Cresol and Birth Control

Aside from the paternalism, subjectivity, and narcissism inherent, one problem with legislating morality is that such sweeping edicts often have (unintended?) public health consequences. A good example can be found with free needle exchanges for IV drug users. While I have never, and do not now, condone recreational IV drug use, if one presumes that humankind’s search for an altered state of consciousness is not going to vanish anytime soon, then substance abuse is a problem that is here to stay.

Accordingly, I must advocate for any measure that will prevent the spread of infectious, and often fatal, diseases, regardless of whether the cold hard reality of that scenario offends societal mores. To do anything less would be counter to the Hippocratic Oath.

But needle exchange is a discussion for another day. Today we deal with sex.

With currently free and unfettered access to all manner of contraceptive resources, including literature and both over-the counter and prescription preventatives, it might come as a surprise that it is well within the lifespans of our parents and grandparents that such was not the case.

The first American book on family planning, Moral Physiology, or A Brief and Plain Treatise on the Population Question, was written by Robert Owen, M.D., and published in 1831. This was followed the next year by Fruits of Philosophy: The Private Companion of Young Married People, by Charles Knowlton, M.D. And though birth control was not illegal at that time in the United States per se, it was certainly not a topic for polite (and mixed) company. Knowlton’s efforts raised the hackles of the Massachusetts courts – actually, his prosecution may have been just as much due to his stated atheism – and he was convicted of obscenity and jailed for three months for tackling in print such a prurient subject.

While admittedly unfortunate for Knowlton, the climate really changed in the 1870s with the arrival of Anthony Comstock. A postal inspector by trade with no formal medical knowledge or training, Comstock and his allies saw contraception as another facet of moral decay that lead to prostitution and venereal disease.

Suffice to say that the Comstock Act, immodestly named after its self-appointed champion, was passed by the U.S. Congress in 1873, and accordingly prohibited the possession and dissemination of not only pornography, but “any article or thing designed or intended for the prevention of conception or the procurement of abortion.” Many states jumped on the decency bandwagon with additional statutes of their own. The discussion of human reproduction and responsible family planning, even between physicians and their patients, was driven largely underground.

Advertisements for contraceptive products, where they existed at all, had to use euphemisms such as “marital aid” and “hygienic device.” Drug stores sold condoms as “rubber goods,” and cervical caps became known as “womb supporters.”

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Lysol disinfectant has been around since the late 1880s, when it was first developed by chemist and physician Dr Gustave Raupenstrauch to help combat a cholera epidemic in his native Germany. As a cleansing solution, it also proved useful when enlisted in hospitals and homes during the worldwide Spanish flu pandemic of 1918-19.

But starting in the 1920s, Lehn & Fink, Inc., which marketed Lysol, initiated a (loud) whisper campaign to encourage another use for the product, one that had been around for a while but would soon become far more widespread with a little corporate encouragement.

Lysol began to be advertised widely for “feminine hygiene.” Print ads showed domesticated wifely types smiling with the caption, “I always douche with Lysol!” This wasn’t because of concerns about unpleasant odor, but rather a thinly veiled circumvention of the laws to tout Lysol as a form of birth control.

During the Great Depression in particular, extra mouths to feed were not desired. Condoms were relatively expensive (and often reused – yuck). Lysol was cheap – a 50¢ bottle of the concentrate made five gallons of disinfectant solution – and purportedly became the most commonly employed contraceptive of the 1930s. Lysol contained cresol, a phenol compound that was known to cause burning and inflammation of tissue. It was then a much stronger preparation than what is sold today. Surely it was annihilatory to semen, just as it was corrosive to the epithelial lining of the female reproductive tract.

The medical literature as early as the second decade of the 20th century was replete with cases of women sustaining Lysol poisoning from “uterine irrigation” (usually because of over-application or incorrect dilution at home). There were also deaths – at least five reported in the United States prior to WWI, though almost certainly the actual number is much higher. Despite this, Lysol continued to be marketed as “safe, gentle, and effective” for feminine hygiene.

Lysol ingestion, as opposed to its use for irrigation, was also a fairly common method of suicide in the first half of the 20th century. Why this didn’t alert medical observers to the potential toxicity of the substance inside the human body remains a mystery. And yet no one seems to have raised an alarm. Dr Joseph DeLee, a prominent American OB-GYN, went so far in 1938 as to publish practice guidelines that encouraged the irrigation of the vagina with Lysol during labor and delivery!

Lysol ad (courtesy of Mother Jones)

Lysol ad (courtesy of Mother Jones)

Once the cresol component in Lysol was replaced with ortho-hydroxydiphenyl in the 1950s, the marketing gradually shifted from feminine hygiene to toilet bowl cleaner, for which we largely know the product today. But this was a gradual tack, and untold numbers of women continued to suffer the consequences of using a caustic liquid in places never designed for it.

Sadly, although contraceptive pills and more efficiently-designed IUDs had been approved by the FDA as early as 1960, it wasn’t until the landmark privacy decisions of Griswold v. Connecticut (1965) and Eisenstadt v. Baird (1972) that the U.S. Supreme Court ruled that it was unconstitutional for the government to prohibit adults from using birth control, or to prevent their doctors from discussing the matter with them.

This was only 40 years ago.

As a physician, I continue to worry about the physical and mental wellbeing of my patients at large far more than I do about the personal beliefs of crusading elected officials.

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Misidentified Creepiness

I recently ran across a collection of amateur photos taken of kids and adults dressing up for Halloween in the 1920s and 1930s. The scenes are innocent enough – no hockey players with machetes or sexy nurses – but there is a certain weirdness to them. It’s hard to explain, but the simplicity of the handmade masks coupled with poor lighting, poor focusing, strange posing, homespun clothing, and Depression-era backdrops make the photos far more eerie than if bright red fake blood and plastic body parts were strewn about the field of vision.

just plain creepy

just plain creepy

Less can be more. Stephen King knows this, and I think this is what Hitchcock discovered when making his horror classics… since when did mere birds or showers give anyone chills before Hitchcock?

I mention this because I’m pretty sure I made a discovery in that collection of photos that may have escaped previous observers. In the grouping was this photo labeled as ‘weird alien creatures going to a Halloween party.’ Though no date is given, from the dress of those in the background, I surmise that the picture was taken no later than the early 20th century.

Michelin Persons

Michelin Persons

But as I looked at the picture, it dawned on me… those aren’t aliens. That’s the Michelin Man! (and his wife?)

In the 1880s, Edouard and Andre Michelin owned and operated a rubber factory in Cermont-Ferrand, a town in the Auvergne region of France. A stranded bicyclist came to them one day with a tire that had separated. It needed hours to repair and then the glue between the tire and the rim had to dry overnight. The next day, Edouard took the bicycle for a test spin… and the tire promptly failed, separating again from the rim. Despite this setback, Edouard was excited about the possibilities that pneumatic tires presented, but he wanted to develop a variety that didn’t have to be glued in order to safely operate. Edouard’s vision became the Compagnie Generale des Etablissements Michelin in May 1888. Three years later, the Michelin Company was granted its first patent for a pneumatic tire that did not require gluing. In 1891, the racer Charles Terront went on to win the Europe’s inaugural long-distance bicycle rally, the Paris-Brest-Paris, using a custom bicycle with Michelin tires.

And every up-and-coming company brand needs a memorable mascot and trademark, n’est ce pas?

At the Universal & Colonial Exposition in Lyon in 1894, the Michelin brothers passed a stack of tires at one booth that reminded them of a large man without arms. Four years later, Edouard met the French cartoonist Marius Rossillon, who went by the nom de plume O’Galop, and the two decided to turn the idea of a man made from tires into the company emblem. Apparently O’Galop had earlier drawn an ad for a Munich brewery featuring a portly man with a huge stein of beer and the caption “nunc est bibendum” (“now is the time to drink”). This idea was adapted to the Michelin campaign, and the 1898 poster below is the first representation of the artistic collaboration.

Michelin poster 1898 (courtesy of Michelin)

Michelin poster 1898 (courtesy of Michelin)

In the poster, Bibendum – as he would come to be known – offers a toast to his scrawny-looking competitors, his glass full of road hazards. The caption reads, “C’est a dire, a votre sante! Le pneu Michelin boit l’obstacle” (“That is to say, to your health! The Michelin tire drinks up all obstacles”).

Anyone who has seen an original Mickey Mouse or Ronald McDonald will understand how trademarks evolve. Bibendum – or as the Anglo world knows him, Michelin Man – was originally thinner (recall that he was made of stacked bicycle tires, not modern auto tires), wore pince-nez glasses, smoked a cigar, and was briefly black (because of the chemicals added to rubber for tires around WWI as a preservative).

Bibendum is one of the world’s oldest trademarks, and I suspect that this photo is a publicity appearance by the Man, and not a creepy Halloween photo at all.

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[Copyright 2013 @ The Alienist’s Compendium]