Monday, March 2, 2015

Civil War Gynecology: Scholars Argue Over Legacy of Surgeon Who Was Lionized, Then Vilified

By Barron H. Lerner, 10-28-03

One would be hard pressed to find a more controversial figure in the history of medicine than J. Marion Sims. Originally lionized as the ''father of gynecology,'' Sims was later reviled by a generation of critics as racist and sexist.

Today, as an operation introduced by Sims is bringing relief to thousands of women in the developing world, a few scholars are quietly hoping to rehabilitate his name. But it is not going to be easy.

Sims, who was born in South Carolina in 1813, was not destined for greatness. He was a lackluster student who showed little ambition after receiving his medical degree.

But he changed after a chance event in 1845. While evaluating a woman with a slipped, or prolapsed, uterus, Sims, then living in Alabama, had her kneel and place her chest close to her knees. This position not only moved the woman's uterus back into place, but it afforded him an excellent view of how childbirth had damaged her anatomy.

Sims used this insight to tackle a most dreaded complication of childbirth, usually caused by prolonged labor. With this disorder, known as the vesico-vaginal fistula, connections develop between a woman's bladder and vagina.

Afflicted women continually drip urine from their vaginas, producing, in the words of one 19th-century physician, ''a most intolerable stench.'' Even worse, fistulas sometimes develop between the bowels and the vagina.

By placing women in his new position, Sims reasoned, he could better visualize the damaged tissues and could surgically repair the fistulas. The logical women to test his theory, he believed, were slaves.

By all accounts, Sims, like a vast majority of his antebellum Southern white counterparts, was a strong proponent of slavery.

Thus, when Sims wanted fistula patients, he simply bought or rented the slaves from their owners.

Sims operated on at least 10 slave women from 1846 to 1849, perfecting his technique. It took dozens of operations before he finally reported success, having used special silver sutures to close the fistulas. Three of the slaves -- Lucy, Anarcha and Betsy -- all underwent multiple procedures without anesthesia, which had recently become available. Sims's records show that he operated on Anarcha 30 times.

Sims's persistence aroused some alarm, and several physicians urged him to stop experimenting. In response, he later reported that the slave women had been ''clamorous'' for the operation and had even assisted him with surgery.

Sims's contemporaries and early biographers heralded his feat. His skillful experiments, according to his obituary in The New York Times in 1883, ''were of great advantage to members of his profession in the treatment of female diseases.'' An inscription near Sims's birthplace termed him ''a blessing and a benefactor to women.''

Statues of Sims were erected in South Carolina, Alabama and New York City, where in 1855 he opened the first hospital exclusively for women. The New York statue stands in Central Park at Fifth Avenue and 103rd Street.

One of Sims's modern legacies is the almost total absence of vesico-vaginal fistulas in the developed world, because of advances in childbirth and the operation he pioneered.

From this lofty perch, Sims had a long way to fall. And fall he did, beginning in the mid-1970's, as Americans dealt with the volatile issues of racial and sexual equality. Historians, many of them sympathetic to the civil rights and women's movements, saw an urgent need to revise Sims's history.

One of the first scholars to weigh in was Dr. Graham J. Barker-Benfield, then a historian at Trinity College in England, who argued that Sims had used slave women as guinea pigs to advance his career.

The women, Dr. Barker-Benfield wrote in 1974, had ''endured years of almost unimaginable agonies'' undergoing repeated surgery. Rather than being willing participants, the women had been powerless to refuse.

Writing in 1985, Diana E. Axelsen, a philosopher at Spelman College, described Sims's patients as ''victims of medical experimentation.'' Wendy Brinker, a South Carolina filmmaker, nicknamed Sims ''Father Butcher'' and asked why the state's monument to him still stood.

Underlying these pronouncements was the belief that Sims's early biographers had been guilty of ''presentism,'' evaluating past events based on their own values at the time. Living in an era that uncritically celebrated white male doctors, the historians contended, these writers had viewed Sims far too favorably.

More recently, a few scholars have been trying to revise this revisionist history. ''To deify or vilify Sims is not the answer,'' said Dr. Deborah Kuhn McGregor, a historian at the University of Illinois at Springfield. Dr. McGregor uses Sims's story in her book ''Sexual Surgery and the Origins of Gynecology'' to discuss the complex ways that race and sex influence medical practice.

One of Sims's strongest defenders these days would have to be Dr. L. Lewis Wall, a Washington University surgeon who believes that the scholars who pilloried Sims were guilty of the same presentism they had identified in others' work.

Dr. Wall has a special reason for coming to Sims's defense. He routinely travels to Africa to repair vesico-vaginal fistulas. Contending that the rest of the world has lost interest in the victims of this disorder, who may still number in the millions, he has founded the Worldwide Fund for Mothers Injured in Childbirth (

''These kinds of pathologies no longer exist here,'' Dr. Wall noted. But women with fistulas are ''absolutely miserable and absolutely outcasts, reeking of urine 24 hours a day,'' he said, noting that he can restore both the health and dignity of such women.

But does this justify what Sims did? Many do not think so. When Dr. Wall made a presentation on Sims at a recent meeting of the American Association for the History of Medicine, members of the audience challenged the idea that his admirable efforts as a surgeon gave him valid historical insights.

Ms. Brinker is not even sure that Sims's procedure worked, pointing out that his logs do not have follow-up data of his ''cured'' patients. ''It was all about his glory,'' she argues.

Probably the only way to definitively resolve the debates over Sims would be to hear the voices of the slave women who were his subjects. But aside from Sims's statements, their words have not been preserved.

At the very least, Dr. Wall suggests on his Web site, someone should build a statue to Lucy, Anarcha and Betsy.

The story of J. Marion Sims is a reminder of how history gets rewritten over time. The hope, of course, is that each new account gets closer to the truth.

Correction: November 7, 2003, Friday An article in Science Times on Oct. 28 about scholars' views of the medical contributions of a pioneer gynecologist, Dr. J. Marion Sims, misstated the affiliation of one historian and the dates of his writings on the subject. It was in his 1968 dissertation, when he was at the University of California at Los Angeles, not in 1974 and not while he was at Trinity College, that the historian, Dr. Graham J. Barker-Benfield, first wrote that Sims had used slaves as guinea pigs.

Image: Spéculum de Sims. J Marion Sims



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