THE AMERICAN FATHER OF BIRTH CONTROL

New England Quarterly, Vol. 6 (1933) 470-490.

ROBERT E. RIEGEL

Among the obscure men who have influenced our present civilization significantly, few deserve greater recognition than a backwoods Massachusetts physician, Charles Knowlton. This man was entirely a New Englander, never even having been outside that section of the country except for two brief trips into New York State. He was largely responsible for the inception of the birth-control movement in America, having written one of the earliest books describing (and approving) the use of contraceptives, and was, indirectly, important to the cause throughout the world. Moreover, he wrote an unusual psychological treatise based (a century ago) on what is now called behaviorism. He was, altogether, a remarkable man. Possibly the future will give him more credit than the past.1

His life extended through the first half of the nineteenth century. The record of his early career remains to us, paradoxically, only because of his very obscurity. Patients were not numerous for a young doctor in the rural sections of Massachusetts therefore Knowlton decided that he would keep a complete case record of each person whom he treated. The only difficulty was lack of patients; consequently he started his records with the history of his own case. The biographer has reaped the benefit which Knowlton hoped would accrue to humanity. The young physician, it so happened, eventually attracted numerous patients, but he not only failed to enter their records on his clean, blank pages, but never even found time to complete his autobiography.2

According to Knowlton's own record: "I have been informed, but whether correctly or not I can never know however confidently I may believethat I, Charles Knowlton, was born in Templeton, Worcester Co., Mass., on the 10th of May, 1800."3 Not sharing Knowlton's skepticism, we can safely assume that these facts are approximately true. His father, Stephen, was a farmer in moderate circumstances, and Charles (together with an older and a younger brother) worked as soon as he was able to be useful. Charles's lasting impressions were memories of shaving pine shingles and drinking New England rumthe quantity of liquor consumed having possibly undergone some exaggeration. Of schooling he had littlepossibly about two months in every summer. But even this little was not effective, for Knowlton was backward, giving no promise of any particular distinction. As he grew older, he improved his arithmetic and grammar; in other subjects he continued hopeless.

Late adolescence he looked back on as a particularly trying period. He pictures himself, at the age of about seventeen, as a tall, spindly, anæmic lad, five feet eleven inches tall, weighing 135 pounds. His one accomplishment was checkers, and his game was good. Physically, he was wan, thin, and nervous; mentally, he was depressed to the point of melancholia. During a period of three years he consulted ten different doctors and tookmedicine regularly three times a day. Among the remedies he tried were bark, wine, tincture of cantharides, iron preparations, balsams, opium, nitrate of silver, alum, vegetable astringents, and blisters. The wonder is that he survived his "cures." He was perpetually careful to avoid over-strain; most of his time he spent in the house. When he ventured away from home, he wrote "take care" in capital letters and fastened the paper to his sleeve to be sure that he would not be tempted to exceed his strength.3

The cause of Knowlton's troubles was "gonorrhoea dormientum,"- which polite language disguises as "self-abuse." Although the physical effects of this practice may not have been of any actual importance (as Knowlton himself later believed) the mental effects were significant. A century ago no one doubted that the habit led to the most terrible and devastating results on both mind and body. Reputable physicians blamed it for everything from pains in the back and poor digestion to paralysis and insanity.4 The very name they used shows their point of view, which must have had its effect on the gawky, weak, impressionable boy. His whole life was colored by this sexual experience, which helps to explain his later interest and attitude in regard to sex.

During his period of ill health Knowlton began his career. In spite of almost continuous sickness and gloom he attended New Salem Academy for half a term_six weeks_in the autumn of 1818. In the winter he felt sufficiently qualified to teach school at Alstead, New Hampshire; then he returned for another six weeks in the academy. During the summer of 1819 he was the patient of Dr. Charles Adams of Keene, New Hampshire, and seized the opportunity of persuading the doctor to teach him a little Latin. The following winter, he resumed his teaching, which he interrupted with regular visits to doctors in Gardner and Templeton. When the term was over, Knowlton discovered, it would seem, that his work as a teacher interfered with his duties as an invalid; consequently he devoted himself entirely to ill health. At twenty-one he was faced with a future as uninspiring as ever confronted a man of his age. Twenty years had left behind them neither special training nor pleasant memories. The future threatened an indefinite invalidism, which could be ended only by death.

The miracle happened in 1821: Knowlton became healthy. The process of his recovery is heartily to be recommended. Not far from the Knowlton farm lived a first-rate mechanic, Richard Stuart by name. Stuart had a passion for mechanical novelties and spent his spare moments experimenting with a machine for producing electricity, just then attracting popular attention. He felt that his machine would show curative effects. Knowlton was willing to try anything by this time; so he moved to the Stuart home as a patient and began to take electric shocks daily. The precise results of this treatment will always remain somewhat doubtful, for Stuart had six lively daughters. In such an environment, Knowlton could hardly remain an invalid, no matter how attractive his valetudinarianism had become. Checkers, backgammon, and chess, and music and dancing soon became the order of the day, and the patient began to improve with remarkable rapidity. Possibly no medical treatment has ever proved more thoroughly enjoyable. On April 17, 1821, he married Tabitha Stuart, then seventeen years old_after which time his health continued to improve. In the light of his own experience, it is easy to see why he always advised marriage as a cure for the worries of youth.5

Having taken a wife, Knowlton was faced with the necessity of finding some occupation that might pay for the sustenance of at least two people. He had good reason to think that there would soon be three_for birth-control was not yet effective in rural Massachusetts. What could have been more natural than that he should capitalize the information he had bought so dearly, and become a doctor? In October, 1821, therefore, he started the study of medicine with Dr. Charles Wilder of Templeton. Finances were troublesome; so Tabitha continued to stay with her parents; while the young husband worked for his board at his teacher's home. He took his avocation so seriously that he soon experienced the desire to dissect a cadaver. Bodies were hard to obtain, however, as long as people believed in physical resurrection; sentiment against dissection was widespread_well-nigh universal_and the laws were stringent. Knowlton waited for a dark night, dug up a newly-buried corpse and carried it off in triumph. The doctor was dumb-founded when he heard of the exploit, but it was harder to dispose of a corpse than to find one; so the body had to remain. The young student kept it in his own chamber (apparently not disturbed by his rather unusual room-mate) and performed his dissections in spare moments.

By 1822, Knowlton realized that he needed regular study; so he planned to go to Dartmouth Medical School, then called the New Hampshire Medical Institution. During that summer he tried to save money by making wooden buckets to sell in Boston. Whether or not he was cheated in the price, as he thought,6 the fact remains that the end of the summer found him without sufficient finances to go to Hanover. News that the medical school would pay fifty dollars for each cadaver brought in for dissection offered a way out. Joining forces with a Templeton boy, who was also planning to attend Dartmouth, he robbed the local cemetery. Unfortunately the weather was warm, and their first acquisition almost immediately began to get "slippery." Realizing they could never transport their tuition money in this form without attracting unwelcome attention, they disposed of the embarrassing body, and dug up another about ten miles away. This they packed in a wagon with their trunks and started off in high hopes. Again warm weather gave their baggage a perceptible odor. At Keene they thought they were caught, but found their fears were groundless. From that point, however, they favored the less frequented inns. By the time they reached Hanover their plunder was offensive. But the worst was yet to come: R. D. Mussey, professor of anatomy, declared that he couldn't use the cadaver, for dissections would have to await cooler weather. The disappointment of the prospective students was so obvious that Mussey relented and gave them twenty dollars, on condition that they dispose of the corpse immediately. One has only to consider prices and professors' salaries of the period to realize the munificence of this generosity.

Measured by modern standards, the Dartmouth Medical School of 1821 was far from magnificent. One brick building, put up in 1811, held all the class-rooms, and laboratories, and the library_as well as rooms for some of the students. The term lasted fourteen weeks, and there were always four lectures a day, and frequently five or six. The tuition fee totalled fifty dollars; and board came to a dollar and a quarter a week. At every lecture the professor in charge quizzed his auditors on the preceding lecture; once a week he examined the whole class more generally. A degree was conferred only after a comprehensive examination at the end of the term. The faculty of the school had been re-organized the very autumn that Knowlton arrived_the only survivor of the upheaval being Professor Mussey, who taught anatomy, surgery, and obstetrics. Daniel Oliver and J. F. Dana were imported from Harvard_the former to teach the theory and practice of medicine, physiology, and materia medica the latter to handle chemistry, pharmacy, and legal medicine. For a short time Dr. Usher Parsons, U.S.N., taught anatomy and physiology.7

Upon his arrival at Dartmouth, Charles was by no means popular. In appearance he was tall and thin, with long, straggling chin whiskers; in temperament he tended to be shy and even retiring, making few friends, and giving the impression of an overwhelming sadness. He and his friend from Templeton and another student shared rooms in a brick building called the "Tontein." All three were poverty-stricken and saved money by economizing on a diet which consisted chiefly of cheap beef, brown bread, and potatoes. They bought grain, had it ground, and baked their own bread. One of them soon collapsed on this fare and had to withdraw. The remaining two continued to exist on approximately thirty cents a week. No wonder that Knowlton was troubled with headaches and digestive upsets. The other students thought him funereal, poked fun at him, and drew caricatures. In fact, he became aware of his deficiencies and tried to remedy them. The obvious act of improvement was to remove the whiskers. Then he became convinced that, even if he could not gain a reputation for good-fellowship, he could, at least, impress his fellow-students with his scholarship. He had observed that in the weekly quizzes practically all the questions were asked of the three or four men in the front row; so he studied diligently, sat in the front row, answered the questions with poise, and thus won some measure of respect from his class-mates. He notes that he participated heartily in the big feed that was traditionally given the students by the faculty at the end of the year. In fact, considering his ordinary diet, he ate not wisely but too well, and for some time afterward was deathly sick.

During the summer vacation of 1823 Knowlton continued his studies with Dr. Stephen Bacheller of Royalston. At this period he attended his first case alone, which was quite an event, even though the patient was suffering from nothing more exotic than croup. In August he was arrested for body-snatching. He denied the charge. After his indictment he returned to Keene where he resumed his medical studies, this time in the office of Dr. Amos Twitchell. Dr. Twitchell had long been interested in the Dartmouth Medical School, had been influential in its establishment, and had at one time, for financial reasons, declined the chair of anatomy and surgery. He was one of the best-known doctors in New England and undoubtedly influenced Knowlton's life.8

When the time came for the resumption of his college career, Knowlton was, as usual, without funds His financial situation was so bad that he could not afford the stage fare for the journey from Keene to Hanover. He walked. During his second year he participated more fully in the social life of the students. His most striking exploit was starting a ghost scare, which he maneuvered in such a way that he was the head of the party which tried to lay the ghostly noises he himself had created. During the course of the year he was called to Worcester to be tried for grave-robbing; the case was continued. At the end of the school term of 1824, he passed his examinations, receiving special compliments from Professor Mussey, and obtained the coveted degree.

When he started his practice of medicine in 1824, Knowlton's resources were youth, a physique never very strong and now handicapped by two years of malnutrition, a fair education, an old sleigh, a horse, one pair of badly-used saddle-bags, an electric machine, and ten dollars in cash. He hung out his shingle at Hawley, near Greenfield, rented a home, brought his wife, and waited for business. An older physician was already well established in the community, and consequently Knowlton was consulted by very few; at a later time he estimated that the work he did in the first three and a half months paid him not more than twenty dollars. The most exciting event of his stay in Hawley was the conclusion of the Worcester case, in which the court finally adjudged him not guilty of robbing a grave or disposing of a body, but convicted him for illegal dissection and imposed a two months' sentence to the county jail. Knowlton's father advanced the money to pay the costs, but the imprisonment had to be gone through with, and Knowlton objected strenuously to the cod, dark room, with its bad furnishings, the poor food, the fleas, and the bed-bugs.

When Knowlton returned from jail, he found business a little better, but still he was not overwhelmed with patients. Having little except poverty to occupy his mind, he planned a book which should bring him fame. His notion was to venture into psychology and write a true explanation of mental phenomena. There was room in this field for a commentator who did not take revealed religion as his starting point. Partly to further this project, Knowlton moved his family to North Adams, in November, 1827, to be conveniently near a printing-press. The writing went on fairly rapidly, for North Adams had plenty of doctors, and medical practice did not prove lucrative. Knowlton realized that the printing of his book was only a part of the battle; so he spent odd moments trying to make advance sales on the basis of his prospectus. These efforts were not noticeably successful, even though Knowlton declared later that no less a person than President Griffin of Williams confessed that his own philosophy did not refute that of Knowlton.

The magnum opus was finally completed early in 1829, and a thousand copies were printed by A. Oakley at North Adams. They were then loaded into a wagon and taken to Pittsfield for binding. The entire cost of the edition to the author came to ninety cents a copy. The name Knowlton gave his book was somewhat intimidating: Elements of Modern Materialism: Inculcating the Idea of a Future State, in which all will be more happy, under whatever circumstances they may be placed, than if they experienced no misery in this life. The conservative tone of the sub-title was belied by the actual contents. The religious element of the book was distinctly its weakest point. Knowlton argued that God must be material inasmuch as He could produce effects, and only material substances produce perceptible effects. Knowlton's God was a material creature who had created the world, foreseeing its general course (but not every specific detail), and then withdrawn from the direct management of the world's affairs.

Much more important was Knowlton's philosophy of mental reaction. His doctrine was, in substance, a brand of early-nineteenth-century behaviorism. The foundation of his interpretation was the rejection of all spiritual and psychical concepts, such as "soul" and conscience," and the insistence that all human phenomena were occasioned by definite and ascertainable forces operating in an orderly world. According to this interpretation, personality is nothing more than the result of past sensations. Such concepts as a "sense of time" mean nothing but a relationship between various sensations. The idea of "free will" is only a myth, for no action can exist without definite and material causes. Such causes may, of course, include passions, which arise within the body_as well as external stimuli. All human actions are essentially selfish; there is no such thing as disinterested benevolence. Words such as "good" and "evil" can mean nothing except as they result in human happiness and unhappiness; so that any specific act may be either good or evil, depending upon its occasion and its results.9

Knowlton's Elements of Modern Materialism might have been influential if any one had read it, but almost no one did. Immediately after its publication Knowlton took a trunk-load to New York to offer to the book sellers; he returned with the same books. By this time his financial condition looked even more hopeless than usual. His debts amounted to about one thousand dollars; his family now included three small children.

Moreover, the tiny professional practice he had previously enjoyed now dropped to the vanishing point partly because he had acquired the unsavory reputation of being an infidel, a deist, and generally a bad character. That he was a deist, is true. To recover himself financially he decided to go on a book-peddling expedition, possibly as far as Canada. Unfortunately he failed to escape the sheriff. The result was that he had to sell all his household goods to satisfy his creditors, at least in part. Immediately thereafter he set out on his tour, which took him through the eastern part of Massachusetts and as far west as Utica. At Amherst he fell foul of the law against unlicensed peddling. Knowlton himself believed that the opposition of President Humphrey to the doctrines of his book played its part in this legal technicality. In spite of this kind of petty persecution, the book still did not sell, and Knowlton did no more than pay his expenses.

Because his diary breaks off in 1829, the life of Knowlton becomes even more obscure for the purposes of record than before. At some time during this period he settled down to the practice of his profession at Ashfield, Massachusetts, about fifteen miles southwest of Greenfield. There he stayed until his death. His most important activity, measured by future values, was the publication of his Fruits of Philosophy, or, the private companion of young married people, the first description of methods of birth-control to be published by a native American who was a physician. The preparation of the manuscript was probably completed in July, 1831; the correct date of publication is 1832. Controversy over these dates arose because Knowlton circulated his manuscript before it was published and no copy of the first edition is known to exist.

Considering Knowlton's unhappy adolescence and his strenuous efforts to support a family which increased every year, his special interest in sex and contraception is not surprising. His professional practice taught him that the too-frequent appearance of children often handicapped newly-married couples financially, beside imposing heavy physical burdens on young wives. His immediate service was to prepare a short description of the most effective contraceptives known, together with their proper use, and a general argument in their favor. He gave this account to those of his patients who needed it most. Probably this manuscript passed from hand to hand for some time before Knowlton felt that it should be printed and circulated more widely. Knowlton was in no sense a crusader about sexual matters; there is every evidence that he was much more interested in other things_particularly his ideas on psychology_than in spreading the knowledge of contraceptives. The late Professor J. A. Field, a recognized authority on problems of population, wrote recently: "Dr. Knowlton appears to have been not only an eccentric, but a sexual hypochondriac, whom years of worry and depression had led to take an interest in the general question of sex.''10 Such a comment seems essentially erroneous. Knowlton was not particularly eccentric; can not be shown to have been a sexual hypochondriac after his marriage; and did not become increasingly concerned with sex because of his various troubles.

Knowlton drew heavily on former knowledge, as might be expected. He gives evidence of having consulted both the birth-control books in English that were published earlier_Richards Carlile's Every Woman's Book, or, What is Love? (1826) and Robert Dale Owen's Moral Physiology (1830), the first of the American books.11 In comparison with the Owen pamphlet, Knowlton's discussion marked a considerable advance. The argumentative support for contraception was done more thoroughly; physiology, as it concerned sex, was discussed_a subject at which Owen only hinted because of his lack of proper information. The description of methods of contraception was better, because more contraceptives were mentioned, and a more satisfactory method than that advanced by Owen was given preference.

Knowlton started his justification of birth-control by insisting that sexual desire was but one of the bodily appetites and should be considered much as any other_that reasonable use will prove healthful and enjoyable, and that its denial, even if not harmful in itself, may lead to a resort to prostitutes or the practice of self abuse_either of which is undesirable. Celibacy in young people at the height of their powers was, in any case, unfortunate. On the positive side, birth-control becomes necessary both for proper social development and for the best interests of the individual. Here Knowlton accepted the Malthusian argument that population would, in time, outrun the food supply; he rejected the population checks of vice, war, famine, and disease as undesirable; and of celibacy as improbable. Only voluntary birth-control could lessen the dangers of the poverty, the ignorance, and the tyranny produced excessive population.

On the personal side he advanced equally cogent arguments. Large families were an excessive financial and nervous strain for the father, often resulting in inadequate training and opportunity for the children. To the mother the result was frequently ill health and early death_not to mention the production of unhealthy, diseased, and malformed children. In many cases the possibility of children deterred young people from marriage_as a consequence of which the man often leads an irregular and immoral life. Young people should be able, argued Knowlton, to marry for love, without having to dread the danger of being compelled to provide for another new child every year.

After his general argument for the desirability of the use of contraceptives, Knowlton passes to a description of the reproductive organs and of the process of generation, insisting that the dissemination of truth is highly desirable and that by its proper use people would be much more healthy and happy. Knowlton's discussion of the process of reproduction is most questionable from the modern point of view, his information being far from correct or complete. In addition to this descriptive material, Knowlton presents reasonable advice for the treatment of sterility and impotence, and sound suggestions concerning other sexual phenomena. The last quarter of the book is devoted to a description of various contraceptives. These descriptions were well done, in spite of the fact that Knowlton's recommendations are now out of date. His presentation is surprisingly good_even for a modern reader.

The reception of Knowlton's book is difficult to determine, inasmuch as very few writers dared even mention the subject. Discussion of sex was generally taboo, and no matter what one heard from one's most intimate friend, or from the next-door neighbor or in the smoking-room, such subjects were distinctly not for the public ear. Magazines and newspapers, of course, avoided mentioning Knowlton's book. The Boston Medical Journal, which provided an exception in treating the matter at all, concluded that "we think . . . the less that is known about it by the public at large, the better it will be for the morals of the community.''12 Obviously the writer felt that although contraceptive knowledge might be given to a few discriminating doctors, for the layman it would serve as a direct incitement to sexual excesses.

In spite of public disapproval, the book circulated. A second edition almost immediately followed the first. This was printed by Abner Kneeland, the well-known Boston free-thinker, in 1833. By 1839 at least nine American editions had been issued, beside nearly a score of English, French, and Dutch reprints. Most of the early American copies were probably passed from hand to hand and read until they fell to pieces_at least there is no extant copy of the first American edition, and very few of the later printings. A recent estimate by Professor Norman E. Himes, our best authority on the subject, maintains that some three thousand copies were sold in the first year and a half alone. When it was revived in England during the latter seventies probably over two hundred thousand copies were distributed in a little over three years. Prior to that time England had consumed some forty-two thousand volumes. There can be little reasonable doubt that Knowlton found a large and receptive audience.13

Knowlton's personal experience with his book was not entirely happy. Shortly after its publication the author was haled before the court at Taunton, Massachusetts, and fined. In December, 1832, he was sentenced at Cambridge, Massachusetts, to three months at hard labor in the house of correction_a sentence which he served. Later he was prosecuted at Greenfield, but after two failures of the jury to agree, the case was nolle prossed.14 The Greenfield case caused a great deal of local excitement which Knowlton later described in a pamphlet. He attributed the popular clamor to the professional jealousy of other doctors and to the opposition to his psychological views on the part of the local ministers and other persons of religious disposition.15

Evidence points to the fact that the cause of birth control was not dominant with Knowlton, that both he, and his contemporaries, were more concerned with his analysis of the functions of the mind. Although Knowlton came into conflict with the law, it is suggestive that his predecessor, Robert Dale Owen, experienced no such difficulty. Knowlton's own comments on the Greenfield case and its origin minimize, as we have seen, the importance of the factor of his support of birth-control. Furthermore, when Knowlton was released from the East Cambridge jail, he immediately addressed an audience on his beliefs. The two lectures which he delivered contain no mention of birth-control; they expanded his ideas on psychology.16 Due, possibly, to his recent experiences, Knowlton's new exposition was much more carefully reasoned and more firmly buttressed with facts. Most of his statements would be received with respectful attention by the modern psychologist. Among other things, he suggested very clearly a theory of physical evolution; in expressing his doubt of the complete creation of man at any one time he concluded that man may have been the "result of a long series of natural operations, such as none of us have seen concluded: though such a series may at this time be going on, and by improvements upon the ourang-outang, or some other animal, may, in a few thousands or millions of years, be completed."17 Opinion, such as this, expressed publicly many years before the appearance of Darwin's classic book, indicate the independence and imagination of the man_if nothing else.

In view of his early activity, the later life of Knowlton was prosaic. For a time he organized independence clubs to promote the cause of free speech.18 Gradually, however, he settled down to his medical practice at Ashfield, Massachusetts, attracting a paying clientele and a circle of personal friends. By the forties he had been accepted by the community, which was willing to overlook, at least, his intellectual wild oats, and to recognize him as a learned, intelligent, tolerant, and friendly neighbor. From 1844 until his death he was a Fellow of the Massachusetts Medical Society.19 With an increased medical practice he found less time for speaking and writing. During the latter thirties he took time to send a few articles to his friend Abner Kneeland in Boston, to be printed in the Boston Investigator, but these articles were far from incendiary_unless one takes violent exception to his support of the virtues of tobacco.20 In the forties his only writings were case records, which he sent to the medical journals, dealing with such safe professional subjects as erysipelas, puerperal fever, the pancreas, lumbar abscess, medical quackery, the fillet in breech presentations, and the autumnal fevers of New England.21 Knowlton died on February 20, 1850, a respected citizen of Ashfield.

The influence of the Knowlton book on birth-control is hard to estimate. It can be considered adequately only in conjunction with the Owen volume which appeared about the same time. They circulated widely, and presumably the information they contained was used. If statistics are trustworthy, there was a noticeable decline in the American birth-rate in the decade immediately following the appearance of the books.22 Some forty-five years later they were both revived in England and resulted in two famous trials for obscenity. These trials provided an immense impetus for the dissemination of literature on birth-control, not only in England, but all over the western world. Beginning with the period of these two trials, the British birth-rate started a decline which has continued steadily until the present time. Other western nations, such as Germany and Holland, experienced similar declines in the same period. If these events have any but the most accidental connection, then the United States should have a prominent place in the history of the birth-control movement. If such be the case, then Charles Knowlton, an obscure physician of Massachusetts, and Robert Dale Owen, American politician and reformer, deserve to rank among the very few unusual men who have actually exercised great influence on the history of the world.