American Gynecology

Summary

American gynecology is the surgical specialty for women’s reproductive health that took shape in the United States in the first half of the nineteenth century. Its founding period was tied directly to slavery. The first American operations to remove an ovary, deliver a baby by cesarean section, and repair a fistula from hard childbirth were nearly all performed by white southern doctors on enslaved Black women. The most famous of these surgeons, J. Marion Sims, developed his fistula technique on three enslaved women named Anarcha, Betsy, and Lucy in Alabama between 1844 and 1849. He later moved to New York and ran the country’s first women’s hospital, where he operated on poor Irish immigrant women. The historian Deirdre Cooper Owens argues that this racial pattern was built into the founding of the field. The argument over how to remember that founding is still active.

Antebellum Origins

The early nineteenth-century United States was an unusual setting for the rise of a new surgical specialty for women. After Congress banned the importation of African-born slaves in 1808, U.S. slave owners turned more attention to increasing slave births domestically; the country’s reproductive medicine expanded in step.(Cooper Owens, Deirdre, 2017) At the same moment, midwifery, which had been the domain of women for centuries, was being taken over by male doctors. American physicians “masculinized” gynecological medicine by creating institutions and pedagogical approaches for men who would now work exclusively on women’s bodies.(Cooper Owens, Deirdre, 2017)

Reproductive medicine was structurally tied to slavery. Each woman sold was medically examined so that she could be priced for sale; doctors formed a cohort of elite white men whose gynecological examinations of Black women shaped the country’s slave markets.(Cooper Owens, Deirdre, 2017) Most pioneering nineteenth-century American gynecological surgeries, including ovariotomies (the removal of diseased ovaries) and cesarean sections, happened during interactions between white southern doctors and Black enslaved patients.(Cooper Owens, Deirdre, 2017) Cooper Owens argues that the surgeons of this era should not be remembered as exceptionally cruel; they were elite white men working inside a culture of scientific racism that gave them ready access to enslaved women’s bodies.(Cooper Owens, Deirdre, 2017)

The institutional forms of the field grew up alongside the same population. In Augusta, Georgia, the brothers Henry F. and Robert Campbell served as editors of the Deep South’s first medical journal, the Southern Medical and Surgical Journal, while running the Jackson Street Hospital that served an exclusively slave population, a tight integration of slavery, medical publishing, and gynecological practice.(Cooper Owens, Deirdre, 2017) Mary, a twenty-eight-year-old enslaved woman, visited Dr. Paul Eve in Augusta in April 1850 for irregular menstruation and vaginal hemorrhaging; Eve assembled a team and excised her uterus in what they claimed was the first successful full uterine removal in the United States. Mary died on July 22, 1850, three months later.(Cooper Owens, Deirdre, 2017)

Founding Figures

The Kentucky surgeon Ephraim McDowell performed the first ovariotomy in 1809, on the white frontier patient Jane Todd Crawford. After that case, McDowell continued his experimental surgical work almost exclusively on Black women, finding four enslaved women with ovarian tumors in the Danville area to operate on over nearly a decade, a striking figure given Kentucky’s small Black population.(Cooper Owens, Deirdre, 2017) McDowell’s transition from one white frontier patient to a mostly enslaved experimental population set a template that subsequent surgeons followed. The British surgeon James Johnson dismissed McDowell’s work in the London Medico-Chirurgical Review by writing that “negresses” would “bear cutting with nearly, if not quite, as much impunity as dogs and rabbits”, a sentence that captures the racial frame within which American ovariotomy was discussed in its founding decade.(Cooper Owens, Deirdre, 2017)

John Peter Mettauer of Virginia was the first American surgeon to attempt a vesicovaginal fistula repair. He performed repeated experimental surgeries on a twenty-year-old enslaved woman over four years, using lead sutures, which corrode in the urinary tract; growing frustrated with his failures, he blamed the persistence of her condition on her ongoing sexual activity, which she had little power to refuse.(Cooper Owens, Deirdre, 2017) Nathan Bozeman, originally Sims’s apprentice, later returned to the Alabama scene with a button-suture variant of the operation; after Sims left for New York, Sims sold his slave hospital to Bozeman, who continued operating it on a primarily enslaved population.(Cooper Owens, Deirdre, 2017)

Beyond the named pioneers, the surgical theatres of the antebellum South used enslaved women as routine experimental material. In an 1835 Charleston ovariotomy, a team of four doctors and two students physically restrained a thirty-five-year-old enslaved woman who “screamed and struggled violently”; her excised ovary was later displayed at the Charleston Medical College’s museum.(Cooper Owens, Deirdre, 2017) On the Glover plantations of Colleton County, South Carolina, enslaved women diagnosed with prolapsed uteri (“falling of the womb”) were transitioned from field hands into long-serving plantation nurses for fifteen years between 1844 and 1859, while those whose conditions made them unprofitable were sold off, an early integration of gynecological diagnosis into the management of slave labor itself.(Cooper Owens, Deirdre, 2017)

Sims and the Anarcha-Betsy-Lucy Series

The most famous founding event of American gynecology took place on a small slave farm in Mount Meigs, Alabama, fifteen miles from the slave-trading center of Montgomery. Between 1844 and 1849, Anarcha, Betsy, Lucy, and roughly nine other unidentified enslaved women and girls lived and worked together in the slave hospital that J. Marion Sims founded for his training and for the surgical repair of his patients.(Cooper Owens, Deirdre, 2017) Cooper Owens treats this hospital as the first women’s hospital in the United States.(Cooper Owens, Deirdre, 2017)

Sims’s first vesicovaginal fistula patient was Anarcha, a seventeen-year-old whose fistula had developed during her protracted labor under Sims’s own care. He then sent for Betsy and Lucy, who had visited him earlier for similar conditions, and leased them from their owners.(Cooper Owens, Deirdre, 2017) After two years of failed surgeries his white medical apprentices quit; he then trained the enslaved patients themselves to work as his surgical nurses.(Cooper Owens, Deirdre, 2017) During the five years they lived on Sims’s farm, Anarcha, Betsy, Lucy, and the others learned the fundamentals of gynecological surgery and, Cooper Owens argues, knew more about the repair of obstetrical fistulae than most American doctors of the period.(Cooper Owens, Deirdre, 2017) After thirty surgeries on Anarcha, Sims successfully closed her fistula with silver sutures, an improvement on Mettauer’s lead sutures, and then repeated the technique on his other patients.(Cooper Owens, Deirdre, 2017)

The 1852 paper announcing the result, “On the Treatment of Vesico-Vaginal Fistula,” appeared in the American Journal of Medical Sciences and quickly became the most-cited single article on the subject. After its publication the journal’s output of articles on sexual surgeries on women increased by more than 100 percent.(Cooper Owens, Deirdre, 2017) Cooper Owens proposes that the enslaved women on whom Sims operated, rather than Sims himself, be regarded as the rightful “mothers” of American gynecology, a designation set against his traditional title as “father”, while acknowledging that patients do not leave archives, doctors do.(Cooper Owens, Deirdre, 2017)

The Speculum and the Vesicovaginal-Fistula Problem

The vesicovaginal fistula was a real and disabling complication of obstructed childbirth in the nineteenth century, before cesarean section became survivable. A torn passage between the bladder and the vaginal canal left women with constant urinary leakage, often shunned in their communities, and frequently in chronic pain. Repairing it was the surgical problem that defined the founding decades of the specialty. The technical contribution that made Sims famous was the substitution of silver wire for lead as a suture material; lead corrodes in the urinary tract, while silver tolerates it well. The instrument that made the surgery possible was a speculum Sims adapted from a bent pewter spoon, which allowed visual access to the anterior vaginal wall in the knee-chest position.

The same anatomical access that made the operation possible also defined how the bodies of patients were treated. White doctors examined enslaved women’s naked bodies, breasts, and genitalia routinely, while according white women the privacy of remaining clothed during examinations except in emergencies, on the assumption that Black women were immodest.(Cooper Owens, Deirdre, 2017) In 1825, Dr. Finley of Charleston published a case of an enslaved woman in her mid-forties whom he described as “menstruating from her mammae,” and offered her body to colleagues as an experimental specimen rather than diagnosing tumor or cancer.(Cooper Owens, Deirdre, 2017) The patterns of access, observation, and display that early gynecologists relied on were not racially neutral, and the surgical instrument that defined the specialty came embedded in those patterns.

Postbellum: Irish Immigrant Women in New York

After Sims left the South for New York in 1853, he co-founded the Woman’s Hospital in 1855, the first hospital in the United States dedicated to gynecological surgery. Cooper Owens identifies a substantive continuity between his southern and northern practice: in northern cities such as New York, doctors relied on poor Irish immigrant women as subjects for exploratory gynecological surgeries in much the same way southern physicians relied on enslaved women, because both groups were accessible vulnerable populations.(Cooper Owens, Deirdre, 2017)

The hospital’s first admitted patient was Mary Smith, an Irish immigrant from western Ireland who had arrived as a single mother and a poor sick woman; her name was the first one listed in the admittance records.(Cooper Owens, Deirdre, 2017) Sims and his protégé Thomas Addis Emmet performed thirty surgeries on Smith over a period of six years, in front of many onlookers, without anesthesia.(Cooper Owens, Deirdre, 2017) Sims later botched a final bladder-stone surgery that destroyed Emmet’s earlier repair, abandoned her treatment, and never published her case; she died two years later as a “common street beggar” not far from the Woman’s Hospital.(Cooper Owens, Deirdre, 2017) The American Medical Association’s Code of Ethics had directly forbidden patient abandonment; Emmet himself stated that Sims abandoned Smith after botching her final surgery, a clear violation of the code.(Cooper Owens, Deirdre, 2017)

The institutional setting of New York gynecology made Irish patients especially available for the same reason enslaved women had been available in the South: their access to ordinary medical care was conditioned on others’ permission. William Sanger’s 1857 study of prostitution and venereal disease in New York City found that several public dispensaries and hospitals had explicit rules forbidding the admission of patients with gonorrhea or syphilis, and noted that physicians often recorded venereal cases under other diagnoses to evade those rules. The same study documented far higher rates of venereal disease among incarcerated women on Blackwell’s Island than in the city’s free population.(Cooper Owens, Deirdre, 2017) The 1858 case of Mrs. F., described by Dr. Gegan in the New York medical literature, illustrates how respectability politics could extend a measure of “whiteness” to married Irish women that enslaved Black women never received: after Mrs. F.’s death, her husband consented to an abdominal incision so Gegan could attempt to remove the fetus, and Gegan respected the husband’s wishes regarding the autopsy in a way that the antebellum surgical literature on enslaved patients almost never records.(Cooper Owens, Deirdre, 2017) The contrast inside the field’s New York clientele defines one boundary of the field’s racial frame: Irish women could, under the right marital and class conditions, be granted the procedural respect routinely denied to enslaved Black women, even as the same hospitals continued to use Irish bodies as experimental material.

By the late nineteenth century, the racial framing of the field was openly stated. The physician Lucien Warner could write that the African “negress” who toiled in the southern fields and the Irish “Bridget” who washed and scrubbed in northern homes shared good health and “comparative immunity from uterine diseases”, using the same superbody trope to fold both populations into the same experimental category.(Cooper Owens, Deirdre, 2017) Cooper Owens treats the doubling as the principal evidence that the field’s racialised foundation had not lifted with the move north.

The Methodological Problem the Field Inherits

Cooper Owens’s central interpretive frame for American gynecology is that its racial foundation is not a piece of unfortunate context but a methodological problem the field still carries. The “medical superbody” concept names the contradiction: enslaved Black women were cast simultaneously as physically superior to white women (more fecund, more pain-tolerant, sturdier) and as biologically inferior, and that paradox allowed them to be exploited as fit-to-suffer experimental subjects.(Cooper Owens, Deirdre, 2017) By the late 1860s, the field’s racial assumptions had begun to operate in both directions: some American gynecologists were performing clitoridectomies on elite white women to treat “neurasthenia,” a sensitivity-disorder framing that was reserved for white women, since Black women were never deemed sensitive enough to qualify.(Cooper Owens, Deirdre, 2017)

Surgical practice itself, as Cooper Owens points out, should have refuted the racial science that licensed it. Doctors used identical operations on Black and white women’s anatomies, the same instruments, the same incisions, the same closures, demonstrating in practice that they were anatomically the same. But the racial ideology of the period was strong enough to obscure the implication, and what survived in the field’s writing was the racial frame, not the anatomical evidence against it.(Cooper Owens, Deirdre, 2017) An 1862 illustration of Sims operating on a fistula patient sanitized this history visually, depicting a fully-clothed white patient with a white nurse handling the speculum and erasing the naked, restrained enslaved women on whom the original procedures were actually performed.(Cooper Owens, Deirdre, 2017) The illustration is one of several visual artifacts in which the field tidied up its own founding.

The doctors’ own writings, read carefully, contradict the racial science they were defending. Cooper Owens reads Sims’s autobiography for the moments where his clinical descriptions of restraining enslaved women during childbirth and surgery contradict the same physicians’ published claims that Black women were impervious to pain.(Cooper Owens, Deirdre, 2017) At Sims’s 1883 funeral, the obstetrician William Waring Johnston eulogized the enslaved patients as “humble negro servitors” who had brought “their willing sufferings and patient endurance” to his research, framing them as voluntary participants when they had no capacity to consent, informed consent did not exist for slave patients.(Cooper Owens, Deirdre, 2017) The contradiction between what the doctors actually wrote about how the surgeries went and how they later wanted them remembered is one of the principal pieces of evidence in Cooper Owens’s account.

The argument extends into the present. Cooper Owens argues that the antebellum framing of Black women as “medical superbodies” impervious to pain remains alive in twenty-first-century gynecology, citing studies that Black women suffer chronic pain at higher rates with less access to pain medication.(Cooper Owens, Deirdre, 2017) How much weight that continuity-claim carries, whether it is a genuine inheritance or a much weaker family resemblance, is the contested question that follows from the field’s founding history.

American Gynecology

American Gynecology

Summary

Antebellum Origins

Founding Figures

Sims and the Anarcha-Betsy-Lucy Series

The Speculum and the Vesicovaginal-Fistula Problem

Postbellum: Irish Immigrant Women in New York

The Methodological Problem the Field Inherits

See Also

Sources