 I'm delighted to welcome everybody to today's lecture in our annual lecture series on the history of medicine and ethics. We're so honored to welcome Baron H. Lerner, MD, PhD, Professor of Medicine and Public Health at NYU's Langone Health Program. Dr. Lerner is a clinician, bioethicist, speaker, historian, the author of five books, a regular contributor to The New York Times, The Washington Post, Slate, and many other publications. Currently, he's the vice president of the American Association for the History of Medicine and is a member of the faculty at New York University's Grossman School of Medicine, where, in addition to his research and clinical work, he teaches medical ethics and also the history of medicine. Professor Lerner received his MD from Columbia in 1986 and his PhD in history from the University of Washington in 1996. Dr. Lerner is also a media commentator and speaker and discusses history, bioethics, and clinical medicine regularly on national public health radio programs, including fresh air, all things considered, takeaway, and all of it. Dr. Lerner currently practices internal medicine and primary care at Bellevue Hospital Center in New York City. Among his current books in print, let me mention just three of them. One is called The Breast Cancer Wars, Hope, Fear, and the Pursuit of a Cure in 20th Century America. This book received the William Welch Medal of the American Association for the History of Medicine. A second book is called One for the Road, Drunk Driving Since 1900. So far as we know, this is the first history of drunk driving in America and was published by Johns Hopkins University Press. The third book that I'll mention is called The Good Doctor, A Father, A Son, and the Evolution of Medical Ethics. This tells the story of Dr. Baron Lerner and of his father, Dr. Phillip Lerner, who practiced, of course, at different times and examines each of their experiences with the evolution of clinical ethics and paternalism and patient autonomy, issues that profoundly influence health care. The title of today's talk is Fallen Medical Heroes, Should We Try to Catch Them? At the conclusion of the talk, we'll be eager to accept questions orally or posted on the Zoom chat. Mindy Schwartz, physician Mindy Schwartz working with us, will be directing the question and answer period. So please join me now in welcoming Professor Baron Lerner. Baron, please. Thank you, Dr. Siegler. I'm so honored to be a part of this lecture series. I wanted to thank Mindy Schwartz for thinking of me when she was setting up the helping set up the group of lectures and congratulate you, Dr. Siegler and your center on your many years of unbelievably important work and bioethics. I vividly remember a visit I had to you folks out a while ago. I think it was before my famous patients book came out or after, and it was an unbelievably great visit, very stimulating and strangely, weird things to remember. I can totally remember the conference room we were sitting in around the table for some reason. But I remember it was an unbelievably stimulating discussion and obviously the work of the center has been so vital for the history of bioethics. So very pleased to participate today. So the good news and bad news. The good news is this is a brand new talk. The bad news is this is a brand new talk. So if you hear me give another one of my talks, it's very polished and has been done many, many times. You'd probably like it, but you guys hear me okay? Yes, can everybody mute? Yes, I think that was a muting issue. Okay. So I was just saying that I did practice the talk, don't worry, but I have no idea how long it really going to be. So I'm going to keep an eye on the clock and try to make it about 45 minutes so we have time for questions and hopefully it raises some interesting and relevant issues. And Elena is going to be advancing the slides because we had a little technical difficulty. So when we have not rehearsed that, but I'm sure it's going to go fine. So I'll just say next slide for when we're going to go ahead. So let's do the next slide. Whoops, that's it. So I'm giving a little outline of the talk. So I'm going to start out and this is obviously as you can tell from the title is going to be talk about both history and ethics. And I'm going to start out with a little discussion of what we historians talk about as presentism. I'm going to tell you a little bit about the history of this within the world of the history of medicine. And then I'm going to go through four cases of recent examples of famous renowned people in medical history whose lives and work have recently been questioned because of other things they did during their careers. And then at the end I'm going to give some caveats and conclusions. So I just wanted to give you sort of a general direction of where I'm headed today. Next slide. Okay, presentism. So this will be a concept known to many of you, but I'll give you one definition. The uncritical adherence to present-day attitudes, especially the tendency to interpret past events in terms of modern values and concepts. I think someone has to mute again. Because the doctors here all suck. Okay. All right. So, okay, so presentism is a huge, I mean I wrote here a huge no-no. When I was a graduate student in history, this was pounded into our heads. What historians do is historicize. We look back in time and we try to understand what was going on in a specific era, what the issues were, what the questions were, and what choices were made. What was thoroughly criticized was presentism. Another way, another term that people will use as being a historical. But taking our modern perspective, looking back and suggesting that people should have behaved in the way we would expect them to behave now. So this is, again, a concept known to many of you. So that's what I'm going to be playing around with today. Now, as you know, I'm going to talk about four people in medicine, but this has been a topic very recently throughout society. The current trend to judge the past due to current issues. And historic, you know, and I'll mention this later, but things like Confederate soldiers and removing of statues, we're going to come to that. But medicine provides a pretty interesting case study of this, in part because so much of medical history has had to do with worshiping medical heroes. So now when we confront complicated issues about their past, we need to try to understand what to do about our previous understandings of these historical figures and how we should understand them now. I want to give a caveat. This talk is not meant to exonerate or apologize for historical figures who've done things wrong. I'm not going into the past and saying everything's okay because this was a different time and place. So I'm going to come back to that concept in a minute. I'm trying to get us to understand historical context. I'm trying to do what historians do. And I, as I was told also in graduate school, history is messy. So I hope this is a messy talk, even though messy may not be such a good idea these days. Okay, next slide. Okay. So, and this is a little bit about what I was saying before. Statue removing founding fathers, there's just in the newspapers in New York just yesterday that they're removing a statue of Thomas Jefferson from City Hall in New York. It's been there like since 1845. Same type of issue. Just Jefferson a slave holder. Should this be there? Should it not? And as I suggested, it may be risky to historicize unless you do it carefully, but we're seeking in this talk to explain and not exonerate. Okay. Why is history of medicine such a good place to start? Next slide. Because history of medicine has been dealing with this for a long time. And a lot of this began in the questioning of this in the 1970s, but what you need to understand first is the way history of medicine was written for many years. Most historians of medicine early on were not historians at all. They were amateur historians. They were often doctors who decided to write historical accounts of what happened in medicine. Their careers and the people they knew and often their mentors. So medical history for hundreds of years was hagi graphic. There's a perfect example is a famous book about William Osler. I'm going to talk about Osler later written by Harvey Cushing, right? So Osler, the great internist at Johns Hopkins, Cushing one of his students, residents, later becomes a very famous doctor himself writes this enormous biography of Osler. That's history. This is what Osler did. This is what Osler thought. This is where Osler was born. And almost always, this is why Osler was a great man and needs to be remembered. This was history. But in the 1970s, a challenge was issued. And this was occurring throughout the medical throughout the historical profession, what we call social history. Looking at historical figures, what was also called great man history was being challenged throughout history and medicine was no different. A big problem with of this was that all you learned about history was about famous doctors who are almost always white being written about by other doctors who are almost always white. So history was this very near history of medicine was this very narrow area. Social historians come in. This is a very famous book for all of us in the world of history of medicine, edited by Susan reverby and David Rosner. I'll show a picture of Susan reverby later because she's going to be giving a talk in this series. This next week. Okay, good. This is product product placement by me. Okay, so she's the best come to her talk. So this book challenged traditional great man history and said we need to understand to understand the real history of medicine you need to look deeper than this. Okay, I don't have a slide of this. So the challenge was who what what are the ways can you understand this history. And it had to do with looking at other people besides white doctors. For one thing, white doctors were often at times racist. They were sexist. They were classes. We know this about that's part of why the profession of medicine was so white and so male for so long. Also this work looked at what we might call the misdeeds of some of these doctors, things they did that actually weren't so good that might not appear in these hagiographic works. And what about nurses? What about other people who worked in hospitals and clinics? And what about patients almost invisible in all the works of medical history until whoever be in Rosner and their other social historian colleagues call the world of history of medicine to task. Now this is a little bit different than what's going on now. It really you know to use a term that's not such an even a good term necessarily so much more canceling doctors what we're going to be talking about in this talk. That really wasn't the goal of early social history. The goal of early social history was to broaden how we understood history and to understand what else was going on and who else what other voices were being stifled. But this challenge is important because to some degree history of medicine has been struggling with this issue ever since. Who are the proper voices to be telling the story of history of medicine and how should it be told? Okay. So now I want to go to my four case studies one at a time. So next slide. Okay. See I did have another slide there. Sorry. Okay. This is when you don't advance your own sites. So let's just look at this. I've said most of this otherwise I did think I had a slide. That's Susan Reverby with a very nice scarf. And this is just some of what I said before so you guys could read it. Other people were being pushed aside. Great doctor history obscured abuses in medicine and these are the other historical figures who are being not seen. Next slide. Okay. So now we're going to come to our four my four case studies and I'm going to say roughly whoops my I just lost my screen one second. So I have to put my passcode back in. Sorry. So we can talk about this during the question and answer because I think it's tricky but I'm going to argue that my four case studies go from most objectionable behaviors to somewhat less objectionable behaviors. And one of the challenges I think is drawing the line. And that's never going to be easy or definitive. But I think it's useful to try to make some distinctions about historical figures as we look back. So this story by this point is going to be pretty well known to a lot of you I think. But I think it's a useful one to talk about. J. Marion Sims also known as the father of modern gynecology and many of you know this story how he did operations in the 1840s to try to fix this very difficult condition that afflicted certain women that's a go vaginal fistula often occurring after childbirth where basically there would be a pathway from the bladder to the vagina and women unfortunately as a result would be incontinent of urine. So a very difficult situation for women and doctors like Sims took an interest in it. What Sims decided to do he was in the south he was from Alabama. He decided to try out a procedure to try to fix this and it's a very long story and again many of you know it. But basically he eventually discovered if you use a certain kind of silk suture and did an operation you could close the fistula and cure these women. This occurred in the 1840s who were his patients. They were by and large slaves. They were slaves who had this condition. They were slaves he obtained for his operations because it was the south and these women had no control over their own destiny or their own bodies so they were black women who underwent this operation and we're going to talk about them in a moment. But let's talk about the heroism of Sims first. He was lauded for doing this procedure this curative procedure this difficult condition and later moved to New York City where he founded a women's hospital in New York City in 1855. Were there women's hospitals in New York City before that? Absolutely not. So Sims is seen as someone who's doing good things for women. He has a whole institution devoted to women's health issues. Helps him get that title of father of modern gynecology. In the early 20th century one of many statues of Sims is constructed. There's some in the south. There's some in New York City because he's a famous doctor. And the one that has gotten a lot of press was not originally in Central Park but was moved to Central Park in 1934 right across the way from the New York Academy of Medicine for those of you who know New York and Fifth Avenue. So Sims if you read medical history up until that era of social history that I told you about was a hero. Father of modern gynecology statues did all these great things. Next slide. So let's talk about these experiments. This is again the one this is a painting in the hagiographic era of the great Sims at the right with one of the slave women. We know three of their names Anarka Betsy and Lucy. There were many others. We don't know their names. This I think is believed by some to be an image of Anarka. And you know here's the great Dr. Sims about to do surgery on her and the two other slave women in the back probably about to get surgery also looking. So it's a very you know you could talk about this photo this image forever as a historical document but I show it because it's the one image that people try to use from that era. But what we know is it wasn't this peaceful by any means and maybe what's going on behind the curtain there suggests that. There was no anesthesia using these surgeries. You can only imagine what the pain must have been like to be having this type of surgery with no anesthesia and Anarka it is said may have had as many as 30 operations. Words used to describe this egregious horrific racist I could go on and on and on. These were slave women. The only reasons Sims could do this is because they were black women. They were slaves. They had no power to say no. And anesthesia existed by this time and Sims chose not to use it. And this is part of a long history of racism and medicine. Okay. Okay. So once this topic is starting to be discussed people start to say how can we continue to have this image of Sims. How can we square somebody who was seen as a hero with these horrific stories that begin to get discussed again more in the 80s and 90s. And by the way I was part of a group around 2020 years ago that's here's the statue that was in Central Park at the time about what to do about this statue. So that's when people in the neighborhood to their credit in Harlem started to say we don't want the statue here anymore because this man was a racist and he did horrible things. We don't really care that others think he's the father of gynecology. We want this removed. So this is where we start to encounter this great debate that I'll be talking about the rest of my talk. What do you do with a historical tribute to somebody like this? Is it ever okay to say times changed and we are now in a different era and it needs to go. We need it out of here. It no longer deserves to be seen in a public space because what he did was so horrific. Or is what I just said presentist. And I'll take you back to my graduate school in history where people would be, you know, what do we need to say about this? Is this a proper historical assessment? So indeed in 2000 when this began to be discussed one of the options that was discussed was putting some type of educational material by this sculpture and leaving it the same. And saying, talking about Sims as a racist, as a brutal surgeon who did these things and making it sort of a teachable moment and a plaque. Now eventually that was decided not to be adequate and it was decided that it was too horrific and the statue has now been moved to Greenwood Cemetery in Brooklyn where is by Sims's grave site. Next slide. Why was that decision made? The consensus was honor and this has been taken down the statue a few years ago. Honoring him was inappropriate. So we weren't erasing him by removing the statue. We were removing the honor of his place, him having a statue and of being in a prominent place. And it was a mistake in retrospect to have put up a statue to somebody like this in that place. And the reasoning again just to underscore whatever we were lauding him for accomplishing was fully immersed in racism. He was it was racism and thoughts and deeds and therefore any sort of honor to him was inappropriate. His victims were completely dehumanized. So to use my metaphor that I called this talk should people be caught? I don't think anybody thinks that sim should be caught. I think that removing this statue and any honor to him was appropriate. Okay next case study. Florence Nightingale. Okay so you know this story is probably not as well known because it's gotten a lot of discussion recently but not as publicly I think as the case with Sims. Okay so a little bit about Florence Nightingale and her initial historical iteration. An iconic figure in the history of nursing. The lady with the lamp. Here's a this is a typical painting of her. What did Florence Nightingale do? She was a nurse during the Crimean War and went out to the areas where the battles were being fought and made or helped make a very important discovery. Assumptions were soldiers who were dying were dying from war but what they were often dying from was disease or side effects of war like infections and other things that happened because they were injured or just diseases. Armed with this information Nightingale the traditional story goes was a hero. She came up with many types of innovations to save the lives of these soldiers. Hygiene, wound care, food preparation, ventilation. You know again we can't go into all this now. Many of you probably know some of this or have heard the version of this and she's a hero as a result and this is interesting reason she's a hero. One is she's a woman and a nurse too. Nurse and a woman. So I just got through telling you how too much of medical history was about the white doctors. So when medical history had the opportunity to actually honor a woman and a nurse it was a natural inclination to do that because here we were actually not being so narrow minded and how about a nurse who figured this sort of stuff out before the doctors did and a woman who figured it out before the men did. So she was lauded and these concepts were to some degree revolutionary and there's actually a new book which I'll put a plug in for by a great historian named Jim Downs who look at her as one of the first epidemiologists. Again we could maybe talk about that in the question answer but like to put in plugs. Okay so a lot of impressive work done by her. Okay and also she was criticized by male doctors at the time because no one wanted a woman or a nurse telling doctors what to do. That went on for a long time. So again she becomes a nursing hero and a feminist hero. Next slide. But and I'll put another plug in for a great blog Nursing Clio. This is one of many articles you can find there. This is particularly about Nightingale called The Racist Lady with a Lamp by an excellent historian Natalie Stake Dussett and I'll summarize some of what she has come up with. Nightingale if you look at her actual writings routinely use racist language and she was what critics have called a staunch supporter of British colonial violence. There was nothing in her writings at all that was anything but supportive of colonialism and the damage to colonial people and the disregard for colonial people that went along with empire building. And when indigenous people pushed back and people in colonies pushed back and were activists Nightingale was not a fan. She was critical of any actions that were rejected colonialism and telling the British what to do specifically about diseases. If you look at her writings there's no very little even though she's very interested in helping indigenous people with their diseases through her hygiene she blames them for their diseases because they are lazy they are unclean things like that they are more diseased. So this is a very different view of Nightingale than is being seen by the traditional history. Next slide. Okay so if you look at people from this era including activists victim blaming is extraordinarily common. You'd be very hard pressed to find activists from the 19th century or early 20th century who and we're going to talk about Margaret Sanger in a moment who use language that doesn't blame victims. So even as activists try to help people whether it's Nightingale or other activists they are dismissive they are critical they're often racist they are often classes they are progressive in some ways but not others. Okay so this brings us back to the topic of this talk which is historicizing. So what do we say about someone like Florence Nightingale who was doing good things for people she didn't much like or respect. Can we use language that says that looks back historically and says let's look at Florence Nightingale in the context of her historical time. There were not a lot of people in Britain who were advocating for the rights of colonial people. There were probably no one at her military hospitals who were doing so but Nightingale did good things for them even though her beliefs were in retrospect not very progressive. Is she somewhat less blame worthy? That is what you might posit if you're trying to historicize her. Okay next slide. Okay so perhaps you noticed how difficult it was for me to even say what I just said and I just had a moment which is sort of a little scary with somebody taking like two sentences of this lecture and posting them on YouTube please do not where it pretends like I'm agreeing with what I just said I am not but I'm just for purposes of being understanding history putting out that point of view because again in some sense that's what historians do they want you to look at the choices people made in their historical moment. So what about her choices and what about her historical moment? Okay so it's difficult and perilous to even raise this idea but I'm going to argue that good historians who contextualize and historicize never do so purely to exculpate they do so to understand okay what were Florence Nightingale's choices? What choices did she have and what choices did she make and ultimately while the era matters the behaviors matter as well the choices matter as well she didn't have to make those choices and indeed there were plenty of people in society maybe not around her and by no means a majority of society who were conceptualizing colonialism in different ways and a very nice quote from the article by Natalie that I mentioned before which I think is very helpful excusing racism of any type of excusing racism or any type of discrimination by claiming it as normal in a particular era is never okay. So I think that argument is the day next slide and for you again we're not going to be able to talk very much about Mary Seacole but an important point that comes across in all my case studies is that when you look at white heroes only you're excluding from the historical story often people of color who one might who were very active in a historical sense and did important things but because white people told all the stories about white people these people have often been invisible from the historic perspective and as some of you may know Mary Seacole was a woman from Jamaica black woman from Jamaica who is also a nurse in the okay I just lost my thing again from the from Jamaica who was also involved one second I put this back in who was also involved during the Crimean war as a nurse and actually had a dwelling where she took injured soldiers who was also very progressive and very innovative as far as taking care of soldiers who was forgotten to history until very recently so you when you focus on one group you exclude another so important not to do let's go on to Margaret Sanger next next slide okay this has gotten a lot of attention recently I'm going to argue that Sanger is even more complicated than certainly than Sims and probably Nightingale but people might challenge me on this but I again I think I'm trying to follow progression here of degree of behaviors so Sanger is as most all of you undoubtedly know was a legendary birth control advocate and feminist as well in the early 20th century in New York City she fought the Comstock laws passed in 1873 that made it illegal to transport birth control devices between states which basically meant it illegal to distribute or sell birth control devices a very restrictive set of laws that were it was basically in place across the country Sanger by dint of her being a nurse who worked initially on the lower east side of New York got very upset about the fact that so many of the families that she was tending to she was in a you know worked as out in the field would had so many children were so poor didn't have enough food or resources and the women kept getting pregnant over and over because they didn't have access or knowledge of birth control to her this was horrible one quote that you find many of these quotes I was resolved to do something to change the destiny of mothers whose miseries were as vast as the sky so what does Sanger do she establishes clinics in poorer neighborhoods in New York first on the lower east side but other places including Harlem that I'll mention in a moment and sets up these clinics and starts to talk to these women about birth control and the fact that they there are items available that she's going to try to get them on the sly or out in the open to help them not continue to have children and to limit their size and to be able to care for their existing children and families the Sanger saw this as a huge financial and emotional burden for these women husbands again I'm stereotyping here but to Sanger the husbands were somewhere between indifferent and hostile to women saying they didn't want to have any more children and women were not empowered to take control of their own bodies in their own lives so this is what Sanger did she set up clinics Sanger was arrested dozens of times because what she was doing was illegal according to the Comstock laws she was distributing information about birth control and birth control items next slide okay I want to mention the issue of race because we're going to talk about Margaret Sanger as possibly a racist in a minute among the places she set up her clinic was in Harlem Sanger didn't much care about where her clinics were and who they were serving but that women were poor and women's families were too large and something needed to be done about it great biography of Sanger pretty old now by Ellen Chesler and I use that I put that slide of Sanger at the bottom people are like oh this must be during the influenza pandemic you're wrong you're being prejudiced this is Sanger wearing a mask because she felt her voice was being stifled when she tried to talk about birth control so this was a acting device by Sanger as part of her activism work every child a wanted child that was her slogan and Sanger found what is now called Planned Parenthood in 1916 was had obviously had a different name at the time next slide okay but Sanger turns out to be complicated when you take a deeper dive into her work this hagiographic view of her as a woman as a feminist as a one of the first people that said women should take control of their bodies the founder of Planned Parenthood starts to be questioned this is one book I actually haven't read this book but I put it here but there's many articles about this why was Sanger criticized okay well eugenics which I don't have time to do a whole historical lesson on and again given this crowd you guys know about it but the belief in the early 20th century that many traits were genetic and passed from generation to generation was extremely strong at this time and I'll say more about that in a minute but the idea of eugenics was either positive or negative eugenics positive eugenics was that people with good genes i.e. white people white Anglo-Saxon people should procreate more and create a better race and people with bad genes should procreate less was very much in the air very common and I'll talk about how powerful it was in a moment that was the idea in that era and things like unfitness terms like feeble mindedness were seen to be genetic so if you had a family that was unfit or feeble minded they would pass that onto the next generation that was eugenics among the terms that Sanger used as you see was she was comfortable with saying that we needed to have elimination of the unfit she would call people who were poor and had bad genes human weeds so you can imagine that metaphor of like pulling out the weeds or something and here's a quote that's actually if you guys want to see a pretty jarring YouTube video I can give you the link in this video she says the greatest sin is having children with disease from their parents and who have no chance to be a human being pretty jarring and recently in the last couple years her name has been removed from the Planned Parenthood clinic she founded and it'll the Margaret Sanger award given out by Planned Parenthood okay next slide okay so this is gonna sound a little bit like Lawrence Nightingale but let's push on this again how could Margaret Sanger be so progressive in one way and not another okay now I'm gonna argue that that you know even asking that question is a little presentous but you can't not ask it because it's so interesting right and again why historians try to get people to look historically is to realize why questions like that may be loaded questions be given but it's a fair question here's someone who said women have no rights I'm empowering women but seemed blind when it came to the notion of empowering people who were perceived as unfit or feeble minded and not saying derisive things about them just the same way she didn't want people to say derisive things about poor women with big families okay let's historicize a little bit carefully um why was saying did Sanger do this okay well as I said you eugenics was mainstream and respected particularly in 1920s and 1930s the ideas that I just summarized briefly were taught at major universities harvard and other universities had eugenics departments you can again google the signs that say eugenics with university buildings and this was being taught as the best science of the day and there's a long list of famous historical figures Teddy Roosevelt Helen Keller WB Du Bois who were supportive to various degrees of eugenics so why did Sanger embrace this next slide she did this in what I would say when you look historically was very pragmatic Sanger was a zealot she had one thought in mind I want more birth control out there I want women to know they can have fewer children I want women who are poor women who have diseases to have fewer children I want them to think they have the option to have fewer children well who was saying this in society then well two groups the birth control people but they were all getting arrested if you spoke up too long and it was the sort of thing you couldn't talk about in public company Sanger was trying but it was shameful almost to talk about birth control so Sanger looked to another group in society was saying similar things to she was albeit in a different way and coming at it from a different historical and scientific perspective she said the eugenicists have similar thing concerns as I do they're interested in people who come from poor families and don't have enough money and maybe aren't that educated in having fewer children so I'm not uncomfortable with those ideas so you can see her with these quotes that I mentioned before not uncommon in her writings and on TV but I'm going to argue that she in her heart of hearts was less a eugenicist than a pragmatist and that's an interesting historical finding because I think it happens all the time if you look at the history of activists and we could talk about other examples and again this does not excuse but helps explain okay okay let's go to Osler and I he's our last one and then I'll we'll finish in about five ten minutes okay Osler is the the latest entrant to this group of famous historical figures in medicine who was famously venerated and now I was getting question okay again super duper fast one of the four founders of Johns Hopkins medical school unbelievable innovator in medical education put medical students on the wards a great humanist most doctors even well read doctors from that era don't write like Osler Osler has a gift for understanding medicine as a so almost as a social process I'm a doctor but I take care of patients they are people technology I'm not a technician I'm a person who sees patients and not disease again that's a terribly brief description of Osler but he's beloved because of that and with with great understanding if you read Osler's writings next slide here's a bio I mentioned earlier biography in Osler here's another one 1999 Michael Bliss some of you have probably read it bliss a great historian he he makes fun of this concept in the beginning of his book he's like I went to write it by R. U. Osler I know it's bad by 1999 to write hagi hagi graphic things it's looked down upon in medicine so I'm going hunting for things that Osler may have done that need to be questioned and he has this quote in the beginning of his book try as they might I could not find a cause to justify the death of Osler's reputation so he's like this guy was just wonderful and deserves to be law okay next slide but we might argue that bliss didn't look hard enough or as this is an original with me that maybe he looked and saw something that other people would have seen differently the topic we could get into if we want to well what's the problem that people writing about recently have with Osler he tolerated racial segregation on the words Johns Hopkins was a fully segregated institution and the black patients at Johns Hopkins got worse care than the white patients at Johns Hopkins didn't seem to bother Osler famous important doctor didn't do anything about it Osler here we are with eugenics again Osler was the vice president of an international eugenics conference in 1912 he didn't speak at the conference about eugenics but he's on the program talking about medicine and he's listed as a vice president there are several but not too many quotes by Osler in which he seems to favor white supremacy when he's asked in various contexts here's one of them we are bound to make our country a white man's country that had to with Canada um Osler was Canadian okay um so you start to see if you pluck and you dig things that Osler said that bliss seemed to miss or ignore that call into question this legacy and makes you wonder what was Osler a racist like we think Sanger was and stim certainly was and I can get what's next slide and here's again an article actually the original article came out of the Canadian Medical Association Journal glad to give people the link and this is an article written to the Montreal Gazette after that article came out that's by a doctor I'm logging myself back in again I just don't know how to not have this happen um written by a doctor uh in Montreal a pediatrician uh where Osler is beloved at McGill where it's the Osler library and she just savages him look at that celebrated physician played a part in creating medical culture that is dehumanized individuals and stigmatized entire communities that's the opposite of what bliss found okay so he is being actively actively questioned next slide but there's been a pushback here um there's a group called the American Osler Society that some of you know about that has been active for decades praising Osler that sort of does a more traditional history of medicine there's been an energetic rebuttal saying come on already using putting myself in their voice these critics you plucked out like a quote here and a appearance at a conference here where's look at the bulk of this man's pronouncements and accomplishments he didn't write about eugenics he didn't there's a couple of quotes he's they're taken out of context and now you're canceling Osler um this has to stop um and maybe using the metaphor of tough this talk maybe Osler should be caught okay so I have a couple of summary slides I know I'm going a little late okay so one caveat maybe I put this here partly because I some of the audience might have raised this and I did want to raise a very important issue should I be even giving this talk maybe there's more important things we should be talking about am I doing the same thing that others have been accused of which is although I'm being pointing out criticism of famous white historical figures and I'm giving them too much attention again what about forgotten minority doctors and nurses or other people in medicine actively excluded by these heroes rejected by these heroes uh evidently Florence Nightingale was critical of Mary Seacole and tried to downplay Mary Seacole's accomplishment shouldn't we just be talking about Mary Seacole and are we just talking about white uh people again I would argue this is a valuable uh lecture but I'm also thrilled at the crucial scholarship that is looking at the actual historical record of minority people uh who worked in this your medicine next slide okay so let's get some concluding things what do I really think here again three one book coming out in the left that's going to be great and two classic books on medicine and race that I just can't say enough about rana and dirge's books um some conclusions let's take criticism of white male historical figures in medicine seriously we're at a very important historical moment there's a reason that we're questioning the traditional historical scholarship activism like black lives matter and me too are active in this country now so it's not surprising that we're revisiting traditional historical stories in new ways I'm not saying that these people writing these works are just looking from our modern perspective and looking back and looking at history from our modern perspective they're not they're historicizing that's why these books are so good so it's okay to take criticism of historical figures uh as meaningful and important and and enjoy this new scholarship next slide another reason this is important it matters to our students this is the medical school class I will put on the record that I run the ethics curriculum at NYU for medical students and recently yes Peggy Harriet Washington's book too I'm not going to be chatting of course medical hard time thank you um that medical students um in my institution have been critical of some of our lectures and some of our small groups and have given us pretty uh intense feedback I welcome it these students care deeply about the history of medicine and the racist aspects of medicine they're not wholly criticism critical of medicine but they're asking those of us who do work in this field to be critical and to look at new perspectives that haven't perhaps been taught in medical school are these students always right I don't think so I think sometimes things get exaggerated and people are saying things that aren't so bad but this is a great opportunity for medicine to examine its past next slide two more slides and I'll be a little more provocative here I don't know the answer to this but what is all of this new questioning of the history of medicine and historical figures say about what I learned in graduate school in history presentism was the worst thing in the world well okay let's historicize that the people who said presentism is a careful point here people who are criticizing presentism you know when I was in graduate school or we're doing it now are themselves historical figures so they are choosing to criticize presentism as historical figures it doesn't mean they are necessarily right because they're saying it they believe they're right and they believe presentism is bad and leads to bad history but presentism itself deserves to be historicized and you could ask another provocative question it is applying modern understandings and language to historical figures and events always wrong now this is but potential slippery slope and people I imagine that in the comments will have lots of points if you understand the point I'm making but it's a question that needs to be asked because certainly people doing work now in the field are less uncomfortable applying things we know now not bad history but applying things we've learned and terms we use now in a historical context last slide okay and what about practically should we save these figures I'm talking about well as I think I've suggested that some behaviors and beliefs are irreparably terrible sims being an example I you know there's some who argue his statue shouldn't even be in the cemetery it should just not be anymore and that's a pretty reasonable argument I strongly support in general removing or eliminating honors for people who made bad historical choices when there were other options people like Margaret Sanger I have I support I have no problem with Sanger's name being removed from the clinic and the award it it's too inappropriate to give someone an award with a name that is associated with some of those quotes that I read now you hope that Planned Parenthood and other organizations continue to talk about Margaret Sanger and do it in a good historical way but awards not so much but at the same time I think we need to be careful of isolated statements that may be unrepresentative here I'm getting closer to Osler you know you could find if you look hard enough and if everything we ever emailed and any historical figure ever wrote or emailed could be obtained and gone through you're probably gonna find stuff that I'd be like somewhere between head scratching and like oh you know I don't think it's helpful to merely be doing that as sort of a gotcha sort of thing so I think we need to be careful and we need to be careful where we draw the lines and remember that none of us whether us in person now or historical figures is ever perfect so I will stop there and I think we have some time for a chat so hope that wasn't too discombobulated and sorry for the technical challenges thank you so much thank you Mindy are you there oh I'm absolutely there thank you Baron I knew you would give a provocative lecture and you identified four people who I think are really emblematic now I would love to have this conversation continue and want to hear what people say but one of the interesting things about some of the people that you mentioned was that the backstory as a clinician is very compelling and that's why I was so excited for you to speak because in of historians those people like Baron and people who live in a clinical world understand the back and forth and the specifics and one of the things about Margaret Sanger is her mother was Catholic and was pregnant 18 times because I had multiple kids and died very young on the other hand it's always challenging to me to you know to vindicate not vindicate but criticize people who lived in a time before things that we now take for granted you know I mean I was listening to the Lincoln Douglas debates and you can't even listen to them with modern because it's so painful and it's so antiquated you know what I mean and that was that was a political debate so I think that this is a great topic and I think it really only opens a lot of Pandora's box I'll just say you know what I'd like one other people to speak so I'll come back to those thoughts should I call people who's gonna Elena do you want to do it I mean I got Peggy and I steal good yeah go ahead Peggy yeah that was a fantastic talk thank you so much I have two two questions the first is just on the eugenics that you know I'm glad you pointed out that Helen Keller was spoken in favor of eugenics from a particular vantage point what difference does that make when it is somebody such as Helen Keller and what difference does it make related to that what difference does it make that you could one could argue that today we practice a different version of eugenics um through prenatal testing and through uh the exercise of of passive euthanasia um treatments of neonates such as anencephalic children um and then the second question is when you what about it you made me think about Moniz and Walter Freeman so this is the leucotomy lobotomy and you know what was what was sort of interesting about them is that they had really good motivations and then arguably particularly Freeman took it off the rails um and a person who to compare them to is Cooney who used to exhibit preemies um in the world's fair because it was the only way that he could treat them and he was beloved by his uh the parents of the babies that he treated um and yet the instant reaction that people have today to his actions is horror that he would exhibit these children if you actually read about what he did you could make an argument that he was far far humane than the physicians were at at the time so anyway those are poorly formulated questions I just thought I'd love to hear your thoughts well let me say a little bit we could talk about each one of those like for hours it's so interesting but you know I guess the way I would try to um understand those things is to get again get people to try to think historically so Helen Keller you know again there's a to plug another interesting historian I had to read in uh is a is a historian who's written about beliefs about eugenics among black populations in the 20s and 30s and there you say wait a minute how could black people have supported eugenics well that's what you that's you go read it how could Helen Keller have supported eugenics she was she was blind and deaf she was feeble minded according to eugenics how okay so you go back and you understand how people can have different thoughts in a different era can have different keep different seemingly contradictory from our modern perspective different thoughts in their minds what choices did people make and I think that's a good lesson for if we're looking at modern issues with for example prenatal testing okay well so that's a fair question and you know I think if you look historically and you say there's a history of eugenics how does our how did people make their choices then what bad choices were made what good choices made and to people who are doing prenatal testing now bring that knowledge to modern prenatal testing and even discuss it um and obviously consent helps these days which there wasn't any then and you know using our knowledge of history to help explain why we're still doing these tests the way they can stigmatize and try to get people who are being tested to understand this as best as possible um and what was it before the preemies you said who was the person you said before coonie yeah monies monies and freemen and yeah lobotomy so again a great another great example lobotomy won the Nobel Prize how could they have been so stupid to give lobotomy the Nobel Prize well jack pressman has a wonderful book on the that historicizes lobotomy the best science of the day okay freemen made bad historical choices freemen was a showman freemen was interested in publicity and freemen didn't have patients best wishes best interests at heart so freemen made bad choices he's a historical figure that deserves to be criticized but if you look at lobotomy more broadly it was a scientific attempt to understand that at that point incurable disease um so that's why history is so important uh a seal yeah thank you for this great talk um listening to the example of florins 19 gale i was just um disturbed because there was um there is a disney cartoon production called dr mcstuffings and the whole idea of it is trying to promote an african-american um little girl that she's a great doctor she treats her stuffed animals taken after the example of her mom who's a doctor and in one of the episodes that i watched with my children they're glorifying florins 19 gales so my question is um if this is part of history do historians uh and experts such as yourself um feel morally obligated to reach out to any um uh production to basically correct um the information that they are trying to put out there especially when this is just targeting young children um that's interesting um you know i wouldn't say correct because you know i i think we i think you know as a historian looking back that you have to be know your audience and be careful um i you know i mean disney you know it's i i mean they're doing something good there it sounds like if they're trying to empower young black girls to see what they can achieve um but but you know a well-placed email to the people who made the film and say hey there were great um great things that went on in this film but there's some new scholarship on florins nightingale um that you might want to know about and here's a copy of this article and you know maybe if you are ever thinking about redoing this film or putting a caveat in part of the film uh you might want to consider doing that because uh florins nightingale while lionized is not unproblematic so it's probably not a bad idea jay hi yeah thanks thanks for thanks for this talk um uh uh i'm a uh i'm a philosopher uh by trade uh so and we are uh currently undergoing this whole conversation in my field of you know where you know giants in our giants in our in you know in the history of philosophy manual con David Hume are all sort of undergoing very similar kinds of uh discussions and so one uh two sort of two sort of thoughts one one possibility here is uh drawing from some something that happens in say constitutional law we think about like severability where you know to what degree can we can we sort of okay this person has objectionable views about about about race about sex and gender to what degree do we can can we sort of can we sort of separate can we sort of you know separate the that sort of those those uh those problem views from their sure of what we take to be their sort of central insights um you know so for example does you know say like immanuel cons views about uh views about gender say actually in actually start to infect some other parts of uh of his of his uh of his contributions a second thought though is that you know there i think there's something important about you know teaching uh i i think there's perhaps something of uh kind of intellectual humility that is i think important in in presenting in presenting you know these past figures as like as as as complicated that we look back on and judge you know perhaps quite harshly to sort of extend to our to our medical students that you know just as these people as brilliant as they are as as moral as they were in many ways are capable of making egregious egregious errors um so you uh you know you are capable of that as well and you should be very mindful of that so so yeah so the separability possibility and also like how sort of this can actually use to uh encouraging intellectual humility in med students yeah i mean those two points go very well together because um you know on the one hand um the separability issue you know one answer to that is um what we think now is you can't separate them right what the activists say now separating them is wrong um and i guess personally i agree with that mostly but but it's a historical choice as well um people who are writing about this who are active in the field of history of medicine and other philosophy now are arguing this that it's not okay to still say margot tanger was cool and let's just put the other stuff to the side um but that's a in in 50 years is it possible that people are going to be like no it's okay to separate maybe and those people who are not separating them were narrow minded and wrong i guess it's possible i don't think that's going to happen because i think we're progressing in a way that is looking at historical figures in a very sophisticated way um but but it's important i think to to to keep that idea out there which segues into your second point about medical students that absolutely all students yes humility um what what you believe now what you're learning now people in 50 years are going to look back at this i don't know what it's going to be um but they're going to look back at things and be like what were they thinking um and it could be things that you feel very passionately about now because there's going to be more knowledge and it's going to be a different historical era so i i that's a great point and i i underscore that with with medical students all the time and and also uh and these are not original ideas to me but but people starting to write about this and trying to put that idea in the head of people give various examples so one that that that you've probably heard and the people are using is this okay 50 years from now um people will be saying i don't know 50 years that's just a made up number how did everybody have cell phones when they darn well knew that they were being manufactured in china and i'm getting this not exactly right by uh people who are being oppressed who weren't making any money and that's how everybody got their cell phones and they willingly use cell phones those people were terrible even if they were great people even if they were climate change activists but if they were doing this on their phones fact with their climate change activism they were oppressors by doing okay this is like a i don't know but it's it's one way to get students to engage that something they're sitting they're potentially criticizing historical figures and they're doing it for good reasons and they might think they're right but something sitting on their desk could be criticized in years to come so it's a very and you got you got to make that argument very carefully but it's very interesting um do we have time for more jake i think we have to finish by 230 thank you so much for this wonderful talk uh i uh briefly wanted to touch on one question that you brought up at the end of your lecture here about um should we be having this discussion or not which quickly i think we should i think it's a important discussion um but you raised something during that discussion um that i thought of when and you mentioned this book um this is the the new jim downs book maladies of empire which i highly recommend um how colonialism slavery and war transformed medicine he talks a lot about erasure how these groups have been written out of the history of medicine and um i just want to say that i think this is a great talk but i think that as you did when you touched on mary seagull this is a great opportunity to shed light on some of those voices that have been erased and so i'm curious if like mary seagull there are other individuals or groups um that could be brought in as examples of this other side of the coin that have been left out of the narrative that could be included as you said you know this is a new lecture right um as you kind of work on this and put it together is there a way that we could try to be more inclusive and shine a light on some of these groups that have been left out of that discussion yeah i yeah you know it would be sort of a longer talk and so but yeah i i mean the certainly the books that i flashed there very quickly by rana and dirja and then harry washington and you know so there's lots of very good history that has been written and is being written that's sort of resurrecting historical figures um and you know i think that's probably a good idea for another iteration of this talk is to actually include a little bit more and maybe try to give some examples of that history to make it more mine was sort of a theoretical i don't mean to say others are doing this work and i'm glad i don't know you know that i can focus on this but it might be a nice way to um actually demonstrate just what types of accomplishments in history was being has been forgotten i guess that's what you're saying although i'm also looking at your historical figures on your wall about trying to see what's up there okay um all right dr learner i just i can't stop without telling you that i was born at women's hospital um on 109th street on the west side of the city in sort of the south part of harlem in 1941 and that hospital i had no idea it was founded by marion sims in 1855 as you told us it was closed in 1964 when it was taken over by st luke's and roseville and integrated into st luke's and roseville so it doesn't exist anymore but but that it was the first women's hospital in new york city was it among the first in the country i think in the country country extraordinary um my mom and father uh thought the world of it yeah and uh but uh thank you for extraordinary talk