EXTRA EXTRA READ ALL ABOUT IT: DOCTOR PERFORMS  NOVEL PROCEDURE  WITHOUT CONSENT OR ANESTHESIA.

But you probably haven’t read about it.  

If I say mad scientist, most people will picture an old man with grey hair standing up. He’s cackling over a surgical table with a scared animal or person.  We will infer that his subject is miserable, possibly there against their will. Imagine if we called a man like that the father of modern gynecology.

 Illustration of Dr. J. Marion Sims with Anarcha by Robert Thom.

Illustration of Dr. J. Marion Sims with Anarcha by Robert Thom.

Dr. James Marion Sims did not necessarily strap screaming women down to a metal table when operating on them; however, he used them as test subjects in the development of a surgical procedure that severely affected many women of the time.

Vesicovaginal fistula. Also called a bladder fistula, this opening occurs between the vagina and urinary bladder. This led to incontinence (constant leaking of urine). This is the most common vaginal fistula. It was more prominent in the mid to the late 1800s because of the limited understanding of the female anatomy, lack of access to proper care during childbirth, and general remedial practices in medicine. Irish immigrants and southern slaves represented majority of VVF cases.  

James Marion Sims is known as a pioneer in medicine for developing a successful surgical procedure for the vesico vaginal fistulas. He achieved this through operating experimentally on female slaves without the use of anesthesia from 1845 to 1849. In his own writings, Sims details his operations on ten female slaves. He himself only claims that one of them enthusiastically gave consent, she allegedly pleaded to have the surgery. That leaves the validity of the other nine “patients” consent in question.  

General anesthesia was available at the time. Performing such an operation in the absence of anesthesia in 2017 would be seen as torture.  General anesthesia facilitates a lack of response to noxious stimuli, and amnesia. Proper dosage of anesthetic agents inhibit or stimulate excitatory or inhibitory neurotransmitter receptors, respectively. They prevent the transmission of pain signals and the subsequent reception of those signals, Without anesthesia his patients were in excruciating pain during and after the procedure. The notion that black people, black women specifically feel less pain is still prevalent among non-black medical professionals.  

Sims's surgical cure for vesico-vaginal fistulas eased both the social stigma and physical discomfort of many affected women. He popularized the use of silver metal sutures to treat and cure women with VVF.  Current treatments of vesico-vaginal fistulas have evolved since the nineteenth century, some of the basic principles utilized by Sims have been incorporated into present-day surgeries. In particular, Sims stressed the significance of continuous bladder drainage after the operation.

Would his achievements mean any less had he used anesthesia? Would his contribution to gynecology be less noteworthy had he documented actual consent?

No. Those things would have simply required compassion and care.  Those things are afforded to people and black women were not, sometimes we still are not, seen as people capable of feeling like white counterparts. “A substantial number of white laypeople and medical students and residents hold false beliefs about biological differences between blacks and whites and demonstrates that these beliefs predict racial bias in pain perception and treatment recommendation accuracy.” (PNAS)

In interest of what is fair and what is fact, I recommend more information should be shared about Dr. Sims’ relationship with his early patients. The fact that they were enslaved women, inhumanely treated should not be omitted because it could detract from his contributions to medicine.

There’s much to learn from this and the continued mistreatment of minority patients/ test subjects. “Racial and ethnic minorities are less likely than whites to undergo invasive cardiac procedures,  to undergo high-cost surgical procedures, or to receive basic preventive and high-technology care. Racial and ethnic minorities are more likely to receive care from lower-quality physicians and lower-quality hospitals.”(JASA)

 Advances in medicine and science should benefit all people but they do not. Research should be conducted in the pursuit of knowledge for the benefit of society; However, racism is present in society. Thus it presents itself in medicine. It is why Dr. Sims thought nothing of operating on women without anesthesia. It is why doctors informed Henrietta Lacks of their collection of her cells AFTER it occurred. Yet, most scholars avoid these facts or make a point to add a statement about misconduct being well intentioned.  The science and medical community must acknowledge the underlying racial and gender biases that currently run rampant.

White-washing and downplaying do nothing for progress. How can anyone learn from mistakes of which there is no record?

Sources

Vaginal fistula

http://www.mayoclinic.org/diseases-conditions/vaginal-fistulas/symptoms-causes/syc-20355762

Remembering Anarcha, Lucy, and Betsey: The Mothers of Modern Gynecology

http://www.npr.org/2016/02/16/466942135/remembering-anarcha-lucy-and-betsey-the-mothers-of-modern-gynecology

James Marion Sims's Treatment of Vesico-Vaginal Fistula

https://embryo.asu.edu/pages/james-marion-simss-treatment-vesico-vaginal-fistula

Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites

http://www.pnas.org/content/113/16/4296.full

Racial Differences in the Use of Epidural Analgesia for Labor

http://anesthesiology.pubs.asahq.org/article.aspx?articleid=1923398