As a medical student, I first came across the name of the American physician J Marion Sims in our gynaecology textbooks. We learnt that he designed the double-bladed vaginal speculum, the Sims speculum, while perfecting his surgical technique for repair of vesico-vaginal fistulae, the abnormal passage created between the bladder and the vagina as a result of trauma, a complication of obstructed labour, among other causes. The resultant constant leakage of urine via the vaginal route can be emotionally and socially devastating to the sufferer. We were taught how the Sims speculum offered a better exposure to the vaginal walls compared to the Cusco bivalve speculum, and therefore the Sims speculum is preferred for gynaecological surgeries.
In my residency years, of course, one had to learn even more about James Marion Sims (1813-1883), with step-by-step details of the repair of such fistulae, pioneered by him. We learnt that his experience was largely obtained from enslaved African-American women, because they were for some reason (negligence, anybody?) more prone to obstructed labour. Even with this knowledge, one still assumed that with his name in the textbooks, that he was presumably some sort of saviour figure, and all his efforts were motivated by wanting to alleviate the suffering of his ‘patients’.
But writer-historian Harriet A Washington’s 2006 book ‘Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present” blows the lid clean off the can of worms bearing Sims’ name. The revelation knocked the wind out of me; there would have been some lurking suspicion about the lack of ethics in medical ‘research’ upon a literally captive sample study in 1800s Alabama, but reading the gory details of the barbarous experiments of someone widely regarded as the ‘Father of Gynaecology’ was a numbing experience.
Sims needed living human guinea-pigs to test and improve his surgical technique, and Washington writes, he “knew that using white women to test such painful surgeries as might be effective against it was impossible.” But in the antebellum Deep South, he could experiment upon black women with impunity.
He “acquired” eleven women, many “borrowed” from their slave-owners after Sims agreed to pay for their upkeep. From 1845 to 1849, he experimented upon these unfortunate women in a shed in his backyard.
In his autobiography ‘Story of My Life’, Sims describes in meticulous detail his examination of and surgery upon black women he mentions by name: Betsey, Lucy and Anarcha.
In page 236, he writes: “I made this proposition to the owners of the negroes: If you will give me Anarcha and Betsey for experiment, I agree to perform no experiment or operation on either of them to endanger their lives, and will not charge a cent for keeping them, but you must pay their taxes and clothe them. I will keep them at my own expense.”
Matters such as privacy, modesty (each woman was stripped naked, and “mounted on the table, on her knees, with her head resting on the palms of her hands” when he examined them), and consent were not a consideration. The women had to be restrained by assistants and held down while he operated upon them without anaesthesia. True, the field of anaesthesia was not well-advanced at the time, but the use of ether was already known to Sims. But like many of his professional peers (white, of course), he believed that perception of the sensation of pain was linked to race and to class. Even a sympathetic biographer S Harris writes in ‘Women’s Surgeon: The Life Story of J Marion Sims’: “Sims’s (sic) experiments brought them physical pain, it is true, but they bore it with amazing patience and fortitude – a grim stoicism which may have been part of their racial endowment.” There was no scientific basis, however, for this belief.
Lest one tries to argue, as L L Wall has done in the paper ‘The medical ethics of Dr J Marion Sims: a fresh look at the historical record’ (Journal of Medical Ethics Jun; 32(6): 346-350) that “it is difficult to make fair assessments of the medical ethics of past practitioners from a distant vantage point in a society that has moved in a different direction, developed different values, and has wrestled—often unsuccessfully—with ethical issues of sex, race, gender, and class that were not perceived as problematic by those who lived during an earlier period of history”, one has to remember that practices of Sims were considered so barbarous even by his medical peers that they requested him to stop his ‘experiments’; others however praised his unorthodox methods. He then proceeded to defend his position, stating that the slave women were “clamorous” for his operation; that they “consented” and even assisted in his subsequent operations in holding down other patients. And this is the dominant narrative that has been passed down in the medical fraternity. Washington drily points out: “Slaves did not have to be recruited, persuaded and cajoled to endure pain and indignity; they could not refuse.”
But the tide against the ‘Father of Gynaecology’ is turning. In their 2013 paper ‘The Portrayal of J Marion Sims’ Controversial Surgical Legacy’, Spettel and White describe him as “a prime example of progress in the medical profession made at the expense of a vulnerable population.”
Earlier this month, Columbia Mayor Steve Benjamin told the media that two years after the state removed the Confederate battle flag from the statehouse, there are still monuments “on our Statehouse grounds that I find wholly offensive.” He was not, as one might think at first, referring to a statue of pro-slavery Confederate general Robert Lee, but to Sims. “The most offensive statue I find on our capitol wasn’t the (Confederate) soldier,” Benjamin said. “It was J Marion Sims. There’s a statue of him here. It should come down at some point.”
Quite literally a fallen idol then! How should the members of the profession react to his legacy, in the new light that has been shed on his dark past? Significant as his contributions to operative gynaecology may have been, to me at least, they are now tainted. It would be easy to argue that he gave the world the speculum that bears his name and countless lives were improved by his surgical techniques, but it is entirely plausible and logically inevitable that someone else, at a later date, in another part of the world perhaps, would have made these innovations, and not so controversially. If we continue to have J Marion Sims in gynaecology textbooks, the full history of his methods should be taught as well. Spettel and White conclude in their paper: “This question is not solely of historical importance, as we will always seek to improve our operative ability. The ethics of surgical innovation, education and experimentation are still relevant today. It behoves us as a profession to discuss, debate or at least include mention of Dr Sims’ controversial legacy in our literature.”