The controversy over Doctor Marion Sims, “The Father of American Gynecology” is now at a fever pitch. His statue on the edge of Central Park gazes across 5th Avenue, right at the New York Academy of Medicine. The Mayor of New York is considering having it removed. The New York Academy of Medicine responded with an open letter, saying (paraphrasing here): “…fine with us, not on our property anyway.” What did Dr. Sims do to deserve such enmity?
I confess to being totally unaware of Dr. Sims’ fame and notoriety. I had gone to New York City to see the Smith medical papyrus at the New York Academy of Medicine (NYAM). It turns out that the papyrus is locked up in an undisclosed location. (But you can see it online at the National Library of Medicine, complete with animated unrolling and translation).
As I waited for the NYAM librarian (visits are by appointment only) I came across the letter about Sim’s statue. Later, I walked across the street to see it for myself. The pose is dynamic, the placards laudatory, and the pedestal completely fenced off. It seems the City of New York does not want the statue vandalized while they determine whether or not his reputation has already been.
The condemnation of Sims stems from a period between 1845-1949 in Montgomery Alabama, where he operated on slave women without consent or anesthesia. He did so while perfecting a surgical cure for vesico-vaginal fistula, one woman requiring 30 procedures before a satisfactory result. But the condition itself is devastating. A complication of prolonged labor, the anomalous communication between bladder and vagina leads to a constant reek of urine, social isolation and depression. A remedy was much wanted by his slave patients. He later relieved Empress Eugenia of France of this affliction, helping to propel him into a lucrative private practice in New York.
His practice in New York served a wealthy, white, clientele. Some women were treated for hysteria by removing their ovaries. Criticizing this practice per se would be to take it out of historical context, and most certainly it would not invite accusations of racism. Husbands are no longer allowed to (as they once did with force of law) commit their wives to involuntary clitoridectomies to treat hysteria. Medical procedures today are subject to ethical review boards.
So it does seem appropriate to contextualize the history of Dr. Sims. To frame the issue, I quote a woman historian, Dr. Deirdre Cooper Owens, writing, objectively I believe, in Rewire (a liberal online journal).
“The controversy is twofold and tends to lack historical nuance. Sims has been painted as either a monstrous butcher or a benign figure…. As a historian and researcher, I am usually frustrated by the ahistoricism and reductionism that has emerged on both sides of the Sims debate. To better understand Sims, his enslaved patients, and the state of medicine, we must contextualize the antebellum South and its racial politics.”
This contextualization includes the facts that healthy slaves were valuable, so restoration of health, not destructive experimentation, was the goal of surgery. Furthermore, anesthesia became the standard of care only late in Sims career. And, it was widely held that blacks were more pain tolerant than whites anyway.
Owens is quick to add that Sims did indeed hold racial prejudices. He treated the fistula of one immigrant Irish woman in the same putatively ’cavalier’ fashion as with the slave women. But this was ‘equality’ only in the sense that he held both the Irish and Negros to be inferior.
Sims legacy includes innovations in technique (a speculum, silver sutures), fertility treatment (by insemination), enlightened attitude toward cancer patients (they were not contagious), trauma surgery (laparotomy for bullet wounds) and gallbladder surgery. His pioneering management of vesico-vaginal fistula led to an enduring benefit for generations of women.
... moves between southern plantations and northern urban centers to reveal how nineteenth-century American ideas about race, health, and status influenced doctor-patient relationships
On the other hand, he was the product of a racist culutre, whose prejudices included a belief that blacks were less sensitive to pain. Later day criticism includes those who point to lack of anesthesia during surgery, and those who claim that he addicted these same patients to opium post operatively, to maintain their compliance. As to the use of anesthesia or not, as a contemporary standard of care, I refer you to the article in J Med Ethics by LL Wall who reviewed the primary sources and concluded that:
"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."
The New York Academy of Medicine hosted Dr. Sims over 150 years ago. The recent President's letter that condemns him seems uninformed by the Academy's own archive.
Ellen, age 30, the subject of repeated operations elsewhere presented to Dr. Sims' New York practice (of exclusively white clientele). She had a large vesico-vaginal fistula which Sims successfully treated. He writes, "This position permits the use of anaesthetics if desired, but I never resort to them in these operations, because they are not painful enough to justify the trouble, and risk attending their administration."
Silver sutures in surgery : the Anniversary Discourse before the New York Academy of Medicine, delivered in the new building of the Historical Society on November 18, 1857.
Dr. Sims’ exposition must be carefully considered. Anarcha, a slave, and Ellen a white patient who could afford a now–famous surgeon, both underwent multiple surgeries for the same condition. In each case Dr. Sims deemed anesthesia to be an unwarranted risk, an opinion shared, as we have seen, by other reputable physicians.
He claimed in his autobiography that he was indebted to the slave women he treated. He published this statement in 1855: “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.”
Should a physician who founded the first Woman’s Hospital in the US, who played a key role in founding the nation’s first Cancer Hospital, and who was president of the American Medical Association, (which was derived from the NYAM in 1845), and so on…be honored with a statue? I say yes. If warranted, put an asterisk somewhere to contextualize the memorial…”Here’s what we deem laudatory, here’s what we do not.”
Perhaps the asterisk should be followed by an exclamation mark—here is a lesson to be learned! There is abundant research showing racial disparity in modern health care, including the under-treatment of blacks for pain.
Wanting to make disappear any semblance of Dr. Sims is unjustified by the historical record. It is a culturally-driven overreach—one that might, were it not for the unfortunate etymology of the term, be called hysterical.