November 28, 2020

Their names—at least the ones we know—were Lucy, Anarcha, and Betsey. There were other women, but their identities have been forgotten.

The man whose name appears in medical textbooks, whose likeness is memorialized in statues, is J. Marion Sims. Celebrated as the “father of modern gynecology,” Sims practiced the surgical techniques that made him famous on enslaved women: Lucy, Anarcha, Betsey, and the unknown others.

He performed 30 surgeries on Anarcha alone, all without anesthesia.

The first one he operated on was 18-year-old Lucy, who had given birth a few months prior and hadn’t been able to control her bladder since. During the procedure, patients were completely naked and asked to perch on their knees and bend forward onto their elbows so their heads rested on their hands.

Lucy endured an hour-long surgery, screaming and crying out in pain, as nearly a dozen other doctors watched. As Sims later wrote, “Lucy’s agony was extreme.”

She became extremely ill due to his controversial use of a sponge to drain the urine away from the bladder, which led her to contract blood poisoning. “I thought she was going to die…it took Lucy two or three months to recover entirely from the effects of the operation,” he wrote.

For a long time, Sims’s fistula surgeries were not successful. After 30 operations on one woman, a 17-year-old enslaved woman named Anarcha who had had a very traumatic labor and delivery, he finally “perfected” his method—after four years of experimentation.

Afterward, he began to practice on white women, using anesthesia. 

If the patients’ masters provided clothing and paid taxes, Sims effectively took ownership of the women until their treatment was completed. He later reflected in his autobiography The Story of My Life on the advantages he found to working on people that were essentially his property: “There was never a time that I could not, at any day, have had a subject for operation.” According to Sims, this was the most “memorable time” of his life.

While some doctors didn’t trust anesthesia, Sims’s decision to not use it—or any other numbing technique—was based on his misguided belief that Black people didn’t experience pain like white people did. It’s a notion that persists today, according to a study conducted at the University of Virginia, and published in the April 4, 2016 Proceedings of the National Academy of Sciences.

Writer and medical ethicist Harriet Washington says Sims’s racist beliefs affected more than his gynecological experiments. Before and after his gynecological experiments, he also tested surgical treatments on enslaved Black children in an effort to treat “trismus nascentium” (neonatal tetanus)—with little to no success.

Sims also believed that enslaved people were less intelligent than white people, and thought it was because their skulls grew too quickly around their brain. He would operate on enslaved children using a shoemaker’s tool to pry their bones apart and loosen their skulls. 

He also invented the modern speculum, and the Sims’s position for vaginal exams, both of which he first used on these women.

That Sims achieved all this has long won him acclaim; how he achieved all this—by experimenting on enslaved women—started being included in his story much more recently. And recently, in the face of growing controversy, New York City moved a statue honoring him out of Central Park.

The move came after decades of concerted effort by historians, scholars, and activists to reexamine Sims’s legacy. Medical professionals, especially gynecologists, have not always taken kindly to criticism from outsiders. Sims was one of their own. To implicate him, his defenders implied, is to implicate medicine in mid-19th century America.

Medical textbooks, however, were slow to mention the controversy over Sims’s legacy. A 2011 study found that they continued to celebrate Sims’s achievement, often uncritically. “In contrast to the vigorous debate of Sims’s legacy in historical texts and even in the popular press, medical textbooks and journals have largely remained static in their portrayal of Sims as surgical innovator,” the authors wrote.

In recent years, one of the most prominent defenders of Sims’s legacy has been Lewis Wall, a surgeon and an anthropologist at Washington University in St. Louis. Wall has traveled to Africa to perform the vesicovaginal fistula surgery that Sims pioneered, and he has seen firsthand what a difference it makes in women’s lives. “Sims’s modern critics have discounted the enormous suffering experienced by fistula victims,” he wrote in a 2006 paper. “The evidence suggests that Sims’s original patients were willing participants in his surgical attempts to cure their affliction—a condition for which no other viable therapy existed at that time.”

Wall also defended Sims on the charge that he refused to give anesthesia only to black patients.

Anesthesia was not yet widespread in 1845, and physicians who trained without anesthesia sometimes preferred their patients to be awake.

There is debate over whether Sims’s specific surgical practices were unusually gruesome for his time. But his practice of operating on enslaved women was certainly not unusual. He wrote about it openly. It is this ordinariness that is noteworthy.

Sims was able to advance so quickly, argues Deirdre Cooper Owens, a historian at Queens College, City University of New York, in her book, Medical Bondage, because he had access to bodies—first enslaved women in the south, and later also poor Irish women when he moved to New York. “These institutions that existed in this country, which allowed easy access to enslaved women’s bodies [and] poor women’s bodies, allowed certain branches of professional medicine to advance and grow and to also become legitimate,” she says. The history of medicine has often been written as the history of great men. Owens wants to turn the focus from the doctors hailed as heroes to the forgotten patients.

This first part—taking the focus away from Sims—is happening. In 2006, the University of Alabama at Birmingham removed a painting that depicted Sims as one of the “Medical Giants of Alabama.” In February, the Medical University of South Carolina quietly renamed the endowed chair honoring J. Marion Sims—the one announced by Hester after the publication of The Horrors of the Half-Known. The minutes of the board of trustees meeting where it happened did not even mention Sims’s name—just the new name of the endowed chair. “The decision was made in recognition of the controversial and polarizing nature of this historical figure despite his contributions to the medical field,” a MUSC spokesperson confirmed in an email to The Atlantic.

The J. Marion Sims statue that stood in Central Park is being relocated to Green-Wood Cemetery in Brooklyn, where Sims is buried. There, the New York Times reports, the statue will be demoted to a lower pedestal and displayed with a sign explaining the statue’s history. There may be an opportunity, now, to use the statue to tell the full story—to tell the stories of Lucy, Anarcha, Betsey, and the other enslaved women and their place in the history of medicine.

Source: The Atlantic, Sarah Zhang, 28.04.2018; history.com

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