Generally in the nineteenth century, physicians from Europe and the United States as a group steered clear of discussing birth control and abortion. Individual physicians in England and the United States, mostly associated with free thought, utopian, or socialist groups, did write and give advice on the topics but the only organized mainstream physician group that dealt with those topics in any detail in the nineteenth century was in the German-speaking countries.
Modern medicine might be said to have begun with the discovery of bacteria by Louis Pasteur (1822-1895) and Robert Koch (1843-1910). It was Koch who had the most significant influence on medicine, and his postulates for identifying bacteria causing diseases served as the basis of the medical revolution: (1) the organism should be found in each case of the diseases; (2) it should not be found in other diseases; (3) it should be isolated; (4) it should be cultured; (5) it should, when inoculated, produce the same disease; and (6) it should be recovered from the inoculated animal. Within a few decades causative agents were discovered at a rapid rate. Koch himself discovered the bacillus associated with tuberculosis and cholera. Not so surprisingly, many of the diseases associated with sex were also found to have a bacterial source. Albert Neisser in 1879 discovered the diplococcus of gonorrhea; Augusto Ducrey and Paul Unnas in 1889 found the bacillus causing soft chancre; and in 1905 Fritz Shaudinn and Eric Hofman found the Spirochaeta Treponema pallidum, the cause of syphilis; and with these discoveries, August von Wasserman, Neisser, and Carl Bruck were able, through a blood test, to document the existence of a syphilis spiro-chete.
Not all of the discoveries were made by German-speaking peoples but it was German-speaking physicians who expanded mainstream medicine into dealing with problems of sexuality. Probably the most influential figure in this endeavor was Richard von Krafft-Ebing (1840-1902), whose Psychopathia Sexualis opened up the study of variant sexual behavior. But it was not only variant sexual behavior that became an object of study but heterosexual activities and the problems of reproduction. Generally, as has been indicated elsewhere in this topic, women played a secondary role in medical thinking. Most of the care of women and their problems often fell into the hands of midwives or other female caretakers, with male experts being summoned when more drastic interventions were needed, as in the case of breech or other difficult births. The development of surgical forceps by the Chamberlen family in England in the seventeenth century, a device that they kept secret for a long period, also enabled physicians to intervene much more effectively on difficult births. Some physicians began to specialize in gynecology and obstetrics, and their entry in full force was a result of two nineteenth-century developments, mainly the perfection of surgical anesthesia, and the new emphasis, following the germ theory, on aseptic techniques in child delivery.
Nineteenth-century German medical experts in women’s medicine had been particularly concerned with questions of deformities of the reproductive organs in women and how to cope with this problem, which had a direct bearing on the question of contraception because it led to the question of what to do for women whose lives might be put in danger by pregnancy. One of the earliest of the modern German physicians to discuss the subject in some detail was Friedrich Adolph Wilde in 1838. Wilde believed that some form of birth control might be a medical necessity in such cases. After investigating the various methods used by women to avoid pregnancy, he believed that only four had any real potential: condoms, coitus interruptus (withdrawal), the sponge, and the cervical cap. The difficulty with the first three is that they were so often unreliable: condoms continually broke or tore, the timing of withdrawal was not an easy thing and this made it undependable, and the sponge was often misplaced. Wilde, therefore, advocated the use of a rubber cervical cap specially designed to cover the cervix and to be worn between menstrual periods. The cap for each woman was to be individually made, based on a wax impression taken of the os. The impression was then used as a model to make a rubber pessary. Whether Wilde invented the cervical pessary or adopted it from others is unclear but his is the first clear mention of it. As a last resort, his final solution for those unable to achieve success with the other methods of contraception was the use of sterilization through the removal of the uterus.
New breakthroughs in rubber technology long after the death of Wilde opened up other possibilities. A method for making liquid latex was developed in 1853 that quickly supplanted the unvulcanized rubber that had been used for various inserts and devices earlier. The most influential writer on the subject was the German Dr. Wilhelm P. J. Mensinga of Flensburgh, and later a professor of anatomy at Breslau University. He sometimes used the pseudonym of C. or K. Hasse. Mensinga in his 1882 study used a latex cover for the top of the vagina. The cover was held in place above the pubic bone by a flat spring, similar to that used in the traditional wind-up spring alarm clocks. It was the Mensin-ga diaphragm that was later used by his student Dr. Aleta Jacobs, who had opened a contraceptive clinic in the Netherlands in 1881 in connection with her medical practice. The diaphragm was popularized in the United States by Margaret Sanger.
Other German physicians experimented with what came to be called intrauterine devices (IUDs), the development of which was based on the pessaries originally used to deal with prolapsed uterus and other uterine difficulties. Particularly noteworthy was Ernest Graefenberg (1881—1957), a German gynecologist who developed a ring of silkworm gut and silver wire, which might be called the forerunner of most modern IUDs. The difficulty with the early IUDs, as with any entry into the uterus, was the problem of infection. Few physicians prescribed such devices because most feared they would cause pelvic infection, and before the development of antibiotics such infections were not infrequently fatal.
Many of the later German physicians such as Graefenberg and Hans Lehfeld fled to the United States because of the Nazis, and they helped push American physicians into the area of contraceptive medicine. Both Graefenberg and Lehfeld were significant advocates of the cervical cap. The rise of the Nazis in Germany undercut the German lead both in sexual medicine and in development of contraceptives, because many of the contraceptive pioneers were Jewish and because the Nazis promoted devotion to “kinder, kuchen, kirke” (children, kitchen, church) for non-Jewish women.
