The founding of American gynecology

In the 1840s, a physician in Alabama was trying to solve a devastating childbirth injury. A long, complicated labor that wasn't able to progress could leave a hole between the bladder and vagina, called a vesicovaginal fistula. Women living with the injury leaked urine continuously. Many were isolated from their families and communities because of the smell, discomfort, and shame attached to the condition.

A successful repair would change medicine. Dr. James Marion Sims believed he could develop one, and the techniques that came from his work later became part of modern gynecologic surgery. For many years, that was essentially the whole story that was taught: a determined doctor, a difficult medical problem, and a major advance.

But here's the fuller story: Sims repeatedly carried out experimental surgeries on enslaved Black women — women could not refuse this if they wanted to. Historical records name Anarcha, Betsey, and Lucy, though other women were also involved and remain unnamed. Anarcha is believed to have endured dozens of operations before Sims reached the repair that brought him recognition.

These were real women who had to live through multiple — again, experimental — surgeries, recoveries, and the knowledge that the next procedure was coming. The legal system discussed earlier in this exhibition had already decided that their choices did not carry the same weight as the choices of the people who claimed ownership over them.

Plate from Types of Mankind (1854), by Josiah Nott and George Gliddon. Nott was a surgeon in Mobile, Alabama, an enslaver, a founder of the Medical College of Alabama, and later a gynecologist in New York. The plate does not compare a Greek man to anyone: the top figure is the Apollo Belvedere, a sculpture, set against a living person below it. Nott and Gliddon, Types of Mankind, Lippincott, Grambo & Co., Philadelphia, 1854. Public domain.

The question of anesthesia is often part of this history. Surgical anesthesia was beginning to enter medical practice during the years Sims operated on these women, but he didn't use it on enslaved Black women. American medicine was filled with false ideas about Black bodies, including the belief that Black people felt less pain or could tolerate more of it.

Many physicians, scientists, and medical schools of the time taught similar ideas about biological differences between races. Even Benjamin Rush — remembered today as an outspoken opponent of slavery — lectured medical students that Black and white people differed biologically in ways that shaped scientific racism. In the decades that followed, Penn physician Samuel George Morton published research he claimed proved that the races differed in intelligence and ability based on skull size. Those ideas were taught, repeated, and treated as legitimate science by much of the medical establishment. Rush lectured at the country’s first medical school and Morton’s craniometry was carried into its textbooks, so this was not a fringe position but the curriculum — and the physicians who learned it went on to attend births, decide who was given pain relief, and train the next generation to do the same. Once ideas like these become part of professional knowledge, they become deeply entrenched in classrooms, textbooks, and clinical practice.

In a 2016 study at the University of Virginia, researchers surveyed 222 white medical students and residents. About half marked at least one false claim about biological differences between Black and white people as possibly, probably, or definitely true — including the claim that Black people’s skin is thicker and that they feel less pain. Participants who held more of those false beliefs were also more likely to rate Black patients' pain as less severe and make different treatment choices.

Medicine has changed tremendously since the 1840s. Procedures that were once impossible are now routine. Countless lives have been saved because of advances in surgery, antibiotics, anesthesia, imaging, blood transfusions, and many other developments. That progress deserves to be recognized. But there are still impactful traces of these antiquated ideas in the profession.

For patients, that history also shapes trust. Pregnancy and birth ask people to do something remarkable: place themselves in the hands of others during one of the most physically and emotionally vulnerable experiences of their lives. Trust becomes harder when a profession’s history includes people whose bodies advanced medical knowledge, but whose choices and consent were treated as secondary, going all the way back to the beginning.

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