This week, we're returning to our archives to grapple with the troubling history of medical experimentation on African Americans and how that history connects to the unequal medical care African Americans still receive today.
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.
The failure to recognize the pain of black patients can be tracked far back in the history of American medicine. Dr. James Marion Sims, a 19th-century physician, has been dubbed the father of modern gynecology. He's honored by three statues across the United States, one of which describes him as treating both empresses and slave women.
This week, we consider what — and whom — this inscription leaves out. Invisible in his shadow are the enslaved women on whom he experimented. Today, they are unknown and unnamed except for three: Anarcha, Lucy, and Betsey.
We speak with Dr. Vanessa Gamble, a physician and historian, to investigate Dr. Sims' complicated legacy. He perfected a surgery that continues to help women today, but he practiced this technique through experimental surgeries on unanesthetized enslaved women.
We also speak with poet Bettina Judd. She helps us connect the experiences of Anarcha, Lucy, and Betsey to the ways black patients are treated today.
Hidden Brain is hosted by Shankar Vedantam and produced by Maggie Penman, Jennifer Schmidt, Rhaina Cohen, and Renee Klahr. Our intern is Chloe Connelly, and our supervising producer is Tara Boyle. You can follow us on Twitter @hiddenbrain, and listen for Hidden Brain stories each week on your local public radio station.
SHANKAR VEDANTAM (HOST): This is HIDDEN BRAIN. I'm Shankar Vedantam. Every week, we look at human behavior through the lens of social science research. Today, we turn our attention to history and the untold stories that so often lie beneath it.
VANESSA NORTHINGTON GAMBLE (GEORGE WASHINGTON UNIVERSITY): When I see the statues and the memorials to Sims, what I see is what's not shown.
VEDANTAM: We'll also look at how, as William Faulkner might say, the past is never dead. It's not even past.
GAMBLE: Black kids with fractures go into an emergency room and do not get the same level of anesthesia as white kids.
VEDANTAM: We'll also hear from poet Bettina Judd on who gets credit for medical advances and who doesn't.
BETTINA JUDD (POET): Sims invents the speculum. I invent the wincing, the if-you-must of it, the looking away.
VEDANTAM: There is a statue in South Carolina honoring a man who is known as the father of modern gynecology. The inscription on the statue reads the first surgeon of the ages in ministry to women treating alike empress and slave.
GAMBLE: J. Marion Sims was a physician who was born in South Carolina in 1813.
VEDANTAM: This is Vanessa Northington Gamble. She's a physician and medical historian at the George Washington University. We asked her to come in to tell us the story of J. Marion Sims who is memorialized in statues not only in South Carolina but also in Montgomery, Ala. and Central Park in New York City.
GAMBLE: He started a clinic in Montgomery, Ala. And at the time, in order to survive financially, he also was a plantation physician where he took care of the enslaved on plantations.
VEDANTAM: This is where the story of Sims becomes complicated because, yes, the inscription on a statue in South Carolina is true. He did invent techniques that help women to this day. He treated slaves as well as high society. He once treated Empress Eugenie, the last empress of France. But there is something not mentioned on the inscriptions on the statues.
GAMBLE: Starting in 1845, he started to conduct experiments on enslaved women. And why we talk about Sims today and why that statue is there is that he perfected a technique to repair a condition called vesicovaginal fistula, and let me tell you what that means. It basically means that there is an opening between the vagina and also the bladder or the vagina and the rectum, which usually comes after traumatic childbirth. And Sims started in 1845 - 1846 according to some sources - a series of experiments to repair these fistulas.
VEDANTAM: This condition was highly stigmatized and dangerous for these women. There was no treatment. So on the one hand, you could say Sims was doing what doctors are supposed to do by taking these women on as patients. But there's another side to what Sims did. He wanted to be a trailblazing researcher, and these women, their bodies, became props in his journey of scientific discovery.
GAMBLE: These women were property. These women could not consent. These women also had value to the slaveholders for production and reproduction - how much work they could do in the field, how many enslaved children they could produce. And by having these fistulas, they could not continue with childbirth and also have difficulty working.
VEDANTAM: There are 10 slave women central to the story. Three are named by Sims in his writing. These women were brought to him by their owners. The first woman was named Anarcha.
GAMBLE: Anarcha was a 17-year-old enslaved woman who had just undergone a very traumatic delivery. Some sources say that she was in labor for three days. At first, he did not want to treat her. He was not interested in treating women. But then what he started to do from a period from 1845 to 1849, he did a series of experimental surgeries on these women. And he uses sutures to try to close up this opening.
VEDANTAM: Now, presumably, this would have been painful.
GAMBLE: It was very painful, and he talks about how Lucy, one of the three women, almost felt as if she were going to die, that she cried out in pain so much because of these surgeries. But at the same time, he writes that the women wanted the surgery because they did not want to have the condition anymore.
VEDANTAM: Were the surgeries that he was performing on them performed without anesthesia?
GAMBLE: They were performed without anesthesia. There was a belief at the time that black people did not feel pain in the same way. They were not vulnerable to pain, especially black women. So that they had suffered pain in other parts of their lives and their pain was ignored.
VEDANTAM: As Sims's reputation as a researcher grew, he began to invite other physicians to come watch as he performed the surgeries.
GAMBLE: So this surgery was done where black women were naked. So when we think about it, I think we think about pain. We also need to think about how these women's dignity were also taken away from them.
VEDANTAM: For a long time, the surgeries didn't work.
GAMBLE: No, he's not successful at the beginning. And so that's why these surgeries went on from 1846 to 1849. And finally after 30 surgeries on one woman, he was finally able to perfect his technique.
VEDANTAM: That woman was Anarcha. The two others who are named in Sims's papers are Betsey and Lucy. I asked Vanessa Gamble whether there was any way to know if these women actually wanted the surgeries.
GAMBLE: We do not know that. The only thing we know is that Sims said that these women - one of the women - clamorously wanted to have the surgery. They wanted to be cured. One of the things in this story that's missing are the words and voices of the women themselves not being translated by Sims.
VEDANTAM: Sims, of course, has a self-interested reason to say that the women wanted what he was trying to do to them.
GAMBLE: Of course he has an interest. And one of the interests is that it mutes the story of slavery in his work, that it mutes the story that the foundations of modern gynecology are based on the body and the pain of enslaved black women.
VEDANTAM: The statue in South Carolina that says that Sims treated empress and slave women alike...
VEDANTAM: Is that true? Was he treating white women the same way?
GAMBLE: He did treat white women. But he treated white women with anesthesia. Sims left - in the 1850s, he left Alabama and moved to New York City for health reasons. And he started a women's hospital in 1855 there. He gained a reputation as an excellent surgeon. And so that he did treat white women. But the technique had been perfected on the bodies of black women.
VEDANTAM: When you hear about a story that took place 150 years ago, there is a part of us that says that was pretty awful, but that was then and this is now. But a lot of your work has actually tried to broaden that idea and said, yes, that was then, but some of what was then is also with us now.
GAMBLE: Right, I mean, one of the things that - I teach a course on the history of race and racism in American medicine. And one of the things that I try to get across to my students is that racism is a very flexible, very adaptive concept. That, yes, black people are not thrown out of hospitals these days because they are black or not excluded from hospitals because they are black. But our focus today is on what happens once one gets into the hospital.
VEDANTAM: It's striking as you say this because I feel like I've read studies in the last few years looking at disparities in how people of color get treated for pain in the late 20th century and the early 21st century. It feels like there is a thread between what happened 150 years ago and what's happening today.
GAMBLE: Right, I agree with you because I think part of this story has to deal with how black bodies are conceptualized by the medical profession. There is a video that Johns Hopkins put out about people with sickle cell disease. And in this video, this woman says when I go to the hospital, even though I'm in pain, I make sure I get dressed up because if I get dressed up, maybe I will be treated better and not be seen as somebody who is seeking drugs. So it still is there in terms of how the medical profession views black people and black bodies.
VEDANTAM: It is true though that some of the things that Marion Sims discovered are still being used or inform medical practice today.
VEDANTAM: He went on to become president of the American Medical Association.
GAMBLE: Exactly, he was a member of the New York Academy of Medicine.
VEDANTAM: So this is a very conflicted legacy because, presumably, some of the things that he helped start or he helped invent are things that are of use to us today and we value and we benefit from that knowledge. And yet that knowledge was obtained at such great cost.
GAMBLE: It was obtained at great cost. And I recently read a 2011 study that was done by physicians. And they looked at medical textbooks to see how Sims was referred. He was referred as a father of modern gynecology, someone who perfected the surgical technique, but no discussion about his legacy in terms of conducting these experimental surgeries on enslaved women. So that's part of the problem. We can say that some of these surgeries that he did, women today are benefiting from, especially in poor countries. But at the same time, we can't forget how that came to be.
VEDANTAM: I'm wondering as someone who is a physician herself, what do you think should be done with those statues?
GAMBLE: You know, it's one of those things where I'm conflicted. If you had asked me this question last spring, I would have given you a different answer. And I'll tell you why I'm conflicted. Last summer, I went to Liverpool. And Liverpool has a remarkable international museum of slavery. And one of the things that I did when I was in Liverpool, I took a slavery history tour because Liverpool was at the center of the transatlantic slave trade. And on an art deco building, there was an image of Neptune - since it's Liverpool and water - and underneath Neptune, there were two black children who were in chains. And the tour guide, who was an 80-plus-year-old black gentleman, asked us do you think this should be taken down? And most people said yes. And he says I think it should stay. And he said I think it should stay because I don't want people to forget it happened. And so I think that we need to do something to commemorate the women, to add something to say, yes, Sims did this, but what about Anarcha? What about Lucy? What about Betsey? I think if we don't do that, that people will forget what happened to those women. So as a historian and as a teacher, I think that it's important for people to know what happened to those women. And if we whisk away these images of Sims, people will forget.
VEDANTAM: How do you hear what these women were going through? So if you could speak to Anarcha and Lucy and Betsey, what do you think they would tell you?
GAMBLE: I think the story they would tell me would not start with Sims. I think the story they would tell me would be about their lives as enslaved women. It would begin there. It would begin how there were times where if that baby had survived, that the baby would have been taken away from them. They would talk to me about how, as being black women, their bodies were used sexually, that they did not have consent and that what happened to them with Sims was part and parcel of what their lives were at that particular time. But I think the other thing they would want us to know is that they were human beings and that they also deserve their story to be memorialized, that we have statues of Sims in Columbia, S.C., in New York City. There are portraits in medical schools of Sims. Where is their story?
VEDANTAM: If you could build a memorial to Anarcha, Betsey and Lucy, or a memorial that stood alongside the memorials that we have erected to Marion Sims in South Carolina and New York City, what would the Memorial say?
GAMBLE: The statute would not be of the experiments because I think that it's important not just to think of them as victims of these experiments. It might be with the three of them together. Or it might be with their holding children, that they were mothers, that they were women. So that would be part of it. So it would not be their prostrate on the altar of science. I think what the inscription would say is Betsey, Anarcha and Lucy, the mothers of modern gynecology.
VEDANTAM: Professor Vanessa Northington Gamble is a physician and medical historian at the George Washington University. When we come back, we'll hear a modern tale of race in medicine through the lens of poetry. Stay with us.
JUDD: In the woman, it is a checklist. Can you imagine anything worse than this? If the answer is no, ask again.
VEDANTAM: Bettina Judd is a professor of gender and women's studies at the College of William and Mary. She's also a poet, and she recently wrote about a medical experience she had in a book called "Patient." drawing not just on her personal history as a black woman but the stories of Anarcha, Betsey and Lucy. Producer Maggie Penman spoke to Bettina Judd and asked her to read some of her poetry.
MAGGIE PENMAN (NPR): In 2006 in her first year of graduate school, Bettina Judd had what she calls an ordeal with medicine. She was driving home from her part-time job and had to pull over because of a sharp pain in her abdomen.
JUDD: In 2006, I had an ordeal with medicine. I must've been found guilty of something. I don't feel innocent here lurking with ghosts. See, it happens like that. I started a thought that is quite benign and end up peccant, debased. I had an ordeal with medicine and was found innocent or guilty. It feels the same because I live in a haunted house. A house can be a dynasty, a bloodline, a body. There was punishment like the way the body is murdered by its own weight when lynched - not that I was wrong but that verdicts come in a bloodline. In 2006, I had an ordeal with medicine. To recover, I learned why ghosts come to me. The research question is why am I patient?
PENMAN: Bettina Judd had to be patient as a doctor told her she was having menstrual cramps and sent her home with painkillers. A few days later, she was told she had a bladder infection and given antibiotics. She was repeatedly given pregnancy tests, though she had told doctors she wasn't having sex with men. She didn't know it at the time but what she was suffering from was an ovarian torsion, a rotation of the ovary that makes it impossible for blood to flow to it. She was experiencing the death of one of her organs.
JUDD: There might be something called an impatient - pregnancy tests, doctors' whispers, my weeklong funk, sterile lubricants, discarded speculums. Every wear of morphine mimics a familiar morning, another dream of drowning in mucus, meeting a dead ovary. She floats in yellow, spits ovum into the poison and wrinkles black and mourning.
PENMAN: Throughout this ordeal, Bettina kept thinking about an article she had read not long before she became ill about J. Marion Sims who operated on slave women in the 1840s. Anarcha, Betsey and Lucy began to haunt her morphine-fueled dreams. She tried to understand what was happening to her through their stories.
JUDD: Nurses ask me how much does it hurt on a scale from 1 to 10? Anarcha Wescott, Betsey Harris and Lucy Zimmerman are taken into the care of a reluctant country surgeon in Montgomery, Ala. See blood on white hospital sheet - tell me I'm having menstrual cramps - Betsey's first birth. Send me home with oxycodone, ibuprofen - Lucy months out of household duties. After five hours in triage, Anarcha is first vesicovaginal fistula and another prescription. In these three, Sims shapes his speculum, invents his silver sutures, perfects protocol for proper handling of the female pelvis. We wake un-anesthetized or addicted to opium - children born, children disappeared - helpless - help.
PENMAN: She kept being asked this question, what is your pain on a scale from 1 to 10? And she would ask herself, well, what is one? What is 10? If I say it's a 10, what will they think? They'll see me, a young African-American woman, alone. Will they think I'm looking for pain pills? I'll give it a seven.
JUDD: Betsey invents the speculum fall 1845. Introducing the bent handle of the spoon, I saw everything as no man had ever seen before from "The Story Of My Life" by J. Marion Sims. I have bent in other ways to open the body, make space. More pliable than pewter, my skin may be less giving. Great discoveries are made on cushion lessons and hard falls. Sims invents the speculum. I invent the wincing, the if-you-must of it, the looking away, the here of discovery.
PENMAN: One day after multiple pelvic exams, after questions about her sexual history, after her answers not being believed, she had a moment of outburst. She said aloud in a roomful of doctors, gynecology was built on the backs of black women anyway.
JUDD: To the patient, tears will only leave you wanting for water and more time, which, as you know, will be spent waiting.
PENMAN: It's been 10 years since Bettina Judd had her ordeal with medicine. Next week, she'll be in Columbia, S.C., and she's going to see statue of Sims, which she says she hopes will stay up for now until we have a conversation about who Sims was and who the women he operated on were, until there's a statue of Anarcha, Lucy and Betsey, the mothers of gynecology, a statue, she says, that she hopes will be bigger than the statue of Sims.
VEDANTAM: Producer Maggie Penman and Bettina Judd.
VEDANTAM: HIDDEN BRAIN is produced by Kara McGuirk-Allison, Maggie Penman and Max Nesterak. Find us on Facebook, Twitter and Instagram and listen to my NPR stories on your local public radio station. To subscribe to our newsletter, send an email to firstname.lastname@example.org with the word subscribe in the subject line. I'm Shankar Vedantam, and this is NPR.
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