Teratology Transformed: Uncertainty, Knowledge, and CJonflict over Environmental Etiologies of Birth Defects in Midcentury America TV Heather A. Dron DISSERTATION Submitted in partial satisfaction of the requirements for the degree of DOCTOR OF PHILOSOPHY in History of Health. Sciences in the GRADUATE DIVISION of the UNIVERSITY OF CALIFORNIA. SAN FRANCISCO Copyright 2016 by Heather Armstrong Dron ii Acknowledgements Portions of Chapter 1 were published in an edited volume prepared by the Western Humanities Review in 2015. iii Abstract This dissertation traces the academic institutionalization and evolving concerns of teratologists, who studied environmental causes of birth defects in midcentury America. The Teratology Society officially formed in 1960, with funds and organizational support from philanthropies such as the National Foundation (Later known as The March of Dimes Birth Defects Foundation). Teratologists, including Virginia Apgar, the well-known obstetric anesthesiologist and inventor of the Apgar Score, were soon embroiled in public concerns about pharmaceutically mediated birth defects. Teratologists acted as consultants to industry and government on pre-market reproductive toxicology testing for pharmaceuticals. However, animal tests seemed unable to clearly predict results in humans and required careful interpretation of dosage and animal species and strain responses. By the late 1960s, amidst the popular environmental movement, teratologists grappled with public claims that birth defects resulted from exposure to industrial pollutants in water or air, or from food additives, pesticides, and industrial waste or effluent. In a crowded field of professionals concerned with pharmaceutical or chemical exposures during pregnancy, teratologists proved adaptive and resilient. Despite influences from the environmental movement, teratologists at times tried to contain the substances and outcomes considered relevant and called for greater vetting of chemical claims, amidst rampant journalistic and public accusations about iatrogenic or industrial harm. Both experimental teratology and epidemiology informed these debates but each faced explanatory insecurities in causal inference iv that left room for parental anxiety and considerable speculation about uncertain harms to susceptible fetuses. Concomitantly, environmental scientists and activist geneticists wanted to expand the definition of a teratogen to include more subtle or long-term outcomes and raising concerns about the as-yet-undetected reproductive hazards associated with chemical profligacy. Thus, by the 1960s and 1970s, a more general definition of non-genetic factors influencing mechanisms of developmental defect was overwhelmed by a vision of toxic chemical hazards, often pharmaceuticals, affecting development (particularly cognitive or neurobehavioral effects). I argue that the protectionist experimental science of teratologists in the 1950s, the calculative science of epidemiological risk and environmentalist’s neo-eugenic claims of damaged children resulting from corporate negligence and industrial pollution that gained ground in the 1960s and 1970s contributed to a late twentieth-century characterization of pregnancy as a risky state. v Table of Contents Introduction ............................................................................................................... 1 Chapter 1: Teratology Transformed: Medicalizing Monsters and Environmentalizing the Womb in Midcentury America (1940–1975) .................. 28 Chapter 2: “Is My Baby All Right?” Advocates and the Popular Press Define Birth Defects and Publicize Teratological Research (1950–1975) ...................... 149 Chapter 3: Vilma Hunt: From Occupational Teratogens and Pregnant Women to a Broader Framing of Environmental Reproductive Hazards (1960–1980) ...... 229 Chapter 4: Lead and Mercury: Heavy Metals, Chemical Brain Drain, and Epidemiological Epistemology (1960–1995) ......................................................... 287 Conclusion .............................................................................................................. 358 Bibliography ......................................................................................................... 368 vi List of Figures and Tables Table 1: Conferences on Environmental Factors and Mechanisms of Abnormal Development 1950–1960................................................................................................................45 Figure 1: Cartoon on the National Foundation’s Expanded Program.........................167 vii Introduction Since the 1970s, there has been ongoing debate about the reproductive effects of chemicals: among pregnant women discussing safe medications, by scientists studying reproductive toxicology, in arguments about workplace protection policies for fertile women, and by local activists concerned about miscarriages that appeared to be linked to herbicide spray or toxic waste disposal.1 This research was animated by key questions about maternal experience: How did the uterus become understood as a site of chemical pollution that could result in deviant infant growth (birth defects)? How did pregnancy become constructed as a risky and pathological state linked to pharmaceutical exposure or occupational or environmental pollution? How did the experiences of pregnancy change as a result of this characterization of chemico-toxic prenatal risks? Yet, instead of the voices of pregnant women, what I found in the historical record was a wealth of published scientific literature about pregnancy and fetal risk, and advice literature addressing potential parents (mostly mothers). Given the sources, my work emphasizes professional debates and discussion of how controversial and incomplete evidence of environmental risks should be or were communicated to pregnant women amidst negotiations between scientists, women’s health activists, the media, and medicine in the 1950s through the 1970s. 1 Leslie J. Reagan, "From Hazard to Blessing to Tragedy: Representations of Miscarriage in Twentieth-Century America," Feminist Studies 29, no. 2 (2003): 357– 78; Theo Colborn, Dianne Dumanoski, and John Peterson Myers, Our Stolen Future: Are We Threatening Our Fertility, Intelligence, and Survival?: A Scientific Detective Story (New York: Dutton, 1996); Sheldon Krimsky, Hormonal Chaos: The Scientific and Social Origins of the Environmental Endocrine Hypothesis (Baltimore, MD: Johns Hopkins University Press, 2000). 1 Some advice literature, such as What to Expect When You’re Expecting, published starting in 1984, was written by parents for parents, seeking to provide clear explanation of some of the threats to pregnancy that “lurked everywhere: in the air we breathed, the food we ate, in the water we drank, at the dentist’s office, in the drugstore, even at home.”2 By the 1980s, as in best-selling author Heidi E. Murkoff’s depiction, prenatal environmental chemical dangers were seen as ubiquitous and insidious risks that must be managed by pregnant women for the well-being of children and the future of the human race. In her view, pregnant women needed to become informed citizens who understood and managed the risks of environmental pollution. Therein lies a paradox, that despite the relative comfort and safety of modern life in a wealthy country in the late twentieth century, some people felt that fetuses were being poisoned, and were particularly concerned about environmental developmental risks to children occurring during the prenatal period. Embryos and fetuses were understood as particularly susceptible to exogenous chemical exposures. Teratology, the study of birth defects, played a role in the modern scientific characterization of pregnancy as susceptible to environmental hazards. In particular, I describe how the discipline and profession of teratology (a medical science rooted in nineteenth-century anatomical and laboratory examination of unusual infants and animals) was transformed, by the modernizing and biomedicalizing impulses of those who organized the Teratology Society in the late 1950s in the context of a rising epidemiological science of chronic diseases, and later by scientific and activist voices of feminists and environmentalists of the late 1960s and early 1970s. Ironically, perhaps, this work 2 Arlene Eisenberg, Heidi Eisenberg Murkoff, and Sandee Eisenberg Hathaway, What to Expect When You're Expecting (New York: Workman Pub., 1984). Also quoted by Marika Seigel, The Rhetoric of Pregnancy (Chicago; London: The University of Chicago Press, 2013), 92–93. 2 privileges professionals, medicine, and the fetus, rather than pregnant women, parental advocates for the disabled, or disabled children. As such, it plays a role in the subsumption of the needs, perspectives, and empirical experience of pregnant women that characterizes fetal patient or personhood. In this history, the academic medical science of teratology proved adaptive and resilient, despite its anachronistic leanings. Teratologists based their knowledge claims on modern techniques of mammalian experiment and epidemiology, in an increasingly crowded professional field addressing prenatal chemical risks. They often relied on laboratory experiment on pregnant animals to understand the mechanisms of abnormal development, experimental teratology, even as epidemiology began to play a greater role in assessing prenatal pharmaco-chemical risks in the 1970s. This work highlights the evolving role of epidemiology and experimental teratology