CHAPTER FIVE — THE CONTROVERSIES

[The Anarcha Archive is a series of short essays about the sources for Say Anarcha. A great deal more about the sources can be found at AnarchaArchive.com.]

In this fifth essay of our series, we’re going to look at the most contentious aspects of the fistula experiments of the so-called “father of gynecology,” J. Marion Sims. These experiments stand at the center of the birth of modern women’s health.

There are really two main controversies: Sims didn’t use anesthesia, and he didn’t seek consent. Today, I’m mainly talking about consent.

But a word about anesthesia. Sims’s defenders point out that chloroform and ether were just beginning to be used at the time of Sims’s experiments. That’s true. In the late 1840s, both were still experimental — and people were dying when the drugs were misapplied.

But chloroform and ether were not the only drugs known to kill pain. The effects of nitrous oxide had been known for decades, and Sims himself sometimes gave patients opium before surgery.

Sims’s champions claim that, as an Alabama surgeon, he couldn’t have known about the latest advances in anesthesia…

…but that makes no sense as one of Sims’s most important publications was an article about the history of anesthesia, tracing it back all the way to the year 1790, more than half a century before his experiments.

The bottom line is that when he was experimenting on enslaved women, he opted to use no pain-killing agent at all.

But what about consent? Did he at least get consent from the women he was going to experiment on?

His champions have suggested that he did. It’s been claimed that Sims repeatedly sought consent from Anarcha, Lucy, Betsey, and the other women — approximately seven others — who were his initial group of experimental subjects.

But that’s not true.

Sims did, once, say that he sought consent from the women he considered to be his patients. But this was a very modest piece, in a small medical journal.

On every other occasion — and in the publications on which Sims’s legacy has come to stand — he said only that he sought consent from the enslavers of Anarcha, Lucy, Betsey, and the others.

Now, to be clear. It is the case that obstetric fistula is a horrific condition. Any woman who has it most definitely would want for it to be cured — meaning that she would be vulnerable to someone who came along and said he might be able to cure it. And the procedure to cure a fistula is a very delicate procedure — it’s not like amputating arm, where you can just hold someone down and do it. No — if fistula surgery is going to have any chance of success, you’re going to have to coerce at least some form of cooperation.

But that’s a lot different from consent. And what we know about Sims is that he didn’t care about consent at all.

It’s not widely known about his career, but when the fistula cases started landing in his lap — as we described in an earlier essay — he was fishing for new surgeries to perform, surgeries that might bring him glory and wealth. Specifically, he was investigating infant lockjaw and major surgeries on cancers of the face and jaw.

I’m not going to go into great detail about these cases, but in 1845, just weeks before Sims met Anarcha for the first time, her performed operations on two young enslaved me, Sam and George.

In one case, when he was about to perform a surgery that involved sawing away most of a cancerous jawbone, Sims applied 60 drops of opium for the pain. But he actually began the surgery before the drug had time to take effect.

Of course, Sims published about both cases. That was the point of doing them. Invite other doctors to watch, bring in a sketch artist to draw the subject of the experiment, and publish your results.

And that’s Sims’s undoing. Because in describing his jaw surgery, Sims made it very clear that what he considered to be the benefit of his method is that it didn’t require a patient who was willing at all.

Again, this was just a few weeks before Sims encountered Anarcha for the first time. And of course he would have been writing and publishing these words sometime later — during the period of the fistula experiments.

An enslaved person cannot, in event, provide consent. But in a way that doesn’t matter. Sims didn’t ask for consent, and he considered it a virtue that he could perform major surgery without any consent at all.