Friday, 15 April 2016

Honoring the Mothers of Gynecology

Honouring the Mothers of Gynecology

This blog was written after hearing Shankar Vendantam’s excellent podcast from the NPR Hidden Brain series on the mothers of gynecology.

The history of healthcare, the history of the noble profession, doctors, nurses, scientists and others has an underbelly of unethicality and double standards. This is often justified by the rationale that the practices were compatible with the ‘standards of the time’. That is one of the fundamental issues, the wrong question is whether it was compatible with the standards of the time, a possibly right question would be whether it was compatible with some of the eternal principles of medical practice. We will find again and again that actions of many of our predecessors in modern healthcare were not compatible with eternal ethical principles of healthcare.

An infamous example of an individual was the American physician J Marion Sims, who acquired black women slaves for the purpose of experimental surgery to resolve vesico-vaginal fistula. He operated on them without anaesthesia when anaesthesia was available and he operated on white women with the same condition only when he had completed his experimental surgery on black slave women after his technique was perfected on these black women. Who were these black women? It seems there were 14 of them; we do not even know their names except three of them. Anarcha, Betsy and Lucy.

In the NPR podcast historian Vanessa Gamble alludes to some potential motives. The women with vesico-vaginal (abnormal connections between urinary bladder and vagina) and recto-vaginal (abnormal connections between rectum and vagina) fistulas that happened after traumatic childbirth, meant that these enslaved women could not work for their ‘masters’ and could not reproduce creating more enslaved people to benefit their ‘owners’. So, it seems that it might not have simply been the desire to progress the frontiers of surgical science that was the primary motivator for Sims to have acted unethically. The view that he might have acted unethically is not just from retrospection, he was challenged about it even within his time.

Vanessa Gamble and Bettina Judd (a poet) talk in the NPR podcast about how these women whose life, living and bodies were used without consent could be recognised; there is some talk on statues along with the one that exists for Sims. Recognising and honouring these women is not tokenism, it is a fundamental for progress of humanity. Statues will act as symbols but they will have the constraints of geography and history whereas Sims will continue to have universality.

The mothers of gynecology should have universality (while Sims would become a lesser part of history). With that in mind I propose the following:

1)      Anarcha should be referred to as the mother of gynecology.

2)      The vaginal speculum currently known as Sims and its variants should from now be known as the Betsy speculum

3)      The surgical procedure to repair vesico-vaginal fistula should be called the Lucy’s repair.

While these three are important, it is also important to stop referring to Sims as the father of gynecology.

These suggestions stem from the principle where an immoral or unethical person is disassociated from any glory that is derived from the outcome of such person’s activity. The new world demands a new kind of approach, the sins, crimes and injustices of the past will remain – the benefits from those should not. The ignominy suffered by these women must be honoured by making them the main story; Sims of course needs a place on the page which he will have as an incidental footnote in the history of gynecology. Success in Healthcare demands these actions, we cannot allow healthcare to fail by not giving the mothers of gynecology their rightful place.

Organisations and persons working for equality and justice should lobby the gynaecological profession to adopt these changes so that they become the norm.


PS: I started writing a blog called ‘What are the nasties in healthcare we may regret in the future?’ and intended to use the mothers of gynecology as an example. Once I started writing it I realised that it will be yet another injustice if the mothers of gynecology did not have their own place in these blog pages.


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