Newsletter #9 (Winter 1994/1995)

Hannah Stone: The Madonna of the Clinic

When Margaret Sanger opened the Clinical Research Bureau of the American Birth Control League in 1923 she sought a woman physician to staff it, convinced that female patients would be more comfortable discussing sex and birth control with another woman. Finding any physician, let alone on who was a woman, was not easy, for as Sanger explained "few doctors wanted to take the risk of identifying themselves with the birth control cause, the risk of becoming a martyr, of losing professional license and standing, of being expelled from their medical societies." ("Hannah M. Stone: In Memoriam," Human Fertility, August 1941, p. 109) Yet Sanger persevered, even after one doctor refused her offer and another had to be dismissed. In 1925, Sanger hired Hannah Mayer Stone, a talented and committed young doctor with impressive academic training who would serve Sanger for the next sixteen years.

Hannah Mayer was born in New York in 1893, the daughter of a pharmacist. She received her own degree in pharmacology from Brooklyn College, and in 1912 was hired as a bacteriologist and serologist at Bellevue Hospital. Soon after she met Abraham Stone, a young Bellevue intern whom she married in 1917. With the U.S. at war, Abraham went off to serve in the military, while Hannah went to medical school. She received her M.D. in 1920 from New York Medical College and Flower Hospital, and joined the pediatrics staff at Woman's Lying-In Hospital in New York City. When Abraham Stone returned home, he and Hannah also set up a private practice.

Hannah Stone first met Margaret Sanger in November of 1921 at the first American Birth Control Conference. Sanger was already well-known for her intense, often confrontational commitment to birth control. Indeed at the final meeting of the conference held at Town Hall, police arrested Sanger for speaking publicly about birth control. The conference helped Sanger organize the resources and support to set up a viable birth control clinic to demonstrate the effectiveness, safety and usefulness of contraceptives when dispensed in an appropriate setting. Using the loophole provided by the 1918 NY State Court of Appeal's Brownsville Clinic decision, which upheld the right of physicians to dispense contraception when medically indicated, Sanger knew she could legally open a birth control clinic administered by a doctor.

In 1923, she hired Dr. Dorothy Bocker to provide the medical services for the newly opened Clinical Research Bureau [CRB] (renamed the Birth Control Clinical Research Bureau [BCCRB] in 1928) at a salary of $5,000. However, after the first year of operation, Dr. Bocker's salary was too high for the clinic's limited budget. More importantly, Sanger was disappointed with the quality of Bocker's work. Not only was Bocker not experienced in gynecological methods, but she had failed to conduct follow-up work on the 20% of clinic patients who had not returned for scheduled visits. Instead Bocker had assumed that their treatment had been successful. Bocker had also used such a wide variety of contraceptive regimes that there was too little data on any one combination of methods to be statistically relevant. As one of Sanger's main purposes in establishing the clinic was to demonstrate the effectiveness of specific contraceptives, Bocker's reports failed to provide the data she needed. Looking for a replacement, Sanger turned to Hannah Stone, already a member of the BCCRB's medical advisory committee. Stone accepted the offer and, unlike Bocker, served the clinic without pay for the next sixteen years.

In Hannah Stone, Sanger found not only a talented medical director, but a calm, soft-spoken, intensely loyal colleague: "Her gaze was clear and straight, her hair was black, her mouth gentle and sweet." Sanger later wrote, "She had a sympathetic response to mothers in distress, and a broad attitude towards life's many problems....These qualities have kept her with us all this time, one of the most beloved and loyal workers that one could ever hope for." (Autobiography, 1938, pp. 360-361). Indeed she came to be known as "the Madonna of the clinic." (Emily S. Mudd Interview, Schlesinger Library Oral History Project on Women in Family Planning, May 21-August 3, 1974) Not only was Stone a sensitive and compassionate physician, but a talented clinician as well, who appreciated the need for compiling the detailed records necessary to prove the effectiveness and safety of birth control. By 1941 Stone had seen 100,000 patients at the clinic and created a detailed patient record for each one. With the data she collected, Stone provided clinical evidence proving that use of the diaphragm, combined with spermicidal jelly, was an effective contraceptive and caused no ill effects to the patient. In 1928 she published some of her findings in "Therapeutic Contraception," one of the first thorough reports on the subject to appear in a medical journal (Medical Journal and Record, 1928), and in 1931 she published additional research in The Practice of Contraception, co-edited with Margaret Sanger. Stone also participated in various studies of the BCCRB's records by outside analysts, which led to several important studies by medical scientists on fertility and gynecology.

Hannah Stone's association with Sanger's clinic jeopardized any hopes she might have had of ascending the medical ranks. Her new work at the BCCRB conflicted with her position at the Women's Lying-In Hospital, and when Stone refused to give up her clinic work, she was asked to resign from the hospital. For Stone the choice was not a difficult one, "`Of course I'll go along with you in this work," she told Sanger, "the other can get thousands to do that work, but this needs some of us who know its importance and who care.'" (Sanger Diary, July 14, 1941, MSM S70:554-5)

In 1929, Stone and four other BCCRB staff members were arrested during a police raid of the clinic. While the charges against Stone were dismissed and the raid generated long sought-after support from the city's medical community, newspaper photos of Stone being led into a paddy wagon created a blemish on her record for many years to come. In 1932, the New York Medical Society tabled Stone's application for admission with no explanation.

In the mid-1930's Sanger asked Stone to act as the guinea pig in a test case designed to challenge Federal laws restricting the importation of contraceptive devices. Stone ordered a box of 120 pessaries from Japan for possible use in her private practice. The U.S. Customs Office was then informed of the impending arrival of the package. Customs seized the package and Hannah Stone brought suit on behalf of the clinic, arguing that as a licensed physician she was permitted to receive the devices for legitimate medical applications. The case, U.S. v. One Package, went to the Second Circuit Court of Appeals in New York, which ruled in 1936 that physicians could legally import contraceptive devices for medical purposes. This landmark decision paved the way for de facto legalization of birth control under the supervision of doctors.

Stone was one of Margaret Sanger's few associates who did not covet the spotlight. The internecine struggles for power within the birth control movement seemed not to touch her. "She was at times left out of this group – pushed off this committee – ignored when she should be recognized," Sanger remembered. "Her work, discoveries, methods snapped up by others with more prominent names & used to their own advantage. Doubtless she must have been hurt, doubtless she must have felt the pangs of the knife thrust through the heart – but never did I hear her beg or ask favors for herself or criticize others for these things. Always she laughed at the reasons given & the methods behind these acts." (Diary, July 14, 1941, MSM S70:57-8)

For Sanger, Hannah Stone's real legacy lay in the quiet and efficient work she accomplished in her role as the clinic's medical director. As Sanger noted, "It was she who...was most responsible for the introduction of the knowledge of contraceptive techniques to the medical profession .... Thousands of medical students and physicians came to the Bureau to observe her techniques and receive instructions under her..." ("In Memoriam", August 1941) And Sanger frequently cited Stone's pioneering work in counseling couples with marital and/or sexual problems. Stone's marriage advice sessions, which began informally at first, led to the organization of a Marriage Consultation Center (run with her husband, Abraham) at the clinic and at the Community Church. In 1935 they published their counseling techniques in A Marriage Manual.

Hannah Mayer Stone died unexpectedly of a heart attack on July 10, 1941 at the age of 48. Abraham Stone replaced his wife as the Medical Director of the BCCRB, and faithfully filled the post for many years, but for Margaret Sanger, Hannah Stone's skill, empathy and dedication were irreplaceable. With her "Madonna-like beauty, coupled with her kindness and graciousness," Stone, according to Sanger, "inspired confidence in all who met her." ("In Memoriam", August 1941) Most of all, Hannah Stone's death left a void for the thousands of women who sought help at the clinic. As Sanger testified, it was Hannah Stone's "infinite patience, her attention to details, her understanding of human frailties, her sympathy, her gentleness – to all these qualities of mind and personality...these thousands of mothers owed their peace of mind, marital harmony, health and yes, in many cases, life itself." ("In Memoriam," August 1941).