Anarcha and the Ethics of Modern Gynecology
There are stories that cannot be told lightly. One such story is that of Anarcha and the ethics of modern gynecology, a history that demands careful reflection.
Not because they are unknown, but because they have been handled carelessly for so long—flattened into footnotes, reduced to names without bodies, or transformed into triumphal narratives that obscure the cost of progress.
The Inheritance began as a question, not a project:
What does modern gynecology carry forward that it does not always name?
As a clinician, I use techniques every week that were developed in the mid-19th century to repair obstetric vesicovaginal fistulas—devastating childbirth injuries that once consigned women to lives of isolation and social death. Today, these repairs are performed with anesthesia, sterile technique, informed consent, and the explicit goal of relieving suffering.
But those techniques did not emerge ethically.
They were refined through repeated experimental surgeries performed on enslaved Black women—most notably Anarcha, along with Lucy and Betsey—without anesthesia and without consent, in Montgomery, Alabama, in the 1840s. Their suffering became the substrate for knowledge that others would later inherit safely.
This history is documented.
What is missing is voice.
Anarcha left no recorded testimony. What survives of her experience exists almost entirely through the writings of the physician who operated on her and the institutional record that followed. The archive preserves technique. It does not preserve interiority.
I did not write The Inheritance to correct the historical record in a traditional sense. Nor did I write it to accuse, condemn, or retroactively adjudicate the past. I wrote it to restore ethical proximity—to refuse the distance that allows us to benefit from knowledge while disowning how it was obtained.
The piece is structured in two voices.
One belongs to Anarcha. Her voice is a reverent imaginative reconstruction, grounded in documented fact but attentive to what the archive cannot hold: repetition, anticipation, endurance, the bodily knowledge of being opened again and again. I wrote her sections with deliberate restraint. There is no spectacle. No reenactment of violence. Pain is conveyed through duration and inevitability, not shock.
The second voice belongs to a modern clinician. This voice is quieter than Anarcha’s, intentionally so. It does not redeem the past or attempt to balance a moral ledger. It simply names what is inherited: that the precision of contemporary repair rests on unchosen suffering; that consent now matters because it once did not; that anesthesia now protects because it once was withheld.
What mattered most to me in writing this piece was restraint.
Graphic detail would have been easier. Moral clarity would have been more comforting. But neither would have been honest. To recreate harm in the name of remembrance risks repeating the very violence one claims to resist. To soften the truth in the name of inspiration risks erasure.
The Inheritance sits in the tension between those impulses.
It does not ask the reader to feel better.
It asks the reader to feel responsible.
This is not a comprehensive history of gynecology, nor a biography of J. Marion Sims, nor a clinical explainer. It is a meditation on what it means to practice medicine with memory—to acknowledge that healing today is inseparable from harm inflicted in the past, and that ethical practice requires more than technical excellence.
Remembering, in this context, is not passive.
It is an ethical act.
I chose to publish The Inheritance as a separate work because it requires a different kind of attention than a blog post allows. It is meant to be entered slowly, read without distraction, and held with care. This essay serves as an orientation—not a substitute.
For those who choose to read it, I offer no resolution.
Only witness.
The Inheritance is available as a standalone publication for readers who wish to engage the full work with the time and attention it asks for.
For more Sunday Still posts click here.
Leave a Reply