Contraception and pregnancy
Reflecting on the wide range of medical indications for female sex hormone therapy, it is striking that hormonal control of reproduction did not develop into one of the therapeutic uses of female sex hormones until the 1950s. This is even more remarkable if one considers the fact that female sex hormones were applied as a medical treatment to regulate the menstrual cycle. The possible application of female sex hormones as contraceptives, however, did not go totally unnoticed. In 1933 Samuel de Jongh, one of Laqueur’s collaborators, advised Organon to introduce Menformon as a contraceptive. The response of Organon to this proposal was rather apprehensive. Tausk suggested that contraception was a very difficult subject in The Netherlands, and advised de Jongh to approach the British birth control clinics. Tausk also considered approaching a Dutch gynecologist, but decided, after discussing the matter with Laqueur, not to promote the introduction of Menformon as a contraceptive. Although Organon did not adopt his suggestion, de Jongh continued to discuss the contraceptive possibilities of female sex hormones. In 1935, in the Dutch journal Acta Breva Neerlandica, de Jongh recommended the use of Menformon as what we now know as the “morning – after-pill.”19 He described the use of Menformon for this purpose during the period between coitus and the time of the next expected menstruation.20
Contraception as a medical indication for female sex hormone therapy was not further explored in clinical trials or research in The Netherlands. In other countries the subject of hormonal contraception seems to have been explored to a considerably greater extent than in The Netherlands. In Austria as early as 1920, the gynecologist Ludwig Haberlandt had emphasized the significance of “hormonal temporary sterilization of women for medical practice and social and sexual hygiene.” In 1930 Haberlandt, in cooperation with an Austrian pharmaceutical firm, introduced the first hormonal contraceptive. Dutch gynecologists evaluated this means of contraception very critically, particularly because of the risk of complete infertility (Pinkhof 1931:99). Although the possibility of birth control by means of the safe period method was discussed in Dutch medical journals, the idea of
developing specific hormonal contraceptives was not mentioned (Organon Archive 12 December 1932).
In this case, the negative attitude of Dutch clinicians, general practitioners and the pharmaceutical industry with respect to birth control constrained the development of research on the use of female sex hormones as contraceptives. Dutch gynecologists generally opposed birth control, arguing that contraceptives—not only hormonal contraceptives but also contraception in general—were a threat to women’s health and the cause of all kinds of gynecological complaints (Snoo 1940). Although after the First World War the issue of birth control had evolved into a major social topic, promoted in particular by a prominent middle-class movement in the United States, and Britain, as well as The Netherlands, the subject of birth control did not become integrated into the research agenda of reproductive scientists.21 After the first World Population Conference held in 1927 in Geneva, “research in reproductive biology was intensified and additional funds became available for specific projects.” These projects, however, did not include research on contraception. In spite of these efforts, American, British, and Dutch researchers “turned to the study of other aspects of reproductive physiology.” Nor were American pharmaceutical companies engaged in contraceptive research. Although there existed a mass market, the moral and political attitude toward contraception constrained the introduction of hormonal contraceptives. Because of these constraints “the subject of birth control was not taken up again until after World War II” (Borell 1987:51-87; Clarke 1987a:130).22
In contrast to contraception, pregnancy did become one of the major issues in sex endocrinology. Sex endocrinologists provided the clinic with a specific test to detect pregnancy by means of analysis of the hormone content of the urine of (pregnant) women. In 1928, the gynecologist Bernhard Zondek and the chemist Selman Ascheim, both working at the Charite hospital in Berlin, introduced the first laboratory test for pregnancy, based on bio-assays in animals, a test that became known as the Ascheim-Zondek test.23 This test had the major advantage of detecting pregnancy at a much earlier phase than the classical gynecological techniques (Tausk 1978:42). Following the example of a German pharmaceutical industry advertising this pregnancy test, Organon decided to include this test in its research program. In 1936 Tausk reported to Laqueur that
The pregnancy test is included in our routine research and on request we can include the analysis of urine samples without any effort…. It has always been our policy to perform these tests free of charge for patients who cannot afford them. In this way, we mean to use the pregnancy test as propaganda.
Although Organon had excluded the prevention of pregnancy from its agenda, the prediction of pregnancy became one of its routine diagnostic assays in the late 1930s.