Greetings, fellow historio-medico aficionados, and welcome to another installment of , our semi-regular series on unusual and thought-provoking subjects in medical history. This month, we are continuing to look back at the contributions of people of color to the history of medicine. We are also shedding more light on the ways medicine has sometimes come at the expense of exploiting marginalized communities and reinforcing or perpetuating racial prejudices. In the past, we have examined accomplished 18th century African American physician ; the , where inmates of Philadelphia's Holmesburg prison were part of a controversial series of dermatological experiments conducted by College of Physicians Fellow Albert Kligman; and , an African American women whose clinically immortal cells, which physicians harvested without her knowledge or consent, went on to make significant contributions to medical and scientific knowledge.
This month's installment also examines the ethics of medical research done at the expense of marginalized and disempowered communities. Contributor Amanda McCall examines the work of J. Marion Sims and the contributions of enslaved women to modern gynecology.
Do the positive contributions a person makes to a field of study negate any harm inflicted on the journey to that point? Can the people who have been taken advantage of be brushed to the side just because whatever knowledge was gleaned at their expense is seen as benefitting the greater good? These are questions that need to be asked when discussing James Marion Sims and his unofficial title of the “father of modern gynecology.” Sims perfected tools and surgical methods that would go on to aid an entire field of medicine and save countless lives, but at what cost? What is the bigger story behind these discoveries?
James Marion Sims was born in 1813, and went on to study at Jefferson Medical College in Philadelphia, Pennsylvania. At the time, medical training was of a shorter duration than what we could consider normal today, lasting only around a year and three months. After he completed his training, Sims eventually settled in Montgomery, Alabama, and began acting as the physician on call for the surrounding plantations. During his time in Montgomery, Sims was asked to help an enslaved woman who had fallen from a horse and was suffering from back and abdominal pain. Upon his initial examination, Sims decided he needed to see into the patient's vagina in order to properly diagnose her. After placing the patient on all fours, Sims examined her using a bent spoon to help him better see inside her vagina. This led him to invent the precursor to the modern speculum and diagnose the patient with a vesicovaginal fistulae, a tear in the lining between the vagina and the bladder. With this discovery, Sims dedicated himself to the underdeveloped fields of gynecology and obstetrics, and search for a surgical cure for vesicovaginal fistulae. From 1845 to 1849, Sims attempted to solve the problem of vesicovaginal fistulae using approximately twelve enslaved women that had been “loaned” to him by their enslavers.
These women, only three of whom have surviving record of their names, developed a vesicovaginal fistulae (VVF) after suffering through particularly traumatic birthing experiences. It is likely that Betsy, Lucy, and Anarcha all wanted their VVF repaired. It was a painful, unpleasant medical condition that allowed urine (and feces in the case of rectovaginal fistulae) to leak out of the vagina. Infection is common, as are very unpleasant odors. Vesicovaginal fistulae commonly caused women to be ostracized from their communities due to the hygienic issues it creates. The enslavers also had motivation to have VVF healed. Affected enslaved women weren’t able to birth more children, and they were less productive in the fields and home because of their condition, thus making them less profitable for their owners. In order to more easily treat his patients, Sims built a small hospital at the back of his property.
During the four years Sims spent perfecting his surgical technique to repair VVF, he subjected these enslaved women to numerous experimental surgeries, each with minimal healing time between them, according to Sims’ journals. Sims operated on Anarcha thirty times before declaring her healed. Repairing the VVF was challenging, and it took Sims many, many attempts to achieve his goal. He operated on these women while they were naked and bent forward on their knees and elbows, a pose known today as a Sims position. The use of anesthesia was in its infancy when Sims began his VVF surgical experimentation, and despite the fact that the efficacy of anesthesia was beginning to emerge in medical circles of the time, Sims never administered any during these surgeries. In his notes he reported that the pain the women experienced was not great enough to justify the trouble or risk despite recording that Lucy’s pain was visibly immense during one of her surgeries.
James Marion Sims’ search for a surgical cure for vesicovaginal fistulae is well documented in the journals he kept while he was practicing in his backyard hospital. But that is just one side to the story, and the only account we have of the enslaved women's stories is the one Sims gives us. Sims reported that the women “clamored” for the surgery and willingly submitted to the repeated procedures. While there is no doubt that this is an issue the affected women would want fixed, did they ever have an opportunity to say no? As enslaved women, did they have any say in the frequency of the surgeries or how their body was regarded during the procedure? They were operated on naked, in a vulnerable position, often with multiple other physicians observing. During this time in medical history the common belief was that African American patients did not feel as much pain as white patients did, and, according to Sims’ journals, he felt the same way. Reportedly, Sims favored quick surgeries to lessen blood loss, and that was one reason he preferred not to use anesthesia even after it was introduced. But how much did Sims’ opinions on his enslaved patients pain tolerance influence how he treated them during his experimental procedures? Sims needed these enslaved women for many reasons, but their contributions to his discoveries are not held in the same regard as his. Not only were they the subjects of Sims’ surgeries, they also stepped in to act as nurses and surgical assistants after Sims’ white colleagues left. They were trained in a respected career that required specialized knowledge but were only able to benefit from this in a very limited way.
James Marion Sims did contribute a great deal to the progression of gynecology and obstetrics. He saw an opportunity to create a name for himself in a field many physicians thought beneath them at the time, but the women whose bodies he built this knowledge on are mostly forgotten to time. Lucy, Anarcha, Betsy, and the other unnamed enslaved women gave so much to further the medical field, yet no first-person account of their stories or voices exist. If Sims is considered the father of modern gynecology, should they not be considered the mothers of modern gynecology? Sims may deserve recognition for the advancements he made possible, but the sacrifices and bravery of his enslaved patients deserve it as well.
Sources:
Cooper Owens, Deirdre. . Athens, GA: University of Georgia Press, 2017.
Deirdre Cooper Owens. August 14, 2017. Accessed September 22, 2020.
Holland, Brynn. History. December 4, 2018. Accessed September 22, 2020.
Wall, L.L. Journal of Medical Ethics 32. No. 6. June 2006: 346-350.
Thanks, Amanda, for your insights. If you want to read more articles by Amanda, please check out her aforementioned as well as her work on .
Until next time, catch you on the strange side!