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 FROM MIDWIVES TO MEDICINE: THE BIRTH OF AMERICAN GYNECOLOGY
Deborah Kuhn McGregor
Rutgers University Press, USA 1998
Review by Lisa Featherstone
In From Midwives to Medicine, Deborah Kuhn McGregor, Associate Professor of History and Women's Studies at the University of Illinois, traces the origins of gynaecology from the mid- 1800s in America. McGregor describes this work as a new and completely revised edition of her earlier work, Sexual Surgery and the Origins of Gynecology: J Marion Sims, His Hospital and his Patients (1989). For readers of her original text, some of the material may retain a familiar feel; others will find this an innovative and important work.
Throughout the text, McGregor stresses the importance of vesico-vaginal fistula (VVF) in the development of gynaecology as a field. VVF results from a difficult confinement, in which small internal tears in the vaginal wall lead to urinary and even faecal incontinence. It is generally caused by prolonged second stage labour: when the cervix is dilated, the head of the baby can cut off circulation to the vaginal tissues. In the days after delivery, the tissue sloughs away, leaving small tears. While not life threatening, VVF was extremely uncomfortable for the woman, as urine could constantly drip from the vagina, leaving her open to irritation, infection and social isolation. McGregor suggests the treatment of this 'accident of childbirth' was central to the establishment of hospitals for women, and gynaecology as a separate discipline.
To illustrate this, she concentrates on the life and career of the surgeon J. Marion Sims who pioneered the treatment of VVF. Some of the most graphic and startling evidence is from Sims' early years of practice. His initial operations were performed on a core group of slave women, many of whom stayed with him for a number of years, and endured repeated operations while Sims' perfected his technique. On these women, he developed Sims' duckbilled speculum, with which he conquered the female body; 'I saw everything, as no man had ever seen before'(p49).
McGregor offers a careful, thoughtful analysis of gender, race and class. Rather than universalising women as a homogenous mass, McGregor thoroughly delineates the differences between women as patients. Hospital patients, whether poor, black or both were viewed as available for surgical experimentation, while middle class women gained the benefits of such trials. As such, McGregor sees race as central to the nascent field of gynaecology. Without access to the bodies of slaves, Sims would have been unable to establish himself as either a surgeon, or a specialist in the field of fistulas. Despite its early claims of 'science', medicine was steeped in the racial ideologies and hierarchies of the day. For example, Sims used no anaesthetics on slave women, claiming the repair of VVF was not painful enough to be worth the 'trouble.' It was a part of Sims' worldview that only his wealthy white clients felt pain.
The first half of the book concentrates on the South, with its social, political and economic distinctiveness, of which slavery is of course emblematic. The second half of the book follows Sims' migration to New York, where a group of wealthy local women patrons established the Women's Hospital, to showcase his work. While many middle class women utilised the hospital, Sims continued to develop his techniques on poor women, the Irish immigrants. Mary Smith, the first patient of the hospital, was an Irish woman suffering from VVF. She endured twenty-four operations, resulting in only a moderate improvement in her condition: she remained unable to adequately retain urine in her bladder. Regardless of his inability to solve such severe problems, Sims confidently continued to innovate new techniques, including 'cures' for dysmenorrhea, vaginismus and infertility.
Overall, this book is an excellent history of the emergence of scientific gynaecology in the United States. Its weakness is perhaps the title; it claims to do too much. This is not, as the heading suggests, a history of midwifery. It concentrates rather on scientific medicine and the development of new technological 'advances' in the emergent field of gynaecology, most particularly following the work of one man, Sims. Its strengths are its attention to the historical categories of race, class and gender, and its careful detailing of individual case studies, which make fascinating (if frightening) reading. The examination of clinical notes is excruciatingly good - graphic and real, but never gratuitous. It is beautifully written, and contains a close and considered analysis. For those interested in the history of women's bodies, childbirth, medicine or science, From Midwives to Medicine will be a compelling, illuminating read.
Lisa Featherstone
Dept of Modern History
Macquarie University, Sydney.
Birth Issues 2001;10(3/4):109-110
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