Peering ‘Behind The Sheet’ Of Gynecology’s Darker History
Nineteenth-century physician J. Marion Sims has gone down in history as the “father of modern gynecology.” He invented the speculum, devised body positions to make gynecological exams easier, and discovered a method for closing vaginal fistulas, a painful, embarrassing and often isolating complication that can result from childbirth.
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. Over a period of about five years, the women underwent dozens of surgeries as Sims attempted, and failed, to fix their fistulas. He rarely used anesthesia.
What were the lives of those women like? A new play, Behind The Sheet, tackles this story from their perspective, imagining not just their pain, but the friendships they might have formed to support each other through surgery after surgery. In this story, the women tend each other’s ailments, make perfume to hide the smell from their fistula condition, and pledge to remember each other even if history forgets them.
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, and the complexity of weighing both their suffering and the benefits of Sims’ work to modern medicine.
Listen to the full, extended interview.
Charly Evon Simpson is the playwright of “Behind The Sheet,” based in New York, New York.
IRA FLATOW: This is Science Friday. I’m Ira Flatow. Until last spring, New York’s 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 The 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 Theatre in Manhattan sciarts producer Christie Taylor sat down with the playwright, Charly Evon Simpson, and here’s that interview.
CHRISTIE TAYLOR: Charly Evon Simpson, welcome to Science Friday.
CHARLY EVON SIMPSON: Thank you. It’s so good to be here.
CHRISTIE TAYLOR: 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?
CHARLY EVON SIMPSON: It seems like he sort of fell into medicine. Sims was trying to find his way and sort of fell into this complication, fistulas, and sort of just found this thing that he could sort of hone in on and really try to figure out.
And then it’s sort of fascinating sort of what he did afterwards. 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 changed the direction of his life. It wasn’t looking too exciting before that and things got interesting.
CHRISTIE TAYLOR: Yeah, and you mentioned those fistulas. What exactly is a fistula?
CHARLY EVON SIMPSON: The way I tend to describe it is fistulas usually occur during childbirth, and the baby is going through the birth canal and gets stuck. 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 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.
CHRISTIE TAYLOR: Yeah, and Sims, who you name George in the play, he was really determined to fix them. So what was he doing? Who were these women he was experimenting on?
CHARLY EVON SIMPSON: 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– Anarcha, Betsy, and Lucy. And what you gather from reading it is that you had these plantation owners who ended up with these women, these slaves, who had this issue. Which, we’re talking about slavery. Black women during that time were breeders. That was part of our, quote, unquote, “usefulness.”
And so suddenly, you know had these women who are in constant pain, who smell terrible, and are not in a position to have children and maybe not even in a position to do all the work that they used to. And so these plantation owners found their way to doctors, Sims being one of them, being like, what is going on? How can we fix this?
And at first, Sims was sort of like, I don’t know what to do 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 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’s sort of how we begin these years of experimentation. You then find out that it took him about four years to actually figure out how to fix fistulas. It still seems a little bit unclear. He was trying different methods, different materials– silk sutures, lead sutures. 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.
In the play, the character of George says “there’s no halfway with this. A hole is a hole.” These women would not be fixed if any urine or any feces could still escape. He would get close, but he would be left with these little, little holes. And it wasn’t until he figured out silver, silver sutures 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.
CHRISTIE TAYLOR: 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
SPEAKER: 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.
SPEAKER: Well, all he did today was remove some of the rotten parts of you.
DINAH: No parts of me are rotten.
SPEAKER: 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.
DINAH: How many times he try on you?
SPEAKER 2: A few.
DINAH: You ain’t fixed, yet?
SPEAKER 2: Not yet.
DINAH: So he can’t do it.
SPEAKER 1: You are helping him get there.
DINAH: What if I don’t want to help him?
SPEAKER 2: When’s the last time anything that we wanted mattered for anything? Besides, he bought you. You’re his now.
CHRISTIE TAYLOR: Could they have consented?
CHARLY EVON SIMPSON: I’ve read– there have been several articles, especially since all this talk of the statue has sort of come up. And some say that, oh, the women must have consented because of where the fistulas are in the part of the body. 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 were 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 weren’t even really considered fully human seems, for lack of a better phrase, seems a little bit ridiculous to me.
This is not to say that maybe– their lives weren’t fantastic. They were in pain, and they were uncomfortable. Of course, they probably– here’s somebody saying, I’m going to try to fix it. They may have been like, OK. That sounds like a good plan. But they’re OK, 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, surgery number one, maybe they’re like, OK, maybe this will end up OK. Anarcha was experimented on 30 times. So at what point, if at surgery number 15, she suddenly was like, actually, I don’t want this. I’m not convinced that her saying that would have any effect on whether or not the experiments continued. So this notion of consent 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.
CHRISTIE TAYLOR: You mentioned the number of surgeries already. That really stood out to me as, wow, 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 named Philomena is talking to another slave named Louis about her surgeries.
LEWIS: Well, how many surgeries has she had?
PHILOMENA: 15, about.
LEWIS: And how many on you? I feel like you in there every other week.
PHILOMENA: You can’t be in there every other week.
LEWIS: Feels like it.
PHILOMENA: I just tend to heal up faster than the others.
LEWIS: So you, uh–
PHILOMENA: 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?
LEWIS: Yes. How many times?
PHILOMENA: I’ve lost count.
PHILOMENA: 20, 25? I don’t know. 28. I’ll be going in for 29 soon enough. The lead sutures didn’t take.
CHRISTIE TAYLOR: And Charly, they weren’t given anesthesia, were they?
CHARLY EVON SIMPSON: Uh-uh. 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 operated on numerous times without the use of anesthesia. Now, anesthesia, at the beginning of his experiments, wasn’t widely used. There were people that were beginning to use it, beginning to understand it. Some of the research that I have done, it does seem like at least towards the end of his experimentations, that ether anesthesia could have been used and it would have been used in other situations.
But something interesting about Sims is that even after he sort of figured out the closing of fistulas, he still didn’t use anesthesia on most the women he was working on.
CHRISTIE TAYLOR: Including white women.
CHARLY EVON SIMPSON: It’s actually something I’ve read since I really wrote the play. That he just didn’t think that pain was worth it. 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 realized in the researching of the plays and in making the decisions for the plays that I will read one thing, and they will be like, oh, yeah, he definitely did. And I’ll read something else, and they’re like, I actually don’t know what he did. 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.
CHRISTIE TAYLOR: So they had to hold each other down.
CHARLY EVON SIMPSON: Yes. So these women– again, we’re talking about pain in an extremely sensitive part of the body. 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 Gynecology. 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 dressings and sort of doing the labor that wasn’t just focused on the closing of the fistula.
CHRISTIE TAYLOR: 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?
CHARLY EVON SIMPSON: I mean, I think something that was extremely– it is extremely important to me in the play and in sort of looking at this history, is acknowledging what the women went through. We can have complicated conversations about consent. We can have these conversations about whether or not ether anesthesia was used or whether or not he used it. Did he use it on black women?
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 it felt important to emphasize that and to really have it hit home. 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 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.
CHRISTIE TAYLOR: I’m Christie Taylor, and this is Science Friday from WNYC Studios.
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. They make perfume. They have hopes of romance. They laugh together. How true do you think that part is?
CHARLY EVON SIMPSON: I hope it is. I like to believe– these were women who were intimately a part of each other’s lives, as you mentioned. They’re holding each other down, and so I really hope that they had a intimate and close and ultimately, loving relationship. But I also, personally, 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.
We’re also talking a lot about pain. And I was not and continue to not be interested in retraumatizing us and having the only takeaway be pain. 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.
CHRISTIE TAYLOR: Are we supposed to hate J. Marion Sims after this play?
CHARLY EVON SIMPSON: 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 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’s 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 led to him opening a Women’s Hospital here in New York City. 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– 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 am 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.
CHRISTIE TAYLOR: We’re out of time. Thank you so much for being here, Charly.
CHARLY EVON SIMPSON: Thank you.
CHRISTIE TAYLOR: Charly Evon Simpson is a playwright living in New York. Her most recent work is Behind the Sheet, running at the Ensemble Studio Theatre in Manhattan until February. Thanks also to Actress Jehan Young, Naomi Lorrain, Shawn Randall, and Cristina Pitter, whom you heard in clips from the play earlier.
IRA FLATOW: That’s SciArts producer Christie Taylor, and you can hear the full interview. Parts you haven’t heard on the air can be heard on our podcast.