Presidential Address (Canadian Society)

The History of Human Infertility

DONALD ROBERT JOHNSTON, M.D., C.M.

Ithat fertility and infertility

T IS INTRIGUING to pause occasionally to look back into the past and find
have occupied the minds of men far back into
antiquity. To earliest man the propagation of the race and its survival was a
source of real anxiety; a woman who failed to conceive and carry a pregnancy
to term was a source of concern and she regarded her plight as a disgrace.
Every land had its set of customs and folklore for the relief of infertility.
The ancient Hindus had a custom which sprang from the worship of the
"Lingam," the erect male organ and the "Yoni," the female genitalia. A hole
in a rock or cloven tree symbolized the female birth passage and females who
passed through such a cleavage would have improved fertility. Aberdeen-
shire women still crawl through the hole in the "Devil's Needle" "for luck,"
but the original custom was applied only to barren women and was a fertility
rite corresponding exactly to the worship of the sacred "Yoni" thousands of
miles and thousands of years away. This same custom applies to the Island
of Innisfallen in County Kerry, Ireland, and in hundreds of other places
throughout the world.
Astrology and numerology were of extreme importance in the Chaldean
and Babylonian arts and medicine in general, but infertility, was a subject
ideally suited to such beliefs. Carefully laid down were the number of the
day and the month which were best for fertility, and the waxing and waning
of the moon in its many phases was of extreme importance. Ancient numer-
ologists were very clear about the association of libido at the full of the moon
and the lunar control of menstruation and, therefore, fertility.
Very modern indeed is the extraction of male and female hormones from
urine and from the afterbirth, but female animals eat their afterbirths and
female chimpanzees in labor and after it, have been observed to drink their
own urine. Hungarian peasant women bite their own afterbirths to improve
their already proven fertility and Chinese women are given dried placenta to
eat to improve their fertility. Javanese women actually eat the placenta for
the same reason. Peculiarly enough, in Kalotaszeg, a woman who does not
Presented as the Presidential Address at the Annual Dinner, Ninth Annual Meeting, The
Canadian Society for the Study of Fertility, Oct. 26, 1962, Ottawa, Canada.

261
262 JOHNSTON FERTILITY & STERILITY

want any more children burns her afterbirth and places the ashes in her hus-
band's drink.
Amulets or good-luck pendants were very commonly used in a tremendous
array of forms dating back to the early Arabic days, and the Egyptians had
great faith in these oddities. There were references to sterility in the Ebers
papyrus from the tomb of EI Assassif, which was probably written about
1550 B.C. just before the Syrians began to exert their influence in Egypt. In
this papyrus, among other information regarding the diagnosis of pregnancy,
the statement was made that "women who had spots before their eyes were
sterile." In the Brugsch medical papyrus, which dates about 1350 B.C., a
very definite statement was made as to how to detect pregnancy: "A water-
melon pounded, is mixed with the milk of a woman who has born a son, and
is given the patient to drink: if she vomits, she is pregnant; if she only has
flatulence, she will never bear again."
The role of the male in the production of pregnancy was not understood by
some primitive people, and the Ingarda Tribe in Australia believed that the
child was the product of some food the mother had eaten. The Euduna Tribe
insisted that the women bore half-caste children because the white settlers
had introduced bread made of white flour instead of the dark native bread.
(The women ate white bread and therefore had half-white children.) The
Trobrian Islanders believe that pregnancy follows rupture of the hymen by
whatever means, and that intercourse is intended purely for pleasure and has
nothing to do with procreation. Fatherhood is a social rather than a biological
concept with most primitive groups. Some tribes believe that someone sends
an invisible "spirit-baby" to enter the woman. The Isleta Indians of New
Mexico obtained from the medicine man a specially treated buckskin belt to
insure barrenness by contrast. Stepping three times over a recently buried
corpse is believed by some tribes of Morocco to prevent pregnancy. Drink-
ing water which has been used to wash a dead person is equally effective.
Eating the hoof-parings of a mule will render a woman sterile as a mule, or the
man may eat, before intercourse, the oviduct of a hen and if this has been
tied into a knot, pregnancy cannot possibly result. However, more exact
knowledge of the role played by the male is evidenced by some of the contra-
ceptive practices of certain primitive societies, where various plugs in the
vagina were used to prevent conception.
There seems to be very little known of Babylonian medicine and obstetrics,
but a little has been gleaned from the cuneiform inscriptions: Ishtar was the
goddess of fertility, and temple prostitutes clustered round every phallic
image raised in her honor. Dodib was the demon of abortion and Labartu
was the female demon who caused premature labor.
VOL. 14, No.3, 1963 HISTORY OF HUMAN INFERTILITY 263

From the ancient Hindu writings it was evident that they had some con-
siderable knowledge of obstetrics. It was known that pregnancy lasted 10
lunar months, and there were many ceremonies to guarantee a normal issue
and to keep away demons that might cause deformities of the babies. They
thought that some "sealing spirits" were responsible for female sterility. If
you wonder where the old wives tale originated that an eighth-month baby
will not survive as well as a seventh-month baby, it is derived from this old
Hindu literature in which it was thought that in the eighth month the vital
force was drawn from the mother to the child and back again repeatedly, so
an eighth-month child would never survive.
The Persian writings contain very little regarding infertility, but the birth
goddess of the Persians was Anaitis, the moon goddess. Young girls were
dedicated by their parents to Anaitis, and worship at her temple was one of
the earliest forms of religious prostitution. When these young women left
the temples those who had accepted the largest number of men were the most
sought after as wives. Anaitis was known to purify the male seed, watch over
the foetus, and provide all female creatures with mother's milk. She insured
an easy labor and was always called upon to help in warding off the evil eye.
Like the early Babylonians and Assyrians, the people of Israel had a goddess
of fertility mentioned in the Bible as Ashtaroth and otherwise known as
Astarte. Strangely enough, worship of this goddess in Babylonia and Assyria
took the form also of prostitution, with maidens giving themselves to stran-
gers for money and the money given to the temples of the goddesses-a very
strange form of worship, indeed, but perhaps very convenient.
The ancient Greeks, as is known, had plenty of gods and goddesses, and
one, Actemia, was so terrified by her mother's suffering at her own birth that
she besought from Zeus the favor of eternal virginity. However, she changed
her mind completely enough to seduce the young Endymion and I would pre-
sume Zeus must have chuckled a little when, in whatever was the fullness of
immortal time, Actemia give birth to 50 daughters. Another goddess was
Eileithyia and her symbols were the moon, because it promotes procreation
and growth, and the cow, because of its fertility. Artemis, the twin of Apollo,
was the daughter of Leto but she was helped into the world by Eileithyia.
Artemis' more than human fertility is symbolized in one statue in Naples
showing her possessing sixteen well-formed breasts. Yet another divinity,
Hera, as the wife of Zeus, was the goddess of marriage and so she too soon
became an assistant of Eileithyia's. The practice of medicine for the ancient
Greeks was a conglomeration of religion, magic, and superstition, but even-
tually medical schools arose about the 7th century B.C. and gradually the
physicians and surgeons of the schools discarded the time-honored elements
264 JOHNSTON FERTILITY & STERILITY

of magic and superstition in favor of more factual medicine. One such physi-
cian was born in 460 B.C.; his name was Hippocrates and he was later to be-
come known as the "father of medicine." He lived perhaps at the height of cul-
ture of ancient Greece with many writers and playwrights. The Greeks were
skilled in medicine, surgery, and obstetrics, and midwives did most of the
obstetrics. One rather charming Greek test of fertility is described as follows:
"If a woman do not conceive, and wishes to ascertain whether she can con-
ceive, having wrapped her in blankets, fumigate below with oil of roses and
if it appear that the same passes through her body to the nostrils and mouth,
know that of herself she is not unfruitful." (Sort of a total Rubins's test.)
The Romans got most of their medicine, including their midwives and birth
goddesses, from Greece. However, this was a great time for medicine and, at
the height of the Roman Empire, the best of Greece and that of the Hindus
was united and Alexandria became a great center of medicine. The best
physicians in Rome were Greeks trained in Alexandria. It is rather interesting
that the physician to the Emperor Claudius received a salary equivalent to
about £10,000 a year. With the tremendous success of the Roman Empire,
however, Rome became decadent and luxury and vice developed to a degree
never previously known. The degree of decadence is illustrated by the fact
that the wives of some of the Emperors such as Faustina and Agrippina and
Messalina often for diversion had a night out and visited the brothels, accept-
ing as many men as came their way. There was a Roman law compelling
prostitutes to dye their hair either blue or yellow and it is reported that Mes-
salina, who was dark, used to wear a yellow wig when she paraded at the door
of her favorite brothel with bared breasts and gilded nipples. One of the
favorite enterprises of the physicians to the wives of these Emperors seemed
to be that of poisoning the rivals of the wives. Medicine sank to a very low
level indeed. Promiscuity seemed to be the order of the Roman day and
reached its peak in the famous baths where both sexes shed their garments
with alacrity and the masseurs and masseuses fulfilled a more primitive func-
tion than in life today.
Pliny was born about A.D. 23 and, though he was not a physician, he col-
lected many medical writings and his writings were passed on to many cen-
turies following his time. As stated earlier, unfortunately, at the height of the
Roman Empire the practice of medicine fell rather badly into decay and many
of the writings passed along by Pliny were rubbish. For example, the eating
of the eye of a hyena with licorice and dill was said to cause a woman to con-
ceive and this was "guaranteed within three days." Once again, if two hairs
were pulled from the tail of a she-ass while being mounted, they would make
a woman conceive even against her will if they were knotted together during
VOL. 14, No.3, 1963 HISTORY OF HUMAN INFERTILITY 265

sexual intercourse. There was one interesting decree in Rome, which origi-
nated with the ruler Pompilius, who ruled Rome from 715 to 673 B.C. He
decreed that if any woman died while she was pregnant the child was to be
cut out of her abdomen immediately. This was part of the Lex Regia, which
under the Emperors became the Lex Caesare, and I presume this was the true
origin of the operation called the cesarean section. Peculiarly enough at that
time, the children born by cesarian section, with the resulting death of their
mothers, were considered to be born under favorable auspices. The fact that
a cesarian section was not called after Julius Caesar is born out by the fact that
his mother Aurelia lived for many years after the birth of Julius Caesar, which
proves that he was born by the vaginal route.
As seen, the Romans contributed very little to anyone's knowledge of fer-
tility. There was, however, one bright star in Roman history who, in my
opinion deserved the name "father of medicine" much more than Hippoc-
rates, and that was one whose name is not nearly so well-known today-
Soranus, who was born in Ephesus in Asia Minor. He studied at Alexandria
in his youth and practiced in Rome during the time of Trajan and Hadrian
about A.D. 98. He was the first specialist in gynecology and obstetrics, thor-
oughly understood his field, and was an original able and judicious thinker.
His work is easily the most important of ancient times and continued to be
important in some degree for 1500 years. Soranus described very accurately
the anatomy of the female pelvic organs and described the differences in these
organs in girls, in pregnancy, and in elderly women. His amazing gynecologic
knowledge is illustrated firstly by the fact that he used vaginal speculums
which were apparently forgotten until the last century, and secondly by his
suggestions as to how to prevent conception, "To prevent conception, the
woman, before coitus, should smear her cervix with rancid oil, or with honey,
or with a decoction of cedar oil or she should push into the os a thin strip of
lint or she should introduce into the vagina an astringent passary." Among
other things he contributed was the fact that the most favorable time for con-
ception is shortly after the menstrual period. He also felt that staying in bed
after coitus might improve fertility. It is said that his teaching brought child-
bearing women more care and kindness and more skill than they had ever re-
ceived before. It is unfortunate for medicine in general that another man by
the name of Galen, who lived about 130 A.D., was a much more prolific writer
than Soranus. He upset a lot of the good that Soranus had done by bringing
back into the medical literature of the time many ill-founded notions. Galen
influenced the thinking and writing medically for many years, even up until
the writings of Soranus )Vere rediscovered in 1838.
Even so, Galen seems to be the last of the highlights of medicine for some
266 JOHNSTON FERTILITY & STERILITY

time and the practice of medicine fell into a terrible morass. The writer
Oribasius, in writing on sterility, felt that both general and local measures
were required. Massage should be applied to the whole body as well as to
the relevant parts. Fumigation, fomentations, douches, irrigations, and pes-
saries were all said to be of value. Along about the year 625 A.D. another
bright writer by the name of Paul or Paulus of Aegina, a Greek Island, ap-
peared. He was apparently a learned physician and a skilful surgeon and able
obstetrician also. He made a note of the fact that coitus designed for concep-
tion should take place after dinner and in bed "because that the woman falling
asleep is more likely to retain the semen." This same writer made some astute
observations on the effect of obesity on sterility and states: ... "for fat persons
are unfit for propagation of children, owing to the want of agreement in their
genitalia and because they do not emit much semen." He recommends care-
ful dieting, fomentations and fumigations, and liquidations and frictions to
the lower belly and buttocks. Pessaries should be prescribed according to the
temperament of the sterile woman and every effort made to correct local dis-
orders. Quite rational is the last point he makes-that in cases of retroversion
of the uterus, conception is more likely to take place after coitus "a posteriori."
Paul died in 690 A.D., about the time Mohammed was appearing on the
Arabic scene.
Mohammed, as will be recalled, took the warring and factious tribes of
Arabia, and welded them into one, and conquered half the known world and
founded the Arabian Empire. The Arabs robbed many of the Greek cities of
their medical books and some of them became fairly competent doctors.
There were many translations into Arabic; one of their writers, Haly Abbas,
is known to have prescribed pessaries containing arsenic for the treatment of
sterility, and certainly this problem was well recognized at this time.
During the years 1000 to about 1500 A.D. there was a great belief in faith-
healing and supernatural power, and obstetrics fell into the hands of midwives
and sow-gelders.
In England, in 1518, the physicians established a college, but midwifery
was very inferior and the midwives were ignorant women, often without edu-
cation, who had borne children themselves or watched other women's labors.
Relics, charms, and incantations were their stock in trade. However, about
1540, during the reign of King Henry VIII, a book called "The Byrth of
Mankynde" was published in England; this was the first step towards more
enlightened midwifery.
There are many instances down through history of famous cases of sterility.
In 1532 Catherine de Medici was married to Henry II when she was not quite
14 years of age and Henry just a little older. For years she failed to produce
VOL. 14, No.3, 1963 HISTORY OF HUMAN INFERTILITY 267

any offspring and consulted physicians, quacks, magicians, and astrologers

but still failed to achieve the pregnancy she desired. Henry II succeeded his
father and took as his mistress Diane Doitiers who had been his father's mis-
tress. She was 17 years older than Henry II and had almost persuaded him to
divorce Catherine to take a wife who was capable of bearing children when,
quite unexpectedly, at the age of 24, Catherine became pregnant and was
safely delivered of the future Francis II. Over the next 12 years there were
nine other children, including twins at the Queen's last confinement. Appar-
ently Catherine's sterility had been the butt of many a joke throughout
England at the time.
It was about this time, 1569, that Dr. William Chamberlen moved from
France to Southampton, England, later to become famous for his obstetric
forceps. The secret of the forceps was well kept for more than 150 years and
it was about 1728, when Hugh Chamberlen, Jr., died, that the secret of the
obstetric forceps leaked out and obstetric forceps came into general use. In
spite of the fact that obstetrics was becoming a little more enlightened, pos-
sibly, knowledge of sterility did not seem to be on the upgrade, and an exam-
ple of the thinking of the times of about 1628 was a recipe for the procurement
of conception consisting of "syrups of Motherwart and Mugwort, spirit of
Clary, root of English Snakeweed, Purslain, Dates, Pistaches, Conserve of
Succory, Cinnamon, Saffron, Conserve of Virvine, Pineapple-kernels picked
and pilled." The instructions were to "stamp all these into an electuary, then
put in gally pots and keep it for use." It would seem, the more items in the
brew, the better the brew. In spite of the foregoing, there was a trend towards
improvement and more books came out for midwives, written mostly by mid-
wives, themselves. Some of the midwives, however, were taught by such
eminent physicians as Ambrose Pare and Francois Mauriceau, names un-
doubtedly well-known. The famous Dr. William Harvey, who was pre-
eminent in discovering the circulation of the blood, also had a very wide
knowledge of obstetrics. However, in spite of the fact that he was one of the
truly brilliant medical men, perhaps the most brilliant of the 1600's, he made
little contribution to the field of infertility. Some other names of the 1600's
easily recognized were Eustachius, Fallopius, Malpighi, and De Graaf.
In the 1700's, in spite of increasing knowledge of medicine, there seems to
have been a great era of quackery and it seems that one Dr. James Graham,
or so he signed himself, though it is doubtful that he ever qualified, had prac-
ticed medicine and had visited America where he apparently heard something
of Benjamin Franklin's work on electricity. He had the good fortune to treat
successfully Georgina, Duchess of Devonshire. Spurred on by her patronage,
he set his famous Temple of Health facing the Thmnes in the Royal Terrace,
Adelphia. He is said to have invested over £, 10,000 in this venture. His great
268 JOHNSTON FERTILITY & STERILITY

temple was open to the rich and poor alike and as the High Priest of the
Temple, he himself lectured from 5:00 to 7:00 P.M. each day. Soft music ap-
parently preceded his discourse and at the appropriate moment his audience
received mild electrical shocks from the carefully wired chairs in which they
were seated. As a grand finale, an enormous spectre came up through the
floor and handed to Graham bottles of his famous "aetherial balsam," which
was guaranteed to promote fertility. The ladies were catered for in much the
same way by a High Priestess, except that they saw Hebe Vestina, the rosy
goddess of health and hymen. Early in her career, Lord Nelson's Lady Hamil-
ton had officiated as Hebe. In addition to the "a etherial balsam," the great
doctor professed to abolish barrenness, although he himself never had any
children. Graham, of course, guaranteed fertiliy, but if despite the guarantee
the "aetherial balsam" did not result in a successful conception and lead to the
production of the loveliest possible children, Graham" placed at the disposal
of his clients his wonder of wonders, the innermost mystery of the Temple of
Health. This was his Celestial Bed which was guaranteed to cure sterility.
Apparently at the time, Graham's Temple became the most talked of attrac-
tion in London. The Celestial Bed was in the center of a spacious room per-
vaded always by rich scents and perfumes, in which could be heard soft music.
from a string orchestra in an adjoining room. The slighest movement of the
occupants made the bed oscillate rhythmically and there ran through it elec-
trical currents varying in intensity with the movements of the bed. This mag-
nificant apparatus was at the disposal of any lady and gentleman, preferably
married. The price for one night in the bed-presumably with breakfast-was
50 guineas. Eventually there was a play written about Graham and his
Celestial Bed and the fee for a night in the bed soon soared to 500 guineas.
Among the extravagances of the set-up were slow dances by half-naked
wenches, notably Emma Lyon, late a servant maid in the home of Dr. Budd.
Emma Lyon became "Emily Hart" when she went to live with Charles Gre-
ville. However, young Greville had to cede her to his uncle, Sir William
Hamilton, in return for the payment of his debts, and some years later she be-
came Lady Hamilton. It was of course her relations with Nelson that made
her memory live.
To go on with our story, the astute observation that previous sterility might
in some way be related to the later development of an ectopic pregnancy was
first suggested by Boehmer in 1752. He described the case of a prostitute who
pursued her venerable profession without becoming pregnant for 20 years.
Then she did become pregnant and the pregnancy was ectopic. It is rather
interesting that ectopic pregnancy had been thought to be due to a sudden
scare during the act of intercourse, such as in an illicit love affair where pet·-
haps the husband suddenly interrupted the coital act. It was thought that this
VOL. 14, No.3, 1963 HISTORY OF HUMAN INFERTILITY 269

sudden start caused the egg to fail to progress along the tube, resulting in
ectopic pregnancy. However, Bussiere of Paris had recorded in 1693 the
finding of an unrupted fetal sac. His case was that of a woman condemned to
death but fond enough of life to have intercourse with a fellow prisoner while
awaiting execution. At autopsy an unruptured tubal pregnancy was found.
It is curious that the moralists missed this example of ectopic pregnancy in a
woman who did not pretend to be chaste and seems unlikely to have been
frightened.
It was in 1786 that Lazzaro Spallanzani had shown that spermatozoa were
essential to fertilization and proved them to have a nucleus and cytoplasm.
About the year 1827 there were two other remarkable discoveries, the first by
Albert Van Kolliker, who demonstrated the true origin of spermatozoa. He
proved they originated in the testicular cells and that they fertilized the
ovum, which then underwent segmentation. He also suggested that heredi-
tary characteristics were conveyed by the cell nuclei. The other discovery
was that of Carl Ernst Von Baer who, in 1827 discovered the mammalian
ovum and made a number of significant contributions to embryology.
James Marion Sims was born in Lancaster County, South Carolina, on
Jan. 25, 1813. He graduated in Philadelphia in 1835 and is probably most
famous for his work on vesicovaginal fistulae. His "Clinical Notes on Uterine
Surgery," written in 1866, the only book he ever wrote, was a masterpiece
and served to separate gynecology from obstetrics as a specialty. His book is
remarkable for its accurate description of the fertile period in relation to the
menstrual cycle-50 years before it was rediscovered and really understood.
Sims records here, too, a successful case of artificial insemination. Later, in
1868, he addressed the New York County Medical Society on the subject
"The Microscope as an Aid in the Diagnosis and Treatment of Sterility." He
advocated the importance of demonstrating spermatozoa in the semen. He
complained that he "was misrepresented, maligned and positively abused
both here and abroad" for his insistence on semen studies, and cited the
Medical Times and Gazette which charged that "this dabbling in the vagina
with speculum and syringe was incompatible with decency and self-respect."
In 1839 a Hamburg botanist, Schleiden, wrote, "There is one universal prin-
ciple of development of the elementary parts of organisms, however different,
and that principle is the formation of cells." This was the beginning of the
cellular theory, and the next step was Schleiden's demonstration that in ani-
mals the ovum is a single cell from which all cells, the tissues and the organs
of the body were derived. Cellular pathology and embryology advanced
steadily and human anatomy was reviewed in ever greater detail. Physiology
and particularly the phYSiology of reproduction attracted many workers. The
influence of the ovaries on menstruation, on the development of the genitalia,
270 JOHNSTON FERTILITY & STERILITY

and the secondary sexual characteristics was studied. With these advances
the way was clear for repeated success. Pain was banished by anesthesia and
the new knowledge of pathology had shown the need for surgery in the treat-
ment of women's diseases. Gynecology ceased to be a medical field and only
an occasional side-line for man mid-wives and eventually it became a surgical
specialty. The use of the vaginal speculum regularly for gynecologic exami-
nations came into vogue against some bitter opposition from both America
and Britain. This was an instrument Soranus had used so many hundreds of
years earlier. In 1839 Augustin Nicolas Gendrin suggested that ovulation
controlled menstruation and it began to be realized that the ovaries had more
control over menstruation than the moon did. The relation of conception to
menstruation became clearer, and Sigmund in 1871 advanced the belief that
a woman menstruated because she failed to conceive. Astonishing cases were
quoted to give point to this theory. One woman menstruated regularly up to
the age of 61 when she was delivered of a lusty child. She was eclipsed by a
a
lady who menstruated happily from 18 to 75. Then sort of is-this-a-record
discussion was ended by Professor Orfila who wrote with all the authority of
the Medico-legal Department of the University of Paris. He described a
woman who became pregnant for the first time at the age of 60, menstruated
regularly up to 99, and died at the age 114!
The proper place of gonorrhea as a causal agent of sterility in the female
was made very clear in 1872 by Emile Noeggerath and, in 1879, Albert Neisser
completed the details of this disease by the discovery of the gonococcus itself.
Prior to the work of Noeggerath, medical men thought that with the disap-
pearance of the purulent discharge the disease ceased.
Towards the end of the 19th century, X-rays were discovered by Wilhelm
Konrad Rontgen and as they became used a little more frequently clinically,
the sterilizing effects of X-rays applied to human ovaries and testicles were
noted by Davis and Varnier as early as 1903. It is probably a fortunate thing
for all concerned that this effect was discovered so early so that protective
precautions could be taken in the widening use of X-rays.
While sterility has been studied as seen over the centuries, obviously more
scientific knowledge has been compiled in this century than in all previous
time. The sterilizing effect of gonorrhea was well documented previously,
as was the effect of tuberculosis on the female pelvic organs. Thyroid deficien-
cies were first treated by Murray in 1891, and the use of thyroid extract has
been an old stand-by in the therapeutic armamentarium of infertility, al-
though controversial. By the turn of the century, it was well established that
the ovaries had a definite effect on menstruation, but it was not really until
1903, when Ludwig Fraenkel showed that the corpus luteum had endocrine
VOL. 14, No.3, 1963 HISTORY OF HUMAN INFERTILITY 271

activity, that the real effect of the ovaries on the genital tract was well estab-
lished. Modern concepts of physiology of menstruation date really from the
isolation of estrogen from the human ovarian follicle in 1923 by Edgar Allen
and Edward Doisy. The discovery of insulin in 1922 by Banting changed the
fertility outlook for the diabetic woman from very poor to fairly optimistic.
The function of the pituitary gland as the controlling agent over the ovarian
function became well established through the work of Aschner in 1912, and
later by the discovery by Smith and Engle, and Aschheim and Zondek, in
1927, of the gonadotropic activity of the anterior pituitary. Thus the idea
that the ovaries act independently of any other body function was dropped.
Mention should be made in this review of the work of Dr. I. C. Rubin and
his carbon dioxide insuiliation test introduced in New York in 1920 to deter-
mine tubal patency. About the same time, in the 1920's, the highly contro-
versial stimulating effect of X-rays on the ovaries was described. The effect of
the psychological factors in the causation of infertility were described and it
was realized then how important the psyche might be in the failure to achieve
pregnancy. The seemingly new idea of artificial insemination or therapeutic
insemination, as some authors prefer to call it, is apparently not actually new
at all. In 1799 Everard Home reported that John Hunter had successfully
performed artificial insemination in a case of a woman whose husband had a
hypospadias. I previously mentioned that J. Marion Sims had a case in 1866
in which a marriage had been sterile for 9 years. Therapeutic insemination
was tried and the birth of a normal child followed. Two years later Girault
was able to enumerate 10 cases, and in 1877 a Papal Encylical condemned the
practice of artificial insemination as abominable. It is possible that thera-
peutic insemination, now revived to a limited extent at least, may become one
of our great therapeutic agents. The effect on basal body temperature of
ovarian function was described in 1940 by Palmer and Moquot, and this has
proved of some value in the treatment of infertility. The effect of the anti-
biotics and chemotherapeutic agents is of prime import. The synthesis of the
sex hormones and the increased potency of some of the newer ones was hailed
as a great advance, only to have doubt cast upon the value of these drugs by
some very eminent authors. The same remarks apply to the use of the corti-
costeroids perhaps.
I have passed rapidly over the history of infertility in this century pur-
posely, as I presumed that my role is to try to narrate some of the interesting
legends of fertility rather than to give a minute factual dissertation.
The story of fertility down through the ages is to me fascinating. With all
the discoveries and therapeutic agents developed in the 20th century, one
would hope that we will eventually be able to do very much more for these
272 JOHNSTON FERTILITY & STERILITY

unfortunate couples. The problem is both stimulating and humiliating. One

cannot but wonder how in 1000 or 2000 years others will think we really rate
as to our knowledge of fertility in 1962!

BIBLIOGRAPHY

1. GRAHAM, H. Eternal Eve. Heinemann, London, England.

2. PODALSKY, E. Medicine Marches On. Harper, New York.
3. SIMMONS, A. Human infertility. New England]. Med., 1956.
4. McDANIEL, W. B. The medical and magical significance in ancient medicine of
things connected with reproduction and its organs. ]. Hist. Med. & Allied Sc. 3: 1948.
5. HOTCHKISS, R. S. Fertility in Men. Lippincott, Philadelphia.
6. KUCZYNSKI, R. R. Pepulation Mevements. Oxford, New York.
7. FIELD, J. A. Essays on Population. Univ. Chicago Press, Chicago.
8. SAUVY, A. Fertility and Survival. Chatto and Windus, London.
9. OPPENHEIM, A. L. A Caesarean Section in the Second Millennium B.C. ]. History
Med. & Allied Sc., 1960.
10. MALKIN, H. J. Observations on social conditions, fertility and family survival in the
past. Proc. Roy. Soc. Med. 53: 1960.
11. Historical Review of British Obstetrics and Gynaecology. Livingstone, London,
England.
12. PRICE, F. A Textbook of the Practice of Medicine. Oxford Medical Publications.
13. CURTIS, A. H. Textbook of Gynaecology. Saunders, Philadelphia.
14. NOVAK, E., and NOVAK, E. Textbook of Gynecology. Williams & Wilkins, Baltimore.
15. HOFFMAN, J. Female Endocrinology. Saunders, Philadelphia.

Training Program in the Physiology

of Reproduction
The Worcester Foundation for Experimental Biology, Shrewsbury, Mass.,
wishes to announce that the next postdoctoral training program in the physi-
ology of reproduction, under a grant from The Population Council, Inc., will
start on July 1, 1964.
Fellowships for the program will be awarded to candidates possessing the
Ph.D. or M.D. degrees, or their equivalents. These fellowships will carry a
stipend of $5,500 per annum and will be for a 12-month period. An allotment
will also be made for round-trip travel to Shrewsbury. Application forms may
be secured from the Program Director and should be returned not later than
Sept. 1, 1963. They will be processed by an Advisory and Selection Commit-
tee of experts, and the fellowship awards will be announced by Dec. 1.
The program will consist of a course of lectures and laboratory work. Dur-
ing the latter part of the year, each Fellow will have the opportunity to par-
ticipate in a research project pertinent to his interests and within the capacity
of the program.