Dhanvanthi Rama Rau’s relations with Clarence Gamble

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The Margaret Sanger Papers
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May 6, 2011, 7:53 a.m. (view history)

Rama Rau basically got Gamble thrown out of the IPPF. They did not get along!

Find context for the following:

MS wrote: “I know that there has been some adverse criticism of him, especially by Helena Wright, who did a bit of gossip concerning his lion hunt and expenses involved, to the representatives in India.  This, together with the rumours that people were to become “Guinea pigs” was an unfortunate piece of bad relationship, and unfortunately he has this to overcome.  I stoutly denied both of these rumours when I heard of them, both in London and to Lady Rama Rau.” (11/10/1953)

“It is unfortunate that Lady Rama Rau and the Minister of Health have aversion relative to the simple methods that Dr. Gamble tried out in Pakistan.  I tried to tell Lady Rama Rau when she was here that we have all had to try out and experiment with methods from the beginning of the birth control movement in this country.” (1/18/1954)

MS wrote “To the best of my knowledge Dr. Gamble has tried to cooperate with Lady Rama Rau.  It seems that the policy laid down regarding Regions will keep anyone from entering such Regions since the whole world has been divided up into Regions.  The Birth Control work can die because one Regional Director rules to keep out all who may be more progressive than he.” (8/25/1955)

MS wrote: “    The most discouraging event to me or in all my life was the way Lady R. R. “poled” all the Governing Body against Dr Gamble--” (10/31/1955)

“ Personally and to your private ear, she is exceedingly distressed and disappointed in Lady Rama Rau’s attitude in Japan, not only about Gamble, who helped India more than any other individual, also helping her to get the $5,000 from the Doris Duke Foundation... Gamble also gave money after the Conference to help them keep going, and yet she utterly refused to hear of money going to the Japanese.” (3/23/1956)

MS complained: “Also, her mean attitude toward granting funds to the Japanese served to emphasize the clear fact that she is not capable of having the real international point of view so essential to the growth of our IPPF.” (8/14/1958)

Sent cc to Dhanvanthi Rama Rau and Vera Houghton.

Discusses his "difficulty about Dr. Gamble" who is planning to visit England soon. "Dr. Gamble proposes, in his forthcoming tour, to visit countries such as India and Japan where family planning organisations already exist. But he also intends to visit various countries...where no national organisations exist. I have suggested that when Dr. Gamble visits these countries he should do so in a private capacity and not as a field representative of the I.P.P.F. This suggestion arises from my reactions to the discussions about Dr. Gamble which were held at our last meeting (22 August) in Stockholm. It was then decided that when he visited countries with no national organisations, Dr. Gamble should take no steps that had not been beforehand authorised and approved by the national associations concerned. You will recall that Lady Rama Rau stressed this point with some vigour and the resolution passed at Stockholm regarding the recognition of field representatives (Rules No. 8 (4) page 18) was therefore carefully worded."

The plain fact seems to be that some people are afraid that Dr. Gamble might use the women in underdeveloped countries for unauthorised experiments in new methods.

 Asks if MS will attend Vogt’s 11/13 meeting on IPPF affairs. “I hope you can for we need your planning. If not, is there anything I can do to carry out your wishes?”

“Did you discuss with Lady Rama Rau the possibility of Dick’s and my representing the IPPF in this year and next. I gather that she has been rather disturbed at some of the clinical procedures that I have recommended in India. Did my letter seem to straighten her out on this? If not, is there anything further I should write to her?”  Reports that the Council on Pharmacy and Chemistry has voted to accept his new spermicidal test part of their evaluation of contraceptives. He says this supports the validity of the salt jelly.

-3pp. cc. MS “I learned that I have not explained to you clearly enough the successive tests which led me to encourage clinical trials of salt as a contraceptive in various forms.” Lab test found that spermicidal jellies with 10% salt were more active than 64 of 70 commercial contraceptives. MSRB conducted clinical trials to determine whether it was irritating, found no discomfort or evidence of irritation on exams. They tried it with a 20% salt concentration, twice what they recommend, and still found it non-irritating. Based on this the Council on Pharmacy and Chemistry of the AMA listed it among “New and Nonofficial Remedies.” Says that salt jelly’s effectiveness is supported  by the testing done on jelly alone as a contraceptive among women who did not have good incentive to control family size, yet the results Tietze found was that of 100 patients, between 4-38 became pregnant, which means one unwanted baby might be born to a couple every nine years.  He expects that salt jelly would be more effective because its spermicidal activity is stronger than that jelly.  Says that the salt, used with sponge or cotton pad can reduce pregnancy to 1/3 of the untreated rate. Says that with a motivated group of users it would be even more effective.

“To test a new, and untried, method in the United States is at present almost impossible. The knowledge of birth control is so widespread that most people know of the condom and the diaphragm techniques and are not ready to accept anything else. Physicians feel that they must prescribe for their patients the best method that is now known, even though others might have equal, or even superior effectiveness. Even if the salt method could be tried in this country is would not give information as to whether it was acceptable and effective under Japanese or Indian conditions.”

Under Koya, Japan has identified a group to test the method, so far finding only about 14% pregnancies, small number of cases and some indication that people whose pregnancy might have been their own faults were included in stats.  Talks about effectiveness of Sampoon vaginal tablets, made in Japan because those are the only ones that he has gotten lab tests on.  This solution was prepared by an American Army doctor during the Occupation and given to the Japanese company. He has asked tablet users to study whether there is any irritation.

He says that she wrote that the supplies of foam tablets had all been distributed , and he will order more, having them sent to the FPAI, she can pay shipping costs from the balance of his donation. “If the method proves satisfactory and successful I feel that the Association will have had a hand in a marked step in advance toward contraception. The tablets can be produced cheaply, salt methods have the advantage that they can spread from one satisfied customer to another  without the cost or difficulty of getting into contact with a physicians or a drug store.”

[174] “As Gamble traveled through Asia promoting simple methods, even enlisting his family and hiring ‘missionaries,’ people sensed his hidden agenda and resented him for it. It did not help that he insisted on using words like coolie and native with the government officials he was constantly importuning. ‘He just will not learn anything about the people he is dealing with,’ one volunteer in Ceylon complained. ‘They are all natives and sex to him.” Rama Rau accused him of pawning off untested methods that no American would willingly choose. [quotes Barbara Cadbury to Margery Butcher, 6/4/1954 in IPPFA, series B, reel 149, frames 2207-2208.]

Notes that Gamble recommended Dr. Devi Krishna Rao to her--he found her and they are impressed by her.

"We have been rather worried about Dr. Gamble's encouragement of Dr. Ghosh's experiment with Dr. Sanyal's 'Ovatrim' in Calcutta. He is paying her to expand her project when the Government of India Family Planning Programmes and Research Committee have definitely declared 'Ovatrim' to be an abortifacient and not a contraceptive and, therefore, requiring closer clinical study. We are anxious not to be diametrically opposed to Governmental policies, especially as we wish to work in co-operation with them so as to create a common integrated programme for the country. Besides this he has suggested the appointment of a Mrs. Margaret Roots as a Field worker for India and Ceylon. Mrs. Roots has never done any Family Planning work, and as far as I am able to gather neither is India nor Ceylon keen on having her. We are still carrying on correspondence about this appointment and I will let you know what the outcome of it will ultimately be."

[163] “Among the Americans who came to Bombay to attend the Third International Conference on Planned Parenthood was Dr Clarence Gamble, who was a friend of Margaret Sanger, though not part of her ‘cabinet’ people. He was a very quiet person and, as the inheritor of the [164] Proctor and Gamble empire, his millionaire status and medical qualifications gave him total independent to promote his own ways of doing things. He was deeply committed to the cause of family planning and carried on research to try to evolve simple methods which could be used easily in the poorer strata of populations. Through extensive travels he made contacts all over India, Sri Lanka, Burma and other countries in Asia and Africa. He was promoting the sponge and oil method as one which was easily accessible and usable, and offered small grants to persons or organisations to try it out. Usually, the amounts were small, often under US$1,000, and supervision was strict, and no large-scale results (so necessary for proper clinical trials) were forthcoming.  The pharmacological aspects interested him and his rooms at the Harvard Medical School were the scene of various experiments.

“Later he took to funding American workers to live in developing countries and promote family planning services. He made one such proposal to us, namely that he was sending Mrs. Margaret Roots who would live in Bombay and work with us. He would, of course, bear all expenses.  He called Lady Rama Rau and me to the Taj Mahal hotel where he was staying to make his proposal. We were taken aback by what appeared to us a rather autocratic suggestion, made in a perfectly gentle manner. It disturbed us, also, because we were at a stage where we were making good headway with our work, winning support from the Government and the general public, and the introduction of a foreign element could be disruptive, especially as the lady in question, though sincere, had neither qualifications nor any previous experience in this line of work.


We managed to avoid this complication by suggesting that the Family Planning Association of Sri Lanka was still struggling to find a sufficient number of workers to promote family planning and he could enquire from them about the possibilities of Mrs. Roots helping them. Both sides agreed and this is what happened. Similarly, another of his protégées was sent to Africa, where she managed to make progress despite touch conditions.”

    Gamble sent them a consignment of Dickinson’s Why Fear Sterilization which they distributed to thousands.

[165] “As far as IPPF was concerned, Dr. Gamble was a bit of a problem. His independence, where he did not see any need to cooperate and arrive at common programmes, showed an obstinacy but at the same time it was offset by his genuineness and commitment. He was someone who carried on doing things he considered important, but he did not listen to others. His family was totally devoted to him and his interest in family planning and contraceptive methods was passed on, so that some of them have also worked diligently in the field after his death.

The only mention of Gamble in her memoirs, and she gets his name wrong!

[263] "The main contraceptives being advocated in India before the conference were the cheap, oil-soaked cotton pads suggested by Dr. Marie Stopes, which I have mentioned, and a palm-sized sponge soaked in a concentrated solution of salt recommended by Dr. Charles Gamble of the United States."

Other discussions of methods

[251] "Years earlier, in 1936, when Margaret Sanger had visited India and talked about birth control,, a few clinics had been opened up here and there, but as no contraceptives were available in India at that time, they soon faded out or changed their emphasis. A few condoms were imported from abroad, but when the Second World War broke out in 1939 these imports were stopped and all the work in this field died. Here and there some doctors advised women to try the simplest method, at one time advocated by Marie Stopes. This was to use crude, unprocessed cotton soaked in oil before sexual intercourse. But most women who wanted to limit their families found this method displeasing and soon discarded it."

Just received a copy of the letter he sent Margaret Sanger with regard to hiring Margaret Roots as an IPPF field worker.

"You have, perhaps, overlooked the fact that we are responsible for the region India, Ceylon, Pakistan, and Burma, and therefore, any field work Mrs. Roots may do in this area would have to be done in close consultation and co-operation with the Family Planning Association of India. In fact, every new scheme that she would undertake in this area would have to be presented for approval to the F.P.A.I. With regard to the other regions in Asia besides these, we would not be responsible for what she undertook. You say that 'I will ask her to keep the International Planned Parenthood Federation informed of her progress, and to send them information which will be useful for their files.' With no reference to the Regional Office whose ground she will be covering, my objection to this appointment will be that Mrs. Roots is not a recognized authority on the subject of either Family Planning or the establishment of clinics or of Public Health requirements, and mass communication programmes. We are anxious that if an appointment should be made by the I.P.P.F., it must have the approval of the Regional Office, and the person appointed must be a specialist in the field of Planned Parenthood, so that she should be in an unassailable position to proffer advice and assist development in the field. Our work lies with doctors--and no doctor will co-operate with an untrained worker."

"I do hope you understand our anxiety to keep a uniformity in the work that we are planning to do through the Regional Office in our area."

She encloses a copy of her letter to Gamble in answer to Sanger's letter about the desirability of employing Mrs. Roots as an IPPF field worker.

"As I have said to him, it is very necessary for us to have experts in the field of family planning to carry on this work, who will be in a position to inspire confidence in those who are still in doubt as to the desirability of establishing such services in Asian countries."