May 9, 2016 • 60 mins
J. Marion Sims is hailed as the father of gynecology, but his legacy is tainted by his experimental surgeries on enslaved women. Cristen and Caroline contextualize Sims' controversy, diagnose medicine's racist past and honor the unsung mothers of gynecology.
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Episode Transcript
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Speaker 1 (00:00):
Hi. I'm Lauren Vogelbaum, a host of the new House
Stuff Works Now podcast. Every week, I'll be bringing you
three stories from our team about the weird and wondrous
developments we've seen in science, technology, and culture. Fresh episodes
will be out every Monday on iTunes, Spotify, Google Play Music,
and everywhere else that find podcasts are found. Welcome to
(00:25):
Stuff Mob Never Told You From House to Works dot Com. Hello,
and welcome to the podcast. I'm Kristen and I'm Caroline.
And this episode was inspired by an article posted over
on NPRS website from their podcast The Hidden Brain, hosted
(00:47):
by our favorite, our favorite Shagri Vidandum Um, and it
was about the so called mothers of gynecology and we're
going to spend the next forty five minutes talking about them.
So I will just hop forward and say that I
posted the article on the Stuff I've Never Told You
Facebook page and the response was overwhelming. Were people not
(01:11):
aware of that history? No? They weren't. I mean I
wasn't either. That was one of the reasons why I
wanted to share it with people. And so of course
we knew with that kind of response, um, that we
needed to take the time and dedicate a whole podcast
to Jay Mary and Sims, who's known as the father
of kinnecology, but the women he experimentally operated on that
(01:38):
essentially allowed him to make all of these scientific breakthroughs
that we do benefit from in R O, B. G
U I N S Offices today, right, and we're gonna
talk a lot about Jay Mary and Simms himself, not
at the exclusion of these women, but almost I guess
you could say that we're looking at these women through
a Jay Mary and Simms lens simply because the fact
(02:02):
that he was a white doctor with a degree of fame,
there's obviously a lot of information out there about him,
and because the women he operated on were enslaved black women,
we don't have records of these women's voices, and so
we have to do our part to dive in and
sort of excavate this history so that we are aware
(02:24):
of this pretty brutal history of early gynecology. And it
also hearkens the social media hashtag say her name. You know,
this is like the nineteenth century version of that, where
most of the women's names were lost to history, but
we do know the names of three Anarca Betsy and Lucy,
(02:45):
and knowing those names and saying those names as we're
going to is also important for filling in these gaps
in our history, right because it makes it it makes
it more real when you realize that these women, they
weren't just name less faceless black women. These were real,
live women who were already experiencing so much pain and trauma,
(03:08):
as we'll talk about. And then we're part of experimental
therapeutic surgery. So let's get down to old J. Marion Sims.
He was a physician from Alabama and from eighty five
to eighteen forty nine, like we said, he performed these
(03:28):
experimental surgeries on enslaved women to repair something called a
vestico vaginal fistula, which are holes between the bladder and
the vagina or holes between the rectum and the vagina
that can result from traumatic childbirth. Yeah, and so because
of the pretty impressive for the time advancements that he
(03:50):
created and championed and the lives that he subsequently saved,
as Kristen said, he's hailed as the father of gynecology
and the founder of modern surgy goal guy Ina College,
and I mean this guy has statues all over the
place in his honor in South Carolina, which is his
home state, Alabama, where he established his medical practice and
made all of those fistula treatment discoveries. And New York,
(04:13):
which is where he later established and ran a booming
women's hospital. Although it's a women's hospital that I think
exclusively serviced white patients. Oh yeah, yes, it was pretty
much for Irish women basically. So it was really starting
in the sixties and seventies with the rise of a
civil rights movement, the women's rights movements that historians and
(04:35):
physicians began looking back at Simms and wondered, like, wait
a second, does he deserve these statues? I mean, yeah,
he accomplished things, but do the ends justify the means
in his case? Right? And so we want to dive
in today to the full story of who he was,
(04:56):
what he did, and who were the women that he
pre formed these repeated, painful, experimental surgeries on without anesthesia.
So let's look back quickly at simms early years. What
shaped this guy? He was born in eighteen thirteen in Lancaster,
South Carolina, and he was neither of great wealth nor
of great brilliance, And honestly, he just figured he might
(05:18):
as well be a doctor, because he was basically like
middle class, normal, average dude, but with a good education.
Uh so he's like, I could have been a lawyer. Nah,
you know, I could be a teacher. I'm not going
to make my fame that way. I guess I'll be
a doctor. It sounds like, you know, kind of the
better call Saul of gynecology. Yes, I love that show, um,
(05:39):
And so he ends up moving to Alabama, though in
eighteen thirty five after two of his first patients, infants
died from a disease causing persistent diarrhea, and he really
lived pretty uneventful and nearly impoverished first few years until
he and his family moved to Montgomery, and there he
started to make a name for himself. He was definitely
(06:02):
a self promoter. He started bragging about being the first
in the South to successfully treat club feet and crossed eyes.
But as a country doctor, he was also paid to
treat sick and injured slaves on plantations, and plantation owners
would be heavily interested in providing this kind of treatment
(06:23):
because sick or injured slaves can't work, and also sick
and injured enslaved women can't give birth, thus it's a
profit loss for these slave owners. And then one day
one of these slave owners sends along to Jay maryan Sims,
two women, Betsy and seventeen year old Anarca, both of
(06:46):
whom had vestico vaginal fistula's. But Anarcas. The seventeen year
olds case was extremely bad because she had a protracted
labor causing holes from her vagina to a bladder and rectum.
And she was also the first case of this that
he'd ever seen, and he'd assisted the doctor with her delivery.
(07:08):
And at first Simms was like, uh, I don't know
if I can help in this case. What what am
I gonna do? I'm better call Saul of you know
ye old gynecology. Gutacology isn't even really a thing yet.
How could I help? Well, yeah, but just like Jimmy
and better call Saul. He figured out a way to help.
(07:31):
But the whole reason that he's like, I don't know
if I can help these ladies, You've got to look
at the context of the time. There had been no
cure for this stuff. So before we get into how
Sims pivoted to gynecology from his general practice, you have
to understand the context of vessica vaginal fistual is because
(07:52):
it is horrific. So we've already hinted at the fact
that they are caused by prolonged and obstructed labor. Basically,
what happens is when the fetus won't fit through the
birth canal. I hope no one's eating, by the way,
because this is brutal. I literally when I was reading
this Christian because what I've included in our notes today
is not anywhere near the full picture. I just hit
(08:14):
the high points because I literally got lightheaded reading about this. Yeah,
graphic details ahead, friend, Yeah, there's like mentions of like
bone plates grinding. I left that out, Okay. So basically,
the fetus won't fit through the birth canal and gets wedged.
With each contraction, it is wedged harder and harder. Eventually
you get massive crush injuries because of this wedging to
(08:36):
the soft tissue of the pelvis, and the blood supply
gets cut off. The fetus suffocates days later, days later.
Because of where we are in our scientific and medical
history at this point, the fetus, having been left where
it is, it finally slides out, as does dead tissue
(08:58):
from the woman's injured pelvis that is secreted, and once
that secreted, a fistula forms. The woman then experiences a
complete loss of urinary and in a woman like anarchist case,
sometimes fecal control, often in addition to horrific side effects
like secondary infertility, complete loss of vaginal function, recurring infections,
(09:22):
and you also have to take the mental health effects
of this into account. One of the huge effects, whether
it's a woman today experiencing it or a woman in
the nineteenth century, is depression because not only have you
lost a child and experienced super traumatic pain, but the
fact that you are constantly experiencing urinary and fecal UH loss,
(09:44):
you end up being an outcast. You face huge stigma
because you can't control your bowels, you can't control your bladder,
and you smell, which then of course contributes to a
loss of dignity and self esteem. And some of these
women did end up killing themselves because of this condition,
and so it was a huge deal for women at
this time. I mean, it was completely debilitating, to the
(10:05):
point that um, in the study that we were reading
UH one of the only things really that some of
these women could do would be to essentially sit on
a chamber pot because I mean they couldn't really go anywhere.
They were constantly ruining their clothes. I mean, they couldn't
do anything. And we should note that this is still
officials are still a major healthcare issue for a lot
(10:28):
of women in developing nations too. But back to the
nineteenth century, this wasn't uncommon at all, partially because of
like lackluster maternity care. But like you said, it was
catastrophic um And in eighteen forty seven a French surgeon
reported the medical community hadn't heard of a single case
(10:51):
where a woman was successfully treated, and physicians were quite
aware of the debilitating effects of this condition. And eighteen
fifties evan report that was delivered at the Georgia State
Medical Society included the description that most of the other
physical evils of life sink into utter insignificance because of
(11:13):
the constant pain and mental trauma that the woman has
to experience. And so it's against this backdrop you have
a physician with no real reputation to speak of, and
you've got this terrible common condition with no cure that
sims ends up pivoting to gynecology. He's he's going out
(11:35):
in his rounds. One day, he's on his horse, he's
going out to treat people all over the region, and
he gets word of a middle aged white woman named
Mrs Merrill who had been thrown from her horse. She'd
experienced an injury. He needed to come right away and treater.
So Sims goes to take care of her and realizes
that Merrill has sustained a pelvic injury and her uterus
(11:58):
is out of place. And now at this point, obviously
he hadn't yet started his focus on gynecological issues. And
in his autobiography, which I ended up really getting sucked
into because did I mention he was a self promoter,
it's a really interesting time capsule of a read. Uh,
he wrote. If there was anything I hated, it was
(12:18):
investigating the organs of the female pelvis. But this poor
woman was in such a condition that I was obliged
to find out what was the matter with her. How chivalrous,
so nice, so nice, and and find out he did.
So what Sims did was have Mrs Merrill squat on
her bed under a sheet for modesty, and he inserted
(12:41):
two fingers into her vagina and by doing that, he
was able to reposition the uterus and she immediately experienced relief.
In Caroline, I don't quick aside reading that, Like, I
didn't know it was so easy to reposition a uterus. Well,
apparently there's lots of pushing in pulling involved, and there
(13:02):
was something about the position that helped introduce air into
the vaginal canal. So like you get you get puffed
up like a balloon. And I say this because literally,
in his autobiography he describes how she massively queaked when
she then lay down on the bed and and I'm
not even saying that as like, I'm literally saying that
(13:26):
this was his Eureka moment. A quief A queef proved
to be a Eureka moment. Yeah, so thanks to Mrs
Merrill and her therapeutic queief, Jay Marian sims that, you
know what, maybe this similar positioning that gave him that
kind of access to the uterus could be helpful to
(13:48):
treat Betsy and Anarca. So he then bought and bent
a silver spoon with his mind like in the matrix,
and I'm not really um. He bent the silver spoon,
which was d of like a prototype or a speculum
and brings Betsy and to examine her, and he said, quote,
(14:09):
I saw everything as no man had ever seen before. Yeah,
I mean just when you're down there as a tourist,
you typically don't see quite as much. But he with
his prototype speculum clearly saw the outline of Betsy's fistula
and was like, it just looks like a tear and
some fabric. Why can't why can't we fix that? And
(14:32):
years later he would write again, questionable. I thought only
of relieving the loveliest of God's creation of one of
the most loathsome maladies that can possibly befall poor human nature.
I felt that I had had a mission of divine origin.
I could not have ceased my labors if I had tried.
(14:53):
And I'm like, okay, let's think about the context of
the time again, right, because we can never forget context.
This is Sminty. This is a a white slave owner
from the South dealing with enslaved women who are traumatized
by childbirth and pain. And he previously was like, oh,
lady parts, and suddenly he's talking about the loveliest of
(15:13):
God's creatures. And he had no motivation beyond helping the
loveliest of God's creatures. I am making my most skeptical
face right now. She sure is, I mean, because that's
quite a change from his earlier position. So anyway, through
all of these Eureka moments, Sims ends up writing to
slave owners around the region to find cases of previously
(15:36):
ignored or untreated vestico vaginal fistulas. So at one point
he writes to the man who technically owned Anarca and Betsy, said,
if you will give me Anarca and Betsy for experiment,
I agree to perform no experiment or operation on either
of them to endanger their lives, and will not charge
(15:58):
a cent for keeping them. But you must pay their
taxes and clothe them. I will keep them at my expense. Oh,
just the language of bodies as properties is overwhelming. Um.
And essentially what he did was rent Anarca and Betsy
and like twelve other women too. It's it's hard to fathom, honestly. Um.
(16:23):
So he paid taxes on them for the years that
he was essentially renting them. Um. But he did complain
about how it was an enormous tax for a young
doctor in a country practice. Yeah, get it, get out
of your Dr Sims. Yeah, I mean it really, it
really would be the same as someone complaining about property taxes.
(16:43):
For him, that was that was the tone it took.
And so anyway, within three months of reaching out to
all of these slave owners, he had started his experimental
therapeutic surgeries on Betsy Anarca and several other women at
this small hospital that he had built behind his house
for this specific purpose. And one of those first operations
was on a woman named Lucy who also had a
(17:06):
really bad case of fistula. Part of her bladder was
entirely gone, and when the man who owned Lucy sent
her to Sims, he really wasn't sure again that he
could help. He wrote, she was very much disappointed for
her condition was loathsome, and she was in hopes that
she could be cured. And during her surgery, he said
(17:29):
that was before the days of anesthetics, he wrote, and
the poor girl on her knees bore the operation with
great heroism and bravery. I succeeded in closing the fistula
in about an hour's time, which was considered to be
very good work. Vanessa Northington Gamble, who's a doctor and
medical historian at George Washington University has some quibbles, she writes,
(17:49):
or she told Shankra Vadantem in that hidden brain piece, listen,
this was very painful, and uh he would Sims would
go on to say that Lucy felt as if she
were going to die and that she cried out in
pain so much because of these surgeries. And it's like, well,
obviously this is insanely painful and with no anesthesia. I mean,
(18:11):
I can't imagine. It makes me like go pale just
thinking about it. And it speaks to Simms's quote speaks
to something that we will address more as we go
through this episode, but it speaks to the assumption that
black women could sustain more pain than delicate, flower white ladies.
(18:32):
And so there was just this assumption that he held,
as did pretty much every other physician in the country
at the time, that like, oh, it's okay, they'll just
like grin and bear it when we expose them to
so much pain. But of course Sims didn't come up
with a magical cure overnight or in like that hour
(18:54):
that he claims it took to operate on Lucy. There
were endless earl years and repeated surgeries again, let us
emphasize without any anesthesia. Um. And he writes about how
at last I performed operations only with the assistance of
the patients himself, basically saying like all of his doctor
friends were just tired of being there and watching him
(19:17):
try and fail um and the and ps. Let's keep
in mind too, that these women were completely naked and exposed,
while this group of white male doctors would be um
watching them. Yeah. I mean, after years of watching and
assisting with these surgeries, these even these fellow doctors were like,
I'm out, Like I can't, I can't do this anymore.
(19:38):
And so Sims did train these enslaved women as his
surgical assistance, and they helped him operate on their fellow patients. Uh.
And he gets to it. Sims gets to a point
where he pauses for a couple of weeks because he's
so disheartened by all of these failures. Again it's all
about him, uh. And so he's really mulling over how
(19:59):
to better suture these fishulas. And he reports that in
the meantime, and this is something you will see in
any source about Sims, he reports that the women were
quote clamorous for him to get back to it. And
on the one hand, I feel like that is used
to justify a lot of brutality and and awfulness and experimentation.
(20:21):
But on the other hand, like, yeah, I mean, if
you were suffering and here's this person who's like, I'm
going to cure you, I'd probably be like, hey, TikTok,
can we get back to it? Uh? So there you
know again there are layers to it. But he ends
up one night getting the idea for a new technique.
He tries it on Lucy but it fails to Then
(20:41):
he finally gets the idea to use a fine silver
thread once he realized that the unsterilized silk thread that
he was using was part of the problem. It was
causing infections, and he had read about a Virginia surgeon
who had used lead sutures. So in spring eighteen forty nine,
he tries his new method on a narca and it's
(21:01):
worth mentioning that this was a narcas unannestetized surgery. Fortunately
for everyone involved, it worked beautifully. She healed really well,
and two weeks later Betsy's and Lucy's fistulas had healed
and closed as well. With this new technique. And the
(21:22):
thing is, I mean, if jam Mary and Sims were
a doctor today, he would be all over social media.
He would be live tweeting all of this stuff. I mean,
the guy was so driven by self promotion, even to
the point you could argue of like self branding, because
he wanted to revolutionized medicine. I mean he specifically took
(21:44):
on these cases because he wanted to get that kind
of fame. And this was something that Jeffrey S. Sarton
wrote about in two thousand four in the Southern Medical
Journal about how you know. Sims even said I had
made perhaps one of the most important discoveries of the
a for the relief of suffering humanity. And in a
way he's right. I mean, it was a massive breakthrough.
(22:07):
But there's that question of was he actually concerned with
the health and safety of anarcha Betsy Lucy and the
other women that he experimentally operated on, or were they,
as Dr Graham J. Barker Benfield would argue in the
nineteen seventies, just guinea pigs to advance this white dude's career.
(22:28):
Because there's no evidence that he ever followed up with
the women, and no data about the rest of the women,
and Chakravadantem says on Hidden Brain quote he wanted to
be a trailblazing researcher, and these women their bodies became
props in his journey of scientific discovery. Yeah, exactly. So,
(22:50):
on the one hand, we get incredibly valuable medical advancements
that will go on to change the lives of callous women,
but it's done on the back, so to speak, of
enslaved women who essentially were at their wits end, who
had no other options available to them. And of course
there's a lot more to this story that we're going
(23:11):
to talk about when we come right back from a
quick break. So, Kristen, I finally got my act together
and went and used square space to build the Caroline
Urban Hub on the Internet. I'm so excited. Yes, I
built a website finally, and it was super easy. And
(23:33):
I knew that using squarespace with all of its amazing
templates would be super easy, but it was even more
smooth sailing than I expected. And at first I wasn't
sure what template to pick because there are a lot
of great ones to choose from. I was able to
sort of mix and match and mess around with the
whole shebang until I figured out what worked best for me.
And I'm really happy with it, and you love it.
(23:55):
I do love it again, It's like I said, it's
just pictures of Corgis and dies wonderful. Well, listeners, if
you want to do what Caroline and I have done
and build your website, because who doesn't need a website
these days? You need to head over to square space
dot com and if you use our promo code mom Stuff,
you can get ten percent off your first purchase with
(24:18):
a free domain. So really, why shouldn't you do it?
Because you don't have to pay until you are ready
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com and use a code mom stuff for ten percent
off and a free domain. And now back to the
show three Ja, Marian Sims packs up his bag and
(24:48):
his family and it's like see later, South, I'm heading
to New York City. New York City, Yeah, and he
immediately sets about establishing a mixed reputation, as you would
a stilm with somebody like this, like, oh good, you're
a really good doctor, but you're kind of a douche
(25:10):
so okay. Some historians and critics have suggested that Sim's
left the South, not because, as he claimed, I'm so
sick like I need to find a better climate that
suits my health better, but because of criticism over quote
immoral slave experiments, and as he was getting set up
in New York, he it is telling that he admitted
(25:33):
some pretty important details of records of those groundbreaking Southern surgeries.
In both a paper on the topic and a lecture
he delivered, he referred to the women as quote healthy
young Negro women, leaving out the whole slave bit and
leaving out the whole part that no, they were not healthy,
they were desperate and also enslaved, and adding insult to injury.
(25:56):
The early illustrations accompanying his writing about the topics show
the patients as white, talk about some revisionist history. So
in eighteen fifty five, just two years later, the Women's
Hospital is established, and it's a public and privately funded
charity hospital exclusively for quote female disorders. I mean in
(26:17):
this from the dude who was so like Lady Pelvis
is um and Sims earns fame through the hospital which
did primarily treat Irish immigrant women. But again he got
the rumor mill going with questions about these experiments on
these often destitute immigrant women, and weather they were happening
(26:39):
with informed consent going on, right exactly. Uh. And during
the Civil War he actually travels to Europe to get
out of the country and in eighteen sixty three treats
Empress Eugenie, wife of Napoleon the third for of Fistula,
and she, by the way, uh, he performed the surgery
(27:01):
on her while she was under chloroform, so she was innesthetized. Um.
And again sort of getting to that mixed reputation in
the early post war period, although he had owned slaves,
he had defended the system of slavery and written many
a poor word about black people in letters to colleagues.
(27:21):
He urged the South after the Civil War to accept
the fifteenth Amendment and just move on. I really am
getting the impression that this guy, like, it's not that
he necessarily has principles, right, It's not like he sticks
by like the awful system of slavery or you know,
wholeheartedly sticks by the freedom of the slaves. He's just like,
can we just like whatever? You know, Like, he's not
(27:45):
genuinely supporting the women that he performed surgeries on, it's
more like, I don't know, can I just get a
better reputation out of this stuff? He's literally only looking
out for himself and any like qualms, quibbles and arguments
about freeing the slaves first of all and then giving
them voting rights. He was just like, I don't I
don't care. You guys are like really bugging me with
all of this. How is this helping me at the
(28:06):
end of the day, exactly? And I mean because of this,
like people really did not like Jay Mary and Simms
the dude slash the douche and and by the way,
Quick Smithy side note, use of douche as a pejorative
is totally validated because, as we know from the episode
Bag the douche douche is a horrible um concoction that
(28:29):
women were tricked into, you know, inserting into their vaginal canals.
So it is an accurate description in a lot of
ways of this guy. He's a terrible thing. It was
in women's vaginas, so true, He's the ultimate douche um.
So nonetheless, his book Clinical Notes on Uterine Surgery was
(28:51):
widely read and it took a straightforward approach to women's
health and gynecological disorders, and the book's emphasis on sterility treatment,
picularly artificial insemination, was way ahead of its time. Yeah,
that's great, and then he totally MUCKs it up again.
And this is actually an interesting Sminty side note for
those of you who listened to our episode on the
(29:13):
Marmorian Flock, the group of ladies sculptors in Rome in
the nineteenth century. Uh. In eighteen seventy, the douche published
a newspaper account of his treatment of famous actress Charlotte Cushman.
And now Kushman was one of the primary patrons and
(29:33):
benefactors of these sculptor ladies. But but seriously, like a
doctor publishing like, hey guys, I treated this famous lady.
H The New York Academy of Medicine immediately was like
are you kidding me? They reprimanded him formally for resorting
to paid advertising and hello, breaking confidentiality. Yeah, I mean
(29:54):
this guy totally again, Like I'm just imagining how awful
he would be on Twitter, like, hey guys, Jen Aniston
just left my office hashtag winning. And so in this
decade of the eighteen seventies, you have colleagues and the
hospital board lobbying charges of unethical experimentation at him. And
there's some like awful and dismissive quote of his that
(30:17):
I neglected to include in the notes. But he's basically
like the ladies meaning the hospital board. He's like the
ladies are at it again. Yeah, he was just he
was a joy. In eight seventy six, hooray, he performs
the first documented gall bladder surgery. I'm getting frustrated with
his string of successes, Like that's great, first gallbladder surgery. Yeah,
(30:39):
but he also at the same time promoted now discredited
techniques like oh very unremoval for various physical and psychosomatic
conditions termed hysterical diseases. There we go, They all floating uterus.
So I mean, already I'm annoyed that he has any
statues take the staff all. I mean, yeah, he was
(31:02):
clearly no sayt um. But what we want to get
into is like, was he evil capital e evil? Has
he been misrepresented? Is he simply a product of his time?
Like what do we know about that? Yeah? I mean,
like do does his do his personal views and the
way that he was able to make those scientific discoveries,
(31:23):
does that discredit essentially those scientific discoveries, you know what
I mean, Like, does it literally knock him off that
pedestal um. And this is something that critics and supporters
have argued over because there's the argument that enslaved people
could not truly grant consent in the way we think
(31:43):
of it today, even if they fully understood the procedures
and were indeed clamorous to be treated. But they were
a vulnerable population, no bones about it. They were subject
to the whims and wishes of the people who owned
them and rented them in Sims's case, like property, and
(32:03):
who wanted to fix them, not so that they could
be healthy and have a better quality of life, but
so that they could be put back to work, right
because you know, you have to keep in mind that
during the system of slavery, black women couldn't pop out
enough babies, and once slavery is over, then you shift
(32:27):
into black people are having too many babies, as we
will discuss in our next episode. Um. But yeah, I mean,
they were absolutely property. They were not human beings, whether
it was a doctor or a slave owner. And so
if these women desperate for relief were owned by Sims
or on some weird loan. Could they have raised objections
(32:51):
if he did in an archist case, for instance, need
to operate thirty times. I mean, we'll never know because
we don't have records of these women's voices. They might
have wanted help, but it doesn't mean that they wanted
the degree of pain and suffering that they were exposed
to in repeated experimental surgeries. But you've got gynecologist and
(33:13):
Simms explainers slash apologists depending on how you see M. L.
Lewis Walls, who argues he's living today he's a modern gynecologist.
As Sims did in his autobiography, that some treatment was
better than no treatment. Right. The women quote had only
two therapeutic choices. Walls rights they could continue as they
(33:34):
were with whatever palliade of treatment might be provided, or
they could agree to undergo experimental surgical operations that might
offer them some relief, perhaps even a total cure for
their condition. And Walls, who uh nowadays treats women in
Africa with bessico vaginal fistulas, says that these women are
desperate for a cure and will willingly submit to almost
(33:55):
any therapy proposed to them, and and to that and
to several other things that Walls says in the paper
that we read that he wrote. I have to say,
does the modern perspective on vessica vaginal fistula patients does
it justify as Walls seems to argue Simms's treatment of them.
(34:16):
It seems to He seems to argue that like you guys,
why are you making stuff up about how awful he was?
And that like like you said, Kristen, I mean, yes,
he made these amazing discoveries that would help so many women,
especially post advent of anesthesia, but were the means a
(34:37):
justification for the ends? And canned Walls with his experience, however, firsthand?
Can he justify the things that Sims did? I mean?
Walls also argues that Simms wrote about discussing the procedures
with patients and receiving their consent to undergo the procedures,
and he says that you basically have to assume that
(34:57):
these women cooperated because he's like, think about how delicate
these procedures were. If the women were forced into it,
you know, and they were thrashing around like trying to
get away, they would be even more injured. And it's like, well,
can like I don't know how you can. Yes, they're
absolutely delicate surgeries, obviously, and you obviously don't want to
(35:18):
be moving around and like thrashing about when someone's got
a scalpel and some suitures in your vaginal canal. But
can you seriously make the argument that like, oh, yeah,
they were like totally down for everything he was doing well,
because I mean, if they were to protest, then they
could be punished, you know, they could face a different
(35:39):
kind of physical pain. So it's a sketchy argument at best.
And yeah, this whole like machiavellian like medicine is um
is honestly tough to unravel because of the benefits, yes,
that we do enjoy today, as you know, people you
(36:00):
know undergo modern O, B G, Y N treatments, you know,
but you still have of course, like to that point,
people like historian Harriet Washington, who underscores the pain that
these women went through the torment um and if anything,
it is a horrifying lesson in us not taking medical
(36:25):
advancements for granted, the medical advancements to treat the female body. Yeah, exactly.
And we've mentioned anesthesia a hundred times already, and the
fact that these women were not under anesthesia when they
underwent these procedures, and so what is the deal? Is
he some cruel, sadistic racist who purposely withheld anesthesia and
(36:47):
probably honestly not a great guy. But if the answer,
of course, as with all of this, is it's not
that simple. So Sims began his surgeries on these enslaved
women a year before anesthesia was successfully demonstrated for the
first time. Because you've got like, for a hundred years
doctors experimenting with different types of experimental anesthetics but no success.
(37:10):
Then in October of eighteen forty six, you get dentist
William T. Morton administering and effective anesthetic sulfuric ether to
a patient having a tumor in his neck removed. And although,
like around this time, you've had a bunch of other
people who had been testing new ideas and methods, Morton
really revolutionized it with his delivery system, which helped control
(37:32):
how much ether a patient inhaled during the procedure, which meant, hello,
your patient wouldn't o d And it basically gave birth
to the field of anesthesiology. But even so, the use
of anesthesia, though it spread rapidly was still not accepted universally.
There were still all sorts of weird, like you shouldn't
(37:52):
be put under because like you might die, but also
like you need to feel the pain and like stay alert. Well,
And I don't know where this Moreton dentist was located,
but I would also be curious to know how long
it would take news of that successful anesthesia to reach
nineteenth century Montgomery, Alabama. Sure exactly, yeah, I mean even
(38:18):
proponents of using anesthesia weren't sure that all patients needed it,
and this was definitely the case unfortunately with doctors men
treating people with vestico vaginal fistulas women. Writing in eighteen
fifty nine, for instance, Sir James Young Simpson, who had
discovered chloroform, wrote, the mere amount of pain endured by
(38:40):
the patient is perhaps less than in most surgical operations,
as the walls of the vestico vaginal septum are far
less sensitive than you would a priori imagine Are you
kidding me? Men? Seriously? Um? Sorry, I'm like ramped up here.
And Simpson's words actually echoed uh sims words that he
had given during an York lecture in eighteen fifty seven.
(39:01):
During a time btw, that he was exclusively treating white women,
some of higher classes at his hospital. He said that,
oh yeah, I never use anesthesia during fistula operations quote,
because they are not painful enough to justify the trouble
and risk attending their administration. Plus he'd written about a
(39:22):
white woman that he'd treated back in eighty nine on
whom he hadn't used anesthesia either. And I would bet though,
that that woman would have been working class, lower class,
because class definitely plays a role if you are a
white woman in whether or not you would receive any
of this old school anesthesia. Because there was this idea
(39:44):
and Sim's totally bought into it, that upper class white
women were simply too fragile and couldn't tolerate surgery without ether.
And this also is around the time when we start
seeing doctors first advocating for cesarean rather than vaginal deliveries
because of the same idea that these they were called
(40:06):
bookish at the time. These bookish, wealthy women just did
not have it in them like a working class a tough,
working class woman did to deliver. So it was the
same kind of thinking extended to anesthesia. And then of course, though,
if you are a woman of color, you are not
going to get anesthesia, regardless of how much money you have,
(40:27):
probably because of this racist notion that Sims actually wrote
about that black women have a quote naturally high pain
tolerance um. In eighteen ninety two, for instance, we have
American neurologists Silas Weir Mitchell writing, oh god, and this
(40:48):
this quote. Oh, I don't even want to quote it.
The savage does not feel pain as we do. So
this includes people of color, people all so from Jewish
and Irish Irish ancestry, also Native Americans and people from
Southern Europe. You were, they were all believed to have
(41:09):
a higher pain tolerance slash an inferior awareness of pain.
This wasn't like some kind of superpower, obviously, this was
a sign that they were poorly bred. Yeah, but the
horrifying paradox is that you've got all these white doctors then,
who accused people of color and people of lower classes
of overreacting to pain, acting foolish in the operating room.
(41:32):
But it's like, um, no, I think I think that's
a false What is that a false truth? What false
logic that? Like? Oh you think that like, oh you
can't feel pain as much. So look at you overreacting,
you foolish person. Shouldn't it be like, oh, no, they're
human and so they feel pain just like any other
human and they're reacting appropriately. And it wouldn't be until
(41:53):
the nineteen forties that doctors started to even just question
this race based idea of pain, but that racist residue
remained and remains the um But going back a few decades,
study from Hawaii found that white surgery patients were likelier
(42:15):
to be given analgesics compared to Filipino, Japanese, or Chinese patients,
in part because of those old school stereotypes about how
different ethnic groups respond to pain. And if we look
at a more recent study from two thousand to this
landmark research found that patients of color again were less
(42:36):
likely to receive the same quality of care as white patients,
even when both groups had similar insurance or the same
ability to pay for care. And oh, it's still with us.
It's still with us, yeah, because a study in January
found that black patients are more likely to die in
the ICU than white patients, and the researchers tied this
(42:58):
to the fact that the doctors literally paid less attention.
They displayed less empathy to patients of color than they
did to white patients. They were more likely to physically
approach and touch and comfort and soothe the white patients,
(43:18):
whereas when they were dealing with the black patients, they
tended to stand at a distance, hold a notebook in
front of them, not offer as many comforting words. And
we should note that the study authors point out that
since most of the doctors most but not all of
the doctors in that study were white, it was hard
(43:38):
to tell whether the quality of care would have been
better if they had been, say, doctors of color. But
they also note that previous research has found that there
does tend to be better doctor patient rapport when both
share the same ethnicity. Yeah, and I mean, you've got
plenty of previous research that shown that up to two
(44:00):
thirds of doctors do display unconscious racial bias. So nothing
like calling people names, are like actively trying to treat
them poorly. But it's bad enough that black patients can
pick up on it. And Caroline and reading about a
discrimination that kind of like unconscious racial bias that a
(44:21):
lot of women of color face when they go to
the doctor. Um, there was an anecdote from one African
American woman saying, whenever I have to go to the doctor,
like if it's something unscheduled, I make sure I dress
well so that I will be taken more seriously. Yeah,
because studies have shown that there's a higher likelihood that
healthcare professionals will assume that people of color are exhibiting
(44:46):
drug seeking behavior and that they are just lying about
their pain to get pills. Basically I mean and speaking
of pain, there was a fascinating and horrifying at the
same time Boston Globe article from June that looked at
pain and the way that it registers and is treated,
and they found that in experiments, both women and people
(45:08):
of color in general have frequently shown lower pain tolerance
when asked to do things like hold their hands in
ice water during experiments, which of course goes against the
person of color aspect, goes against all of those racist
assumptions from the nineteenth century that we've been talking about.
And when they're looking at gender specifically, researchers have found
(45:30):
that our different pain tolerances emerged during puberty, and women
end up more susceptible to things like migraines, back pain
and fibromyalgia. And there's been all of these studies that
show that heart surgery patients, if you're a man, you're
more likely to get pain men's and if you're a woman,
you're more likely to get sedatives, which ties into the
(45:50):
whole continuing assumption about hysteria and considering how chronic pain
conditions tend to affect more women than men. And there's
also this issue of doctors having to be convinced to
give them the right kind and the enough of their
pain relievers. Um. And if we look at socioeconomics to
(46:14):
research has found that low income Americans are likelier to
suffer pain compared to their high income peers, probably due
to correlates with manual labor, unhealthy diets, and not being
able to afford going to the doctor. Yeah, and so
you're starting to see percolating to the surface, really just
(46:37):
echoes of everything that we talked about in SIMS day.
You're seeing people being taken less seriously, pain being taken
less seriously because it's in a woman or someone of
a lower socioeconomic class, or someone of color. And speaking
of race and ethnicity, and among pain patients, black people
and Hispanic people are likelier to report that their pain
(46:59):
is fear, and Black women are much likelier, for instance,
to die from breast cancer. Black women are hyper overrepresented
in breast cancer patients, but they are more likely also
to die of it, hyper overrepresented in the sense of
population proportion. So we also find that black pain patients
(47:21):
are less likely overall compared to white patients to receive
pain medication, and when they do receive it, they receive
less of it. And studies of post top care have
repeatedly found that white patients receive higher doses of opioids
than patients of color, Right, And so what's going on?
I mean the researchers talk about conscious and unconscious bias,
(47:43):
but also docs assumptions about patients, insurance and payments, so
you know, like racism, racism, racist assumptions basically. Um there's also,
though weird internalized ideas about pain. A University of Virginia
professor Sophie Trey Walter in asked people to think about
pain in certain situations and then showed them pictures of
(48:05):
a black or a white person and asked the participant
how much pain the person in the picture was in
both white and black participants rated black patients pain as
less severe. In a related steady found that this pain
bias that's tied to black or white patients emerges as
(48:27):
early as seven and tree Walter attributes this kind of
benevolent racism to the belief that black people have harder
lives and that hardship leaves to toughness. And this also
leads us to the trope of you know, the strong
black woman, which can be very harmful as well because
(48:51):
of all of these very practical issues of literally like
you know, doctors assuming like, well, you don't need as
much pain treatment, um, but also just those those racist
ideologies too that um give us, you know, kind of
quote unquote permission to maybe not consider their needs as
(49:12):
much because it's like, oh, well, you know, they're so
strong or so have they been through so much so
even I guess physical pain can also be withstood to
a stronger degree. Again, echoes of the way that people
were thinking about enslaved people in this country, like oh,
they're tough, they're fine, But then again, like those people
were literally viewed as property. Well, and speaking of which
(49:35):
I mean this chapter of gynecology. Early gynecological history is
part of a broader legacy of people of color really
being used as guinea pigs for a lot of medical
experimentation that has gone on UM in the United States.
(49:56):
Todd Sabbatt, for instance, who's a medical history in at
East Carolina University, told BuzzFeed News quote, medicine is an
integral part of the story of slavery. And this is
something that had Henrietta Washington writes about in her book
Medical Apartheid UM that we referenced in our podcast a
while back now on Henrietta Lacks, who died from cervical
(50:20):
cancer UM but without her family's consent. UH cells were
taken from her, I guess, from her cervix and they
infinitely reproduce these HeLa cells as they're known today. And
thanks to these HeLa cells, there have been all sorts
of medical breakthroughs that have resulted. But the family you
(50:43):
know of Henriette Lacks rightfully feels so wronged by this
because again, it's like bodies just being used as property,
right Yeah, as Chakravadanta said, just props for someone else's advancement.
And again it's the same thing with sims of like
you know, researchers and physicians have been able to make
(51:05):
incredible discoveries based on stolen cells from this woman who
was not informed and who later died and her family
who was never informed. And it's also I mean, these
issues also are not exclusive to the bodies of women
of color. I mean, you have the infamous Tuskegee Syphilis
(51:26):
study that was initiated in ninety two, which deliberately infected
four hundred black men with syphilis. Um. If we go
back to eighteen fifty five, around the same time that
Jayme Marrian Simms is building his women's hospital, you have
John fed Brown, who was an escaped slave. Recall that
(51:48):
the doctor to whom he was indentured would produce painful
blisters on his body in order to observe quote how
deep my black skin went. Um. And then, if we
want some more horrifying examples, we also have in the
fifties black Floridians being deliberately exposed to swarms of mosquitoes
(52:09):
carrying yellow fever and other diseases, and experiments conducted by
the Army and the CIA. And finally we have in
the sixties and seventies. And I say finally, just as
this is the end of my list. This is not
the end of uh these instances. But in the sixties
and seventies, you have African American boys being subjected to
(52:31):
sometimes paralyzing neurosurgery by researcher at the University of Mississippi
who believed that brain pathology could be the root of
children's hyperactive behavior. So the subjects he chose black boys, right,
And so this this country, I mean, we have an
(52:51):
undeniable history of racist medical developments. Yeah, I mean, And
and the thing is we can't go back in time
and change it. And a solution obviously is not okay,
all of those procedures out the door. You know, if
we were to retire every single medical procedure that traces
(53:11):
back to either a recent or distant past racist experimentation
or ideology, I mean, hospitals would just collapse in on
themselves probably. So what do we do in that case?
I mean, what do we do in the cases of Lucy,
Betsy Anarca and the other women who are really the
(53:34):
mothers of gynecology. Well, Victoria Gamble, who we cited earlier,
had the suggestion of memorializing them through their own statues.
If SIMS has three why don't these three women have
any And so she says that, you know, the statues
would not be based on the experiments that they were
(53:55):
subjected to, because we shouldn't think of them just as victims.
She says, it might be the three of them together,
or it might be withholding their children, because they were
mothers and they were women, so that would be part
of it. Uh So it would not be she says,
they're prostrate on the altar of science. And then she says,
I think what the inscription would say is Betsy, Anarca
(54:17):
and Lucy the mothers of modern gynecology. And I think
that that statue should happen. How do we build a statue, Caroline?
Do you like kickstart that? I yeah, that's like the
only thing that I can think of is that. I'm
sure some listener who works for the government knows how
you get a statue directed, because I mean, can we
(54:38):
start like a campaign? I mean, I'm sure we could.
And you know, I think there's an interesting point about
sims of statues. A lot of people have argued for
them to come down. But there was one anecdote we read,
and I'm so sorry I can't remember who it was.
If it was Gamble or if it was another researcher.
But she said that she had initially supported taking all
of the Sims statues down until she took a tour
(55:01):
of basically the slave trade in Liverpool in the UK,
and there was the statue of Neptune with two black
boys basically in chains at the base of the statue,
and people have been arguing for that to come down,
And the black man who was leading the tour said, well,
(55:23):
I don't think it should because if this statue comes down,
people will forget, people will not talk about it anymore
because they will not see this visible reminder of the
horrors that happened right here in this city. And so
I think, um, that argument could also be applied to Sims.
It would be nice to maybe see on the plaques
(55:45):
by his statues, maybe an asterisk explaining that, um, while yes,
he did develop some incredible life changing procedures, he did
it at the expense of women and who basically had
no choice. So, listeners, we now want to know what
you think about all of this. A. Do you know
(56:07):
how we can get a statue built? B? Have you
are you a patient of color who has ever experienced
this kind of discrimination in the doctor's office. UM, we
want to hear your stories because obviously this is yes
history that we've been talking about, but it is history
that lives on today. So mom Stuff at how stuff
(56:29):
works dot com is our email address. You can also
tweet us at mom Stuff podcast or messages on Facebook,
and we've got a couple of messages to share with
you right now. I've got a letter here from another
Christian in response to our colorism episode. She says, you
(56:50):
mentioned a study that stated how the dark skinned black
women who were surveyed all said that they had at
some point wanted to be lighter skinned, but the light
skinned black women surveyed had never wanted to be darker.
This reminded me of something I used to do in
my childhood, a very light skinned Mexican American girl. I
would purposely try to stay out in the sun as
long as I could, wanting to become dark like my sisters,
(57:12):
most of my family members, and the group of Mexican
kids at my school. I would even take suntan lotion
and rub it all over myself and then go lie
out in the sun. I remember that, even at a
young age, I was conscious that darker skinned Mexicans were
perceived as more authentically Mexican, and that my light skin,
compounded with the fact that I wasn't taught Spanish, made
it more difficult for me to gain acceptance in Mexican
(57:34):
social groups and even within my own family, in which
only my mother, grandmother, and I are light. Don't get
me wrong, I definitely know my privilege as a light
skinned Mexican and have seen firsthand how, for example, my
father's dark skin has made him a target for random searches,
being followed around department stores, being asked for receipts upon
leaving a store, and even having racial slurs hurled him
(57:56):
from moving cars. I know without a doubt that I
moved through life differently than he does, and that our
skin colors impact our daily lives. In fact, my mom
once told me that instead of focusing on radio journalism,
I should go into TV news, as it would be
easy for me to get a job since as a
Latina I would be a diversity higher but that I
looked quote white enough to not be perceived as threatening
(58:18):
to the status quo a happy medium for everyone. Even now,
I struggle with feeling authentically connected to my Mexican heritage
due to my light skin, but I try to remember
that authentic Mexicans come in all shades, from white to
black and everything in between. Thanks for these thoughts and
memory provoking podcasts, and thank you Kristen, so I've got
to let her here from chin Wei also about our
(58:40):
colorism episode, and chin Wei writes, I was going to
skip this particular episode, but I'm glad I listened to
the end. As a dark skinned woman, I'm kind of
tired of everyone telling me how bad my life should be,
how hard I must have it, and how I most
certainly hate myself. I've never experienced those things. I'm not
sure what luck prevented me from not having that particular experience,
(59:02):
but I'm very grateful for it. I struggle between trying
not to have my experienced eras and trying to support
any relief exposure of colorism can bring to those impacted
by it. I know it must have been difficult for
two white women to speak about this, so I applaud
your efforts. I do think there's so much nuance missed
when you don't have personal experience to draw on, and
I think this episode could have been made slightly better
(59:25):
from first hand accounts. And for the record, Shinway totally
agree with you there. As a black, non African American woman,
I want to give particular credit to African American women
for continuing to push this conversation worldwide. I think there's
been a lot of progress on this issue, a lot
of recognition of our biases and active individual steps to
(59:45):
combat it as well. And there's still more to do.
But I truly believe my darker tone nieces and nephews
will grow up in a different society than the one
my peers experienced. Thanks for the attempt, Hinway, well, thank
you for sharing your personal experiences with us, because I mean,
I think, as we said in that podcast, we wanted
(01:00:07):
to hear firsthand accounts because you're absolutely right to white
skinned women cannot firsthand relate to this um. So keep
the conversation going. Friends, Mom Stuff at how stuff works
dot com is where you can send your letters and
for links to all of our social media as well
as all of our blogs, videos, and podcasts with our sources.
(01:00:29):
If you want to learn more about the mothers of gynecology,
head on over to stuff Mom Never Told You dot
com for more on this and thousands of other topics.
Does it, How stuff works dot com
Hi. I'm Lauren Vogelbaum, a host of the new House
Stuff Works Now podcast. Every week, I'll be bringing you
three stories from our team about the weird and wondrous
developments we've seen in science, technology, and culture. Fresh episodes
will be out every Monday on iTunes, Spotify, Google Play Music,
and everywhere else that find podcasts are found. Welcome to
(00:25):
Stuff Mob Never Told You From House to Works dot Com. Hello,
and welcome to the podcast. I'm Kristen and I'm Caroline.
And this episode was inspired by an article posted over
on NPRS website from their podcast The Hidden Brain, hosted
(00:47):
by our favorite, our favorite Shagri Vidandum Um, and it
was about the so called mothers of gynecology and we're
going to spend the next forty five minutes talking about them.
So I will just hop forward and say that I
posted the article on the Stuff I've Never Told You
Facebook page and the response was overwhelming. Were people not
(01:11):
aware of that history? No? They weren't. I mean I
wasn't either. That was one of the reasons why I
wanted to share it with people. And so of course
we knew with that kind of response, um, that we
needed to take the time and dedicate a whole podcast
to Jay Mary and Sims, who's known as the father
of kinnecology, but the women he experimentally operated on that
(01:38):
essentially allowed him to make all of these scientific breakthroughs
that we do benefit from in R O, B. G
U I N S Offices today, right, and we're gonna
talk a lot about Jay Mary and Simms himself, not
at the exclusion of these women, but almost I guess
you could say that we're looking at these women through
a Jay Mary and Simms lens simply because the fact
(02:02):
that he was a white doctor with a degree of fame,
there's obviously a lot of information out there about him,
and because the women he operated on were enslaved black women,
we don't have records of these women's voices, and so
we have to do our part to dive in and
sort of excavate this history so that we are aware
(02:24):
of this pretty brutal history of early gynecology. And it
also hearkens the social media hashtag say her name. You know,
this is like the nineteenth century version of that, where
most of the women's names were lost to history, but
we do know the names of three Anarca Betsy and Lucy,
(02:45):
and knowing those names and saying those names as we're
going to is also important for filling in these gaps
in our history, right because it makes it it makes
it more real when you realize that these women, they
weren't just name less faceless black women. These were real,
live women who were already experiencing so much pain and trauma,
(03:08):
as we'll talk about. And then we're part of experimental
therapeutic surgery. So let's get down to old J. Marion Sims.
He was a physician from Alabama and from eighty five
to eighteen forty nine, like we said, he performed these
(03:28):
experimental surgeries on enslaved women to repair something called a
vestico vaginal fistula, which are holes between the bladder and
the vagina or holes between the rectum and the vagina
that can result from traumatic childbirth. Yeah, and so because
of the pretty impressive for the time advancements that he
(03:50):
created and championed and the lives that he subsequently saved,
as Kristen said, he's hailed as the father of gynecology
and the founder of modern surgy goal guy Ina College,
and I mean this guy has statues all over the
place in his honor in South Carolina, which is his
home state, Alabama, where he established his medical practice and
made all of those fistula treatment discoveries. And New York,
(04:13):
which is where he later established and ran a booming
women's hospital. Although it's a women's hospital that I think
exclusively serviced white patients. Oh yeah, yes, it was pretty
much for Irish women basically. So it was really starting
in the sixties and seventies with the rise of a
civil rights movement, the women's rights movements that historians and
(04:35):
physicians began looking back at Simms and wondered, like, wait
a second, does he deserve these statues? I mean, yeah,
he accomplished things, but do the ends justify the means
in his case? Right? And so we want to dive
in today to the full story of who he was,
(04:56):
what he did, and who were the women that he
pre formed these repeated, painful, experimental surgeries on without anesthesia.
So let's look back quickly at simms early years. What
shaped this guy? He was born in eighteen thirteen in Lancaster,
South Carolina, and he was neither of great wealth nor
of great brilliance, And honestly, he just figured he might
(05:18):
as well be a doctor, because he was basically like
middle class, normal, average dude, but with a good education.
Uh so he's like, I could have been a lawyer. Nah,
you know, I could be a teacher. I'm not going
to make my fame that way. I guess I'll be
a doctor. It sounds like, you know, kind of the
better call Saul of gynecology. Yes, I love that show, um,
(05:39):
And so he ends up moving to Alabama, though in
eighteen thirty five after two of his first patients, infants
died from a disease causing persistent diarrhea, and he really
lived pretty uneventful and nearly impoverished first few years until
he and his family moved to Montgomery, and there he
started to make a name for himself. He was definitely
(06:02):
a self promoter. He started bragging about being the first
in the South to successfully treat club feet and crossed eyes.
But as a country doctor, he was also paid to
treat sick and injured slaves on plantations, and plantation owners
would be heavily interested in providing this kind of treatment
(06:23):
because sick or injured slaves can't work, and also sick
and injured enslaved women can't give birth, thus it's a
profit loss for these slave owners. And then one day
one of these slave owners sends along to Jay maryan Sims,
two women, Betsy and seventeen year old Anarca, both of
(06:46):
whom had vestico vaginal fistula's. But Anarcas. The seventeen year
olds case was extremely bad because she had a protracted
labor causing holes from her vagina to a bladder and rectum.
And she was also the first case of this that
he'd ever seen, and he'd assisted the doctor with her delivery.
(07:08):
And at first Simms was like, uh, I don't know
if I can help in this case. What what am
I gonna do? I'm better call Saul of you know
ye old gynecology. Gutacology isn't even really a thing yet.
How could I help? Well, yeah, but just like Jimmy
and better call Saul. He figured out a way to help.
(07:31):
But the whole reason that he's like, I don't know
if I can help these ladies, You've got to look
at the context of the time. There had been no
cure for this stuff. So before we get into how
Sims pivoted to gynecology from his general practice, you have
to understand the context of vessica vaginal fistual is because
(07:52):
it is horrific. So we've already hinted at the fact
that they are caused by prolonged and obstructed labor. Basically,
what happens is when the fetus won't fit through the
birth canal. I hope no one's eating, by the way,
because this is brutal. I literally when I was reading
this Christian because what I've included in our notes today
is not anywhere near the full picture. I just hit
(08:14):
the high points because I literally got lightheaded reading about this. Yeah,
graphic details ahead, friend, Yeah, there's like mentions of like
bone plates grinding. I left that out, Okay. So basically,
the fetus won't fit through the birth canal and gets wedged.
With each contraction, it is wedged harder and harder. Eventually
you get massive crush injuries because of this wedging to
(08:36):
the soft tissue of the pelvis, and the blood supply
gets cut off. The fetus suffocates days later, days later.
Because of where we are in our scientific and medical
history at this point, the fetus, having been left where
it is, it finally slides out, as does dead tissue
(08:58):
from the woman's injured pelvis that is secreted, and once
that secreted, a fistula forms. The woman then experiences a
complete loss of urinary and in a woman like anarchist case,
sometimes fecal control, often in addition to horrific side effects
like secondary infertility, complete loss of vaginal function, recurring infections,
(09:22):
and you also have to take the mental health effects
of this into account. One of the huge effects, whether
it's a woman today experiencing it or a woman in
the nineteenth century, is depression because not only have you
lost a child and experienced super traumatic pain, but the
fact that you are constantly experiencing urinary and fecal UH loss,
(09:44):
you end up being an outcast. You face huge stigma
because you can't control your bowels, you can't control your bladder,
and you smell, which then of course contributes to a
loss of dignity and self esteem. And some of these
women did end up killing themselves because of this condition,
and so it was a huge deal for women at
this time. I mean, it was completely debilitating, to the
(10:05):
point that um, in the study that we were reading
UH one of the only things really that some of
these women could do would be to essentially sit on
a chamber pot because I mean they couldn't really go anywhere.
They were constantly ruining their clothes. I mean, they couldn't
do anything. And we should note that this is still
officials are still a major healthcare issue for a lot
(10:28):
of women in developing nations too. But back to the
nineteenth century, this wasn't uncommon at all, partially because of
like lackluster maternity care. But like you said, it was
catastrophic um And in eighteen forty seven a French surgeon
reported the medical community hadn't heard of a single case
(10:51):
where a woman was successfully treated, and physicians were quite
aware of the debilitating effects of this condition. And eighteen
fifties evan report that was delivered at the Georgia State
Medical Society included the description that most of the other
physical evils of life sink into utter insignificance because of
(11:13):
the constant pain and mental trauma that the woman has
to experience. And so it's against this backdrop you have
a physician with no real reputation to speak of, and
you've got this terrible common condition with no cure that
sims ends up pivoting to gynecology. He's he's going out
(11:35):
in his rounds. One day, he's on his horse, he's
going out to treat people all over the region, and
he gets word of a middle aged white woman named
Mrs Merrill who had been thrown from her horse. She'd
experienced an injury. He needed to come right away and treater.
So Sims goes to take care of her and realizes
that Merrill has sustained a pelvic injury and her uterus
(11:58):
is out of place. And now at this point, obviously
he hadn't yet started his focus on gynecological issues. And
in his autobiography, which I ended up really getting sucked
into because did I mention he was a self promoter,
it's a really interesting time capsule of a read. Uh,
he wrote. If there was anything I hated, it was
(12:18):
investigating the organs of the female pelvis. But this poor
woman was in such a condition that I was obliged
to find out what was the matter with her. How chivalrous,
so nice, so nice, and and find out he did.
So what Sims did was have Mrs Merrill squat on
her bed under a sheet for modesty, and he inserted
(12:41):
two fingers into her vagina and by doing that, he
was able to reposition the uterus and she immediately experienced relief.
In Caroline, I don't quick aside reading that, Like, I
didn't know it was so easy to reposition a uterus. Well,
apparently there's lots of pushing in pulling involved, and there
(13:02):
was something about the position that helped introduce air into
the vaginal canal. So like you get you get puffed
up like a balloon. And I say this because literally,
in his autobiography he describes how she massively queaked when
she then lay down on the bed and and I'm
not even saying that as like, I'm literally saying that
(13:26):
this was his Eureka moment. A quief A queef proved
to be a Eureka moment. Yeah, so thanks to Mrs
Merrill and her therapeutic queief, Jay Marian sims that, you
know what, maybe this similar positioning that gave him that
kind of access to the uterus could be helpful to
(13:48):
treat Betsy and Anarca. So he then bought and bent
a silver spoon with his mind like in the matrix,
and I'm not really um. He bent the silver spoon,
which was d of like a prototype or a speculum
and brings Betsy and to examine her, and he said, quote,
(14:09):
I saw everything as no man had ever seen before. Yeah,
I mean just when you're down there as a tourist,
you typically don't see quite as much. But he with
his prototype speculum clearly saw the outline of Betsy's fistula
and was like, it just looks like a tear and
some fabric. Why can't why can't we fix that? And
(14:32):
years later he would write again, questionable. I thought only
of relieving the loveliest of God's creation of one of
the most loathsome maladies that can possibly befall poor human nature.
I felt that I had had a mission of divine origin.
I could not have ceased my labors if I had tried.
(14:53):
And I'm like, okay, let's think about the context of
the time again, right, because we can never forget context.
This is Sminty. This is a a white slave owner
from the South dealing with enslaved women who are traumatized
by childbirth and pain. And he previously was like, oh,
lady parts, and suddenly he's talking about the loveliest of
(15:13):
God's creatures. And he had no motivation beyond helping the
loveliest of God's creatures. I am making my most skeptical
face right now. She sure is, I mean, because that's
quite a change from his earlier position. So anyway, through
all of these Eureka moments, Sims ends up writing to
slave owners around the region to find cases of previously
(15:36):
ignored or untreated vestico vaginal fistulas. So at one point
he writes to the man who technically owned Anarca and Betsy, said,
if you will give me Anarca and Betsy for experiment,
I agree to perform no experiment or operation on either
of them to endanger their lives, and will not charge
(15:58):
a cent for keeping them. But you must pay their
taxes and clothe them. I will keep them at my expense. Oh,
just the language of bodies as properties is overwhelming. Um.
And essentially what he did was rent Anarca and Betsy
and like twelve other women too. It's it's hard to fathom, honestly. Um.
(16:23):
So he paid taxes on them for the years that
he was essentially renting them. Um. But he did complain
about how it was an enormous tax for a young
doctor in a country practice. Yeah, get it, get out
of your Dr Sims. Yeah, I mean it really, it
really would be the same as someone complaining about property taxes.
(16:43):
For him, that was that was the tone it took.
And so anyway, within three months of reaching out to
all of these slave owners, he had started his experimental
therapeutic surgeries on Betsy Anarca and several other women at
this small hospital that he had built behind his house
for this specific purpose. And one of those first operations
was on a woman named Lucy who also had a
(17:06):
really bad case of fistula. Part of her bladder was
entirely gone, and when the man who owned Lucy sent
her to Sims, he really wasn't sure again that he
could help. He wrote, she was very much disappointed for
her condition was loathsome, and she was in hopes that
she could be cured. And during her surgery, he said
(17:29):
that was before the days of anesthetics, he wrote, and
the poor girl on her knees bore the operation with
great heroism and bravery. I succeeded in closing the fistula
in about an hour's time, which was considered to be
very good work. Vanessa Northington Gamble, who's a doctor and
medical historian at George Washington University has some quibbles, she writes,
(17:49):
or she told Shankra Vadantem in that hidden brain piece, listen,
this was very painful, and uh he would Sims would
go on to say that Lucy felt as if she
were going to die and that she cried out in
pain so much because of these surgeries. And it's like, well,
obviously this is insanely painful and with no anesthesia. I mean,
(18:11):
I can't imagine. It makes me like go pale just
thinking about it. And it speaks to Simms's quote speaks
to something that we will address more as we go
through this episode, but it speaks to the assumption that
black women could sustain more pain than delicate, flower white ladies.
(18:32):
And so there was just this assumption that he held,
as did pretty much every other physician in the country
at the time, that like, oh, it's okay, they'll just
like grin and bear it when we expose them to
so much pain. But of course Sims didn't come up
with a magical cure overnight or in like that hour
(18:54):
that he claims it took to operate on Lucy. There
were endless earl years and repeated surgeries again, let us
emphasize without any anesthesia. Um. And he writes about how
at last I performed operations only with the assistance of
the patients himself, basically saying like all of his doctor
friends were just tired of being there and watching him
(19:17):
try and fail um and the and ps. Let's keep
in mind too, that these women were completely naked and exposed,
while this group of white male doctors would be um
watching them. Yeah. I mean, after years of watching and
assisting with these surgeries, these even these fellow doctors were like,
I'm out, Like I can't, I can't do this anymore.
(19:38):
And so Sims did train these enslaved women as his
surgical assistance, and they helped him operate on their fellow patients. Uh.
And he gets to it. Sims gets to a point
where he pauses for a couple of weeks because he's
so disheartened by all of these failures. Again it's all
about him, uh. And so he's really mulling over how
(19:59):
to better suture these fishulas. And he reports that in
the meantime, and this is something you will see in
any source about Sims, he reports that the women were
quote clamorous for him to get back to it. And
on the one hand, I feel like that is used
to justify a lot of brutality and and awfulness and experimentation.
(20:21):
But on the other hand, like, yeah, I mean, if
you were suffering and here's this person who's like, I'm
going to cure you, I'd probably be like, hey, TikTok,
can we get back to it? Uh? So there you
know again there are layers to it. But he ends
up one night getting the idea for a new technique.
He tries it on Lucy but it fails to Then
(20:41):
he finally gets the idea to use a fine silver
thread once he realized that the unsterilized silk thread that
he was using was part of the problem. It was
causing infections, and he had read about a Virginia surgeon
who had used lead sutures. So in spring eighteen forty nine,
he tries his new method on a narca and it's
(21:01):
worth mentioning that this was a narcas unannestetized surgery. Fortunately
for everyone involved, it worked beautifully. She healed really well,
and two weeks later Betsy's and Lucy's fistulas had healed
and closed as well. With this new technique. And the
(21:22):
thing is, I mean, if jam Mary and Sims were
a doctor today, he would be all over social media.
He would be live tweeting all of this stuff. I mean,
the guy was so driven by self promotion, even to
the point you could argue of like self branding, because
he wanted to revolutionized medicine. I mean he specifically took
(21:44):
on these cases because he wanted to get that kind
of fame. And this was something that Jeffrey S. Sarton
wrote about in two thousand four in the Southern Medical
Journal about how you know. Sims even said I had
made perhaps one of the most important discoveries of the
a for the relief of suffering humanity. And in a
way he's right. I mean, it was a massive breakthrough.
(22:07):
But there's that question of was he actually concerned with
the health and safety of anarcha Betsy Lucy and the
other women that he experimentally operated on, or were they,
as Dr Graham J. Barker Benfield would argue in the
nineteen seventies, just guinea pigs to advance this white dude's career.
(22:28):
Because there's no evidence that he ever followed up with
the women, and no data about the rest of the women,
and Chakravadantem says on Hidden Brain quote he wanted to
be a trailblazing researcher, and these women their bodies became
props in his journey of scientific discovery. Yeah, exactly. So,
(22:50):
on the one hand, we get incredibly valuable medical advancements
that will go on to change the lives of callous women,
but it's done on the back, so to speak, of
enslaved women who essentially were at their wits end, who
had no other options available to them. And of course
there's a lot more to this story that we're going
(23:11):
to talk about when we come right back from a
quick break. So, Kristen, I finally got my act together
and went and used square space to build the Caroline
Urban Hub on the Internet. I'm so excited. Yes, I
built a website finally, and it was super easy. And
(23:33):
I knew that using squarespace with all of its amazing
templates would be super easy, but it was even more
smooth sailing than I expected. And at first I wasn't
sure what template to pick because there are a lot
of great ones to choose from. I was able to
sort of mix and match and mess around with the
whole shebang until I figured out what worked best for me.
And I'm really happy with it, and you love it.
(23:55):
I do love it again, It's like I said, it's
just pictures of Corgis and dies wonderful. Well, listeners, if
you want to do what Caroline and I have done
and build your website, because who doesn't need a website
these days? You need to head over to square space
dot com and if you use our promo code mom Stuff,
you can get ten percent off your first purchase with
(24:18):
a free domain. So really, why shouldn't you do it?
Because you don't have to pay until you are ready
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com and use a code mom stuff for ten percent
off and a free domain. And now back to the
show three Ja, Marian Sims packs up his bag and
(24:48):
his family and it's like see later, South, I'm heading
to New York City. New York City, Yeah, and he
immediately sets about establishing a mixed reputation, as you would
a stilm with somebody like this, like, oh good, you're
a really good doctor, but you're kind of a douche
(25:10):
so okay. Some historians and critics have suggested that Sim's
left the South, not because, as he claimed, I'm so
sick like I need to find a better climate that
suits my health better, but because of criticism over quote
immoral slave experiments, and as he was getting set up
in New York, he it is telling that he admitted
(25:33):
some pretty important details of records of those groundbreaking Southern surgeries.
In both a paper on the topic and a lecture
he delivered, he referred to the women as quote healthy
young Negro women, leaving out the whole slave bit and
leaving out the whole part that no, they were not healthy,
they were desperate and also enslaved, and adding insult to injury.
(25:56):
The early illustrations accompanying his writing about the topics show
the patients as white, talk about some revisionist history. So
in eighteen fifty five, just two years later, the Women's
Hospital is established, and it's a public and privately funded
charity hospital exclusively for quote female disorders. I mean in
(26:17):
this from the dude who was so like Lady Pelvis
is um and Sims earns fame through the hospital which
did primarily treat Irish immigrant women. But again he got
the rumor mill going with questions about these experiments on
these often destitute immigrant women, and weather they were happening
(26:39):
with informed consent going on, right exactly. Uh. And during
the Civil War he actually travels to Europe to get
out of the country and in eighteen sixty three treats
Empress Eugenie, wife of Napoleon the third for of Fistula,
and she, by the way, uh, he performed the surgery
(27:01):
on her while she was under chloroform, so she was innesthetized. Um.
And again sort of getting to that mixed reputation in
the early post war period, although he had owned slaves,
he had defended the system of slavery and written many
a poor word about black people in letters to colleagues.
(27:21):
He urged the South after the Civil War to accept
the fifteenth Amendment and just move on. I really am
getting the impression that this guy, like, it's not that
he necessarily has principles, right, It's not like he sticks
by like the awful system of slavery or you know,
wholeheartedly sticks by the freedom of the slaves. He's just like,
can we just like whatever? You know, Like, he's not
(27:45):
genuinely supporting the women that he performed surgeries on, it's
more like, I don't know, can I just get a
better reputation out of this stuff? He's literally only looking
out for himself and any like qualms, quibbles and arguments
about freeing the slaves first of all and then giving
them voting rights. He was just like, I don't I
don't care. You guys are like really bugging me with
all of this. How is this helping me at the
(28:06):
end of the day, exactly? And I mean because of this,
like people really did not like Jay Mary and Simms
the dude slash the douche and and by the way,
Quick Smithy side note, use of douche as a pejorative
is totally validated because, as we know from the episode
Bag the douche douche is a horrible um concoction that
(28:29):
women were tricked into, you know, inserting into their vaginal canals.
So it is an accurate description in a lot of
ways of this guy. He's a terrible thing. It was
in women's vaginas, so true, He's the ultimate douche um.
So nonetheless, his book Clinical Notes on Uterine Surgery was
(28:51):
widely read and it took a straightforward approach to women's
health and gynecological disorders, and the book's emphasis on sterility treatment,
picularly artificial insemination, was way ahead of its time. Yeah,
that's great, and then he totally MUCKs it up again.
And this is actually an interesting Sminty side note for
those of you who listened to our episode on the
(29:13):
Marmorian Flock, the group of ladies sculptors in Rome in
the nineteenth century. Uh. In eighteen seventy, the douche published
a newspaper account of his treatment of famous actress Charlotte Cushman.
And now Kushman was one of the primary patrons and
(29:33):
benefactors of these sculptor ladies. But but seriously, like a
doctor publishing like, hey guys, I treated this famous lady.
H The New York Academy of Medicine immediately was like
are you kidding me? They reprimanded him formally for resorting
to paid advertising and hello, breaking confidentiality. Yeah, I mean
(29:54):
this guy totally again, Like I'm just imagining how awful
he would be on Twitter, like, hey guys, Jen Aniston
just left my office hashtag winning. And so in this
decade of the eighteen seventies, you have colleagues and the
hospital board lobbying charges of unethical experimentation at him. And
there's some like awful and dismissive quote of his that
(30:17):
I neglected to include in the notes. But he's basically
like the ladies meaning the hospital board. He's like the
ladies are at it again. Yeah, he was just he
was a joy. In eight seventy six, hooray, he performs
the first documented gall bladder surgery. I'm getting frustrated with
his string of successes, Like that's great, first gallbladder surgery. Yeah,
(30:39):
but he also at the same time promoted now discredited
techniques like oh very unremoval for various physical and psychosomatic
conditions termed hysterical diseases. There we go, They all floating uterus.
So I mean, already I'm annoyed that he has any
statues take the staff all. I mean, yeah, he was
(31:02):
clearly no sayt um. But what we want to get
into is like, was he evil capital e evil? Has
he been misrepresented? Is he simply a product of his time?
Like what do we know about that? Yeah? I mean,
like do does his do his personal views and the
way that he was able to make those scientific discoveries,
(31:23):
does that discredit essentially those scientific discoveries, you know what
I mean, Like, does it literally knock him off that
pedestal um. And this is something that critics and supporters
have argued over because there's the argument that enslaved people
could not truly grant consent in the way we think
(31:43):
of it today, even if they fully understood the procedures
and were indeed clamorous to be treated. But they were
a vulnerable population, no bones about it. They were subject
to the whims and wishes of the people who owned
them and rented them in Sims's case, like property, and
(32:03):
who wanted to fix them, not so that they could
be healthy and have a better quality of life, but
so that they could be put back to work, right
because you know, you have to keep in mind that
during the system of slavery, black women couldn't pop out
enough babies, and once slavery is over, then you shift
(32:27):
into black people are having too many babies, as we
will discuss in our next episode. Um. But yeah, I mean,
they were absolutely property. They were not human beings, whether
it was a doctor or a slave owner. And so
if these women desperate for relief were owned by Sims
or on some weird loan. Could they have raised objections
(32:51):
if he did in an archist case, for instance, need
to operate thirty times. I mean, we'll never know because
we don't have records of these women's voices. They might
have wanted help, but it doesn't mean that they wanted
the degree of pain and suffering that they were exposed
to in repeated experimental surgeries. But you've got gynecologist and
(33:13):
Simms explainers slash apologists depending on how you see M. L.
Lewis Walls, who argues he's living today he's a modern gynecologist.
As Sims did in his autobiography, that some treatment was
better than no treatment. Right. The women quote had only
two therapeutic choices. Walls rights they could continue as they
(33:34):
were with whatever palliade of treatment might be provided, or
they could agree to undergo experimental surgical operations that might
offer them some relief, perhaps even a total cure for
their condition. And Walls, who uh nowadays treats women in
Africa with bessico vaginal fistulas, says that these women are
desperate for a cure and will willingly submit to almost
(33:55):
any therapy proposed to them, and and to that and
to several other things that Walls says in the paper
that we read that he wrote. I have to say,
does the modern perspective on vessica vaginal fistula patients does
it justify as Walls seems to argue Simms's treatment of them.
(34:16):
It seems to He seems to argue that like you guys,
why are you making stuff up about how awful he was?
And that like like you said, Kristen, I mean, yes,
he made these amazing discoveries that would help so many women,
especially post advent of anesthesia, but were the means a
(34:37):
justification for the ends? And canned Walls with his experience, however, firsthand?
Can he justify the things that Sims did? I mean?
Walls also argues that Simms wrote about discussing the procedures
with patients and receiving their consent to undergo the procedures,
and he says that you basically have to assume that
(34:57):
these women cooperated because he's like, think about how delicate
these procedures were. If the women were forced into it,
you know, and they were thrashing around like trying to
get away, they would be even more injured. And it's like, well,
can like I don't know how you can. Yes, they're
absolutely delicate surgeries, obviously, and you obviously don't want to
(35:18):
be moving around and like thrashing about when someone's got
a scalpel and some suitures in your vaginal canal. But
can you seriously make the argument that like, oh, yeah,
they were like totally down for everything he was doing well,
because I mean, if they were to protest, then they
could be punished, you know, they could face a different
(35:39):
kind of physical pain. So it's a sketchy argument at best.
And yeah, this whole like machiavellian like medicine is um
is honestly tough to unravel because of the benefits, yes,
that we do enjoy today, as you know, people you
(36:00):
know undergo modern O, B G, Y N treatments, you know,
but you still have of course, like to that point,
people like historian Harriet Washington, who underscores the pain that
these women went through the torment um and if anything,
it is a horrifying lesson in us not taking medical
(36:25):
advancements for granted, the medical advancements to treat the female body. Yeah, exactly.
And we've mentioned anesthesia a hundred times already, and the
fact that these women were not under anesthesia when they
underwent these procedures, and so what is the deal? Is
he some cruel, sadistic racist who purposely withheld anesthesia and
(36:47):
probably honestly not a great guy. But if the answer,
of course, as with all of this, is it's not
that simple. So Sims began his surgeries on these enslaved
women a year before anesthesia was successfully demonstrated for the
first time. Because you've got like, for a hundred years
doctors experimenting with different types of experimental anesthetics but no success.
(37:10):
Then in October of eighteen forty six, you get dentist
William T. Morton administering and effective anesthetic sulfuric ether to
a patient having a tumor in his neck removed. And although,
like around this time, you've had a bunch of other
people who had been testing new ideas and methods, Morton
really revolutionized it with his delivery system, which helped control
(37:32):
how much ether a patient inhaled during the procedure, which meant, hello,
your patient wouldn't o d And it basically gave birth
to the field of anesthesiology. But even so, the use
of anesthesia, though it spread rapidly was still not accepted universally.
There were still all sorts of weird, like you shouldn't
(37:52):
be put under because like you might die, but also
like you need to feel the pain and like stay alert. Well,
And I don't know where this Moreton dentist was located,
but I would also be curious to know how long
it would take news of that successful anesthesia to reach
nineteenth century Montgomery, Alabama. Sure exactly, yeah, I mean even
(38:18):
proponents of using anesthesia weren't sure that all patients needed it,
and this was definitely the case unfortunately with doctors men
treating people with vestico vaginal fistulas women. Writing in eighteen
fifty nine, for instance, Sir James Young Simpson, who had
discovered chloroform, wrote, the mere amount of pain endured by
(38:40):
the patient is perhaps less than in most surgical operations,
as the walls of the vestico vaginal septum are far
less sensitive than you would a priori imagine Are you
kidding me? Men? Seriously? Um? Sorry, I'm like ramped up here.
And Simpson's words actually echoed uh sims words that he
had given during an York lecture in eighteen fifty seven.
(39:01):
During a time btw, that he was exclusively treating white women,
some of higher classes at his hospital. He said that,
oh yeah, I never use anesthesia during fistula operations quote,
because they are not painful enough to justify the trouble
and risk attending their administration. Plus he'd written about a
(39:22):
white woman that he'd treated back in eighty nine on
whom he hadn't used anesthesia either. And I would bet though,
that that woman would have been working class, lower class,
because class definitely plays a role if you are a
white woman in whether or not you would receive any
of this old school anesthesia. Because there was this idea
(39:44):
and Sim's totally bought into it, that upper class white
women were simply too fragile and couldn't tolerate surgery without ether.
And this also is around the time when we start
seeing doctors first advocating for cesarean rather than vaginal deliveries
because of the same idea that these they were called
(40:06):
bookish at the time. These bookish, wealthy women just did
not have it in them like a working class a tough,
working class woman did to deliver. So it was the
same kind of thinking extended to anesthesia. And then of course, though,
if you are a woman of color, you are not
going to get anesthesia, regardless of how much money you have,
(40:27):
probably because of this racist notion that Sims actually wrote
about that black women have a quote naturally high pain
tolerance um. In eighteen ninety two, for instance, we have
American neurologists Silas Weir Mitchell writing, oh god, and this
(40:48):
this quote. Oh, I don't even want to quote it.
The savage does not feel pain as we do. So
this includes people of color, people all so from Jewish
and Irish Irish ancestry, also Native Americans and people from
Southern Europe. You were, they were all believed to have
(41:09):
a higher pain tolerance slash an inferior awareness of pain.
This wasn't like some kind of superpower, obviously, this was
a sign that they were poorly bred. Yeah, but the
horrifying paradox is that you've got all these white doctors then,
who accused people of color and people of lower classes
of overreacting to pain, acting foolish in the operating room.
(41:32):
But it's like, um, no, I think I think that's
a false What is that a false truth? What false
logic that? Like? Oh you think that like, oh you
can't feel pain as much. So look at you overreacting,
you foolish person. Shouldn't it be like, oh, no, they're
human and so they feel pain just like any other
human and they're reacting appropriately. And it wouldn't be until
(41:53):
the nineteen forties that doctors started to even just question
this race based idea of pain, but that racist residue
remained and remains the um But going back a few decades,
study from Hawaii found that white surgery patients were likelier
(42:15):
to be given analgesics compared to Filipino, Japanese, or Chinese patients,
in part because of those old school stereotypes about how
different ethnic groups respond to pain. And if we look
at a more recent study from two thousand to this
landmark research found that patients of color again were less
(42:36):
likely to receive the same quality of care as white patients,
even when both groups had similar insurance or the same
ability to pay for care. And oh, it's still with us.
It's still with us, yeah, because a study in January
found that black patients are more likely to die in
the ICU than white patients, and the researchers tied this
(42:58):
to the fact that the doctors literally paid less attention.
They displayed less empathy to patients of color than they
did to white patients. They were more likely to physically
approach and touch and comfort and soothe the white patients,
(43:18):
whereas when they were dealing with the black patients, they
tended to stand at a distance, hold a notebook in
front of them, not offer as many comforting words. And
we should note that the study authors point out that
since most of the doctors most but not all of
the doctors in that study were white, it was hard
(43:38):
to tell whether the quality of care would have been
better if they had been, say, doctors of color. But
they also note that previous research has found that there
does tend to be better doctor patient rapport when both
share the same ethnicity. Yeah, and I mean, you've got
plenty of previous research that shown that up to two
(44:00):
thirds of doctors do display unconscious racial bias. So nothing
like calling people names, are like actively trying to treat
them poorly. But it's bad enough that black patients can
pick up on it. And Caroline and reading about a
discrimination that kind of like unconscious racial bias that a
(44:21):
lot of women of color face when they go to
the doctor. Um, there was an anecdote from one African
American woman saying, whenever I have to go to the doctor,
like if it's something unscheduled, I make sure I dress
well so that I will be taken more seriously. Yeah,
because studies have shown that there's a higher likelihood that
healthcare professionals will assume that people of color are exhibiting
(44:46):
drug seeking behavior and that they are just lying about
their pain to get pills. Basically I mean and speaking
of pain, there was a fascinating and horrifying at the
same time Boston Globe article from June that looked at
pain and the way that it registers and is treated,
and they found that in experiments, both women and people
(45:08):
of color in general have frequently shown lower pain tolerance
when asked to do things like hold their hands in
ice water during experiments, which of course goes against the
person of color aspect, goes against all of those racist
assumptions from the nineteenth century that we've been talking about.
And when they're looking at gender specifically, researchers have found
(45:30):
that our different pain tolerances emerged during puberty, and women
end up more susceptible to things like migraines, back pain
and fibromyalgia. And there's been all of these studies that
show that heart surgery patients, if you're a man, you're
more likely to get pain men's and if you're a woman,
you're more likely to get sedatives, which ties into the
(45:50):
whole continuing assumption about hysteria and considering how chronic pain
conditions tend to affect more women than men. And there's
also this issue of doctors having to be convinced to
give them the right kind and the enough of their
pain relievers. Um. And if we look at socioeconomics to
(46:14):
research has found that low income Americans are likelier to
suffer pain compared to their high income peers, probably due
to correlates with manual labor, unhealthy diets, and not being
able to afford going to the doctor. Yeah, and so
you're starting to see percolating to the surface, really just
(46:37):
echoes of everything that we talked about in SIMS day.
You're seeing people being taken less seriously, pain being taken
less seriously because it's in a woman or someone of
a lower socioeconomic class, or someone of color. And speaking
of race and ethnicity, and among pain patients, black people
and Hispanic people are likelier to report that their pain
(46:59):
is fear, and Black women are much likelier, for instance,
to die from breast cancer. Black women are hyper overrepresented
in breast cancer patients, but they are more likely also
to die of it, hyper overrepresented in the sense of
population proportion. So we also find that black pain patients
(47:21):
are less likely overall compared to white patients to receive
pain medication, and when they do receive it, they receive
less of it. And studies of post top care have
repeatedly found that white patients receive higher doses of opioids
than patients of color, Right, And so what's going on?
I mean the researchers talk about conscious and unconscious bias,
(47:43):
but also docs assumptions about patients, insurance and payments, so
you know, like racism, racism, racist assumptions basically. Um there's also,
though weird internalized ideas about pain. A University of Virginia
professor Sophie Trey Walter in asked people to think about
pain in certain situations and then showed them pictures of
(48:05):
a black or a white person and asked the participant
how much pain the person in the picture was in
both white and black participants rated black patients pain as
less severe. In a related steady found that this pain
bias that's tied to black or white patients emerges as
(48:27):
early as seven and tree Walter attributes this kind of
benevolent racism to the belief that black people have harder
lives and that hardship leaves to toughness. And this also
leads us to the trope of you know, the strong
black woman, which can be very harmful as well because
(48:51):
of all of these very practical issues of literally like
you know, doctors assuming like, well, you don't need as
much pain treatment, um, but also just those those racist
ideologies too that um give us, you know, kind of
quote unquote permission to maybe not consider their needs as
(49:12):
much because it's like, oh, well, you know, they're so
strong or so have they been through so much so
even I guess physical pain can also be withstood to
a stronger degree. Again, echoes of the way that people
were thinking about enslaved people in this country, like oh,
they're tough, they're fine, But then again, like those people
were literally viewed as property. Well, and speaking of which
(49:35):
I mean this chapter of gynecology. Early gynecological history is
part of a broader legacy of people of color really
being used as guinea pigs for a lot of medical
experimentation that has gone on UM in the United States.
(49:56):
Todd Sabbatt, for instance, who's a medical history in at
East Carolina University, told BuzzFeed News quote, medicine is an
integral part of the story of slavery. And this is
something that had Henrietta Washington writes about in her book
Medical Apartheid UM that we referenced in our podcast a
while back now on Henrietta Lacks, who died from cervical
(50:20):
cancer UM but without her family's consent. UH cells were
taken from her, I guess, from her cervix and they
infinitely reproduce these HeLa cells as they're known today. And
thanks to these HeLa cells, there have been all sorts
of medical breakthroughs that have resulted. But the family you
(50:43):
know of Henriette Lacks rightfully feels so wronged by this
because again, it's like bodies just being used as property,
right Yeah, as Chakravadanta said, just props for someone else's advancement.
And again it's the same thing with sims of like
you know, researchers and physicians have been able to make
(51:05):
incredible discoveries based on stolen cells from this woman who
was not informed and who later died and her family
who was never informed. And it's also I mean, these
issues also are not exclusive to the bodies of women
of color. I mean, you have the infamous Tuskegee Syphilis
(51:26):
study that was initiated in ninety two, which deliberately infected
four hundred black men with syphilis. Um. If we go
back to eighteen fifty five, around the same time that
Jayme Marrian Simms is building his women's hospital, you have
John fed Brown, who was an escaped slave. Recall that
(51:48):
the doctor to whom he was indentured would produce painful
blisters on his body in order to observe quote how
deep my black skin went. Um. And then, if we
want some more horrifying examples, we also have in the
fifties black Floridians being deliberately exposed to swarms of mosquitoes
(52:09):
carrying yellow fever and other diseases, and experiments conducted by
the Army and the CIA. And finally we have in
the sixties and seventies. And I say finally, just as
this is the end of my list. This is not
the end of uh these instances. But in the sixties
and seventies, you have African American boys being subjected to
(52:31):
sometimes paralyzing neurosurgery by researcher at the University of Mississippi
who believed that brain pathology could be the root of
children's hyperactive behavior. So the subjects he chose black boys, right,
And so this this country, I mean, we have an
(52:51):
undeniable history of racist medical developments. Yeah, I mean, And
and the thing is we can't go back in time
and change it. And a solution obviously is not okay,
all of those procedures out the door. You know, if
we were to retire every single medical procedure that traces
(53:11):
back to either a recent or distant past racist experimentation
or ideology, I mean, hospitals would just collapse in on
themselves probably. So what do we do in that case?
I mean, what do we do in the cases of Lucy,
Betsy Anarca and the other women who are really the
(53:34):
mothers of gynecology. Well, Victoria Gamble, who we cited earlier,
had the suggestion of memorializing them through their own statues.
If SIMS has three why don't these three women have
any And so she says that, you know, the statues
would not be based on the experiments that they were
(53:55):
subjected to, because we shouldn't think of them just as victims.
She says, it might be the three of them together,
or it might be withholding their children, because they were
mothers and they were women, so that would be part
of it. Uh So it would not be she says,
they're prostrate on the altar of science. And then she says,
I think what the inscription would say is Betsy, Anarca
(54:17):
and Lucy the mothers of modern gynecology. And I think
that that statue should happen. How do we build a statue, Caroline?
Do you like kickstart that? I yeah, that's like the
only thing that I can think of is that. I'm
sure some listener who works for the government knows how
you get a statue directed, because I mean, can we
(54:38):
start like a campaign? I mean, I'm sure we could.
And you know, I think there's an interesting point about
sims of statues. A lot of people have argued for
them to come down. But there was one anecdote we read,
and I'm so sorry I can't remember who it was.
If it was Gamble or if it was another researcher.
But she said that she had initially supported taking all
of the Sims statues down until she took a tour
(55:01):
of basically the slave trade in Liverpool in the UK,
and there was the statue of Neptune with two black
boys basically in chains at the base of the statue,
and people have been arguing for that to come down,
And the black man who was leading the tour said, well,
(55:23):
I don't think it should because if this statue comes down,
people will forget, people will not talk about it anymore
because they will not see this visible reminder of the
horrors that happened right here in this city. And so
I think, um, that argument could also be applied to Sims.
It would be nice to maybe see on the plaques
(55:45):
by his statues, maybe an asterisk explaining that, um, while yes,
he did develop some incredible life changing procedures, he did
it at the expense of women and who basically had
no choice. So, listeners, we now want to know what
you think about all of this. A. Do you know
(56:07):
how we can get a statue built? B? Have you
are you a patient of color who has ever experienced
this kind of discrimination in the doctor's office. UM, we
want to hear your stories because obviously this is yes
history that we've been talking about, but it is history
that lives on today. So mom Stuff at how stuff
(56:29):
works dot com is our email address. You can also
tweet us at mom Stuff podcast or messages on Facebook,
and we've got a couple of messages to share with
you right now. I've got a letter here from another
Christian in response to our colorism episode. She says, you
(56:50):
mentioned a study that stated how the dark skinned black
women who were surveyed all said that they had at
some point wanted to be lighter skinned, but the light
skinned black women surveyed had never wanted to be darker.
This reminded me of something I used to do in
my childhood, a very light skinned Mexican American girl. I
would purposely try to stay out in the sun as
long as I could, wanting to become dark like my sisters,
(57:12):
most of my family members, and the group of Mexican
kids at my school. I would even take suntan lotion
and rub it all over myself and then go lie
out in the sun. I remember that, even at a
young age, I was conscious that darker skinned Mexicans were
perceived as more authentically Mexican, and that my light skin,
compounded with the fact that I wasn't taught Spanish, made
it more difficult for me to gain acceptance in Mexican
(57:34):
social groups and even within my own family, in which
only my mother, grandmother, and I are light. Don't get
me wrong, I definitely know my privilege as a light
skinned Mexican and have seen firsthand how, for example, my
father's dark skin has made him a target for random searches,
being followed around department stores, being asked for receipts upon
leaving a store, and even having racial slurs hurled him
(57:56):
from moving cars. I know without a doubt that I
moved through life differently than he does, and that our
skin colors impact our daily lives. In fact, my mom
once told me that instead of focusing on radio journalism,
I should go into TV news, as it would be
easy for me to get a job since as a
Latina I would be a diversity higher but that I
looked quote white enough to not be perceived as threatening
(58:18):
to the status quo a happy medium for everyone. Even now,
I struggle with feeling authentically connected to my Mexican heritage
due to my light skin, but I try to remember
that authentic Mexicans come in all shades, from white to
black and everything in between. Thanks for these thoughts and
memory provoking podcasts, and thank you Kristen, so I've got
to let her here from chin Wei also about our
(58:40):
colorism episode, and chin Wei writes, I was going to
skip this particular episode, but I'm glad I listened to
the end. As a dark skinned woman, I'm kind of
tired of everyone telling me how bad my life should be,
how hard I must have it, and how I most
certainly hate myself. I've never experienced those things. I'm not
sure what luck prevented me from not having that particular experience,
(59:02):
but I'm very grateful for it. I struggle between trying
not to have my experienced eras and trying to support
any relief exposure of colorism can bring to those impacted
by it. I know it must have been difficult for
two white women to speak about this, so I applaud
your efforts. I do think there's so much nuance missed
when you don't have personal experience to draw on, and
I think this episode could have been made slightly better
(59:25):
from first hand accounts. And for the record, Shinway totally
agree with you there. As a black, non African American woman,
I want to give particular credit to African American women
for continuing to push this conversation worldwide. I think there's
been a lot of progress on this issue, a lot
of recognition of our biases and active individual steps to
(59:45):
combat it as well. And there's still more to do.
But I truly believe my darker tone nieces and nephews
will grow up in a different society than the one
my peers experienced. Thanks for the attempt, Hinway, well, thank
you for sharing your personal experiences with us, because I mean,
I think, as we said in that podcast, we wanted
(01:00:07):
to hear firsthand accounts because you're absolutely right to white
skinned women cannot firsthand relate to this um. So keep
the conversation going. Friends, Mom Stuff at how stuff works
dot com is where you can send your letters and
for links to all of our social media as well
as all of our blogs, videos, and podcasts with our sources.
(01:00:29):
If you want to learn more about the mothers of gynecology,
head on over to stuff Mom Never Told You dot
com for more on this and thousands of other topics.
Does it, How stuff works dot com
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