Sophia Gosselin

Dr. Ernst Gräfenberg - Remembered by one of his patients

(Original contribution to this web site, 2006)


1. Meeting Dr. Graefenberg

2. A Difficult Birth

3. A Paediatrician for a Difficult Baby

4. Graefenberg and Contraception

5. A Solemn Warning

6. Nature's Cruellest Mistakes

7. The Man Who Was Dr. Graefenberg


1. Meeting Dr Graefenberg


The war had ended, my fiance had returned to civilian life and we had married in the summer of 1945.  By the spring of 1946 I was pregnant and ill all the time.  Our New York City GP referred me to Dr. Ernst Graefenberg, a German refugee obstetrician. "Although you're only 20, your general health worries me.  Dr. Graefenberg is the best obstetrician-gynaecologist in America and probably in the world."  A few days later my husband and I came to 865 Park Avenue, a fashionable address in Manhattan.  The doctor's offices, as was then the custom for doctors, lawyers, and dentists, occupied a suite of street-level rooms in an apartment building at the corner of the Avenue and 77th Street.  The secretary showed us to the waiting room which, by American standards, was smaller than average and plainly--perhaps starkly--furnished.  Moments later the doctor opened the door of his office to show out his previous patient.  The secretary introduced us to the doctor who asked my husband to wait a few moments longer while Dr. Graefenberg took down my particulars.  I found myself in a tiny office, the desk in front of the widow (giving onto 77th Street) occupied most of the room.  A man of average height, wearing a doctor's white coat, sat on the far side of the desk, his back to the window; I sat in front of the desk.  The room was bare except for the compulsory framed certificate from New YorkState hanging on the wall confirming that "Ernst Graefenberg, MD" was licenced to practice medicine.  I was nervous and shy then--and still am today--but the man who greeted me and began to ask basic medical questions had such a friendly smile that I to relaxed slightly. Suddenly he looked at me: "Is something troubling you? You seem pale and frightened",  his eyes now expressing concern.  "Oh yes, Doctor.  I am extremely worried; I feel ill most of the time and most of my body hurts.  Is this what a pregnancy should be?  Is this normal?  Am I normal?"  I had confessed my secret fear to this stranger but was not prepared for his reply. "No, of course not, it's not normal; you're not normal" he replied in a serious manner.  He must have seen my terror and went on "I'm not normal either, you know" he said firmly. I began to reach for my coat, meaning to run out of this madman's office but he held me back, putting a miniature wooden barrel in my hands. "I keep paperclips in this tiny box but there is a huge barrel, bigger than a beer barrel, in my back office" he said, pointing vaguely to his right. "That barrel is permanently filled with formaldehyde. Should I ever come across a normal person, I'll quickly shove him or her into the barrel and nail the lid firmly down. Then I'll be able to show to the world that rarest of scientific exhibits, A Normal Human Being!"  He burst out laughing with those words and I even managed a weak smile yet I knew from that moment I would be able to get along with this German refugee physician.  "You see, no one is "normal"; that word should never be applied to a human being.  Everyone alive today is an individual person, different from everyone else; everyone who has ever lived was different from everyone else; everyone who will ever live in the future will be totally different from everyone who has lived before.  Even identical twins have differences from each other. For someone to be "normal" implies that someone else is "abnormal" but who is to decide which of us is the "normal" one and which one is "abnormal"?  All of us, every single human being, is totally different from everyone else, each of us is a variation on a theme, a theme called Humanity," he said, the smile covering his face again.

He now led me into the examining room, a much larger and very bright room with windows on Park Avenue and on 77th Street.  Before examinng me, he asked my permission, a courtesy in which he would never fail in the future. A few moments later he assured me that all was well.  "You have a very small body consequently you must expect the growing baby to move things aside so that it has more room for itself.  Some women can find these rearrangements of their anatomy uncomfortable."  From my answers, he had determined that the baby would probably arrive around 10 October 1946.  He now called in my husband and explained to us that he would make a reservation for that date at ParkEastHospital, a small private hospital on 83rd Street, just east of Park Avenue.  He explained that he charged a single, surprisingly modest, fee that would cover pre-natal care, the birth, and post-natal care.  Turning to me he continued "I want to see you at least every three weeks until the start of October, more frequently thereafter.  My secretary will give you some instruction sheets as to diet and exercise.  The more you walk within reason, the better for you and for the baby.  My fee covers as many visits as you wish to make and you may telephone me at any hour of the day or night.  It is essential that you  not worry, your life must be calm, tranquil.  You'll need lots of sleep but if anything concerns you, let me know.  I am here to see you through the next few months and to help bring your husband's and your child safely into the world.  Promise me that you'll come to see me or telephone if you are at all anxious about anything!"  My husband and I left, both smiling; Dr. Graefenberg had set my fears to rest.

At my next appointment Dr Graefenberg explained that women who became pregnant before the age of 30 or 35 gave themselves and their baby a better chance of a healthy, happy outcome.  "You'll be 21 by the time the baby is born, the perfect age.  You are Nature's partner in her most magnificent endeavour, the fabrication of a new Human Being.  Let me do any worrying, and enjoy the next few months."  A few visits later, he explained the birth process; he stressed that every obstetrician dislikes performining a Caesarian operation--birth should be the most natural event in one's life. He seemed to have three facial expressions--he smiled most of the time but he laughed very often. However, when speaking on a subject of particular importance to him he became profoundly serious. Perhaps the strongest impression one gained of him was of his modesty, a shyness combined with an inner reserve and self-effacement.  Somehow he had devised a method to make the most of his time and patients were carefully scheduled to waste neither their time nor his.  As one patient left, the next one would be shown into his office.  As that patient left, the next patient would have arrived.  He spoke perfect idiomatic English, his manner lacking any Germanic rigour one might have expected; however he kept his distance at all times. He was unassuming, a rare trait in someone so admired and respected by others in his profession. All I knew was what our GP had told us; in those days one did not have access to information.  It would be a long time before he told me of some of his cases in pre-Second World War Germany. At no time in the nearly three and a half years I was to be his patient did Dr. Graefenberg speak of himself, of his private life.  He never pulled out a wallet--the way many Americans did--to allow one to admire photos of children, of family gatherings.  There were no photographs; apart from that tiny miniature wooden barrel  there were no personal mementos of any kind in his working premises.  To this day, I don't understand how he performed the daily miracle that was his working life--how did he make time for his very many patients, granting them every second of his existence.  Did he eat?  When did he sleep?  Why did he not look tired?  My husband and I estimated him to be about 50 or 55 years old; now I know him to have been about 65 at the time.  Where did he find his energy?  During the time I was his patient (Spring 1946 to late Autumn 1949) the only other professional person I saw on his working premises was a part-time nurse, called in when Dr. Graefenberg would perform minor surgery in the examining room.  By American standards of the time, his life could be described as frugal, his existence contained within the twenty or so blocks of Manhattan--from his office at the corner of 77th Street, to the Park East Hospital at nearby 83rd Street, to Mt. Sinai Hospital at 98th street (at the edge of Harlem) where he took his gynaecological cases.  We even suspected that he lived in an apartment in the building in which he had his office, perhaps to save time.  But that is only a guess.


2. A Difficult Birth


I saw Dr. Graefenberg every three weeks, or slightly more often, for the next several months. Despite my physical miseries, aches and pains, and continuing discomfort, these months were among the happiest of my life.  My husband and I planned our future existence together with happiness and confidence.  We were completely happy.

A few months before the impending birth, Dr. Greafenberg expressed some concern that the baby was growing too large.  Never had I eaten so many green vegetables; my husband and I joked that our baby might be tinged in green when he  or she joined us.  The date for the birth came--and went.  "Don't worry" my obstetrician assured me.  "Babies have no notion of time.  They are born when they are ready.  Whenever the time comes, count on me to be there, to see that everything goes well."  He spoke with such certitude that I imagined for a moment that this man controlled the world and everything in it, despite his modesty and shyness.  Now, he examined me every two or three days, taking measurements to make sure there would be room for the passage of the baby's head. Finally, just before mid-November our baby announced he or she was on the way.  My husband and I drove to ParkEastHospital to find Dr Graefenberg waiting.  He examined me yet again after courteously asking permission, before giving his instructions to the duty doctor and obstetric nurses.  He gave them instructions as to tests to conduct and which drugs to give me to ease labour, smiling as always.  Sixty years ago, there was no ultra-sound, no tests to predetermine the gender of the foetus, and very few of the advances in medicine today's physicians and patients take for granted.  Dr. Graefenberg promised to come every two hours or so and kept his word.  In a haze of sedation I knew that time was passing but that labour was advancing very slowly, if at all.  It was when two house doctors came to sit by my bed that I realised there might be problems.  Dr. Graefenberg had told me time and again of his dislike of surgically-assisted births, of the Caesarian operation.

I looked out of the window to see that day had turned to night; Dr. Graefenberg now came back.  Taking my hand in his, he calmly explained to me that a complication had arisen: labour was not progressing, the cervix refused to open and he informed me that continued labour would pose a danger to me as well as to the baby.  Yet labour had lasted too long to permit a safe Caesarian operation now and he asked my permission to authorise him to perform another operation to outwit a reluctant cervix, an operation he had devised  in Germany for cases such as this.  "Count on me, I promise that when you wake up you and your husband will be the parents of your baby." I was wheeled to the operating theatre, the last thing I remember before falling asleep was a nurse who tied the ribbons of a surgical gown behind Dr. Graefenberg's back. Today, this complication is unheard of because medicine has drugs to counteract nonprogression of labour, caused by an insufficiency of a hormone produced in childbirth by the pituitary gland.  However, it wasn't until 1953 that a French scientist defined the exact chemical composition of this hormone--a discovery for which he was awarded a Nobel Prize two years later.  By then, pharmaceutical firms could synthetise the hormone Oxytocin.  A young friend of mine has this condition too, but in her case she was given some injections and (to use her words) the baby just popped out.  Non-progression of labour is no longer the life-threatening condition it once was for the mother and the child. An insufficiency of Oxytocin in pregnancy and childbirth might previously have resulted in an over-long pregnancy; the new mother might have found that she was unable to give milk; now all those problems are in the past.

I woke up as I was being wheeled to my room, to be told that my husband and I were now the parents of a healthy baby boy. A hospital doctor came to tell that the labour and subsequent operation had tired the neonate who had been taken to the hospital nursery with a speclist nurse to watch over him.  Later that morning, Dr. Graefenberg brought our son to us.  "Let the hospital know when you and your husband have chosen a name for you son, so that I may write out the birth certificate." My husband and I looked at each other and he told the obstetrician that we desired to name the baby "Ernst" after the man who had probably saved his life.  The obstetrician tried to look serious, saying "I appreciate the honour you do me.  However, on reflection I hope you will agree that no helpless newborn should be lumbered with the name of Ernst, or Ernest--or worse, Ernestine!" and he burst out laughing.  Although I was to be this man's patient for several more years, I remained so in awe of him that I never dared ask him if he disliked his own name or if he had spoken out of his singular modesty.  In the next few days, other obstetricians, doctors and nurses at the Hospital came to see me, asking permission to read the notes at the foot of my bed.  Dr. Graefenberg's operation (he had called it a low Caesarian) had never been seen at that hospital before.  One nurse told me that Dr. Graefenberg insisted on soft classical music, low light levels, and low voices when he attended a birth:  he taught them that an infant's entry into the world should be made as pleasant as possible.


3. A Paediatrician for a Difficult Baby


My husband came from a large family; to them, birth was a natural process easily accomplished by any sensible woman--I had not met his expectations.  The major operation I had undergone meant that it would be a couple of weeks before I could look after my son on my own.  Our GP had advised us to engage a specialist nurse for the first month of the child's life, to spend 12 hours per day with us, 7 days a week.  My husband, my mother and I would care for the baby the rest of the time.  That, at least had been the plan.  Everyone knows newborn babies sleep for most of the 24 hours, staying awake about one hour to take their bottle and admire their new world--everyone, that is, except our son. This child had misread Nature's manufacturing instructions; he cried for 23 hours a day, only sleeping fitfully a few moments at a time.  The nurse left after a week saying she'd never seen such a difficult neonate, adding that no sum on earth would tempt her to remain.  My husband left about two weeks later to visit his parents for a month, explaining that he needed to sleep.  The next departure from our team was the paediatrician whom our GP had recommended "I can't have a young patient who will not permit me to touch him" he said, putting the baby back in my arms.  My mother had been an only child, as I had been.  All we knew of babies is what we'd read in the currently popular book on babies by Dr. Spock.  This worthy expert had not known that there could exist a baby who cried for hours on end, until even the neighbours in our apartment building complained.  My son seemed dissatisfied with the world and everyone in it and cried loudly of his displeasure.  About six weeks after the birth, I went for my first post-natal examination by Dr. Graefenberg, leaving the baby with my mother.  "You seem unusually silent for a new mother.  Is anything wrong?" he asked.  All the misery I had courageously held back now burst out in a flood of uncontrollable sobs.  I confessed that the baby-nurse had quit; that my husband was disappointed in me and in the baby; and that even the paediatrician had resigned!  I'd been unable to find a replacement doctor for the baby, the word having gotten around that this tiny patient must be avoided.  "Oh, is that all," said  the ever smiling Dr. Graefenberg.  The smile turned into a huge beam when he said "Would you permit me to be your son's paediatrician until someone better can be found?" This totally amazing offer left me speechless; he may have mistaken my silence for disapproval and continued "I can promise you I know all about babies; or is it that you don't trust me?"  When I'd finally recovered my voice I told him I'd trust him to the end of the earth but felt compelled to remind him that he was otherwise occupied; he was one of the busiest obstetricians in New York City; he had  a huge gynaecological practice.  My son and I dared not impose on his generosity. There must be some paediatrician in this immense city who could take on a tiny, noisy patient.  "Let's come to an agreement then.  Let me be the baby's locum-paediatrician until someone better can be found."  As I write these words his voice still rings in my ears, with the kindest, most magnanimous offer I would ever hear. For the next 3 to 4 months my son and I went to 865 Park Avenue where Dr. Ernst Graefenberg showed me he had yet more hidden talents; he did  indeed know all about babies.  The doctor and I nearly had a disagreement when I asked what his fees would be.  He looked at me with pain in his eyes. "How can I charge you for a service I would so enjoy?"  In the end,  I made him promise to find a doctor who limited his patient list to babies, one  who did not dabble in obstetrics and gynaecology on the side.  At first, my son and I came to 865 Park Avenue every week, then every two weeks and - in time - another paediatrician was found for my son, one who was greatly amused to be replacing such a famous man as Dr. Graefenberg.

Somehow, Dr. Graefenberg had acquired a baby scale.  He weighed the child regularly, checked the hearing, the eyesight, gave the infant the proper jabs and innoculations.  He would prove himself to be the best paediatrician in America and probably in the Universe.

When, how had he learned all this?  Had he taken paediatric courses in medical school?  Had he come from a large family, did he himself have children?  I never knew, I never dared ask this gentle man a single personal question; I never dared intrude on the privacy in which he wrapped himself.  What is certain is that my son knew who was boss.  From the moment we reached the door on Park Avenue, he stopped crying.  It was almost as if Dr. Graefenberg had some sort of magic power over babies, or at least this particular baby. The child obviously felt safe with this man, safe in a way he felt nowhere else; the infant knew that Dr. Graefenberg's arms were the safest place for him in the world.  This kindest, most knowledgeable of doctors proceeded to teach me how to be a mother, but while talking to me, he always addressed his tiny patient.  The child seemed to understand, replying with his eyes and nodding his head positively from time to time.  The doctor now advised me on every aspect of an infant's needs: how to dress him (a minimum of clothing, nothing tight ever), how he should sleep (on his back, without pillows), what he should drink, what were the signs of an emergency, how to cope with more minor problems.  "You must understand that this child isn't 'yours'; he isn't your husband's; he isn't your mother's grandchild.  First and foremost, he is himself who belongs to himself alone.  Mankind only comes in two varieties; male and female.  The variety 'Baby' doesn't exist, there are only men or women who have not yet reached adult size.  Just because he is not grown to adult size, cannot yet talk, doesn't make your son any less sentient. He was born with his instincts, his views, his likes and his dislikes.  You will have noticed that your son is quick to let you know of his displeasure; if you put yourself in his place you can see that it must be terribly frustrating to be unable to speak, to be only able to communicate by crying."  When speaking to me, the doctor was addressing the child, almost as if expecting an answer.

Another time, Dr Graefenberg instructed me to act toward my baby as if he were an adult, to show the child the same respect, the same consideration I would to an adult, the same courtesy and politeness.  "Everyone on earth merits the same basic courtesy from others.  This child is no different.  How would you feel if someone treated you as if you were just a wet, dirty, smelly bundle, a nuisance?".  Another time he told me that parents should frequently let their babies and children know how very much loved they are, how precious their welfare and well-being is to those who care for them.  "Everyone should be treated as you yourself would want to be treated.  If you act toward you son--toward anyone who hasn't yet reached adulthood--as if they were a rich relative from whom you hoped to obtain a fortune, the child will instinctively feel the respect and thrive on it."  He would repeat over and over again that babies as a human variety didn't exist, only Men and Women.  Every baby was just a man or a woman on the way to reaching full adult size.  "A baby who received kindness, respect, consideration and courtesy will respond in the only way it can---it will calm down, will sleep better, will be able to digest his or her milk and later, the solid food.  You were a baby once; so was I (at this, I had to try to avoid laughing, while I tried to imagine the august Dr. Graefenberg as a crying naughty infant).  Since infancy can't be avoided, he'd say, try to make it as pleasant as possible for the child--and the parent.  Another time, he tried to explain why my son cried for hours on end but almost never slept.  "Almost anything can upset an infant; his clothing may feel uncomfortable, he may be too warm, or too cold.  The light level around him may be too bright, or there may be too much noise--it disturbs his tranquility.  He may dislike your make-up, or the perfume you wear.  Babies are very sensitive to noise and odours, sudden noises frighten them--put the telephone in another room; put a damper on the doorbell.  Avoid strong cooking smells.  Never forget that he is not yet able to escape to another room if something upsets him, nor can he tell you what is wrong."  This obstetrician/gynaecologist-cum paediatrician seemed to know more about childcare than was in all the books I'd read.  "You'll probably find that the main reason my small patient cries so much is that he is hungry.  An infant's brain grows phenomenally during the first year or two of life; an infant needs nourishment for that growth.  Milk alone often fails to provide sufficient nourishment for the growing brain.  He may be so hungry that he will gulp his milk too quickly for his small digestive system, and the milk shoots back up violently.  However, the baby's very young stomach can't yet digest solid food.  May I suggst ways that might help your son?" He now instructed me to oblige the baby to drink more slowly; should the child swallow air will trying to drink faster, he'll develop painful colic in his intestines.  "Prepare a hot-water-bottle with hand-warm water, NEVER hot, lest you burn his skin; put the warm bag on your lap, cover it with a thick towel or a light blanket, place the infant (stomach down) on this arrangement and then gently massage his back.  A baby's cry of pain (from colic or  any other reason) is quite distinct from the usual cries.  The massage should propel the air out, the infant's cries of pain will cease, and he should just fall asleep." I kept wondering how an obstetrician, a gynaecologist knew all this.  Had he at one time taught paediatrics?  I couldn't answer then nor can I answer now.  Nevertheless, the wealth of his knowledge was so immense that I did ask him one day why he had never written a book, perhaps "All About Babies, by Ernst Graefenberg, MD".  He burst out laughing, replying that such an enterprise would have to wait until his Third Lifetime.  To my surprise look he explained laconically  that his Second Lifetime would be fully occupied in the study of Pain.

He taught me other tricks to soothe the infant's digestive misery: "Boil some sweet young carrots until all flavour has leeched out of them, strain out the carrots and keep the concentrated carrot water in the refrigerator--though never more than 48 hours.  If the baby cries from hunger try mixing some concentrated carrot water with plain boiled water, and serve this preparation lukewarm in a bottle.  Never give an infant any liquid that hasn't been fully boiled before hand, not even bottled water.  This soothing drink provides some additional easily digestible liquid nourishment."  Another trick he gave me was more exotic: lacking a European "tisane", buy some Darjeeling tea and brew some freshly each time needed.  This tea turns bitter within 5 or 10 minutes thus must be quickly utilised once made.  To a bottle of lukewarm water, add one teaspoon or less of tea. If at first the baby finds the taste too strange, add a pinch--no more--of sugar.  This is an excellent soporific for babies; as soon as possible, omit the sugar--the water shouldjust be pale blond, barely tinted.  "You will find,"he told me, "that a baby soon goes off to sleep--like a baby--after taking this preparation."  It was important, he warned me, to stop giving a child tea as soon as the first baby tooth appeared.

"Learn patience.  When all other causes for a baby's cries have been eliminated, when he's not too warm, or too cold, when he has no fever or rash, when no safety pin is digging into him, when his clothing is not too tight, when you check that his clothing is clean and dry, the reason for his misery  will be hunger.  Use the tricks I've taught you. As soon as he can digest it, can swallow it without choking, you can try pureed foods, vegetables such as carrots, or bananas.  You'll be amazed at the quantities that tiny body can absorb."  Of course, as always, Dr. Graefenberg was right.

In time all this precious paediatric advice did soothe my ever crying baby son; however my husband's attitude towards us had changed drastically.  His entire pesonality was altering.  The wonderful, charming, happy man I had loved and married was no longer there.  My adored husband, my baby's father looked at us both as if he hated us at times.


4. Dr. Graefenberg and Contraception


When I attended Dr Graefenberg for my first post-natal examination I begged his forgiveness for having taken so much of his time when my son had been born in mid-November 1946.  He had come to see me several times while labour progressed and had been called back to the Hospital when the duty doctors and obstetric nurses determined that labour was not progressing as it should.  I told him how sorry I was to have kept him from his sleep half the night while he performed a special operation to facilitate my son's birth.  He smiled but said firmly "You should never apologise to a doctor for caring for his patients.  Delivering babies is my profession, it's not only what I do-- it's what I love doing.  I chose this profession because I love bringing babies into the world.  This is the most marvelous of all jobs--it is I who should thank you for giving yet another opportunity to help the start of a new life.  I was able to assist your son's birth in what might have otherwise been problematic circumstances. I'm quite used to delivering babies in the middle of the night.  They seem to prevent to enter the world at a quiet time, between 3 and 5 am, when everyone else sleeps, when the body is at its most quiescent.  I learned to do without sleep long ago, the joy my job brings me  all the rest I need.  With each new life, mankind makes a fresh start, and I'm involved in that majestic event.  Can you imagine any more wonderful occupation?"  Another time, when I tried to thank him for having delivered my son safely in circumstances that could so easily have been tragic, he replied "When you and your husband engaged me that Spring to be your obstetrician you paid me a fee to look after your health during the pregnancy and to deliver your child safely; you engaged me to use my skill and experience to enable the birth of a healthy baby.  In taking your money I agreed to a moral contract.  I can't really describe the pleasure I take when I can provide a safe delivery for the mother or when I hand a healthy baby to the parents. My job is profoundly fulfilling.  I can't imagine ever doing anything else.  It's my job and I love it." The sincerity shone from his eyes, the pleasure he took from his work seemed to provide all the nourishment and rest he needed.

Three or four months after our son's birth I was forced to acknowledge that my beloved husband's personality was changing negatively; he became morose and at times I caught him looking at me or at his son with a  hatred that frightened me.  I felt unsure of my marital future and turned to Dr. Graefenberg for advice.  Under these circumstances I felt it unwise and perhaps dangerous to undertake another pregnancy and now asked the doctor to explain contraception to me.  The man who until now had been my obstetrician now became my gynaecologist. The question of birth control was probably as old as Mankind, he told me, adding that he needed to be certain I understood what contraception involved, the risks it entailed.  During several visits to his office, many lasting an hour or longer, this man (whose time was so immensely precious) had the generosity to explain  the process of human reproduction. Early in my pregnancy, he'd been shocked to learn how little I knew of human anatomy (in my biology classes, we'd studied animals and insects but never the human body.).  He sent me out to buy some basic books on medicine and anatomy written in lay language, telling me to read them until I knew  a bit more about human bodies. "You're not a frog, you're not a bumblebee, you're a human--human biology is what you should know." He did me the courtesy not to speak down to me but used medical language now to explain his interest in the human reproduction process.  He told me that when he began to practice medicine some decades ago in Germany (I now know it to have been around 1905, more than 40 years before the time of which I write, although he was never precise about  his personal background) he had immediately been shocked by the condition of the pregnant women who came to his hospital.  The sorrow and misery he encountered had led him to examine the oldest subject of all--birth control.  He told me that over several years he had analysed known methods of birth control but found them all wanting.  He had designed several forms of contraceptive devises, changing and evolving them until he could now offer his patients a system known as the Graefenberg Ring, an intra-uterine device that--within certain limitations-- was the best birth control method he could recommend.  He showed me a tiny coiled ring shape made of silver (telling me he had tried other metals, even platinum, but had found this particular silver amalgam most effective). The gynaecologist attached the doll-sized ring to the wall of the uterus with a stitch or two--the whole operation taking less than 10 or 15 minutes.  When a fertised egg attempted to attach itself to a woman's uterus  it dropprf off if it found the uterus occupied by an earlier occupant--much in the way  unfertilised eggs are sloughed off  by a woman body at monthly intervals. The Ring mimicked a previously occupied uterus. Dr. Graefenberg further explained that this type of contraceptive presented an additional risk of infection to the woman that could--in severe cases--render her infertile.  The ring's presence in a uterus required as a sine qua non that  the most scrupulous cleanliness be  practised at all times by the woman and by her partner.


I can't now recall the cost of the ring and the minor operation to insert it (Dr Graefenberg's part-time nurse was present) but no anaesthesia had been required for the event which took place in the doctor's examination room.  He asked me to return every month over the next three months to ascertain that I had not developed an infection or an adverse reaction.  It was during these subsequent visits to his office that he told me of the conditions he came across in his hospital in Germany before the war.  Some patients had come to him more dead than alive, some had died in his arms.  Some had been victims of botched abortions, some had attempted to procure their own abortion, a few had even tried to cut out their  foetus-filled womb,  brought too late to his ward, only to die in pools of their blood.  His language (usually courteous and gentle) would alter drastically, the sadness and despair still with him after so many decades.  He told me how helpless he'd found himself when faced with the brutal reality of some women's existence.  Some were so worn after bearing 10, 15, or even 20 children, that they came to a doctor for the first time ever only to die on his ward in a vain attempt at yet another childbirth. These cases, and others he preferred to forget, had been the incentive to the development of the Graefenberg Ring. Over many years he had studied the process of fertilisation, of egg implantation, and of female anatomy.  Soon, he'd determined that the safest method was to prevent the implantation of the fertilised egg. To reach that conclusion, he had learned more anatomy, human physiology, chemistry, the innermost workings of human reproduction, and even some esoteric subjects such as metallurgy, scarcely noticing the effort demanded.  Sadly, the end result, the Ring, had several major drawbacks.  It was unsuitable for the very women whose travails had inspired him.  It necessitated a level of hygiene in both a man and a women not even conceivable by the women he had original meant to help, women so poor some did not even have running water, women who bore child after child in miserable sanitary conditions, and other women in even more distressing circumstances.  He made it clear to me in many ways that birth control, contraception, was a subject of profound importance to him.


5. A Solemn Warning


About six weeks after Dr. Graefenberg had fitted me with his intra-uterine device he telephoned to ask me to come to his office as he had a Solemn Warning for me.  "Oh Doctor" I asked, eternally terrified, "Is it cancer?   Or is anything frightful going to happen to my wonderful baby?"  "No, no," he replied, "Not that sort of solemn.  You don't have cancer and your baby is perfect" he said.  The big smile on his face when I arrived the next day confirmed his reassurance.

"I've concluded that you have an unsually low pain threshold, much lower than most people." During the next hour Dr. Graefenberg told me he had long had a particular interest in the nature of pain.  During his years as a doctor in Germany he'd been surprised to notice that some patients' reaction to pain was not what he would have expected.  A doctor or a scientist would have to devote a lifetime to the study of pain whereas his professional life had been otherwise occupied. However, he said that he now seen a large enough number of patients with a rarely low pain threshold to permit him to arrive as some preliminary conclusions, enough to permit him to warn me of this condition's consequences and advantages. "Pain is Nature's language," he explained,"the way it warns the body's occupant that something is wrong, but the vocabulary is severely limited--it has no subtelty, is rarely  sufficiently specific and--most of the time--the message comes too late."  Some people have another condition; they feel no pain at all, or so little as to pass unnoticed.  Such a person may have a brain tumour yet remain unaware until the eyesight is affected. Lacking an ability to feel pain is not condusive to longevity, he added.  His field of medicine meant that the majority of his patients were women; he had found that men could also have low pain threshold but to a lesser degree.  He stressed that he had not seen enough low pain threshold patients to arrive at any valid conclusion--certainly none that could be of scientific value. However, he now offered what anecdotal  data he had accumulated that might help me in my the rest of my life. "You'll have to attempt to learn your body's own language" he explained.  During preceeding centuries science and medicine had learned to interpret pain; symptoms of many medical conditions could be recognised, yet no accepted definition of pain had been agreed upon todate.  Patients such as myself posed an additional problem to the medical profession; their pain pattern was far more variable than for the generality of mankind.  His own experience suggested that there might exist certain physical attributes shared by many such persons. For instance, some had very pale thin skin; some had red or reddish auburn hair; some had low temperture, some had a slow heartbeat, some felt the cold more intensely than most other persons, some had a slow pulse, some had low blood pressure.  However he had found that some persons had none of these traits, some only had one or two, some had several.  It had surprised him that many of his patients whom he had found to have low pain threshold were Eastern Europeans, or of Eastern European origin--by those words, he added, he generously extended Eastern Europe well into Asia.  He joked that whoever in the future devoted his or her life to the in-depth study of pain would find it a totally fascinating subject but that he had seen too few such persons statistically for his conclusions to be valid.  He could be entirely wrong, he reminded me but--if I accepted that proviso--he now asked me to learn my body's own personal language of pain.  He asked me to keep au fait of medical advances on pain, pain threshold, and pain control, and to recognise my body's signals.  He gave the name of hyperaesthesia to this condition.  "I suggest you start your homework by taking your temperature morning and night, two or three times a month, for about two years to ascertain your average temperature.  Otherwise you might well go to a doctor at some future time feeling seriously ill; the doctor would take your temperature, find it to be 36.6C, and conclude that there was nothing much wrong with you when in fact you might have a raging fever.  He advised me to have my pulse and blood pressure checked at regular intervals, over a two year period, to determine my average pulse rate and blood pressure.  These few tools would enable the medical profession to provide me with appropriate treatment.  Some persons, he told me, can teach themselves to control some inevitable pain by mental effort, by concentrating on something else to such an extent as to erase all else from the mind.  I took his advice (on this as on so very much else) and although I have had severe generalised rheumatoid arthritis since the age of 29, I have been able to lessen the dosage of analgesics by mind-control of pain. (Sadly, there is a limit, a pain level at which it cannot be overriden solely by mental gymnastics.)"There are other aspects of your condition that you must consider" he now told me.  "It is more than probable that your pain warnings will be out of the ordinary, will not follow any pattern found in the general population.  For instance, you may receive a pain warning so early in a body's malfunction that no scientist, no doctor, no test could determine what is going wrong.  This facet of your condition is one of its principal advantages.  Such a pain might be in error--only time would tell if it had a sequela.  I would need to keep track of perhaps minor pain warnings to determine at some later time if the malfunction was now sufficiently defined for medicine and science to help me.  A barely discernible pain might prove to be the only, yet vital, warning I would ever get; even  if I were to have a sharp knock at the door of my body from pain it might be days, weeks or even years before a medical condition existed that could be treated.  I would have to listen to the warning of 'pain speaking'; I would need to interpret this very personal inner language.  One of these gentle nudges might well save my life one day if I listened to that early warning.  There was only one other aspect of this condition he felt I should learn.  I might find, doctors treating me might find, that medicines might work differently on me than would otherwise be expected.  A drug might be much too strong, a lesser dose or a weaker treatment might be more appropriate.  Similarly, a medicine that had proved ideal on the general population might have no effect whatsoever on me, and another treatment might be in order.  "Your life will be a voyage of discovery; only you will be able to interpret your body's language to any attending physician," he told me, smiling as always.  Listening to him had been so fascinating that I asked him if he had written books or professional articles on the subject of Pain and its peculiarities.  "It's too vast a subject," he replied.  "It would take a lifetime to understand pain sufficiently to share such knowledge with others, even at the lay level.  But it is a subject in which I am so interested that I intend to devote my Second Lifetime to it."  I glanced at him to see if he was joking but he seemed quite serious.  He reminded me that I should learn enough science and basic medicine to look after myself, especially now that I had the added rsponsiblity for a  little boy, my son.  He repeated that persons with a low pain threshold -- unlike those who feel little or no pain -- should have a long and healthy life.

At the time (I was 21 or 22), I thought him over-cautious.  I'd never heard of this condition before but nevertheless had survived until then.  He gave me this Solemn Warning some 58 years ago.  For urgent personal reasons I left America in late autumn l949 to work with the Allied Occupation in Germany but I was to follow Dr. Graefenberg's advice on this as on every other subjects he had so generously advised me.  His advice was to save my life in l965, and again in March/April of this year 2006.

My employers transferred me to France where, in late 1950s or early 1960s I heard that some clinical trials would soon start to determine the exact nature of blood and to understand the maladies of the blood.  I was one of several hundred volunteers who attended the research labs under the direction of Prof. Dausset. The volunteers contributed derma samples and tiny blood samples which scientists used in varying ways.  Each Christmas, the Research Institute would hold a party for all the scientists and the human guinea pigs.  Finally, the work was completed with unexpected but precious results.  Prof Dausset and his team had discovered a basic secret of Nature--tissue typing.  All of us received French decorations at a ceremony in early May 1967; a few years later, Prof. Dausset shared a Nobel Prize for this work (with an American team who had worked solely on animals. ) How I  wish there could have been some way to tell Dr. Graefenberg that many of his dreams would now become reality and for me to convey my immense gratitude to him.  Not long after I moved to Germany with my little boy at the end of l949 Dr Graefenberg developed Parkinsons Disease and was obliged to give up his medical practice in 1953.  He died in Manhattan in 1957.


6. Nature's Cruellest Errors 


By 1948 I became convinced that my son and I were no longer safe with my husband.  In my immense sadness I consulted Dr Graefenberg, pouring out my misery to him.  "My life is over" I said. " How can one survive such heartbreak.  Now I know what agony, catastrophe and tragedy are!" I wept because my world had crashed and I was desperately afraid for myself and for my son. "The boy and I are in prison" I told Dr Graefenberg, "a prison from which there is no escape.  What can I do?"  I was surprised to see the change in my doctor's expression, the smile vanished but a severe one looked at me in disappointment.  "Broken life? Agony? Tragedy you claim?  Why my child you do not even comprehend the extent of such words.  You are a free agent, live in a free country. There is no prison barring your escape except perhaps one in your mind.  You are free to come and go, you can always leave."  He seemed so annoyed with me that I felt suddenly small and selfish.  We were to continue this conversation, Dr Graefenberg and I, from the end of l948 until late autumn 1949--sometimes every few weeks, sometimes less often.  He now showed a different aspect of his personality, the serious and profoundly sad doctor/scientist hidden from me until then.

"Let me tell you about tragedy, agony, broken lives, catastrophes, prisons" he say, turning away from me to look out of the window, out to some cruel distant image.  "You do not, could not comprehend the meaning of such words. In my profession I have seen tragedy, heartbreak such as you could not imagine in a nightmare, been witness to agony, have learned to comprehend just what a prison can be for some unfortunate humans."  The word 'sex' had never had occasion to be spoken in our doctor/patient relationship.  When referring to the differences between men and women he had used the word 'gender'.  He probably thought me too immature; perhaps he was constrained by Victorian attitudes regarding sex, birth control, contraception, and other related subject matters then prevalent in America.  He may have thought me too innocent; I can't say, now, sixty or so years later.  I didn't know then, he never told me, --I only recently learned--that he had an additional field of interest in science and medicine, one called sexology.  I suspect that in the 1920s and early 1930s when he was a 'sexologist' and attended international Sexology Congresses, Sexology was an umbrella-word that also connotated contraception, birth control, in addition to an assortment of sexual malfunctions and dysfunctions.  Even in the 1950s, abortion could not be mentioned in most countries, and birth control was known by the euphemism of Family Planning--words with a more positive connotation.  Dr. Graefenberg now made the immense effort to define Agony, Heartbreak, Catastrophe and Tragedy for me.  He used his precious time, his energy, to give me a sense of proportion in life, that I might become less selfish, less self-centered.

He told me of some of Nature's Cruellest Mistakes and scolded me for unintentionally comparing my anodyne situation with that of persons who have been wronged by Nature.  He told of men and of women whose body was an inescapable prison; people with gender malfunction, or dysfunction, for whom science and medicine at that time could offer no remedy.  I can't tell you the names of the conditions he described--he never told me.  However, he now told of cases that had caused him intense pain and continued so to do.

"You have led a happy, lucky life, my child" he pointed out. "Permit me now to tell you how life --no, existence--is for some women, some men."  From the day I'd met this man, his admiration for Nature had been almost palpable. "We are all variations on a theme" he'd told me, "the theme of Humanity."  He now taught me that Nature is not perfect, Nature can make errors, mistakes so cruel as to be unimaginable.  "You already know that gender is determined at the start of life.  I've told you that mankind comes in only two varieties: Men and Women, and that babies are not some distinct species of their own." He'd stop, look at me, then look away. "When Nature errs in the design for a new Human Being, she does so in infinite variety, with lincredible cruelty.  Some babies are born diseased, some are misshapen, some are blind, some are deaf, some will never speak; yet perhaps these are the luckier ones. Some will be helped by doctors, some will have corrective operations.  In the distant future, some may be given replacement parts for those that don't work or are incorrectly made by nature." He'd stop often, these cases causing him obvious pain.

"There are other persons, victims of catastrophes so immense that only they could adequately describe the extent of their tragedies. Some are born neither male nor female; some have some characteristics of both genders; some have neither. I can assure you that those persons will suffer in ways you will never understand; they will never escape the prison that is their own body. Medicine, science can be grateful on their behalf perhaps that such births are comparatively rare when measured against the myriad of humanity. To themselves, they are just as unique as you or I are to ourselves. They are their own prison, their entire world." Another time he reminded me that of all mankind's basic instincts, probably sexual reproduction is the strongest. "Without it, none of us would exist; without it mankind would end."  He told me that the purpose of his life had been to give medical assistance to those who came to him for help and he had chosen obstetrics with its associated gynaecology because he found total joy in each child he brought into the world; he also found satisfaction in solving gynaecological problems surgically or by whatever means existed. In trying to help me to understand the power of the sexual instinct, he would  use similies from nature: a swarm of bees, an ants' nest.  How could a doctor prevent bees from swarming to start a new hive, to create new bees?  Or stop ants from flying to mate in mid-air to start new nests, hundreds of millions of ants?  "What can I say to man to emasculates himself in my hospital to escape his inner agony?  What help can I give a woman who tells me she was born a man and begs me to provide her surgically with male sexual attributes?  What help was there for the man who dragged a young girl to my ward saying he'd bought her from her father?  "Doctor" he begged me, "I've bought her, I own her.  Please remove her uterus and insert it in me. I WANT TO BE ABLE TO BEAR A CHILD, I was born a woman!"  Some such patients had had to be removed by force from his hospital.  "Nevertheless I cannot forget that some killed themselves before my eyes once they understood there was no medical help I could give them?"  He said he had not even tried to explain the moral and ethical aspects of their demands to such persons--could anyone speak of ethics to bees, or to ants? "When an infant is born of indeterminate sex, how does the doctor determine which gender to attribute to that baby?  Some malformations could be repaired or correctd surgically. But how can a doctor put himself in the mind of someone born a woman who 'feels' male; or of a man who knows he was born a woman?"  He showed me that even for an obstetrician, there can be tragedy at a birth.  I took the advice he was indirectly conveying to me and escaped the danger in which I believed my son and I to be. I found a job in Germany with the Allied Occupation forces and left America in late autumn 1949.  I confess that I wept when I said good-bye to Dr Graefenberg. "If you feel you are doing the right thing, surely that is all that matters in life!"  Those were his last words to me.


7.  The Man who was Dr. Ernst Graefenberg


I cannot speak for his relationship with his other patients.  I never knew any to talk to.  He devoted his life during the 3 and a half years I knew him to his patients to the exclusion of all else.  The doctor I knew bears little resemblance to the one whose name is found all over the Internet, in newspaper and magazine articles.  It can't be that he led a double life--he had no time for that.  He once told me  that he preferred to operate  as early in the day as possible on those of  his gynaecological  patients whom he had  sent  to Mt Sinai Hospital.  By 8 or 8:30 am, he then made the rounds of all his Mt Sinai Hospital patients, stopping at ParkEastHospital to drop in on the maternity cases, and by 9:30 am he was at his office seeing all the other patients.  He could be called out at any hour of the ay or night for a maternity case, a birth.  "Babies have no understanding of the calendar, weekends, holidays, Christmas, none of that means anything to them yet. They are born when they feel like it, and I am always happy to assist in their arrival." He told me that Saturdays were set aside for working women who could not get free time during the week. Those of his patients (many indigent ones, whose fees were met by those of his clients who were so rich as to have their own trust funds) who might be reluctant to come to 865 Park Avenue were seen at their home or at Mt.SinaiHospital.  He tried to go for a walk in the evening but was always on call.  Nights were often disturbed when a patient telephoned, or a baby made an unexpected arrival.  "Don't ask me why I work so hard.  I've told you.  I love my job.  It's the best job in the world!"

Once, when I hadn't know him long, I told him of my arrival in America in 1938 (my American family and I had lived in France) when no one could understand the clipped English accent I had acquired at school in England.  I'd told him that I'd gone to the cinema all day long for two or three weeks until my ears had become atuned to American speech and I could make myself understood.  "No cinemas for me when I came to America" he replied.  "I was shocked to learn that I, who had been a physician for several decades, now had to take my medical examinations all over again, and in a foreign language!"  He then laughed "I found that most written medical exams contain a great many Latin words, and Latin is Latin in any language."  Although he was now in middle age, he had passed the exams with flying colours.  "But for a while the thought that I might not be able to be a doctor any more terrified me.  I cannot imagine any other life."  Why has no one written his biography?  He had hundreds of patients in all social classes.  He brought hundreds of babies into the world during the years he worked in New York City (1940/1 to early 1953).  All these men and women, with his name on their birth certificate, just like my son, why have none of them spoken up for this extraordinary man?  I know he was shy, immensely modest, self effacing, reserved, keeping his distance.  But I wish people who still remember him, people whose family and friends left souvernirs about him would make themselves known.

I believe that his immensely varied expertise had several sources.  He was obviously a polymath, a genius, a man with a capacity to observe what others might not see; a man who could reach conclusions not immediately obvious to lesser mortals.  His strongest trait was probably his respect and love for Humanity.  Each iota of learning he had imbibed was melded into a whole put to the welfare of his patients.  Was he aware of his extraordinary talents?  I doubt it, he was too modest to pay attention to himself.  But I must try to convey to you that his mental brilliance, his disparate knowledge, his 'caring' emanated from him like an aura.  My working life was to place me in close contact with the High and Mighty; in my private life I met, however briefly, two recognised geniuses.  Dr. Ernst Graefenberg was of an entirely different dimension, so superior in every respect that I lack words to describe him as I would wish.  He was the most exceptional man I have ever had the honour to know.  His words of advice, his warnings, have stayed with me my lifelong. I have quoted him to my family, my friends, to physicians I have met, to everyone who would listen. My son of course knows all about the extraordinary man without whom my now- 60 year old son would not have been born alive.  Dr Graefenberg has been my guide and my advisor through what is now a long life.  It is a debt that can never be repaid but through these souvenirs I'd like to share the memory of Dr. Graefenberg with you.


Never can Medicine or Science have had a greater representative than a German named Ernst Graefenberg.