Honoring the Mothers of Gynecology

Honouring the Mothers of Gynecology

This blog was written after hearing Shankar Vendantam’s excellent podcast from the NPR Hidden Brain series on the mothers of gynecology.

The history of healthcare, the history of the noble profession, doctors, nurses, scientists and others has an underbelly of unethicality and double standards. This is often justified by the rationale that the practices were compatible with the ‘standards of the time’. That is one of the fundamental issues, the wrong question is whether it was compatible with the standards of the time, a possibly right question would be whether it was compatible with some of the eternal principles of medical practice. We will find again and again that actions of many of our predecessors in modern healthcare were not compatible with eternal ethical principles of healthcare.

An infamous example of an individual was the American physician J Marion Sims, who acquired black women slaves for the purpose of experimental surgery to resolve vesico-vaginal fistula. He operated on them without anaesthesia when anaesthesia was available and he operated on white women with the same condition only when he had completed his experimental surgery on black slave women after his technique was perfected on these black women. Who were these black women? It seems there were 14 of them; we do not even know their names except three of them. Anarcha, Betsy and Lucy.

In the NPR podcast historian Vanessa Gamble alludes to some potential motives. The women with vesico-vaginal (abnormal connections between urinary bladder and vagina) and recto-vaginal (abnormal connections between rectum and vagina) fistulas that happened after traumatic childbirth, meant that these enslaved women could not work for their ‘masters’ and could not reproduce creating more enslaved people to benefit their ‘owners’. So, it seems that it might not have simply been the desire to progress the frontiers of surgical science that was the primary motivator for Sims to have acted unethically. The view that he might have acted unethically is not just from retrospection, he was challenged about it even within his time.

Vanessa Gamble and Bettina Judd (a poet) talk in the NPR podcast about how these women whose life, living and bodies were used without consent could be recognised; there is some talk on statues along with the one that exists for Sims. Recognising and honouring these women is not tokenism, it is a fundamental for progress of humanity. Statues will act as symbols but they will have the constraints of geography and history whereas Sims will continue to have universality.

The mothers of gynecology should have universality (while Sims would become a lesser part of history). With that in mind I propose the following:

1)      Anarcha should be referred to as the mother of gynecology.

2)      The vaginal speculum currently known as Sims and its variants should from now be known as the Betsy speculum

3)      The surgical procedure to repair vesico-vaginal fistula should be called the Lucy’s repair.

While these three are important, it is also important to stop referring to Sims as the father of gynecology.

These suggestions stem from the principle where an immoral or unethical person is disassociated from any glory that is derived from the outcome of such person’s activity. The new world demands a new kind of approach, the sins, crimes and injustices of the past will remain – the benefits from those should not. The ignominy suffered by these women must be honoured by making them the main story; Sims of course needs a place on the page which he will have as an incidental footnote in the history of gynecology. Success in Healthcare demands these actions, we cannot allow healthcare to fail by not giving the mothers of gynecology their rightful place.

Organisations and persons working for equality and justice should lobby the gynaecological profession to adopt these changes so that they become the norm.

M. HEMADRI 

Links

http://www.npr.org/2016/02/16/466942135/remembering-anarcha-lucy-and-betsey-the-mothers-of-modern-gynecology

https://en.wikipedia.org/wiki/J._Marion_Sims

http://www.medscape.com/viewarticle/479892

PS: I started writing a blog called ‘What are the nasties in healthcare we may regret in the future?’ and intended to use the mothers of gynecology as an example. Once I started writing it I realised that it will be yet another injustice if the mothers of gynecology did not have their own place in these blog pages.

©M HEMADRI

Follow me on Twitter @HemadriTweets

My mini e-book 'Standardised Management Conversation' is available - click http://www.amazon.co.uk/Standardised-Management-Conversation-Hemadri-ebook/dp/B018AWBJTU 
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The Evolution of Language and its Impact on Racism

The Evolution of Language and its Impact on Racism

Some normal innocent original words took new meanings and won’t go away. It blights us today.

A muse on the four words, Fair, Black, Dark and White
(All etymology used in this essay is from Online Etymology Dictionary http://www.etymonline.com )

FAIR

Whenever we see injustice, someone or a group of persons negatively affected due to no fault of theirs we claim it is unfair, we then want to fight for fairness and we want a fair society.

Fair in this context means equitable and free from bias.

Let us look at the evolutions of the word ‘fair’. 

Originally the old original English meaning was ‘beautiful’ 'pleasing to sight, attractive' and similar; it also referred to good weather.  Then around the 1200 the word fair included references to 'light skinned people'. Are you beginning to see where we are going with this? The gradual slow association between pleasing to sight, attractiveness to lighter skin. Then by 1300 the word fair begins to be associated with "according with propriety; according with justice," and also refers good/auspicious and by 1400s it refers to "equitable, impartial, just, free from bias". From 1860 it refers to "comparatively good."

So the history of the word fair starts with beautiful which gets linked to light skinned persons, begins to refer also to justice and then good. 

Fair - white skin – just/unbiased – good 

That is the sequence associations of the evolution of the word fair.

DARK 

Let us now look at the word dark
The online Etymology dictionary says ‘Old English deorc "dark, obscure, gloomy; sad, cheerless; sinister, wicked," from Proto-Germanic *derkaz (cognates: Old High German tarchanjan "to hide, conceal"). "Absence of light" especially at night. Another old English link was darkly which meant horrible or foul.

That is the original meaning.

It is only as late as 1670 that dark begins to refer to ignorant. By 1700s it refers to negativity and by 1775 the word is used to refer to black people.  

The sequence here is
Dark/obscure/gloomy/sinister  -  Ignorant  -  Black people (and brown people)


BLACK

Original English had two meanings for the word Black. 'When used as a noun it referred to the colour Black. The online Etymology Dictionary says ‘When used as an adjective ''Old English blæc "dark," from Proto-Germanic *blakaz "burned" (cognates: Old Norse blakkr "dark," Old High German blah "black," Swedish bläck "ink," Dutch blaken "to burn"), from PIE *bhleg- "to burn, gleam, shine, flash" (cognates: Greek phlegein "to burn, scorch," Latin flagrare "to blaze, glow, burn"), from root *bhel- (1) "to shine, flash, burn;" Or bleach''. This was probably the reference to and origins of 'blacksmith' 

'The same root produced Old English blac "bright, shining, glittering, pale;" the connecting notions being, perhaps, "fire" (bright) and "burned" (dark). " Used of dark-skinned people in Old English.'

In 1300 it begins to refer to colour of sin and sorrow, by 1500 the word black began referring  to 'dark purposes and malignant' by 1500 it is also used to refer to dishonour, besmirch;  It then gets a reference to blackmail (perhaps because it burned and scorched and not a reference to colour). So we can see the links and connotations are changing and evolving from black being a reference to colour to references to negative and bad things.

The pnemonic and bubonic plague of the 1300s was at that time not called 'black death'. In the 16th century, after the 1300 to 1500 evolution of black from reference purely to colour or burn/blaze/glow/livid,  to include negative meanings, the word black was retrospectively attached to those tragic deaths.

By 1600 you have blacklists, by 1800 you have blacksheep

Black eye "discoloration around the eye from injury"  in 1600, which is obviously a description of a physical condition, morphs into  ‘Figurative sense of "injury to pride, rebuff"  by 1744. By 1880s it also means "bad reputation".

The term Blackguard from a jovial mocking reference in 1500s becomes a references to criminal classes by 1700s

By 1920s 'in the black' means a corporate loss and by 1930s references to 'black markets' are established.

Even the black widow spider has brown, red, black and yellow on its shell but gets called 'black'

The sequential evolution is from the original black which was a colour and a reference to black persons, and had very positive terms to illustrate it gradually moved over a long period of time to refer to everything bad and negative.



WHITE

The Online Etymology Dictionary says
‘White means …. "whiteness, white food, white of an egg," . Also in late Old English "a highly luminous color devoid of chroma. In old English the word White also referred to  "bright, radiant; clear, fair,"  In other language derivatives it meant  "white; to shine" (cognates: Sanskrit svetah "white;" Old Church Slavonic sviteti "to shine," svetu "light;" Lithuanian šviesti "to shine," svaityti "to brighten"). '

White was also used as a surname for persons with fair hair or complexion. 
It is indeed interesting that both black and white originally referred to 'shine' but obviously referring to different colours the meanings diverge as time passes by.

It is not as though the word white is not associated with negative meanings. But whenever it is associated with a negative meaning it is in comparison with another negativity where white comes out better off.


White collar crime – is associated with a softer version of behaviour, associated with genteel persons, linked with notions of education

White trash - is not when white people behaved in a trashy manner, it is when white people were in comparable positions to black servants (in America)

White Elephant - was a gift of honour though it was one which ruined you. The ‘elephant’ (i.e. the gifted object) is obviously of a high value, the maintenance of which cannot be afforded by an economically weaker person.

White wash - is cover up negativity, bad news, bad things.

White lie - is even a lie becomes a good thing; it is seen as a thing done to ‘benefit’ others.

	FAIR	DARK	BLACK	WHITE
Original meaning	Beautiful, pleasing, attractive	Obscure, gloomy, sad, wicked, absence of light	Colour Black, dark, burned, gleam, shine, flash, blaze, glow, bright, glittery, Also used for dark skinned people	Colour White, radiant, clear, fair, shine, brighten One with fair hair or complexion
1200	Original + light skinned people
1300	Both of above + Just/impartial		Sorrow, sin
1500s			Malignant purpose Dishonour, besmirch, blackmail Blackguard (jovial reference)
1600s		Ignorant	Blacklists, Blackeye (as in physical description)
1700s		Black people	Blackeye (as in Injury to pride) Blackguard (criminal class)
1800	All of above + ‘Comparatively good’		Blackeye (as in bad reputation)	White trash White elephant
1900s			In the black (as in financial loss) Black market	White wash White lie White collar crime

THE IMPACT OF THESE WORDS ON RACISM

Are you seeing how it works? Humans are pattern matchers. Human brain is not primarily for analysis though very capable of it. The default position is pattern matching. Here is a more recent example of pattern matching related distortion. The nazis used the swastika and now though the swastika is actually a powerful holy positive symbol used (potentially) by a billion people in other parts of the world, in the white western European-American world it is a negative symbol. We do not look at the meaning, we look at the usage and assign meaning. Our pattern matching in the western world, now fears the swastika as a nazi thing not how it actually is which is a Vedic thing.

Similarly our pattern matching is now helpless when it comes to racism, it associates black and dark with everything negative. It associates white with everything positive. We have becomes inadvertent slaves of aspects of our possibly distorted evolution of the English language. It served the purposes of white Europe in previous times.

In 1500s many European countries abolished slavery in their own countries as they were actively taking slaves from Africa. The language associations described above show a change in usage mostly in the 1500s and then it surges forward. This links clearly with the origins of the history of European involvement in the slavery of black people around that time and its growth. There seems to have been a desperate psychological need to create these new negative links on the color-people-trait theme so as to distance justify and garner support for the white Europeans who were trading black people as slaves. The links with dark colour and negativity has left a legacy which is now seemingly impossible to resolve.

Slavery itself was much older but that was not linked to colour. It was linked to debt, war, crime, punishment. We still see the effects of those kinds of linkages in human trafficking, poverty traps etc but those are linked to numericals, philosophy, economics; and not linguistic or visual based. Therefore when we think of say human trafficking we are able to look at it in an analytical mode when process, numbers becomes solutions. When we talk about racism we become pattern matches and emotion becomes a defense. 


CHALLENGING AND CHANGING THE LINGUISTICS

It can be expected that anyone who uses this rationale or logic for a change of language is going to face at the least a push back and at worse a back lash. The importance of context when interpreting words or phrases is paramount. Context however is immediate to the circumstance; even historic context is shadowed by our immediate context. Our current circumstance and context is preloaded with centuries of evolution and thus the links are woven into the genetics of the evolution of language. If context is indeed everything, then the language developed for the context of the 16^th 17^th and 18^th centuries becomes incorrect for usage in the 21^st century. By using such language in the 21^st century we become automatic accomplices to perpetuation of archaic practices.
 
It is not a simplistic matter of political correctness, it is not moral policing, it is not thought control. It is a matter of looking clearly at the evidence and its impact. Language links up with imagination and imagery then becomes etched in our mind to be called up on every occasion we pattern match (which is pretty much all the time) – these are the origin of unconscious and subconscious bias. This is the reason why often even black people taking the Implicit Association Test on race seem to be biased towards white people.

Colour needs to be disentangled from its links to bias. This will neither be easy nor quick. There are possibly many ways of doing this. Language architects can be engaged to weed out negative connotations. This need not always be people, software can enable this effort. The positive connotations of the words currently used negatively could be increased. The latter would be a better approach but understandably both approaches would be needed.

At a personal level, every reader of this article is urged to stop using at least these four words, FAIR, DARK, BLACK and WHITE for anything other that in its original meanings. Words such as black should not be used for accountancy (‘in the black’) or the various negative connotations. Black should be used only to refer to colour. Similarly with other words. Anything other than the original meanings should be subject to extraordinarily vigorous challenge and such usage be eliminated. The future generations may have a ray of hope for an impartial world (not a fairer world) if language distortions are ironed out. 

It can be done. It is not too late.

©M HEMADRI 

Follow me on twitter @HemadriTweets

Post Script
The links between dark/black and negative is mainly a Europe influenced phenomenon. In the parts or the world now known as India an incarnation of God was called Krishna which literally means the 'dark/black one' - Krishna is even now the God for a billion people with all its positive connotations. However, due to the power of English across the world and the history of Britain in its influence across the world even in India the same links between colour and positive or negative traits apply though not directly to Krishna (yet). Of course, that part of the world has its own linguistic history based biases persisting till today.


References and search term links

http://www.etymonline.com/index.php?term=fair
http://www.etymonline.com/index.php?allowed_in_frame=0&search=dark&searchmode=none
http://www.etymonline.com/index.php?allowed_in_frame=0&search=black&searchmode=none
http://www.etymonline.com/index.php?allowed_in_frame=0&search=white&searchmode=none

NB: While this blog site is primarily about healthcare, I have an interest in issues such as bias, race and its impact on healthcare. I hope a better understanding these issues in the broader context, helps us deal with healthcare in a better manner.