Re-envisioning fertility science: From J. Marion Sims’s invasive gynecology to Sophia Kleegman’s “conservative surgery” hermeneutic

ABSTRACT

This essay explores the discursive means by which ingrained trajectories of medical knowledge and practice have been re-envisioned and recalibrated in U.S. history. It takes for its case study the development of the field of fertility science and medicine, which is an outgrowth of Dr. J. Marion Sims’s notorious, nineteenth-century gynecological tradition of invasive and injurious surgeries targeting the female body. More specifically, this essay offers a critical-comparative analysis of Sims’s mid-to-late-nineteenth-century medical publications and Dr. Sophia Kleegman’s mid-twentieth-century medical publications to highlight the differing pedagogies of sight at work therein. The analysis reveals that—in contrast to the objectivist, myopic, and exclusively female-focused visual pedagogy that Sims articulated—Kleegman’s pedagogy provided disciplinary readers with a distinct, “conservative surgery” hermeneutic for scientific study and treatment that illuminated new diagnostic heuristics related to the proximity of pain, the scale of efficiency, and the boundaries of corporality and expertise. In this way, Kleegman’s articles instantiated an alternative disciplinary optics that balanced past ways of seeing with emergent, ethically calibrated modes of clinical judgement. Ultimately, this technical intervention into medical vision facilitated the realization of increasingly humane and effective practices across reproductive medicine and fertility science beginning in the mid-to-late-twentieth century.

KEYWORDS:

• Feminist science studies
• gynecology
• rhetoric of health and medicine
• rhetorical history
• visual communication

Acknowledgements

The author is grateful to Editor Karrin Anderson, Editorial Assistant Kristen Herring, and two anonymous, expert reviewers for their outstanding guidance of and support for this work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Sophia J. Kleegman, “Sterility,” American Journal of Surgery 33, no. 3 (September 1936): 403. https://doi.org/10.1016/S0378-4320(36)90006-4.

2 Sophia J. Kleegman, “Therapeutic Donor Insemination,” Fertility & Sterility 5, no. 1 (1954): 14. https://doi.org/10.1016/S0015-0282(16)31504-7.

3 Sophia J. Kleegman, “Surgery of the Ovary,” American Journal of Surgery 23, no. 3 (March 1934): 419. https://doi.org/10.1016/S0002-9610(34)90618-8; Susan Wells, Out of the Dead House: Nineteenth-Century Women Physicians and the Writing of Medicine (Madison: University of Wisconsin Press, 2001), 28.

4 Deirdre Cooper Owens, Medical Bondage: Race, Gender, and the Origins of American Gynecology (Athens: University of Georgia Press, 2017), 5.

5 Owens, Medical Bondage, 1.

6 On descriptions of enslaved, Black women as “breeders” or as “breeding,” and nineteenth-century appeals to limit the reproduction of poor, Irish immigrants, see Cooper Owens, Medical Bondage, 19–20, 98.

7 Judith M. Roy, “Surgical Gynecology,” in Women, Health, and Medicine in America, ed. Rima D. Apple (New York: Routledge, 1990), 174.

8 It was not until the 1870s that “woman’s doctors”—who were understood to be distinct from obstetricians in that their primary mode of intervention was surgery—came to be called “gynecologists:” Roy, “Surgical Gynecology,” 174.

9 Over the course of her career, Kleegman published nine scientific articles. These serve as artifacts for the analysis at hand. Three were published in the American Journal of Surgery, two in Fertility & Sterility, and one each in The Lancet, Medical Clinics of North America, and Medical Women’s Journal, respectively.

10 Margaret Arny and John R. Quagliarello, “History of Artificial Insemination: A Tribute to Sophia Kleegman, M.D.,” Seminars in Reproductive Endocrinology 5, no. 1 (February, 1987): 1–3. https://doi.org/10.1055/s-2007-1021847.

11 Kleegman, “Surgery of the Ovary,” 423.

12 On the role of the scientific journal article in general as a primary knowledge-production site, see Alan G. Gross, Joseph E. Harmon, and Michael S. Reidy, Communicating Science: The Scientific Article from the 17th Century to the Present (New York: Oxford University Press, 2002), vii. For a discussion of the role that scientific journals played in the development of modern gynecological medicine and pedagogy specifically, see Cooper Owens, Medical Bondage, 78, 84, 101; and Adele E. Clarke, “Reproductive Science, 1913–1971,” in Centennial History of the Carnegie Institution of Washington, Vol. 5, eds. Jane Maienschein, Marie Glitz, and Garland E. Allen (New York: Cambridge University Press, 2004), 83–116.

13 NYU School of Medicine, “Sophia Kleegman ’24,” Grapevine: The Alumni Magazine, Fall 2018, 40. See also, Barbara Sicherman and Ilene Kantrov, “Kleegman, Sophia Josephine,” in Notable American Women: The Modern Period, ed. Barbara Sicherman and Ilene Kantroy (Cambridge, MA: Harvard University Press, 1980), 398–400.

14 Jordynn Jack, “A Pedagogy of Sight: Microscopic Vision in Robert Hooke’s Micrographia,” Quarterly Journal of Speech 95, no. 2 (2009): 193. https://doi.org/10.1080/00335630902842079.

15 Rhetorician T. Kenny Fountain articulates “trained vision” in the context of medical education specifically as a way of “being in the world that shape[s] lived experience” and is the foundation of technical expertise. Such vision involves the “organization of perception through the interplay of multimodal displays and objects, interpretative frameworks, and the situated activities that create and deploy them;” Rhetoric in the Flesh: Trained Vision, Technical Expertise, and the Gross Anatomy Lab (New York: Routledge, 2014), 5.

16 Miriam Solomon, Making Medical Knowledge (New York: Oxford University Press, 2015), 12.

17 Donna Haraway, “Situated Knowledges: The Science Question in Feminism and the Privilege of Partial Perspective,” Feminist Studies 14, no. 3 (Autumn, 1988): 580. https://doi.org/10.2307/3178066.

18 Haraway, “Situated Knowledges,” 594, 589.

19 Haraway, “Situated Knowledges,” 585.

20 Ibid.

21 Londa Schiebinger, Nature’s Body: Gender in the Making of Modern Science (Boston: Beacon Press, 1993), 160.

22 Robin E. Jensen, Infertility: Tracing the History of a Transformative Term (University Park: The Pennsylvania State University Press, 2016), 38–70; Rachel Malane, Sex in Mind: The Gendered Brain in Nineteenth-Century Literature and Mental Sciences (New York: Peter Lang, 2005), 37–38.

23 Dorothy Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty (New York: Pantheon Books, 1997); and Owens, Medical Bondage.

24 Martin Pernick, A Calculus of Suffering (New York: Columbia University Press, 1985); Roy, “Surgical Gynecology,” 185.

25 Marie Jenkins Schwartz, Birthing a Slave: Motherhood and Medicine in the Antebellum South (Cambridge, MA: Harvard University Press, 2006).

26 Owens, Medical Bondage, 118–119.

27 James H. Cassedy, Medicine in America: A Short History (Baltimore, MD: Johns Hopkins University Press, 1991), 67.

28 Deborah Kuhn McGregor, From Midwives to Medicine: The Birth of American Gynecology (New Brunswick, NJ: Rutgers University Press, 1998), 6.

29 Roy, “Surgical Gynecology,” 174.

30 See, Harriet A. Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Doubleday, 2006), 67–70.

31 Mary Poovey, “‘Scenes of an Indelicate Character’: The Medical ‘Treatment’ of Victorian Women,” Representations 14, no. 2 (1986): 139. https://doi.org/10.2307/2928438. On the lack of knowledge and training available to early gynecologists, see also Roy, “Surgical Gynecology,” 179; McGregor, From Midwives to Medicine, 19–21.

32 Washington, Medical Apartheid, 65.

33 Washington, Medical Apartheid, 64.

34 McGregor, From Midwives to Medicine, 54.

35 McGregor, From Midwives to Medicine, 67.

36 Rachel Dudley, “The Role of Feminist Health Humanities Scholarship and Black Women’s Artistry in Re-shaping the Origin Narrative of Modern, U.S. Gynecology,” Humanities 10, no. 1 (2021): 58, accessed June 1, 2021, https://doi.org/10.3390/h10010058. See also, Owens, Medical Bondage, 1–2.

37 Pernick, A Calculus of Suffering, 7.

38 Pernick, A Calculus of Suffering, 3–7, 156–157; McGregor, From Midwives to Medicine, 50.

39 Owens, Medical Bondage, 55. On the framing of early surgeons and surgical procedures as “heroic,” see Pernick, A Calculus of Suffering, 30. Sims’s research on ovariotomies and the “uterine elevator” include: “Ovariotomy: Pedicle Secured by Silver Wire after the Failure of the Actual Cautery to Arrest the Haemorrhage,” British Medical Journal 1, no. 316 (1867): 50–51. https://doi.org/10.1136/bmj.1.316.50; “A New Uterine Elevator,” American Journal of the Medical Sciences 35 (1858): 132–134. https://doi.org/10.1097/00000441-185801000-00011.

40 See, for example, Luce Irigaray, Speculum of the Other Woman, trans. Gillian C. Gill (Ithaca, NY: Cornell University Press, 1985).

41 Nicole Ivy, “Bodies of work: A meditation on medical imaginaries and enslaved women,” Souls 18, no. 1 (2016): 11. https://doi.org/10.1080/10999949.2016.1162590. Following Sims’s 1852 publication on his vesico-vaginal fistula surgery, publications on similar interventionist, gynecological surgeries increased by over 100 percent: Owens, Medical Bondage, 55. In his memoir, Sims recalls inviting many other doctors and interested parties to “witness the experiments” he did on the enslaved women in his care, as well as on a range of other female patients over the course of his career: The Story of My Life (New York: D. Appleton and Company, 1888), 210–222.

42 Owens, Medical Bondage, 11. Overall, Sims published five central, scientific articles on issues related to reproductive health. These serve as artifacts for the analysis at hand with three published in the British Medical Journal, one in the Chicago Medical Examiner, and one in The Lancet.

43 J. Marion Sims, “On the Treatment of Vesico-Vaginal Fistula,” American Journal of the Medical Sciences 45, no. 25 (1852): 60. https://doi.org/10.1007/BF01901610.

44 Ibid. See also, for example, J. Marion Sims, “Remarks on Battey’s Operation,” British Medical Journal 2, no. 887 (1877): 916–918. https://doi.org/10.1136/bmj.2.885.840. Therein he discusses “cases” extensively, including those “lost” in surgery or not improved by surgical intervention at all (916).

45 Sims, “On the Treatment of Vesico-Vaginal Fistula,” 82.

46 Sims, “On the Treatment of Vesico-Vaginal Fistula,” 59.

47 Ibid.

48 Ibid. [emphasis added].

49 Sara Ahmed, The Cultural Politics of Emotion (New York: Routledge, 2004).

50 John A. Lynch, The Origins of Bioethics: Remember When Medicine Went Wrong (East Lansing: Michigan State University Press), 8–9.

51 For evidence of the “horror and fear of women’s bodies” that was communicated in late-nineteenth-century U.S. medical rhetoric, see Wells, Out of the Dead House, 25–26.

52 J. Marion Sims, “Illustrations of the Value of the Microscope in the Treatment of the Sterile Condition,” British Medical Journal 2, no. 409 (1868): 465–466. https://doi.org/10.1136/bmj.2.410.492.

53 Ibid.

54 Ibid.

55 Sims, “Illustrations of the Value of the Microscope,” 466.

56 For a history of the monstrous-maternal trope within the medical sciences, see Rosi Braidotti, “Signs of Wonder and Traces of Doubt: On Teratology and Embodied Differences,” in Between Monsters, Goddesses and Cyborgs: Feminist Confrontations with Science, Medicine and Cyberspace, ed. Nina Lykke and Rosi Braidotti (London: Zed Books, 1996), 135–152.

57 Martha Solomon, “The Rhetoric of Dehumanization: An analysis of Medical Reports of the Tuskegee Syphilis Project,” Western Journal of Speech Communication 49, no. 4 (1985): 241. https://doi.org/10.1080/10570318509374200.

58 Sims, “On the Treatment of Vesico-Vaginal Fistula,” 68.

59 Sims, “On the Treatment of Vesico-Vaginal Fistula,” 79.

60 Cooper Owens offers significant evidence that Sims and other gynecologists following his lead second-guessed their female patients’ accounts of pain and held patients down during agonizing surgeries: Medical Bondage, 46, 58, 104, 112.

61 See Roy, “Surgical Gynecology,” 185–186.

62 In the cases of his Black and Irish-immigrant patients in particular, Sims collected neither patient histories before treatment nor follow-up information after patients left his care (McGregor, From Midwives to Medicine, 66).

63 Kleegman, “Sterility,” 403.

64 For an overview of some of the major changes that transpired in the reproductive sciences in terms of technology, diagnosis, and medical treatment beginning in the early twentieth century, see Clarke, “Reproductive Science, 1913–1971,” 83–116. See also, Margaret Marsh and Wanda Ronner, The Fertility Doctor: John Rock and the Reproductive Revolution (Baltimore, MD: The Johns Hopkins University Press, 2008).

65 Kleegman cites Sims directly and without criticism several times, thereby demonstrating that her work builds from his trajectory while, all the while, redirecting that trajectory in impactful ways. See, for instance, Sophia J. Kleegman, “Infertility in Women,” in Gynecology, Vol. 1, ed. R. J. Lowrie (Springfield, IL: Charles C. Thomas Publisher, 1952), 629; and Sophia J. Kleegman and Sherwin A. Kaufman, Infertility in Women: Diagnosis and Treatment (Philadelphia, PA: F.A. Davis Company, 1966), 80, 90.

66 Pernick, A Calculus of Suffering, 148–167. See also, Kristin K. Barker, “A Ship Upon a Stormy Sea: The Medicalization of Pregnancy,” Social Science and Medicine 47, no. 8 (1998): 1067–1076. https://doi.org/10.1016/S0277-9536(98)00155-5.

67 Katy Rothfelder and Davi Johnson Thornton, “Man Interrupted: Mental Illness Narrative as a Rhetoric of Proximity,” Rhetoric Society Quarterly 47, no. 4, (2017): 363. https://doi.org/10.1080/02773945.2017.1279343. See also, Dennis A. Lynch, “Rhetorics of Proximity: Empathy in Temple Grandin and Cornel West,” Rhetoric Society Quarterly 28, no. 1 (1998): 5–23. https://doi.org/10.1080/02773949809391110.

68 Kleegman, “Surgery of the Ovary,” 419.

69 Sophia J. Kleegman, “Office Treatment of the Pathologic Cervix,” American Journal of Surgery 48, no. 1 (1940): 298. https://doi.org/10.1016/S0002-9610(40)90261-6.

70 Sophia J. Kleegman, “Diagnosis and Treatment of Infertility in Women,” Medical Clinics of North America 35 (1951): 827. https://doi.org/10.1016/S0025-7125(16)35282-8.

71 Kleegman, “Surgery of the Ovary,” 421; “Therapeutic Donor Insemination,” 14.

72 Kleegman, “Diagnosis and Treatment of Infertility in Women,” 817; Sophia J. Kleegman, “Recent Advances in the Diagnosis and Treatment of Sterility,” Medical Woman’s Journal 46, no. 1 (1939): 8; Kleegman, “Sterility,” 403.

73 Haraway, “Situated Knowledges,” 594.

74 Kleegman, “Surgery of the Ovary,” 423.

75 In this way, Kleegman distinguished herself and her “conservative surgery” hermeneutic from the tradition of late-nineteenth-century “conservative” gynecological practitioners—many of whom were women such as Dr. Elizabeth Blackwell—who renounced completely gynecological surgery, largely in service to maternalist and eugenic beliefs about the delicate and sacred nature of the Anglo-Saxon female reproductive system. See, Regina Morantz-Sanchez, Conduct Unbecoming a Woman: Medicine on Trail in Turn-of-the-Century Brooklyn (New York: Oxford University Press, 2000), 107–108; Elizabeth Blackwell, The Influence of Women in the Profession of Medicine (London: George Bell and Sons, 1889).

76 Sophia J. Kleegman, “Preventive Aspects of Infertility,” Fertility and Sterility 17, no. 6 (1966): 775. https://doi.org/10.1016/S0015-0282(16)36127-1.

77 Ibid.

78 Amanda M. Friz and Marissa L. Fernholz, “The Male Gaze in the Medical Classroom: Proximity, Objectivity, and Objectification in ‘The Pornographic Anatomy Book,’” Women’s Studies in Communication 43, no. 3 (2020): 292–316. https://doi.org/10.1080/07491409.2020.1740899.

79 See McGregor, From Midwives to Medicine, 68.

80 Sophia J. Kleegman, “Medical and Social Aspects of Birth Control,” Journal-Lancet 55, no. 22 (1935): 731.

81 Kleegman, “Medical and Social Aspects of Birth Control,” 730.

82 Kleegman, “Medical and Social Aspects of Birth Control,” 730.

83 Peter Conrad, The Medicalization of Society: On the Transformation of Human Conditions into Treatable Disorders (Baltimore: Johns Hopkins University Press, 2007).

84 Sims, The Story of My Life.

85 See, for instance, Sims, “On the Treatment of Vesico-Vaginal Fistula,” 59–81; “Illustrations of the Value of the Microscope,” 465–466.

86 Jensen, Infertility.

87 Kleegman, “Sterility,” 393.

88 Christa J. Olson, “American Magnitude: Frederic Church, Hiram Bingham, and Hemispheric Vision,” Rhetoric Society Quarterly 48, no. 4 (2018): 380–397. https://www.tandfonline.com/doi/abs/10.1080/02773945.2017.1347952.

89 Kleegman, “Sterility,” 403.

90 Cooper Owens, Medical Bondage, 8.

91 Kleegman, “Sterility,” 404.

92 Ibid.

93 Kleegman, “Therapeutic Donor Insemination,” 17.

94 Kleegman, “Diagnosis and Treatment of Infertility in Women,” 821. See also, Kleegman, “Sterility,” 403. Surgeries to reposition the uterus were among the most common early, gynecological interventions: Roy, “Surgical Gynecology,” 191. Sims, “A New Uterine Elevator,” 132–134.

95 Kleegman, “Diagnosis and Treatment of Infertility in Women,” 823–824 [emphasis in original].

96 Kleegman, “Preventive Aspects of Infertility,” 775.

97 Kleegman, “Recent Advances,” 9; “Therapeutic Donor Insemination,” 14.

98 Haraway, “Situated Knowledges,” 595.

99 Ibid. [emphasis in original].

100 Sims notes that he is “in the habit of examining the vaginal and cervical mucus for spermatozoa some hours after coition,” which does not necessarily imply that he never tested sperm in isolation but nevertheless provides convincing evidence that, at least in terms of his scientific and clinical practices, he consistently bound the (in)fertile body exclusively within the female body; “Illustrations of the Value of the Microscope,” p. 465.

101 Haraway, “Situated Knowledges,” 595.

102 Kleegman, “Sterility,” p. 396; “Recent Advances,” 2.

103 Kleegman, “Sterility,” p. 396.

104 Kleegman, “Sterility,” 403.

105 Gerald L. Moench and Helen Holt, “Sperm Morphology in Relation to Fertility,” American Journal of Obstetrics and Gynecology 22, no. 2 (1931): 199–210. https://doi.org/10.1016/S0002-9378(31)90545-0.

106 Kleegman, “Sterility,” 395.

107 Kleegman, “Diagnosis and Treatment of Infertility in Women,” 821.

108 Kleegman, “Diagnosis and Treatment of Infertility in Women,” 817–846.

109 Kleegman and Kaufman, Infertility in Women.

110 See, for instance, Kleegman, “Sterility,” 405; “Recent Advances in the Diagnosis and Treatment of Sterility,” 9. Historians Margaret Marsh and Wanda Ronner identify Kleegman as one of “several prominent women physicians” who studied and began reporting on male-factor infertility in the 1930s, but they footnote only Dr. Margaret C. Sturgis in addition to Kleegman, and Sturgis’s published research focused not on infertility but on uterine cancer. They also note that, while Dr. Samuel Meaker spoke to the issue of male sources of infertility in the 1930s, he reported that it was responsible for infertility in only very rare instances: The Empty Cradle: Infertility in America from Colonial Times to the Present (Baltimore: The Johns Hopkins University Press, 1996), 155; 160–161.

111 Lynch, The Origins of Bioethics, xiv, 56.

112 See, for instance, Leandra Hinojosa Hernández and Sarah de los Santos Upton, Challenging Reproductive Control and Gendered Violence in the Américas: Intersectionality, Power, and Struggles for Rights (Lanham, MD: Lexington Books, 2018); Rachel Bloom-Pojar and Maria Barker, “The Role of Confianza in Community-Engaged Work for Reproductive Justice,” Reflections 20, no. 2 (2020): 84–101; Washington, Medical Apartheid.

113 Natalie Fixmer-Oraiz, Homeland Maternity: US Security Culture and the New Reproductive Regime (Urbana: University of Illinois Press, 2019), 139.

114 For an excellent explication of a specific intervention that represents the possibility for increasingly humane, ethical treatment in gynecology and fertility science, see Berkley Conner, “Mapping Redesign: Gynecological Neoliberalism and the Spatiality of Project Yona’s Speculum,” Women’s Studies in Communication, 44, no. 4 (2021): 611–631. https://doi.org/10.1080/07491409.2021.1925797.

115 See Wells, Out of the Dead House, 174–178.

116 See Tasha N. Dubriwny, “Consciousness-Raising as Collective Rhetoric: The Articulation of Experience in the Redstockings’ Abortion Speak-Out of 1969,” Quarterly Journal of Speech 91, no. 4 (2005): 395–422. https://doi.org/10.1080/00335630500488275; and Matthew J. Sobnosky, “Experience, Testimony, and the Women’s Health Movement,” Women’s Studies in Communication 36, no. 3 (2013): 217–242. https://doi.org/10.1080/07491409.2013.835667.

117 Amber Johnson and Kesha Morant Williams, “‘The Most Dangerous Place for an African American is in the Womb’: Reproductive Health Disparities and Anti-Abortion Rhetoric,” Journal of Contemporary Rhetoric 5, no. 3–4 (2015): 145–159.

118 Jack, “A Pedagogy of Sight,” 192.

119 Haraway, “Situated Knowledges,” 596.

Additional information

Funding

This research was supported by a National Endowment for the Humanities Faculty Fellowship.

Notes on contributors

Robin E. Jensen

Robin E. Jensen (Ph.D., University of Illinois at Urbana-Champaign) is a Professor of Communication at the University of Utah who studies historical and contemporary discourses about health, science, sex, and gender.