Science Friday - SciFri Extra: ‘Behind The Sheet’ Of Gynecology’s Darker History

Episode Date: January 22, 2019

The 19th-century physician J. Marion Sims may have gone down in history as the “father of modern gynecology,” but Sims’ fistula cure was the result of experimental surgeries, pre-Emancipation, on at least 11 enslaved black women. Only three of whose names have been remembered— Anarcha, Betsey, and Lucy. A new play, Behind The Sheet, imagines their life—not just the pain, but the friendships they might have formed to support each other through surgery after surgery. In this extended conversation, Science Friday producer Christie Taylor talks to playwright Charly Evon Simpson about the process of inventing a story for these women despite the limited documentation of their lives, the controversy around a J. Marion Sims statue in New York City, and Sims’ legacy in black women’s maternal health outcomes today. Behind The Sheet was funded in part by The Sloan Foundation, which is also a funder of Science Friday. Further Reading Read an essay by Rich Kelley about the scientific an historical context of Behind The Sheet. Listen to Undiscovered's episode covering Sims' research and how people of color are still underrepresented in medical research. Read an article reported by Vox on the removal of a statue of Sims in New York in April 2018. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Hey there, Ira here. Did you catch our interview last week about the darker side of J. Marion Sims, a pioneer in modern gynecology, and the enslaved women he operated on? Sci-fi producer Christy Taylor interviewed playwright Charlie Yvonne Simpson, author of Behind the Sheet, which tells of these women and their lives. We didn't have time to air the full interview on the radio, so here it is. It is worth a listen. This is Science Friday. I'm Ira Flato. Until last spring, New York Central Park featured a statue of Dr. J. Marion Sims, considered the father of modern gynecology. He invented the speculum, devised methods for easier examinations, and in 1855, he built the country's first women's hospital.

His biggest breakthrough was devising a surgical cure for a common complication associated with childbirth. But his success came at a huge cost, the pain and suffering of nearly a dozen. enslaved black women who were his experimental subjects. A new play, behind this sheet, takes a closer look at what the daily lives of those women might have been like and the ethics of his work. The play is running at the Ensemble Studio Theater in Manhattan. SciArts producer Christy Taylor sat down with the playwright. Charlie Yvonne Simpson, and here's that interview.

Charlie Yvonne Simpson, welcome to Science Friday. Thank you. It's so good to be here. So I know I first heard about J. Marion Sims when the controversy over his statue got a lot of publicity last year. I had never really thought about where gynecology came from, but it turns out Sims was this Alabama plantation owner who everyone kind of thought was crazy at the time. What was his life like? Who was he? It seems like he sort of fell into medicine.

You know, Sims was trying to find his way in medicine and sort of fell. into, you know, this complication of fistula's and sort of just found this thing that he could sort of hone in on and really try to figure out. And then, you know, it's sort of fascinating sort of what he did afterwards, you know, he eventually moves to New York and he opens a women's hospital. And it really does seem sort of like this discovery of his change the direction of his life. It wasn't looking too exciting before that and things got interesting. Yeah, and you mentioned those fistulas. What exactly is a fistula?

The way I tend to describe it is fistulaes usually occur when, you know, during childbirth and the baby is going through the birth canal and gets stuck. A lot of times it's getting stuck because maybe the mother's hips aren't wide enough. You know, for some reason the baby can't get through. and the baby's head will push against the birth canal. And if it's doing that over an extended period of time, the skin that it is pushing into loses blood flow and it dies. And what can occur is that these holes are formed in the birth canal. And sometimes those holes are between the birth canal and the urethra.

And sometimes it's between the birth canal and the rectum. And basically what is then just created is as a fistula and urine and or feces can then go through those holes, thus creating a situation where a woman feels like she's constantly leaking these bodily fluids and is in pain, obviously. Yeah, and Sims, who you named George in the play, he was really determined to fix them. So what was he doing? Who were these women he was experimenting on? You can actually learn a lot. He wrote an autobiography called The Story of My Life, and he goes into the stories of three of the women that he worked on, Anarka, Betsy, and Lucy. And sort of what I gather, and what you gather from reading it is that you had these plantation owners who had ended up with these women, these slaves, who had this issue, which, you know, we're talking about slavery.

Black women during that time were breeders. That was part of our quote-unquote usefulness. and so suddenly you now had these women who are in constant pain who smell terrible and who are not in a position to have children and maybe not even in position to do all the work that they used to do. And so these plantation owners found their way to Dr. Sims being one of them being like, you know, what is going on? How can we fix this? So on and so forth. And at first Sims was sort of like, I don't know what to do, you know, and kind of sent them back on their way. And it was actually working on someone else who had a completely sort of different problem, but dealt with her uterus. He sort of discovered that he could get a really good look inside of a woman and thus at fistulas if he sort of fashioned a tool to look in.

And so that's actually how we get the speculum. And so that sort of revelation then caused him sort of be like, wait, wait, bring back these women. And I think there's a way. I can see the problem now. I think there's a way to fix it. And so that's sort of how we begin this, these years of experimentation. You then find out that it took him about four years to actually figure out how to fix fistula's. And that process is a little, it still seems a little bit unclear.

Like he was trying different methods, different materials, you know, silk sutures, lead sutures. Lead sutures. Yes. Lead sutures. and sort of discovering along the way, oh, this doesn't work for this reason. Oh, this, you know, we now know lots of things about why lead sutures might not be the best choice. But at the time, he did not know. You know, he made mistakes.

He left a sponge in one of the women accidentally. And, you know, we all kind of cringe at that because we know that that would cause a big infection. It's not great when we hear surgeons accidentally leave things in people. You know, and so those four years was him really just trying to figure out how can I close this hole in this delicate. part of the body. It's so simple, but it's like you have to close the hole completely. There's no, you know, in the play, one of the character, George says, there's no halfway with this, a hole as a whole. You know, these women would not be fixed if any urine or any feces could still escape. And so he would get close, but he would be left with these little

little holes. And it wasn't until he figured out silver. Silver switches would be great. and a certain way of creating a suture that sort of allowed the body to sort of cover itself with new skin. Did he sort of solve the issue? There are some accounts that claim these women consented to, or they asked to have these surgeries tried on them. But you seem to think otherwise or portray otherwise in this play. Here's a recording from a scene in the play where a newly arrived slave, Dinah, is being told what's going to happen to her. We should get you moving. Master George won't like that you're still here and not resting.

He'll want you rested before he tries. Tries. Well, all he did today was remove some of the rotten parts of you? No parts of me are rotten. I just mean the parts of you beyond fixing, the parts of you that have already died. He had to clear those away, and then once you heal, he can try to close the hole. At least that's what those papers say. How many times he try on you?

A few. You ain't fixed yet? Not yet. So he can't do it. You were helping him get there. What if I don't want to help him? When's the last time anything? that we wanted mattered for anything.

Besides, he bought you. You're his now. Could they have consented? You know, I've read, you know, there have been several articles, especially since all this talk of the statue has sort of come up. And, you know, some say that, oh, the woman must have consented because of where the fistula's are, the part of the body, you know, they had to agree to sort of lay there and open their legs. And here's my thing. You are talking about women who were enslaved. And being enslaved means

you are the property of someone else. That means that you do not own your own body, your own self. So the idea of consent in a world where these women, you know, weren't even really considered fully human, seems, for lack of a better phrasing, seems a little bit ridiculous to me. This is not to say that maybe, you know, their lives weren't fantastic. They weren't, they were in pain and they were uncomfortable. Of course, they probably, you know, here's somebody saying, I'm going to try to fix it. They may have been like, okay, you know, that sounds like a good plan. But they're okay, I don't think would really have any effect on whether or not they would be experimented on. Obviously, I wasn't there, but I'm going to sort of push against this notion of consent.

Also, you know, surgery number one, maybe they're like, okay, maybe this will end up okay. Anarka was experimented on 30 times. So at what point, you know, if at surgery number 15, she suddenly was like, actually, I don't want this, you know, I'm not convinced that her saying that would have any effect on whether or not the experiments continued. So this notion of consent when, you know, with people who society was not giving humanity to seems really at odds. I have a hard time even really using the word consent when it comes to what these women could have done or could have said in terms of the experiments. You mentioned the number of surgeries already. That really stood out to me as well.

They were operated on nearly as soon as they had recovered from the last one sometimes, that they would get infections between. He would have to clear the infections out. Here's another clip from the play where a slave name's Philomena is talking to another slave named Lewis about her surgeries. Well, how many surgeries have she had? Fifteen, about. And how many on you? I feel like you in there every other week. You can't be in there every other week.

Feels like it. I just tend to heal up faster than the others. So it has been quite a few times. He says I'm a better candidate than some of the others. Shouldn't you be getting off to bed, Lewis? Yes, how many times? I've lost count. Philomena.

20, 25? I don't know. 28. I'll be going in for 29 soon enough. The lead suit just didn't take. And Charlie, they weren't given anesthesia, were they? This is one of the points that people bring up a lot when it comes to Sims. And the fact is that these women were operating on numerous times without the use of anesthesia.

Now, anesthesia at the beginning of his experiments wasn't widely used. In fact, sort of in the play, in the timing of the play, you know, just seen Marie have one of the characters sort of relaying to George about this like presentation about ether anesthesia that has happened up in Boston. And there was a presentation about ether anesthesia, you know, in the play, we're in October, I think it was in October of like, I think it was 1845 or 1846. And so, you know, there were people that were beginning to use it and beginning to understand it. from some of the research that I have done, you know, it does seem like at least towards the end of his experimentations that ether anesthesia, you know, could have been used and wouldn't, you know,

would have been used in other situations. But, you know, something interesting about Sims is that even after he sort of figured out the closing of fistula, he still didn't use anesthesia on most of the women he was working on. white women? I actually think so. It's actually something I've read since I really wrote the play that he just didn't think that pain was worth it, you know, but I've also read things where that he had used it on white women. So, I mean, that's a lot of the things that I sort of realized in the researching of the plays and making the decisions for the plays that, you know, I will read one thing and they will be like, oh, yeah, no, he definitely did. And I'll read something else.

I'm like, I actually don't know if he did. You know, and sort of in the play trying to find that balance. What we do know is that he did not use anesthesia on these women and really didn't believe the pain was big enough for anesthesia to be used. So they had to hold each other down. Yes. So, you know, these women, you know, again, we're talking about pain in an extremely sensitive part of the body.

And through my research, it became clear that these women were, they were almost like the nurses in these experiments. And in fact, there are articles like there's something I read a few years ago that called them the mothers of gynaecology. These are the mothers of gynecology, if we're going to call Sims the father. And because they were in the room, they were holding each other down. They were cleaning dresses, dressings, excuse me, and sort of. of doing the labor that wasn't just focused on the closing of a fistula. One thing that I found really powerful and really uncomfortable at the same time about this play is how you don't shy away at all from the physicality of it.

Your actors talk about leaking and smells and pain over and over and over again. And the word leaking really does come up many times. You really wanted us to shift uncomfortably in our seats during this, didn't you? I mean, I think something that was extremely, it is extremely important to me in the play and sort of looking at this history is acknowledging what the women went through. You know, we can have complicated conversations about consent. We can have these conversations about whether or not he either anesthesia was used or whether or not he used it. Did he use it on black women? You know, we can have all of these debates.

But at the end of the day, we had a group of black women. We know three of their names, but there were more who went through these surgeries. And they went through it, and it was painful. And their lives, a pain was a part of their lives, whether or not they were being operated on. So even when they were off the table, pain was going to be a huge part of their lives. and it felt important to emphasize that and to really have it hit home we can get in our heads about all of this history

and we can debate it but the fact of the matter is there were women who experienced this and that's the part of the story that I think hit me the most when I was reading about Sims and about these surgeries was just sort of sitting there

with this notion that you know these women were in pain. They were in so much pain. And I can't imagine what it would be like to experience what a fistula is and what it is to feel like you're leaking and dripping and have no control of that. I mean, in society as it is, we have all these products to make us smell better.

And that's just like on a normal day. So I can only imagine what it felt like, what these women experienced, how other people treated them because of this complication that they ultimately had no control over. And it felt really, really important to be like, yes, we can have all of these debates, but let's actually take a moment and acknowledge what physically happened. Yeah. And in this play, you not only try to imagine the pain that they must have felt and been through,

but you give them lighter moments as well. You've also imagined sisterhood, community, camaraderie, they make perfume, they have hopes of romance, they laugh together. How true do you think that part is? I hope it is, you know. Yeah, I like to believe, you know, these were women who were intimately a part of each other's lives, you know, as you mentioned, you know, they're holding each other down. And so I really hope that they had a intimate and close and ultimately loving relationship. You know, I hope that that's not my 21st century hope. But, you know, I also, you know, personally, you know, I am a black woman and I have ancestors who were enslaved.

And I can't imagine what that must have been like. And one of the ways in which I guess I can even begin. to fathom surviving those circumstances is imagining that my ancestors had people to love and to laugh with and to ultimately live with, to give them back the humanity that the society at the time stripped away. And so it felt important to put that in the play. We're also talking, you know, a lot about pain, and I am, I was not and continued to not be interested in, you know, re-traumatizing us and having us, you know, having the only take away be pain. You know, I was interested in showing these women's humanity. And part of humanity is fighting to find joy sometimes. It's fighting with each other.

It's pushing back. It's making perfume as they do in the play. Yeah, so that felt really, really important to include, if I was going to include Black Pain to make sure that I was including Black Joy. On a slightly different note, when you take a story like this, how do you decide how much scientific detail to put in so it feels realistic without bogging down these lives that you're also trying to portray? It was important.

You know, this is a Sloan commitment. So the Sloan Foundation supported this play. And so, you know, on one hand, it's like it's part of my job to include the science in it. You know, but on the other hand, I wanted enough science so that we as audience could begin to understand what sort of question Sims was asking, what the experience of the women was going to be. and sort of to get a feel for what those years were, both for him and for the women. You know, so sometimes I talk about sutures, and, you know, there's one point where I talk about the clamp suture, which is sort of the suture that he lands on at the end. You know, there's a lot of questions.

It's like, how do I explain this? How do I make it clear? And, you know, I guess maybe it's helpful that I'm myself, am not a science. So I read a lot of this information and often put the information that I understood or felt like I understood. Who knows if I actually understand it? And the information that made sense to me and fulfilled or filled out my understanding, put those sort of details in the play. There was also, you know, there's a lot of questions I would get in the development of the play of, okay, great, we know it took all this time. But like, what was he doing?

What was he doing? And so I would read article after article, book after book, trying to get a sense. And from what I read, and, you know, if somebody's listening that knows a bit more, please tell me. But from what I gathered was that he was just sort of like trying and failing and waiting for women to heal up again so they could try again. Trying to emphasize that as much as emphasizing what he was doing became really, I think, important part of the piece of the frustration that I imagine he probably felt. and obviously that the women felt and sort of having that be in the play. You know, in our more modern life, we see medicine and we see, oh, wow, they figured out this thing and they did that. And it feels a little bit.

We'll be like, oh, it feels slow, but, like, ultimately it wasn't necessarily that slow. And I think also, like, having the sense of, like, you know, gynecology wasn't a field. All of this was being figured out at the time, you know, and emphasize. realizing what they knew, what they found out, and how long that sort of knowledge took to gain felt important. Are we supposed to hate J. Marion Sims after this play? I mean, I leave that up to you. I can only answer that personally. And personally, I don't hate Sims. I think that J. Marion Sims, like many other doctors and scientists and just people at the time, lived within an evil system, which we call slavery, that put certain, you know, certain. people, white people, above black people and took away black people's humanity. And that is

terrible and that is evil. And I hate that. And I hate that that system allowed for what we now look back on as racist practices or practices infused with racial bias to take place. That said, I also acknowledge the fact that Sims' work was important. Figuring out how to close fistulas helped not only black women. It did help white women and other women throughout the United States and throughout the world, quite frankly, even as the procedure may have been refined. And his work, you know, led to him opening a women's hospital here in New York City. And, you know, he's called the father of modern gynecology for a reason. I go to the gynecologist, they use a speculum.

I can appreciate that. But I think it is important for me, and I hope for anyone sort of seeing the play, to be able to hold that to be like, yes, this is, you know, good job. Sims, you figured it out. But you don't have to agree with the way that he did it. You don't have to like it, and we don't necessarily have to forgive him for his methods. I think it's more important to hold both of those things, to hold the good that he did and hold the bad way that he did it and somehow learn to honor both sides of that. Personally, I think that that's something we could do better of in general and not necessarily having to fall one way or the other.

I think, too, the thing I'm actually, what I hope people leave with even more so than that is these women. because the thing that actually upsets me more is like the conversation about whether he's good or bad or evil actually just totally ignores the fact that these women were there and these women deserve to be honored and remembered in the same breath that we remember Sims, if not before we remember Sims. Do they need a statue of their own? I would hope so. You know, because the thing is, you know, the pedestal, so Sims' statues,

on the perimeter of Central Park. They removed his actual statue, but the pedestal actually still is there. So there's a big question of like, what's going to happen with the pedestal? Do we want to add something? You know, and that's something, you know, basically, it was added in my scope, but what sort of interests me in the conversation about the statue? If the pedestal is still there and I don't know what's going to happen to it. And if his statue still exists, even though it's in Greenwood Cemetery, it still exists. And there are statues of him in other states.

here in the U.S. Why not have a statue to these women? Why not honor them that way if we are making arguments as to why we should even keep the statue of him? Again, personally, the statue of him doesn't so much bother me, but the lack of the statue of the women does. So, you know, if we're going to honor him, then we need to honor them. And it shouldn't just be their names.

on a plaque, which, you know, unfortunately people may or may not read. I would be open to other ways of honoring them. You know, we're having a big lots of discussions about statues, so maybe statues are not the best way to honor people anymore. I don't know. But I would love it if there were a representation of the women that felt as striking as the statue of Sims. So is this play behind the sheet,

Is it only about the dark history of the beginning of gynecology? Or is there something in here that you would want modern gynecologists to keep in mind? The story of Anarka Betze and Lucy came more to light as I was writing the play, in part because of all of the studies and articles that were talking about black maternal mortality rates. I, as a black woman, I'm three to four times more likely to die from a pregnancy-related complication. than a white woman of the same age, same socioeconomic background, all of these things. And a lot of these articles actually mentioned Anika Betsy and Lucy and the work of Sims, in part because we see an example of black women's pain, either being misunderstood, being ignored, or ultimately being sort of like endured so that this thing could be fixed really in white women.

You know, and so if that's where gynecology started, it doesn't surprise me that we find ourselves in a situation where black women find themselves being ignored when they talk about their symptoms or their pain being misunderstood. Their particular bodies and particular histories being ignored. there have been studies, there was a study in the University of Virginia did a few years ago where, like, doctors in medical school, there were some that still believed that, you know, black people don't feel pain in the same way. So clearly these notions have persisted whether we like it or not. And so I think for me in writing the play, it became a way of me personally being like, okay, so like how do we get here? And honestly, it doesn't necessarily surprise me that we are where we are if that's the way gynecology started. And that's not to say, like, I have friends who are doctors and who are like, oh, my God, this is terrible. You know, and there are lots of good doctors.

I know that. But I do think that I hope the play A brings light to the history, which I was at the gynecologist. My gynecologist didn't know this history. So, you know, brings that to light. And perhaps, you know, makes, you know, gynaecologist maybe sometimes take a step back and make sure and question themselves if they are listening to black women specifically. But ultimately, women also, there's a whole lot of other issues that deal with gynecology and women's pain and being ignored in general.

So I hope that it sort of gets doctors to take that extra time and sort of question whether or not they're listening. And I hope that it allows for people who are going to the gynecologist to feel like they can to speak up for themselves and to really make sure that they are finding the doctors that are listening to them or finding situations that allow for more communication. So now you actually see there's like a lot of doulas are being asked to be in labor rooms to be another voice, to be another pair of eyes, you know, and to hopefully begin to sort of prevent these complications from getting worse.

I do hope that the play opens up that dialogue and adds to the conversation around the, you know, horrible reality of black maternal mortality rates. And we're out of time. Yeah. Thank you so much for being here, Charlie. Thank you. Charlie Yvonne Simpson is a playwright living in New York. Her most recent work is behind the sheet running at the Ensemble Studio Theater in Manhattan

until February. Thanks also to actors Jahan Young, Naomi Lorraine, Sean Randall and Christina Pitter, whom you heard in clips from the play earlier.