Gynaecology’s Dark and Hidden Past

Female reproductive rights are currently blazing across headlines and demanding your attention. Between Planned Parenthood being targeted by Republicans, access to safe abortions dwindling, and medical reasons to take oral contraceptives being swept under the rug in favour of political agendas, it kinda feels like the discussions surrounding our uteruses are stuck in the medieval era. Gynaecology, the medical field surrounding the female reproductive system and diseases that are unique to those with female anatomy, seems unassuming when it comes to fields that are saturated with controversy and scandal. Put into the context of those with uteruses fighting desperately to centre themselves in the discussion about their own anatomy, however, it begins to become more clear how this field — one that often evokes the same mildly uncomfortable feeling as saying the word ‘hormones’ to a teenager— might have a dark past. The history of gynaecology has been rewritten over time to erase the racism, abuse, and tragedy that was inflicted upon Black women for the sake of ‘medicine’. It’s time to talk about it.

Gynaecology has a dark past involving slavery, racism, abuse, and madness.

The Story of Lucy, Betsey, and Anarcha

James Marion Sims is hailed as the ‘father of modern gynaecology’. For context, his office was based in Montgomery, Alabama in the 1840s and early 1850s. Yes, the same Montgomery that thrived off of cotton fields and slave markets; this is where Sims was based when he began performing surgery on enslaved women. His practice became so popular with rich plantation owners that he was able to build a small hospital for enslaved women and gain respect and money by performing as many surgeries on slaves as he could. It must be emphasized that he wasn’t treating the women because he cared for them or their wellbeing — he explicitly stated many times that he was just after the money that came from the plantation owners in exchange for increasing the productivity of the women working their cotton fields. There are also conflicting accounts as to whether he was well-liked or not — he was respected for his practice but disliked due to his repulsive personality. Finally, he wasn’t even trained in gynaecology. He was a surgeon, not a gynaecologist. In fact, he hated gynaecology and wrote openly about his distaste for “investigating the organs of the female pelvis” in his autobiography.

Over the course of his practice, he encountered some women with a condition called a vesicovaginal fistula, which is doctor-speak for a hole that can develop in the vagina after childbirth, opening it up to the bladder. Because there is now a pathway from the bladder to the vagina, urine can flow through the hole and cause incontinence by exiting the body via the vagina. It’s not a fatal condition but it is uncomfortable and can lead to the loss of function down there if left untreated. At the time, there was no way of treating it. Sims wanted to be the guy to find a way.

He started by developing one of the first versions of the modern speculum and naming it after himself. It does NOT look comfortable, but since when did that matter to him? It seems as though he thought he had been the first person to invent a speculum, as he says in his autobiography that he was able to see the inside of a vagina in a way that “no man had ever seen before”. In reality, the precursors to speculums have been in use since ancient Greece and Rome. He took a look at one woman’s vesicovaginal fistula using a spoon as a makeshift speculum and was amazed to discover that the fistula was obvious and readily visible. He figured it could just be stitched up, and a catheter could be inserted for a while until it wasn’t needed anymore.

Once he was equipped with his shiny and new vagina-opening stick, he set out to begin his horrifyingly inhumane research on Black women. Here was the deal he made: for a slave with a vesicovaginal fistula, he would provide free food and care if their owners provided clothing and paid their taxes. Only three of the women’s names were recorded: Betsey, Anarcha, and Lucy. It was 1845 when his first experimental surgery was performed on Lucy. Here is how he describes it:

That was before the days of anaesthetics, and the poor girl, on her knees, bore the operation with great heroism and bravery. I had about a dozen doctors there to witness the series of experiments that I expected to perform. …The operations were tedious and difficult. The instruments were on the right principle, though they were not as perfect as they were subsequently… I succeeded in closing the fistula in about an hour’s time, which was considered to be very good work.

Read that paragraph critically. He is writing about an enslaved woman who was forced to let a man experiment on her vagina without anaesthesia. The indignity of that alone is enough, but she had to go through this procedure for an entire hour with a group of men scrutinizing the experimentation being done on her whilst applauding the experimenter for his intelligence and innovation. He states earlier that she had consented to the procedure, but I wonder what he defined as consent and whether she had the choice to say no. Consent doesn’t count when there is no other option available. She also had a freaking hole in her vagina — she was probably quite desperate to have it fixed, making her easy to coerce or extort. I can’t imagine the humiliation she must have experienced.

Sims’ claim that anaesthesia didn’t exist in 1845 is a hotly contested assertion. Modern anaesthesia was in its infancy during the early to mid-1800s, but it was definitely around. Diethyl ether was used as an anaesthetic for the first time in 1842 by Crawford Long, while nitrous oxide — of laughing gas and whip-it fame — was used in 1844 by dentist Horace Wells. Is it possible that it just hadn’t made it to Alabama yet in 1845? Perhaps. Long was practicing medicine in Georgia and didn’t publish his findings until 1849. Wells was in Connecticut, and his findings were publicly released in 1847. The idea that a surgeon wouldn’t know that research on anaesthesia was being performed seems absurd, but it is true that information did not travel fast at the time. For this, Sims is innocent until proven guilty, but I am veeeerrrrrryyyyyy skeptical. There is a strong chance that he didn’t want to pay for anaesthesia when he could get away with just… not.

Things quickly got worse for Lucy. Sims couldn’t figure out how to get a catheter to stay in the bladder, so he had the *genius* idea of putting a piece of sponge up there with a string hanging down so that the urine could drip down by capillary action. Within five days, she developed a fever, increased heart rate, and sepsis. When he investigated, Sims discovered that the sponge had hardened inside her, completely wedged in her bladder and urethra. She had developed toxic shock syndrome so severe that Sims thought she was going to die; he acknowledged that she was in extreme agony. He then couldn’t figure out how to remove the sponge properly, so he just yanked it out. Fortunately, she recovered fully.

Sims describes her near-death experience as an “unfortunate experiment”.

Rather than accepting that his experiments had the strong potential to kill someone, he was more motivated than ever after his test on Lucy. He saw the surgery as a strong success — she had gone through unbearable pain and nearly died, but it worked out in the end, so he took this as a sign that he should try again. The next test subject was Betsey. He realized that the sponge was what had caused so many complications with Lucy, so he shied away from his completely random and non-medically accepted ideas. For Betsey, he performed exactly the same surgery in the exact same setting, but he replaced the sponge with a catheter (even though he had just said that he couldn’t figure out how to make the catheter stay in the bladder — was he lying so that he could experiment with his weird sponge, or did he discover how to make it work in the few months in between Lucy and Betsey?). He gave her one week to recover before taking out the stitches. Lo and behold, the surgery didn’t work at all. He sounds like a poorly written fictional villain: “to my great astonishment and disappointment, the operation was a failure”. The second time he attempted to perform a medical experiment on someone, he gave her seven days to heal and was “astonished” when it didn’t work. WTF? It must have been even more astonishing to him when he saw that the operation didn’t work solely because he had done a bad stitching job. He doesn’t acknowledge that he did a poor job, but rather brags that the hole was now closed, save for some spots where the hole wasn’t closed. Does this remind you of anyone?

So far, he has nearly killed one woman because he shoved a sponge in her urethra, and totally botched an experiment on another woman’s vagina. Naturally, he decides that he is actually pretty good at this, and goes for trial number three. The third woman was Anarcha. She had a vesicovaginal fistula, but also had a fistula between her vagina and rectum. This woman was going through immense suffering as she had to experience incontinence of both urine and fecal matter, both through the vagina. My heart goes out to her. His did not. I can’t bring myself to repeat here how he describes her condition, but I will say that where sympathy should have lived, there resided only disgust. To absolutely nobody’s surprise, he botched this one too. Again, he did a poor stitching job. Interestingly, on page 241 of his autobiography, he slips up and says that the stitches had turned out the same as the other two. He accidentally admits that he had lied about Lucy’s operation being a success aside from, you know, almost killing her. Yikes.

He now has three failed experiments performed on Black women’s vaginas.

These were the only operations that were explicitly detailed, but he kept experimenting for four more years without any success. Every single attempt, for four years, failed. He was putting Black women through immeasurable pain and suffering even after it should have been obvious that his treatment idea wasn’t working. The initial dozen or so doctors who had been supporting him had abandoned the idea completely, yet he continued trying. He performed multiple attempts on the same women. Eventually, he ran out of any assistance at all and had to “perform operations only with the assistance of the women themselves”. His brother asked him to stop, and he replied that the women are “perfectly satisfied” with what he was doing for them. He even went so far as to say that he would die before giving up his experiments. He had completely gone mad.

After four years of trying and failing, it finally occurred to him that maybe his stitching technique sucked, so he tried a new material on Anarcha. This was her thirtieth operation. Let that sink in. This was her thirtieth operation. She had been living with him for four years while continuously having him prod around in her vagina for the sake of some perversion of medical experimentation. There was no anesthesia for any of the operations, and she had to be held down by the other women as she herself held them down when it was one of them on the operating table. The sheer cruelty is difficult to comprehend.

This time, he was completely successful. He did the same technique on the other women living with him, and those were successful too. Finally, after years of violating these women over and over, he had achieved what he set out to do. There is no guilt or shame. He felt only pride, joy, and fulfillment. In his words, he “had made, perhaps, one of the most important discoveries of the age for the relief of suffering humanity”.

For the relief of suffering humanity.

What irony.

Aftermath and Legacy

Let’s be real here, it was the 1840s. There wasn’t much of a standard for ethics in medicine yet. That is not an excuse for what he did to the women. He humiliated them, caused them immense pain, and forced them to suffer through it for four years. He didn’t recognize when he was failing and he had no empathy for the women. He showed no regard for their lives, calling Lucy’s close call an “unfortunate experiment”. He should not get a pass just because this was in the 1850s and he ended up finding a way to treat vesicovaginal fistulas. Nothing about what he did makes him deserving of the title of the Father of Modern Gynaecology.

Recently, his legacy has come under question as we re-examine the story of these women from a modern lens. The city of New York had his statue removed from Central Park, and the story is beginning to be shared in a way that centres the women rather than Sims. Some have even taken to calling them the “Mothers of Modern Gynaecology”.

This is far from an isolated incident. Take, for example, the famous Tuskegee experiment, where African American men and women who had syphilis were used to examine the long-term effects of the infection under the ruse that they would be receiving free health care from the government (spoiler alert: they weren't). After it was discovered that Penicillin is effective in treating syphilis, it was still withheld from the patients along with the information that they could easily be cured. Eleven children died in a Meningitis study in Nigeria by American pharmaceutical company Pfizer in the 1990s, around the same time that 1000 babies contracted HIV in an experiment in Zimbabwe by American doctors. Canada is also guilty of doing shady research on Indigenous peoples, particularly in residential schools. Nowadays, there are ethical standards that have to be met when human experimentation is occurring, but that doesn’t mean that there isn’t a racial disparity that is still ongoing to this day. As scientists and doctors, we have a responsibility to learn the history of our professions so that we can learn from the mistakes that generations before us made and work towards a future that everyone can be proud of. No more racial discrimination in science or medicine. No more.

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Canadian scientist-in-training, learning cool stuff and writing about it

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