FR01-21 MONUMENTS CELEBRATING THE PAST: AFRICAN SLAVE EXPERIMENTATION IN THE DEVELOPMENT OF VESCIO-VAGINAL FISTULA REPAIR — J MARION SIMS: UROLOGIC SURGERY HERO OR VILLAIN?

Abstract

INTRODUCTION AND OBJECTIVES: The “Unite the Right” rally in Charlottesville Virginia in 2017, highlighted the controversy of Confederate Memorials. Such statues are felt not to celebrate true “heroes“, but glorify abhorrent values and insensitivity to the legacy of African slavery. The controversy of Confederate statues brought new light to the ethics of J Marion Sims, and to the statue that honored him. METHODS: A PubMed and periodical review, and of historical documents at the New York Academy of Medicine and the Augustus C Long Health Sciences Library. RESULTS: A bronze statue honoring J Marion Sims was erected in Bryant Park, New York City in 1894, and moved opposite the New York Academy of Medicine in 1934. The statue was the center of protests in 2017 as reports of his surgical experimentation on Black slaves became publicized. In April 2018, the statue was moved to Green-Wood Cemetery. J Marion Sims was born in South Carolina, on January 25, 1813. He graduated from Jefferson Medical College in 1835 and moved to Macon County Alabama and became a “plantation physician”. In Montgomery Alabama in 1845, he built a 4 bed hospital to treat female slaves. To facilitate vaginal exam, Sims developed a double bladed vaginal speculum, made out of pewter spoons. From 1845 to 1849, Sims performed surgical experiments on 12 female Black slaves with obstetrical vesico-vaginal fistulas (VVFs). There was no informed consent. Sims refers to 3 slaves by name. VVF repairs on Betsy and Lucy all failed. Anarcha had 13 VVF and recto-vaginal fistula operations before surgical success. Sims did not use any anesthetic during surgeries. A common belief at the time was that Blacks did not feel as much pain as Whites. In 1852, he published the first report on VVF repair,using silver-wire sutures. In 1855, he founded Woman's Hospital, the first such hospital in the US. During the Civil War, Sims toured hospitals in Europe. Sims also studied neonatal tetanus, which was common among Black slave children. Sims thought tetatus arose from skull bone movement during birth. Experiments to realign the bones were fatal. Sims concluded death from “sloth and ignorance of their mothers and the black midwives”. Sims received many honors during his career, including statues and Presidency of the American Medical Association. CONCLUSIONS: Sims was a surgical and urologic pioneer. His contributions are morally precarious by his use of surgical experimentation on enslaved people, without consent nor anesthesia. The Sims controversy allows us to re-evaluate how American medicine deals with race.