Medical Bondage

Race, Gender, and the Origins of American Gynecology

Deirdre Cooper Owens

• Publisher: University of Georgia Press
• Year: 2017
• ISBN:
  9780820351346
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

The accomplishments of pioneering doctors such as John Peter Mettauer, James Marion Sims, and Nathan Bozeman are well documented. It is also no secret that these nineteenth-century gynecologists performed experimental caesarean sections, ovariotomies, and obstetric fistula repairs primarily on poor and powerless women. Medical Bondage breaks new ground by exploring how and why physicians denied these women their full humanity yet valued them as "medical superbodies" highly suited for medical experimentation.

In Medical Bondage, Cooper Owens examines a wide range of scientific literature and less formal communications in which gynecologists created and disseminated medical fictions about their patients, such as their belief that black enslaved women could withstand pain better than white "ladies." Even as they were advancing medicine, these doctors were legitimizing, for decades to come, groundless theories related to whiteness and blackness, men and women, and the inferiority of other races or nationalities.

Medical Bondage moves between southern plantations and northern urban centers to reveal how nineteenth-century American ideas about race, health, and status influenced doctor-patient relationships in sites of healing like slave cabins, medical colleges, and hospitals. It also retells the story of black enslaved women and of Irish immigrant women from the perspective of these exploited groups and thus restores for us a picture of their lives.

CHAPTER ONE

THE BIRTH OF AMERICAN GYNECOLOGY

[Medicine] is a profession for which I have the utmost contempt. There is no science in it. There is no honor to be achieved in it; no reputation to be made.

—John Sims to his son, James Marion Sims, the “Father of American Gynecology”

AFTER CONGRESS BANNED THE IMPORTATION OF AFRICAN-BORN SLAVES in 1808, American slave owners became even more interested in increasing the number of slave births in the United States. At the same time that the stature of the United States was rising globally, especially as an increasingly profitable slave-based nation, another one of the country’s industries, namely, reproductive medicine, was developing and expanding rapidly. It was not long before medical doctors and slave owners began to work closely to protect the reproductive health of black women who were held in bondage. Doctors developed complex relationships with slave owners, slave traders, one another, and finally, the enslaved women they treated for gynecological diseases. Despite the complicated connections between white men and black women as doctors and patients, they sometimes worked collectively in the name of healing, but most often they did so separately. Their end goal was nevertheless the same: to maintain the reproductive health of enslaved women so that they could continue to produce children.

Since the early seventeenth century, colonial Virginian legislators determined that the status of enslaved children would be tied solely to their mothers’ station.¹ A century later, bearing many children was a constructed measure of success for enslaved women, with some slave owners going as far as to reward slave mothers of large broods with gifts and, in rare instances, manumission. On Mary Reynolds’s plantation, her owner promised to give every bondwoman who birthed twins in a year’s time “a outfittin’ of clothes for the twins and a double warm blanket.”² Reynolds also told the story of a slave mother on her plantation who received certain privileges because of the sexual relationship she had with her master. A light-skinned enslaved woman, originally from Baton Rouge, Louisiana, was placed in a house, located some distance from the other slave quarters on the plantation. The woman had been bought as a seamstress, possibly a euphemism for “fancy girl” or sex slave.³ After a few years, she bore a number of children for the plantation master, Mr. Kilpatrick. Yet he seemed so taken with his concubine that he violated racial etiquette and acknowledged his paternity of their children. According to Mary Reynolds, the plantation owner purchased the children’s clothes, visited them daily, and allowed them to call him “Daddy” publicly. Of course, the archival records do not indicate how Kilpatrick’s slave mistress felt as his concubine and the mother of his enslaved brood.

Unlike the fertile women Mary Reynolds mentioned who lived on her plantation, an infertile enslaved woman presented a problem not only for her owner but also for those white residents who lived in a slave society dependent on black women’s reproductive labor. Alice Sewell remembered how her enslaved grandmother was “swapped away” because she “didn’t bear children.” She stated that after her grandmother had lived on the new slave farm, her current owner informed her former master “dat Grandmama was heavy with child.” Sewell recalled how “sick” her grandmother’s previous owner was over the sale and that Alice’s mother never saw her mother again, “till she had all dem thirteen children.”⁴

As black women’s birthrates increased, white medical doctors began to work in midwifery in greater numbers too. Midwifery was not a medical field that men had previously controlled; it had been the domain of women for centuries. Since the country’s colonization and founding, its citizens had believed that maintaining women’s health was a job divinely ordained for women. Although there was a long history of male involvement in professional women’s health care in Europe, American women—like most women globally—tended to one another when they gave birth. Despite women’s predominance within the field, American doctors “masculinized” gynecological medicine by creating institutions and cultivating pedagogical approaches for men who would work exclusively on women’s bodies.⁵ These early Americans were building on a practice begun by their European predecessors nearly a century earlier. American men’s entrance into this exclusively female terrain was regarded by some citizens as not only intrusive but also unnatural. Their outcry gained attention as the criticism entered the pages of colonial newspapers, like the Virginia Gazette, which described male midwives as “immoral” in a 1722 opinion piece.⁶

Despite these initial protests, however, white men continued to enter reproductive medicine over the course of the century. As a result, formally trained doctors devoted serious consideration to the complaints, conditions, and diseases of women. As these men became increasingly concerned with formalizing medicine more broadly and legitimizing certain branches of the field such as women’s health, they transformed it into modern American gynecology. Most importantly, women’s health improved globally as early American gynecologists innovated surgical procedures that aided in successful cesarean births, obstetrical fistulae repair (which stopped incontinence and repaired vaginal tearing after childbirth), and the removal of diseased ovaries via abdominal surgeries.

The partnerships formed by medical doctors and schools, especially those located in the South, with slave owners to treat the reproductive ailments that affected enslaved women gave them even greater access to black women’s reproductive bodies and, later in the century in the North, to those of poor Irish immigrant women. Male midwives relied on the bodies of vulnerable populations like the enslaved and the poor to advance their medical research, to create effective surgical procedures to cure women of formerly incurable gynecological conditions, and, to a lesser degree, to provide a pedagogical model for physicians who were interested in understanding what they believed to be the biological differences between black and white women.

In slavery, healthy black people who labored diligently made the system economically valuable. Within the professional women’s health-care world, deceased and living black women’s bodies were also profitable. Doctors used the diseased reproductive organs of black cadavers to facilitate gynecological research and provide education in the field of gynecology. Career benefits also accrued to these medical men, who achieved their professional goals through the publication of their research in medical journals.

As the number of medical journals increased and they became more accessible, their popularity extended beyond the medical profession. Some lay planters relied on medical advice culled from these journals in the slave-management periodicals to which they subscribed.⁷ Health problems proved to be a physical and economic burden to slave-owning southerners, and those who had a stake in maintaining a healthy slave labor force appreciated the availability of professionalized medical advice via the medical journal. Medical librarian Myrl Ebert, whose work provides the genealogy of American medical journals from 1797 to 1850, posits, “The advent of medical societies in America, combined with the need for better communication among native physicians, produced the first truly American medical periodical literature.” Medical journals symbolized the growth of modern American medicine because they allowed doctors to make “demands for definitive ethics in practice, medical legislation for the protection of patient and physician, and the reorganization, expansion, and adjustment of medical education.”⁸

If medical journals had by midcentury become so important culturally and socially, especially concerning matters of racial difference, how did this transformation occur so quickly when America had lagged behind Western Europe medically for nearly two centuries? During the late eighteenth century, American medical journals were limited and consisted typically of “reprints, translations, or imitations of European counterparts.”⁹ The Medical Repository began publication in 1797 as the first medical journal published in the United States, and in it a number of pioneering articles appeared. Dr. John Stearn wrote on the “use of ergot in childbirth” before American gynecology and obstetrics were even formalized as professionalized branches of medicine.¹⁰ By 1850, American editors had published 249 periodicals about health and medicine, and out of that group, 189 were medical journals specifically. The growth of the American medical journal demonstrated that although Americans continued to rely on their kith and kin to care for them during illness, the status of formally trained medical men grew as they continued to professionalize and document their work through medical periodicals.¹¹ By the late 1870s, gynecologists’ reputations had certainly improved from the low point indicated by the dismissive remarks made by the father of James Marion Sims at the start of Sims’s career.¹²

In Augusta, Georgia, the brothers Dr. Henry F. and Dr. Robert Campbell served as editors of the Deep South’s first medical journal, Southern Medical and Surgical Journal, and they served an exclusively slave population at the Jackson Street Hospital they founded. Enterprising and elite men like the Campbell brothers connected their private medical practices with other institutions such as slave hospitals, regional and national medical societies, and leading medical journals. In the case of the Campbells, slavery, medicine, and medical publishing formed a synergistic partnership in which southern medicine could emerge as regionally distinctive, at least through its representation in medical literature, and especially with regard to gynecology. For instance, Henry Campbell worked on enslaved patients as a gynecological surgeon, published medical case narratives of those operations in the Southern Medical and Surgical Journal, helped to found the American Gynecological Society in 1876, and in 1885 served as the president of the American Medical Association (AMA).¹³ For pioneering southern doctors like Henry and Robert Campbell, the American medical journal served to legitimize their careers as much as the work they performed in early American gynecology served to authenticate their professional writings.

Antebellum-era doctors wrote articles that were supposed to be value neutral and to be free of bias and prejudiced claims about patients’ race, gender, and class. Much of their writing, however, reflected the scientific racism of the day. Gynecology, specifically, was becoming increasingly scientific because of its growing focus on research and experimentation. Gynecologists’ ideas and practices demonstrated a broader belief that their forays into formal medicine should be trusted precisely because they were now leading a new medical field that was formerly the domain of women, who were considered inherently inferior. These doctors medicalized women’s biological functions and problems that needed “expert” medical intervention. Moreover, their scientific research, which included experimental trials, accorded them the slowly growing respect of other Americans by midcentury.

Particularly by midcentury, physicians’ medical writings offered laypersons and professionals alike foundational texts that modeled how to treat and think about black and white women and their perceived differences based on biology and race. The authors of these texts understood at the time, as historian Bruce Dain has argued, “that a sharp distinction between nineteenth-century biology and eighteenth-century natural history [was] not tenable.”¹⁴ Natural historians had primarily sought to classify and understand plants and animals, and they did so by describing the fertilization processes of plants and the mating of animals, for example, using language that likened them to human courtship rituals. In the nineteenth century, scientists and medical doctors began to not only study humans but also research ways to treat human diseases. The blending of science and medicine that occurred during the nineteenth century opened up space for research and even more rigid racial categorization to occur. Medical journals denoted this merger. Historian of slavery Walter Johnson describes medical journals as a site “where race was daily given shape.”¹⁵

Racial reification occurred in these journals when questions emerged about whether certain diseases, features, and behaviors were endemic to women of African descent, for example, steatopygia (enlarged buttocks), elongated labia, low-hanging breasts, and lasciviousness.¹⁶ The discourses on bondwomen and other racialized “inferior” bodies gave rise to the “black” female body serving as “a resource for metaphor,” as literary theorist Hortense Spillers put it.¹⁷ The descriptors in the American grammar book on race range from “Hottentot Venus” and “fancy girl” to “humble negro servitor.” And one of the most common descriptive terms for enslaved black women was “breeder.” In nineteenth-century America, the slave and, later in the century, the poor immigrant woman epitomized the “breeding woman,” whose primary value lay in her ability to reproduce. There was little room for women who did not fit into this category. These names were all deeply rooted in America’s long fascination with black women as hypersexual beings. Even as medical branches like gynecology and obstetrics grew, black women and those whom blackness was sometimes mapped onto, such as the Irish, were seen as willing and strong servants for white medical men, impervious to physical pain and unafraid of surgeries.

Southern hospitals that treated enslaved women who suffered from gynecological conditions proved to be critical sites where ideas about black and white biological distinctions were given credence. The Medical College of Georgia was one of the early sites of medical teaching about black and white differences. In mid-April 1850 in Augusta, Georgia, Mary, a twenty-eight-year-old married black woman who experienced irregular menstrual cycles and vaginal hemorrhaging, visited Dr. Paul Eve, a professor of surgery at the college, for treatment of her illnesses.¹⁸ Eve was one of the South’s leading surgeons and a founder of the AMA.¹⁹ Besides disclosing her medical history and list of symptoms to the doctor (she had experienced problems with excessive vaginal discharge for three years), Mary also expressed concern because she had never conceived. Dr. Eve was not surprised by her symptoms; as he claimed, these kinds of gynecological ailments were common among local black women. He wrote, “The history of diseases among our negro population is generally very imperfect and unsatisfactory, and this is especially true as regards uterine derangements.”²⁰ After diagnosing Mary with cancer, Eve assembled a surgical team, and they excised her cancerous uterus. The doctors claimed it was the first successful full uterine removal operation performed in the United States. Mary’s postsurgery recovery was initially successful. As she recuperated, Mary asked the doctors a question that continued to nag her: why had she not yet menstruated after her surgery?

Mary may never have learned that the removal of her womb had rendered her infertile and not very valuable as a slave or perhaps as a wife who was supposed to birth children, for she died on July 22, 1850, three months after her initial visit to Eve. Her surgical team, however, understood fully the nature of her surgery and its likely consequences for an enslaved woman of childbearing age.

After Mary’s death, her diseased uterus proved useful and valuable for another leading gynecologist, Dr. Charles Meigs, Dr. Eve’s northern colleague. Eve granted Meigs permission to display Mary’s preserved womb in his Philadelphia medical museum, so other doctors could observe how cancer ravaged uteri.²¹ Even postmortem, some black women seemed unable to escape the gaze and ownership of white men.

Black women, like Mary, were exceptionalized in American society because of their blackness, alleged hypersexuality, and their seemi...