die." He was granted
permission to operate and described the procedure as such, "We went in to the room -
it was before the days of
anesthetics – and, pulling out a bistoury (scalpel), I plunged it into his belly. I think
it was one of the most happiest
moments of my life when I saw the matter flow and come welling up opposite the
bistoury." After days of continued
discharging, the man eventually made a full recovery. Such was the nature of Sims’ first
surgical experience as he
began to "practice" medicine.
Acting primarily as a plantation physician, Sims became known for operations on club feet,
cleft palates and
crossed eyes. He began to treat enslaved babies suffering from what he called
"trismus nascentium." Today, we
know this condition as neonatal tetanus. Tetanus originates in horse manure, and it is
probable that the proximity of
horse stables to slave quarters was the direct cause of the high rate of tetanus in
enslaved babies. In an article
published by Sims on the subject, he comes to quite another conclusion that offers us a
glimpse into his personal
bias. "Whenever there are poverty, and filth, and laziness, or where the intellectual
capacity is cramped, the moral
and social feelings blunted, there it will be oftener found. Wealth, a cultivated
intellect, a refined mind, an
affectionate heart, are comparatively exempt from the ravages of this unmercifully fatal
malady. But expose this
class to the same physical causes, and they become equal sufferers with the first."
Because he attributed the cause
of the disease to the moral weakness of the enslaved Africans, he never suggested the need
to improve their living
conditions.
Sims also attributed the condition in part to an accident at childbirth. He argued that
the movement of the skull
bones during a protracted birth lended to trismus. Clearly designating patients by class
and race, Sims began to
exercise his freedom to experiment on his captives. He took custody of suffering, enslaved
infants and with a
shoemaker’s awl, a pointed tool used for making holes in leather, tried to pry the bones
of their skulls into proper
alignment. According to his published articles, this procedure was only practiced on
enslaved African babies.
Because he "owned" these poor, innocent children, he had free access to the
bodies of the ones that died to use for
autopsies, which he usually performed immediately after death. Sims routinely blamed
"slave mothers and nurses
for infant suffering, especially through their ignorance."
Enslaved African midwives were undoubtedly numerous throughout the South. For hundreds of
years, childbirth
was not considered a "sickness" and for the most part, physicians did not attend
births. But in the mid-nineteenth
century, the attitude of the medical practitioners towards midwifery was changing.
Medicine was now challenging
female-governed childbirth. The early obstetricians excluded midwives from their research
and dismissed their
collective knowledge. The African midwive’s distinct tradition of spiritual rituals, usage
of herbs and knowledge
handed down orally across generations earned them an honored place within the enslaved
communities. Just as the
Southern physician was at the core of his social web, the midwife enjoyed the same social
status. This could have
fueled the white master’s need to remove them from positions of prominence. The old
persecution of midwives by
white males, reminiscent of witch hunts, was beginning to play out again on southern
plantations.
One spring afternoon in 1845, Sims was summoned to the Westcott plantation about a mile
out of Montgomery. A
young, enslaved woman named Anarcha, one of seventy-five enslaved Africans who lived
there, had been in labor
for three days without delivering. Sims tried to aid the birth by applying forceps to the
impacted head of the fetus.
He recalled having little experience using the instrument. The baby was born – no record
if it lived or died – and the
mother had sustained several vesico-vaginal fistulas, or vaginal tears, resulting in
incontinence. It is unclear as to
whether Sims inflicted the damage himself while using the unfamiliar forceps or whether it
occurred as a result of
the prolonged birth. Several days after Anarcha delivered, her master sent her to Sims in
hopes he could repair the
damage. He found her condition repugnant. Obliged to her master as her value as property
was diminished
considerably, he reluctantly began to attempt to repair Anarcha’s badly damaged body.
Under slavery, women were pivotal in its very definition. Slavery was perpetuated through
the status of the mother.
If she was a slave, not only was she enslaved for life, but so were her children. They
were frequently the objects of
aggressive sexual rapes from those who held power over them. The culture and economy of
slavery imposed the
role of "breeder" on these women and their ability to reproduce was equated with
their worth as property to the
masters. They never received enhanced diets or lower work loads for pregnancy and often
endured great hardships
during childbirth. Reasons for prolonged labor among African women were probably closely
related with their diet.
In a relatively high percentage of African Americans, dairy products not only fail to
yield calcium in digestion, but
also can cause sickness. Calcium deficiencies during childhood often resulted in rickets.
This condition wasn’t fatal,
however, it caused skeletal deformities, among them a contracted pelvis that would have
resulted in a prolonged
delivery. Not surprisingly, vesico-vaginal fistulas were prevalent among enslaved women.
Sims showed an uncommon willingness to break cultural barriers in his treatment of female
disorders. Most
physicians in the Victorian period shunned the impropriety of visually examining a woman
internally. They
generally relied on the use of touch as a more genteel method. Earlier in his career, Sims
treated a female patient
who had been thrown off a pony. He placed her on her hands and knees and fashioned a crude
tool from a pewter
spoon to expand the walls of the vagina. This spoon was the first prototype for the
speculum, called the Sims
speculum. The patient’s relief was immediate, since the change in air pressure
successfully relocated her uterus to
its proper position. Sims described the moment as if he had a spiritual epiphany. "I
cannot, nor is it needful for me
to describe, my emotions when the air rushed in and dilated the vagina to its greatest
capacity whereby its whole
surface was seen at one view, for the first time by any mortal man." His success with
this single procedure
convinced Sims he could find a surgical remedy for vesico-vaginal fistulas. Finally, he
could make a name for
himself.
Eager to devote the rest of his life to this condition, he built a crude hospital in his
backyard that had a capacity of
sixteen beds and fashioned over 71 surgical instruments. Sims sent for as many cases as he
could find. Plantation
owners were happy to turn over their slaves to Sims for experimentation. They were of
little use to their masters in
their present condition. Over the next three and a half years, between January 1846 and
June 1849, he
experimented surgically on as many as eleven patients at one time. Two enslaved women in
addition to Anarcha -
Betsy and Lucy – were also young women who contracted fistulas giving birth for the first
time. Together, these
three women endured repeated operations and were patients of Sims for the duration of the
hospital’s existence.
Anarcha is believed to have undergone over thirty operations.
Sims subscribed to a commonly held belief that Africans had a specific physiological
tolerance for pain, unknown by
whites. He never felt the need to anesthetize his black patients in Montgomery. The white
women who came to him
later, after the surgery was an accepted form of treatment, were unable to withstand the
same operation without
anesthesia according to Sims. While he never administered anesthesia during the
experiments, he did include
opium in his postoperative treatment. Opium kept the patients still, which aided the
healing process, and Sims
found the accompanying constipation a necessity in the aftermath of surgery. He also
emphasized giving the patient
minimal food and water for a two-week period.
In the first months of the original surgeries, Sims would invite his colleagues to witness
the operations. As the
number of operations grew and the failures mounted, Sims soon found himself operating
alone, relying on the
assistance of the hospitalized victims themselves. After a couple of years of repeated
surgeries and failures, his
wife’s brother, Dr. Rush Jones from the neighboring county of Lowndes, implored him to
stop his experiments.
"We have watched you, and sympathized with you; but your friends here have seen that
of late you are doing too
much work, and that you are breaking down. And, besides, I must tell you frankly that with
your young and growing
family, it is unjust to them to continue in this way, and carry on this series of
experiments." Sims replied, "I am
going on.. to the end. It matters not what it costs, if it costs me my life." To
those close to Sims, it appeared his
preoccupation was becoming an obsession.
Sims had been suturing the vaginal tears with materials common to that era, mostly silk
and catgut, which absorbed
bodily fluid. This caused inflammation around the wounds, promoting horrible infections
that would never heal. Sims
had his jeweler fashion some fine silver wire for suturing wounds. He used it on one of
Anarcha’s fistulas at the
base of her bladder. Days later, when Sims found no infection, he declared that silver
sutures were the key to
mending vesico-vaginal fistulas. He quickly utilized the sutures on all of his captives
and claimed to have cured
them all, but there is no outside evidence to support his claim. He declared, "I had
made, perhaps, one of the most
important discoveries of the age for the relief of suffering humanity." Sims never
recorded if he was able to heal
Anarcha of her other fistulas and to this day, physicians debate the type of suture to use
in the operation, although
the condition is rarely seen anymore. Sims’ level of "success" remains ambiguous
by all medical accounts.
In the fall of 1849, Sims was stricken with an intestinal illness and spent several years
moving from place to place
in search of relief. In 1853, he moved to the cooler climate of New York. While Sims
maintained a strong
commitment to the morality of owning slaves and held a strong allegiance to the South, he
began to revise and
moderate his tone for the different political climate he found on Madison Avenue. Sims
evaded the issue of slavery
and race and never admitted publicly that he experimented on patients who did not own
their own bodies. In his use
of woodcuts that accompanied his lectures, he portrayed his earlier patients as white
women. Now that he chose to
practice among white women of the upper and middle classes, he stated of his surgeries,
"I though only of relieving
the loveliest of all God’s creation." It seems he’d forgotten his distaste for
Anarcha, Betsy and Lucy and all of the
other enslaved women he had mutilated and/or killed.
J. Marion Sims went on to convince a group of philanthropic women of the old New York’s
elite class that his
motives were sincere and his methods proven. He garnered enough enthusiasm and financial
support to set up a
woman’s charity hospital in May of 1855. Sims was once again in business to perform his
operations, this time, on
poor Irish immigrant women. He traveled extensively to Europe and enjoyed the reputation
of being a famous
American doctor. While abroad in 1863, he was asked to examine Empress Eugenie of France.
This is how the
inscription came to read, "treating alike empress and slave," although he
employed very different methods of
treatment depending on the patient’s social status. He faithfully sent money to support
the confederacy, but never
returned to the south. He died in New York in 1883.
The success of J. Marion Sims as "the father of gynecology" in the United States
rested solely on the personal
sacrifices of the enslaved African women he experimented on from 1845 to 1849. Had they
not been his property,
giving him carte blanche to cut them open and sew them back up as he saw fit, he could
have never devised the
surgical technique that brought him international recognition. He never expressed any
interest in the cause of
vesico-vaginal fistulas or in the health of the women themselves. Nor did he concern
himself with the extent of
recovery made by the patients. And never did he express moral uncertainty because he had
kept several women
captive for the expressed purpose of painful surgical experimentation. Undeniably,
nineteenth century medical
practices were crude and painful, but Sims’ contemporaries felt he was unnecessarily
cruel. Other physicians of that
unfortunate era experimented on the enslaved, but among them, James Marion Sims was one of
the worst.
Since it was illegal for enslaved Africans to read or write, an offense punishable by
death, Anarcha, Betsy and Lucy
left no account of their ordeal. We can only imagine what they endured at the hands of
Sims and what horror an
enslaved woman must have felt at the news that she was being sent to him for treatment.
Surely rumors must have
run rampant among enslaved communities about what he did to women there. All over South
Carolina, Sims has
been honored and memorialized with statues and plaques. Buildings, hospitals, schools and
streets bare his name.
While it is impossible to negate the historical context of his racial, class and gender
biases, shouldn’t we agree to
apply some standard of humanity to those we choose to honor?
Wendy Brinker is an activist and artist in Columbia, South Carolina. She
co-hosts talk radio’s The Seed Show,
www.seedshow.com, with attorney Tom
Turnipseed. She wishes to thank Tom Pickett for his research assistance.
Online Source: http://www.coax.net/people/lwf/jm_sims.htm