THE ETHICS COLUMN
Judging Medical History
By Jacob M. Appel MD JD
Twice a day, every weekday, during my four years of residency training at New York’s Mount Sinai Hospital, I walked past the statute of Dr. J. Marion Sims (1813-83) on my way to work. Located on Fifth Avenue at 103rd Street, opposite the New York Academy of Medicine, the monument praises Sims as a “surgeon and philanthropist” whose “brilliant achievement carried the fame of American surgery throughout the world.” To a degree, this is unquestionably true: Often referred to as the “Father of Gynecology,” Sims’ accomplishments include pioneering the cure of vesiculo-vaginal fistulas and inventing an eponymous speculum that made many subsequent advances in women’s healthcare possible. What is not mentioned is that much of Sims’ pioneering but controversial research was performed on African-American slaves during the 1840s.
An ongoing debate exists in the medical literature regarding the ethics of Sims’ conduct. One on side, Durrenda Ojanuga Onolemhemhen of Wayne State University has argued that these slaves, including women named Lucy and Anarcha, could not meaningfully consent to the procedures as they were regarded as human chattel and that the painful procedures were conducted without anesthesia—although anesthetics were already available to well-off white women. (Anarcha underwent thirty surgeries without anesthesia while the doctor attempted to perfect his procedure.) An excellent, critical account can be found in Harriet Washington’s Medical Apartheid. Troubling concerns also have been raised regarding experimental procedures that Sims conducted upon indigent Irish-American women when he operated at Woman’s Hospital in Manhattan. In response to these critics, urogynecologist L. Lewis Wall has defended Sims as a man of his time who offered female slaves treatment for a debilitating condition.
The Sims controversy raises challenging questions: How should history judge the achievements of medical pioneers who used research techniques, such as experimentation on vulnerable subjects, that are clearly not ethical today? Should Dr. Sims be honored with a statute at all? Modern medicine has confronted these issues haphazardly. A few of the most egregious medical offenders have had their honors revoked.
For instance, diseases named after avowed Nazis such as Hans Reiter, who approved lethal concentration camp experiments, and Friederich Wegener have been renamed: Reiter’s syndrome is now reactive arthritis; Wegener’s granulomatosis became granulomatosis with polyangiitis. At the opposite extreme, few American’s know that Jonas Salk, the beloved father of the polio vaccine, previously engaged in research that sprayed “wild influenza” into the nasal passages of psychiatric patients. Of course, Jonas Salk is not Hans Reiter. But neither, arguably, was J. Marion Sims. So how do we sort the Hippocratic wheat from the chaff?
Maybe we don’t have to. Instead, physicians and medical historians might do well to gather the empirical data and let the public decide who deserves accolades and who merits condemnation. Needless to say, the public can only do that if they have the information. Some argue for tearing down Dr. Sims’ statue. Far better to put up a marker alongside it, explaining in detail the nature of his work, so that passersby—both physicians and laypeople—can form their own opinions. #
