Civil War Life: A Letter to Her Husband, Benjamin Wells

From: edinborough.com

This letter was written by Melissa Hoisington Wells of Fabius, Michigan, to her husband. At the time, Benjamin was stationed near Nashville, Tennessee with the 11th Michigan, Company A.

Fabius
Sunday June 22nd 1862
Dearest Ben,

After a silence of three long weeks I again resume my pen to let you know that I am still in the land of the living although I am not enjoying the best of health at the present time. I do not know how long or how nicely written my letter will be for my hand trembles so that it is with difficulty that I can write but I will do the best I can, hoping that you will make all due allowances. No doubt you are feeling anxious to hear from me and I would have written before had I been well enough but likely you know the reason before now. I have received five letters from you since I wrote and I will answer them all as soon as I can the dates of them were May 23rd and 26th and 30th and June 5th and 10th. To tell the truth I hardly know what to say but I will try to think of enough to make out a letter if it is not as interesting as it might be. The rest of the folks are well as usual.

I have been quite sick for nearly three weeks but am on the gain now. I have not fully regained my strength yet but if nothing happens any more than I know of now, I think I shall soon be restored to good health again. Perhaps you would like to know some of the particulars concerning my sickness but to be frank about it, I am half ashamed to tell you anything about it. But I presume there is no one that feels any more anxious to know than you do and if you will not think that I am immodest I will tell you.

Fred wrote to you two weeks ago today and told you all the news. You have doubtless received the letter by this time however I hope you have not for I would have been much obliged to him if he had waited and given me a chance to write the particulars. I think it would been more suitable than for him to have done it. After he had written the letter, he brought it down and read it over to me before enclosing it. I did not feel very well pleased with all he wrote and I do not see what he meant by writing as he did. I should thought he would know that you would feel bad enough without his taking particular pains to hurt your feelings. Now I have not the least recollection of wishing any such thing on you as he stated to you in his letter.

It would been very ungenerous for me to wish you to suffer because I had to and I do not think that I said any such thing, although I was suffering such extreme pain that I might have said and done a great many things that I know nothing about now-- for I do not believe that I was conscious half the time of what was going on. As for Em, I cannot say much for her for you know as well as I do that she is very apt to say just what she thinks when she is angry but since I have been sick she has been very kind and attentive and willing to do all she possibly could for me, and I do not believe she really meant what she said-- at least she says she did not and I have every reason to believe what she says and I cannot help feeling out of patience with Fred for writing such a letter. He should never sent it-- had it been in my power to prevent it but I could not help myself. The letter was written and of course he would do as he pleased with it whether I liked it or not. I think it was very unfriendly of him but likely he thought it was all right so I thought I would do the next best thing as soon as I was able I would write to you and tell you how the thing was and have the matter made right if I possibly could. You must not feel hard nor mind anything about it for I certainly do not wish to hurt the feelings of the best friend I have and now don't feel bad nor care anything for what he said and I am sure you will not, now that you know how it is. I cannot blame you if you did feel hurt when you received his letter I think I would had I been in your place.

I had a long painful time in the beginning. I was sick over 48 hours and it seemed as if I never could live through it I was in such agony all the time from the time I was taken until I got through-- which was from Thursday night until Sunday morning. But it appears I did and am living yet and thank fortune I managed to get along without the help of a doctor and I think that is half of the battle and it is my most earnest wish that I may never be called to pass through another such a siege, although I little know what suffering there is yet in store for me. I can be content to live with but one child in all the rest of my life rather then endure again what I already have. I thought of you many times during those long tedious hours and often wished that you were with me. It seemed as if I could endure the trial with much better fortitude, but since it is over with, I cannot help feeling thankful that you were not here to witness my suffering, for such it surely is I do not think I never had one faint idea of what it was until I had the experience. I had no other help but Mother and Mrs. Parsons. I think she is excellent help at such a time and if there were more like her, the world would be so much the better off. I shall never believe if I live to be a hundred years old that it is any place for a Physician-- but perhaps you are getting impatient to know the result of all this fuss, but you likely know for Fred wrote it in a letter to pay me for all this trouble.

I have a boy that weights 8 lb and 1/4. He is two weeks old today, born the 8th inst. I cannot describe to you how he looks but he resembles other babies I think for they all look alike to me when they are so young, but just as he is at the present time you can imagine a little round chubby form lying near me as I write in a long white flowing dress and blue edged blanket sucking his tiny fist in the innocence of babyhood.

Dear Ben, how I wish you could see him. I am sure you would love it quite as well as I do it you could only come home now what times we could have I feel even more anxious to see you than before, but I live in hopes that the time will soon come when you will be at home again and we will be happy once more as we used to in times gone by. I feel sometimes as if I could not wait for the time to come it seems so long since you went way. It is nearly 7 months ago. I think that is a long, long time to be separated from the dearest and best friend I have, but I will hope for the best. I feel more encouraged now than I have for some time before, for I feel that with me the worst time is now passed and if you were only with me now I should think that long dark night had indeed passed away and the bright morning had again dawned.

I received those things you sent also your likeness for which I was very happy to receive. It looks quite natural but I cannot help think very sober. You must felt downhearted about something when it was taken. What was the matter with you, my Benny dear? I would like to know. You must excuse this bad writing for my pen is a miserable concern. I can hardly make a respectable looking mark. I will write again as soon as I feel well enough and try to write a longer letter and a better one if I can write soon and I remain,

your affectionate wife
Melissa
Courtesy: Bentley Historical Library at the University of Michigan.

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The Complicated Birth of Midwifery

By Abby Norman on September 13, 2015

Around 353,000 babies are born every day. Some of them will be born in hospitals, others at home with the assistance of a midwife or doula, while others will make their grand entrance in the back of a car or ambulance somewhere in between home and hospital.

The history of childbirth, and in particular of midwifery, is a complicated and often cyclical one. Throughout 19th century America, midwives attended the majority of births, especially in the American South. Improved medicine and accompanying technologies meant that by the early 20th century, midwifery was highly discouraged, only to come around again when the natural birth movement was born in the 1960s.

In other words, the natural act of childbirth reflected the technological, social and medical beliefs and practices of the time. You can learn a lot about what life was like in a particular time period by examining societal attitudes toward childbirth.

16th Century
Midwives have been around since the beginning of human history. No doubt our caveman ancestors had other female tribe members help hold them up or stagger into a cave long enough to give birth. Even prior to modern language, some human acts require no verbal communication: coitus and childbirth among them.

If we start by looking at a period in history when midwifery became a specified community role, we’d start around 1522. At this point, elder females in communities worldwide ruled the roost when it came to helping younger women deliver babies. Having been licensed and educated in childbirth, midwives were highly respected community members. So much so that when they arrived to aid a laboring woman, it was the mom-to-be’s task to make the midwife feel at home and appreciated, offering her “groaning beer” or special cakes.

Midwife History Medieval
Thus childbirth became a very social event, where women close to the new mom would join the midwife in the home to cluck around, eat cake, drink and maybe lend a hand as the woman struggled. These women had a cute nickname, too: God sibs. Over time, the name morphed into a term you’re probably more familiar with: gossips.

Towards the middle of the century, and after hearing horror stories of childbirth fatalities, a family known as the Chamberlens created a tool that they believed would change the birthing game forever. They created the obstetric tool commonly known as forceps, and they guarded their invention ferociously.

They would often attend births with the tool hidden under their cloaks, blindfolding the mother so that she wouldn’t see it, and bang pots and pans to disguise the sound of the tool (which they feared, if heard, could give away the key to its design). It would be another two hundred years before forceps became widely used, in part because the original prototype would be discovered in the floorboards of the Chamberlens’ house long after the inventors had died.

Midwife History Experiments
The next major renaissance in midwifery and obstetrics came from the Antebellum South. Young doctors practiced suturing techniques on female slaves and often bought slaves specifically with that purpose in mind. Subsequently many common gynecological procedures were developed during this time, most notably the treatment of fistulas, tears that can occur during childbirth and lead to complicated infections if they aren’t repaired.

Victorian England
Across the pond, London’s destitute women were dying in droves of something called “childbed fever”, or puerperal fever. “Lying-in” hospitals, which were also cropping up in many U.S. cities during this time, were almost entirely dedicated to delivering the poorest women’s babies. It’s an interesting corollary to modern times, when giving birth to a baby in the hospital can cost up to $32,000.

As women came into the hospital to give birth—only to die within a week—young doctors were scurrying back and forth between the birthing room and the morgue to suss out why these women had died. Unfortunately, they weren’t washing their hands after conducting the autopsies, and continued to spread the very bacteria that had killed the women on whom they were performing autopsies to the otherwise healthy women in the ward.

Midwife History Crib
Luckily for the women of London, “germ theory” (what we would call bacteriology today) began to take hold in city hospitals, and new medical students were being taught proper hand washing and sterilization techniques. Not surprisingly, as soon as these simple innovations were added to lying-in protocols, the occurrence of childbed fever dropped dramatically.

PR damage had already been done, however, and most upper class Victorian women wouldn’t be caught dead in a hospital to give birth. Queen Victoria herself gave birth at Buckingham Palace—though, not without help. It was she who blew the next winds of change into midwifery in the form of ether.

Twilight Sleep

Midwife History Victoria
Word got out that the Queen herself had made use of ether to ease the pain of childbirth, and many religious figureheads were strongly opposed to it. Pain was the point of birth, because it was the punishment women endured on Eve’s behalf (eating the apple and all that). Queen Victoria thought that was hogwash, and many women followed suit. They began to regularly request not just the use of ether, but cocaine, marijuana and opium.

Obstetricians and occasionally midwives attended births at the homes of middle and upper class women, bringing along their drugs and tools. Given these women’s perceived delicate nature, many worried that if they were not relieved of childbirth pain, their babies would suffer because they would be too exhausted to parent. Thus, it was not the poor, inner city women of the lying-in hospitals who got the ether, but the countesses, duchesses and baronesses.

Midwife History Nurse
The decades wore on and women’s rights—particularly their reproductive rights—became a social focus in a way that they hadn’t been before. In the decades that would follow, women would essentially surrender themselves entirely to the childbirth process. They would kiss their husband goodbye, go into the hospital, be knocked out with a drug cocktail (called scopolamine) and wake up several hours later cleaned up with a pink, sleepy baby in their arms. This was Twilight Sleep.

What the women weren’t aware of, however, was that while they were in this “sleep” they were often strapped to the bed to keep from injuring themselves—or nurses—as they writhed about in agony. It wasn’t uncommon for them to be put in padded pens so that they couldn’t escape during the birth, which was often a problem considering the drug cocktail was known to cause vivid hallucinations. But since women woke up from Twilight Sleep with no memory of the birth, they had no complaints and hailed it as a revolution.

Natural Birth Movement and Lamaze

Natural Birth Figures
Childbirth became largely medicalized during the early to mid 20th century. Women went into the hospital, had their Twilight Sleep, and woke up fresh-faced with a baby in their arms. The baby went home and a woman had the wise words of Dr. Benjamin Spock to guide them in child-rearing. The supportive, female-empowering and maternal community of midwives had been somewhat forgotten—along with the entire childbirth experience, thanks to scopolamine.

As the Gestalt theory of psychology, being more in touch with one’s inner experience, became more prevalent, the idea that a woman should be an active and aware participant in the birth of her child soon followed. This was the basis for Dr. Lamaze’s work, which followed in the footsteps of Russian psychologist, Ivan Pavlov. Remembered largely for his studies with salivating dogs, Pavlovian psychology had one key offering to laboring mothers: the art of mental preparation.

Dr. Lamaze was convinced by the idea of “psychoprophalaxis”: if a woman could convince herself that she was ready to give birth, then she would be. By psychologically conditioning herself for the reality of giving birth, she could manage her pain without drugs. This idea was further ingrained into the minds of women everywhere when Dr. Grantly Dick-Read published his formidable tome, Natural Childbirth, in the 1970s. Dr. Dick-Read promoted the idea that childbirth itself wasn’t painful, women just made it painful by worrying about it.

Yoga Moms
This was the foundation for the Lamaze classes of the ‘80s, which have by contemporary standards almost become a trope: a room full of heavily pregnant women, their birth partners, and a lot of “hee hee hoo hoo” going on. The co-founder of Lamaze, Elizabeth Bing, also taught many of the courses and lauded the technique.

That is, of course, until she had her own children.

In an interview many decades later, Bing admits that she not just requested—but demanded—an epidural and drug relief when she gave birth to her son. Despite decades of debunking the necessity of either to thousands of women, she wasn’t even a little bit sorry.

Modern Times

In today’s world, women have more options than ever before when it comes to having babies on their own terms—at least when it comes to delivery (abortion restrictions in the U.S. continue to abound) and, assuming a woman has health insurance to pay for the costly services. They can choose home births, hospital births, hospital births with a midwife, doulas, water births, planned cesarean sections or, if they’ve had a c-section before, they can opt for a “VBAC” —a vaginal birth after cesarean.

Regardless of what the mother has in her birth plan, one thing has been true about childbirth since the dawn of time: the baby is the one that decides when it’s time to be born.

Abby Norman is an author based in New England. Her memoir FLARE has been acquired by Nation Books (Hachette). Her work has been featured on The Rumpus, Medium, Hippocampus Magazine, The Atlantic, The Mary Sue and The Huffington Post.

From: all-that-is-interesting.com

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Willie Johnston: Eleven-Year-Old Medal of Honor Winner

From: civilwarchildren.wordpress.com

He was transferred from the 20th Regiment to Company H of the 3rd Vermont on May 12, 1865. He was officially discharged August 31, 1865 at Battleboro, Vermont, receiving the same bounty as his father of $500 from the United States government and $187.50 from the St. Johnsbury government.

Nothing is known of Willie’s life after this point. He is believed to have enrolled in Norwich University in Northfield, Vermont in 1866, graduating in 1870. After this point, Willie practically vanishes. He may have died in 1936, but even that is debatable. Willie never married or had children. He never requested or drew a pension. Nothing more is known about the life of the youngest Medal of Honor recipient in United States history. This mystery is only confounded by his drum being found in a house in Chelsea, Massachusetts on May 9, 1888. A note attached to the drum read, “Willie Johnston, aged 13, Company D, Third Vermont Regiment. Presented with a medal by Secretary Stanton for carrying this drum through the Seven Days Fight before Richmond, being the only drum carried the last of June and 1st of July.” While the mystery surrounding Willie’s life after the Civil War is frustrating, the bravery and courage of someone so young in the midst of battle are undeniable.

In 2005 a statue of Willie Johnston was erected in Santa Clarita, California. The plaque on the statue reads:

"William J. Johnston Jr.
Presented the Medal of Honor on September 16, 1863 for gallantry in the Seven Days Battle and the Peninsula Campaign."

“Willie” was a five foot tall, eleven year old drummer boy in Company D, Third Vermont Volunteers Infantry of the Union Army, when he earned the Congressional Medal of Honor. He alone saved his drum and held his ground, and his devotion to duty is an inspiration to children and adults alike. Abraham Lincoln and Secretary of War Stanton honored Willie with the following words:

“For exemplifying the spirit of all our soldiers, and for serving your country so well. The nation has decided to honor you. May all our citizens demonstrate the devotion shown by this young man.”

The statue stands in kind remembrance of a boy who, in all likelihood, never set foot in California.

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J. Marion Sims, the Father of Gynecology: Hero or Villain?

By Jeffrey S. Sartin
From: Southern Medical Journal

J. Marion Sims (1813-1884) has been called the Father of Gynecology for his revolutionary approach to treating the diseases of women. He rose from humble origins to become a successful surgeon, teacher, and writer. His innovations included the first successful treatment for vesicovaginal fistula, the first gallbladder surgery, and the introduction of antiseptic principles in all areas of surgical treatment. The Sims position and Sims speculum are eponymic tributes to his accomplishments. In recent years Sims has, however, become a focus of controversy because of his experimental surgeries on slave women. His powerful personality and messianic attitude led him to minimize moral problems, and to bristle against opposition. Ethical principles of autonomy and beneficence are important criteria for evaluating Sims' research. An exploration of the nature of Sims' work and the atmosphere in which he practiced will illuminate the critical ethical questions surrounding Sims' use of slave women as experimental subjects.

J. Marion Sims (1813-1884) has been called The Father of Gynecology, and was the first physician to have a statue erected in his honor in the United States. During his lifetime he treated European royalty and was rivaled only by William Osler in his reputation abroad. He is credited with originating the first successful treatment for vesicovaginal fistula, a common and odious condition in the mid-1800s. He made great strides in introducing antisepsis into the surgical modus operandi. Every day physicians refer to the Sims position and use the Sims speculum, eponymic tributes to his accomplishments.

In recent years, however, Sims has become increasingly famous as a focus of controversy. From 1845 to 1849 he carried out a series of experimental surgeries on slave women that would bring him fame and fortune, as well as controversy. Indeed, controversy dogged him throughout life, even as his reputation grew, fueled by his forceful personality and self-righteousness. It is certainly ironic that an icon of medicine like Sims could be mentioned in the same context as Nazi medical experimenters and the authors of the notorious Tuskegee study on syphilis. An exploration of this apparent paradox reveals as much about the state of medicine during Sims' lifetime as about the man himself.

J. Marion Sims was born in 1813 in Lancaster County, SC, to a father of modest means and a mother from a somewhat more respectable family. Education was for him, like so many other Americans of his background, a ticket out of a hardscrabble and uncertain life. His early college career was undistinguished: I never was remarkable for anything while I was in college, except good behavior, Sims later wrote. At age 20 he had to choose a professional course of study, and he chose medicine by default. I would not be a lawyer; I could not be a minister; and there was nothing left for me to do but to be a doctor. Sims found medicine very stimulating, and worked hard in medical school. Upon graduation in 1835, however, he went back to Lancaster County to establish a practice with more than a little trepidation because of his lack of practical knowledge and experience.

This anxiety was soon borne out by events, as he lost his first two patients, infant children afflicted by persistent diarrhea. Deciding his luck might be better out West, he moved to Alabama in October 1835 and hung out his shingle. He mostly floundered that first year, finding himself compelled to treat grave conditions with the inadequate medical armamentarium of the times. The possibilities of aggressive empiricism were, however, suggested by an early experience in which a patient developed abdominal pain, with certain signs pointing equivocally toward a liver abscess. Sims convinced the reluctant patient to undergo surgery without anesthesia, and later recorded: I think it was one of the happiest moments of my life when I saw the matter [pus] flow and come welling up opposite that bistoury [scalpel].

Sims had an active but uneventful career in Mount Meigs, AL, until 1840, at which time he moved with his young family to Montgomery. We had no money, and always lived from hand to mouth, Sims later recalled of his arrival in the city. In Montgomery he began to make a name for himself as a respectable physician. He boasted of being the first doctor in the South to successfully treat club-foot and cross-eyes.

In the latter part of 1845, Sims' fortune took a decided turn for the better. According to his autobiography, Sims had been referred a young female slave named Anarcha, who suffered from a vesicovaginal fistula as a consequence of protracted labor. Sims pronounced her incurable, and was on the verge of sending her away, when an incident of pivotal importance occurred. A middle-aged woman was thrown from a horse, sustaining a pelvic injury. The young physician, then 32 years old, was called to examine her. His initial examination suggested uterine malposition as the cause of her pain, and in the attempt to examine her more thoroughly he had her squat on her knees and elbows in bed. He then introduced both his forefinger and middle finger into the vagina, and immediately the pelvic organs relaxed and the woman experienced relief.

This experience led Sims to an epiphany: he could use the same unconventional position to examine and treat his patient with the vesicovaginal fistula. That same day he bent a pewter spoon into a crude instrument and introduced it into the vagina of another slave patient named Betsey, and, according to his account, I saw everything, as no man had ever seen before.

This was a literal as well as a metaphorical statement, for Sims was resolved to approach the examination and treatment of diseases of women in a new way. He modified his improvised speculum and began to design instruments for the surgical repair of this condition. Within three months he was ready to try the new techniques on his first slave patient, Anarcha, as well as another half-dozen female slaves with similar fistulae. He set them up in a special hospital building adjacent to his family home, making arrangements with their masters for their upkeep while under his care.

The next 3 years were trying for Sims, as he operated again and again in an attempt to solve the problem of persistent fistulae. He came to realize that closure of the surgical wounds with the standard, unsterilized silk or gut sutures was the cause of the operation's failure. He read of a Virginia surgeon's use of lead sutures and had a local jeweller make sutures of silver wire. This innovation prevented the wound infection which would predictably result in breakdown of the suture line.

When Sims examined Anarcha one week after her thirtieth surgery for fistula repair, he found "no inflammation, . . . no tumefaction . . ., and a very perfect union of the little fistula." In fact, more than that, he knew he was revolutionizing medicine, not just in the form of an innovative surgical technique, but in terms of the approach of physicians to diseases in women.

At the time of this success Sims became chronically ill with a diarrheal illness. He traveled extensively to find the right combination of climate, water, and food to improve his health, and eventually decided to move to New York City in 1853. One year earlier he had published his account of the fistula repair in the Journal of the American Medical Sciences. This article, while well received, was not quite enough to provide Dr. Sims with a suitable medical practice in New York, and he and his family (including now six children) struggled for several years until a fortuitous series of events culminated in the establishment in 1855 of the Woman's Hospital, a publicly and privately funded charity hospital exclusively for the treatment of female disorders. By that time Sims' health had improved, and he was up to the task of moving forward as a charismatic teacher and the leading surgeon on the hospital's staff.

Over the next several decades, Sims' reputation grew. His hospital attracted a core of physicians–Drs. Thomas Emmet, Edmond Peaslee and T. Gaillard Thomas–who may be fairly said to be the progenitors of gynecology as a respected medical specialty in America. Sims, at first the most reticent of men, began to draw crowds of students in the surgical amphitheater, to write prolifically on all manner of diseases, and to lecture far and wide. His fame preceded him to Europe, and he moved there semipermanently during the American Civil War. In 1863 he ministered to the health of Empress Eugenie, wife of French Emperor Napoleon III. That year he began writing his innovative work Clinical Notes on Uterine Surgery, which was controversial but widely read. All over the world doctors read Sims' casual, chatty text and promptly revolutionized their treatment of women's ailments according to its precepts. Its straightforward approach to female diseases was refreshing, and its emphasis on treatment of sterility, including artificial insemination, was ahead of its time.

In the latter part of Sims' career he remained a forceful presence in gynecology. Perhaps his chief mark of distinction was a willful empiricism, the belief that no medical problem was insoluble, given enough thought and effort. He became an expert on pelvic and abdominal surgery, performing the first documented gallbladder surgery in 1878 and helping to usher in the new era of therapeutics made possible through the use of general anesthesia. He authored a highly influential pamphlet heralding the role of Crawford Long of Georgia in discovering ether and helped cement Long's role in the medical history books. He was a forceful advocate for the use of Lister's antiseptic principles in surgery, leading the vanguard for this then-controversial theory. His reputation is only slightly tarnished by his promotion of certain now-discredited techniques, such as cervicotomy for sterility and dysmenorrheaand ovarian removal (ovariotomy, or Battey's procedure) for various physical and psychosomatic conditions then termed hysterical diseases. He was an enthusiastic practitioner of these techniques, but hardly as evangelical as many of his colleagues at the Woman's Hospital, who reflected peculiarly Victorian notions regarding sexuality, organic disease, and mental illness.

After Sims was comfortably ensconced in his New York practice at Woman's Hospital, he began to display a habit of occasional intemperate outbursts which provoked conflict and alienated many of his colleagues. In 1857 he used the occasion of a prestigious address before the New York Academy of Medicine (reprinted as Silver Sutures) to criticize his former protégé Nathaniel Bozeman, who revised Sims' vesicovaginal procedure and had the temerity (from Sims' point of view) to try to claim some of the glory for himself. Notwithstanding the fact that [Bozeman was] without any professional position till I gave it to him, that he is indebted to me for what he could never have obtained without my aid, he appropriates to himself every step of the operation that resulted from my own individual and unaided efforts..., Sims complained in the introduction to his honorary address. He made a lifelong enemy of Dr. Bozeman, a result which would vex Sims again and again over the next 20 years.

In 1870 Sims published a newspaper account of his treatment of a famous actress, Charlotte Cushman, and found himself accused of ethical charges before the New York Academy of Medicine. He received a reprimand for resorting to paid advertising, and betraying the secrets of a patient. This did not have a material effect on his practice, embarrassing though it was. In 1871 Sims was involved with helping to develop emergency medical services for the French during their conflict with Prussia. During a meeting of the American Sanitary Committee in Paris, he engaged in a heated quarrel with an American dentist named Evans. Sims grabbed him by the neck and punched him in the face before being forcibly restrained. Sims left Paris before charges were filed.

In 1874 Sims committed a more critical error. For at least 2 years a great deal of personal animosity had simmered between Sims and the other eminent surgeons at Woman's Hospital, Drs. Emmet, Peaslee and Thomas. A large portion of this was professional jealousy, fueled in no small part by Sims' egotism, which led him to regard Woman's Hospital as his own personal fiefdom. The other board members voted to ban cancer surgery from the hospital and to limit the number of spectators at surgeries. Sims saw these restrictions as aimed directly at him, but kept quiet initially. At the hospital's anniversary party in November (normally a staid affair of good cheer) he let loose. I have never heeded your edict and never will; and if you are aggrieved at this you can have my resignation at your next meeting if you wish it. To his surprise and regret, the hospital board took him up on his offer, and Sims was unceremoniously relieved of his association with the preeminent women's hospital in the country, which he was instrumental in founding 20 years earlier.

In 1875 he was elected president of the American Medical Association, partly based on the efforts of partisans who were upset at his treatment during the Woman's Hospital affair. His tenure was energetic, if not eventful. He continued to spend much time abroad, while managing a small boutique practice in New York. In 1877 he plunged into a reopening of the Woman's Hospital controversy by responding to a pamphlet written by Drs. Emmet, Peaslee and Thomas, and which was highly critical of his behavior. As biographer Seale Harris points out, It was one of the unwisest things he ever did. The resulting publication ensured that J. Marion Sims would continue to nurture enmity for many years until a belated reconciliation with his erstwhile friends and colleagues.

As the accolades accumulated in the latter part of his career, Sims' health declined. He suffered from recurrent episodes of diarrhea throughout his adult life, and in later years was troubled by the angina of ischemic heart disease. In 1883 an ailing Sims dictated The Story of My Life to a young secretary, covering his career up through the Civil War years. It would remain unfinished, cut short by his sudden death due to myocardial infarction on November 13, 1884, less than one day after performing a complicated operation upon a woman of some prominence.

J. Marion Sims has become an icon of medicine because of his accomplishments, which are truly too numerous to mention in a short paper. His keen intellect was always open to innovation. He overcame an unpromising background and the opprobrium arising from his Southern origin to make a name for himself not just in the quintessential American city of culture and knowledge, New York, but also in London and Paris. Monuments bear his likeness in New York City and the capitals of Alabama and South Carolina.

He reflected the heroic ideal in medicine, which became prominent in the 19th century. Famous practitioners such as Jean-Martin Charcot and Francois Broussais (a strong advocate of bloodletting) in Paris; Robert Liston, James Syme and James Young Simpson in Britain; Theodor Billroth in Vienna; and William Halstead at Johns Hopkins in the United States, tried ever more radical cures for challenging conditions. They refused to let Nature merely take its course, but boldly went against the grain of received medical wisdom.

So, Sims fit in with these iconoclasts in his search for new therapies. And yet, the ethical dilemma remains: was it proper for Sims to carry out his experimental surgeries as he did?

The question is bound up in issues of race and class. Sims' neglect of anesthesia illustrates this point. He considered his vaginal surgeries to be minor procedures and did not use anesthesia with either his African-American or Irish-American patients, for the most part. However, he found that upper-class white women could not tolerate surgery without ether. As McGregor states, Throughout his medical career Sims maintained a classbound prescription for the use of anesthesia with an unspoken premise that those women in the wealthy tier were by far the most vulnerable to pain. To be fair, this was not untypical of practitioners in the latter 1800s. Use of ether during surgery and childbirth had been reported in 1846 and 1847, respectively, but only after the Civil War did the surgical use of anesthesia become widespread, and even then cultural values intervened in its acceptance.

Sims was also of his time with regards to race relations. He owned slaves in Alabama, and in fact actually purchased one or more of the slave women he experimented on. After the end of the Civil War he defended the system of slavery in his letters. His writings are littered with uses of pejorative terms for African-Americans. However, he was not a virulent racist, and by all accounts treated black patients politely, if in a patriarchal fashion. In the early postwar period he urged the South to accept the 15th Amendment freeing the slaves, and move on.

While Sims did not disguise the facts of his cases, he did not trumpet them, either. It is implied that he was particularly keen to avoid the details of the women and their situation when he was trying to get established in New York. His 1852 paper on the successful vesicovaginal repair and his 1857 Silver Sutures lecture referred to his patients as healthy young negro women, failing to mention that they were slaves. Early illustrations from his writings show the women as white.

Some critics have suggested that the reason Sims left his native South had more to do with gossip about his immoral slave experiments than with his physical health.[13] In fact, he found himself in a similar situation in New York, as his Woman's Hospital catered to destitute Irish immigrant women, whose inferior social status did not allow them to decline questionable treatments. He was criticized directly for unethical experimentation by his colleagues and the hospital administration during the acrimonious debates of the 1870s: The Lady Managers began to be convinced that the lives of all the patients in the institution were being threatened by these mysterious experiments.

In the end, the critical questions are not whether Sims was biased regarding race and class, or whether he was embarrassed by how others would perceive his past actions. They revolve around standard ethical principles of beneficence and autonomy, judged both by the standards of his times, as well as through the filter of history.

Regarding beneficence, ample evidence exists that Sims wished the best for his patients and for the broader community of female patients. He undertook the experimental treatments on his patients with the understanding that no operation would endanger life, or render their condition any worse. As he wrote mellifluously 12 years after he saw his first case of vesicovaginal fistula, I thought only of relieving the loveliest of God's creation of one of the most loathsome maladies that can possibly befall poor human nature.

However, one inescapable conclusion is that Sims' optimism, tinged with messianic fervor, blinded him to the suffering of his patients and any associated ethical implications. His brother-in-law Dr. B.R. Jones implored him to give up his surgeries, but Sims avowed, I felt that I had a mission . . . of divine origin . . . I could not have ceased my labors if I had tried. With the hindsight of history and a more mature ethical framework, we may ask if Sims' ends justified his means, or, more accurately, if the subjects were merely means to Sims' ends. It is quite clear that Sims falls short of modern Kantian ethical principles: To treat persons merely as means, strictly speaking, is to disregard their personhood by exploiting them . . . without regard to their own thoughts, interests, and needs. In that vein he sketches only the briefest of details of the effect of his surgeries on the health of his patients, and never records the ultimate outcomes. (In fact, arch-nemesis Bozeman scathingly questioned Sims' results after his death.

The concept of autonomy is a similar ethical morass where Sims is concerned. Obviously, slaves had no autonomy, by definition. The Irish patients of Woman's Hospital had little autonomy. Can we judge Sims not by the standards of our times, but by those of his? Critics point out that many contemporaries made medical advances without the use of uninformed captive patients. Kentucky's Ephraim in 1809 performed perhaps the first successful abdominal operation, and in 1842 Georgia's Crawford Long used ether as an anesthetic for the first time, in both cases on informed, free, white patients. James Simpson of Edinburgh, a fierce rival of Sims, was critical of Sims' early work and made the following barbed observation in 1863: I took occasion to make an extensive series of experiments . . . upon the relative qualities of different metallic threads . . . [on] a number of unfortunate pigs, which were always, of course, first indulged with a good dose of chloroform.

ne cannot escape the implication that if it were not for Anarcha, Betsey, Lucy, and the other unknown slave women undergoing dozens of operations without anesthesia while under bondage to Sims, he would have ended up an anonymous practitioner in Alabama. This dependence of the southern professional on chattel slavery was exemplified by J. Marion Sims no less than the masters of cotton plantations. The stain of the most shameful portion of America's heritage cannot be whitewashed when we consider his place in history, even as we recognize his many accomplishments.

J. Marion Sims was simultaneously a man of his time and a man ahead of his time. While it might be concluded that his place in history results from the latter, and any ethical questions arise from the former, the truth is complicated. Though modern critics may not wish to remove Sims' monuments from their current homes, they would not be remiss in asking to have monuments erected beside them to Lucy, Betsey and Anarcha.

From: medscape.com

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Civil War Gynecology: The Medical Ethics of Dr. J. Marion Sims: A Fresh Look at the Historical Record

By L. L. Wall
From: Journal of Medical Ethics

Abstract
Vesicovaginal fistula was a catastrophic complication of childbirth among 19th century American women. The first consistently successful operation for this condition was developed by Dr J Marion Sims, an Alabama surgeon who carried out a series of experimental operations on black slave women between 1845 and 1849. Numerous modern authors have attacked Sims's medical ethics, arguing that he manipulated the institution of slavery to perform ethically unacceptable human experiments on powerless, unconsenting women. This article reviews these allegations using primary historical source material and concludes that the charges that have been made against Sims are largely without merit. Sims's modern critics have discounted the enormous suffering experienced by fistula victims, have ignored the controversies that surrounded the introduction of anaesthesia into surgical practice in the middle of the 19th century, and have consistently misrepresented the historical record in their attacks on Sims. Although enslaved African American women certainly represented a “vulnerable population” in the 19th century American South, 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.

J. Marion Sims (1813–1883) was arguably the most famous American surgeon of the 19th century and today he is generally acknowledged as the founder of modern surgical gynaecology. His rise to prominence began with his development of the first consistently successful operation for the cure of vesicovaginal fistula, a catastrophic complication of childbirth in which a hole develops between a woman's bladder and her vagina and leads to constant, unremitting, and uncontrollable urinary incontinence. Attempts to cure this condition had eluded many previous generations of surgeons who had tried to repair these devastating injuries time and again, but without significant success.

Lauded as a conquering surgical hero in his own time and generally admired by succeeding surgeons in the decades following his death, Sims's reputation diminished considerably in the mid‐twentieth century as it was assaulted by a series of strident critics who condemned him for his reputedly unethical behaviour. The primary reason for these attacks on Sims is that his initial attempts to cure vesicovaginal fistulas were carried out on a group of enslaved African American women whom he quartered in a small hospital behind his house in Montgomery, Alabama. Between late 1845 and the summer of 1849, he carried out repeated operations on these women in a dogged effort to repair their injuries. One young woman, a slave named Anarcha with a particularly difficult combination vesicovaginal and rectovaginal fistula, underwent 30 operations before Sims was able to close the holes in her bladder and rectum.

In interpreting these historical events, some modern writers have denounced Sims with the kind of righteous indignation that is usually heard only from pulpits. Durrenda Ojanuga—for example, writing in the Journal of Medical Ethics—has castigated Sims for achieving fame and fortune as “a result of unethical experimentation with powerless Black women” and refers to his attempts to cure vesicovaginal fistulas as “a classic example of the evils of slavery and the misuse of human subjects for medical research”. Ojanuga and like minded critics present a picture of Sims as a cold, brutal, calculating misogynist who carried out a series of unwarranted surgical experiments on unwilling but helpless slaves in pursuit of his own self advancement. This paper will demonstrate that the attacks launched against Sims by these modern writers are actually not substantiated by the primary historical sources relating to the case, nor are their charges consistent with any deep clinical understanding of the predicament faced by women who have developed a vesicovaginal fistula from obstructed labour; rather, their analysis of Sims's early surgical operations on vesicovaginal fistulas can be seen as a striking example of Herbert Butterfield's observation that “for the compilation of trenchant history there is nothing like being content with half the truth”.

Distilled to their essential points, Sims's modern critics make three major claims about Sims and his early operations for vesicovaginal fistula. The first assertion is that it was unethical “by any standard” to perform experimental surgical operations on slaves because slaves, by definition, could not have given voluntary informed consent for surgery. Underlying this assertion is the hidden presupposition that enslaved women with fistulas did not want surgical care for their condition (vesicovaginal fistula) and that they were therefore coerced into having unwanted (and perhaps, unnecessary, surgery). The second assertion is that Sims's failure to use ether anaesthesia during these operations was racist: that he did not use anaesthesia when performing fistula surgery on black women, but later, after he had developed his operation and moved to New York to found the Woman's Hospital there, he routinely used anaesthetics when operating on white women who, it is alleged, unlike blacks, were unable to stand the pain involved.

The third assertion is that the use of slaves for medical experimentation was unnecessary because substantial advances in medical care were made in the 19th century by Southern physicians who experimented in an ethical manner using white women from whom they obtained “informed consent”, a circumstance that modern critics assert did not exist with regard to Sims's operations on these early slave women. Close examination of primary source material demonstrates that each of these claims about Sims is either unsubstantiated or demonstrably false. The inevitable conclusion seems to be that the accusations levied against Sims by modern authors are largely the result of the unquestioned presuppositions that these authors have made regarding the clinical problem Sims and his first patients faced; shoddy historical research, and an abysmal lack of understanding of the future life prospects faced by a woman who had a vesicovaginal fistula in 1845.

What is a vesicovaginal fistula and how does it originate? Obstetric vesicovaginal fistulas do not arise, as many authors commonly state, as the result of “tears” to the bladder during labour; rather, they are the result of a massive crush injury to the soft tissues of the pelvis. Obstetric vesicovaginal fistulas develop during prolonged obstructed labour when the fetus will not fit through its mother's birth canal. In the presence of absolute cephalopelvic disproportion, the contracting uterus tries to force the fetus through the birth canal but only succeeds in gradually wedging the fetus more and more tightly into the maternal pelvis until eventually it can no longer be moved at all. At this point, the soft tissues of the woman's bladder, cervix, and vagina are trapped progressively more and more tightly between two immovable bony plates—the fetal skull and the mother's pelvic bones—and the blood supply to the entrapped tissues is shut off. In such cases the fetus almost invariably dies from asphyxiation, and if the mother lives through her ordeal and does not herself die from uterine rupture, sepsis, haemorrhage, or the sheer exhaustion of labouring in this fashion for days on end, a day or two later the fetus decays, macerates, and finally softens enough to slide out of its mother's vagina. Some time thereafter, a slough of necrotic tissue comes away from the injured woman's vesicovaginal septum, and a fistula forms. To the agony of days of unrelieved labour and the sorrow of delivering a dead child is now added the physical and social calamity of complete loss of urinary (and often faecal) control.

The injuries that women receive from prolonged obstructed labour are not limited to vesicovaginal and rectovaginal fistulas. These injuries form only a small part of a broader spectrum of injuries known as the “obstructed labour injury complex”. In addition to the continuous stream of urine (and sometimes faeces) to which they are subjected, these victims of prolonged obstructed labour also often suffer from secondary infertility; loss of vaginal function due to extensive scarring of the birth canal; damage to the pubic bones; contractures of the lower extremities from neuromuscular damage; recurring pelvic and urinary tract infections; horribly diminished self esteem, damaged body image, and, not infrequently, severe depression, even suicide. The cumulative devastation wrought by this process can be appalling. It is hardly the “relatively minor condition” referred to by historian Deborah Kuhn McGregor.

In alleging that it is unethical for slaves to participate in any form of medical experimentation, Ojanuga and other writers seem to imply that it would never have been appropriate for slaves to undergo innovative surgical operations, no matter what their problems might have been. Critics of this stripe conveniently ignore the differences between non‐therapeutic and therapeutic medical experimentation. In the former case, participants can have no reasonable expectation of obtaining direct personal benefit from whatever is done, but in the case of therapeutic experimentation research participants may gain direct—and sometimes substantial—medical relief as a result of their participation in a clinical trial. At the time Sims began his attempts to repair the fistulas afflicting his African American slave patients, there was no effective therapy for a vesicovaginal fistula. Many surgeons in different countries had made repeated but unsuccessful attempts to close vesicovaginal fistulas and put an end to the tormenting loss of urine that these suffering women experienced. With rare exceptions, all such attempts failed. The French surgeon Alfred Velpeau, writing in 1847, maintained that the medical community had not accepted a single reported case of successful cure of a vesicovaginal fistula without dispute.  The common experience of surgeons who undertook the care of women with vesicovaginal fistulas was a repeated series of failures, with the desperate patients returning again and again, begging that another attempt be made to give them some relief.

Because Sims's patients had a condition that was generally acknowledged to be incurable, they had only two therapeutic choices: they could continue as they were, with whatever palliative treatment might be provided, or they could agree to undergo experimental surgical operations that might offer them some relief, perhaps even a total cure, for their condition. What would the first alternative have been like? What “palliative treatments” were available to fistula sufferers at this time? Is it true, as Diane Axelson has charged, that both Sims and his subsequent biographer, Seale Harris, portrayed the physical condition of women with fistulas with “unjustified exaggeration”? Is it reasonable to suppose, as Patricia King has speculated, that “given the other aspects of slave life, it is not clear that these women would have ranked this problem high on their list of medical problems that needed attention”? Consider the following description of what it was like to be a woman with a vesicovaginal fistula in the mid‐19th century, given by Dr P M Kollock at the annual meeting of the Georgia State Medical Society in April, 1857:

"The poor woman [with a vesicovaginal fistula] is now reduced to a condition of the most piteous description, compared with which, most of the other physical evils of life sink into utter insignificance. The urine passing into the vagina as soon as it is secreted, inflames and excoriates its mucous lining, covering it with calcareous depositions, and causing great suffering. It trickles constantly down her thighs, irritates the integument with its acrid qualities, keeps her clothing constantly soaked, and exhales without cessation its peculiar odour, insupportable to herself and those all around her. In cases where the sloughing has been extensive, and the loss of substance of the tissues great, and where neither palliative nor curable means have availed for the relief of the sufferer, she has been compelled to sit constantly on a chair, or stool, with a hole in the seat, through which the urine descends into a vessel beneath."

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. That patients with a vesicovaginal fistula are desperate for a cure and will willingly submit to almost any therapy that is proposed to them is the universal experience of surgeons who have worked with this condition, both in the 19th century and today.

In her article, which is critical of Sims, Durrenda Ojanuga states that: “The enslaved women were not asked if they would agree to such an operation as they were totally without any claims to decision making about their bodies or any other aspect of their lives”. This statement is untrue. Sims gave numerous accounts of these early fistula operations during the course of his career, and, although they differ in some details, they all state quite plainly that he discussed what he proposed to do and obtained consent from the patients themselves before undertaking any operations. Writing in the New York Medical Gazette and Journal of Health in January, 1855—for example, Sims declared:

"For this purpose [therapeutic surgical experimentation] I was fortunate in having three young healthy colored girls given to me by their owners in Alabama, I agreeing to perform no operation without the full consent of the patients, and never to perform any that would, in my judgment, jeopard life, or produce greater mischief on the injured organs—the owners agreeing to let me keep them (at my own expense) till I was thoroughly convinced whether the affection could be cured or not."

It is true that under Southern law, slaves were the property of others and Sims could not have legally operated on them without the consent on their owners; however, this cannot be taken as a priori proof that these slaves were unwilling patients. As a matter of surgical practicality, considering the delicate and tedious requirements of performing surgery inside the vagina and the exceedingly difficult circumstances of exposure and inadequate lighting under which he was forced to operate, Sims could not have carried out these operations successfully without the cooperation of the women involved. Even the slightest movement, much less the active resistance of these patients, would have rendered it impossible for him to have completed his operative procedures. Indeed, when his regular medical assistants tired of working with him, Sims trained the patients themselves to act as his surgical assistants and they thereafter helped him operate on one another in turn! In fact, in a passage in his autobiography that his modern critics have apparently not understood, Sims wrote that at a time when he had stopped attempting surgery on these women due to his repeated failures and was wondering how best to proceed, they “clamoured” for operations, insisting that he keep trying to cure their injuries. No wonder he owed these women a debt of gratitude for their persistence and their cooperation—a debt that he readily acknowledged publicly on numerous occasions.

Why did Sims not use anaesthesia when carrying out these operations? Was he an “anaesthetic racist,” as has some authors allege? Vanessa Northington Gamble—for example, maintains that, in contrast to the way he treated slaves, Sims only operated on white women using anaesthesia.4 The chronology of events is extremely important here. Sims grew up as a surgeon in the days before anaesthetics and was accustomed, as were all of his contemporaries, to the pitfalls and requirements of preanaesthetic surgery. Durrenda Ojanuga writes: “He performed his first operation on a slave woman named Lucy. Lucy was operated on without anaesthetics as Sims was unaware of the advances which had been made in this area of medicine.” This statement is not true. Sims began his fistula operations on his enslaved patients in late 1845, before the anaesthetic properties of ether were known. Ether anaesthesia was not discovered and publicly demonstrated in Boston until October 16, 1846, nearly one year later.  Although the use of anaesthesia spread rapidly, its acceptance was not universal, and there was considerable opposition to its introduction from many different quarters, for many different reasons. As historian Martin Pernick has written:

"Our twentieth century sensibilities recoil at the thought that sane, responsible physicians could ever have opposed the use of anaesthetics. Today, the concept of operating on a fully sentient patient conjures up only hellish images of concentration camp doctors. Yet in mid‐nineteenth century America, humane, conscientious, highly reputable practitioners and ordinary lay people held many misgivings about the new discovery. Neither sadists nor fools, these critics alleged a variety of rational drawbacks to the use of anaesthesia."

Many 19th century surgeons felt that attempts at repairing vesicovaginal fistulas were neither serious nor painful enough operations to warrant the risks of general anaesthesia. Sir James Young Simpson, the discoverer of chloroform and probably the most vigorous advocate of the use of anaesthesia on women during the 19th century, was one of these people. Writing about the use of anaesthesia during fistula surgery in 1859, a full decade after Sims's initial surgical experiments had been completed, this champion of anaesthesia could declare that chloroform was not absolutely necessary in the performance of fistula operations, since “The mere amount of pain endured by the patient is perhaps less than in most surgical operations, as the walls of the vesicovaginal septum are far less sensitive than you would a priori imagine”.

Ojanuga further states that: “Many white women came to Sims for treatment of vesicovaginal fistula after the successful operation on Anarcha. However, none of them, due to the pain, were able to endure a single operation.” This allegation, often repeated, is also false. For example, Sims published a detailed case study of a white woman who came to him with a fistula in 1849, which he was eventually able to repair after three operations, none of which involved the use of anaesthesia. Terri Kapsalis, writing with reference to Sims's later career in New York, declares that “the widespread use of anesthetics finally allowed Sims to bring his surgeries to white women and allowed for the establishment of places such as the Woman's Hospital”. Sims himself, however, in a public lecture to the New York Academy of Medicine given on November 18, 1857, at a time when he was actively engaged in the practice of surgery at the Woman's Hospital in New York (whose clientele were almost exclusively white and many of whom were of middle or upper middle class origin), noted that he never resorted to the use of anaesthetics in fistula operations “because they are not painful enough to justify the trouble, and risk attending their administration”.  In retrospect this was certainly an unfortunate error in clinical judgment—a mistaken “calculus of suffering”—but it was not anaesthetic racism. It is also worth pointing out that if Sims had used anaesthesia in operating on his first fistula patients before the safety and efficacy of ether and chloroform had been sufficiently established for routine clinical use, this, too, would have constituted another therapeutic experiment on slaves.

In her final assault against Sims, Durrenda Ojanuga maintains that significant medical breakthroughs were achieved in the antebellum South without using slaves in therapeutic experiments. To buttress her argument, she compares Sims unfavourably with Dr Ephraim McDowell (1771–1830) of Danville, Kentucky, and with Dr Crawford W Long (1815–1878) of Georgia. McDowell was the first surgeon to successfully open the peritoneal cavity and carry out a major intra‐abdominal operation. With her consent, McDowell removed a 22 pound benign ovarian tumour from Jane Todd Crawford, a white woman, on December 13, 1809, without anaesthesia, carrying out the operation on a kitchen table. She recovered completely and survived to a ripe old age. Crawford Long was a Georgia dentist who noticed the intoxicating effects of sulfuric ether that the youth of his community were using as a recreational drug during periodic “ether frolics”. He decided to try ether as an anaesthetic agent during surgical operations. In 1842 he successfully removed a small tumour from the neck of James Venable, a white man, who had given his consent to the procedure.

These examples are true as far as they go, but both accounts given by Ojanuga selectively omit major pieces of information that, once known, completely deflate the case she is attempting to make against Sims. Although it is true that McDowell performed his first ovariotomy on Jane Todd Crawford, a white woman, Ojanuga neglects to inform her readers that McDowell performed this operation at least seven more times during his lifetime and that four of these patients were black slave women, one of who died from complications. With respect to Crawford Long, Ojanuga omits to mention the fact that he also used ether anaesthesia in a number of other surgical experiments in addition to the initial operation he performed on James Venable. For example, Long wrote the following in his article on the anaesthetic use of ether in the Southern Medical and Surgical Journal of December, 1849:

"Surgical operations are not of frequent occurrence in a country practice, and especially in the practice of a young physician; yet I was fortunate enough to meet with two cases in which I could satisfactorily test the anaesthetic power of ether. From one of these patients I removed three tumours the same day: the inhalation of ether was used only in the second operation, and was effectual in preventing pain, while the patient suffered severely from the extirpation of the other tumours. In the other case, I amputated two fingers of a negro boy: the boy was etherized during one amputation, and not during the other; he suffered from one operation, and was insensible during the other."

Both free whites and enslaved blacks were involved in all of these experimental surgical operations. McDowell's operations were clearly performed with therapeutic intent, although it is unclear to what extent some of these black patients consented to surgery. If one assumes that the amputations performed by Long were clinically indicated, then he was performing necessary surgery while conducting a rather brutal (and probably unnecessary) comparative trial of the effects of ether on surgical pain.

Conclusion
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. J Marion Sims was a dedicated and conscientious physician who lived and worked in a slaveholding society. As such, he was often called upon to care for slaves with legitimate medical needs. Among the needs that many 19th century women faced—both white and black—was the need for treatment of catastrophic complications of childbirth such as vesicovaginal fistulas. The operations carried out by Sims on black slave women from 1845–1849 represented his attempt to cure them of an odious and devastating condition that was then considered incurable. His operations, which at first were unsuccessful, were performed explicitly for therapeutic purposes and, as far as we can tell from the surviving sources, were carried out with the patients' cooperation and consent. At the time Sims began his efforts to close vesicovaginal fistulas, there was no effective alternative to surgical treatment and the quality of life to which such patients were reduced by their injuries was acknowledged by all medical writers of the time as unendurable. There is no doubt that slaves in the mid‐19th century American South were a “vulnerable” population who were often subjected to significant abuse by the slaveholding system. To suggest, however, that for that reason alone no attempts should have been made to cure the maladies of such enslaved women, especially when they were desperate for help and no other viable alternatives existed, seems ethically bankrupt itself. Whatever his other failings may have been, J Marion Sims pursued this clinical goal with vigour, determination, and perseverance, and both his patients then and countless thousands of women since, benefited from his success.

Acknowledgements
The author gratefully acknowledges the support of the Reynolds Historical Library of the University of Alabama at Birmingham for the award of a Reynolds Historical Research Fellowship and the support of the American College of Obstetricians and Gynecologists, for the award of the ACOG‐Ortho Fellowship in the History of American Obstetrics and Gynecology, both of which helped support the research on which this paper is based.

From: ncbi.nlm.nih.gov

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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 (www.wfmic.org).

''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

From: nytimes.com

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A Civil War Preventative

By Lori Eggleston

I’ve posted previously about dealing with a moth infestation on my first day on the job at the museum [National Museum of Civil War Medicine].  My second day on the job was memorable as well. I’d gotten a quick look at the collection room the previous day, but I wanted to get a closer look at the artifacts stored there.  It was partly to ensure that the moths hadn’t infiltrated the collection room, but mostly because I was curious about the artifacts!  So I started opening drawers.  The contents of the very first drawer I opened caused me to do a double-take though. I had to check the label to be certain that it was what it appeared to be.  It really was a Civil War era condom! 

By the 1860s, animal skin and rubber condoms, sometimes called “preventatives” or “French letters”, were available for use.  Typically they were used to prevent sexually transmitted diseases.  Syphilis and gonorrhea were common in both armies during the Civil War.  However, this condom was accompanied by a circular which also touted its use for married couples as a birth control device.

Sex was not a topic which was discussed openly at that time, so it is interesting to note the language and euphemisms used in the circular.  You can see how carefully he words his description, “…as to the nature of the article, they are called CUNDUMNS, or Preventatives; they are used for a private purpose by males when having intercourse with the opposite sex.  The object in using them is as follows:  Single young men use them to prevent themselves from becoming diseased when having intercourse with women of a public character…” 

He continues and points out the merits of using them as contraceptives, “…but where I sell one for the above purpose, I sell a hundred for domestic use, for the husband to use with his wife…  Indeed, all wives when they become acquainted with this article, they become strong advocates for the husband to use the preventative with them, and they certainly show their good sense in doing so, for the wife saves her own health, and can have just as many children as they can comfortably raise, and need not have any more than they think fit.”

Being a good salesman, he then lists the price, “$3.00 per single paper or dozen.  Also on hand Yarners or Ticklers, at $3.00 per dozen.”  That was a bit pricey for the time, which may explain why it is reported that sometimes condoms were washed and reused!  Surprisingly though, they did appear to be effective at preventing the transmission of diseases.

Displaying the condom presented some challenges.  The animal skin is delicate and very prone to damage from light, heat, and relative humidity (RH) at both ends of the spectrum.  A high RH can promote the growth of mold or mildew, while a low RH can dry out the skin and cause it to shrink or crack.  I had to ensure that the conditions in its display would be appropriate for it. 

There was also some apprehension about the public’s reaction to a condom on display.  I had several conversations with the museum’s director about the pros and cons of displaying it, and how to most appropriately display it.  In the meantime, it went out on short-term loans twice, which gave us a chance to gauge the reaction to it.  The displays in both venues, Arlington House, the Robert E. Lee Memorial in Arlington, VA, and the National Civil War Museum in Harrisburg, PA, had positive reviews.

Ultimately, we felt that that the condom did help to tell the story of the Civil War soldiers, and was in line with the museum’s mission of preserving the legacy of Civil War medical innovation.  We did put it in one of the higher cases though, so that it is not in obvious view of our youngest museum visitors.

So I guess the lesson this week is to be careful which drawer you open!

From: guardianoftheartifacts.blogspot.com

Image: This condom is made of sheep or goat skin. The thin ribbon across the top was not used to tie it in place, but added stability and helped to prevent the condom from splitting.

Learn more about condoms during the Civil War  at www.CivilWarRx.com.

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Born Southern: Childbirth, Motherhood, and Social Networks in the Old South

By V. Lynn Kennedy

In "Born Southern", V. Lynn Kennedy addresses the pivotal roles of birth and motherhood in slaveholding families and communities in the Old South. She assesses the power structures of race, gender, and class—both in the household and in the public sphere—and how they functioned to construct a distinct antebellum southern society.

Kennedy’s unique approach links the experiences of black and white women, examining how childbirth and motherhood created strong ties to family, community, and region for both. She also moves beyond a simple exploration of birth as a physiological event, examining the social and cultural circumstances surrounding it: family and community support networks, the beliefs and practices of local midwives, and the roles of men as fathers and professionals. The southern household—and the relationships among its members—is the focus of the first part of the book.

Integrating the experiences of all women, black and white, rich and poor, free and enslaved, these narratives suggest the complexities of shared experiences that united women in a common purpose but also divided them according to status. The second part moves the discussion from the private household into the public sphere, exploring how southerners used birth and motherhood to negotiate public, professional, and political identities. Kennedy’s systematic and thoughtful study distinguishes southern approaches to childbirth and motherhood from northern ones, showing how slavery and rural living contributed to a particularly southern experience.

Published by: The Johns Hopkins University Press

From: muse.jhu.edu

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