We are often told by the authorities that DES wasn't used much here in Australia, that DES was "an American thing". A review of the promotion of oestrogenic products in medical journals of 1949-1950 dispels this myth
A hidden part of our history
Politicians, health authorities and doctors have said to us, both as a group and as individuals, that DES wasn't used much here. Both my mother and I have been told (when we have raised with doctors our DES exposure) that DES was "an American thing"' -that it was mainly or only used in the USA.
This lie, this hidden part of our history, has angered me for some time.
I decided to search through issues of the Medical Journal of Australia (later retitled the Australian Medical Journal) for the years 1949-1950. While I mainly concentrated on the Medical Journal of Australia (MJA), I also went through some American and British publications that Australian doctors would have been reading and be influenced by.
This particular era seemed a good starting point as it was around the time that I was born; and it was also the time when the theories of Dr George Smith and his wife Dr Olive Watkins Smith were controversial topics amongst the medical profession. (1) Their theory was to treat threatened pregnancies with DES as a prophylactic measure from the 7th week of pregnancy onwards, in increasing doses. (2) My mother, and many others of her age group, remembers taking these large and increasing doses.
So, how could this DES usage not be true?
I was shocked by the heavy promotion of oestrogen products in them. For example, the Medical Annual 1949 has a large bookmark attached advertising ORGANON: PURE HORMONES. The articles in the MJA are very revealing for the many uses of oestrogen; the many age groups that were targeted; and the experimental way in which the drugs were used. I decided to write about and quote from these articles. They more or less tell their own story and reflect the thinking of their time -a quaint time, it seems, when poets such as Milton are quoted, and when some articles read like travelogues.
At this time DES was regarded in the same category as vitamins and other modern 'wonder drugs', such as insulin and antibiotics. In a review of the 1948 British Pharmacopoeia, sex hormones are included as one of the "important additions"; and as a great leap forward in prescribing practice. It is stated that
" No longer do we find cinchona bark, lobelia, linum or jalap, but in their place is a large number of synthetic drugs, vaccines and antitoxins, hormones, vitamins or antibiotics." (3)
And the 'sex hormones' were certainly put to use.
Premature Labour
In an article on premature labour Donald F Lawson of Melbourne considers that uncontrollable weight gain, while pregnant, may be indicative of multiple pregnancy. Multiple pregnancy carries with it considerable risk of both toxaemia and premature labour. Lawson refers to the Smiths' theory and recommends the prescribing of large doses of DES as good obstetric practice:
"There is reason to hope that in certain conditions in which toxaemia can reasonably be anticipated, the use of large doses of diethylstilboestrol, as advocated by Smith and Smith, will either avert the toxaemia or delay its onset, and so permit the birth of a more mature child. It is good obstetrics to diagnose multiple pregnancy early and use the stilboestrol in these cases, too, for the purpose of reducing toxaemia, and to delay the onset of labour. It is considered wise, for the same reasons, to give large doses of stilboestrol to all patients with hypertension or diabetes who become pregnant." (4)
Premature Babies
DES was not only given to prevent premature labour, but it was also given to premature babies. So, if you were born prematurely and you didn't get DES before you were born, you were more than likely to get a dose soon after you were born.
Melbourne paediatrician Kate Campbell’s paper on the clinical management of the premature infant is the lead article in Medical Journal of Australia (MJA) in February 1950.
In the section on hormonal therapy, Campbell states:
"Maternal blood during pregnancy has a high oestrin content. Therefore, we administer to infants weighing under four pounds, one quarter of a milligramme of stilboestrol per day, beginning about the fourth day. Along with this, thyroid (whole gland) is given, in a dosage of one-twentieth of a grain per pound of baby weight per day."(5)
Acne
WH Goeckerman theorised that a hormonal preparation would be beneficial in the treatment of acne. He therefore experimented with desoxycorticosterone and antuitrim, only to be disappointed with these preparations.
In 1940 he decided to treat all female patients with oestrogens. Both natural and synthetic preparations were administered, sometimes individually and sometimes in combination. The dose was adjusted to the requirements of the individual. The author concluded that a combination of the natural and synthetic oestrogens is the best, although synthetic oestrogen alone is often effective.(6)
Always Experimental -for Morning Sickness!
One of the most surprising discoveries amongst the articles was Treatment of Vomiting of Pregnancy by ‘Oestrogenine Compound’ by G Whyte of Esk, Queensland. (7)
This is particularly surprising given that toxic symptoms of DES, known and well documented at the time, included nausea and vomiting. (8)
However Whyte reports:
“Vomiting of pregnancy, or as it is frequently called “morning sickness”, is a distressing although not serious complaint. Hence I was pleased to note in November 1948, that a patient who had been suffering from this disorder ceased vomiting when Oestrogenine Compound’ was administered.”
Based on this observation Whyte then went ahead to treat 12 patients, and reports that all except one obtained relief.
“Five of these 12 patients have now been confined, and there is no signs that this treatment has had any ill-effect on either mother or baby.”
He further notes
"According to the manufacturer (Fawns and McAllan) ‘Oestrogenine Compound’ contains extracts of the thyroid gland and the anterior lobe of the pituitary gland, ‘Neo-Oestrogenine’ (dienoestrol) and calcium phosphate.
Not surprisingly, Whyte found that giving dienoestrol alone did not help the morning sickness, but claims success when the compound was used. (7)
Just as revealing of this 'women as experiments' culture is a letter from Donald F Farmer, in reply to Whyte's article. Farmer found Whyte's article interesting because he had been using Lipolutin (a progesterone, manufactured by Parke Davis) for morning sickness in his practice. He concludes his letter by saying
"For myself, my results have been gratifying, but I hope they may be more so by using Oestrogenine in addition to Lipolutin. (9)
Acroparaesthesia
This syndrome (consisting of pain, tingling and numbness of the hands and digits) is one that affects both pregnant women and middle-aged women. James H Young of Perth (Senior Honorary Physician, Clinic for Rheumatism and Arthritis, Royal Perth Hospital) states that acroparaesthesia is probably an endocrine disorder. In this study he treated 15 patients with large doses of oral oestrogens and reported all obtained rapid relief Nevertheless, he does find side effects from these large doses:
"In using large doses of dienoestrol or ethynyl oestradiol in the treatment of patients with acroparaesthesia, menopausal flushes, osteoarthritis of the interphalangeal joints and osteoporosis, I have noted occasional toxic symptoms (nausea, enlargement of the breasts, vaginal discharge, vaginal haemorrhage, frequency of micturition and haematuria)."
He therefore holds some caution in prescribing:
"My present practice in treating these patients is to prescribe dienoestrol, 1.5 milligrammes to be taken once or twice daily.”
The dose is increased if the symptoms are not controlled. If the symptoms are abolished, the dose is continued for two months then stopped. The treatment is recommenced if the symptoms recur. (10)
Painful Periods & Menopause
THE MEDICAL JOURNAL OF AUSTRALIA ADVERTISER July 2, 1949
AA Moon of Sydney discusses the different treatments, including oestrogen use, for dysmenorrhoea (painful periods) and the climacteric (menopause). He notes that oestrogens have been prescribed, by many doctors and for many years, for these conditions.
Much to his credit, he promotes the taking of a careful history, and general medical measures for the alleviation of menopausal symptoms in 80% of women. However,
"…the remainder require endocrine therapy. Oestrogens are used as tiding the patient over the stage of hormonal imbalance.· He cautions that "Women who menstruate regularly although they are at or beyond the recognised menopausal age should not be given oestrogens.”
Moon gives other warnings for oestrogen use and these are quite revealing. He warns that oestrogen can become habit forming and he deplores self medication. He also states that, according to agreed opinion,
"oestrogens should not be given to patients who have had previous treatment for carcinoma of the reproductive organs or breast."
Another caution is that oestrogens may cause uterine bleeding in post-menopausal women who have been on synthetic oestrogens for a long period or who have been overdosed.(11)
Carcinogenic Potential Recognised
It was known amongst the medical profession that oestrogen had a potential carcinogenic
affect.
AA Moon acknowledges that
“Oestrogens have carcinogenic effects on susceptible experimental animals, and it has been inferred that similar effects can occur in women.” (11)
James H Young states
“The possible carcinogenic effect of these drugs is probably only theoretical, but not be overlooked.” (10)
In a British publication, Medical Annual 1949, there is a case study of a patient with prostate cancer who was treated with large amounts of DES. While it was recognised that both familial predisposition and the DES contributed to the cancer; this patient developed breast cancer secondary to the oestrogen treatment. Similar studies, and earlier studies, are cited in this article. (12)
This little review, concerning a short period of time in our history, is only the tip of the iceberg.
I haven’t mentioned the many advertisements for oestrogen products. These, like the medical articles, are extremely revealing. For example, ‘Ovendosyn’ is advertised as “the method of choice” for the suppression of lactation.
THE MEDICAL ANNUAL ADVERTISMENTS 1949
I have picked a time in medical history when oestrogen usage was only just beginning, and yet it is evident that oestrogen products were being extensively promoted and used in this country for all sorts of bizarre reasons.. Interestingly, even back then, there was an awakening awareness of their carcinogenic potential.
References
1. M Vickers DES -The Wonder Drug We Should Wonder About. Health Action Nov/Dec 1985
2. C Laitman Orenberg DES: The Complete Story New York:St Martin's Press 1981
3. RH Thorp The British Pharmacopoeia from the Viewpoint of the Pharmacologist. MJA 5 August 1950; vol.2 no.6
4. DF Lawson Premature Labour MJA 25 February 1950; vol.1 no.8
5. K Campbell Clinical Management of the Premature Infant MJA 25 February 1950; vol.1 no.8
6. WH Goeckerman Hormonal Therapy for Acne Vulgaia. Archives of Dermatology & Syphilology 1950. Reported in MJA 14 October 1950; vol.1 no.12
7. G Whyte Treatment of Vomiting of Pregnancy by Oestrogenine Compound MJA 25 March 1950; vol.1 no.12
8. The Physician’s Index 1940. Equity Press, Melbourne.
9. DF Farmer Letters to the Editor MJA 20 May 1950; vol.1 no.20
10. JH Young Acroparaesthesia MJA 27 May 1950 vol.1 no.21
11. AA Moon Dysmenorrhoea and the Climacteric: Pschosomatic Assessment and Treatment MJA 11 February 1950; vol.1 no.6
12. H Bailey & NM Matheson Surgery of the Prostate Medical Annual 1949 Bristol:London Simpkin Marshall Ltd 1949 p 266-270
Published in our newsletter DESPATCH in 2007