Gynecology was built on Black women's suffering. We're still reckoning with its racist roots today

In 2018, New York City removed a statue of medical icon James Marion Sims, which had stood in Central Park (just across the street from the New York Academy of Medicine) since 1934. The statue bore a plaque praising Sims' "brilliant achievements" in medicine; Sims, who died in 1883, was posthumously called the "father of gynecology." He is most famous for improving the technique to repair obstetric fistulas, which are abnormal openings between a woman's genital tract, urinary tract or rectum that cause urinary incontinence. While rare today in developed countries, an obstetric vesicovaginal fistula was a major complication of childbirth among 19th century women in America.

Though Sims' research sounds important on paper, his achievements — and those of many other "fathers of gynecology" — occurred at the expense of poor immigrant women and Black women, some of whom were enslaved. The removal of Sims' statue happened after New York City's mayoral commission looked at monuments in the city that could "create controversy" or "strong public response in the future."

"Pioneering gynecological surgical procedures, many of which were initially performed on enslaved women and later on poor immigrant women, were responsible for much of the field's rapid advancement in cesarean sections, obstetrical fistulae repair, and ovariotomies," Dr. Deirdre Cooper Owens wrote in her book "Medical Bondage: Race, Gender, and the Origins of American Gynecology." "Modern American gynecology could certainly exist without slavery, but slavery's existence allowed for the rapid development of this branch of medicine, and especially of gynecological surgery."

The removal of the statue of James Marion Sims is a symbol of a larger reckoning happening among medical historians, who are rethinking the role of figures in the field once considered iconic. The reckoning is occurring amid a larger cultural conversation that has involved bringing more of a people's perspective to the history of the United States, including within fields like medicine.

Salon interviewed the speaker, historian and author more about the origins of modern gynecology and the racist legacy that haunts the field of gynecology. This interview has been edited and condensed for clarity.

James Marion Sims went on to serve as the president of the American Medical Association in 1875 and the American Gynecological Society in 1879, which would be shocking to people now. But as you've written and spoken about, it was common in the 19th century to experiment on enslaved Black women. He wasn't unique in this.

So I really wrote the book to be more inclusive. My book wasn't about James Marion Sims, it was really about how in the world do we understand American gynecology without first understanding 19th century America and slavery. The institution of slavery was a big part of that. And so it's often surprising for people to learn that some of the first bodies that moved the field into what we consider a "modern" one were enslaved bodies.

I wanted to write a book that told the story of the patients, those patients who were essentially forced because of their status as chattel, as property, who were forced to have their bodies be used to cure other folk.

I think what's important for me is to show that in the Atlantic world in the late 18th century and the 19th century, across Europe and the Americas, that vulnerable bodies were used by men of science, by men of medicine, because they had easy access to bodies that that were owned by others, and so they could enter into these business agreements. I think what's important is to really dispel the myth that there's kind of like one person who did it all, but to really look at this as a snapshot of 19th century America. James Marion Sims really only becomes the father of American gynecology once he dies. Don't get me wrong, he does these pioneering surgical reparative methods, particularly for the debut of obstetric fistula, so he does these successful reparative surgical methods, but he's not called the father until after death.

And so for me, it was, let me show in the first chapter, kind of all of these men given the moniker of father — they're all building on really harmful beliefs around women, and especially Black women, that we don't experience pain, or if we do, it's pretty slight, that women generally think from their uterine and not their brains, all of those kinds of things are really detrimental. And the long-lasting effects are the things that have stayed with us.

As you just mentioned, there was a medical fictitious belief that Black women could withstand pain easier than white women. Today, we have a maternal mortality crisis that disproportionately affects Black women. Do you think a part of that false belief lives on in modern gynecology today?

I would just add one corrective, it wasn't just enslaved Black women, it was that all Black people were insensible to pain. You had really progressive men like [Founding Father Benjamin Rush — in fact, the only founding father with a medical degree — who, despite his abolitionist leanings, and politics — he believed in women's rights and prison reform and I could go on and on — and yet he has a talk published in 1799, that essentially says his Black patients [whom he had performed amputations on] were insensitive to pain, and were holding their limbs up not really knowing that they were supposed to be in pain or to express that they had suffered in some way.

These things have been pernicious, but also long standing. Every so often you'll start to see 18th century racial science crop up [in medicine]. Even in the 21st century... we have medical practitioners at every level who believe these fictions about the alleged differences between Black people and white people. And so yeah, I would say for sure that the remnants and the retention of an 18th century racial science that we should have done away with a long time ago, there's the imprint that is still with us.

Is the entire field of medicine predicated on racism, and experimenting on enslaved Black women or poor and powerless, women?

I wouldn't say the whole field of medicine. As a historian, I have to be very careful. I can't presuppose that these medical advancements wouldn't have happened. They might have happened had there not been enslaved people's bodies or poor immigrant bodies to experiment on.

But, I'm simply saying the development of certain branches might not have happened so quickly had there not been the institution of slavery that essentially allows you to use vulnerable bodies that are considered movable property. You don't have to ask these people whether you can experiment on them or treat them. You simply go to the owners, and it's a business deal. That was the nature of the economic relationship between medicine and slavery.

There are certainly branches that have depended greatly upon researching and experimenting on the exploitation of enslaved people, vulnerable populations, people who were orphaned or people who were institutionalized in some way whether those were prisons or hospitals for those suffering from mental illnesses, which then were called lunatic asylums.

I think about dentistry, I think about obstetrics and gynecology, I think about even the beginnings of epidemiology. There's a wonderful book by a historian of medicine named Jim Downs, it's called "Maladies of Empire." He looks globally at prisoners and enslaved people on ships and these doctors and scientists who are using their bodies to figure out if oxygen exists, or looking at the epidemiological origins of certain diseases. And so once again, I think some advancements happened because it was a society where there were so many people who were vulnerable based on a bonded status.

You've said before that these women experimented on are actually the forgotten "mothers of gynecology?" How do you think your book, and our understanding the history of medicine, would have been different if you could have read firsthand accounts of the enslaved Black women who were experimented on?

I'm writing about people whose names have either been lost to records, and if we do know their names, it's sometimes only the first name or some pejorative nickname. As a historian, when you're devoting so much time, years, going through these archives and reading these records, they're almost always records that are written by the men who owned these women.

But I can sometimes read through the doctor's words, through their case narratives, and I can sometimes say, "this person struggled." Some say the patient "lost sense of themselves and fought violently as we were trying to restrain them," so you know that the victimized patients weren't necessarily passive all the time. There's a whole mythology around the passivity of enslaved people, which we know isn't true.

In terms of James Marion Sims, I don't know if any of those women had been plantation nurses or slave nurses, where he got them from, but having to then perform work on each other and themselves... You know, I'm wondering how that felt.

For me, it was really about telling the history of American medicine, that included all of the players, and so even if I couldn't say "Betsy wrote this," I could at least say "there were 12 enslaved women, or there were five enslaved women" or "this doctor wrote about the surgical operations on the 'negresses,'" as they were then called. And I can pinpoint that there had always been a black presence as people were building and creating in legitimating these branches of medical study and practice.

So much is lost by not having firsthand accounts.

There's been a lot of talk about reparations in America, and I'm curious to hear from you. I mean, what can that look like in the field of gynecology? How can the country rewrite the narrative of gynecology more accurately?

That is a heavy question. And I think that there are many answers.

When I think about the long practice of extracting labor from [poor or Black women's] bodies or experimenting on those bodies — whether it's the experimentation of birth control that happened with mentally ill people in the in the early 20th century in Massachusetts in a hospital for the insane, or the Tuskegee Experiment, or the ones we've yet to discover — what I'd say in terms of reparations is that Black people's health care should not be linked to just your labor in the United States. I would say this for anybody in the United States.

In my estimation, it's not just universal health care, but also compassionate health care. And I always point to the Black birthing crisis that has gone on for as long as people have collected records. But beyond that, the United States continues to fail women and birthing people because the situation has gotten even more dire. For all women, and birthing people, Black women continue to be at the top of the statistics in terms of experiencing pregnancy complications in deaths. But for white women, those numbers for mortality and morbidity for them and in their infants is also increasing.

That's what I think we really need to reckon with is that there should be universal health care — because the system, as it stands now, is not helpful when it comes to reproductive health.