Behind the Bastards - Part Two: The Father of Gynecology

Episode Date: July 14, 2022

Robert is joined again by Dr. Kaveh Hoda to continue to discuss the history of gynecology. See omnystudio.com/listener for privacy information.

Alphabet Boys is a new podcast series that goes inside undercover investigations. In the first season, we're diving into an FBI investigation of the 2020 protests. It involves a cigar-smoking mystery man who drives a silver hearse. And inside his hearse look like a lot of guns. But are federal agents catching bad guys or creating them? He was just waiting for me to set the date, the time, and then for sure he was trying to get it to happen. Listen to Alphabet Boys on the iHeart Radio App, Apple Podcast, or wherever you get your podcasts. Did you know Lance Bass is a Russian-trained astronaut?

That he went through training in a secret facility outside Moscow, hoping to become the youngest person to go to space? Well, I ought to know, because I'm Lance Bass. And I'm hosting a new podcast that tells my crazy story and an even crazier story about a Russian astronaut who found himself stuck in space. With no country to bring him down. With the Soviet Union collapsing around him, he orbited the Earth for 313 days that changed the world.

Listen to the last Soviet on the iHeart Radio App, Apple Podcast, or wherever you get your podcasts. And I say, they seem to be fine. We sheared them recently. Respectfully, I care about your goats. They're goats, you know? They're good. They're good at stuff. They're pretty hearty. They're so pretty. That's why they've been goats for so long. They make my heart full.

Kava, have you ever known any goats? You've been friends with the goats? Dr. Kava Hoda? Are we starting? Oh, yeah. We started a while ago. Your introductions, they're just like an inspiration to us low level podcasters. It's like, you know, people who don't appreciate your intros, they're like the same group of people that thought like Miles Davis,

Bitches Brew was just sound. You know what I mean? Thank you. Thank you. A lot of people compare me to Miles Davis for many reasons. You're like the thirst and more of podcast introductions is what I'm trying to say. Thank you. Not quite as good as Ray Donk, who pioneered the tuk-tuk sound, but yeah. Agreed. And to get to your question, I don't know goats,

but they were domesticated in Iran. That's a fun fact for you. They were. I didn't know that. Yeah. They were. You're welcome. The Angora goats I have. Angora comes from, I think, Angkawa.

So those are, I guess, turkey. But yeah, that's that whole... Not as good, but that's cool. Not as good. Not as good. I don't have any. I mean, minor Nigerian. Oh.

Some of them. Yeah. They're beautiful. I would love to get some Iranian goats one day. My goats are very cosmopolitan, you know? They don't judge. Yeah. Everyone could use an Iranian goat, I suppose.

I would love an Iranian goat. So we are. This is happening. This is the show. This is the show. This is the show. Oh, yeah. So how do you like medical experimentation on unconcenting people?

I don't love it. I don't love it. Not a fan. Not a fan. Okay. Yeah, that is one of those things that is currently not supposed to be done. We'll see. Give Skotis another couple of years, am I right?

Good times. So we should probably start by talking about what the experiments that Dr. Sims was conducting on these women actually entailed because boy, it's a little gruesome. As we noted last time, Sims bragged that there was never a time in which he could not experiment on a subject if he wanted to. But he also noted, quote, my operations all failed. This went on not for one year, but for two and three and even four years. And failed operations in this case means a woman is cut into and then gets no relief

from the already unpleasant symptoms that she's dealing with, right? So this is a problem, right? Absolutely brutal. Yeah. It's gnarly. And obviously, like, I don't know, one of the things that is a little more complicated, at some point, some group of people were going to need to endure surgeries that were not pleasant in order to figure out how to do this properly, which is the case with every

surgical procedure, right? Some number of people are going to have to go through that procedure when it is less polished and effective because, like, that's the way learning works, right? Yeah. It is. It is. But it's always, there's always cares taken to do as little harm as you potentially can. And it makes a big difference if you say, yes, I'm willing to endure this for the sake

of not just my own relief in the future, but expanding the frontiers of human knowledge. Yeah. Exactly. That whole consent issue. It's like a lot of astronauts died and we celebrate how cool that whole period was for us in the Soviet Union, but a lot of them died. And it would be less of a cool thing if they had been forced at gunpoint to go risk their lives in spaceships, right?

Right. There would be less movies made about it. Yeah. Apollo 1 would be an even more fucked up story if, like, those guys had been led into that capsule at gunpoint before they burned alive in there. Right. Yeah. But, you know, again, it's fundamentally noble and beautiful when human beings agree

to endure suffering to expand the frontiers of knowledge. It's really fucked up when you force them to do that. I don't think this is complicated ethics. I'm not a great ethics guy, but I think this is pretty cut and dry. Now, I will say Sims was a competent scientist in the technical sense. He was methodical with how he proceeded with his experiments. He started by having his own specialized instruments made, which took him three months. The first of these patients that he operated on was Lucy.

She was 18 years old and she had just given birth several months before this all started. Because again, when you're talking about enslaved women, their primary economic value is in producing more people that you can buy and sell. And so you start that process as early as you can. Sims noted, quote, the case was a very bad one. The whole base of the bladder was gone and destroyed and a piece had fallen out, leaving an opening between the vagina and the bladder at least two inches in diameter or more. That was before the days of anesthetics 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. All the doctors had seen my notes and examined them and agreed that I was on the eve of a great discovery. Everyone of them was interested in seeing me operate. Now this was initially true. Sims's experiments were at first attended by many other doctors and there was a lot

of enthusiasm for his work. It is worth noting though that during this procedure, his patients were kept completely naked. They were asked to sit on their knees and bend forward onto their elbows with their heads resting in their hands. Lucy's surgery took about an hour and the doctors who viewed it reported that she screamed and cried the entire time. Sims himself wrote that Lucy's agony was extreme.

His fellow doctors were, again, these are guys who are fine with using enslaved people as test subjects, but they were still horrified by how brutal this was. The realities of the surgery became too unsettling for a lot of them to ignore. Sims himself wrote, quote, I succeeded in closing the fistula in about an hour's time, which was considered to be very good work. I placed my patient in bed and it does seem to me now, since things were so simple and clear, that I was exceedingly stupid at the beginning. Now in specific, the stupid thing he had done was he'd used a sponge to draw away urine

from the bladder. Given the fact that people didn't know properly about things like germs and sanitation at this stage, he wound up giving her blood poisoning. Yeah, so he had to do a bunch of stuff as a result of this blood poisoning. He thought that she was going to die from it. She barely survived. It takes her months to recover from this first operation, which isn't most. I think most people would be like, well, that's not great.

That's not how you want that to go. Sims is encouraged, though, because once she does survive and he gets her on his table again, he sees that the fistula he'd been working on, it hasn't gone away, but it's smaller than he was now than it was. Now since he can't operate on her again right away because she nearly died. So he immediately follows up by bringing Betsy up and doing a different version of the experiment on here using a self-retaining catheter instead of a sponge. Now this experiment failed, too, and Sims makes no note as to how painful it was for

his subject. And it's probably worth noting going back to one of Sims's colleagues at this point to, again, give a contrast for how other doctors were approaching the same problem. In his defense of Sims, Dr. L. L. Wall argues that fistuli were just so horrific that we can assume consent on behalf of the women used to subjects, even though they were enslaved, because who wouldn't want to be cured of this? Quote, and this is Wall, consider the following description of what it was like to be a woman with a vesicovaginal fistula in the mid-19th century, given by Dr. P. M. Coluck at the annual

meeting of the Georgia State Medical Society in April, 1857. The poor woman is now reduced to the condition of the most piteous description, compared with which most of the other physical evils of life sink into other insignificance. The urine passing into the vagina as soon as it is secreted and flames and excoriates its mucus lining, covering it with calcareous depositions, causing extreme suffering. It trickles constantly down her thighs, irritates the integument with its acrid qualities, keeps her clothing constantly soaked, and it makes her basically insupportable to herself and all those around her.

So in pointing this out and kind of harping an extent about how unpleasant these things are to endure, Wall is basically repeating the argument that Sims makes in his own memoirs. Here's how Sims writes about his third named test subject, Anarka. Quote, her life was one of suffering and disgust. Death would have been preferable. But patients of this kind never die. They must live and suffer. Anarka had added to the fistula an opening which extended into the rectum.

Her person was not only lonesome and disgusting to herself, but to everyone who came near her. Now, this is Sims's argument for why his experimentation was noble. Life was unlivable in this condition. So what choice did he have but to repeatedly cut into these people? Now he conducts at least 30 failed surgeries on Anarka, each as gruesome as the ones we've detailed before. And this again, there's a lot that's fucked up here.

For one thing, he's the one saying death would have been preferable. She doesn't say death would have been preferable. This fucking guy, I bet you he doesn't even get like a rectal exam without taking a Vicodin first. You know what I mean? Exactly. To go through an hour long plus thing naked, all these people staring at you. This intense pain.

It's honestly the something out of it's like out of the movie hostile. Yeah. It's it's and again, all of these doctors are kind of like pointing, doing something fucked up even because that description we've read above is of a of a free woman like dealing with it. Now horrible it is. No matter who they're talking about, they all make the comment that like your life isn't worth living with this thing.

And again, none of them ask these women if they think their lives are worth living, right? Like that's that's one aspect of this that's messed up. And if they did that even bother to document it, they didn't care enough that it didn't matter enough to them to document it. They think it's gross. And so like that's to them, it's like that's again, not that this is not a serious problem. It very clearly is. But that's pretty messed up in my head.

Now Monica Cronin adds in the Journal of Anesthesia and Intensive Care, quote, After years without success, Sims decided to stop operating until he could solve a problem with sutures. He describes the women in his hospitals becoming clamorous for him to continue. The impression he creates is that the women were desperate for him to continue his experiments, which cements their role as collaborators. Now a few things are worth noting here. The first is that the conditions affecting Anarca and the other enslaved women that Sims experimented on did not form in a vacuum, while many free women also certainly suffered

from fistula, including members of royalty and other ladies of wealth and status. Slavery absolutely influenced the condition. This is ignored in nearly every discussion of what was done to these women. Anarca went into labor in 1845 when she was 17 years old. This was thankfully her first delivery. She spent three days in agony before a doctor arrived. Monica Cronin writes, quote, Biological anthropologist Patricia Lambert writes that nutritional deficiency diseases such as rickets, scurry, pellagra, and iron deficiency anemia are thought

to have been common in enslaved communities. Perhaps like other enslaved people, Anarca's diet was nutritionally deficient, and she developed rickets, which caused malformation of her pelvis, obstructed labor was a common result. So again, part of why Anarca and these other women may have had difficult laborers that led to these fistula is that they were malnourished because they were enslaved, right? I'm sure nobody was getting great prenatal care back then, but nobody was getting it worse than these women.

Yeah. Now, the doctor who finally shows up to treat Anarca when she's having this difficult pregnancy was, of course, James Marion Sims. He was eventually able to deliver her baby using forceps, which he had very little experience with because as he later wrote, if there was anything I hated, it was investigating the organs of the female pelvis. He noted that the baby's head was, quote, so impacted in the pelvis that labor pains had almost ceased.

Anarca did survive the surgery, but the use of the forceps in the general nightmare situation of the labor are what led to her fistula. It is worth noting James Marion Sims does not record whether or not the baby survived. He didn't consider that particularly like worth noting at all. And she could not write or read, we know nothing about how she felt about the conditions she suffered after pregnancy. Sims writes luredly about how nasty and gross it was. And I think his attempt, his account of her drips with clear disgust disguised as sympathy.

That said, her condition was undoubtedly painful. And like any person, she surely desired a cure. That does not mean that she must then have truly consented to Dr. Sims's experimentation. We don't have to theorize on this matter. The existence of contemporary doctors like Hayward, who conducted fistula surgeries and experimented on free consenting people at the same time, puts the lie to this. Quote, and this is from Cronin, Hayward records the way in which some women he treated simply returned home, although a cure had not been achieved and he never heard from them again.

The patient presented in 1842, four years before anesthesia, and Hayward records that she evidently had no confidence in a successful result and therefore returned home, despite being in very much the same condition she was when she came. Here, Hayward records a situation in which consent was conditional on a successful outcome. Given the opportunity to grant or withdraw consent for further surgery, this woman withdrew it, despite the limitations brought on by her condition. And that's the kicker to me, right? Other doctors who were fighting the same condition that Sims was held to something that approximates

modern medical ethical standards, right? They attempted what they attempted. And when the woman said, I'm done, they let her go, right? And that also shows that, like, yeah, it's very impossible, all these women, after that first surgery would have said, you know what, I'll deal with it. We can't know because they never got the chance to, but like... I can't imagine. I honestly just can't imagine.

And I know that they probably did this whole thing like, well, women are just stronger than men. They can handle this. Oh, yeah. We're talking about that a little later too. Yeah, yeah. But I mean, I just, I mean, I can't imagine anyone strong enough to deal with that. I mean, I, yeah.

There are certainly some people, I suspect out of the population of people who had this, there would have been, there were individuals who would have truly and freely consented. Yeah, if it takes 30 times, let's fucking do it. There's always people who are kind of outliers like that. The fact of the matter, and maybe some of the women that Sims was experimenting on would have freely chosen this, but we'll never know, right? Like no one bothered to ask them and they were not able to give free consent. I just, I mean, at any point in his writings, Sims, does he like acknowledge this was crazy

what this, this patient went through doing these surgeries so many times? Does he acknowledge? He's made a couple, he makes a couple of blade of brief claims that like, oh, she handled it bravely. Like, but honestly, I mean, again, he doesn't even name the majority of the women he was experimenting on. And we don't even know how many times he did on each of them, right? We know he experimented 30 times on an ARCA before he got it right.

Now, obviously, most people in medical science as a whole today takes it as axiomatic that an enslaved person cannot consent to being experimented on medically. Dr. Waldez agrees with this and he uses Sims' own writing to argue that consent was given, quote, Sims gave numerous accounts of these early fistula operations during the course of his career. And although they differ in some details, they all state quite plainly that he discussed what he proposed to do and obtained consent from the patients themselves before undertaking any operations.

Writing in the New York Medical Gazette and Journal of Health in January 1855, for example, Sims declared, For this purpose, I was fortunate in having three young healthy colored girls given to me by their owners in Alabama. I agreeing to perform no operation without the full consent of the patients and never to perform any that would, in my judgment, jeopard life or produce greater mischief on the injured organs. The owners agreeing to let me keep them at my own expense till I was thoroughly convinced

whether the affliction could be cured or not. Now he writes this in 1855. Now he starts his experiments in 1845. He finishes in 49. Right. So this is something he's writing years after he gets his, this is how we do it kind of thing. A lot of Sims critics will point out that his autobiography, which is published decades

after this, emphasized consent because it was now vogue to act like you'd always believe that slavery was bad. The fact that he does write this about their consent prior to the Civil War could be seen as evidence that he did care about obtaining what he saw as consent. However, he's also writing for an international audience who view slavery rightly as a boring. So you could also argue that he just knew he was like playing to a crowd about his patients' autonomy. Right.

He's writing for Europe, you know, because he goes and he works in Europe after this, right? Yeah. That's probably why he makes this note. More importantly, Monica Cronin notes that Sims's recollections and claims about his own work and treatment of his patients were never entirely trustworthy. He claimed in his own public writings that in 1845, prior to starting his experiments, he had investigated the literature on the subject thoroughly and walked away convinced

that there were no good solutions proposed. This is unlikely. Hayward had published his first account of a successful procedure in 1839. That's six years before Dr. Sims starts his. Another doctor, Matt Tower, had done the same in 1840. Now, without Bing, which is the search engine we all use, I'm aware, searching was a lot harder. Ask Jeeves, actually.

No, you're a Jeeves man, you're a Jeeves man. That's not my brand, but I respect it. But without the only two good search engines being an asked Jeeves, searching was a lot harder back then. But Monica Cronin notes in 1853 that Dr. Sims wrote a monograph that mentioned the work of both Hayward and Matt Tower. Now, maybe he was unaware of them in 1845, but he, there's a good chance he was aware of them.

And one could argue that he should have been aware of them because they were some of the only dudes publishing in the field that he was experimenting in. Absolutely aware of them. I'll tell you how it goes. He'll go to some sort of convention and he'll go to some sort of like thing where he's with a bunch of doctors trying to impress all these doctors from Europe with his like procedure and his technique. And then what those doctors do is try and impress everyone in the room with their knowledge

of the literature. And one of those doctors was surely knowledgeable about prior cases and brought it up. And his response was probably like, well, you know, yes, of course I've seen the paper. Yes. I've seen the case report. But, you know, that they weren't dealing with the type of fistula that I'm dealing with here. This kind of fistula is a very different thing, et cetera.

So he was definitely exposed to it. Yeah. I think that. And again, that's, again, that's what Cronin's arguing. And by the way, the fact that you've been talking about anesthesia a couple of times, the fact that she is an expert on anesthesia, writing for the Journal of Anesthesia will be real relevant. But we got some other shit to get through.

But you know what we got to get through first, Kave? Yeah. I know. We got to get through capitalism. Capitalism is the thing, man. I'm all about it. I'm all about it. It's good.

It allows me to have. Goats. Thank you. Goats. Think capitalism for your goats. Honestly, I think the goats are before, but like pretty good sandwiches. I will say this for capitalism. It's been a real boon for sandwich innovation.

Yeah. Probably. You have fewer kinds of sandwiches prior to capitalism. Yeah. I think I can come out of capitalism. I think I can agree with that. Sandwiches. And yeah, yeah.

Goats. Sandwiches. And goat. And goats. Goats invented. Goats invented. The goat invented by John capitalism. In 1940.

All right. During the summer of 2020, some Americans suspected that the FBI had secretly infiltrated the racial justice demonstrations. And you know what? They were right. I'm Trevor Aronson and I'm hosting a new podcast series, Alphabet Boys. As the FBI sometimes, you got to grab the little guy to go after the big guy. Each season will take you inside an undercover investigation.

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Okay. So when it comes to modern defenses of Dr. Sim's LL Wall next claims, quote, as a matter of surgical practicality, considering the delicate and tedious requirements of performing surgery inside the vagina and the exceedingly difficult circumstances of exposure and inadequate lighting under which he was forced to operate, Sims could not have carried out these operations successfully without the cooperation of the women involved. Even the slightest movement, much less the active resistance of these patients, would have rendered it impossible for him to have completed his operative procedures.

Indeed, when his regular medical assistants tired of working with him, Sims trained the patients themselves to act as his surgical assistants, and they thereafter helped him operate on one another in turn. He ends that sentence with an exclamation point. Now, there's a lot that's wrong with that, right? There's a lot that's wrong. She didn't fight, so she must have been fine with it. Oh, I hate this so much.

Now, first off, his argument is, again, they must have consented because they didn't fight, and then they were so into it that they got trained as surgical assistants, which he frames as like, look at how cool it is. They're helping him with his great work. Again, he frames this as kind of a triumph. However, number one, obviously, he effectively owns these women in a legal sense. They could not have agreed to it. But also, like, other write-ups of the fact that he trains some of these women to be surgical

assistants are a lot less cheery. Oh, can I guess? Yeah. Is it more like, you need to hold this person down while I do this? Ding, ding, ding, ding, ding. Yes, yes. I hate this guy. By being, he is literally, they're not fighting, and they're agreeing to hold down each other

while you're like, it's pretty bad, like what you think about it, that wall today is making that argument. Again, Wall simply says that Sims is regular medical, by which I mean white, medical assistants tired of the work, and that's why he had to train these women. The context Cronin provides makes the reality seem a bit more dire. Quote, originally, Sims had a lot of support from the local medical community. For Lucy's operation, he records another dozen or so doctors in attendance to witness his work and to insist and support him.

As time passed, he received less and less support. His brother-in-law, also a doctor, all but begged him to stop, citing the expensive housing additional enslaved women as well as the injustice to his young and growing family because his attention was so diverted. Within two years of beginning his experimentation, Sims was cast into professional isolation. He wrote that despite the many problems he experienced, his patients were, all perfectly satisfied with what I am doing for them. I cannot depend on the doctors, and so I have trained them to assist me.

So furthermore, when Sims does finally figure out how to do this procedure in a replicable way, and he publishes an article on it in 1852, he figures it out before, but the article comes out in 52, he describes several parts of the procedure for which assistance was required, like the things he needed these women's help for. And as you said, first, I mean, it does include stuff like cleaning instruments and holding the speculum in place, but it involves having them hold each other down while he performs surgery on them. You can, yeah, I'll make your own conclusions about the ethics of that, but it's real weird

that Wall goes to bat for this part of it to me. That's what's interesting about this, and I'm actually kind of glad that you've given me someone to hate that's still alive. You know what I mean? It's rare that you do that. Usually, you give me these stories of people who are terrible, and then they die, and they die happily and peacefully. But rarely is there like, oh, there is a chance that this person could experience some consequences.

And that's almost heartwarming to me. Yeah. And one of the stories that we're not going to get into enough of the last few years is Wall like steadily losing this argument within his own field to people, because he has, he spent years defending Sims. And eventually, people have pretty much stopped listening. I don't know what's going on with the guy, but he is very much dedicated to like defending this man's legacy.

Yeah. Yeah. As opposed to just like defending like, well, we need to, you know, this is a chapter in medical history that's worth studying, which it certainly is. But part of what's worth studying is stuff that's fucked up about it. Yeah. Yeah. So nearly every critical piece about Dr. Mary and Sims will note that one of his sins

was failing to use anesthesia on his enslaved patients. NPR writes a pretty representative summary of this critique, quote, modern critics of Sims also note that he conducted these experiments without anesthesia, although the commission does not focus on this element of his research. His research began during the early days of modern anesthesia, as his defenders have noted, after perfecting the technique on black women without anesthesia, Sims went on to offer it to white women. But he treated white women with anesthesia, Gamble noted Sims's own statements on this

are mixed. Years after his initial tests, he said he still didn't believe in using anesthesia for fistula surgeries, because they are not painful enough to justify the trouble and risk. But he also said the experimental surgeries on his enslaved subjects were so painful that none but a woman could have borne them. And in his autobiography, he describes conducting fistula operations in Europe on wealthy women who were sedated. So this is such like a small part of a bigger problem about how men do all kinds of things

do awful things to women and then basically are like women. How do they handle us? Huh? Wow. So strong. My wife put up with me sucking so bad and clearly and you're probably going to talk about this later. But clearly, you know, this a big part of his his thought that like she can handle the pain

is because she's black too. Because that was a racism. And now. And now I don't know. We'll get to that. Yeah. Yeah. We'll get to that.

That's the P&S that I want to tell you about later if you don't already have it. Oh, we're going to talk about your P&S a lot. Yeah. Let's get into the P&S. We had to had to do that at some point. Yeah. Yeah. It was inevitable.

It was inevitable. That was just physics, baby. That was just that was just tides rolling in. So now I will note. So NPR makes the statement that like he does conduct fistula experiments or operations of women who are sedated in Europe, it is worth noting to be completely fair about this that NPR does not make a note of when he used anesthetic on wealthy white women. And this is important, right?

And this is again, not to like forgive this man, but it is worth noting just to be accurate. This is a period in which they are starting to figure out anesthetics, right? This is a period in which that that science is very much being born in a meaningful way. It was a not at the time, a completely agreed upon thing. There was substantial medical debate on whether you should anesthetize patients and when you should anesthetize them and how one of the, this is aside, but one of the weird things to me is that they figure out how to make and have and use nitrous oxide like a hundred something years before this point, like in the 1700s, people are having like nitrous parties.

They don't use it until like around this period for the first time in an actual medical procedure. Like we know about this shit for a hundred years before someone's like, Hey, this thing that makes it impossible to feel pain and makes people just kind of like pass out. What have we, what have we used that on surgery? Could we maybe try that instead of like getting them drunk and hacking off a limb? Right. At some point someone would be like, they would move a lot less, I think if they weren't screaming and writhing in pain.

Seems like alcohol sucks as a painkiller. Oh, well, back to the axe. It does. It is one of those things where it's like, you had like, you had God's perfect anesthetic for a hundred years before anyone was like, what if we use this for surgery? Could this work on the biggest problem in medical science? Yeah. I mean, also like, party in with it.

Fuck it. Just keep this at the parties. Like, I mean, by 1846, like, it had been well-described as in the few. Yes. We're getting into that. Yeah. Sorry. Go on.

I just wanted to note that like the fact that he's doing in the 1860s in Europe, he's using anesthetic, doesn't mean that in 1845 he would have had it, right? Right. Right. Or known that it was the right thing to do. The timing matters here because you can't specifically call it cruelty for not enslaving his enslaved, for not sedating his enslaved patients. Yeah, if he did not have the ability to do so, right?

Right. This is basically the argument that Wall makes in defensive Sims in this specific aspect. Now, again, this is why I'm particularly partial to Monica Cronin's reposts to Wall because she is an expert in the history of anesthesiology and she is particularly trenchant in her dissection of these claims. She notes that while Sims did his experiments in Alabama over in Georgia where he had also spent time, a prominent doctor named Crawford Long had been using ether as a sedative since 1842.

Tools like that could have sedated his patients were available if he had wanted them. I should note, as Cronin does, that the concept of anesthetizing patients was new in this period. It was not universally agreed upon as to when you should anesthetize people. That said, she seems to conclude that based on the experiments going on around him, it is unfair to criticize him for not using the anesthetics when he started in 1845. He may not have realistically been able to get access to them, but after 1846 and he carried out dozens of surgeries after 1846, he had the opportunity, the tools were available

and it was well documented that they worked. Quote, Leonard F. Vernon argues Sims's lack of training and experience in the use of ether would have prevented him from using it as it may have been more of a danger than the actual surgery. The idea recurs in defensive Sims, yet lack of training and experience did not stop him from using forceps on an arca. Certainly did not stand in his way when attempting surgical repair for obstetric fistula and it did not prevent other medical practitioners from using ether anesthesia in their day-to-day

practice either. It's like being like, well, it was still a little experimental and maybe he didn't know how to use it. It's like, he didn't know how to do any of the shit he was doing. He was an experimental physician. I mean, they were doing it for dental procedures. Yes. Yes.

He could have. He was just a sort of, you know, excruciating, horrific procedure without sedation. And obviously, like, again, I think that you should have to consent for, I had an uncle who died because he got anesthetic that he really did not want and it was kind of like a fucked up situation. This was before I was born, obviously, but like, I think you should have to consent before getting anesthetized, obviously, at least to the extent that that's possible. Sometimes people arrive in like a sedative extremis and, you know, you have to assume

certain things. But in the case of an experimentation, obviously, they can't consent to being anesthetized any more than they can consent to the experiment. But if you're going to experiment on unconsenting people, I guess it's better to try to sedate them. Yeah. Yeah. I don't know.

If you're going to do something bad to them, at least do something bad that makes them comfortable. Yeah. At least try to all, at least show that you care about their comfort. I guess, I don't know, mitigating is the wrong word, but that would at least show that you view them as things that like people that are capable of experiencing pain, right? Um, so, yeah, now, in PR, another critical write-ups of Sims will suggest that he may have acted as he did out of a widespread belief that black people suffered pain less acutely

than white people. It is worth noting that this errant belief is still very much alive in medicine today and influences patient treatment and outcomes in 2022. As the website Hidden Brain notes, quote, black patients continue to receive less pain medication for broken bones and cancer. Black children receive less pain medication that white children for appendicitis. One reason for this is that many people inaccurately believe that blacks literally have thicker skin than whites and experience less pain.

Again, this is, it's certain that this affected Sims. As far as I'm concerned, it is an absolute fact that this impacted Dr. Sims's treatment of these people because it still impacts the way doctors do their shit today. Um, now, obviously, LL Wall rejects this. He notes that Sims repeatedly talked about how much pain Anarka, Betsy and the other women were in. He definitely does talk about them being in pain, but it's always so that he can be like what a hero I am for treating them.

And like they wanted me to, like, right, anyway, um, part of, yeah. Sorry. I, before we get, leave that point, I mean, I think it's a really important point to show that it's still an issue that question about people thinking that black people had thicker skin, literal thicker skin, they tested that amongst medical students and medical students thought a little bit more than the average, like thought a little bit more than you would expect that black people had thicker skin. Jesus Christ.

Yeah. And no, it's terrible. I mean, you know, medical students are not like born out of some sort of vacuum. They come from society. No, no, of course. But, but you know, you would think those people would know a little bit better, but that was not uncommon. There was a, that, that study about the appendicitis, the, the white kids getting more medication

for appendicitis and black kids. I was like back in 2005, 2015, there was a journal of pain article that came out showing that, uh, pharmacies in black neighborhoods always carried less, uh, opiates and pain medication than the pharmacies in white neighborhoods, like almost across the board. It was, it, so just in general, that's, that's still, I'm glad you brought up. It's still a problem we have in the medical community. I mean, it's, it's been talked about for, for a while now, but every couple of years, a new article comes out saying like, we're under treating these, this population.

Jesus, God, um, well, so when it, I mean, what, one thing, so I, again, I don't want to just be, because LL wall is very, very specific whenever people make arguments about this guy and he gets into like the, well, he says this and this guy says, so to be specific, I just mentioned, I'm certain that, that Dr. Sims had this racist belief about his black patients, there is documented evidence that he held beliefs like this, um, and not just towards black people. And this is, again, makes that case, uh, and I'm going to quote again from Cronin's write up, Mary Smith was one of the first women listed on the patient register at Sims's

newly opened women's hospital in 1855. Her first delivery had been in Ireland where she had experienced a prolapsed uterus, a herniated and prolapsed bladder, fecal incontinence and urine leakage that had rubbed her vulva raw. On examination, Sims declared her a most offensive and loathsome subject. Sims and his junior colleague, Thomas Emmett, performed over 30 operations on Smith over a six year period without anesthesia. The women's hospital did not routinely administer anesthesia until after the end of the Civil War in 1865.

The way Sims wrote about treating a woman patient in France in 1861 provides a stark contrast to Mary Smith's treatment. Even with five other people who could assist, Sims performed two operations on a 21 year old woman. She was, he wrote, young, beautiful, rich and accomplished. And he had never seen a case of this kind, which was attended with such suffering. Clearly, none of the enslaved or poverty stricken women he treated earlier had displayed their suffering in quite the right way.

This was a woman who, as Sims described, belongs to the higher walks of life. So he not only is this a guy who certainly believes that enslaved black women are less capable of experiencing pain, he believes that poor Irish women do not experience pain to the same way as this rich French lady. This is documented and it's very clear when you look at the writing about this. This is a deeply classist, racist man who believes that your ability to experience suffering is dependent upon your social status. Yeah.

The whole Princess and the P thing. If you're rich and you come from like aristocracy, you could feel the tiny little pee on your gentile skin from like 14 mattresses away. Yeah. And it's just very telling to, again, 1855, 10 years after the start of these experiments when there were certainly anesthetics and sedation available, he is still when the woman's poor and somebody he doesn't think about as like a proper woman operating without any kind of anesthetic.

Right. And again, 30 operations on this lady. You know? Wow. But you know who always operates with anesthetic? At least most of the 30 times. Yeah. The products and services that support this podcast will make sure you have ample access

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During the summer of 2020, some Americans suspected that the FBI had secretly infiltrated the racial justice demonstrations and you know what, they were right. I'm Trevor Aronson and I'm hosting a new podcast series, Alphabet Boys. Because the FBI sometimes you got to grab the little guy to go after the big guy. Each season will take you inside an undercover investigation. In the first season of Alphabet Boys, we're revealing how the FBI spied on protesters in Denver. At the center of this story is a raspy voiced cigar smoking man who drives a silver hearse.

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He's part of that whole Blue Zone diet, they live to the story of the long ages. Lot of shellfish in the ether. Some ceviche, a jar of ether, and thou, baby. That's the secret. Oh, man. That's not a bad, that's not a bad afternoon, actually. So anyway, once Dr. Sims, because he figures this, I think, 1849 is like when he kind of gets it right, although obviously the fact that he takes him 30 times to get it right

on another patient in 1855, it's a messy process, right? But he releases his bombshell report on how to fix fistula in 1852. He releases a follow-up monograph in 1853, and he becomes famous across the world. He moves to New York City, and he starts the very first hospital for women in the United States. That is Dr. Sims, first women's hospital. Now this is really controversial at the time, and he does, again, a lot of people think it's gross to do medicine on women.

So he does have to, he does get, I don't know what credit you want to give him, but it is like a thing. He has to fight to fund and operate this hospital and to train doctors specifically in treating women's health issues, and that's a positive move. It's good that that happened. During the Civil War, Sims, who described himself as a loyal southerner, moves to Europe, where he works on fistula patients across the continent and the Isles. There is some evidence that he acted as a government agent for the Confederacy while

he was there, helping them seek loans and diplomatic recognition. Secretary of State Seward describes him as a, quote, secessionist in sentiment and hostile to the government. It's very possible he was a Confederate spy while he was in Europe. Another reason to not root for this dude. Yep, yep, he really keeps making the decisions he keeps making. In 1863, while the war is, you know, going, going around, it's kind of like the height of shit.

He treats the Empress Eugenie of France for a fistula. This is like one of the things he's most famous for is he fixes the, because she's this back when France as an Empress, they don't for, in like another seven or eight years, because they lose a war pretty bad. But at this point, she's like one of the most famous women in the world, right? She has a fistula. He fixes it. This is controversial.

There are claims that there's zero evidence whatsoever that he actually treated her for anything. And people who will argue that he was basically pretending to treat a medical issue in order to secretly do diplomacy with France on behalf of the Confederacy. Obviously, I'm not competent to go into detail on that, but it is an argument people make. He was very likely doing some shady shit on the Confederacy's behalf while he's in Europe. He remained a racist his entire career, as this section from NPR's Write Up Makes Clear. His racism had brutal consequences for patients outside the realm of gynecology too, quote.

Before and after his gynecological experiments, he also tested surgical treatments on enslaved black children in an effort to treat Trismas nasentium, neonatal tetanus with little to no success. Sims also believed that African Americans were less intelligent than white people and thought it was because their skulls grew too quickly around their brain. He would operate on African American children using a shoemaker's tool to pry their bones apart and loosen their skulls. Oh, my God.

Again. Fucking hate this guy. A dude who sucks here. Yeah. Fucking hate this guy. Yeah. He's a pretty bad guy. Dr. Sims stayed in Europe for a while after the end of the Civil War.

He returned in 1871 to work at the women's hospital and eventually he establishes the first cancer institute in the United States, the New York Cancer Hospital. He was a unanimously elected president of the American Medical Association in 1876. In 1877, he starts suffering angina attacks. He catches typhoid in 1880, which starts a rapid decline. He makes his, he writes half of the autobiography basically that we've cited today when he dies of a heart attack on November 13th, 1883 in Manhattan. In recognition for his achievements, J. Marion Sims had several statues made in his honor,

including one in Manhattan Central Park. After years of controversy, it was removed in 2018. I think a couple others that were moved in 2020, at least one. And yeah, that's, that's that dude. I, I mean, this is obviously he's, this guy is a true bastard. Yes, I think that's clear. But what, but what is interesting and really important about this is that, I mean, there's echoes of what happened because of him that still reverberate through today and cause us

a lot of, in the medical community, a lot of, I think, would need to be some deep introspection and some reckoning. I mean, things like this, Henrietta Lacks, Tuskegee, how could they not leave these real intense historical scars on the collective psyche of this community? Yeah. Who, by the way, I mean, if you, they'll, they'll, you'll probably hear some of the, you'll hear reports, a lot of African Americans don't feel like they're being listened to by the medical community.

We talked about some of the studies that show they got less pain from the, the PNAS, the really great name of that. What's that? Is it procedural, procedure, procedurals of the National Academy of Sciences? Yeah. In the 2016 article, that was the show that they got less pain meds and that is, you're still to this day, like African American women, indigenous women are two to three times more likely to die during childbirth.

I mean, this is still stuff that we're dealing with. And because of this, understandably, as a doctor, I run into a lot of, uh, iatrophobia, like people afraid of the healer of the medical community and, and when, so people are like, why would the African American community not want to get the COVID vaccine? You're like, fuck, look, look at the history that we have. Reasonable. It's this, it's this, like there's, um, one of the most fucked up things the CIA has done recently is they, they had a fake vaccine drive in Pakistan where they were really testing

people's blood to see if they could find people related to Osama bin Laden to track him down and like weren't vaccinating people. And it was just like, yeah, of course there's distrust of Western vaccine programs. The CIA. Thank you. Um, wow. Well, and it's, and also like you bring up indigenous women, there were, we're not talking about this today.

So I don't want to go into too much detail because I don't want to get something wrong. But like there were a lot of vaccine trials done with real questionable consent on indigenous populations in the United States. You know? Yeah. No, you did a good, you're a really good, um, I forget which, where you did it. I think it was on this show. You talked about, you know, the history of vaccines and there's some problematic components.

Yeah. Like, again, like with everything, right? Like, right. Like with voting, you know? Yeah. Yeah. Um, it's not a factor. It's not a, it's not an inherent characteristics of vaccines.

It's an inherent characteristic of like the white supremacist state that has existed for a couple of hundred years. Um, yeah. Which kind of colors everything. There's, um, there's a really good 1941 paper titled The Negro's Contribution to Surgery published in the Journal of the National Medical Association by Dr. John A. Kenney of the Tuskegee Institute, um, who was, uh, like a groundbreaking black dermatologist. Um, and he kind of, he writes in that paper, I suggest that a monument be raised and dedicated

to the nameless Negroes who have contributed so much to surgery by the guinea pig root. Um, I found this in an article about them removing a statue of Sims. Um, and I don't know, I'm not much of a statue guy one way or the other, but certainly that's a better idea for a statue than one to this guy. Absolutely. Absolutely. I mean, people also need to remember. This is, I mean, we think this is like ages and ages ago, the Tuskegee experiment ended

in like, right? 1972. We'll talk about that one of these days. Yeah. 1972. Like I had attendings teaching me that were alive and practicing medicine at that time. So it's like not that long ago that this was a thing that was happening. Yep.

Yep. And like, I mean, a bunch of the, I mean, presumably one hopes at least that a number of the women that he was experimenting on probably lived into the 20th century or the 19th century. Wait, 20th century. Yeah. 20th century. Yes.

The centuries are always hard because it's one less than the number. Yeah. No, it doesn't make any sense. You know how counting works, Kava. Yeah. I don't know. I don't know. I think you probably shouldn't enslave people and you also shouldn't conduct medical experiments

on them. That's my, that's my radical left wing rant for the day. Pinko nut. Yeah. I don't want to get political here. Oh, okay. Bad. Okay.

But yeah, probably bad. Probably bad. Yeah. I don't know. I think it's worth really digging into, because we could have done, I kind of considered doing like a much broader episode where this guy would be a chunk and then we'd talk Henrietta Lax and Tuskegee, but there's so much to say about how this is conducted, about how other doctors who are not experimenting on enslave people do things differently, about how this

guy is like received, how he justifies it, how his, what he just, I really think, and I think we'll probably wind up focusing on each of those other, those other, I don't know what to call them, like pieces of medical history, like in detail, because I think it is worthwhile. There's always a lot to like drill down here about how it was justified at the time, how it's been justified since the, how the language that people use is around the, this kind of stuff acts to sort of hide the horror, even by doing things that are like, you, you claim to be advocating for the patient, but what you're really doing is kind of like making

suffering porn about this person in order to like say that basically anything I do is justified, which seems bad to me. Have we started the hashtag ADAP? All doctors are bastards. There we go. There we go. The doctors are the cops. If we do that.

No, I mean, actually, this is so important that we talk. I mean, unfortunately, timely now, because we have to, we're talking about autonomy and people's rights. Jesus Christ. It's like a basic medical ethic that we still do not have in this country, and it seems to be going backwards. Yeah. And it's the same.

I mean, there's a, there's a huge degree to which like, it's the same thing with journalism, right? You, we can talk about the history of white supremacy and journalism, how journalism was used to like whip up fear of, how probably a decent chunk of Dr. Sims's terror of like runaway slaves was stoked by articles in the local press about like horrible things done by runaway slaves in whatever town or whatever. And then shit like, you know, the Spanish-American war, the kind of yellow press and how, you know, and the Iraq war and the ways in which, you know, today a lot of idiots in legacy

media are writing these like, well, we have to examine, you know, really, there's a lot of more problems with conversion, with gender transition and stuff than like, and we should, and doing this, writing this stuff in a way that like plays into this right-wing outrage machine and being like, well, we're not writing things that are meant to do that. It's just other people taking us out of context and it's like, yeah, but if you're putting shit out, if you don't think about the ethics of what you're doing, if you'd like, you're, you're like, and the actual impact of what you're doing, it's the same. It's the same thing.

We have these, these things that are really important as institutions, medicine and the media and, and all of this stuff that is, are, are critical for having a society. And a lot of people within them who don't like some of the con, some of the really thorny ethical questions that are necessary when you look at the history of these institutions like guys like, I think, wall, who want to just celebrate what is legitimately groundbreaking medicine, right? And Sims was groundbreaking and a lot of his application of medicine. And he wants to, wall wants to celebrate that and he doesn't want to really like look at

what's super fucked up about this guy. And I, you know, there's a lot of people who do that for a bunch of things. It's this, it's this constant problem we have of like, and I think wall is, I don't think doing wall is doing the effortful version. The low effort version is to say like, oh, you just want to ignore like, you just want to cancel history, right? Or it's like, no, I'm telling you the history of Mary and Sims. I think it's important to talk about the history of Mary and Sims.

I wish like hell we knew more about the history of Betsy, of Anarka, of Lucy, of like these and the women he does not name who he experimented upon because they are also critical parts of medical history. Yeah. No, exactly. It's the opposite. You don't, you want the history to be known. It's just certain things that should not be celebrated.

Yeah. Yeah. I don't, we don't need to make him into a hero to discuss what he did because what he did is important. Yeah. Yeah. This is an ongoing story in medicine. But when I was in training, we started moving away from eponyms because ostensibly, because

we wanted to focus on the science of it, not the name of the person, but because and so often in medicine, you run across someone like Wegener, and Wegener's granulomatosis, sorry, I killed that word and I should know it better. But anyways, Wegener's disease, because he was a Nazi, you know? And things were, and he was an important pathologist in many ways. But you know, we need to be able to separate what he did and talk about it and make sure it's known because it's an important part of making sure we don't move backwards. And guess what?

If we don't focus on that, we move backwards and we're moving backwards right now. Yeah. Absolutely. I mean, it's, we'll probably wind, I mean, we'll definitely going to be talking about Hans Asperger too at some point, which is another, another Nazi, you know? But yeah, Nazis and Confederates. This is the kind of confederate history I'm interested in telling. Yeah.

All right, Kamma, you got any pluggables to plug? I do. I certainly do. You can follow me at the House of Pod on Twitter and you can listen to my humor adjacent medical podcast, The House of Pod, anywhere you listen to podcasts. If you want to do something a little different, you can listen to my recap fun show I do with Rebecca Watson, who is amazing and I highly recommend you check her out and her YouTube videos.

And then we do a show called Girls on Boys. It is a fun deep dive about the show, the boys in it. And I'll explain in it why I hate Alfred Molina with a burning passion of a thousand. Wow. Wow. Yeah. I got a thing for Alfred. Sophie.

I got a thing for Alfred. Yeah, I know. Get Jamie Loftus on the Loftus. Yeah. Set off the Loftus signal. Yeah, Jamie Loftus fucking loves Alfred Molina. You are now her sworn enemy. She sure does.

Listen, we'll talk about Not Without My Daughter anytime. Wow. Wow. We've got, we have the makings of a podcast feud. I'm calling you out, Jamie Loftus. She's literally texting me right now and I'm, I'm for your safety, I will not tell her at the moment. Let her know.

What's up? What's up? We're throwing a feud down. This is, this could be the rumble in, I don't know, like a coffee shop, maybe. I'm literally sipping tea as this is happening. Yeah. We're, we're spilling some mad tea. Don't, don't, don't hurt me, Jamie Loftus.

It's gonna be an even bigger, an even bigger thing than my feud with, isn't there someone named Ezra at NPR? Yeah. Ezra Miller, I think. That fucker. Yeah. Fuck you, Ezra Miller. Yeah.

I'm gonna fuck him up. Or the Ezra who does the show. Yeah. Oh, wait. Is there an Ezra who does the show? Ezra Miller is the Flash. But he's, he's a problematic guy too. I mean, that guy sounds like he sucks.

But Ezra Klein, that's the NPR guy. I'm gonna fuck you up, Ezra Klein. Yeah. I'm gonna back you up on that one. Yeah. Let's do it, bro. Let's mess up Ezra. Your enemy is my enemy, Robert.

Yeah. Are you not gonna tell people to get colonoscopies? That's normally what you do. Oh, yeah. Get your colon cancer screening if it's appropriate for you. Talk to your doctor about it. When you need to do that. Oh, okay.

Okay. That's fair. Yeah. I'll talk to my doctor. Yeah. I'm not gonna, I mean, there's like, it's like, there's like so many like different things to talk about when it comes to colonoscopies and colon cancer screening, different versions of colon cancer screening, when you should start, what your risks are.

Well, so let me run this through because I had a lady at a yurt tell me that coffee enemas make that it impossible to get that cancer. And so I did that for a couple of years and then I figured coffee enemas, if they make it, if they'll stop me from getting colon cancer, you know, it'll do an even better job as Red Bull. So I've been doing that for like the last five years every day. But listen, this is important. Coffee is your friend.

It is not an enema. It is amazing. I love coffee. I did a whole episode with prop, by the way. We had Deepak Chopra's brother who's a coffee aficionado. Come on. Oh, wow. And one of the greatest like living American hepatologists had them on all to talk about

coffee. Great. Don't put it, don't put it in your butt. It will cause damage at worst, cause you significant damage. That best it will ruin your coffee and your butt. Okay. But I have, as I said, moved on to Red Bull. So that's because the torene helps, right?

That makes it clean. Yeah. No, it's the chemicals that clean out the stuff in there. Yeah. It's like putting bleach in there. A lot of people don't get enough torene in their assholes. No. American with not this American diet.

All right, everybody, that's going to do it for us here at behind the bastards. Um, at this point, probably donate to a bail fund. I don't know what's going to happen in the next week or so after the whole, um, after the road decision. But yeah, probably, probably good to go donate to a bail fund. Bye. Alphabet boys is a new podcast series that goes inside undercover investigations. In the first season, we're diving into an FBI investigation of the 2020 protests.

It involves a cigar smoking mystery man who drives a silver hearse and inside his hearse with like a lot of guns. But our federal agents catching bad guys or creating them, he was just waiting for me to set the date, the time, and then for sure he was trying to get it to happen. Listen to alphabet boys on the iHeart Radio app, Apple podcast or wherever you get your podcast. What if I told you that much of the forensic science you see on shows like CSI isn't based on actual science and the wrongly convicted pay a horrific price to death sentences in

a life without parole. My youngest, I was incarcerated two days after her first birthday. Listen to CSI on trial on the iHeart Radio app, Apple podcasts or wherever you get your podcasts. Did you know Lance Bass is a Russian trained astronaut that he went through training in a secret facility outside Moscow, hoping to become the youngest person to go to space? Well, I ought to know because I'm Lance Bass and I'm hosting a new podcast that tells my crazy story and an even crazier story about a Russian astronaut who found himself stuck

in space with no country to bring him down. With the Soviet Union collapsing around him, he orbited the earth for 313 days that changed the world. Welcome to the last Soviet on the iHeart Radio app, Apple podcasts or wherever you get your podcasts.