Part Two: The Father of Gynecology

Robert is joined again by Dr. Kaveh Hoda to continue to discuss the history of gynecology. 

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Episode Transcript

Speaker 1 (00:00):
Oh, and where where is it hot? Isn't it hot?
It's hot, babe, it's summer. The goats are fine. Um.
This is Behind the Bastards, a podcast where every week
Sovie Liftman asks me if my goats are okay, and

(00:20):
I say, they seem to be fine. We shared them recently. Respectfully,
I care about your goats. Their goats, you know, they
they're good. They they're good at stuff. They're pretty hardy.
They've been good. That's why they've been goats for so long.
Have you ever known any goats? You've been friends with
the goats? Dr Cava Jota, are we starting your your introductions?

(00:49):
They're just like an inspiration to us low level podcasters.
It's like, uh, you know people who don't appreciate your intros.
They're like the same group of people that I thought
Miles Davis bitches brew was just sound. You know what
I mean? Thank you, thank you a lot of people
compare me to Miles Davis for many reasons. You're like
the Thurston More of podcasts introducing thank you, thank you.

(01:13):
We're not not quite as good as Ray Donk, who
pioneered the tuk tuk sound, but yeah, agreed, um and
to get to your question. I don't know goats, but
they were domesticated in Iran. That's a fun fact for you.
They were, Yeah, they were yea the Angora goats I
have Anga comes from. I think Ankawa. Um, so that

(01:36):
they're those are I guess Turkey Um, but yeah, that's
that whole. Not as good, but it's not as good,
not as good. I don't have any I mean my
mine or Nigerian um some of them. Yeah, so they're beautiful.
I have I have there there. I would love to
get some Mernian goats one day. My goat. My goats
are very cosmopolitan, you know, they don't judge. Yeah, everyone

(02:00):
could use an Iranian goat. I suppose I would love
it Irani. So we are this is happening where this
is show. How how do you like? How do you
like medical experimentation on unconsenting I don't. I don't love it.
Not a fan, not a fan. Okay, yeah, that is

(02:22):
that is one of those things that is like currently
not supposed to be done. Um, we'll see give gifts
goes another couple of years, am I right? Uh? Good times.
So we should probably start by talking about what the
experiments that Dr Simms was conducting on these women actually

(02:44):
entailed because boy it's a little gruesome. Um. As we
noted last time, Sims bragg that there was never a
time in which he could not experiment on a subject
if he wanted to. But he also noted, quote, my
operations all failed. This went on not for one year,
but for two and three and even four years, and
failed operations in this case means a woman is cut

(03:06):
into and then gets no relief from the already unpleasant
symptoms that that she's dealing with. Right, So this is
a problem, right, absolutely brutal. Yeah, it's it's gnarly and obviously,
like I don't know, one of the things that is
a little more complete. At some point, some group of

(03:26):
people were going to need to endure surgeries that were
not pleasant in order to figure out how to do
this properly, which is the case with every surgical procedure, right,
some number of people are going to have to go
through that procedure when it is less polished and effective,
because like that's the way learning works, right, Um, yeah,

(03:49):
it is, it is. But um it's always there's always
cares taken to do as little harm as you potentially
can Um. And it makes a big difference if you say, yes,
I'm willing to endure this, you know, for the sake
of not just my own relief in the future, but
expanding the frontiers of human knowledge. Yeah, exactly, the whole

(04:10):
consent issue. It's like a lot of astronauts died and
and we celebrate how cool that whole period was for
us in the Soviet Union. But you know, a lot
of them died, and it would be less of a
cool thing if, like they had been forced at gunpoint
to go risk their lives and spaceships. Right, probably movies

(04:31):
made about it. Yeah, Apollo One would be an even
more fucked up story if like those guys had been
led into that capsule at gunpoint before they burned alive
in there. Um yeah, um. But you know, again, it's
fundamentally noble and beautiful when human beings agree to endure
suffering to expand the frontiers of knowledge. It's really fucked
up when you forced them to do that. Um. I

(04:53):
don't think this is complicated ethics. I'm not a great
ethics guy, but I think this is pretty cut and dry. Um. Now,
I will say Simms was a competent scientist, in the
technical sense. He was methodical with how he proceeded with
his experiments. UM. He started by having his own specialized
instruments made, which took him three months. The first of
these patients that he operated on was Lucy. She was

(05:15):
eighteen years old and she had just given birth several
months before this all started. Because again, when you're talking
about enslaved women, their primary economic value is in producing
more people that you can buy and sell um, and
so you you start that process as early as you can.
Uh Sims noted quote. The case was a very bad one.
The whole base of the bladder was gone and destroyed,

(05:36):
and a piece had fallen out, leaving an opening between
the vagina and the bladder at least two inches in
diameter or more. That was before the days of anesthetics,
and the poor girl on her knees bore the operation
with great heroism and bravery. I had about a dozen
doctors there to witness the series of experiments that I
expected to perform. All the doctors had seen my notes
and examined them and agreed that I was on the
eve of a great discovery. Every one of them was

(05:57):
interested in seeing me operate. Now this was initially true.
Simms's experiments were at first attended by many other doctors,
and there was a lot of enthusiasm for his work.
It is worth noting, though, that during this procedure his
patients were kept completely naked. They were asked to sit
on their knees and bend forward onto their elbows with
their heads resting in their hands. Lucy's surgery took about

(06:18):
an hour, and the doctors who viewed it reported that
she screamed and cried the entire time. Sims himself wrote
that Lucy's agony was extreme. Now, his fellow doctors were again,
these are guys who are fine with using enslaved people
as test subjects, but they were still horrified by how
brutal this was um and you know, the realities of

(06:38):
the surgery became kind of too unsettling for a lot
of them to ignore. Simms himself wrote, quote, I succeeded
in closing the fistula in about an hour's time, which
was considered to be very good work. I placed my
patient in bed, and it does seem to me, now,
since things were so simple and clear, that I was
exceedingly stupid at the beginning. Now in specific The stupid
thing he had done was he'd used a sponge to

(06:59):
draw away written from the bladder. Given the fact that
people didn't know properly about things like germs and sanitation
at this stage, he wound up giving her blood poisoning. Um. Yeah,
so he had to do a bunch of stuff as
a result of this blood poisoning. He thought that she
was going to die from it. Um. She barely survived.
It takes her months to recover from this first operation. Um,

(07:21):
which isn't most I think most people would be like, well,
that's not great, that's not how you want that to go.
Sims is encouraged though, because once she does survive and
he gets her on his table again, he sees that
the fistula he'd been working on it hasn't gone away,
but it's smaller than he was um now than it
was now since he can't operate on her again right

(07:43):
away because she nearly died, so he immediately follows up
by bringing Betsy up and and doing a different version
of the experiment on here, using a self retaining catheter
instead of a sponge. Now, this experiment failed to UM,
and Sims makes no note as to how painful it
was for his subject, and it's probably worth noting going

(08:03):
back to one of Sims's colleagues at this point to
again give a contrast for how other doctors were approaching
the same problem. In his defensive Sims, doctor L. L.
Wall argues that fish july were just so horrific that
we can assume consent on behalf of the women used
to subjects, even though they were enslaved, because who wouldn't
want to be cured of this quote? And this is
a wall. Consider the following description of what it was

(08:26):
like to be a woman with a vesico vaginal fishula
in the mid nineteenth century, given by Dr P. M.
Kolak at the annual meeting of the Georgia State Medical
Society in April eighteen fifty seven. The poor woman is
now reduced to a condition of the most piteous description
compared with which most of the other physical evils of
life sink into other insignificance. The urine passing into the
vagina as soon as it is secreted in flames and

(08:47):
excoriates its mucous lining, covering it with calcareous depositions, causing
extreme suffering. It trickles constantly down her thighs irritates the
integument with its acrid qualities, keeps her clothing constantly soaked. Uh,
and it makes are basically insupportable to herself and all
those around her. Um. So, in in pointing this out
and kind of harping in an extent about how unpleasant

(09:09):
these things are to endure, Wall is basically repeating the
argument that Sims makes in his own memoirs. Here's how
Sims writes about his third named test subject, ANARCA quote.
Her life was one of suffering and disgust. Death would
have been preferable, but patients of this kind never die,
They must live and suffer. An ARCA had added to
the ficial and opening which extended into the rectum. Her

(09:32):
person was not only loathsome and disgusted to herself, but
to everyone who came near her. Now, this is Simms's
argument for why his experimentation was noble. Life was unlivable
in this condition, So what choice did he have but
to repeatedly cut into these people? Um. Now, he conducts
at least thirty failed surgeries on anarca, each as gruesome
as the ones we've detailed before. And this again there's

(09:54):
a lot that's fun up here. For one thing, Um,
he's the one saying death would have been preferable. She
doesn't say that would have been preferable. This fucking guy,
I bet you he doesn't even get like a rectal
exam without taking a vicut in first. You know what
I mean to go through an hour long plus thing naked,
all these people staring at you, this intense pain. It's

(10:16):
honestly the something it's like out of the movie Hostel. Yeah,
it's it's and and again all of these doctors are
kind of like pointing doing something fucked up, even because
that description we've read above is of a of a
of a of a free woman like dealing with it
and how horrible it is. But no matter who they're
talking about, they all make the comment that, like, your

(10:36):
life isn't worth living with this this thing. And again
none of them ask these women if they think their
lives are worth living, right, Like, that's that's one aspect
of this that's messed up. Um, And if they did
that even bother to document it, they didn't care enough
that it didn't matter enough to them to document it.
They think it's gross and so like that's to them.
It's like, that's again, not that this is not a

(10:58):
serious problem, that very clearly is, but that's pretty messed
up in my head. Um now. Monica Cronan ads in
the Journal of Anesthesia and Intensive Care quote, after years
without success, Sims decided to stop operating until he could
solve a problem with sutures. He describes the women in
his hospitals becoming clamorous for him to continue. The impression
he creates is that the women were desperate for him

(11:19):
to continue his experiments, which cements their role as collaborators. Now,
a few things are worth noting here. The first is
that the conditions affecting Anarca and the other enslaved women
that Simms experimented on did not form a vacuum. While
many free women also certainly suffered from fistula, including members
of royalty and other ladies of wealth and status, slavery

(11:39):
absolutely influenced the condition. This is ignored in nearly every
discussion of what was done to these women. And Arca
went into labor in eighteen forty five, when she was
seventeen years old. This was thankfully her first delivery. She
spent three days in agony before a doctor arrived, Monica
Cronan writes. Quote. Biological anthropologist Patricia Lambert writes that nutritional

(12:00):
deficiency diseases such as rickets, scurvy, pelagra, and iron deficiency
anemia are thought to have been common and enslaved communities.
Perhaps like other enslaved people, and Arca's diet was nutritionally
deficient and she developed rickets, which caused malformation of her
pelvis obstructed labor labor was a common result. So again,
part of why Anarca and these other women may have
had difficult labors that led to these fistula is that

(12:22):
they were malnourished because they were enslaved. Right, I'm sure
nobody was getting great prenatal care back then. Nobody was
getting it worse. Yeah. Now, the doctor who finally shows
up to treat Anarca when she's having this difficult pregnancy was,
of course James Mary and sims Uh. He was eventually
able to deliver her baby using forceps, which he had

(12:45):
very little experience with because, as he later wrote, if
there was anything I hated, it was investigating the organs
of the female pelvis um. He noted that the baby's
head was quote so impacted in the pelvis that labor
pains had almost ceased. Anarca did survive the surgery, but
the use of the forceps in the general nightmare situation
of the labor are what led to her fistula. UM.

(13:06):
It is worth noting James Mary and Sims does not
record whether or not the baby survived. He didn't consider
that particularly like worth noting at all. Um. Since she
could not write or read, we know nothing about how
she felt about the conditions she suffered after pregnancy. UM.
Simms writes lurally about how nasty and gross it was.
Um and I think his attempted his account of her

(13:28):
drips with clear disgust disguised as sympathy. That said, her
condition was undoubtedly painful, and like any person, she surely
desired a cure. That does not mean that she must
then have truly consented to Dr Simms's experimentation. We don't
have to theorize on this matter. The existence of contemporary
doctors like Hayward, who conducted fishalist surgeries and experimented on
free consenting people at the same time, puts the light

(13:51):
of this quote. And this is from Cronin. Hayward records
the way in which some women he treated simply returned
home although a cure had not been achieved, and he
never heard from them again. The patient presented in eighteen
forty two, four years before anesthesia, and Hayward records that
she evidently had no confidence in a successful result and
therefore returned home despite being in very much the same

(14:11):
condition she was when she came here. Hayward records a
situation which consent was conditional on a successful outcome. Given
the opportunity to grant or withdraw consent for further surgery,
this woman withdrew it despite the limitations brought on by
her condition. And that's that's the kicker to me, Right,
other doctors who were fighting the same condition that Sims

(14:31):
was held to something that approximates modern medical ethical standards. Right,
they attempted what they attempted, and when the woman said
I'm done, they let her go, right, And that also
shows it, like, yeah, it's very impossible all these women
after that first surgery would have said, you know what,
I'll deal with it. We can't know because they never
got the chance to. But like, I can't imagine, I

(14:54):
honestly just can't imagine. And I know that they probably
did this whole thing like, well, women are just stronger
than men. They can handle Oh yeah, we're talking about
that a little later too. Yeah, but I mean, I
I just, I mean, I can't imagine anyone's strong enough
to deal with that. I mean, I there are certainly
some people. I suspect that if the population of people
who had this, there would have been there were individuals

(15:17):
who who would have who would have truly and freely consented. Yeah,
it takes thirty times, let's do it. There's always people
who are kind of outliers like that. Um, the fact
of the matter, and maybe maybe some of the women
that Sims was experimenting on would have freely chosen this,
but we'll never know, right, Like, no one bothered to
ask them, and they were not able to give free consent.
I just, I mean, at any point in his writings

(15:39):
Sims does he like acknowledge this was crazy, what this
this patient went through doing these surgeries so many times?
Does he acknowledge he's made a couple He makes a
couple of blaze of brief claims that like, oh, she
handled it bravely like um, but honestly, I mean again,
he doesn't even name the majority of the women he
was experimenting on, and we don't even know how many

(16:02):
times he did on each of them. Right. We know
he experimented thirty times on an Arca before he got
it right. Um. Now, obviously, uh, most people in medical
science as a whole today takes it as axiomatic that
an enslaved person cannot consent to being experimented on medically.
Dr Wall disagrees with this, and he uses Simms's own

(16:23):
writing to argue that consent was given. Quote. Simms gave
numerous accounts of these early FISTU law operations during the
course of his career, and although they differ in some details,
they all state quite plainly that he discussed what he
proposed to do and obtained consent from the patients themselves
before undertaking any operations. Writing in the New York Medical
Gazette and Journal of Health in January eighteen fifty five,
for example, Sims declared, for this purpose, I was fortunate

(16:46):
in having three young, healthy colored girls given to me
by their owners in Alabama. I agreed to perform no
operation without the full consent of the patients, and never
to perform any that would in my judgment jeopard life
or produce greater mischief on the injured organs, the owners
agreeing to let me keep them at my own expense
till I was thoroughly convinced whether the affliction could be
cured or not. Now he writes this in eighteen fifty five.

(17:06):
Now he starts his experiments in eighteen forty five, he
finishes in forty nine. Right, so this is something he's
writing years after he gets his this is how we
do it kind of thing. Um. A lot of Sims
critics will point out that his autobiography, which is published
decades after this, emphasized consent because it was now vogue
to act like you'd always believe that slavery was bad.
The fact that he does write this about their consent

(17:27):
prior to the Civil War could be seen as evidence
that he did care about obtaining what he saw as consent. However,
he's also writing for an international audience who view slavery
rightly as a borrent, so you could also argue that
he just knew he was like playing to a crowd
about his patients autonomy. Right, he's writing for Europe, you know,
because he goes and he works in Europe. After this right.

(17:47):
That's probably why he makes this note. More importantly, Monica
Cronin notes that sims recollections and claims about his own
work and treatment of his patients were never entirely trustworthy.
He claimed in his own public writings that in eighteen
forty five, prior to starting his experiments, he had investigated
the literature on the subject thoroughly and walked away convinced
that there were no good solutions proposed. This is unlikely.

(18:10):
Hayward had published his first account of a successful procedure
in eighteen thirty nine, that's six years before Dr sims
starts his Another doctor Mattawer, had done the same in
eighteen forty. Now, without being, which is the search engine
we all use, I'm aware, UM, searching was a lot harder.
So you're a Jeeves man. You're Jeeves man. That's not

(18:30):
my brand, but I respect it. Um. But without without
the only two good search engines being and asked Jeeves,
searching was a lot harder back then. But Monica Cronin
notes in eighteen fifty three that Dr Sims right wrote
a monograph that mentioned the work of both Heyward and Mattawer.
Now maybe he was unaware of them in eighteen forty five,
but he there's a good chance he was aware of them,

(18:52):
And one could argue that he should have been aware
of them because they were some of the only dudes
publishing in the field that he was experimenting it, absolutely
aware of him. I'll tell you how it goes. He'll
go to some sort of convention and he'll go to
some sort of like thing where he's with a bunch
of doctors trying to impress all these doctors from Europe
with his like procedure and his technique. And then what

(19:12):
those doctors do is trying to press everyone in the
room with their knowledge of the literature. And one of
those doctors was surely knowledgeable about prior cases and brought
it in, and his response was probably like, well, you know, yes,
of course I've seen the paper case report, but you
know that they weren't dealing with the type of fistula
that I'm dealing with here. This kind official is a

(19:32):
very different thing, etcetera. So he was definitely exposed to it. Yeah,
I I think that, And and again that's again that's
what Cronin's arguing. And by the way, the fact that
you've be talking about anesthesia a couple of times. The
fact that she is an expert on anesthesia writing for
the Journal of Anesthesia will be real relevant. But we
got some other ship to get through. But you know
what we've got to get through first, Yeah, I know,

(19:53):
we got to get through capitalism. Capitalism is the thing, man,
I'm all about it. I'm all about it. It's good.
It allows me to have goats. Thank your goats. Honestly,
I think the goats are before. But like pretty good sandwiches,
I'm gonna I will say this for capitalism. It's been

(20:13):
a real boon for sandwich innovation. Probably have you have
fewer kinds of sandwiches prior to capitalism. It's the only
good thing to come out of capitalism. I think I
can agree with that. Sandwiches and yeah, sandwiches and goats
invented the goat invented by John capitalism in nine. All right,

(20:41):
we are back, Okay. So when it comes to modern
defenses of dr Simms, L. L. Wall next claims quote
as a matter of surgical practicality, considering the delicate and
tedious requirements of performing surgery inside the vagina and the
exceedingly difficult circumstances of exposure and adequate lighting under which
he was forced to operate. Sims could not have carried
out these operations successfully without the cooperation of the women involved.

(21:05):
Even the slightest movement, much less the active resistance of
these patients, would have rendered it impossible for him to
have completed his operative procedures. Indeed, when his regular medical
assistants tired of working with him, Sims trained the patients
themselves to act as his surgical assistance, and they thereafter
helped him operate on one another. In turn, he ends
that sentence with an exclamation point. Now there's a lot
that's wrong with that, right, there's a lot that's wrong.

(21:27):
She didn't fight, so she must have been fine with
it so much. Now, first off, his argument is again
they must have consented because they didn't fight, And then
they were so intuit that they got trained a surgical assistance,
which he frames is like, look at how cool it is.
They're helping him with his his great work. Again, he

(21:49):
frames this is kind of a triumph. Um. However, number one,
obviously he owned effectively owns these women in a legal sense,
they could not agree to it. But also, like other
write ups of the fact that he trains some of
these women to be surgical assistants are a lot less cheery. See,
can I guess, yeah, Is it more like you need

(22:11):
to hold this person down while I do this? Ding
ding ding ding ding? Yes? Yes, by being he is
literally they're not fighting and they're agreeing to hold down
each other while I like, it's pretty pretty bad like
when you think about it. Um, that Wall, that wall
today is making that argument. Um and again Wall simply

(22:31):
says that Simms is regular medical by which I mean
white medical assistants tired of the work, and that's why
he had to train these women. The context Kronin provides
makes the reality seem a bit more dire. Quote. Originally,
Simms had a lot of support from the local medical
community for Lucy's operation. He records another dozen or so
doctors in attendance to witness his work and to assistant

(22:52):
support him. As time passed, he received less and less support.
His brother in law, also a doctor, all but begged
him to stop, citing the expensive housing additional enslaved women,
as well as the injustice to his young and growing family.
Because his attention was so diverted. Within two years, of
beginning his experimentation, Simms was cast into professional isolation. He
wrote that despite the many problems he experienced, his patients

(23:14):
were all perfectly satisfied with what I am doing for them.
I cannot depend on the doctors, and so I have
trained them to assist me. So. Furthermore, when Simms does
finally figure out how to do this procedure in a
replicable way and he publishes an article on at in
eighteen fifty two, he figures it out before, but the
article comes out in fifty two. He describes several parts

(23:35):
of the procedure for which assistance was required, like the
things he needed these women's help for. And as you
said first, I mean, it does include stuff like cleaning
instruments and holding the speculum in place, but it involves
having them hold each other down while he performs surgery
on them. Um, you can. Yeah, I'll make your own
conclusions about the ethics of that. But it's real weird
that Wall goes to bat for this part of it
to make That's what's interesting about this. And I'm actually

(23:57):
kind of glad that you've given me someone to hate
that's still alive, you know what I mean, it's rare
that you do that. Usually you give me these stories
of people who are terrible and then they die and
there's like that and they died like happily and peacefully.
But rarely is there like, oh, there's a chance of
this person could experience some consequences and that's that's almost

(24:19):
heartwarming to me. Yeah, and I one of the stories
that we're not going to get into enough of the
last few years is Wall like steadily losing this argument
within his own field to people, um because he is
He's spent years defending sims Um and eventually people have
pretty much stopped listening. Um. I don't know what's going

(24:39):
on with the guy, but he is very much dedicated
to like defending this man's legacy as opposed to just
like defending like, well, we need to you know, this
is a chapter in medical history that's worth studying, which
it certainly is. But um, part of what's worth studying
is stuff that's sucked up about it. Yeah. Um, So

(25:01):
nearly every critical piece about Dr Mary and Simms will
note that one of his sins was failing to use
anesthesia on his enslaved patients. NPR writes a pretty representative
summary of this critique quote. Modern critics of Simms also
note that he conducted these experiments without anesthesia, although the
Commission does not focus on this element of his research.

(25:22):
His research began during the early days of modern anesthesia,
as his defenders have noted, After perfecting the technique on
black women without anesthesia, Simms went on to offer it
to white women, but he treated white women with anesthesia.
Gamble noted Simms's own statements on this are mixed. Years
after his initial tests, he said he still didn't believe
in using anesthesia for fistualist surgeries because they are not

(25:43):
painful enough to justify the trouble and risk, But he
also said the experimental surgeries on his enslaved subjects were
so painful that none but a woman could have borne them,
And in his autobiography he describes conducting fistal operations in
Europe on wealthy women who were sedated. So this is
such like a small part of a bigger problem about

(26:05):
how men do awful things to women and then basically
are like women. How do they handle us? Huh? So strong?
That was my wife put up with me sucking so
bad and clearly and you're probably gonna talk about this later,
but clearly you know this a big part of his uh,
his thought that like she can handle the pain, it's

(26:25):
because she's black too. Because that was and now and
now I don't know where to get to that. Yeah, okay,
we'll get to that. There's a there's a study from
a journal called Penis that I want to tell you
about later if you don't already have it. So we're
going to talk about your penis a lot. Let's get
into the pens We we had to had to do
that at some point. So it was inevitable. That was

(26:49):
just physics, baby, That was just that was just tides
rolling in. So now I will note so NPR makes
the statement that like uh, he does conduct fistial experiments
or operations and women who are subated in Europe. It
is worth noting, to be completely fair about this, that
NPR does not make us note of when he used

(27:09):
anesthetic on wealthy white women. And this is important, right,
And this is again not to like forgive this man,
but it is worth noting just to be accurate. This
is a period in which they are starting to figure
out anesthetics, right, This is a period in which that
that science is very much being born in a meaningful way. Um,
it was a not at the time a completely agreed

(27:32):
upon thing. There were substantial medical debate on whether you
should anesthetize patients and when you should anesthetize them, and
how one of them. This is a side but one
of the weird things to me is that, um, they
figure out how to make and have and use nitrous oxide,
like a hundred something years before this point, like in
the seventeen hundreds, people are having not like nitrous parties.

(27:54):
They don't use it until like around this period for
the first time in an actual medical procedure, Like we
know about this ship for a hundred years before someone's like, hey,
this thing that makes it impossible to feel pain and
makes people just kind of like pass out. What have
we What have we use that on surgery? Can we
maybe try an in instead of like getting them drunk
and hacking off a limb? Right at some point someone

(28:16):
would be like, they wouldn't move a lot less, I
think if they weren't screaming and writing. And it seems
like alcohol sucks as a pain killer. Oh well, back
to the axe, Yeah, it does this. It is one
of those things where it's like you had like you
had God's perfect anesthetic for a hundred years before anyone

(28:36):
was like, what have we use this for surgery? Could
this work on the biggest problem in medical science? Yeah?
I mean also like keep partying with it, fuck it,
don't keep this at the parties. I mean by eighteen
forty six, like, uh, it had been well described. We're
getting into that. Yeah. Sorry, I just wanted to note that,

(28:59):
like the fact that he's doing in the eighteen sixties
in Europe he's using anesthetic, doesn't mean that in eighteen
forty five he would have had it right or known
that it was the right thing to do. The timing
matters here because you can't specifically call it cruelty for
not enslaving his enslaved, for not sedating his enslaved patients. Yeah,
if he did not have the ability to do so, right. Um.

(29:21):
This is basically the argument that Wall makes in defensive
sims in this specific aspect. Now, again, this is why
I'm particularly partial to Monica Cronin's ra posts to Wall,
because she is an expert in the history of anesthesiology. Um,
and she is particularly trenchant in her dissection of these claims.
She notes that while Sims did his experiments in Alabama,

(29:42):
over in Georgia, where he had also spent time, a
prominent doctor named Crawford Long had been using ether as
a sedative since eighteen forty two. Tools like that could
have sedated his patients were available if he had one
of them. I should notice Cronan does that the concept
of anesthetizing patients was new in this period. It was
not universally agreed upon. Is to win you should anesthetize people.

(30:02):
That said, she seems to conclude that, based on the
experiments going on around him, it is unfair to criticize
him for not using the anesthetics. When he started in
eighteen forty five, he may not have realistically been able
to like get access to them. But after eighteen forty six,
and he carried out dozens of surgeries after eighteen forty six,
he had the opportunity. The tools were available and it

(30:24):
was well documented that they worked. Quote Leonard F. Vernon
argue Simms's lack of training and experience in the use
of ether would have prevented him from using it, as
it may have been more of a danger than the
actual surgery. The idea recurs in defensive sims, Yet lack
of training and experience did not stop him from using
for steps on Anarca certainly did not stand in his
way when attempting surgical repair for obstetric fistula, and it

(30:47):
did not prevent other medical practitioners from using ether anesthesia
in their day to day practice either. It's like being like, well,
it was still a little experimental, and maybe he didn't
know how to use. It's like he didn't know how
to do any of the ship he was doing. He
was an experimental position, Like yeah, and I mean they
were doing it for dental procedures. Yes, yes, he could
have could have scruciating, horror, horrific procedure without And obviously,

(31:13):
like again, I think that you should have to consent
for I had an uncle who died because he got
an esthetic that he really did not want and it
was kind of like a fucked up situation. This was
before I was born, obviously, Um, but like, I think
you should have to consent before getting anesthetized. Obviously, at
least to the extent that that's possible. Sometimes people arrive
in like a sedative extremists, and you know you have

(31:34):
to assume certain things. But like in the case of
an experimentation, obviously they can't consent to being anesthetized anymore
than they can consent to the experiment. But if you're
going to experiment on unconsenting people, I guess it's better
to try to sedate them. Yeah. Yeah, I don't know,
do something something bad that makes them comfortable. Yeah, at
least try to all, at least show that you care

(31:56):
about their comfort. I guess, I don't know. Mitigating is
the wrong word, but would at least show that you
view them as things that the people that are capable
of experiencing pain, right, um so yeah um now. NPR
and other critical write ups of Sims will suggest that
he may have acted as he did out of a
widespread belief that black people suffered pain less acutely than

(32:17):
white people. It is worth noting that this errant belief
is still very much alive in medicine today and influences patment,
patient treatment, and outcomes. In two as the website Hidden
Brain notes quote, black patients continue to receive less pain
medication for broken bones and cancer. Black children receive less
pain medication that white children for appendicitis. One reason for

(32:38):
this is that many people inaccurately believe that blacks literally
have thicker skin than whites and experience less pain. Again,
this is it's certain that this affected Sims. As far
as I'm concerned, it is an absolute fact that this
impact did Dr sims treatment of these people, because it's
still impacts the way doctors do their ship today. UM. Now,
obviously L. L. Wall rejects this. UM. He notes that

(33:01):
Sims repeatedly talked about how much pain and Arca, Betsy
and the other women were in. He definitely does talk
about them being in pain, but it's always so that
he can be like what a hero I am for
treating them, and like they wanted me to, Like right anyway, um,
part of yeah, sorry, I before we leave that point,
I mean, I think it's a really important point to

(33:22):
show that it's still an issue that question about people
thinking that black people had thicker skin, literal thicker skin.
They tested that amongst medical students, and medical students thought
a little bit more than the average, Like I thought
a little bit more than you would expect that black
people had thicker skin. Jesus Christ. Yeah, you know, it's

(33:43):
it's terr I mean, medical students are not like born
out of some sort of vacuum. They come from so up.
But but you know, you would think those people would
know a little bit better. But that was not uncommon.
There's a that that study about the appendicitis the white
kids getting more medication for a pendicize and black kids.
I was like, back in two thousands, five, two thousand,
there's a journalist paying the article that came out showing that, uh,

(34:06):
pharmacies and black neighborhoods always carried less opiates and pain
medication than the pharmacies in white neighborhoods, like almost across
the board. It was so just in general. That's that's
still I'm glad that you brought up. It's still a
problem we have in the medical community. I mean, it's
it's been talked about for for a while now, but
every couple of years, some new article comes out saying

(34:28):
like we're under treating these this population. Jesus God. Um. Well,
so when it I mean, what one thing? So I again,
I don't want to just be because l O. Wall
is very very specific. Whenever people make arguments about this
guy and he gets into like the b he says
this and this guy says. So to be specific, I

(34:50):
just mentioned I'm certain that that Dr Sims had this
racist belief about his black patients. There is documented evidence
that he held beliefs like this um and not just
towards black people. And this is again makes that case. Uh.
And I'm gonna quote again from Cronin's right up. Mary
Smith was one of the first women listed on the

(35:10):
patient register at Simms's newly opened Women's hospital in eighteen
fifty five. Her first delivery had been in Ireland, where
she had experienced a prolapsed uterus, a herniated and prolapsed bladder,
fecal incontinence, and urine leakage that had rubbed her vulvar raw.
Upon examination, Simms declared her a most offensive and loathsome subject.
Simms and his junior colleague Thomas Emmett performed over thirty

(35:32):
operations on Smith over a six year period without anesthesia.
The women's hospital did not routinely administer anesthesia until after
the end of the Civil War in eighteen sixty five.
The way Simms wrote about treating a woman patient in
France in eighteen sixty one provides a stark contrast to
Mary Smith's treatment working with five other people who could assist,

(35:52):
Sims performed two operations on a twenty one year old woman.
She was, he wrote, young, beautiful, rich and accomplished, and
he had never seen a case of this kind which
was attended with such suffering. Clearly, none of the enslaved
or poverty stricken women he treated earlier had displayed their
suffering in quite the right way. This was a woman who,
has Sims described, belongs to the higher walks of life.

(36:15):
So he not only is this a guy who certainly
believes that like enslaved black women are less capable of
experiencing pain, he believes that poor Irish women do not
experience pain to the same way as this rich French lady.
This is documented and like it's it's very clear when
you look at the writing about this, like he this
is a deeply classist, racist man who believes that your

(36:36):
ability to experience suffering is dependent upon your social status.
The whole princess and the p thing, like if you're
if you're rich and you come from like aristocracy, you
could feel the tiny little pia and your your genteel
skin from like mattresses away. Yeah, and it's it's just
very telling to again eighteen fifty five, ten years after

(36:59):
the star to these experiments, when there were certainly anesthetics
and sedation available. He is still when the woman's poor
in somebody he doesn't think about as like a proper
woman operating without any kind of anesthetic, right, and to
get thirty operations on this lady, you know wow, Um,

(37:19):
but you know who always operates with than aesthetic at
least most of the thirty times. Yeah, the products and
services that support this podcast, um will make sure you
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(37:41):
If you just wanted to, like huff out of a
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(38:02):
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(38:25):
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do not give him what any cause to do this

(38:47):
more than he already is. No, I'm a doctor. I
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big trust me right now a doctor. Yeah yeah, So
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(39:33):
it's very flammable, bar the whole blue zone diet. A
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thou baby, oh man, that's not a bad and that's
not a bad actually yeah um so um. Anyway, once

(39:58):
Dr Sims because he figures is I think eighteen forty
nine is like when he kind of gets it right,
although obviously the fact that he's he takes some thirty
times to get it right on another patient eighteen fifty five.
It's a messy process, right. But he releases his bombshell
report on how to fix Fishila in eighteen fifty two.
He releases a follow up monograph in eighteen fifty three,
and he becomes famous across the world. He moves to

(40:20):
New York City and he starts the very first hospital
for women in the United States. UM, that is Dr
Sim's first women's hospital. Now this is really controversial at
the time, and he does Again a lot of people
think it's like gross to do medicine on women. UM,
so like he has to, he does have to, he
does get I don't know what credit you want to
give him, but it is like a thing he has

(40:41):
to like fight to fund and operate this hospital and
to like train doctors specifically and treated women's health issues.
And that's a positive move. It's good that that happened. UM.
During the Civil War, Simms, who described himself as a
loyal Southerner, moves to Europe, where he works on fish
sula patients across the continent and the Aisles. There is
some evidence that he acted as a government agent for

(41:03):
the Confederacy while he was there, helping them seek loans
and diplomatic recognition. Secretary of State Seward describes him as
a quote secessionist and sentiment and hostile to the government.
It's very possible he was a Confederate spy while he
was in Europe. Um another reason to not root for
this dude. Yep, yep. He really keeps making the decisions

(41:24):
he keeps making. In eighteen sixty three, while the war
is you know, going going around, it's kind of like
the height of shit. Um, he treats the Empress Eugenie
of France for officila. This is like one of the
things he's most famous for is he fixes the because
she's This is back when France has an empress. They
don't for in like another seven or eight years because
they lose a war pretty bad. But at this point

(41:45):
she's like one of the most famous women in the world. Right, Um,
she has a fistula, he fixes it. This is controversial.
There are claims that there's zero evidence whatsoever that he
actually treated her for anything. UM, and people who will
argue that he was basically pretending to treat a medical
issue in order to secretly due diplomacy with France on

(42:06):
behalf of the Confederacy. UM. Obviously, I I'm not competent
to go into detail on that, but it is an
argument people make. He was very likely doing some shady
ship on the Confederacy's behalf while he's in Europe. UM.
He remained a racist his entire career, as this section
from NPRS rite up makes clear. His racism had brutal
consequences for patients outside the almost gynecology to quote. Before

(42:30):
and after his gynecological experiments, he also tested surgical treatments
on enslaved black children in an effort to treat Christmas
nascentium neo natal tetanus, with little to no success. Sims
also believed that African Americans were less intelligent than white people,
and thought it was because their skulls grew too quickly
around their brain. He would operate on African American children
using a shoemaker's tool to pry their bones apart and

(42:51):
loosen their skulls. Oh my god, a dude who sucks here? Right?
This Yeah, he's he's a pretty bad guy. Um. Dr
Sims stayed in Europe for a while after the end
of the Civil War. He returned in eighteen seventy one
to work at the Women's Hospital, and eventually he establishes

(43:12):
the first cancer institute in the United States, the New
York Cancer Hospital. He was an unanimously elected president of
the American Medical Association in eighteen seventy six. Um in
eighteen seventy seven, he starts suffering in Giana attacks. He
catches typhoid in eighteen eighty, which starts a rapid decline.
He makes his like he writes half of the autobiography

(43:33):
basically that we've cited today when he dies of a
heart attack on November thirteenth, eighteen eighty three, in Manhattan.
In recognition for his achievements, Jay Mary and Sims had
several statues made in his honor, including one in Manhattan's
Central Park. After years of controversy, it was removed in
two thousand and eighteen. I think a couple others were
moved in at least one. Um and yeah, that's uh,

(43:57):
that's that dude. I I mean, this is obviously he's
this guy is a true bastard um, Yes, I think
that's clear. But what but what is interesting that really
important about this is that, I mean, there's echoes of
what happened because of him that still reverberate through today

(44:18):
and cause us a lot of in the medical community,
a lot of I think would needs to be some
deep introspection and and some reckoning. I mean things like
this Henrietta lacks Tuskegee and they how could they not
leave these real intense historical scars on the collective psyche
of of this community. Who, by the way, I mean

(44:40):
if you they'll, they'll you'll probably hear some of you
here reports. A lot of African Americans don't feel like
they're being listened to by the medical community. We talked
about some of the studies that show they got less
pain from the pan Astia, really great name of that.
What's is procedural procedure, procedurals of the nation. What kind
of the science to day was They had that two

(45:01):
thousand sixteen article that was the show that they got
less pain meds and that is still to this day.
Like African American women, Indigenous women are two to three
times more likely to die during childbirth I mean, this
is still stuff that we're dealing with. And because of this,
understandably as a doctor, I run into a lot of

(45:22):
i atrophobia, like people afraid of the heeling of the
medical and what's what people are like, why would the
African American community not want to get the COVID vaccine?
You're like, fuck, look look at the history that we reasonable.
It's this, it's this, like there's um. One of the
most fucked up things the CIA has done recently is
they they had a fake vaccine drive in Pakistan where

(45:44):
they were really testing people's blood to see if they
could find people related to Osama bin Laden to track
them down, and like, weren't vaccinating people And it was
just like, yeah, of course there's distrust of Western vaccine
programs the c I A thank you, um wow. Well,
and it's and also like you bring up Indigenous women.
There were we're not talking about this today, so I

(46:05):
don't want to go into too much detail because I
don't want to get something wrong, but like, there were
a lot of vaccine trials done with real questionable consent
on indigenous populations in the United States. You know, yeah,
I know you did a good did a really good Um.
I forget which where you did? I think was on
this show you talked about, you know, the history of vaccines,
and there's some problematic components. Yeah, like like like with

(46:27):
everything right, like like with voting you know. Um yeah, Um,
it's not a factor. It's not a it's not an
inherent characteristics of vaccines. It's an inherent characteristic of like
the white supremacist state that has existed for a couple
of hundred years. Um. Yeah, which kind of colors everything.
There's a there's a really good nineteen forty one paper

(46:49):
titled the Negroes Contribution to Surgery published in the Journal
of the National Medical Association by Dr John A. Kenney
of the Tuskegee Institute, UM, who was like a groundbreaking
black dermatologist. Um. And he kind of he writes in
that paper, I suggest that a monument be raised and
dedicated to the nameless Negroes who have contributed so much
to surgery by the guinea pig route. UM. I found

(47:11):
this in an article about them removing a statue of Sims. UM.
And I don't know, I'm not much of a statue
guy one way or the other, but certainly that's a
better idea for a statue than one to this guy. Absolutely,
as I mean, people also need to remember this is
I mean, we think this is like ages and ages ago.
The Tuskegee experiment ended in like one of these days, yeah,

(47:34):
ninety two. Like I had attendings teaching me that were
alive and practicing medicine at that time. So it's like
not that long ago that this was a thing that
was happening. Yep, yep. And like I mean, a bunch
of the I mean, presumably one hopes at least that
a number of the women that he was experimenting on
probably lived into the twentieth century or the nineteenth century.

(47:58):
Twent century, Yeah, the century are always hard because it's
one less than the number. You know, it doesn't you
know how counting works? Yeah? Um, I don't know. I
think he probably shouldn't enslaved people, and you also shouldn't
conduct medical experiments on them. Um. That's my that's my
radical left wing rant for the day. Um. I don't

(48:21):
want to get political here, Okay, okay, um, but yeah,
probably bad, probably bad, But I don't know. It's I
think it's worth really digging into because we could have done.
I kind of considered doing like a much broader episode
where this guy would be a chunk, and then we
talked Henrietta Lacks and Tuskegee. But there's so much to

(48:41):
say about how this is conducted, about how other doctors
who are who are not experimenting on enslaved people do
things differently, about how this guy is like received, how
he justifies it, how he's what he just I really think,
and I think we'll probably wind up focusing on each
of those other those other I don't know what to
all them, like pieces of medical history, like in in detail,

(49:03):
because I think it is worthwhile. There's always a lot
to like drill down here about how it was justified
at the time, how it's been justified since the how
the language that people uses around this kind of stuff
acts to sort of hide the horror um even by
doing things that are like you, you claim to be
advocating for the patient, but what you're really doing is

(49:24):
kind of like making suffering porn about this person in
order to like say that basically anything I do is justified,
which seems bad to me. Have we started the hashtag
a dab all doctors are bastards? The doctors are the cops.
Um No, I mean, actually this is so important that
we talked. I mean it aually timely now because we

(49:45):
have to. We're talking about autonomy in people's rights. Jesus Christ.
It's like a basic medical ethic that we still do
not have in this country. And it seems to be
going backwards. Yeah. And it's the same I mean, there's
a there's a huge degree to which like it's the
same thing with journalism, right. We can talk about the
history of white supremacy and journalism. How journalism was used

(50:07):
to like whip up fear of slave how probably a
decent chunk of Dr Simms, terror of like runaway slaves
was stoked by articles in the local press about like
horrible things done by runaway slaves and whatever town or whatever.
Um and then ship like you know, the Spanish American War,
the kind of yellow press and how you know, and
the Iraq War and the ways in which you know,

(50:28):
today a lot of idiots in legacy media are writing
these like are to well, we have to experseamine, you know.
Really there's a lot more problems with conversion, with with
gender transition and stuff than like and we should and
and doing this writing this stuff in a way that
like plays into this right wing outrage machine and being like, well,
we're not writing things that are meant to do that.

(50:49):
It's just other people taking us out of context. And
it's like, yeah, but if you're putting shit out, if
you if you don't think about the ethics of what
you're doing, if you like you're you're like in the
actual impact of what you're doing, it's the same. It's
the same thing. We have these these things that are
really important as institutions medicine and in the media and
and all of this stuff that is are critical for

(51:11):
having a society, and a lot of people within them
who don't like some of the some of the really
thorny ethical questions that are necessary when you look at
the history of these institutions, Like guys like I think
Wall who want to just celebrate what is legitimately groundbreaking medicine, right,
and SIMS was groundbreaking, and a lot of his application

(51:33):
of medicine um, and he wants to Wall wants to
celebrate that, and he doesn't want to really like, look
at what's super fucked up about this guy Um, And
you know, there's a lot of people who do that
for a bunch of things. It's this, it's this constant
problem we have of like and I think wall is.
I don't think doing wall is doing the effortful version.
The low effort version is to say, like, oh, you

(51:53):
just want to ignore, like you just want to cancel history. Right.
It was like, no, I'm telling you the history of
Mary and Sims. I think it's important to talk about
the history of Marion Sims. I wish, like hell, we
knew more about the history of of Betsy Um of Anarca,
of Lucy, of like these and then women he does
not name who he experimented upon because they are also
critical parts of medical history. Yeah, no, exactly, it's the opposite.

(52:18):
You don't you want the history to be known. It's
just there's certain things that should not be celebrated. Yeah, yeah,
I don't. We we don't need to make him into
a hero to discuss what he did, because what he
did is important. Yeah. Yeah, this is an ongoing story
in medicine. There's like when I was in training, we
started moving away from eponyms because ostensibly because we want
to focus on the science of it and not the

(52:39):
name of the person, but because so often in medicine
you run across someone like Wagner. Then Wagner's gran granulumatosis.
Sorry killed that word and I should know it better.
But anyways, Wagner's disease because he was a Nazi, you know,
and and things were, and he was an important pathologist
in many ways. You know, we need to be able

(53:01):
to separate what he did and talk about it and
make sure it's known because it's an important part of
making sure we don't move backwards. And guess what if
we don't focus on that, we move backwards, and we're
moving backwards right now. Yeah, absolutely, I mean, it's we'll
probably wind. I'm we're definitely gonna be talking about Hans
Asberger too at some point, which is another another Nazi

(53:22):
you know, Um, But yeah, Nazis and Confederates. Um, this
is the kind of Confederate history I'm interested in telling. Um. Alright, Kada,
you I do, I certainly do. You can follow me
at the House of Pod on Twitter, and you can
listen to my humor adjacent medical podcast, the House of
Pod anywhere you listen to podcasts. If you want to

(53:46):
do something a little different, you can listen to my
recap fun show I do with Rebecca Watson, who is amazing,
and how the recommend you you check her out in
her YouTube videos and that we do a show called
Girls on Boys. It is a fun deep dive about
the show the boys in it, and I'll explain in
it why I hate Alfred Molina with a burning passion

(54:09):
of a thousand wounds. Wow, yeah, I gotta thing, Sophie,
Sophie Ye, Jamie Loftus on the loftist set off the
loftist signal. Jamie Loftus fucking loves Alfred Milina. You are
now her short enemy I hate. Listen, we'll talk about
not without my daughter anytime. Wow. Wow, we've got we

(54:31):
have the makings of a podcast few cast. She's literally
texting me right now and I'm You're safety. I will
not throwing a few down. This is this could be
the rumble in I don't know, like I'm literally six,

(54:51):
this is happening. Yeah, yeah, we're spilling some mad tea.
This is going to be an even bigger, an even
bigger thing than my feud with Isn't there someone named
Ezra at NPR? Yeah, Ezra Miller, I think that fucker. Yeah,
you Ezra Miller. Yeah, I'm gonna suck him up. Or

(55:12):
the Ezra who does the show Yeah? Oh wait, is
there an Ezra who does the show Flash? But he's
I mean that guy sounds like he sucks, but as reclined.
That's the NPR game. I'm gonna suck you up as reclined.
Yeah that one. Yeah, bro, let's mess up Ezra. Yeah.

(55:32):
Or you're not going to tell people to get colonoscopy
because that's normally what you. Yeah, get your colon cancer screening.
If it's appropriate for you, talk to your you need
to do that. Okay, Okay, that's fair. Yeah, I'm not gonna.
I mean, there's like it's like there's like so many
like different things to talk about when it comes to
colonoscopies and colon cancer screening, different versions of colon cancer screening.
When you should start, what your risks are? Um, well,

(55:54):
so let me let me let me run this through.
Because I had I had a I had a I
had a I had a lady at a at a
at a yurt tell me that coffee enemas make that
it impossible to get that cancer. And so I did
that for a couple of years. And then I figured
coffee enemas if they make it, if they'll stop me
from getting colon cancer, you know, it'll do an even
better job as Red Bull. So I've been doing that

(56:16):
for like the last five years every day. Uh listen,
this is important. Coffee is your friend. It is not
a nanima. It is amazing. I love coffee. I did
a whole episode with prop By the way, we had
Deepak Choper's brother, who's a coffee efficient auto come on
and one of and one of the greatest, like living

(56:37):
American hypotologists, had them on all to talk about coffee. Great.
Just don't put it. Don't put it in your butt.
It will cause damage. At worst, cause you significant damage.
At best, it will ruin your coffee and your butt. Okay,
but I have, as I said, moved on to Red Bull.
So that's oh yeah, that's right because the torain helps, right,
that makes it clean. Yeah, it's the chemicals that clean

(56:59):
out the up in there. Yeah, it's like putting bleach
in there. A lot of people don't get enough touring
in their assholes. Um, no American with not with this
American diet. Alright, everybody that's gonna do it for us
here behind the bastards um at this point, probably donate

(57:19):
to a bail fund. I don't know what's going to
happen in the next week or so, after the whole um,
after the road decision, but yeah, probably probably did to
go donate to a bail fund by