James Marion Sims is still considered one of the most controversial figures in the history of medicine. We know him as the progenitor of the science of gynecology, one of the first researchers in this field. He was spoken of as a man who managed to make an incredible breakthrough, but at the cost of the suffering of the then most vulnerable segment of the population - black slaves.
In the mid-19th century, gynecology was one of the most unexplored and obscure areas of medicine. The morality of that time called to consider everything that is located below the waist of women - immoral and dirty. Medical students learned to accept babies on dummies, so they saw the first real birth "in the fields", with the beginning of real practice. Obstetrics was not at all considered a scientific field - any midwife could handle it.
Diseases, however, did not disappear anywhere - morality was not a decree to them. One of the common problems was bladder fistula. In the days when doctors still did not know how to artificially accelerate childbirth, sometimes women suffered for several days. It so happened that too strong a push tore the inner wall, as a result of which a fistula formed. As a result, urine and feces entered the vagina and could cause an infection, but even if this did not happen, the life of the young mother was ruined.
Johann Dieffenbach, a 19th century surgeon, sympathized with the man whose wife, as a result of this trauma, "became a vessel of disgust" and "the object of her husband's bodily antipathy." Despite the symptoms, women rarely died, much more often they lived for decades in isolation, rejected by society.
Failure after failure
The path of the future "father of modern gynecology" began in 1813. Marion hated school and almost lost his college degree. The father, however, passionately wanted his son to break out into the people and find a worthy profession.
Subsequently, Sims recalled how his father told him: “My son, I must confess that I am disappointed in you. If I had known in advance, I would never have sent you to study. I feel the deepest contempt for the kind of activity you have chosen. There is no science. There is no way to gain honor or build a reputation. The very thought that my son is my son! - will wander from door to door with a box of pills in one hand and a syringe in the other, will be fiddling with the sick … never thought I would have to see this."
Sims attended the South Carolina College of Medicine and assisted a city doctor as an apprentice. In those days, there was no obligatory number of years of study - a student became a practitioner as soon as he felt that he had gained enough knowledge. Sims dropped out of that college and moved to a more prestigious one in Philadelphia. Lectures, which spoke about women's diseases, "drove his insides in awe," Marion felt disgust. After graduation, he moved back to Lancaster.
His first two patients were two babies. They died of diarrhea because, as Sims later admitted, he had no idea how to treat them. Eventually Marion moves to Mount Meigs and is hired as an assistant to an elderly doctor. Surprisingly, here his business went uphill, and soon Sims and his wife moved to Montgomery - a city that unexpectedly became the cradle of the first scientific discoveries in gynecology.
What we know about Sims' operations today is not very credible. For example, it is known that he was able to cure the jaw cramps in a child by pulling the baby's jaw towards himself. "Jaw cramp" was the local name for tetanus, and attempts to correct jaw trismus are pointless. Sims used a saw to remove the swelling from the black slave's face by tying him to a barber chair with leather straps.“The patient seemed very worried,” Sims writes in his diaries.
Removal of the ovaries, he considered an excellent remedy for neurosis, and the incision in the cervix - help with infertility. But all this was a common practice, he became interested in female surgery later.
An unexpected success with one of the patients led the doctor to the idea that with the help of a digital examination, vaginal tears could be identified and sutured. Of course, there was only one way to check this. For his experiments, Sims recruited dark-skinned female slaves.
Any slave owner will be happy if there is a doctor who can "fix his slaves" who, due to the fistula, were no longer suitable for work and would not give offspring, and therefore they willingly provided Sims with "material for experiments." Marion Sims was not the first physician to use black slaves for medical experiments. Thomas Jefferson, for example, tested a new smallpox vaccine on two hundred slaves in the summer of 1801.
“Doctors' behavior,” writes Todd L. Savitt in his book Medicine and Slavery, “was because African Americans, being property or even free, but still in a subordinate position, could be used in medicine for public demonstration, while whites with similar problems enjoyed a higher status of anonymity and confidentiality."
Experiments
So began his experiments on the treatment of urinary fistula, which lasted from 1845 to 1849. Twelve young black girls became "test subjects". Initially, Sims was assisted by medical students and young doctors, intrigued by promising discoveries. The girls were operated on without anesthesia: they were cut open and stitched. It is known that one of the test subjects - Anarch - underwent 13 operations. Sims was convinced that dark-skinned women hardly felt pain, and therefore, they were convenient materials for research. Although anesthesia had already been invented, Sims refused to use ether.
There were women who asked the doctor to take them into their research, but Sims refused - he was sure that "decent" ladies would not endure such pain.
However, experimental failures followed failures, and over time, colleagues turned their backs on Sims. According to his autobiography, the slaves themselves persuaded him to continue experiments. They held each other during operations. In 1849, he finally succeeded by stitching Anarch's fistula with silver threads, and then other women.
President of the Women's Hospital
After this breakthrough, Sims' career took off: he moved to New York and founded the first Women's Hospital in the state. Marion was elected president of the American Medical Association. However, in the same hospital, he had constant conflicts with the directorate, consisting of only women. Sims insisted that his operations should be seen by as many people as possible, and the ladies objected that patients should not become entertainment for the idle crowd.
Sims longed for his sons to bear a double surname - Marion-Sims, in order to carry away the successes of his father for centuries, but he never had sons, so the surname of Sims died with him. When Sims died of pneumonia at the age of 70, the obituary of the Washington City Medical Society wrote: "Among the great luminaries, Sims swept like a comet, leaving a streak of bright light behind him."
James Marion Sims
Until now, the question of his ethics is very acute. Whether he was a butcher, whose success came to him by chance, or a genius who made a difficult ethical choice, is difficult to say today. What is clear is that Sims left behind not only several important discoveries for gynecology, but also a long bloody trail of his experiments.
