Anarcha was an African American slave woman. She was one of the seventy-five slaves who worked the Wescott plantation, just on the outskirts of Montgomery, Alabama. One hundred and seventy years later, she and her two slave sisters would be the center of attention of medical historians, feminists, and even National Public Radio, as they all ascended to be known as the unsung Mothers of Modern Gynecology.
But first . . .
Editor’s Note: When writing about history, one must include historical perspective, or we are left to judge that period by our own standards rather than the standards of the time. For example, today we talk about institutionalized racism in the US, but in antebellum America, in the deep south particularly, there was blatant, in-your-face racism.
Additionally, once you’ve given perspective, to make that history come alive, writers often toss in their own perspective, or opinions, as it were. To have no bias is impossible, but one can aspire to objectivity by being “fair and balanced,” to borrow a phrase, and the more information you can gather, the more fair and balanced you can be.
As one historian put it:
Historians live and operate within a certain era and cannot help but be biased. The trick is to be aware of this bias as much as possible and try to write as fair and balanced an assessment of events and people as you can. The amount of research material often dictates what you can do.
The key to an objective understanding of a certain period in history is the amount of material you can dig up.
This article along with the biography of Dr J Marion Sims were originally researched and written in the first half of 2004. At that time, the only materials we’d found on him were his books, and a few articles scattered about the web, many of them teaming with errors. Since then, everyone and his brother has published something about Sims and his most famous patient, Anarcha, including National Public Radio. When we first wrote about Anarcha, she was practically unknown.
Given the wide variety of perspective in all the accounts we’ve recently uncovered, the question of whether Sims was a monster or a healer is still up in the air. As for Anarcha, a number of pieces actually concluded what we had concluded 14 years ago, and that is she, and two sister slaves, Betsey and Lucy should be acknowledged as the Mothers of Modern Gynecology.
Now that we have gathered up as much information as possible, and read every viewpoint from PhD to blogger with an iPad, we’re are going to offer you an even more balanced (yes, and fair) presentation of their histories, and offer you, hopefully, a more dynamic and sensible perspective of both Sims’ work and Anarcha’s participation. Note the word “participation,” because everywhere you look, authors have focused only on the fact that she was a slave and could not decline to participate.
Given the glut of information now available to us, perhaps we have another, more thoughtful angle to pass on to you. We hope you enjoy this trip into the past. [Our initial article on Anarcha was published to the web the first part of 2004.]
Anarcha went into labor one day. Three days later, she was still in labor. Dr Marion Sims was called in to assist with the delivery. He writes in his autobiography that he used forceps on the fetus’s head, but that he really didn’t know what he was doing since he’d had so little experience with the device. He failed to mention whether the baby survived the ordeal. He doesn’t even tell us the sex of the baby. However, we do know that the mother experienced several vaginal tears from the birthing. She became incontinent afterwards due to the damage. Incontinence is a nice, sterile way of saying she was constantly pissing herself, and in that unbearable southern heat, became an outcast due to the horrid stink she wallowed in constantly.
The use of “forceps” was common in those days, but Sims had never used them before, and, according to one historian, Sims “tried it repeatedly on other slave women. Each of these attempts, however, resulted in an infant fatality. Sims blamed all of these deaths not on his own use of the forceps, but the slave mother’s inherent stupidity.” [Anarcha]
Editor’s Note: The above paragraph, on how Sims repeatedly and unsuccessfully used forceps in deliveries came with no footnotes or references. After a lengthy search of the internet, scouring through some 70 documents, books, and lectures, we could not find anyone repeating this claim, so we must assume that the writer just made it up.
Anarcha did not recover well from the birth. We know from another historian, Dr Paul Howard, that Anarcha was so ill, she had to turn her child over to the care of another. (So, I guess we do know the child survived.)
Anarcha suffered from what today is known as a vesico-vaginal fistula. I’ve read tons of things about fistulas without anyone bothering to tell me exactly what they were. First off, poor women, malnourished women, suffer from fistula more often than healthier women.
The root causes of fistula are grinding poverty and the low status of women and girls. In developing countries, the poverty and malnutrition in children contributes to the condition of stunting, where the girl’s skeleton, and therefore pelvis as well, do not fully mature. This stunted condition can contribute to obstructed labor, and therefore fistula. [Fistula Foundation]
Hence you’d be right in assuming that their occurrence among slave women was greater than among the white population at that time. But what is a fistula?
It’s is a tear in the vagina, a complication of childbirth that often leaves women leaking urine and/or feces. Because of this, infection is inevitable and the poor women simply reek and are forced into exile of sorts, and live with the horrible smell by themselves. As a slave, you become worthless, and already underfed, you aren’t about to get more food with this condition.
Dr J Marion Sims had already earned his reputation as a good doctor and competent surgeon, but admitted that he knew nothing about women and their female disorders. In his autobiography he wrote:
I never pretended to treat any of the diseases of women, and if any woman came to consult me on account of any functional derangement of the uterine system, I immediately replied, ” This is out of my line ; I do not know anything about it practically, and I advise you to go to Dr. Henry or Dr. McWhorter.”
You can find the full text of his book here: The Story of my Life (though it’s not a very good optical character recognition scan).
Five days after Sims had assisted with Anarcha’s delivery, he was called back only to discover she suffered from a fistula. He went home and researched it and reported to Mr Wescott that it was hopeless:
“Mr. Wescott, Anarcha has an affection that unfits her for the duties required of a servant. She will not die, but will never get well, and all you have to do is to take good care of her so long as she lives.” Mr. Wescott was a kind-hearted man. a good roaster, and. accepting the situation, made up his mind that Anarcha should have an easy time in this world as long as she lived.
Then by coincidence, another slave owner came to him telling him of one of his young servants suffering from the same disorder. Her name was Betsey. By an even further coincidence, this happened again, and this time the girl was 19, with a two month old child, and her name was Lucy.
Each time, Sims apologized that there was nothing he could do.
“Is there no chance for your being mistaken about the case, without having seen it?”
I said, “No, there is no chance for me to be mistaken. It is absolutely incurable.”
“Are you not disposed to investigate it,” he said, “and see if there is not some chance?”
I said, “No, I don’t want to see it.”
There would have ended Sims’ future career as a gynecologist, except for another coincidence, but this time it was a white woman who fell from her horse and he was called into care for her without knowing a thing about her condition, only that she was in need of a doctor.
He found her lying in bed, in pain and complaining of tenseness in her bladder and rectum. And here is where the coincidence comes in as Sims recalls in his autobiography, “If there was anything I hated, it was investigating the organs of the female pelvis.”
Obviously it was a problem with her uterus and inserting a digit or two found it had spun around facing the other direction. He had no idea what do except panic, when suddenly he recalled a lecture he’d heard in medical school that he was sure went in one ear and out the other because he’d had no desire ever to futz around with female parts. For some reason, he remembered exactly what to do.
Long story short, he did what the lecturer had told him to do and the uterus popped back into place with a long sigh that sounded very much like a fart. Sims told the mortified woman that it had come from her vagina because he’d restored “the retroverted organ to its normal place.”
He did all this without ever seeing what was actually going on, because in that time, doctors did everything to women under their dresses.
An examination of “female parts” was conducted up her skirt by palpation [examination by hand]. Most physicians shunned the idea of actually looking at these parts.
But here we must take a step backwards for a bit of clarification, so as to understand why today so many people want this racist’s statue removed from the public eye.
Because of the location of his practice, he’d worked for many plantation owners, and had done some amazing work on the “colored” population.
In fact, between 1840 and 1845 he’d built a pretty lucrative practice, mainly because he was one of the best surgeons of his time. He was described by his friend and contemporary, the famous surgeon Samuel D. Gross, M.D. (1805-1885) as: “a bold operator, sometimes to the point of recklessness, but he thoroughly understands the nature of his cases, and carefully weighs the consequences of the employment of the knife, which he wields with consummate ability.” [“J. Marion Sims, A Study of the Alabama Years and the Treatment of Vesico-vaginal Fistulas,” Paul S. Howard, MD]
Historians love to point out that Sims was a self-promoting, egotistical, braggart. But he was also a damn good surgeon.
Being from a family of physicians and nurses (if you don’t mind a short digression), my favorite “doctor story” is about the physician who lost a young patient and just stood there, his head hung low, over her lifeless body, when suddenly she awoke, startling him. She said, “I went to heaven and saw God!” With tears in his eyes, the doctor asks her, “What is he like?” She responds, “Nice enough guy, but he has a Doctor Complex.”
So Sims is a good doctor, a fine surgeon, and he’s a braggart. Big deal. He’s a racist and a sexist. So is every Southern Gentleman of his time. Big deal. He was among the first white, American physicians to examine, with he eyes, the female parts of a naked adult woman on his examination table and he was hounded and scolded for such terrible behavior and derided even today.
Yes, if not for slavery, Sims would never have had the chance to do what he did, cure what he cured, and win adoration around the world for his vast accomplishments as a surgeon.
Dr Sims, ‘the father of gynaecology’ was the first doctor to perfect a successful technique for the cure of vesico-vaginal fistula, yet despite his accolades, in his quest for fame and recognition, he manipulated the social institution of slavery to perform human experimentations, which by any standard is unacceptable.
The medical ethics of the 'Father of Gynaecology', Dr J Marion Sims,
We shall come back to this.
As he was leaving this woman’s home, he realized that if he could put one of the slave women in the same position he’s put this last patient, on her knees, face in her palms, he’d be able to look around and see exactly where and how the fistula was situated, and he might be able to actually work on something considered incurable.
On his way home, he ran into a store to buy a big pewter spoon.
That, ladies and gentlemen, was the first speculum; a large, “bent,” pewter spoon.
Betsey was still at his home when he arrived and he asked her if she’d allow him one final examination before he sent her home. She agreed, got on his table with her bottom in the air, and Sims instructed his students stand astride the table and splay her nates (butt cheeks).
He inserted the spoon, and lo and behold, “the air rushed in with a puffing noise, dilating the vagina to its fullest extent.”
Introducing the bent handle of the spoon I saw everything, as no man had ever seen before. The fistula was as plain as the nose on a man’s face. The edges were clear and well-defined, and distinct, and the opening could be measured as accurately as if it had been cut out of a piece of plain paper. The walls of the vagina could be seen closing in every direction ; the neck of the uterus was distinct and well-defined, and even the secretions from the neck could be seen as a
tear glistening in the eye, clear even and distinct, and as plain as could be. I said at once, “Why can not these things be cured?
Sims got so fired up, scoured the county for cases to work on, added another story onto his hospital so that he now had 16 beds, and he began gathering and fashioning the instruments he would need. He contacted the slave owners and told them he was on the eve of a great discovery.
If you will give me Anarcha and Betsey for experiment, I agree to perforin no experiment or operation on either of them to endanger their lives, and will not charge a cent for keeping them, but you must pay their taxes and clothe them. I will keep them at my own expense.
Local doctors heard about Sims’ project and they too, after seeing his notes felt he was on the eve of something great.
Six months at the most. That’s what Sim’s and everyone felt. Just six months at the most.
Three years later, his brother in law, Dr Rush Jones came to his hospital and said,
I have come to have a serious talk with you. When you began these experiments, we all thought that you were going to succeed at once, and that you were on the eve of a brilliant discovery that would be of great importance to suffering humanity. “We have watched you, and sympathized with you; but your friends here have seen that of late you are doing too much work, and that you are breaking down. And, besides, I must tell you frankly that with your young and growing family it is unjust to them to continue in this way, and carry on this series of experiments. You have no idea what it costs you to support a half-dozen niggers, now more than three years, and my advice to you is to resign the whole subject and give it up. It is better for you, and better for your family.”
Without the aid of anesthesia, Betsey, Lucy, Anarcha and others whose names have been lost to history, underwent operation after operation, only to wind up in bed, still suffering from infections bought on by the surgeries.
Lucy’s case was exasperating. She nearly died of infection, but by irrigating her bladder, everything cleared up and she felt better than she ever had. Her fistula had vanished leaving just a slight tear. Further operations failed. Betsey proved impossible as surgery after surgery failed repeatedly.
Then came Anarcha. Her case was probably the worst he’d ever seen. Sims wrote of her:
This woman had the very worst form of vesico-vaginal fistula. The urine was running day and night, saturating the bedding and clothing, and producing an inflammation of the external parts wherever it came in contact with the person, almost similar to confluent small-pox, with constant pain and burning: The odor from this saturation permeated everything, and every corner of the room; and, of course, her life was one of suffering and disgust. Death would have been preferable. But this kind never die; they must live and suffer. Anarcha had added to the fistula an opening which extended into the rectum, by which gas — intestinal gas — escaped involuntarily, and was passing off continually, so that her person was not only loathsome and disgusting to herself, but to everyone who came near her.
Anarcha was operated on more than the other two. All failures. I’ve read accounts that say she had 16 surgeries. One said she’d had over 30. There are even higher, exaggerated number. In Sim’s autobiography, he says she’d had 30.
But the most common criticism made against Sims, like the one above by Durrenda Ojanuga, is that he experimented on slaves; slaves who could not protest or refuse this service; slaves who were held hostage by this mad doctor who operated without the use of anesthesia!
The focus on “medical experiments on slaves,” is just over the top. These women suffered 24/7 and were outcasts in their own homes. And one more thing:
There was no cure for this condition.
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.15 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. [“The medical ethics of Dr J Marion Sims: a fresh look at the historical record,” LL Wall, MD, PhD]
And how horrible a condition was it? Just read what Dr P M Kollock at the annual meeting of the Georgia State Medical Society in April, 1857 had to say:
The poor woman [with a vesico-vaginal 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. [ibid]
It is here that some historians (detractors) point out, that through an agreement with her master, Anarcha became Dr Sims’s guinea pig. She regularly underwent surgical experiments, while positioned on Sims’s table, squatting on all fours, and fully awake without the comfort of any anesthesia. They also point out that it was commonly accepted that African Americans had a higher tolerance for pain than their white counterparts. Commonly accepted but utterly wrong.
However, because we have access to more information today, we can actually give you that “fair and balanced” historical perspective.
Because she was a slave, Sims could have done anything he had wanted to her short of murder. A slave could not protest or resist. However, Anarcha and her sister slaves suffered from this terrible condition and she willingly submitted to the good doctor.
Sims wrote in the New York Medical Gazette and Journal of Health in January, 1855:
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. [ibid]
On top of this, detractors add — quite ironically, I must say — that he performed his experiments without any anesthesia.
Those who rag on about “surgical experiments on slaves” should know that their invectives land on deaf ears confronted with the very simple and undeniable fact that there was no cure for vesico-vaginal fistulas.
Everything done to help women suffering from that condition was an experiment.
And Sims’ first operation was performed one year prior to So, let us set the record clear: Every operation to cure this horrible condition was an experiment.
Cries that he operated on them without using anesthesia absolutely lack historical perspective. His first surgery occurred one year before the “first successful public demonstration of ether anaesthesia for a surgical operation, performed on October 16, 1846 in Boston/Massachusetts.” [The 16th October 1846 and its outcome]
And though the use of ether spread relatively quickly, how to use it, the side effects, etc, were unknown to most and as Wall points out, “its acceptance was not universal, and there was considerable opposition to its introduction from many different quarters, for many different reasons.” And goes on to quote historian Martin Pernick:
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. [“The medical ethics of Dr J Marion Sims: a fresh look at the historical record,” LL Wall, MD, PhD]
The phrase we should note is “twentieth century sensibilities,” for only through historical perspective can we judge the surgeons of that time, because Sims knew of anesthesia, just like he knew of Joseph Lister’s work with carbolic acid to make the operating room germ free. But he was a man driven and focused on this one horrible malady, and (did I say I’d point out some irony?) even if he did use ether or chloroform, because he had not experience with it, that too would have been an experiment on a slave.
He was no Dr Mengele [J. Marion Sims] and he admits he did not use anesthesia because he was just unfamiliar with its use.
Wall in his “The medical ethics of Dr J Marion Sims: a fresh look at the historical record,” points out:
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”.
Sims experimented on Anarcha, Betsey, Lucy and many slave women whose names have been lost to history. They all underwent many, many surgeries before Sims finally succeeded.
What I find interesting about Sims’ detractors, is they quote him here and quote him there, but they say there’s no proof that he ever cured anyone, of this disorder, let alone Betsey, Lucy, or Anarcha.
He wrote in his autobiography that the operations were finally a success, but that’s not enough? He wrote that he performed nothing without their consent, but we are told they were slaves and couldn’t decline to be operated upon, so . . .
What he writes is all fine and dandy until he answers his detractors, and then it’s unbelievable, as if he knew that 170 years from then Americans would all turn into snowflakes easily offended and ready with a breakfast bowl of umbrage.
He quickly utilized the sutures on all of his captives and claimed to have cured them all, but there is no outside evidence to support his claim. He declared, “I had made, perhaps, one of the most important discoveries of the age for the relief of suffering humanity.” Sims never recorded if he was able to heal Anarcha of her other fistulas and to this day, physicians debate the type of suture to use in the operation, although the condition is rarely seen anymore. Sims’ level of “success” remains ambiguous by all medical accounts. [Marion Sims: One Among Many Monumental Mistakes by Wendy Brinker]
The ambiguity of his success exists only for those who wish to write him off as a monster. The following is from his autobiography and should be accepted at face value since there exists no contrary account.
This was in the month of May, I think, though possibly it was June (1849). In the course of two weeks more, Lucy and Betsey were both cured by the same means, without any sort of disturbance or discomfort.
Then I realized the fact that, at last, my efforts had been blessed with success, and that I had made, perhaps, one of the most important discoveries of the age for the relief of suffering humanity. [The story of my life.]
The man was driven. He had never been a healthy man having contracted malaria early in life. When he was finally finished, he moved north for heis health, which had considerably deteriorated.
In the Autobiography of Samuel D. Gross, M.D., he publishes a letter from Sims just after his arrival in New York after leaving his practice in the south for his health. Besides suffering from bouts with malaria, Sims had overworked himself performing these “experiments,” and weighed only 96 pounds.
His letter states:
During the last year my principal assistants were the patients; and they always eagerly looked forward to the time of having their operations repeated, often contending with one another who should be the next. All the operations were performed without an anesthetic. Indeed, I had been at work a year before the introduction of ether.
Yes, he did not use anesthesia, though he did give them opium afterwards for the pain. When he finally tried using chloroform assisting other physicians, the patient died and Sims swore only to use ether in the future.
Most important is this fact: J Marion Sims, MD, repaired the fistulas. He was the first person in history to cure this condition, and despite all the spin historians want to put on this, focusing on how his patients must have suffered through his experiments, one thing they all conveniently forget is that Anarcha stayed on with him as his assistant and gladly had him operate on her because what he was doing was important to her and all women suffering this debilitation condition. Eventually she was completely cured.
Anarcha, Betsey, and Lucy left no written legacy. Slaves were not permitted to learn reading and writing. But with Anarcha’s assistance, Sims honed his craft and developed instruments that sit in medical museums today though they do have modern counterparts. In fact, the design of his speculum is very close to what is used today. [Why No One Can Design a Better Speculum]
Anarcha and her sister slaves certainly are the unsung Mothers of Modern Gynecology, but what about Sims? History seems to suddenly be judging him as a monster, focusing on his “experiments on slaves without anesthesia,” rather than on the simple fact that he cured them all of something that was incurable.
Here is a lot of further reading on this polemical subject.
Editor’s Final Note: As you can see, we’ve included here a lot of “negative” articles here, mainly because we live in a society today that loves to be shocked. We need our 24/7 plate of umbrage and somebody to flame. We live in a society where a tasteless joke on Twitter can ruin a person’s life (Justine Sacco) because people love their outrage more than their humanity. In my research, one person even compared to Sim’s knowing about anesthesia and not using it to the Tuskegee syphilis experiment, in which scientists knew about antibiotics but didn’t use them.
That is absurd. Sims was saving lives and the people at Tuskegee were murdering people. It’s that freaking simple.
And don’t forget to read our article on Dr J Marion Sims.
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