I sat down meaning to write more about Kansas today but instead the internet, in the person of PZ Myers, brought me new information about slavery’s role in advancing gynecological medicine. Specifically, slavery abetted the perfection of the speculum.
I didn’t know from speculums until a few years ago when PZ posted news that a reader had sent him a box of the things as a gag gift. He explained then that doctors use them to open up a woman’s private parts for examination and related how he held up a pair and gave his wife an inquiring look. This produced the intended laugh from me. I like a good, earthy joke as much as the next person. The instrument itself probably did not cross my mind once between that day and this one. Those of us born with male parts have that privilege.
The rest of this post necessarily runs heavily to horrors rather than levity. If the above upset anybody, you may want to come back tomorrow rather than continue on with this one.
But the speculum, like everything else people make, came from somewhere. Someone had to invent it, which one would imagine involved some uncomfortable experimentation. That experimentation might have crossed ethical lines we would not, but one tends to think of medical experimentation as a twentieth century phenomenon. We remember the Tuskegee syphilis studies, where for forty years the United States government observed black men with syphilis and refused to treat them. They had to see the progression of the disease, you understand. That sort of work simply did not suit white men. You needed someone expendable and in America hallowed tradition dictates that expendable lives come with black skin.
The Tuskegee study took place in Alabama. It ran for forty years, only ending in 1972 when the news leaked to the papers. By a mix of coincidence and contingency, the modern speculum also hails from the Heart of Dixie. The two things have little to do with one another, save for the medical subject matter, but if not in Alabama then both would have likely taken place somewhere with a similar history. Black Americans live mostly in the South because whites brought them there and then worked fairly hard to keep them there, before and after the Civil War.
The speculum did not take so long as that to develop, though it has many antecedents. We owe it to an Alabaman doctor, John Marion Sims. His work, even at the time, provoked considerable controversy. What could a white man do to a black woman, a slave, in the 1840s that would raise eyebrows? Sexual and sexualized violence did not suffice. Rather, Sims looked at the parts he needed to examine instead of groping about blindly:
Sims didn’t want to have to look at a woman’s genitals. “If there was anything I hated, it was investigating the organs of the female pelvis,” Sims wrote in the autobiography he half completed before he died. This was a time when men and women interacted in very strict, pre-determined ways. Early illustrations from medical textbooks show doctors examining women’s pelvic areas by reaching their arms up beneath the layers of skirts and feeling around, literally blindly.
You can imagine how well that worked. When treating a white woman, Sims realized that he actually did need to see her private parts. But how could he do that? He got an idea and decided to try it out on someone who he felt much more at liberty to experiment with, a slave woman:
He fetched a slave, had her lay on her back with her legs up, and inserted the bent handle of a silver gravy spoon into her vagina. That’s right, the very first modern speculum was made out of a bent gravy spoon.
Useful inventions have come from nauseating places before, but Sims didn’t just have a new idea and give it a whirl. He tested it on a slave woman. With the ability to see, he could go in and close the fistulas that caused the pain which brought women to his doorstep. He spent years, starting in 1845, perfecting surgical techniques to close them that would have been impossible for anybody working blindly by touch. These surgeries spared women pain and perhaps death. The vaginal examinations he made possible with his instrument, soon developed from its humble origins into the familiar object, have probably saved the lives of countless women. This blogger counts his mother among them.
Sims, however, did not have a steady parade of white women ready for him to perform surgery on. He needed expendable lives:
Sims’s early gynecological experiments were done on slave women who, in many cases, he purchased and kept as property in the back of his private hospital. Along with this violent legacy, Sims left behind a few medical advances and inventions—one of them being the vaginal speculum. While the design has been refined, the speculum women see today isn’t all that different from the one Sims used on his captive patients.
He could do what he wanted with his own property, and did so:
He performed many of his experimental procedures without the benefit of anesthesia, and some of these slave women were operated on up to 30 times.
The controversy did not concern Sims’ mistreatment of his slaves, but rather the fear that his device would turn them into sex maniacs:
The British physician Robert Brudenell Carter reinforced this fear in his 1853 book, On the Pathology and Treatment of Hysteria, writing that he had “seen young unmarried women, of the middle class of society, reduced by constant use of the speculum to the mental and moral condition of prostitutes; seeking to give themselves the same indulgence by the practice of solitary vice; and asking every medical practitioner … to institute an examination of the sexual organs.”
We would benefit most from nineteenth century values like this by leaving them in the era, but respected medical men at the time really thought like this.
Even setting aside my personal stake in all of this, I think the world better for having Sims’ speculum in it. The horrors that birthed it are not the fault of the device, but of the man. None of that, however, will undo what must have amounted to the repeated medical rape and torture of slave women to perfect the technique. Would someone else have invented the modern design eventually? Probably. That other person might have done so at a similar time or not long thereafter, thus removing questions of sparing more people by having the speculum sooner. But we do not live in that world.
Talk about how we owe the things we value to the sacrifices of the past too often focuses on sacrifices made violently by men in arms. Those heroes deserve recognition, we hear constantly. With notable exceptions, mostly for American soldiers of the wrong color, they get it. The women Sims operated on do not. They too had the wrong color. To that they added wrong sex. Even the article recounting all of this doesn’t include their names. I don’t know that anybody knows them. Yet John Marion Sims sacrificed them; we benefit from it today.
We can ignore that. Stories like this make us uneasy and nobody likes that. But if we have a place in our culture for remembering good things that came to us at tragic costs, then we have a place for those women. Don’t they deserve a monument?
That might open some floodgates. Americans have stolen a great deal, bodies and lives included, from other Americans who had the misfortune of the wrong skin color, sex, or some other sin that seemed vitally important at the time. We could benefit from owning up to our stolen inheritances. Others have paid far greater prices than a mild disquiet for them.