Dr. Sims' Legacy

Regular readers will know that that there are certain specific themes that surface again and again in my writing. The nature of heroism is one of them. And the specific relationship of the Jewish people to the Land of Israel, and particularly to Jerusalem, is another. But the single topic I believe I possibly have returned to the most times over these last eleven years of writing weekly is the question of the reasonableness of expecting an individual to transcend the beliefs that are considered ordinary and uncontroversial in his or her society, and in so doing to see the world as it truly is and to act accordingly. It sounds as though it should be the simplest thing in the world to look out at the world through your own eyes…and then to process and respond to what you are actually seeing and not what you’ve been told, in some cases even since childhood, that you see. In reality, however, it is not only a challenge, but—at least for some—among life’s most daunting, difficult tasks.

In that context, I have wondered how reasonable or rational it would have been for the world to expect a German child, every single one of whose authority figures at school, in church, and even at home was either a Nazi or a Nazi sympathizer, to condemn Nazism—and particularly Nazi anti-Semitism—as something depraved and debased, and to risk everything to save, say, a Jewish child facing deportation to the camps. I’ve written about slavery in antebellum America in that vein as well, and particularly about the way so many clergypeople, Christians and Jews alike, seemed almost weirdly incapable of transcending what everybody knew about race to see slavery as the brutal affront to human dignity that it seems to us so clearly to have been. And I’ve also written about the strange inability of so many Jews for so long—and we are talking here not about centuries but about millennia of persecution and endless exile—about their inability to see that they didn’t actually have to live in exile at all, that they could just as easily have made their way to Eretz Yisrael and settled there, that they could have claimed their rightful patrimony not by praying that it come to them via miracle or as a chapter in the coming redemption of the world, but actually by making it so through the labor of their hands and the sweat of their brow.

Clearly, it isn’t that easy to look around at the world, to take note of details that everybody knows to be true…and to reject them as absurdities without caring how that act of rejection might conceivably impact on you personally and on your place in society. Nor do you win any points for knowing better than people in past centuries with respect to propositions that the whole world has long since rejected! The challenge is to look at the actual world in which you live, to take note of its givens and its most (not least) normative beliefs and opinions, and then to have the moral courage to reject as false the propositions that seem to you personally not to be in harmony with what you actually see of the world when you look out at it through your own eyes and allow the matrices of your own working brain intelligently and morally to process what you see.

So these were the thoughts that came to mind as I saw the pictures in the paper the other day of workers removing the statue of J. Marion Sims from its pedestal on Fifth Avenue just outside of Central Park. I mentioned him in a letter last October when I was writing about the issue of whether statuary honoring Confederate war heroes should be removed or left in place. (Click here to revisit that discussion.) But I didn’t elaborate much on his situation, which is why I’d like to return to it today.

J. Marion Sims was, by all accounts, one of the great physicians of his day. Indeed, he is often acclaimed as the father of modern gynecology and as the personal innovator of any number of surgical procedures that have helped countless women, including the repair of both vesicovaginal and rectovaginal fistulas, twin problem that ruined the lives of countless women before he proposed a successful way to intervene surgically to fix them both. And if that—and all his many other achievements—were all there were to his story, his would be an uncontroversial legacy of medical greatness and his place in the pantheon of surgical and medical innovators would be uncontested.

The problem, however, is that, between 1845 and 1849 in Montgomery, Alabama, Sims developed his surgical technique to repair the kind of fistulas mentioned above by conducting experiments on slaves who were delivered to him by their owners to see if he could fix their problems. Three of them he personally named Anarcha, Betsy, and Lucy, and it was on them that he performed the bulk of the experiments that led him to the discovery of surgical techniques still in use today to assist women. And that leads to the question I would like to consider today: how shall we, sitting on the moral high ground more than a century and a half after the passage of the Thirteenth Amendment, judge a southerner in antebellum Alabama who didn’t see slavery for what it was?

It feels as though reasonable arguments could be made in both directions. On the one hand, these women actually were suffering from the problem Sims set himself to solving and, as noted, each was cured as a result of his efforts. On the other hand, Sims had no way to know if his experimentation would be successful and was, in effect, using these women as human guinea pigs to see how they would respond to various ideas he had about how to repair the various kinds of fistulas that so plagued women in his day. It was a long, unpleasant process for the women involved. Anarcha, for example, underwent thirteen different surgeries before her recto- and vesicovaginal fistulas were declared permanently and successfully repaired.

Also, none of the women was anesthetized before her surgery. (They were, however, given opium to address their pain after the procedures were completed.) To be fair, though, I should note that the 1840s were the very years in which the use of anesthetic drugs before surgery was first being introduced, and it was apparently not uncommon for doctors trained in an earlier era to resist their use. Indeed, when Sims later moved to New York to found the Women’s Hospital, he declined to use anesthesia on his (white, non-slave) patients too when he set to repair their fistulas surgically.

Sims’ own testimony regarding the crucial issue of consent is key. Writing in 1855 in the New York Medical Gazette and Journal of Health, Sims wrote as follows:

For this purpose [of 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, jeopardize 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.

And so the water becomes considerably muddier. He claimed he had their consent. But what could that mean when the women involved were the property of their white owners, whom he openly writes “gave” the women to Sims to see if he could find a way to cure them? Was he lying about them giving consent? What could that even have meant? What he really said to them, no one knows. What would have happened if any of them had declined to proceed, ditto. But what we do know is that these were slaves, the human property of their white masters, and that they were given by those masters to J. Marion Sims for medical-surgical experimentation.

Was Dr. Sims a precursor of Dr. Mengele? That seems exaggerated—Dr. Mengele, who was not even a real physician (his title references his Ph.D. in physical anthropology from the University of Munich), conducted incredibly cruel experiments on innocents at Auschwitz and elsewhere, and was probably insane. Dr. Sims, on the other hand, was a real physician not at all unreasonably revered by many as the father of gynecology and as the individual, even today, the most responsible for solving the most terrible of medical problems specifically faced by women in his day. Clearly, Sims was unable to see slavery as the morally depraved institution it surely was and took advantage of black women “given” to him by their owners to further his work. And so we are left with a relatively simple question: does the fact that the doctor’s experiments were successful and led to tremendous advances in the care of women obviate the fact that the experimentation that led to those advances was done on un-anesthetized slaves who were apparently called upon to hold each other down during the experimental surgical procedures performed on them?

The City of New York has decided that it does not. And just a few days ago, the statue—in place across from the New York Academy of Medicine since 1934 and for two decades before that in Bryant Park—was duly removed and will be set up near the doctor’s grave in Green Wood Cemetery in Brooklyn.

It’s a difficult issue to resolve. All agree that the man did great good and that his work led to countless women being rescued from horrific ailments. All also agree that the path the doctor followed to that great good was morally flawed, and more than just slightly. And so we come back to the question I opened by asking: how reasonable is it, exactly, to condemn people ex post facto  for not seeing the world as we see it now, for not having the insight to transcend the things everybody just knows about the world and its institutions, for not being able to see what millions in his day also could not clearly see?

The world has changed considerably since I was a child. Attitudes towards gay people, towards the place of women in society, towards the place of racial minority groups in American culture, even towards animals in the zoo—all of these have undergone sea changes since I was a child learning about the world from my teachers and, because my parents taught me to respect those teachers, believing what I was told. Should I be condemned for not having had the maturity as a nine-year-old to see things more clearly than my own teachers, then my own parents? I bristle at the thought. But I also wonder what Anarcha, Betsy, and Lucy would say if the fate of Dr. Sims’ legacy were placed in their hands to determine. Ultimately, the decision really should be theirs to make. But given the impossibility of resolving the issue that way, I think the City of New York probably acted correctly in moving the statue to a position near Dr. Sims’ grave and taking it from its pre-eminent position on New York’s grandest avenue facing one of its pre-eminent medical institutions.