Medical Bondage

Introduction AMERICAN GYNECOLOGY AND BLACK LIVES

„When invoking the term "body," we tend to think at first of its materiality—its composition as flesh and bone, its outline and contours, its outgrowth of nail and hair. But the body, as we well know, is never simply matter, for it is never divorced from perception and interpretation."
—Carla Peterson, Recovering the Black Female Body

The first women's hospital in the United States was housed on a small slave farm in Mount Meigs, Alabama, a lumber town about fif- teen miles from Montgomery, a large slave-trading center. From 1844 to 1849, Anarcha, Betsy, Lucy, and about nine other unidentified enslaved women and girls lived and worked together in the slave hospital that Dr. James Marion Sims founded for his training and for the surgical repair of his patients. He had his workers, probably enslaved, build the hospital for the treatment of enslaved women affected by vesico-vaginal fistulae, a common obstetrical condition that caused incontinence, and that was brought on by trauma and by the vaginal and anal tearing women suffered in childbirth. Years after he performed his pioneering work, all experimental, Sims achieved success and an international good reputation. He would later be known as the "Father of American Gyne- cology." The women he operated on continued to perform the duties slaves were expected to complete. These bondwomen tended to the domestic needs of the Sims family, which included a sick child. They cooked, cleaned, stoked and kept the fire burning during the winter, fetched well water, wiped sweaty brows and dried crying eyes, planted and picked vegetables, and nursed their babies, all while serving at the same time as experimental patients. As Sims's surgical nurses, they learned the fundamentals of gynecological surgery from arguably the most successful gynecologist of the nineteenth century. During the five years they lived on Sims's farm, they helped him birth a new field. It is no exaggeration to state that these enslaved women knew more about the repair of obstetrical fistulae than most American doctors during the mid- to late 1840s. In studies of James Marion Sims's career and especially of his "Alabama years," the occupational status of his enslaved patients as nurses has been con- sistently overshadowed by discussion of their illnesses. This study of slavery, race, and medicine, on the other hand, makes a sustained effort to examine and understand the richness of the personal and work lives of slaves, especially of Sims's slave nurses. Their experiences offer us a lesson about the relationship between the birth of American women's professional medicine and ontological blackness. During the antebellum era, most American doctors believed that blackness was not only the hue of a person's skin but also a racial category that taught substantive lessons about the biology of race and the so-called immu- tability of blackness. Following this biological theory, a black woman could be the same species as a white woman but also biologically distinct from and inferior to her. By examining the work lives of enslaved women patients and nurses through the prism of nineteenth-century racial formation theory, we can better understand not only the science of race but also the contradictions inherent in slavery and medicine that allowed an allegedly inferior racial group to perform professional labor requiring substantial intellectual ability. In the case of Dr. Sims's slave nurses, scholarship has examined their ex- ploitation as patients forced to work as surgical assistants. This book, however, shifts the focus to the lack of recognition these women received as nurses, even though nursing was considered a feminine profession in which intelligence and judgment were valued. This book also demonstrates how slavery and racial science were self-contradictory in their assumptions about black people's in- feriority. Although historical records list the New York hospital Sims founded in 1855 as the country's first women's hospital, we also know that a decade earlier he had created an Alabama slave hospital for women. During its last two years under Sims's leadership, he taught his patients how to assist him during surgeries. Once Sims left the South for New York, he sold his women's hospital to a junior colleague, Nathan Bozeman, Sims's former medical assistant and a fellow slave owner, who continued operating it as a gynecological hospital and treated and experimented on patients from a primarily slave population.1 Like Sims, Dr. Bozeman later sold the hospital and returned the enslaved patients to their owners. He went on to advance his burgeoning medical career and
promote his button suture surgical method, which he touted as more successful than the Sims silk suture method. For pioneering gynecological surgeons, black women remained flesh-and- blood contradictions, vital to their research yet dispensable once their bodies and labor were no longer required. Neither Sims nor other early American phy- sicians viewed Sims's slave patients as the maternal counterparts to Sims in his role as the "Father of American Gynecology." There was no social or cultural impetus for professional white men, heavily invested in their racial, gendered, and slaveholding dominance, to do so. To remedy this failure to acknowledge their contribution, this book recognizes the unheralded work of those enslaved women recruited against their will for surgeries and made to work while hos- pitalized, and the labor of those poor immigrant women who willingly entered crowded hospitals in an effort to be healthy reproductively. Medical Bondage is not so much about historical recovery as it is about the holistic retrieval of owned women's lives outside the hospital bed. I place them in the annals of medical history alongside the doctors who performed surgeries on them. Slavery forced sick women to experience their lives in ways unimaginable to other Americans. Slavery created an environment in which black women performed more rigorous labor than white women and some white men. Be- cause the agricultural work that all enslaved people performed was identical, doctors sometimes erased gender distinctions when they assessed the physical strength and health of black women. White people believed that black women could sustain the brutal effects of corporal punishment such as whippings just as black men allegedly could. When these women fell ill, a physical state where most people are allowed to be weak, white society objectified and treated them as stronger medical "specimens." As a consequence, enslaved women vacillated between the state of victim and of agent. The historical arc of American gynecology resembles other American histo- ries in that it is triumphant. It is a polyphonic narrative that contains the voices of the elite and the downtrodden, and if studied closely, this history evidences how race, class, and gender influenced seemingly value-neutral fields like medi- cine. In works such as Sharla Fett's Working Cures, Marie Jenkins Schwartz's Birthing a Slave, and Deborah Kuhn McGregor's From Midwives to Medicine, enslaved women and Irish immigrant women emerge as historical actors wor- thy of examination. These scholars have rightly focused on sexual violence, reproduction, and the family, and Medical Bondage introduces both science and medicine into the discourse. By chronicling the lives of enslaved women, this book demonstrates that slavery, medicine, and science had a synergistic relationship. It departs from the work of Fett, Jenkins Schwartz, and Kuhn McGregor not only because it is a comparative study of black slave women, Irish immigrant women, and white medical men. It also delves deeply into the creation of antebellum-era racial formation theories about blackness: the idea that race was biological and determined one's behavior, character, and culture. Further, my study broadens the work of important historians of medicine like Todd Savitt who have focused on race and medicine but not examined the central role of slaves in the history of gynecology. Historians of race and medi- cine have recast different topics such as antebellum medical care, the health effects of emancipation, and late-nineteenth-century concerns about tubercu- losis, race, and the city. My work returns the discussion to the plantation while also examining how American gynecology developed. Medical Bondage also builds on two significant arguments about the relation- ship between slavery and medicine. First, reproductive medicine was essential to the maintenance and success of southern slavery, especially during the ante- bellum era, when the largest migration and sale of black women occurred in the nation's young history. Doctors formed a cohort of elite white men whose work, especially their gynecological examinations of black women, affected the country's slave markets. Each slave sold was examined medically so that she could be priced. Second, southern doctors knew enslaved women's reproduc- tive labor, which ranged from the treatment of gynecological illnesses to preg- nancies, helped them to revolutionize professional women's medicine. Slave owners used these men's medical assessments to ascertain whether a woman would be an economically sound investment. Was she a fecund woman or in- fertile? Did she have a venereal disease that could infect others slaves on a farm or plantation? These questions mattered, and doctors provided the answers for buyers. Most pioneering surgeries such as ovariotomies (the removal of dis- eased ovaries) and cesarean section surgeries that occurred in American gyne- cological history happened during interactions between white southern doctors and their black slave patients. As a comparative study, Medical Bondage analyzes the medical experiences and lives of Irish women during the antebellum era, in addition to those of slaves of African descent. This study does not consider the work lives of Irish immigrant women as maids, prostitutes, and factory workers in every aspect but focuses in particular on the medical impact that gynecology had on them. By the 1850s, the massive influx of recently arrived Europeans had become in- tertwined with modern American medicine. There has been little written about Irish women's reproductive medical lives, although many of these women expe- rienced multiple pregnancies, like most American women of the antebellum era. This monograph shines a brighter light on the biomedical experiences of one of the largest groups of immigrant women in America during the age of slavery.
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Seite 22 von 182American Gynecology and Black Lives 5 Poor Irish-born women relied disproportionately on hospitals and physicians in northern cities. In some urban areas, Catholic hospitals were founded to meet both the spiritual and the medical needs of Irish women. In cities such as New York, doctors relied on this patient group as subjects for exploratory gynecological surgeries in much the same way southern physicians did enslaved women, because these women were an accessible vulnerable population. Within the crowded field of slavery studies and the growing genre of race and medical history, this book offers a different narrative about the history of American slavery, race, gender, and medicine. My research also proves that slavery and Irish immigration were intrinsically linked with the growth of modern American gynecology. Sims's work on Irish immigrant patients, es- pecially his first New York patient, Mary Smith, evidences that he practiced a form of nineteenth-century medicine guided by the belief that elite white lives should be held in higher esteem than poor, foreign ones even while he relied on immigrant and black women's disorders to discover cures for the illnesses of all women. It reveals how nineteenth-century Americans' ideas about race, health, and status influenced how both patients and doctors thought of and interacted with each other before they entered sites of healing such as slave cabins, medical colleges, and hospitals. Racial formation theories were being created and debated just as women's professional medicine was developing. American medicine was moving from the periphery to the center in global Western medi- cine largely because of the innovative surgical work performed by gynecolo- gists. Pioneering gynecological surgical procedures, many of which were ini- tially performed on enslaved women and later on poor immigrant women, were responsible for much of the field's rapid advancement in cesarean sections, obstetrical fistulae repair, and ovariotomies. The import of these medical ad- vances is immense because European medicine had previously dominated how physicians understood medicine in America. These theoretical and practical developments in women's medicine began to transform the United States into a leader in modern gynecology. Up until the late eighteenth century, U.S. physicians relied on the ancient Greek and Roman humoral system of understanding and treating the body.3 For example, American doctors, like their European colleagues, bled their pa- tients to release toxins. The practice was a common one and was popularized by leading medical men such as early American patriot Benjamin Rush, who is now considered the "Father of American Medicine." Early on Rush also as- serted that blackness was a genetic pathology and taught his medical students that blackness was a form of leprosy.4 Although Rush's theory of blackness as a disease seems rooted in the Western world's general belief in scientific racism, he was asserting that black and white people were not different species. Thus blackness was not caused by natural anatomical differences, and ultimately black and white people were at least biologically identical. American medicine came into its own after an American physician per- formed the modern world's first successful abdominal surgery and southern doctors began to use surgical methods that permanently repaired reproduc- tive conditions. The reverberations of these surgical triumphs were felt glob- ally. Following the publication of James Marion Sims's groundbreaking 1852 medical article on the treatment of vesico-vaginal fistulae repair, he received numerous invitations from European royalty to treat their female relatives for various gynecological conditions and diseases. With Sims's achievement, American frontier medicine, much of it occur- ring in slave communities, had become a leading source for medical knowl- edge production globally. Yet the central role that enslaved women played in these advances—by providing doctors the bodies and sometimes labor needed for experimentation, treatment, and repair—went unacknowledged. Modern American gynecology could certainly exist without slavery, but slavery's exis- tence allowed for the rapid development of this branch of medicine, and espe- cially of gynecological surgery. Like black enslaved women, Irish immigrant women faced a number of ob- stacles that obstructed their progress in society. These disadvantages included the debilitating physical effects of manual labor, sexual abuse, multiple births, disease, medical experimentation, and violence. My examination of the treat- ment of black and Irish women does not reduce them to uncomplicated victims of xenophobia and medical racism. I have chosen to follow theorist Saidiya Hartman's recommendation to not re-create the trauma and oppressive gaze that historical actors experienced at the time in my historical treatment of them. In my regulation of how "pained black bodies" are discussed and interpreted for readers' knowledge and ultimately their assessment, it is not my intention to cross the line of objectifying these historical actors.5 I direct attention toward not only enslaved women's lives but also those who were treated as "black" and bring into sharper focus what happened to them medically. My theorizations about their experiences, pains, uses, and their bodies should not be read as another way of reifying black women as disem- bodied "objects." Another challenge was locating sources where slave voices were not muted, filtered, or spoken by those who held power over them. I have attempted, however, to present these women as complicated, whole, and fully human, although the physical and psychological costs exacted by slavery were inhumane.
Since coining and defining the term "medical superbody," I have wrestled with its use because it is a fraught denominator. Other than the problematic descriptor "degraded," which was broadly used to label disempowered women, no historic label from the antebellum era encapsulates the complexities and contradictions that were part and parcel of enslaved women's socio-medical ex- periences. Consequently, my use of medical superbody is intentionally messy, ambiguous, and contentious because black women's entrance into gynecology proved complex for white doctors, who viewed them through an optical mi- croscope, using only two lenses, simplicity and complication. How could these women be both healthy and sick, strong yet rendered weak by the treatments and surgeries they endured? And ultimately, why were black bodies, which contained conflicting messages about their physical prowess and intellectual inferiority, positioned as the exemplars for pioneering gynecological surgi- cal work that was to ultimately restore allegedly biologically superior white women to perfect health? One of the more important functions of the "black" objectified medical superbody for white doctors was that black women were used not solely for healing and research but largely for the benefit of white women's reproduc- tive health. They represented "the medicalization of life," whereby peculiar female diseases and even normal female biological functions were "problema- tized" and placed under the "advice procedures" of male experts who brought competencies within the orbit of an increasingly industrialized doctor-client relationship. It was a space where the medical superbody was the "epitome of consumerism" and pedagogy. „She " became "it," even in an arena like medicine, where patients were supposed to be treated as subjects, not objects. Medical Bondage is ultimately a historical telling of the impact of this medical scrutiny on the lives of enslaved women and poor immigrant women; it is also the story of the white medical men who fixated their gaze on these two groups.
Slave hospitals were the premier site for creating theories about black women's exceptionality, and medical journals were the ideal medium for de- scribing what transpired in these hospitals and articulating the resultant no- tions. In their pages, doctors presented and defined black women as "the other." Medical journals allowed for the medicalization of black and Irish women that was critical to the racialization project and process. Medical journals also described the "rival geographies" that existed between patients and early gynecologists.' In these spaces of respite— their homes, the woods, underground dwellings such as caves—slaves would use the time to heal themselves outside the surveillance of local whites and their owners. Slaves were almost always engaged in secretive activities, a necessity given the omnipresence of owners. Despite the furtiveness of slaves to "steal away," white doctors still had overwhelming access to black people's bodies and engaged in experimental gynecological work. White medical men moved black patients' bodies and body parts across a terrain that only they controlled. Historian Stephanie Camp has argued that "geographies of containment" were spaces where slaveholders put the idea of restraint into praxis. The slave hospital in this study is an exemplar of this kind of corporeal geographic containment. Hospitals were the backdrops for physicians' medical writings that offered laypersons and professionals alike foundational texts that explained, usually in explicit and carefully crafted language, how to treat and think about black and white women patients who shared the same diseases. Medical journals were critical sites "where race was daily given shape."" These texts offered readers allegedly value-neutral explanations about black biological difference and dis- ease. For example, women of African descent were believed to have elongated labia and low-hanging breasts and to be more lascivious than white women." Case narratives, the written descriptions of patient histories and exchanges with doctors, appeared in medical journal articles and chronicled the multifar- ious ways that black women experienced both antebellum professional medical care and racism. These sources are as important as plantation records, ledgers, and interviews in what they reveal about doctors' objectifying attitudes toward slaves and poor immigrants. Medical journals constitute the bulk of my source material. American doctors, especially pioneering southern ones who helped to create gynecology, saw themselves involved in a field that was becoming increasingly elite and professionalized and in some ways beginning to outpace European physicians' medical research in sexual surgery. Southern doctors believed "their medicine was inseparable from their need to pronounce it."

Southern slave owners and medical doctors relied on these publications to manage their slaves. Slave management journals devoted the bulk of their pages to the medical care of enslaved people, especially women. Masters, mistresses, and overseers let physicians' published articles serve as guides for their treat- ment of bondwomen who were pregnant, had given birth, or suffered from gynecological ailments. Even as black women were sexually exploited and suffered from physical and psychological scars, often inflicted by the men who owned them, the maintenance of enslaved women's bodies was still considered a priority. White southerners knew black women literally carried the race and extended the existence of slavery in their wombs. Medical Bondage attempts to repair the gaping fistula in the historiographies of the patients. However, in my effort to suture these historiographic holes, I humanize the experiences of the women who were both objects and subjects. The task is a difficult one because archives do not lend themselves to exploring and cap- turing the wholeness of enslaved people's lives. The study of U.S. slavery has changed greatly since early historian U. B. Phillips first wrote a pro-southern and Confederate-sympathizing history that praised slave owners for their be- nevolent treatment of their slaves. Since 1985, when Deborah Gray White and Jacqueline Jones inserted women into our discussions of U.S. slavery, histori- ans have spent the next three decades examining enslaved women's labor, both productive and reproductive, and how the group resisted and negotiated their bondage. Since the late 1990s, a small number of scholars have investigated the impact of medicine (both professional and folk), healing, childbirth, and motherhood on enslaved women's lives.' Medical Bondage joins a small but growing cohort of scholarship that interweaves the histories of slavery and medicine to investigate how each system affected the other. Further, this book elucidates how reproduction made the experience of enslaved black women markedly different from that of enslaved men's. Enslaved women had more frequent contact with doctors and, due to gynecological problems, were placed in hocnitals more often than enclayed men They were the chierts of ctudy 

The archival sources that allowed me to piece together the fragmented lives of women whose voices and experiences were published in snippets in the writings of white medical men are varied. I have relied largely on nineteenth- century medical journals, judicial cases from appellate courts, physicians' daybooks, the private diaries and plantation records of slave owners, census records, Works Progress Administration oral history interviews with former slaves, and slave memoirs. Other important sources that help to reveal the social conditions of the era are antebellum-era newspaper advertisements and medical texts and manuals. Fortunately, a number of archives have holdings devoted ex- clusively to slave history and medicine. In contrast, the bulk of archival records for Irish immigrant women's medical lives are scant, and most of my research on this group was culled from digital archives of nineteenth-century medical journals, medical textbooks, and hospital records.' Although the very earliest histories of slavery and medical history make no mention of enslaved women, they played a crucial role in the evolution of American medicine and must be acknowledged as scholars engage in the important work of tracing the origins of the intersections of race, gender, and medicine in early America. This study also serves as a counternarrative to socio-medical histories that do not question the veracity of hagiographic top-down histories about "great white medical men."15 Enslaved women played a central role in the advances made in gynecology by early pioneering gynecological surgeons, like Dr. Charles Atkins, who believed in the physical superiority of black women to bear pain easily. Atkins eventually published his findings about one of his slave patients, Nanny, nearly six years after her surgeries in 1825, in one of the coun- try's leading medical journals. In medical journals, biological findings became ideology. Although southern white male physicians repeatedly encountered physically fragile enslaved women whose bodies were weakened by the rigors of harsh agricultural work performed in cotton, rice, tobacco, and sugarcane fields and multiple pregnancies, these men held fast to their belief in black mamone nhercinal atronath and ones in childhinthl