WEBVTT - Special Episode: Dr. Wendy Kline & Exposed 0:00:44.159 --> 0:00:47.519 Hi, I'm Aaron Welsh and this is This Podcast Will 0:00:47.600 --> 0:00:51.000 Kill You. Welcome to the latest episode of the tp 0:00:51.360 --> 0:00:55.240 w k Y book Club series, where I interview authors 0:00:55.280 --> 0:00:58.520 of popular science and medicine books about their latest work. 0:00:59.240 --> 0:01:03.000 We've started out very strong this season and we've got 0:01:03.240 --> 0:01:05.520 such a great lineup for the rest of the year. 0:01:05.800 --> 0:01:09.040 These are honestly some of my favorite episodes to put together. 0:01:09.720 --> 0:01:11.280 If you'd like to get a sneak peek at the 0:01:11.319 --> 0:01:14.759 upcoming books that we'll be featuring on these book club episodes, 0:01:15.120 --> 0:01:17.600 head over to our website This Podcast Will Kill You 0:01:17.640 --> 0:01:19.720 dot com, where you can find a link to our 0:01:19.720 --> 0:01:24.080 bookshop dot Org affiliate account under the extras tab. Once 0:01:24.120 --> 0:01:28.920 you're on our bookshop page, you can see various TPWKY booklists, 0:01:29.120 --> 0:01:32.880 including one for this book club series. I'll be posting 0:01:32.920 --> 0:01:35.880 more books there throughout the season, so check in regularly 0:01:35.959 --> 0:01:38.640 to see which books will be featured in the upcoming 0:01:38.680 --> 0:01:43.200 weeks and months. As always, we love hearing from you 0:01:43.240 --> 0:01:46.560 all about these and our other episodes, and so if 0:01:46.600 --> 0:01:49.440 you have anything that you'd like to share, reach out 0:01:49.480 --> 0:01:53.040 through the contact us form on our website. Favorite book 0:01:53.040 --> 0:01:55.640 Club episodes so far, a book you'd like to see 0:01:55.640 --> 0:01:59.640 featured suggestions for other episode topics, send them our way. 0:02:00.560 --> 0:02:02.800 Two last things before moving on to the book of 0:02:02.840 --> 0:02:06.880 the week. The first is to please rate, review, and subscribe. 0:02:06.960 --> 0:02:09.959 It really does help us out. And the second is 0:02:10.040 --> 0:02:13.520 that you can now find full video versions of most 0:02:13.560 --> 0:02:17.320 of our newest episodes on YouTube. Make sure you're subscribed 0:02:17.320 --> 0:02:20.440 to exactly Write Media's YouTube channel so you never miss 0:02:20.480 --> 0:02:21.280 a new episode. 0:02:21.320 --> 0:02:21.639 Drop. 0:02:22.520 --> 0:02:25.600 With that business out of the way, I am so 0:02:25.760 --> 0:02:30.480 excited to introduce this episode's author and book. This week 0:02:30.560 --> 0:02:33.639 I got to sit down with doctor Wendy Klein, professor 0:02:33.680 --> 0:02:37.920 of history at Purdue University and author, to discuss her book, 0:02:38.160 --> 0:02:42.680 Exposed the Hidden History of the pelvic Exam. If you've 0:02:42.840 --> 0:02:46.760 ever had a pelvic exam, you know the drill, the discomfort, 0:02:46.919 --> 0:02:50.720 the vulnerability, the waiting for it to be over. There 0:02:50.800 --> 0:02:54.600 are myriad ways that people feel about these routine exams, 0:02:54.800 --> 0:02:58.360 from neutral to dread, and yet we don't really talk 0:02:58.440 --> 0:03:01.480 that much about them. We put up with them, or 0:03:01.480 --> 0:03:04.799 maybe we avoid them, but at least speaking for myself, 0:03:05.040 --> 0:03:09.200 we don't question their existence, how they originated, or ways 0:03:09.200 --> 0:03:12.519 they can improve. We just accept them as a fact 0:03:12.600 --> 0:03:17.000 of life. But as doctor Klein demonstrates and exposed routine 0:03:17.040 --> 0:03:21.800 pelvic exams are a relatively recent addition to preventative care guidelines, 0:03:22.240 --> 0:03:26.959 guidelines which are currently being revisited. To understand the present 0:03:27.040 --> 0:03:30.520 day landscape of routine pelvic exams, we have to explore 0:03:30.560 --> 0:03:35.560 their past, a past fraud with abuse and concealment. Doctor 0:03:35.640 --> 0:03:38.880 Clin takes readers through the murky history of pelvic exams, 0:03:38.960 --> 0:03:42.480 and in doing so, reveals how the field of gynecology 0:03:42.640 --> 0:03:46.200 has been shaped both by those who use shame as 0:03:46.240 --> 0:03:49.440 a weapon as well as those who seek to empower 0:03:49.560 --> 0:03:53.880 women through knowledge about their own bodies. Exposed is so 0:03:54.040 --> 0:03:56.960 much more than a history and current assessment of one 0:03:57.000 --> 0:04:02.040 of the most commonly performed medical procedures. It reveals how 0:04:02.080 --> 0:04:06.480 the paternalistic view that medicine has held for women harms 0:04:06.640 --> 0:04:09.520 rather than helps, and it also highlights some of the 0:04:09.680 --> 0:04:14.720 incredible advocacy groups working to ask the crucial question, how 0:04:14.760 --> 0:04:18.400 can we make things better? I had such a fantastic 0:04:18.440 --> 0:04:21.240 time chatting with doctor Klein, and I am thrilled to 0:04:21.279 --> 0:04:24.039 be sharing this conversation with you all. I do want 0:04:24.040 --> 0:04:26.719 to note before we get into things, that this episode 0:04:26.760 --> 0:04:30.279 does feature discussions of abuse and medical trauma, so please 0:04:30.400 --> 0:04:33.960 keep that in mind. With that, let's take a break 0:04:34.120 --> 0:05:01.760 and then get started. Klein, thank you so much for 0:05:01.839 --> 0:05:02.720 joining me today. 0:05:02.920 --> 0:05:05.000 It is my pleasure. I'm delighted to be here. 0:05:05.520 --> 0:05:09.160 In your book Exposed, you take readers through the history 0:05:09.200 --> 0:05:12.919 of one of the most commonly performed medical procedures, the 0:05:12.920 --> 0:05:17.080 pelvic exam. And before we get into the murky origins 0:05:17.240 --> 0:05:19.240 of this exam, I would love for you to set 0:05:19.279 --> 0:05:21.960 the stage just by taking us through how a pelvic 0:05:22.000 --> 0:05:24.960 exam is done today, kind of just an overview step 0:05:25.000 --> 0:05:28.040 by step, and importantly why they are performed. 0:05:28.720 --> 0:05:32.239 So a public exam consists of three parts. The first 0:05:32.520 --> 0:05:37.080 is the examination of external genitalia and then second is 0:05:37.120 --> 0:05:42.120 the speculum exam, and that's typically accompanied by a pap 0:05:42.200 --> 0:05:46.680 smear to test for cervical cancer. And then the third 0:05:47.440 --> 0:05:50.040 part is a bi manual exam, and that is when 0:05:50.680 --> 0:05:53.800 the healthcare provider inserts one to two fingers into the 0:05:53.880 --> 0:05:56.840 vagina while using the other hand to press on the 0:05:56.880 --> 0:06:01.080 abdomen with the other hand in order to evaluate organs. 0:06:01.279 --> 0:06:04.480 Fairly standard procedure. It hasn't changed a whole. 0:06:04.240 --> 0:06:08.240 Lot over the last century or so, and the primary 0:06:08.320 --> 0:06:12.200 purpose is to test for cervical cancer, but there are 0:06:12.240 --> 0:06:16.520 other aspects as well, right, just to look for any abnormalities, discomfort, 0:06:17.120 --> 0:06:20.520 and opportunity to talk with a provider if you have 0:06:20.600 --> 0:06:25.520 any questions, either about sex or discomfort or anything else. 0:06:26.480 --> 0:06:30.440 It is really remarkable and maybe a bit alarming, how 0:06:30.440 --> 0:06:34.960 little it seems to have changed since it was first introduced. 0:06:35.400 --> 0:06:36.920 And I would love for you to take me through 0:06:36.960 --> 0:06:40.720 the origins of how this exam came to be, especially 0:06:40.760 --> 0:06:43.839 the role that was played by the so called father 0:06:43.920 --> 0:06:46.279 of gynecology, James Mary and Simms. 0:06:46.760 --> 0:06:49.760 Right, yeah, And of course I could talk all day 0:06:49.800 --> 0:06:54.280 about this, right, And I mean it's such an interesting conversation. 0:06:54.400 --> 0:06:57.279 But I mean, if you think about it, for centuries, 0:06:57.920 --> 0:07:03.599 women's genitalia was hidden, right, unlike male genitalia, which is 0:07:03.640 --> 0:07:07.400 quite obvious, It was very difficult for anybody to see 0:07:07.520 --> 0:07:11.680 or know what a woman's reproductive organs actually looked like. 0:07:12.400 --> 0:07:17.360 And that all changes in the nineteenth century. James mary 0:07:17.360 --> 0:07:24.640 and Simms was a doctor in Alabama, and he claims he. 0:07:24.600 --> 0:07:29.120 Takes credit right for discovering quote a class covering speculum 0:07:29.520 --> 0:07:30.600 in actuality. 0:07:30.640 --> 0:07:34.320 There were other types of speculums in France in the 0:07:34.360 --> 0:07:38.040 eighteen thirties, for example. But Simms was a master showman 0:07:38.320 --> 0:07:41.640 and took all the credit for this. He gets the 0:07:41.680 --> 0:07:44.520 idea when he's looking peering into. 0:07:44.280 --> 0:07:45.200 A patient's vagina. 0:07:45.240 --> 0:07:48.000 She's fallen off a horse, and she's in all kinds 0:07:48.040 --> 0:07:49.200 of discomfort, and. 0:07:49.120 --> 0:07:51.640 He gets the idea of using a. 0:07:51.600 --> 0:07:56.320 Spoon and bending it to kind of reflect and inserting 0:07:56.320 --> 0:07:59.680 it into her vagina. And he says this like, I 0:07:59.720 --> 0:08:04.320 find it rather hilarious. He says in his memoir introducing 0:08:04.360 --> 0:08:07.360 the bent handle of the spoon, I saw everything as 0:08:07.480 --> 0:08:08.680 no man had ever. 0:08:08.480 --> 0:08:10.280 Seen before, right. 0:08:10.440 --> 0:08:14.640 So he kind of lays his flag this idea of 0:08:14.680 --> 0:08:18.880 this new territory that he had essentially claims right. And 0:08:18.920 --> 0:08:23.200 so it was in fact a fairly revolutionary concept that 0:08:23.720 --> 0:08:27.600 you could actually see what had been hidden for centuries 0:08:27.600 --> 0:08:28.320 and centuries. 0:08:28.840 --> 0:08:32.920 And you know, on the one hand, it's saved probably 0:08:33.120 --> 0:08:38.800 millions of lives. It's changed how we understand gynecology. But 0:08:39.080 --> 0:08:40.839 there are some repercussions. 0:08:41.000 --> 0:08:45.200 And I will also say that it didn't go uncontested. 0:08:45.320 --> 0:08:49.880 I mean, even many physicians or budding gynecologists in the 0:08:49.920 --> 0:08:54.599 mid nineteenth century were really uncomfortable with the idea because 0:08:55.600 --> 0:08:58.320 what's happening in the nineteenth century when you think about 0:08:58.559 --> 0:09:03.160 upper middle class white womanhood, Victorian morality, and this idea 0:09:03.240 --> 0:09:06.240 that it was appropriate to appear inside a woman's vagina 0:09:06.679 --> 0:09:10.880 was highly problematic. So there was actually debates among gynecologists 0:09:10.920 --> 0:09:15.160 about whether touch was more appropriate than the gaze, right, 0:09:15.480 --> 0:09:17.719 and that what a good provider should be able to 0:09:18.400 --> 0:09:21.920 sense from their fingers rather than the visual gaze. And 0:09:21.960 --> 0:09:26.360 it's debated among these doctors like should we should we 0:09:26.400 --> 0:09:30.160 go ahead and welcome this new tool or should we 0:09:30.280 --> 0:09:31.000 disdain it? 0:09:31.040 --> 0:09:34.080 And I think that's a really fascinating conversation and debate 0:09:34.720 --> 0:09:35.760 between these doctors. 0:09:35.960 --> 0:09:38.640 The other thing is some of them are concerned that 0:09:38.679 --> 0:09:41.600 it's going to turn women into like sex maniacs. 0:09:41.840 --> 0:09:43.600 They're going to start loving. 0:09:43.960 --> 0:09:48.040 Having this speculum put inside their vagina and it will 0:09:48.400 --> 0:09:55.200 essentially corrupt women. So anyway, it wasn't immediately accepted as 0:09:55.280 --> 0:10:00.120 the ideal tool, but it was gradually accepted and promoted 0:10:00.120 --> 0:10:01.760 by people like James Mary and Simms. 0:10:02.640 --> 0:10:05.360 We've come a long way in some in some ways 0:10:05.640 --> 0:10:08.280 and not so much in others. But you know, when 0:10:08.280 --> 0:10:11.160 I was reading your book, I found myself thinking a 0:10:11.160 --> 0:10:14.280 lot of course about public exams and how I relate 0:10:14.320 --> 0:10:16.600 to them and my experience with pelvic exams. And I 0:10:16.640 --> 0:10:20.800 was wondering, you know, what your experience was like with 0:10:20.880 --> 0:10:24.040 pelvic exams or is like, and whether that's changed as 0:10:24.080 --> 0:10:26.080 you have as you worked on this book. 0:10:26.800 --> 0:10:29.880 You know, that's a great question eron and I'm surprised, 0:10:29.920 --> 0:10:33.600 like nobody's ever asked me that before. Again, a lot 0:10:33.640 --> 0:10:36.679 of talks, and that is not a question I've actually 0:10:37.200 --> 0:10:41.160 I've had. And so, you know, I feel lucky because 0:10:41.400 --> 0:10:44.600 I feel like I'm one of those people that doesn't 0:10:44.640 --> 0:10:48.640 particularly enjoy it. It's unpleasant, but it hasn't been traumatic 0:10:48.679 --> 0:10:52.760 for me. I'm fairly comfortable with my body. I tend 0:10:52.760 --> 0:10:55.559 to have good relationships with the doctors that I visit. 0:10:55.440 --> 0:10:56.560 The ob ginds. 0:10:57.800 --> 0:11:01.880 I'll talk about what I'm researching as they're probing inside 0:11:01.880 --> 0:11:02.120 of me. 0:11:02.400 --> 0:11:06.640 You know, I love that. But so I wasn't. 0:11:06.520 --> 0:11:09.120 Drawn to the topic because of some horrible thing that 0:11:09.240 --> 0:11:11.840 happened to me, which is I know for some people 0:11:12.240 --> 0:11:14.400 it's raised their curiosity about it. 0:11:14.440 --> 0:11:18.240 For me, it was more, you know, why are we 0:11:18.320 --> 0:11:23.040 not talking about this procedure? Right? So many people endure 0:11:23.080 --> 0:11:24.280 this on a regular. 0:11:23.920 --> 0:11:27.080 Basis, and so someone like me, it's unpleasant, but for 0:11:27.200 --> 0:11:33.280 some people it's hugely traumatic, painful, terrifying, And yet we're. 0:11:33.080 --> 0:11:36.640 Not really supposed to talk about it for many reasons. 0:11:36.760 --> 0:11:40.160 And so that kind of raised the question, why is 0:11:40.200 --> 0:11:42.839 it something that we just don't talk about it when 0:11:42.840 --> 0:11:44.760 it's something that we all experience. 0:11:45.400 --> 0:11:48.520 Yeah, just the expectation of this is what you have 0:11:48.600 --> 0:11:52.480 to do and that's it, and you just endure it. Yeah, 0:11:52.679 --> 0:11:56.000 and you know, but going back to the history of 0:11:56.080 --> 0:11:59.040 the pelvic exam and how it initially when it was introduced, 0:11:59.040 --> 0:12:02.000 it was not like you said something that a lot 0:12:02.000 --> 0:12:05.079 of people were like, absolutely, let's do this. And so 0:12:05.240 --> 0:12:08.600 who were the people who were likely to receive a 0:12:08.640 --> 0:12:12.040 public exam in these early decades and who was not 0:12:12.400 --> 0:12:13.360 likely to receive one? 0:12:13.880 --> 0:12:17.600 Yeah, great question and really important to this story. The 0:12:17.640 --> 0:12:21.320 first patients were basically the first guinea pigs. 0:12:20.960 --> 0:12:23.880 And you can probably yes who they were not. 0:12:24.440 --> 0:12:28.160 They were not white, middle class women, and this is 0:12:28.360 --> 0:12:31.319 fairly well known in the historiography. But James Mary and 0:12:31.400 --> 0:12:35.920 Zims did most of his procedures first unenslaved patients, and 0:12:35.960 --> 0:12:39.640 we know about three, in particular, Lucy, Betsy and anarka 0:12:39.960 --> 0:12:45.280 who endured multiple procedures countless times over a period of 0:12:45.280 --> 0:12:50.360 nearly four years without anesthesia. In part I should add 0:12:50.440 --> 0:12:56.320 that anesthesia was incredibly dangerous and not frequently used in 0:12:56.400 --> 0:12:58.360 the eighteen forties when he was doing this. 0:12:58.440 --> 0:13:03.320 But still, you know, extremely painful. These were enslaved women 0:13:03.400 --> 0:13:07.559 who had all were all suffering from besico vaginal fistulas, 0:13:07.679 --> 0:13:14.640 basically a tear between the vagina and the bladder as 0:13:14.679 --> 0:13:19.520 a result of prolonged childbirth, and possibly also the use 0:13:19.559 --> 0:13:22.959 of forceps. We don't know specifically in these. 0:13:22.720 --> 0:13:26.000 Instances, but you know, talk about tools that can actually 0:13:26.360 --> 0:13:31.400 really damage. Yeah, and so he claims that what they 0:13:31.400 --> 0:13:34.760 were suffering was worse than death. So it was in 0:13:34.800 --> 0:13:39.719 their interest to kind of endure these procedures because he 0:13:39.880 --> 0:13:42.960 was he believed to be helping them, but he was 0:13:43.040 --> 0:13:47.160 equally made the point that he was restoring labor to 0:13:47.679 --> 0:13:53.760 these women's quote unquote owners. Right, but regardless, and there's 0:13:53.760 --> 0:13:56.199 so much we don't know, because of course those voices 0:13:56.240 --> 0:14:00.720 are silenced. We only know through the absurd and through 0:14:00.760 --> 0:14:06.840 Sims himself what they experienced. And even if they were consenting, 0:14:07.360 --> 0:14:09.600 they can't consent by virtue of the fact that they 0:14:09.679 --> 0:14:12.079 had no power to do so. They were enslaved women. 0:14:12.840 --> 0:14:17.640 So what does it mean that a procedure that's considered 0:14:18.040 --> 0:14:21.440 immoral or an ethical or just distasteful to do on 0:14:21.480 --> 0:14:25.360 a white middle class woman is done on these bodies, 0:14:25.840 --> 0:14:29.120 but with the idea that if they could be perfected, 0:14:29.600 --> 0:14:32.800 then right then it would be appropriate to. 0:14:32.800 --> 0:14:34.720 Use on these other bodies. 0:14:34.920 --> 0:14:41.440 And that's basically what happens enslaved women, sex workers, basically 0:14:42.240 --> 0:14:45.720 women who were disempowered. And of course, if you think 0:14:45.720 --> 0:14:48.120 about it, one of the reasons Sims is interested in 0:14:48.360 --> 0:14:52.360 taking these tools and then applying them to the white 0:14:52.880 --> 0:14:56.320 middle and upper classes is money, right, That's where he's 0:14:56.360 --> 0:14:59.920 going to get his client tele that's where the concern 0:15:00.040 --> 0:15:03.120 learn about suffering and alleviating suffering. 0:15:03.640 --> 0:15:07.000 It's going to be focused on. But he needs the tools. First. 0:15:08.400 --> 0:15:10.600 Let's take a quick break, and when we get back, 0:15:10.760 --> 0:15:30.920 there's still so much to discuss. Welcome back everyone. I've 0:15:30.920 --> 0:15:34.120 been chatting with doctor Wendy Kline about her book exposed 0:15:34.280 --> 0:15:37.320 the hidden history of the pelvic exam. Let's get back 0:15:37.320 --> 0:15:43.200 into things. And then once he had those tools, you know, 0:15:43.280 --> 0:15:46.760 still though the pelvic exam, the speculum was not, as 0:15:46.800 --> 0:15:50.440 you said, widely adopted immediately. And so then what were 0:15:50.440 --> 0:15:54.360 some of the things that led to its increase in popularity, 0:15:54.400 --> 0:15:55.880 I guess, or it's acceptability. 0:15:56.520 --> 0:15:59.760 Yeah, I mean, there's a basic shift that occurs over 0:16:00.520 --> 0:16:03.680 roughly like a fifty to seventy year period, from the 0:16:03.720 --> 0:16:07.520 emergence of gynecology as a medical specialty, which I should 0:16:07.600 --> 0:16:11.440 add comes hand in hand with the development of the speculum, right, it. 0:16:11.400 --> 0:16:13.520 Was the tool that justified. 0:16:13.000 --> 0:16:18.440 The need for a male medical model to differentiate themselves 0:16:18.480 --> 0:16:23.240 from say, female midwives. So most of their work was 0:16:23.280 --> 0:16:28.040 done either with obstetrics with childbirth or with patients. 0:16:27.600 --> 0:16:29.880 That are suffering, not on healthy women. 0:16:30.440 --> 0:16:35.200 Gradually, there's a shift from pathological or surgical gynecology to 0:16:35.480 --> 0:16:39.240 preventive gynecology, and there are a couple of reasons for that. 0:16:39.960 --> 0:16:44.400 The most kind of blatant in terms of developing gynecology 0:16:44.440 --> 0:16:47.960 as a specialty is obvious. They want to expand their 0:16:48.000 --> 0:16:51.760 patient base, right, They don't want it to be up 0:16:51.800 --> 0:16:55.640 to the patient to determine when they think they need 0:16:55.680 --> 0:16:59.760 to see a doctor. By pushing for preventive medicine and 0:16:59.800 --> 0:17:03.240 an case, preventive gynecology, you're widening your patient base. You're 0:17:03.280 --> 0:17:07.440 encouraging you know, every woman of reproductive age should see 0:17:07.440 --> 0:17:10.679 a doctor on a regular basis, and boom, suddenly you've 0:17:10.720 --> 0:17:12.800 got a much wider patient population. 0:17:13.240 --> 0:17:15.480 Now, I mean, that's the cynical part. Obviously. 0:17:15.680 --> 0:17:18.679 You know, they believe that they were helping, and oftentimes 0:17:18.680 --> 0:17:22.879 they were so, but it was a smart way to 0:17:23.000 --> 0:17:26.160 expand their patient base. I have an entire chapter about 0:17:26.640 --> 0:17:30.240 one doctor, doctor Robert Dickinson, who is the president of 0:17:30.280 --> 0:17:34.200 the American Gynecological Society in nineteen twenty, and he makes 0:17:34.240 --> 0:17:37.000 a big case. He's, you know, like, what separates us 0:17:37.040 --> 0:17:41.320 from surgeons. We need to define ourselves as something other 0:17:41.400 --> 0:17:46.560 than surgeons of the female reproductive tract or organs, and 0:17:47.280 --> 0:17:51.000 we should be talking about sex and birth control and 0:17:51.080 --> 0:17:55.640 all these topics that male doctors, because most of them 0:17:55.640 --> 0:17:58.439 were male, are kind of skirting around as kind of 0:17:58.520 --> 0:18:02.040 again inappropriate. We shouldn't be talking about these things. We 0:18:02.119 --> 0:18:06.560 want to show that we are morally upright, upstanding citizens. 0:18:07.080 --> 0:18:11.000 We're not perverts, and therefore we should avoid talking about 0:18:11.040 --> 0:18:14.439 these things. Dickinson's like, no, that's exactly what we should 0:18:14.440 --> 0:18:18.520 be doing. We should step in and he basically suggests 0:18:18.520 --> 0:18:22.840 that doctors. Gynecologists should also be marriage counselors. They should 0:18:22.880 --> 0:18:26.720 be talking about sexual discomfort, they should be asking about 0:18:26.760 --> 0:18:29.760 birth control, et cetera, et cetera. And again it's a 0:18:29.800 --> 0:18:33.520 way of widening their base of asserting their authority. But 0:18:33.640 --> 0:18:36.720 it paves the way for this notion of prevented gynecology. 0:18:37.320 --> 0:18:39.080 Then on top of that you have the development of 0:18:39.119 --> 0:18:43.480 the pap smear, right, and so that's a little bit later. 0:18:43.600 --> 0:18:46.680 It becomes kind of standardized in the early nineteen forties. 0:18:47.320 --> 0:18:51.320 George Papa Nicolau, that's why we have the name figures out. 0:18:51.800 --> 0:18:54.840 He's not even looking for this, but when he's taking 0:18:55.080 --> 0:18:58.679 cervical smears first out of guinea literal guinea pigs, and 0:18:58.720 --> 0:19:03.960 then he uses his wife, who volunteers cervical smears daily 0:19:04.160 --> 0:19:06.480 for decades decades. 0:19:06.640 --> 0:19:09.359 I couldn't get over that. It was like literally. 0:19:09.280 --> 0:19:13.280 Human gay pig in the name of science, and realizes 0:19:13.359 --> 0:19:17.159 that by taking these smears, by looking at the fluid, 0:19:17.200 --> 0:19:21.040 you can determine whether there are any signs of cancer, 0:19:21.200 --> 0:19:25.960 basically of tumors. So once that is established, then there's 0:19:26.000 --> 0:19:31.120 a very clear reason why preventive gynecology makes sense. Right, 0:19:31.200 --> 0:19:34.280 This is a way of early detection, trying to see 0:19:34.320 --> 0:19:37.960 if there's any signs. So it's kind of a gradual process, 0:19:38.040 --> 0:19:40.880 but I'm really interested in those kind of those years 0:19:40.920 --> 0:19:43.840 in the twenties up to the forties where there is 0:19:43.920 --> 0:19:48.639 talking as much about sex as they are about vaginal health, 0:19:48.840 --> 0:19:52.439 I would say, and offering, among other things, pre marital 0:19:52.520 --> 0:19:56.399 pelvic exams, like getting a woman ready for her wedding 0:19:56.480 --> 0:20:00.000 night to ensure that she will kind of be comfortable 0:20:00.240 --> 0:20:02.040 with sex, et cetera. 0:20:02.920 --> 0:20:07.760 That was a fascinating chapter about Dickinson and that quote 0:20:08.200 --> 0:20:11.760 that you include where he says there is never a 0:20:11.800 --> 0:20:15.720 precise way of separating the woman from the doctor's idea 0:20:15.760 --> 0:20:19.199 of her. It just has been rattling around in my 0:20:19.280 --> 0:20:20.639 head ever since reading that. 0:20:23.040 --> 0:20:24.000 Yeah, he kept me up. 0:20:24.200 --> 0:20:26.800 There are many nights that I did not sleep when 0:20:26.840 --> 0:20:28.640 I was doing research for that chapter. 0:20:29.040 --> 0:20:31.639 And it came gradually because he has. 0:20:31.600 --> 0:20:36.440 Terrible handwriting, and all of this was scratched, scribbled onto 0:20:36.480 --> 0:20:39.040 tiny little note cards that I found in the archive, 0:20:39.800 --> 0:20:42.560 and so it took a long time to piece together 0:20:42.640 --> 0:20:45.360 exactly what he was saying and how he was saying it, 0:20:45.920 --> 0:20:51.000 and so the horror was kind of gradually emerging. You 0:20:51.040 --> 0:20:53.639 know and until I was realizing that he was in 0:20:53.720 --> 0:20:58.360 fact sexually abusing some of his patients and acknowledging it 0:20:58.400 --> 0:21:02.520 in his own handwriting. And he's also a great case 0:21:02.560 --> 0:21:07.680 for a historian because he took prolific notes of every 0:21:07.760 --> 0:21:09.880 because he saw his patients as case studies. 0:21:09.880 --> 0:21:10.680 He was kind of. 0:21:11.000 --> 0:21:13.919 Interested in learning from them, and so as soon as 0:21:13.960 --> 0:21:17.439 he would examine them, he would write down, describe what happened. 0:21:17.440 --> 0:21:21.480 He would even quote the conversation. He would quote, supposedly 0:21:21.600 --> 0:21:24.359 verbat him what the patient had said to him. So 0:21:24.560 --> 0:21:26.080 even though we don't have. 0:21:26.000 --> 0:21:28.320 A record of these individual women. 0:21:28.600 --> 0:21:32.600 Most of the time, we have his quoting his memory 0:21:32.680 --> 0:21:35.960 of what took place, and he's very upfront about what 0:21:36.040 --> 0:21:41.520 he's doing. So yeah, that was really really disturbing in 0:21:41.640 --> 0:21:44.239 terms of that. I also just want to add on 0:21:44.320 --> 0:21:47.080 top of it because I think this is really interesting 0:21:47.119 --> 0:21:51.639 because my first book was a history of the eugenics movement. Well, 0:21:52.040 --> 0:21:57.240 Dickinson was a eugenicist, and he embraced not only sterilizing 0:21:57.359 --> 0:22:00.639 certain women, but encouraging the right time of women to 0:22:00.680 --> 0:22:03.720 have more children. And that's why he was so interested 0:22:03.760 --> 0:22:07.120 in pre marital pelvic exams and the idea that he's 0:22:07.160 --> 0:22:10.320 a marriage counselor because he wants to ensure that these 0:22:10.359 --> 0:22:15.000 women stay in stable marriages, why so they have more children, 0:22:15.280 --> 0:22:18.359 And it's the quote unquote right kind of children. Right, 0:22:18.480 --> 0:22:21.600 So that's partly why he's kind of putting his foot 0:22:21.600 --> 0:22:26.760 in the door opening this like wider conversation about women's roles, 0:22:27.359 --> 0:22:31.800 believing that gynecologists should in fact be these moral arbiters 0:22:31.800 --> 0:22:36.400 that come in and help stabilize marriages by having these 0:22:36.480 --> 0:22:41.199 kind of hidden conversations to ensure that women continue to 0:22:41.960 --> 0:22:43.320 have sex and reproduce. 0:22:44.080 --> 0:22:46.959 That lens I feel like is so important. 0:22:47.000 --> 0:22:50.280 You know, his work or ideas or notes or practice 0:22:50.600 --> 0:22:53.119 and abuse didn't happen in a vacuum, like he was 0:22:53.200 --> 0:22:56.920 a product of that, how eugenics was had a hand 0:22:57.040 --> 0:23:01.240 in every everything. He seems to approach his patients from 0:23:01.320 --> 0:23:04.480 this framework of I am not going to believe what 0:23:04.640 --> 0:23:07.879 they say, like I am already doubting what this person 0:23:08.119 --> 0:23:09.760 is going to say to me. And I feel like 0:23:09.920 --> 0:23:13.959 this is again part of this larger trend that was 0:23:14.000 --> 0:23:17.160 happening around this time with the speculum and then other 0:23:17.240 --> 0:23:22.240 instruments being utilized by physicians to learn about their patient's 0:23:22.280 --> 0:23:25.240 bodies without having to actually talk to, or listen to, 0:23:25.520 --> 0:23:29.240 or believe the patient themselves. And what do you feel 0:23:29.280 --> 0:23:32.199 like were the consequences of this shift where suddenly a 0:23:32.240 --> 0:23:35.480 woman becomes an unreliable narrator about her own body. 0:23:36.119 --> 0:23:39.280 I think it's a really important shift, which is again 0:23:39.440 --> 0:23:41.959 one of the reasons why I wrote this book. I mean, 0:23:42.000 --> 0:23:43.480 if I just step back for a moment and we 0:23:43.560 --> 0:23:47.280 think about science and technology doesn't happen in a vacuum. 0:23:47.920 --> 0:23:54.199 It is all about context and agendas and professionalization and 0:23:54.320 --> 0:23:58.600 attitudes about women in a particular time and place. So 0:23:59.400 --> 0:24:02.119 if you take a particular tool or procedure and you 0:24:02.200 --> 0:24:05.359 track it over the time, while the procedure may not 0:24:05.600 --> 0:24:07.400 change that much, I mean, that's one of the first 0:24:07.400 --> 0:24:10.080 things we said. The tool is pretty much the same, 0:24:10.680 --> 0:24:13.879 the examination is pretty much the same, and yet the 0:24:14.080 --> 0:24:19.280 meaning behind it changes radically depending on different contexts. So 0:24:19.359 --> 0:24:22.960 in a time period in which eugenics was extremely popular, 0:24:23.880 --> 0:24:26.040 the tool and the procedure. 0:24:25.680 --> 0:24:28.200 Are going to be used in a very different way. 0:24:28.920 --> 0:24:30.359 So back to your. 0:24:30.359 --> 0:24:36.080 Question about moments in which tools kind of replace listening 0:24:36.119 --> 0:24:39.639 to the patient, in this case, the female patient. I 0:24:39.680 --> 0:24:43.919 think it's a reminder of the extent to which this 0:24:44.160 --> 0:24:51.280 was a paternalistic, fairly misogynistic culture in which women's voices 0:24:51.359 --> 0:24:55.320 were not always taken seriously. 0:24:55.000 --> 0:24:56.680 And they weren't always believed. 0:24:57.080 --> 0:25:01.920 And so for Dickinson, it's like, your genitals can tell 0:25:01.960 --> 0:25:06.800 me the truth more than your voice or your experience. 0:25:07.359 --> 0:25:13.159 And that's a very disturbing message, right, And this is 0:25:13.200 --> 0:25:18.959 among white, educated, middle class women. This isn't even you know, 0:25:19.080 --> 0:25:22.480 wouldn't it be great if Sims had kept a diary 0:25:22.560 --> 0:25:26.600 the way Robert Dickinson did. What was he saying about 0:25:26.680 --> 0:25:28.040 Lucy Betsy and Anarcha? 0:25:28.440 --> 0:25:28.640 Right? 0:25:29.359 --> 0:25:32.119 And what were they thinking? I mean, this is historians 0:25:32.520 --> 0:25:36.439 greatest tool and biggest frustration is the clues and then 0:25:36.480 --> 0:25:39.280 the absence of clues and what we wish we knew, 0:25:39.359 --> 0:25:42.639 And there's so much we don't know, but we can expect. 0:25:43.400 --> 0:25:47.080 You know that the power differential wasn't just my male female. 0:25:47.119 --> 0:25:51.200