of information about the practical methods of birth control that exists from the Middle Ages.

He first advocates sexual restraint, He advise men to place a hemlock plaster on the testicles before coitus, which was supposed to decrease desire. He also provides a long list of herbs taken from ancient Latin sources he had read about, and then he added his own list, including sage but not figs (Riddle 1997).

Europe and the Condom: 16th to 18th Centuries

The condom, one of the best known and still most popular contraceptive devices used by men today, was named after Dr. Condom, a court physician for King Charles II of England (Riddle 1992). The earliest known medical description of a male condom is by the Italian anatomist Gabriel Fallopius in 1564. He was an early authority on syphilis and recommended that a linen sheath covering the penis could be used specifically as an anti-venereal disease precaution (Gordon). This linen sheath was soaked in a chemical solution and then allowed to dry before being used. It was big enough to cover the glans of the penis and was held in place with a ribbon (Collier).

Casanova Testing Condoms Giovanni Giacomo Casanova was one of the more famous early users of condoms in the 18th century, and he had various names for them, including “English Riding Cap” Other early types of condoms were made out of dried animal skins that were sewn together. One of the more famous users of animal skin condoms was Giovanni Giacomo Casanova (1725‒1798). According to his memoir, Casanova lists 116 lovers by name but leaves nameless hundreds more women and girls he had sex with, ranging from ages 9 to 70 and from every social status from chambermaids to noblewomen. He claimed to use a half a lemon as a penis cap, and he admitted to using condoms and had a variety of names for them, including “English riding coat.” He reportedly liked to blow them up to test them to make sure they would not leak and he compared his use of animal skin condoms to “shutting himself up in a piece of dead skin” (Bullough).

The condom was revolutionized when Charles Goodyear and Thomas Hancock invented the process to vulcanize rubber in 1833‒1834. The earliest rubber condoms had a seam and were about as thick as a bicycle inner tube (Collier). However, these types of condoms covered only the glans of the penis and could be easily lost or were too tight, constricting the penis.

In 1912, inventor Julius Fromm invented a new process for making condoms by dipping glass molds into a raw rubber solution. This process was called “cement dipping” and required the addition of benzene or gasoline to make the plastic liquid (ibid). Then, latex was invented in 1920 and condoms made from this material were finer and thinner and much cheaper to produce. Most condoms are still made out of latex today.

Margaret Sanger: 1916 to 1960s

Comstock Law Symbol Birth control was technically illegal in the early 20th century, so some women had to turn to the black market for “women’s protection devices,” or even turn to using Lysol as a vaginal douche

At the end of the 18th century in the United States, various birth control methods and devices—including condoms, douching syringes and solutions, vaginal sponges, diaphragms, and cervical sponges—could be purchased openly from mail-order houses and pharmacies. In 1873, the U.S. government passed a broad anti-obscenity bill called the Comstock Law which was meant to outlaw obscenity in general but also criminalized the use and sale of any and all birth control devices.

Because of this law, birth control had to be purchased on the black market. Some birth control devices had to be relabeled and sold as “women’s protection devices,” and some women even turned to using the popular household disinfectant Lysol as a vaginal douche to prevent conception, which remained popular throughout the 1920s and 1930s (Tone). It was into this climate that Margaret Sanger arrived in the early 20th century. Her passion was providing universal birth control.

Perhaps no person has had a greater impact on birth control in the United States than Sanger, the founder of Planned Parenthood. She coined the term “birth control” in an essay she wrote for Women Rebel in 1914 (Zorea). A visiting nurse in the poorest sections of New York City in the early decades of the 20th century, Sanger opened the first makeshift birth control clinic in a tenement storefront in the Brownsville neighborhood of Brooklyn, NY, with her sister Ethel (Chesler). She and her sister instructed eight women at a time on how to use over-the-counter birth control, including condoms, suppositories, and rubber pessaries. She was arrested in 1917 for illegally distributing Mizpah pessaries, which were flexible, thimble-sized cervical caps made of corrugated rubber and reportedly Sanger’s favorite (Tone).

Planned Parenthood Founder Activist and nurse Margaret Sangster made the term “birth control” a household word Sanger spent the next 50 years dedicating herself to the proposition that access to a safe and reliable means of preventing pregnancy was a necessary condition of women’s liberation and, in turn, human progress. She founded Planned Parenthood and spearheaded the contraception movement of the 1920s and 1930s and made “birth control” a household word. She lived to see the 1965 ruling of the Supreme Court in Griswold vs. Connecticut, which guaranteed constitutional protection to the private use of contraceptives.

She died on September 6, 1966, just before family planning became incorporated into federal public health and welfare programs. While Margaret Sanger’s name may no longer be as well known, she played an undeniable role in how women are able to access birth control (Chesler).

The Pill: 1960s

The story of the birth control pill centers on two Harvard professors, Drs. Gregory Pincus and John Rock. Pincus was a gynecologist practicing at Harvard Medical School in the 1950s. In the 1930s, he was already experimenting with in-vitro fertilization and did not hesitate to brag about his research to the media. He was denied tenure and later fired by Harvard.

Pincus was then approached by Margaret Sanger and her colleague—Chicago socialite, MIT graduate, and fellow activist—Katherine McCormick. Sanger explained that she was looking for someone to invent an inexpensive, easy-to-use, and completely foolproof method of contraception, preferably a pill. Pincus agreed to try (Eig).

His colleague, gynecologist Dr. John Rock, was a devout Catholic who, nevertheless, believed that the birth control pill was a natural way to prevent pregnancies. He taught obstetrics at Harvard Medical School for more than 30 years and was a pioneer in in-vitro fertilization and the freezing of sperm cells. He was also the first scientist to extract an intact fertilized egg from a human female (Gladwell).

The Pill The birth control pill revolutionized contraception in the 1950s, and today, four out of every five sexually experienced women have used the pill at some point The birth control pill was the crowning achievement to Pincus’ and Rock’s careers. While Pincus and another colleague, Min-Chueh Chang, worked on the mechanism of the pill, Rock used his name to shepherd it through the scientific trials and bring it before the FDA. He believed it was a natural form of birth control, in that it worked by natural means to suppress ovulation. He argued that the birth control pill mimicked Progestin, the hormone that pregnant women produce to prevent ovulation. The birth control pill was simply Progestin in tablet form. It was instantly recognizable by its packaging, a small, round, plastic dial pack that was the physical embodiment of the 28-day cycle (ibid).

The pill (as it would simply come to be known) would prove to be one of the greatest inventions of the 20th century. Women from around the world flocked to their doctors’ offices for prescriptions. For the first time, women were taking a medicine that was unrelated to prevention or illness. The Catholic Church condemned it as immoral, and several African-American leaders denounced it as “technology of genocide” (ibid).

Approved by the Food and Drug Administration for contraception in May 1960, the pill revolutionized contraception. It was illegal for unmarried women to use the pill in any state until Eisenstadt v. Baird in 1972. Nonetheless, by 1965, it had become the most popular form of birth control in the country, used by more than 6.5 million married women and an untold number of unmarried women (Tone).

The IUD: 1970s to the Present

By the 1960s, evidence was mounting that the birth control pill was not going to be the miracle solution that women had hoped for. It was proving to be just too expensive, required ongoing medical monitoring, and was causing problems from migraines to nausea to the threat of stroke.

The Intrauterine Device (IUD) was cheaper and did not mess with female biochemistry like the pill. Plus, it was one-stop birth control. Once it was inserted, a woman never needed to worry about conception again. It seemed like a godsend because it was cheaper than the pill and women didn’t need to remember to swallow a pill every day. Once implanted, an IUD was also almost impossible to remove and rarely, if ever, came out on its own.

Women in Europe and Japan had been using IUDs for birth control as early as the 1930s. The first commercially manufactured model—called the Gräfenberg ring, after its inventor German gynecologist Ernst Gräfenberg—was invented in the 1920s and was made of silkworm gut shaped with silver wire into a ring (ibid). It was very effective in its clinical trials, but due to its size and rigidity, it was extremely painful to have inserted without anesthesia. It also caused complications such as pelvic inflammatory disease and it worsened conditions such as endometriosis.

American gynecologists were hesitant to recommend the use of IUDs well into the 1950s. In the 1920s, an obstetrician named J. Whitridge Williams at Johns Hopkins School of Medicine even carried a watch with a gold intrauterine ring attached that he had personally extracted from a “placenta at term.” Its visibility on his chain was proof that the IUD did not work (ibid).

Plastic IUD Eighteen deaths and over 200,000 illnesses have been attributed to the Dalkon Shield, the most infamous IUD, which was patented in 1971 However, in the 1950s, antibiotics were invented that cured pelvic inflammatory disease, and American scientists began inventing IUDs made out of malleable plastics that doctors could stretch into linear form before insertion but which regained their shape once inside the uterus. They did not require anesthetics to insert and were much cheaper to produce and, consequently, more affordable for women.

Perhaps the most infamous IUD was the Dalkon Shield, patented in 1971. It contained a fishhook-like barb and a balloon-like vane, which pierced the uterus. It did not require painkillers to insert, and the woman was supposedly safe from pregnancy afterward. It was never mass produced, though, because it made hundreds of women sick and allowed numerous pregnancies. Eighteen women died as a result of use of the Dalkon Shield (ibid). Its failure sent shockwaves through the birth control community and resulted in litigation and negative press that changed the face of research and development among the contraceptive community.

Modern Developments: 1980 to the Present

The past three decades have introduced an array of new birth control devices. Norplant, which consists of six soft plastic capsules containing synthetic progesterone that are implanted into the patient’s upper arm, is capable of releasing hormones for five years. There is also the Depo-Provera shot, which is injected into the woman’s arms or buttocks every three months. The female sponge has made a return. And there are hormone-releasing patches, gels, and vaginal rings; a new IUD; a one-size-fits all diaphragm; a silicone-rubber cervical cap; and even male injections and implants (Fishel).

As of 2010, the National Center for Health Statistics reports that 99% of sexually experienced women ages 15‒44 have used some form of contraception at least once in their lives and it is now almost universally accepted (Zorea). Birth control may seem to be a very modern topic, but it has ancient roots. Perhaps the first method was coitus interruptus, but various methods—some fascinating and some dangerous—have been used by all civilizations through the course of history and are still being developed today to provide the best means to prevent unwanted pregnancies.

-- Posted April 23, 2015


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