The founding of American gynecology

American gynecology has a founding story, and for more than a century it was told as a story of genius.

Between 1845 and 1849, in a small backyard hospital in Montgomery, Alabama, a physician named J. Marion Sims developed the first reliable surgical repair for vesicovaginal fistula — a devastating childbirth injury that left women incontinent and, in that era, often abandoned. The technique worked. It is the foundation of modern gynecologic surgery. Sims became president of the American Medical Association. Statues were raised to him, including one in Central Park that stood until 2018.

He developed the technique by operating on enslaved women. He did it repeatedly, over four years, without anesthesia, on women who could not refuse.

Ether was already in use for surgical anesthesia during part of this period. Sims did not use it on these patients. The justification available to him, and widely held in American medicine at the time, was that Black people experienced less pain.

We know three of their names because he wrote them down: Anarcha, Betsey, and Lucy. Anarcha was operated on around thirty times. There were roughly a dozen women in total. The rest were never named in the record at all.

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.

This chapter is the mirror of the one that opened the exhibition.

Act I was about what Black women knew and practiced, and how that knowledge was taken from them. This is about what was done to Black women's bodies in order to build the profession that replaced them. The two happened in the same country, in overlapping decades, to the same population.

The part that reaches into a shift this week is the belief, not the surgery. In 2016, researchers at the University of Virginia surveyed medical students and residents and found that a substantial share endorsed false beliefs about biological differences between Black and white bodies, including differences in pain tolerance and skin thickness. Those who did so rated Black patients' pain lower and made less accurate treatment recommendations.

That is a hundred and seventy years after Montgomery, in people who were not yet licensed.

The technique survived because it worked. The belief that justified how it was developed survived because nobody went back and removed it.