After coming back from around the world I found nothing had been done about the Tenth Street clinic, which I had expected to be in operation. No members of the Academy of Medicine had come forth to back Dr. de Vilbiss, and I had paid the rent for the last twelve months while vainly waiting.

Now I gave it up and decided to start afresh. The more I had studied, the more clearly I had recognized that it was not possible to advise a standard contraceptive for all women any more than it was possible to prescribe one set of eyeglasses for all conditions of sight. Only upon examination and careful check-up could you determine the most suitable method. No detailed statistics had ever been kept except at Brownsville, and those case histories had never been returned to me by the police. I wanted to collect at least a thousand such records for a scientific survey before any opposition could interfere with the plan.

Many women were still coming to me personally for information at 104 Fifth Avenue. The best thing to do was have a woman doctor right there to take care of them—a quiet way to begin. It was hard to locate one foot-loose and free; I could have no shying or running off at the first indication of trouble. In making inquiries I heard of Dr. Dorothy Bocker, who held a New York City license though she was at present in the Public Health Service of Georgia. This single, cordial, and enthusiastic young woman knew practically nothing about birth control technique, but was willing to learn. The difficulty was that she wanted five thousand dollars a year.

At first this appeared an almost unsurmountable obstacle. Here was just the person I had been looking for, but it seemed beyond my power to raise so large a sum. I was loaded with the financial weight of the Review and the League. That organization had been admitted as a membership corporation and hence could not secure a license to conduct a clinic, which in New York was synonymous with a dispensary. No clinic, therefore, could be included in its budget; it would remain a department of the League by courtesy only, being actually my private undertaking. Where could I find someone to donate such an enormous amount?

Then I remembered Clinton Chance, a young manufacturer of Birmingham, who had prospered exceedingly both before and during the War. He and his wife, Janet, had become good friends of mine during my 1920 visit to England. Having felt the need of a more sound and fundamental outlet for his riches than that provided by charity, he had come to see that birth control information was far better for his employees than a dole at the birth of every new baby. He was not in any sense a professional philanthropist, but only wanted to help them be self-sufficient.

Clinton had once offered me money to set the birth control movement going in England, but I had refused then because England had enough co-workers, who were handling the situation well, and, furthermore, my place was in the United States. He had then said to me, “I won’t give you a contribution for regular current expenses, but if ever you see the necessity for some new project which will advance the general good, call on me.”

Now I cabled Clinton at length, explaining my need. He promptly answered, “Yes, go ahead,” and soon arrived an anonymous thousand pounds to cover Dr. Bocker’s salary for the first year. I made out a contract for two. She was to come in January, 1923, and we were to shoulder the risks and responsibilities together.

Even to choose a name for the venture was not easy. I had been steadily advertising the term “clinic” to America for so long that it had become familiar and, moreover, to poor people it meant that little or no payment was required. But the use of the word itself was legally impossible, and I was not certain that the same might not be true of “center” or “bureau.” I wanted it at least to imply the things that clinic meant as I had publicized it, and also to include the idea of research.

Finally, one of the doors of the two rooms adjoining the League offices, readily accessible to me and to the women who came for advice, was lettered, Clinical Research.

It was still a clinic in my mind, though frankly an experiment because I was not even sure women would accept the methods we had to offer them. We started immediately keeping the records. Dr. Bocker wrote down the history of the case on a large card, numbering it to correspond with a smaller one containing the patient’s name and address. Each applicant she suspected of a bad heart, tuberculosis, kidney trouble, or any ailment which made pregnancy dangerous, she informed regarding contraception and advised medical care at once.

In our first annual report, which attracted much attention, all our cases were analyzed. We said, “Here is the proof—nine hundred women with definite statistics concerning their ages, physical and mental conditions, and economic status.”

As time went on I became less and less pleased with Dr. Bocker’s system. She had no follow-up on patients, and I wished the clinic to be like a business in the thoroughness of its routine. I refused to approve methods as a hundred percent reliable until there had been not merely one but three checks on each woman who had been to the clinic. To begin with, she was to return two or three days after her initial visit; she usually did that. But if she did not come back inside three months, then a social worker in our own employ should be sent to call on her. Finally, she was to be examined once a year. Dr. Bocker did not see eye to eye with me that this was the only way to put the work on a sound scientific basis of facts, and we agreed to part company in December of the second year.

Dr. Hannah M. Stone, a fine young woman from the Lying-In Hospital, volunteered to take Dr. Bocker’s place without salary. Her gaze was clear and straight, her hair was black, her mouth gentle and sweet. She had a sympathetic response to mothers in distress, and a broad attitude towards life’s many problems. When the Lying-In Hospital later found she had connected herself with our clinic, it gave her a choice between remaining with us and resigning from the staff. She resigned. Her courageous stand indicated staunch friendship and the disinterested selflessness essential for the successful operation of the clinic. These qualities have kept her with us all this time, one of the most beloved and loyal workers that one could ever hope for.

The clinic could serve New York, but its practical value outside was restricted, and I was always seeking some way of remedying this. We took the preliminary step in Illinois, where no laws existed against clinics. I had arranged a conference in Chicago at the Drake Hotel, October, 1923, the first of a regional series. Mrs. Benjamin Carpenter and Dr. Rachelle Yarros, who had been with Jane Addams at Hull House, had to obtain a court decision before Dr. Herman Bundesen, Commissioner of Health, would issue a license for the second clinic in the United States.

Meanwhile, between 1921 and 1926, I received over a million letters from mothers requesting information. From 1923 on a staff of three to seven was constantly busy just opening and answering them. Despite the limitations of the writers and their lack of education, they revealed themselves strangely conscious of the responsibilities of the maternal function.

Childbearing is hazardous, even when carried out with the advantages of modern hygiene and parental care. The upper middle classes are likely to assume all confinements are surrounded by the same attention given the births of their own babies. They do not comprehend it is still possible in these United States for a woman to milk six cows at five o’clock in the morning and bring a baby into the world at nine. The terrific hardships of the farm mother are not in the least degree lessened by maternity. If she and her infant survive, it is only to face these hardships anew, and with additional complications.

In the midst of an era of science and fabulous wealth reaching out for enlightenment to advance our civilization, with millionaires tossing their fortunes into libraries and hospitals and laboratories to discover the secrets and causes of life, here at the doorstep of everyone was this tragic, scarcely recognized condition.

It was an easy and even a pleasant task to reduce human problems to numerical figures in black and white on charts and graphs, but infinitely more difficult to suggest concrete solutions. The reasoning of learned theologians and indefatigable statisticians seemed academic and anemically intellectual if brought face to face with the actuality of suffering. When they confronted me with arguments, this dim, far-off chorus of pain began to resound anew in my ears.

Sensitive women of our clerical staff were constantly breaking down in health under the nervous depression caused by the fact we had so little knowledge to give. One who went to Chicago to help rehabilitate soldiers wrote me, “I’m feeling much better. These men who have lost a leg or arm come in, apparently disqualified forever, but something is being done about them, and it is happy work, not forlorn like yours.”

To prove that the story could be told by the mothers themselves, ten thousand letters, with the assistance of Mary Boyd, were selected and these again cut to five hundred. Eventually this historical record appeared in book form as Motherhood in Bondage.

Whenever I am discouraged I go to those letters as to a wellspring which sends me on re-heartened. They make me realize with increasing intensity that whoever kindles a spark of hope in the breast of another cannot shirk the duty of keeping it alive.

Woman and the New Race, which sold at first for two dollars, had a distribution of two hundred and fifty thousand copies, and it made my heart ache to know that poor women who could ill afford it were buying the book and not finding there what they sought. To the best of my ability I tried to supply general information, but the only way of extending genuine aid was to persuade doctors to give it professionally.

By a happy chance I met Dr. James F. Cooper, tall, blond, distinguished, a fine combination of missionary and physician, who left no stone unturned when a patient came to him, but devoted his whole attention to her—everything in her life was important to him. He was recently back from Fuchow, China, and was establishing himself in Boston as a gynecologist. Since he was thoroughly convinced of the vital necessity for birth control and could talk technically to his profession and interpret to the layman as well, my husband pledged his salary and expenses for two years, and I induced him to associate himself with us as medical director to go forth and try to convince the doctors throughout the country that contraceptive advice would save a large proportion of their women patients.

In January, 1925, Dr. Cooper started on a tour which covered nearly all the states in the Union. In the course of the two years he delivered more than seven hundred lectures. Occasionally he was suspected of ulterior motives, of attempting to advertise the products he recommended, but this did not sway him from his persistence. Where he found laxity on the part of medical organizations he spoke to lay associations, which applied pressure on their own physicians, demanding information. As a result of this trip, doctors really began to awake to the problem of contraception, and when it was ended we had the names of some twenty thousand from Maine to California who had consented to instruct patients referred to them.

At this point began the huge and difficult process of decentralization, so that the New York office need no longer be a clearing house. Each request which lay outside the pale of the Cooper influence required voluminous correspondence. One letter, enclosing a stamped, return-addressed envelope, was mailed to the woman, asking her to furnish us the name of her doctor. We then wrote him to inquire whether he would give her information, and offered to send supplies if she could not afford them. If he said yes, we notified her to that effect; if he said no, we gave some other doctor in her vicinity an opportunity to co-operate.

We were immediately confronted with the situation that even willing doctors had little to recommend. Literally thousands of women reported that such ineffective methods had been tendered them they had refused to pay. We ourselves did not have a great deal, and this put us in a weak position; the acceptance of the theory was ahead of the means of practicing it.

The jelly I had found in Friedrichshaven had turned out to be too expensive, because it was made with a chinosol and Irish moss base, and the price of the former was prohibitive in preparing it for poor women. Dr. Stone and Dr. Cooper, therefore, devised a formula for a jelly with a lactic acid and glycerine base, which was within our means. Most of their cases, however, were sufficiently grave for them not to feel justified in using it alone experimentally. Consequently, they took the precaution of having a double safeguard by combining the chemical contraceptive with the mechanical—jelly with pessary—which proved ninety-eight percent efficacious.

At this time we could not import diaphragms directly. Although I had given various friends going to Germany and England the mission of bringing them in, this could not be done in sufficient quantity. Furthermore, since bootlegging supplies could not continue indefinitely I had to find out how they could legally be made here.

Two young men came to help in whatever way was most necessary. Herbert Simonds, who had been in advertising, began to investigate the possibility that some recognized rubber company should make our supplies. When one and all were fearful, he and Guy Moyston, who did some publicity for us, concluded they would form the Holland-Rantos Company, selling only to physicians or on prescription. They spent their own time and thousands of dollars personally on research, in the end perfecting a quality of rubber that could stand the variations of climate in the United States—hot houses and cold winters, Florida dampness and Western dryness.

Meanwhile, Julius Schmid, an old established manufacturer, had been importing from his own concern in Germany a few diaphragms, but only on a modest scale because he did not want to run afoul of the Comstock law. As soon as he saw a potential market in the medical profession he fetched from the Fatherland several families who had been making molds there, gave them places to live in, and set up a little center, expanding gradually until eventually he sold more contraceptive supplies than any firm in the world.

But this was all in the future.

Soon after we had developed an organization in which economists, biologists, and other scientists could be articulate, they came into the movement. Dr. S. Adolphus Knopf, a tuberculosis specialist, who had been one of the first to greet me when I came out of jail, never missed an opportunity to contribute articles to medical journals and to write letters. Professor Edward Alsworth Ross’s books continued to popularize the sociological and economic aspects. Professor E. M. East of the Bussy Institute of Harvard University published a study of population titled Mankind at the Crossroads, which obtained wide circulation. His one-time pupil, Dr. Raymond Pearl of Johns Hopkins, was carrying on the same work showing exactly how much food a certain number of acres could produce at what cost. Universities generally began to show an interest; students wrote asking for scientific and historical data upon which to base their theses.

Young people in colleges, partly because their ideas were not yet biased, offered a fallow field for my personal campaign of education through lecturing. I particularly enjoyed their quickness and alertness and their interludes of comic relief. Nowhere has this combination been more apparent than in a recent visit to Colgate University. Four boys met me at the station and somehow or other we all squeezed into an automobile which shortly deposited me at the home of one of the professors for tea and to meet the faculty. “This is house-party night,” he told me. “The girls are here, and most of the boys won’t get to bed until daylight. We’ll have to rout them out to hear you at chapel tomorrow.” He added that during his twelve years in the University no woman had spoken on that platform.

“Have they prejudices against women speakers?”

“Oh, no, no. There’s just no subject a woman can deal with better than a man.”

Well! I thought, if the boys will all have been out to parties and I’m the first woman speaker, here is a challenge! No sociology or dull population figures for them from me.

The next morning, determined to make them take notice, I ransacked my bag for my smartest dress, adjusted my lipstick, and carefully set my hat at an angle. Nevertheless, I was a bit ill at ease. My anxiety was not allayed when Norman Himes, professor of sociology, said, “Now, Mrs. Sanger, we probably shan’t be able to hear you in this hall. The acoustics are very bad. They can hardly hear me and I have a big voice.”

This was even less encouraging. I felt I was likely to be the last as well as the first woman at Colgate. However, I replied bravely, “I can speak up and we can have some wave if they can’t hear me. Anyhow, there probably won’t be many; why can’t they be moved up front?”

“Yes, that’s what we’d better do.”

We went in to find the chapel jammed. Some of the students were standing in the door, others against the walls.

Professor Himes introduced me at the top of his lungs. “Louder! Louder!” The boys waved their hands. The more he tried to make himself heard, the more restless they became. When I stood, however, they had to listen if they were to hear me. There was no waving, no calling. They roared with laughter and clapped at everything I said. This seemed fine, but I suspected that I could not have really made so profound an impression as to deserve so much applause.

Someone afterwards commented to Professor Himes, “We’ve never seen the boys so appreciative.”

“Oh,” he remarked, “they thought if they could keep Mrs. Sanger talking long enough they wouldn’t have to go to their examinations.”

From the time I started lecturing in 1916 I have appeared in many places—halls, churches, women’s clubs, homes, theaters. I have had many types of audiences—cotton workers, churchmen, liberals, Socialists, scientists, clubmen, and fashionable, philanthropically minded women.

Once in Detroit Mrs. William McGraw, Sr. had organized a public meeting and luncheon at the Statler Hotel. When I arrived I encountered a situation which might well have embarrassed a less doughty hostess. She had invited a dozen of the most prominent women in the city to sit at the speaker’s table. Mrs. A. had asked, “Will Mrs. B. sit there also?” Mrs. B. had inquired, “Will Mrs. C. be next to me?” Each wanted social support. Mrs. McGraw had blandly refused to tell them; consequently not one had accepted. Although five hundred came, only two places were set at the great banquet table on the platform. Mrs. McGraw and I ate in solitary splendor with nothing but the floral decorations for company.

All the world over, in Penang and Skagway, in El Paso and Helsingfors, I have found women’s psychology in the matter of childbearing essentially the same, no matter what the class, religion, or economic status. Always to me any aroused group was a good group, and therefore I accepted an invitation to talk to the women’s branch of the Ku Klux Klan at Silver Lake, New Jersey, one of the weirdest experiences I had in lecturing.

My letter of instruction told me what train to take, to walk from the station two blocks straight ahead, then two to the left. I would see a sedan parked in front of a restaurant. If I wished I could have ten minutes for a cup of coffee or bite to eat, because no supper would be served later.

I obeyed orders implicitly, walked the blocks, saw the car, found the restaurant, went in and ordered some cocoa, stayed my allotted ten minutes, then approached the car hesitatingly and spoke to the driver. I received no reply. She might have been totally deaf as far as I was concerned. Mustering up my courage, I climbed in and settled back. Without a turn of the head, a smile, or a word to let me know I was right, she stepped on the self-starter. For fifteen minutes we wound around the streets. It must have been towards six in the afternoon. We took this lonely lane and that through the woods, and an hour later pulled up in a vacant space near a body of water beside a large, unpainted, barnish building.

My driver got out, talked with several other women, then said to me severely, “Wait here. We will come for you.” She disappeared. More cars buzzed up the dusty road into the parking place. Occasionally men dropped wives who walked hurriedly and silently within. This went on mystically until night closed down and I was alone in the dark. A few gleams came through chinks in the window curtains. Even though it was May, I grew chillier and chillier.

After three hours I was summoned at last and entered a bright corridor filled with wraps. As someone came out of the hall I saw through the door dim figures parading with banners and illuminated crosses. I waited another twenty minutes. It was warmer and I did not mind so much. Eventually the lights were switched on, the audience seated itself, and I was escorted to the platform, was introduced, and began to speak.

Never before had I looked into a sea of faces like these. I was sure that if I uttered one word, such as abortion, outside the usual vocabulary of these women they would go off into hysteria. And so my address that night had to be in the most elementary terms, as though I were trying to make children understand.

In the end, through simple illustrations I believed I had accomplished my purpose. A dozen invitations to speak to similar groups were proffered. The conversation went on and on, and when we were finally through it was too late to return to New York. Under a curfew law everything in Silver Lake shut at nine o’clock. I could not even send a telegram to let my family know whether I had been thrown in the river or was being held incommunicado. It was nearly one before I reached Trenton, and I spent the night in a hotel.

In Brattleboro, Vermont, my audience was made up of another slice of America—honest, strong, capable housewives who made their pies and doughnuts and preserves before they came. When I had finished there was not a murmur of commendation from the three hundred. The minister of the church where the meeting was held had asked me to stand beside him to say how-do-you-do when they came out. They just went by, eyes straight ahead.

On the telephone afterwards, however, each was asking what the other thought. The cases I had cited were typical of their own community. “Was she referring to this one or that one?” they queried.

I returned two days later to lunch with a doctor and four or five social workers, and was surprised to hear, “The women want to start a clinic.”

“But there wasn’t any enthusiasm when I suggested it the other morning.”

“The people around here don’t express much openly. They were moved to quietness. But just the same they’re starting a clinic in Brattleboro.”