1846-49

Marion Sims conducts surgical experiments on as many as 11 (slave) patients residing at his clinic in Montgomery, AL in search for surgical cure of vesico-vaginal fistula. (Obstetric fistulas resulted from obstructed labor, misshapen pelvis resulting from poor nutrition or rickets; use of pessaries, etc. [Schwartz, 234-236]).  Sims’ innovations included development of duckbilled speculum, the sigmoid catheter (to drain off urine while the surgical wound healed), and silver suture (McGregor, 47-54; Schwartz, 237-240).  The ultimate benefit of using infection-resistant silver sutures was counterbalanced by the “savage medical abuse” to which he subjected his original 11 slave subjects, with the first, Anarcha, receiving 30 surgeries over the 4-year period.  The fact that the surgical benefits of his discovery were unfairly distributed was a violation of distributive justice: “One danger of violating distribute justice is that this tends to perpetuate social inequality , and this is exactly what has happened with vesicovaginal fistula” (Washington, 100). “He never felt the need to anesthetize his black patients in Montgomery.  White women with vesico-vaginal fistulas who came to Sims in 1849, to have what finally had become viable surgical therapy, were unable to withstand the same operation without anesthesia.  Through his medical career Sims maintained a class-bound [actually a racist] prescription for the use of anesthesia with an unspoken premise that those women in the wealthy tier were by far the most vulnerable to pain” (51; cf. Schwartz, 231; Washington, 94  -96, ).  “Imprisonment” was Sims’ metaphor for control of his enslaved  experimental subjects.  He addicted them to morphine, but refused to administer it during his surgeries, giving it only after the surgery to ease recovery (Washington, 95-96). Sims avoided writing about his reliance on slave subjects; in his big article on vesico-vaginal fistula of 1852 he described the slave women “in typically ambiguous and indirect language” (59). . . . Even in his extensive use of woodcuts for illustration, Sims evaded the issues of slavery and race by portraying his patients as white even when they were African America” (60).  . . . in retrospect, Sims attributed his four-year preoccupation with perfecting a treatment for vesico-vaginal fistula as a reflection of his concern to find relief for women.  He had forgotten his original distaste for treating female disorders and now chose to practice only among the white women of the upper and middle classes” (61).  Sims’ former student, Nathan Bozemen, who operated with Sims, improved his  technique via his button suture (vs. Sims’ clamp suture) (Schwartz, 240-242).  He claimed that fewer than half of Sims’ slave subjects gained relief from the four-years of experimental surgeries (Washington, 97).