WEBVTT 00:00:00.000 --> 00:00:02.040 Welcome back to the Deep Dive. I am so glad you 00:00:02.040 --> 00:00:04.200 could join us today because we are heading into 00:00:04.200 --> 00:00:07.780 some truly fascinating territory. Yeah, we really 00:00:07.780 --> 00:00:10.859 are. Today's mission is to examine the complex, 00:00:11.080 --> 00:00:14.140 controversial and honestly profoundly impactful 00:00:14.140 --> 00:00:17.800 life of a 19th century American physician. Right. 00:00:18.059 --> 00:00:21.019 A man named Nathan Bozeman. And, you know, when 00:00:21.019 --> 00:00:23.000 you first look at the source material we're working 00:00:23.000 --> 00:00:26.120 with today. So short. Right. You might wonder 00:00:26.120 --> 00:00:27.960 if there's even enough here to sustain a full 00:00:27.960 --> 00:00:31.219 analysis. We are looking at a remarkably brief 00:00:31.219 --> 00:00:34.859 Wikipedia entry on Mosman. Just a handful of 00:00:34.859 --> 00:00:37.280 bullet points. Exactly. Just outlining a life 00:00:37.280 --> 00:00:40.899 that spanned from 1825 to 1905. But if you know 00:00:40.899 --> 00:00:42.960 how to read between the lines, an entire hidden 00:00:42.960 --> 00:00:45.140 world opens up. Yeah, the brevity of the main 00:00:45.140 --> 00:00:47.619 text is actually really deceptive. It is. The 00:00:47.619 --> 00:00:49.700 real story here is hidden at the very bottom 00:00:49.700 --> 00:00:51.479 of the page. In the references. In the references, 00:00:51.560 --> 00:00:54.619 exactly. The entry itself just briefly outlines 00:00:54.619 --> 00:00:57.039 his birth, education, and career milestones. 00:00:57.219 --> 00:00:59.119 But when you scroll down to those footnotes. 00:00:59.119 --> 00:01:02.630 You see this crazy juxtaposition. Right. You 00:01:02.630 --> 00:01:05.590 see a citation for an 1878 medical directory 00:01:05.590 --> 00:01:08.890 sitting right next to a 2020 academic journal 00:01:08.890 --> 00:01:12.510 article about structural racism. Wow. And by 00:01:12.510 --> 00:01:14.709 tracing the gap between those two sources, we 00:01:14.709 --> 00:01:17.150 aren't just reading a simple biography. We're 00:01:17.150 --> 00:01:20.109 uncovering a massive story about the messy evolution 00:01:20.109 --> 00:01:23.000 of American medicine. incredibly fierce professional 00:01:23.000 --> 00:01:25.579 rivalries. And a deeply unsettling historical 00:01:25.579 --> 00:01:28.459 reality that still echoes in modern healthcare 00:01:28.459 --> 00:01:31.219 discussions. It is a masterclass in how history 00:01:31.219 --> 00:01:33.700 is recorded and then constantly re -evaluated. 00:01:33.819 --> 00:01:35.879 We are going to look at all these different angles 00:01:35.879 --> 00:01:39.060 to get the full picture of who this man was and 00:01:39.060 --> 00:01:41.459 what his career actually meant for the development 00:01:41.459 --> 00:01:43.859 of modern gynecology. Okay, let's unpack this. 00:01:43.959 --> 00:01:45.980 Let's do it. Starting with the foundation of 00:01:45.980 --> 00:01:48.640 his career. The text notes that Nathan Bozeman 00:01:48.640 --> 00:01:52.159 was born on March 25, 1825. Yep. And he studied 00:01:52.159 --> 00:01:54.359 medicine at the University of Louisville, graduating 00:01:54.359 --> 00:01:57.650 in 1848. Now setting the stage for you. Getting 00:01:57.650 --> 00:02:00.709 a medical degree in 1848 means walking into a 00:02:00.709 --> 00:02:02.510 profoundly different world than the one we know 00:02:02.510 --> 00:02:04.650 today. Oh, completely. You really have to strip 00:02:04.650 --> 00:02:06.530 away almost every modern assumption you have 00:02:06.530 --> 00:02:10.009 about health care. In 1848, the University of 00:02:10.009 --> 00:02:12.250 Louisville Medical Institute was a prominent 00:02:12.250 --> 00:02:15.389 school, sure, but medical education at the time 00:02:15.389 --> 00:02:18.389 was heavily lecture -based. Just listening to 00:02:18.389 --> 00:02:21.069 people talk. Yeah. A doctor graduating in that 00:02:21.069 --> 00:02:23.569 era was entering a field that lacked standardized 00:02:23.569 --> 00:02:26.460 clinical trials. Modern sterile environments 00:02:26.460 --> 00:02:29.879 or any real understanding of germ theory. Exactly. 00:02:30.159 --> 00:02:33.319 Germ theory wasn't a thing yet. Anesthesia, like 00:02:33.319 --> 00:02:36.199 ether, was only just beginning to be demonstrated 00:02:36.199 --> 00:02:38.460 in surgical theaters. So it's the Wild West of 00:02:38.460 --> 00:02:41.680 medicine. Pretty much. So a young physician like 00:02:41.680 --> 00:02:44.159 Bozeman was stepping into a profession that was 00:02:44.159 --> 00:02:47.280 largely experimental. Procedures and anatomical 00:02:47.280 --> 00:02:49.939 understandings were still being fiercely debated 00:02:49.939 --> 00:02:52.960 or outright invented by individuals on the fly. 00:02:53.099 --> 00:02:55.620 Right, which makes his first major career move 00:02:55.620 --> 00:02:58.719 so critical. Bozeman heads down south to Montgomery, 00:02:58.860 --> 00:03:00.900 Alabama. And the source outlines that this is 00:03:00.900 --> 00:03:03.060 where his path collides with another incredibly 00:03:03.060 --> 00:03:06.120 prominent physician. J. Marion Sims. Yes. They 00:03:06.120 --> 00:03:08.319 operated a facility together, which was referred 00:03:08.319 --> 00:03:11.159 to in the text as Sims and Bozeman's Surgical 00:03:11.159 --> 00:03:13.500 Infirmary for Negroes. They start as collaborators. 00:03:14.240 --> 00:03:17.400 But the source explicitly tells us that Bozeman 00:03:17.400 --> 00:03:20.759 eventually transforms from a partner to a fierce 00:03:20.759 --> 00:03:23.520 critic of this highly controversial doctor. Yeah. 00:03:23.659 --> 00:03:25.819 What's fascinating here is the psychological 00:03:25.819 --> 00:03:28.979 depth of that professional shadowing. Shadowing 00:03:28.979 --> 00:03:30.860 is a good word for it. Right. Because it goes 00:03:30.860 --> 00:03:34.020 far beyond a simple workplace disagreement or 00:03:34.020 --> 00:03:36.639 a parting of ways. Yeah. The dynamic between 00:03:36.639 --> 00:03:39.580 Bozeman and Sims becomes deeply intertwined and 00:03:39.580 --> 00:03:45.340 incredibly competitive. So in 1853. He moves 00:03:45.340 --> 00:03:47.280 to New York because he was suffering from poor 00:03:47.280 --> 00:03:50.180 health. And Bozeman's reaction to his partner 00:03:50.180 --> 00:03:52.900 leaving isn't just to, I don't know, take over 00:03:52.900 --> 00:03:55.439 a few patient files. No, not at all. He literally 00:03:55.439 --> 00:03:57.939 purchases Sim's entire medical practice. And 00:03:57.939 --> 00:04:00.639 then he purchases Sim's private house. I mean, 00:04:00.659 --> 00:04:02.599 have you ever encountered a professional rivalry 00:04:02.599 --> 00:04:05.000 so intense that when your colleague leaves town, 00:04:05.219 --> 00:04:08.639 you buy the home they lived in? It's wild. It 00:04:08.639 --> 00:04:11.180 feels like a very deliberate, almost aggressive 00:04:11.180 --> 00:04:14.659 way of stepping into another person's shoes and 00:04:14.659 --> 00:04:17.410 claiming their space. Absolutely. Stepping into 00:04:17.410 --> 00:04:20.389 the house is a highly symbolic move. It speaks 00:04:20.389 --> 00:04:23.389 volumes about the ambition driving 19th century 00:04:23.389 --> 00:04:25.810 medical pioneers. They wanted to be the ones 00:04:25.810 --> 00:04:28.110 remembered. They were acutely aware that they 00:04:28.110 --> 00:04:30.829 were founding a new surgical discipline and they 00:04:30.829 --> 00:04:33.529 were intensely focused on their own legacies. 00:04:33.750 --> 00:04:36.550 So buying the practice in the home is a way of 00:04:36.550 --> 00:04:38.930 claiming Sims's entire professional territory 00:04:38.930 --> 00:04:42.069 in Alabama. Exactly. And the shadowing doesn't 00:04:42.069 --> 00:04:44.819 stop there. Decades later, when Bozeman also 00:04:44.819 --> 00:04:47.660 relocates to New York City, he eventually succeeds 00:04:47.660 --> 00:04:50.560 Sims as the surgeon of the New York Women's Hospital. 00:04:50.759 --> 00:04:53.680 Wow. He follows his geographical path, steps 00:04:53.680 --> 00:04:56.459 into his institutional roles, and actively works 00:04:56.459 --> 00:04:58.459 to replace him. Taking over another doctor's 00:04:58.459 --> 00:05:01.500 life, basically step by step. Step by step. But 00:05:01.500 --> 00:05:03.060 before we get to New York, we need to look at 00:05:03.060 --> 00:05:04.980 what they were actually doing at that infirmary 00:05:04.980 --> 00:05:07.519 in Montgomery. Yes, we do. The source material 00:05:07.519 --> 00:05:10.839 presents a stark, factual core about how these 00:05:10.839 --> 00:05:13.579 early medical techniques were developed. It states 00:05:13.579 --> 00:05:15.939 that Bozeman conducted gynecological surgeries 00:05:15.939 --> 00:05:19.259 on slaves in Alabama. And this is where those 00:05:19.259 --> 00:05:21.420 references at the bottom of our source material 00:05:21.420 --> 00:05:24.180 become crucial for grasping the full historical 00:05:24.180 --> 00:05:26.620 weight of the text. Right. To understand what 00:05:26.620 --> 00:05:28.980 was happening in Alabama, the source points us 00:05:28.980 --> 00:05:32.660 to a 2020 article by Jamila K. Taylor. Published 00:05:32.660 --> 00:05:35.180 in the Journal of Law, Medicine and Ethics. Exactly. 00:05:36.009 --> 00:05:38.370 The title of her work is Structural Racism and 00:05:38.370 --> 00:05:41.230 Maternal Health Among Black Women. The juxtaposition 00:05:41.230 --> 00:05:43.850 of the sources is just striking. It really is. 00:05:44.009 --> 00:05:47.149 We have an 1878 directory, The Physicians and 00:05:47.149 --> 00:05:49.949 Surgeons of the United States, which frames men 00:05:49.949 --> 00:05:53.410 like Sims and Bozeman as heroic medical pioneers 00:05:53.410 --> 00:05:55.930 who advanced the field of gynecology. A very 00:05:55.930 --> 00:05:58.720 traditional 19th century view. Right. But then 00:05:58.720 --> 00:06:01.720 we have this 2020 academic journal, which looks 00:06:01.720 --> 00:06:04.600 at the exact same men and the exact same timeline, 00:06:04.860 --> 00:06:07.379 but analyzes it through the lens of power dynamics 00:06:07.379 --> 00:06:10.100 and structural racism. And the modern academic 00:06:10.100 --> 00:06:12.920 analysis is requiring us to look at who the foundational 00:06:12.920 --> 00:06:15.420 subjects of these early surgeries were. Who was 00:06:15.420 --> 00:06:17.379 actually on the operating table. The historical 00:06:17.379 --> 00:06:19.680 record confirms that enslaved women were the 00:06:19.680 --> 00:06:21.680 patients enduring these experimental procedures 00:06:21.680 --> 00:06:24.180 in Alabama. They were suffering from a devastating 00:06:24.180 --> 00:06:26.980 condition called vesicovaginal fistula. Yes. 00:06:27.180 --> 00:06:29.839 Which is a severe tear between the bladder and 00:06:29.839 --> 00:06:33.319 the vagina, usually caused by prolonged obstructed 00:06:33.319 --> 00:06:35.899 childbirth. It was a condition that caused immense 00:06:35.899 --> 00:06:39.209 suffering and social ostracization. And Sims 00:06:39.209 --> 00:06:41.110 and Bozeman were trying to invent a surgical 00:06:41.110 --> 00:06:44.149 cure for it. But by citing Taylor's 2020 journal, 00:06:44.370 --> 00:06:47.310 the source material anchors the medical advancements 00:06:47.310 --> 00:06:50.230 of that era to the reality of the patients themselves. 00:06:50.350 --> 00:06:52.949 Right. Because these women were enslaved, the 00:06:52.949 --> 00:06:55.269 fundamental issues of medical consent, bodily 00:06:55.269 --> 00:06:58.170 autonomy, and human rights simply did not exist. 00:06:58.970 --> 00:07:01.629 It changes the entire narrative of medical discovery 00:07:01.629 --> 00:07:04.250 when you realize the foundation of the surgical 00:07:04.250 --> 00:07:06.889 technique was developed on individuals who had 00:07:06.889 --> 00:07:09.629 no legal right to say no to the procedure. It 00:07:09.629 --> 00:07:11.670 really does. The source doesn't editorialize 00:07:11.670 --> 00:07:14.189 this, but presenting the 1878 directory next 00:07:14.189 --> 00:07:16.670 to the 2020 journal allows you to see how the 00:07:16.670 --> 00:07:19.430 historical record is constantly demanding that 00:07:19.430 --> 00:07:22.430 we look closer at the human cost of early innovation. 00:07:22.889 --> 00:07:25.310 It forces a broader perspective on the development 00:07:25.310 --> 00:07:28.529 of maternal health practices. The journal explores 00:07:28.529 --> 00:07:31.649 the historical thread between how early gynecological 00:07:31.649 --> 00:07:34.509 medicine was forged in the 19th century and the 00:07:34.509 --> 00:07:36.769 disparities in maternal health care that are 00:07:36.769 --> 00:07:39.370 still being analyzed today. The surgeries in 00:07:39.370 --> 00:07:42.189 Montgomery represent a pivotal moment where medical 00:07:42.189 --> 00:07:44.889 ambition intercepted with the absolute power 00:07:44.889 --> 00:07:48.050 imbalances of American slavery. Perfectly stated. 00:07:48.480 --> 00:07:51.339 So as the timeline moves into the 1860s, that 00:07:51.339 --> 00:07:54.139 historical backdrop shifts dramatically. It sure 00:07:54.139 --> 00:07:56.959 does. The nation fractures, and the source notes 00:07:56.959 --> 00:07:59.360 that Bozeman serves as a surgeon for the Confederate 00:07:59.360 --> 00:08:02.300 States of America during the Civil War. Specifically, 00:08:02.480 --> 00:08:04.779 it places him at the First Battle of Manassas 00:08:04.779 --> 00:08:08.959 in July 1861. Going from an infirmary in Alabama 00:08:08.959 --> 00:08:12.339 to the battlefield of Manassas has to be an unimaginable 00:08:12.339 --> 00:08:14.540 shock to the system for a medical professional. 00:08:14.740 --> 00:08:17.360 It is a profound transition. The First Battle 00:08:17.360 --> 00:08:19.439 of Manassas, also known as the First Battle of 00:08:19.439 --> 00:08:21.839 Bull Run, was the first major land battle of 00:08:21.839 --> 00:08:23.860 the American Civil War. And nobody on either 00:08:23.860 --> 00:08:26.139 side was prepared for the scale of the carnage. 00:08:26.600 --> 00:08:29.360 Nobody. People famously came out from Washington, 00:08:29.500 --> 00:08:31.879 D .C. with picnic baskets to watch the battle, 00:08:32.000 --> 00:08:34.159 thinking it would be a quick skirmish that would 00:08:34.159 --> 00:08:37.570 end the rebellion. Wow. Just watching it like 00:08:37.570 --> 00:08:40.289 a show. Instead, it was a chaotic bloodbath. 00:08:40.289 --> 00:08:42.730 The medical corps were completely overwhelmed. 00:08:42.990 --> 00:08:44.789 What does that actually look like for a surgeon 00:08:44.789 --> 00:08:47.450 on the ground? I mean, he has been the last decade 00:08:47.450 --> 00:08:51.850 painstakingly developing slow, deliberate pelvic 00:08:51.850 --> 00:08:54.990 surgeries. Right. And suddenly he is thrust into 00:08:54.990 --> 00:08:57.830 a situation with thousands of casualties and 00:08:57.830 --> 00:09:00.710 artillery fire. It means abandoning meticulous 00:09:00.710 --> 00:09:04.190 experimental technique. for rapid triage and 00:09:04.190 --> 00:09:08.330 survival. Chaos. Complete chaos. M &S's Bozeman 00:09:08.330 --> 00:09:09.970 would have been dealing with shattered limbs 00:09:09.970 --> 00:09:12.549 from mini balls, artillery shrapnel wounds, and 00:09:12.549 --> 00:09:14.970 massive blood loss. Joe's horrific trauma. The 00:09:14.970 --> 00:09:17.009 primary surgical intervention of the day for 00:09:17.009 --> 00:09:19.950 a shattered limb was amputation, performed as 00:09:19.950 --> 00:09:22.830 quickly as possible, often under incredibly chaotic, 00:09:23.070 --> 00:09:25.029 unhygienic conditions. And he's right in the 00:09:25.029 --> 00:09:27.769 middle of it. The sheer volume of trauma he witnessed 00:09:27.769 --> 00:09:29.909 and treated would have radically altered his 00:09:29.909 --> 00:09:33.500 perspective on medicine. It shifts a doctor from 00:09:33.500 --> 00:09:35.940 thinking purely about innovative cures to managing 00:09:35.940 --> 00:09:39.759 catastrophic damage control. That level of intense, 00:09:40.000 --> 00:09:42.279 high -stakes trauma surgery clearly shaves him. 00:09:42.360 --> 00:09:45.700 Because after the war ends, Bozeman relocates 00:09:45.700 --> 00:09:48.419 north to New York City. Yes. And rather than 00:09:48.419 --> 00:09:50.899 quietly settling into private practice, he throws 00:09:50.899 --> 00:09:52.720 himself right back into the fray. He definitely 00:09:52.720 --> 00:09:56.629 didn't choose the quiet life. In the 1870s, Bozeman 00:09:56.629 --> 00:09:59.649 gets into a highly publicized dispute with a 00:09:59.649 --> 00:10:02.409 prominent European physician, Professor Gustav 00:10:02.409 --> 00:10:04.289 Simon. Here's where it gets really interesting. 00:10:04.470 --> 00:10:06.309 Oh, yeah. They weren't arguing over hospital 00:10:06.309 --> 00:10:08.350 administration or who got the corner office. 00:10:08.509 --> 00:10:11.110 They were having a bitter transatlantic argument 00:10:11.110 --> 00:10:14.070 over the specific application of a surgical procedure. 00:10:14.370 --> 00:10:16.970 Very public. Very bitter. The source states they 00:10:16.970 --> 00:10:19.639 were fighting about. the wide and indiscriminate 00:10:19.639 --> 00:10:22.759 use of a procedure called colpolysis. If we connect 00:10:22.759 --> 00:10:25.220 this to the bigger picture, this dispute with 00:10:25.220 --> 00:10:27.360 Professor Simon reveals the mechanics of how 00:10:27.360 --> 00:10:29.759 medical consensus was hammered out in the late 00:10:29.759 --> 00:10:31.980 19th century. Without a medical board telling 00:10:31.980 --> 00:10:34.419 them what to do. Exactly. To understand the fight, 00:10:34.539 --> 00:10:37.200 we have to understand the procedure. Culpolysis 00:10:37.200 --> 00:10:39.659 is a surgical operation that involves closing 00:10:39.659 --> 00:10:42.120 the vaginal canal. Okay. In the 19th century, 00:10:42.320 --> 00:10:44.539 doctors like Simon were using it as a treatment 00:10:44.539 --> 00:10:48.279 for severe pelvic organ prolapse or for those 00:10:48.279 --> 00:10:50.639 same fistulas we mentioned earlier. The ones 00:10:50.639 --> 00:10:54.360 Bozeman was working on in Alabama. Yes. Essentially 00:10:54.360 --> 00:10:56.960 obliterating the vaginal canal to stop leakage 00:10:56.960 --> 00:11:00.059 or provide structural support when they felt 00:11:00.059 --> 00:11:02.820 the tissue couldn't be properly repaired. Closing 00:11:02.820 --> 00:11:06.169 the canal completely sounds like a massive life 00:11:06.169 --> 00:11:09.009 -altering intervention for the patient. Why was 00:11:09.009 --> 00:11:11.870 Bozeman calling its use wide and indiscriminate? 00:11:11.950 --> 00:11:14.370 Because Simon and his followers were allegedly 00:11:14.370 --> 00:11:17.049 performing it too frequently and on patients 00:11:17.049 --> 00:11:19.549 who might have been cured through more restorative 00:11:19.549 --> 00:11:21.830 means. So they were rushing to the extreme option. 00:11:22.389 --> 00:11:25.769 Indiscriminate implies exactly that, that a drastic 00:11:25.769 --> 00:11:28.549 irreversible procedure was being used as a primary 00:11:28.549 --> 00:11:31.070 solution rather than a last resort. And like 00:11:31.070 --> 00:11:34.259 you said, no regulatory bodies. Right. Without 00:11:34.259 --> 00:11:37.379 modern regulatory bodies like the FDA or standardized 00:11:37.379 --> 00:11:39.519 medical boards to issue clinical guidelines, 00:11:39.879 --> 00:11:43.299 new surgeries were often applied broadly by enthusiastic 00:11:43.299 --> 00:11:46.019 doctors. And Bozeman wasn't having it. Bozeman, 00:11:46.200 --> 00:11:48.799 having spent years developing restorative fistula 00:11:48.799 --> 00:11:51.840 surgeries in Alabama, fundamentally disagreed 00:11:51.840 --> 00:11:54.419 with Simon's destructive approach and decided 00:11:54.419 --> 00:11:57.639 to publicly challenge him. So if you don't have 00:11:57.639 --> 00:12:00.179 a medical board to appeal to, how do you stop 00:12:00.179 --> 00:12:03.840 a doctor across the ocean from popularizing a 00:12:03.840 --> 00:12:05.860 surgery you think is dangerous? You take them 00:12:05.860 --> 00:12:07.940 to task in the medical journals. Just call them 00:12:07.940 --> 00:12:10.139 out in print. You publish papers outlining their 00:12:10.139 --> 00:12:12.600 failures and your successes. You present your 00:12:12.600 --> 00:12:15.039 arguments at medical society meetings and essentially 00:12:15.039 --> 00:12:17.700 try to publicly embarrass or logically defeat 00:12:17.700 --> 00:12:20.179 your opponent in front of your peers. That sounds 00:12:20.179 --> 00:12:22.500 intense. It was an era of medical feuding where 00:12:22.500 --> 00:12:25.100 doctors wrote scathing letters and treatises 00:12:25.100 --> 00:12:27.570 defending their... techniques and attacking the 00:12:27.570 --> 00:12:29.909 competence of their rivals. And Bozeman was clearly 00:12:29.909 --> 00:12:32.149 a veteran of that kind of public warfare. Oh, 00:12:32.169 --> 00:12:34.490 absolutely. The source material provides another 00:12:34.490 --> 00:12:37.049 fascinating citation that highlights exactly 00:12:37.049 --> 00:12:40.789 how he operated. Right. It references an 1884 00:12:40.789 --> 00:12:44.529 publication written by Bozeman himself featured 00:12:44.529 --> 00:12:47.799 in the gynecological transactions. The title 00:12:47.799 --> 00:12:50.779 of his paper is incredible. It really is. History 00:12:50.779 --> 00:12:53.139 of the Clamp Suture of the late Dr. J. Marion 00:12:53.139 --> 00:12:55.860 Sims and why it was abandoned by the profession. 00:12:56.139 --> 00:12:58.639 That title alone is a master class in professional 00:12:58.639 --> 00:13:01.700 dismantling. Even 30 years after he bought Sims 00:13:01.700 --> 00:13:04.480 House in Alabama and even after Sims had passed 00:13:04.480 --> 00:13:07.399 away, Bozeman is still writing papers to ensure 00:13:07.399 --> 00:13:10.080 his rival's techniques are discredited. He never 00:13:10.080 --> 00:13:12.559 let it go. What exactly was the Clamp Suture 00:13:12.559 --> 00:13:15.240 and why was Bozeman so determined to see it abandoned? 00:13:15.759 --> 00:13:18.179 The clamp suture was a specific technique J. 00:13:18.220 --> 00:13:21.360 Marion Sims developed for closing those vesicovaginal 00:13:21.360 --> 00:13:23.480 fistulas. The ones they worked on together. Yes. 00:13:24.000 --> 00:13:26.960 Sims famously used silver wire for his sutures, 00:13:26.960 --> 00:13:28.960 which was a major breakthrough because it resisted 00:13:28.960 --> 00:13:31.460 infection better than the silk threads used previously. 00:13:31.759 --> 00:13:33.620 Okay, that makes sense. But to hold the wire 00:13:33.620 --> 00:13:35.600 in place and relieve tension on the delicate 00:13:35.600 --> 00:13:39.480 tissue, Sims used lead weights or bars. The clamps. 00:13:39.679 --> 00:13:42.919 Heavy lead clamps. Right. Bozeman argued and 00:13:42.919 --> 00:13:45.340 eventually convinced much of the profession that 00:13:45.340 --> 00:13:47.899 these heavy lead clamps were actually dangerous. 00:13:48.220 --> 00:13:51.379 He argued they caused tissue necrosis and prevented 00:13:51.379 --> 00:13:54.080 proper healing. So Bozeman was pushing his own 00:13:54.080 --> 00:13:57.399 alternative method. Precisely. Bozeman had developed 00:13:57.399 --> 00:14:00.179 something called the button suture. Okay. Which 00:14:00.179 --> 00:14:03.940 used a thin lead plate shaped like a button to 00:14:03.940 --> 00:14:06.179 distribute the tension more evenly across the 00:14:06.179 --> 00:14:09.100 tissue rather than Sims' heavy clamps. And writing 00:14:09.100 --> 00:14:11.720 an entire history on why his former partner's 00:14:11.720 --> 00:14:15.039 technique was abandoned by the profession was 00:14:15.039 --> 00:14:18.059 Bozeman's way of cementing his own legacy as 00:14:18.059 --> 00:14:20.820 the superior surgeon. Exactly. It was all about 00:14:20.820 --> 00:14:23.419 legacy. It paints a vivid picture of the medical 00:14:23.419 --> 00:14:26.100 landscape of the time. We tend to imagine the 00:14:26.100 --> 00:14:28.360 progress of medicine as a quiet, steady march 00:14:28.360 --> 00:14:31.159 forward in sterile laboratories. Very clean and 00:14:31.159 --> 00:14:33.639 objective. Right. But this shows that medical 00:14:33.639 --> 00:14:35.960 standards were forged in the fire of these bitter 00:14:35.960 --> 00:14:38.340 professional feuds. Doctors were eventually shouting 00:14:38.340 --> 00:14:40.299 at each other through the pages of medical journals 00:14:40.299 --> 00:14:42.059 to establish what was safe, what was reckless, 00:14:42.220 --> 00:14:44.100 and who deserved the credit. They had to publicly 00:14:44.100 --> 00:14:47.340 prove their peers wrong to stop dangerous procedures 00:14:47.340 --> 00:14:50.100 like indiscriminate colpolysis from spreading. 00:14:50.600 --> 00:14:54.159 or to phase out flawed techniques like the clamp 00:14:54.159 --> 00:14:56.799 suture. It was an incredibly combative environment. 00:14:57.000 --> 00:14:59.740 The ambition required to pioneer a new field 00:14:59.740 --> 00:15:02.360 of surgery meant that these men were not just 00:15:02.360 --> 00:15:05.259 fighting disease, they were fighting each other 00:15:05.259 --> 00:15:08.159 for historical immortality. Looking over this 00:15:08.159 --> 00:15:11.230 entire timeline, We have covered an astonishing 00:15:11.230 --> 00:15:14.149 amount of ground from a source that initially 00:15:14.149 --> 00:15:17.070 looks so brief. We really have. We have traced 00:15:17.070 --> 00:15:19.269 a life from a medical graduation in Louisville 00:15:19.269 --> 00:15:21.950 in 1848 to the development of early gynecology 00:15:21.950 --> 00:15:24.769 in a Montgomery infirmary. We have seen Bozeman 00:15:24.769 --> 00:15:28.269 go from a collaborator of J. Marion Sims to his 00:15:28.269 --> 00:15:31.850 greatest critic. Absorbing his practice and meticulously 00:15:31.850 --> 00:15:34.460 dismantling his surgical methods in print. We 00:15:34.460 --> 00:15:36.299 followed him through the chaos of battlefield 00:15:36.299 --> 00:15:38.700 triage as a Confederate surgeon at Manassas. 00:15:38.860 --> 00:15:40.820 And watched him spend his later decades in New 00:15:40.820 --> 00:15:43.580 York battling European professors over the ethics 00:15:43.580 --> 00:15:45.519 and safety of extreme surgical interventions. 00:15:45.899 --> 00:15:48.120 And through it all, his legacy remains permanently 00:15:48.120 --> 00:15:50.700 tethered to those early years in Alabama. The 00:15:50.700 --> 00:15:52.779 foundational work that allowed him to argue with 00:15:52.779 --> 00:15:55.700 Simon in the 1870s or publish takedowns of Sims 00:15:55.700 --> 00:15:58.620 in the 1880s was entirely built upon surgeries 00:15:58.620 --> 00:16:01.799 performed on enslaved black women. It's unavoidable. 00:16:02.110 --> 00:16:04.289 The inclusion of the Modern Journal article in 00:16:04.289 --> 00:16:06.370 the source material ensures that we cannot look 00:16:06.370 --> 00:16:08.190 at the medical triumphs without acknowledging 00:16:08.190 --> 00:16:11.230 the profound lack of human rights that facilitated 00:16:11.230 --> 00:16:14.309 them. So what does this all mean? For you, the 00:16:14.309 --> 00:16:17.009 listener, taking all of this in, I think it serves 00:16:17.009 --> 00:16:19.669 as a powerful reminder that the medical knowledge 00:16:19.669 --> 00:16:22.690 we rely on today didn't materialize out of thin 00:16:22.690 --> 00:16:25.289 air. No, it didn't. It came from a deeply messy, 00:16:25.590 --> 00:16:28.450 highly contentious, and ethically fraught history. 00:16:28.960 --> 00:16:31.320 The span of the footnotes we explored today tells 00:16:31.320 --> 00:16:34.210 the whole story. You have the 1878 medical directory, 00:16:34.389 --> 00:16:37.470 which likely viewed Bozeman and Sims as untouchable, 00:16:37.509 --> 00:16:39.970 heroic figures bringing light to the dark corners 00:16:39.970 --> 00:16:42.169 of surgery. And then you have the 2020 journal, 00:16:42.330 --> 00:16:44.909 which looks at the structural racism embedded 00:16:44.909 --> 00:16:47.250 in how that light was achieved. It demonstrates 00:16:47.250 --> 00:16:49.750 that history isn't just a static list of dates 00:16:49.750 --> 00:16:52.330 and procedures. It is a constant reevaluation 00:16:52.330 --> 00:16:55.230 of the past as our own societal ethics evolve. 00:16:55.610 --> 00:16:57.490 That's a great point. This raises an important 00:16:57.490 --> 00:16:59.970 question about the nature of historical progress. 00:17:00.330 --> 00:17:03.049 Okay. When we look at Nathan Bozeman, we see 00:17:03.049 --> 00:17:06.349 a man full of intense contradictions. He was 00:17:06.349 --> 00:17:08.650 a physician who fiercely pushed back against 00:17:08.650 --> 00:17:11.069 the reckless, indiscriminate surgeries of his 00:17:11.069 --> 00:17:14.289 peers, arguing for safer, more restorative techniques. 00:17:14.589 --> 00:17:17.390 Which isn't good. Yet his own expertise was forged 00:17:17.390 --> 00:17:19.970 in an environment where his patients had no ability 00:17:19.970 --> 00:17:23.309 to consent. Right. History rarely offers us simple 00:17:23.309 --> 00:17:26.029 narratives of pure heroes or absolute villains. 00:17:26.369 --> 00:17:28.970 It usually presents us with a complex web of 00:17:28.970 --> 00:17:31.589 ambition shifting more. moral frameworks, and 00:17:31.589 --> 00:17:35.049 the undeniable human cost of innovation. It is 00:17:35.049 --> 00:17:37.710 a profound complexity to sit with. And it leaves 00:17:37.710 --> 00:17:39.769 us with something really fascinating to consider 00:17:39.769 --> 00:17:42.009 as we wrap up today's deep dive. What's that? 00:17:42.269 --> 00:17:44.410 If our current medical foundation is built upon 00:17:44.410 --> 00:17:46.950 these fierce 19th century rivalries and practices, 00:17:47.049 --> 00:17:49.470 which we now analyze through a radically different, 00:17:49.529 --> 00:17:52.710 highly critical lens today, how might the historians 00:17:52.710 --> 00:17:55.569 of the year 2150 look back at the medical procedures, 00:17:55.849 --> 00:17:58.009 the ethical standards, and the professional disputes 00:17:58.009 --> 00:18:00.180 of our own time? That is a great question. What 00:18:00.180 --> 00:18:02.240 blind spots do we have right now in our clinics 00:18:02.240 --> 00:18:04.599 and hospitals that will be glaringly obvious 00:18:04.599 --> 00:18:07.400 in the footnotes of the future? Something to 00:18:07.400 --> 00:18:09.400 mull over. Thank you so much for joining us on 00:18:09.400 --> 00:18:10.039 this deep dive.