Book Review

Eve's Herbs: A history of contraception and abortion in the West

N Engl J Med 1997; 337:1398November 6, 1997

Article

Eve's Herbs: A history of contraception and abortion in the West
By John M. Riddle. 341 pp. Cambridge, Mass., Harvard University Press, 1997. $39.95. ISBN: 0-674-27024-X

John Riddle has established his reputation as a leading expert on ancient Greek pharmacology. In an earlier study, Contraception and Abortion from the Ancient World to the Renaissance (Cambridge, Mass.: Harvard University Press, 1992), he argued that a much more reliable knowledge of oral contraceptives existed in the ancient and medieval worlds than had previously been thought. In this book, Riddle attempts a broader but partly overlapping study, a history of abortion and contraception in the Western tradition (Europe and the United States, with a glance at the Islamic world). More specifically, he challenges the common view that oral contraception was little practiced and largely ineffective until the 18th century. It has long been held that high infant mortality helped to account for the relatively static population in classical antiquity. Riddle rejects this explanation, attributing the relative stability of ancient and medieval populations to the extensive use of herbal contraceptives by married women, knowledge of which was passed on for centuries by means of a folk tradition. Not only were herbal contraceptives believed to be effective by the women who used them, argues Riddle, but primitive and traditional societies continue to rely on them today. Riddle cites numerous examples of substances found in nature (e.g., pomegranate, Queen Anne's lace, and pennyroyal) that are described as contraceptives or abortifacients by such classical writers as Soranus and Dioscorides. Modern pharmacologic studies have shown a number of them to be effective. Even some magical prescriptions contained ingredients that have been found to prevent contraception.

Riddle contends that both the knowledge and the use of antifertility agents spread in the Middle Ages, although Christian teaching regarding the sanctity of human life and the desirability of producing children led to the condemnation of abortion and birth control. But the chain of transmission was broken in the 13th century owing to several factors. New licensure requirements meant that physicians were increasingly drawn from universities and were unfamiliar with contraceptives, canon law regarding abortion became more restrictive, and medical writers responded by disguising the properties of contraceptives and abortifacients. The prosecution of witches in early modern Europe led to the decline of “wise women,” who had for centuries transmitted the lore of contraception. The professionalization of medicine by men pushed midwives out of a field that they had traditionally dominated, further reducing the sources of popular knowledge of contraception. By the 17th and 18th centuries, that knowledge was everywhere disappearing from Europe, and it remained for researchers in the 20th century to rediscover it.

Riddle argues his case with learning and perspicacity. He draws widely on the specialist literature of a number of disciplines as he discusses, among other things, the theology of the ensoulment of the fetus and the demographics of early modern Europe. His thesis, however, is a highly speculative one that is built on very slender data. The problem for Riddle is the absence of evidence of the widespread use of effective contraceptives before the modern era. He is forced to assume that because of social constraints, knowledge of contraception remained a secret lore, which was transmitted orally or alluded to in written sources in coded form. Not only is much of the evidence adduced by Riddle circumstantial, but in too many cases he must account for the silence of the sources by invoking the necessity of their cloaking the real intent of oral contraceptives. In fact, their silence much more plausibly argues against the widespread use of contraceptives. In order to avoid this conclusion Riddle resorts to ingenious argument that not infrequently amounts to special pleading and the use of circular reasoning (see, for example, pages 156 and 157). Even more problematic is the extent to which traditional contraceptives were effective. The question is not whether contraceptives were sometimes used by ancient and medieval women (they clearly were) or whether some of them were effective (they might have been). The point at issue is whether oral contraceptives were sufficiently widely known and effective to permit many if not most married women to limit the number of children they bore and therefore to account for the relative stability of the population of Europe for several centuries. Riddle fails to demonstrate that they were. The fact that some of the herbal contraceptives and abortifacients recommended by ancient and medieval pharmacologic writers have been found to be effective by modern researchers does not prove that they were necessarily so when used within a folk tradition. There are simply too many variables.

Eve's Herbs is a revisionist study that is certain to provoke debate. While Riddle has left no stone unturned in his effort to demonstrate that premodern women were able to limit conception on a wide scale, one must conclude that his thesis remains unproved and unlikely.

Gary B. Ferngren, Ph.D.
Oregon State University, Corvallis, OR 97331