Slave Women and the Birth of Gynecology
© Nicole Paschal, All Rights Reserved
If taking a stroll through New York’s Central Park, one might see the statue of Dr. James Marion Sims. Known as the “father of gynecology,” the monument was dedicated to Sims in 1894. Having lived from 1813-1883, Sims served as the president of the American Medical Association, helped to designated gynecology as a separate practice, invented the Sims' vaginal speculum, and opened a hospital for women. However, his greatest achievement and claim to fame was curing the problem of the vesico-vaginal fistula. However, controversy exists because he found his surgical cure, use of silver sutures and speculum from performing a number of trial and error procedures on slave women from 1845 to 1849. Since the mid- twentieth century, academia has debated whether Sims was an ingenuous doctor who furthered the progression of medical science for women or a 19th monster who conducted painful unethical experiments on women who couldn’t say “No.”
In his autobiography, “The Story of My Life,” Sims details multiple accounts where his experience with slaves was used to further his research. What Sims considers his first great discovery in medicine (226) refers to a slave infant on the plantation of Henry Stickney in 1845. The child had lock jaw, convulsions, and had bound his fist so tight that his little nails were nearly piercing his flesh. The child, which soon died, had what was called trismus nascentium. It was an affliction that attacked predominantly Black slave infants within their first 2 weeks of life. The children affected with the disease died traumatically and in a time where many thought Blacks to be an entirely different species, the medical community swarmed around such curious race-related phenomena. In reality, lack of medical care, overwork, malnutrition, and the filth and squalor of slave quarters lay behind the majority of slave afflictions.
After post-mortem examination on at least one slave infant, Sims believed the malady had something to do with pressure on the child’s brain. He wrote research papers how turning the child on its side rather than its back could cure the condition. We now know, however, that trismus nascentium was from the tetanus bacillus that infects children when unsanitary instruments are used to cut the umbilical cords. Apparently Sims' treatment was not adopted by the medical community, for he wrote, “My doctrines in respect to the pathology and treatment of trismus nascentium have not been adopted or accepted by the profession at large; but I am sure they are true” (225).
Slave Girl Experiments
After being a surgeon and family practitioner 10 years, Sims stated in his biography that he had no intent on treating diseases of women and would often refer such cases to another doctor (226). He happened upon his research through a case of a 17-year-old slave girl named Anarcha that had been in labor 72 hours. The girl’s master, on the third day, contacted Marion Sims. The death of the slave and the child would have been a major loss of profit. The child’s head was compacted in the pelvis during that time. Using forceps, he pulled the child out. Soon afterward Anarcha lost all ability to hold her urine and feces, making her not fit for work in the house or field. Sims deemed the case incurable, but soon after was contacted by another slave owner with the same problem and an 18-year-old slave named Betsy that had just given birth.
Although any woman could suffer from it, vesico-vaginal fistula problems were common amongst slave women and girls that had long, difficult births without proper medical care. So Sims read on the subject and soon after, a third slave master contacted him about an 18-year-old named Lucy with the same problem. After much convincing from her owner, Sims examined Lucy in the corner of his yard, an area for Black patients. Eventually, he believed he could cure the problem of the vesicovaginal fistula and wrote to the masters of Anarcha and Betsy, “If you will give me Anarcha and Betsy 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” (236).
It took 3 months for Sims to have his own experimental instruments made. Without anesthesia, Lucy was the first to bear the operation on her hands and knees while 12 visiting doctors watched Sims’ experimental procedure. According to Sims, her bladder had fallen, leaving an opening between the bladder and vagina approximately 2 inches in diameter. He referred to the operation as being on the “…eve of a great discovery…,” and said it was, “… tedious and difficult…” (237).
Sims made improvements on the instruments he constructed as he worked. Eventually, he inserted a piece of sponge inside the neck of Lucy’s bladder and sewed it up. Naturally, within days she developed what Sims referred to as “blood poisoning” (238), and became deathly ill. After 5 days, he cut open her sutures to remove the sponge, but it had hardened. Suffering from inflammation and infection, Sims wrote that he thought, “Lucy’s agony was extreme,” and “She was going to die.” (238). However, Lucy lived and Sims continued his experimentation. Regarding Lucy’s first experiment he wrote, “It inaugurated a series of experiments that were continued for a long time” (239).
Afterwards, Sims then moved on to the other women, Anarcha and Betsy, allowing Lucy time to heal in between surgeries. The process of experimentation continued for four years with the women solely under Sims’ care. “It would be tiresome for me to repeat in detail,” Sims wrote, “all the strategies of improvement in the operation that were necessary before it was perfect (241).
Sims as an unethical doctor and exploiter of Slave Women?
In 1993 Durrenda Ojanuga, Ph.D. wrote that the problem with Sims' experiments were that he used the institution of slavery to harbor human guinea pigs to perfect his procedures. Violating all concepts of human rights and medical ethics, the women were property subject to Sims' trial and error experiments. According to Ojanuga, such slave experimentation was not popular at the time. Rumors and whispers even began to circulate around town about the young doctor who kept experimental slaves. Other doctors would engage in experiments often using white patients with informed consent, according to Ojanuga. The slave women possessed no agency, no means to deny the upwards 30 operations endured for four years each. As property of their master, it was he who determined that they should be submitted to experimentation, not them.
Ojanuga writes that after the procedure was perfected, White women wanted the vesico- vaginal fistula operation as well. However, no White woman could endure the operation without anesthesia and it was only after use of anesthetics that Sims was able to do the surgery at the Women’s Hospital he later founded. Although it was commonly believed that Blacks did not feel the same pain as Whites, the truth was that the slave women, as human chattel, could not cease the operation like the White women. In a time when investigation of almost any malady involving the vagina was considered improper amongst White male doctors, slave women served as the means to further Euro-American medicine due to their subjugated status. Being powerless, they could only endure the extreme pain and embarrassment that was repeatedly administered. Sims experiments are “…a classic example of the evils of slavery,” wrote Ojanuga, “and the misuse of human subjects for medical research.”
Sims as innovator in Women’s Health?
A 2006 article by L.L. Wall in the Journal of Medical Ethics defends Sims. According to Wall, the vesico-vaginal fistula is part of a greater set of illness called the obstructed labor complex. In addition to the inability to control urination and (and possibly defecation as well) it could include neuromuscular damage, scarring, secondary infertility, self-esteem issues, severe depression and even suicide in women today. He contends that it is erroneous to assume that the slave women did not want to pursue the operations despite the pain. “ Given the choice between living the rest of their lives in this manner or of taking a chance-however remote- that Sims might be able to cure them, it is not surprising that these patients, even though they were enslaved, would have jumped at the opportunity to have surgery,” wrote Wall.
Wall also believes that Sims could not have carried out the operations without cooperation by the women. The slightest move, writes Wall, would have kept him from completing the procedures. Also, he notes that after so many surgeries, the local doctors and assistants failed to come and help Sims. Sims then trained the other slave women to help him during surgery. Wall uses this point to contradict Ojanuga’s view that the women had no consent. Another point Wall makes is that anesthesia was publicly demonstrated in Boston 1846, a year after Sims began his slave experiments. If Sims had used it on the slaves, notes Wall, it too would have been an experiment.
The Debate: Who do you agree with?
If you could have it you're way:
The Story of my Life, J. Marion Sims, 1884.
The medical ethics of Dr J Marion Sims: a fresh look at the historical record, LL Wall, Journal of Medical Ethics. 2006 June; 32(6): 346–350.
The medical ethics of the'Father of Gynaecology, D. J. Marion Sims, Durrenda Ojanuga, Journal of Medical Ethics 1993;19:28-31