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  • The Fertility Doctor: John Rock and the Reproductive Revolution
  • Deborah McGregor
The Fertility Doctor: John Rock and the Reproductive Revolution. By Margaret Marsh and Wanda Ronner. Baltimore, MD: Johns Hopkins University Press, 2008. Pp. 384. $29.59 (cloth).

John Rock’s name is best known in association with contraceptive trials supervised by American scientists and pharmaceutical companies. His story became notorious because women in Puerto Rico served as the trial subjects from the late 1930s up to the time of the “discovery” of the pill in the late 1950s. Most versions begin with Clarence Gamble’s field study on the island testing the at-best-imperfect birth control technology of spermicidal foams and jellies. Next came female sterilization, a history first interpreted as involuntary but more recently understood as a choice found preferable to fallible and untried forms of contraceptives urged upon the island women.1 Subsequently came the oral contraceptive trials. In 1956 Boston physician John Rock and his partner, laboratory scientist Gregory Pincus, chose Puerto Rico as the site for their trials. Although Rock was cautious and respectful of the trial subjects, issues of race and sex remained.

The Fertility Doctor takes a biographical approach to this story, its psychological focus guiding the book and portraying Rock as charming, charismatic, and motivated by good intentions. Though Rock was a Catholic who remained faithful to his religion, his ethical standards came from within, “a fiercely independent man who, right or wrong, held to his own ethical standards and rejected the idea that others could dictate morality to him” (27). The authors’ access to extensive personal records as well as public archives and patients’ case records gives them the authority to probe the meaning of Rock’s Catholicism. For his contemporaries and for us in retrospect, Rock was enigmatic in his loyalty to his faith and his insistence that various experiments he did, including abortions, did not violate church ethics. Rock also argued that the pill itself did not interfere with reproduction but rather mirrored nature and the rhythm of the female reproductive cycle.

Born in 1890, Rock graduated from Harvard Medical School in 1918. By 1926 he was director of the Harvard Free Hospital’s infertility clinic. Rock’s first practice covered a broad spectrum but specialized in infertility. It was a charity-based institution, so Rock had both poor patients and private, more well-to-do patients who gave him experience in obstetrics and gynecology. Rock’s patients were subjects for research on menstruation and ovulation to determine the biorhythm of ovulation. Researchers could ascertain when ovulation had occurred, but no one could predict its onset. Rock, who was primarily a surgeon, obtained data from biopsies of the lining of the uterus (endometrium). In order to obtain endometrial biopsies, laparotomies (abdominal surgeries) were necessary—major surgery before antibiotics were therapeutically established. Women in this long-term [End Page 343] study were often, ironically, patients diagnosed as needing hysterectomies, yet they were asked to solicit coitus with their husbands just after menstruating with the goal of temporary impregnation. Rock’s study set up various diagnostic devices preceding such a surgery to catch the moment of ovulation and follow it with surgery, hoping to find a newly fertilized embryo. Apparently, no one called this abortion. In 1950 Rock published his study of eight thousand endometrial biopsies done in the 1930s, which established him as foremost in his field.

Marsh and Ronner find that Rock, in his endometrial study and other research activities, acted well within the ethical standards of the day, which were minimal at best, and they portray him as almost tediously devoted to informed consent. They set out to demonstrate the contributions Rock made to the history of medicine in supplying the foundation for reproductive medicine with his major accomplishments, including the first in vitro fertilization.

The book builds critical context for the period of the 1930s, when medical science recognized the existence of hormones in name only, a mystery barely comprehended. Fairly quickly, scientists determined that both progesterone and estrogen played a part in fertility and in sexuality but took considerable time to learn how to use hormones. Discovery and experimentation involved laboratory experiments and...

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